Survivors of the AIDS epidemic in the 1980s and ‘90s fear efforts to combat the monkeypox outbreak will unnecessarily stigmatize the LGBTQ+ community already bearing the virus’ brunt.
Men who have sex with men have been hit the hardest by monkeypox to date, but LGBTQ+ health advocates say improper messaging risks branding monkeypox as a “gay disesase,” eroding effective preventive measures and allowing the virus to spread. Reports that phlebotomists at LabCorp and Quest Diagnostics, two of the largest medical testing companies in the US, refused to draw blood from suspected monkeypox patients shows the stigma is already settling in, health professionals warn.
“In the ‘80s, when HIV first hit, the government was slow to respond because of who it was prevalent amongst, and to have this happen again—we’re 41 years into this and what have we learned?” said Vince Crisostomo, director of Aging Services at the San Francisco AIDS Foundation, who is also a long-term survivor of HIV/AIDS. “We just went through the second pandemic of our lives, Covid, and to come right into this and to find the same sort of weird messaging? There’s a huge disconnect.
“This really triggered my post-traumatic stress because on top of my own experience, I’m having to deal with the people we serve in our own community and hearing a lot of the same things.”
The Centers for Disease Control and Prevention reports more than 30,000 monkeypox cases globally as of Aug. 8, with nearly 9,000 in the US. Monkeypox is primarily transmitted through skin-to-skin contact—which includes sex. However, treating monkeypox as a sexually transmitted infection contributes to stigma that hinders efforts to contain the virus.
“There’s an absolute way in which we can be honest about what monkeypox is while also being honest about what communities are currently impacted by it without causing harm to those communities,” Torrian L. Baskerville with the Human Rights Campaign said.
Messaging With Stigma
Effective messaging around monkeypox will acknowledge that men who have sex with other men are bearing the brunt of the outbreak while allowing other populations to adequately assess their risks, advocates said.
To the dismay of LGBTQ+ public health advocates, WHO Director-General Tedros Adhanom Ghebreyesus advised men who have sex with men to reduce the number of sexual partners and reconsider sex with new partners during a July 27 briefing.
“How do we get the information out there where there’s no stigma around it? That’s hard because it’s already starting with stigma,” said Paul Aguilar, chair of Harvey Milk Democratic Club’s HIV Caucus who is also a long-term survivor of HIV/AIDS.
“When you have it on national news and they’re talking about men who have sex with men and that’s all they’re talking about, but they add that last part that says well anyone could get it—that should not be the lead.”
The abstinence message had worrying echoes to the AIDS response decades earlier for community advocates.
“I was so disappointed to see that statement from the WHO because it’s as if we haven’t learned in 2022 that abstinence-based programs have never worked for anything, not for HIV, not pregnancy,” said Jona Tanguay, a health-care provider at Whitman Walker Health in DC and the vice president for education at GLMA Health Professionals Advancing LGBTQ Equality.
Doctors Grapple With Approach
LGBTQ+ public health advocates said some patients who were thought to have monkeypox reported instances where lab workers refused to treat them.
Medical professionals also seem to be struggling to refine their messaging and treatment of patients, said Garfield Clunie, president of the National Medical Association.
“For every single patient that walks your door, you use universal precautions because every disease doesn’t have a phenotype or outward appearance, so you have to treat everyone exactly the same. You can’t treat someone differently because of their sexual orientation, or race, or gender, or for any other reason,” Clunie said.
“It’s part of our oath and I don’t know why that would be done, but people have certain biases within them, whether they’re implicit or explicit. There are people who are going to come to conclusions about certain things that they believe to be true, and that may cause them to behave a certain way around certain people but that is not correct.”
Clunie added that he’ll work to educate members of the association to improve the medical community’s knowledge of monkeypox.
Fearing messaging around monkeypox will dissuade the highest risk groups from protecting themselves or seeking treatment, LGBTQ+ health advocates are once again marshaling their own resources to educate their community. The Human Rights Campaign published information on what monkeypox is and isn’t on its website and social media outlets to dispel some of the misinformation that’s currently out there.
“What we’ve been doing is the same thing that we’ve always had to do as community, as LGBTQ and often marginalized communities, been having to do for ourselves, which is provide the resources that we and the community need,” Baskerville said.