Southern Decadence, advertised as the largest LGBTQ+ festival held annually in the Deep South, is scheduled for Labor Day weekend (Sept. 1-5) in New Orleans. It typically attracts 100,000 to 300,000 participants and is a major economic boon to the city in a season when tourism is otherwise sluggish. Health officials at the state and local level say Louisiana’s meager vaccine supply will leave the state vulnerable to a large monkeypox outbreak following such a massive event.
Southern Decadence could also further the virus spread in other parts of the country if visitors become infected while in New Orleans and carry monkeypox back to their hometowns, they said. “This will be a superspreader event without additional vaccine doses ahead of time to get as many people as possible [vaccinated],” said Jennifer Avegno, New Orleans health director and an emergency room physician, in an interview this week.
Joseph Ladapo — Florida’s surgeon general appointed by the state’s anti-LGBTQ Republican Gov. Ron DeSantis — is trying to make people distrust the monkeypox vaccine, stating that there is “little data” on it, which is misleading.
Ladapo’s position is hardly surprising considering that he spent years spreading COVID-19 disinformation and echoing DeSantis’ distrust in vaccines.
On Tuesday, DeSantis criticized the Democratic governors of California, Illinois, and New York for declaring states of emergency over monkeypox. The declarations give their governments greater ability to mobilize resources against the virus. (U.S. President Joe Biden declared a national state of emergency for monkeypox on Thursday.)
DeSantis said the governors were using the emergency declarations to stoke fear, control people, and “restrict your freedom.”
Ladapo backed up DeSantis’ words, stating, “It’s just kind of remarkable to see some of the headlines — the headlines that very clearly are trying to make you afraid of monkeypox or fill-in-the-blank. You know, because if you’re not afraid of this there will be something else after that and something else after that.”
“These people are determined to make you afraid and do whatever it is they want you to do. And, um, you know, I hope that more and more people choose not to do that,” he added.
Then after revealing that Florida had distributed 8,500 monkeypox vaccines, Lapado said, “You should know that there’s actually very little data on this vaccine.”
To understand why Lapado’s claim is misleading, a little background is necessary.
As of Tuesday, the U.S. Centers for Disease Control and Prevention (CDC) has reported 6,326 monkeypox cases within the United States. The Florida Department of Health shows 525 monkeypox cases statewide, The Florida Phoenix reported.
The Jynneos vaccine is made from a virus that is closely related to, but less harmful than, monkeypox viruses. It does not cause disease in humans and cannot reproduce in human cells.
A study of 400 individuals found that the Jynneos vaccine was as effective against monkeypox as the ACAM2000 smallpox vaccine, which the FDA approved in 2007. The safety of Jynneos was assessed in more than 7,800 individuals who received at least one dose of the vaccine, the FDA said. Previous studies have shown that smallpox vaccines are 85% likely to provide a high level of immunity against monkeypox for up to two years, according to the MIT Technology Review.
Ladapo’s authority on vaccines is highly questionable at best.
In July 2020, near the start of the COVID-19 pandemic, he appeared in a 43-minute viral video as part of a group called America’s Frontline Doctors. The group, which had no epidemiologists or immunologists qualified to speak on infectious diseases, promoted the anti-malaria medication hydroxychloroquine as a “cure” for COVID-19, even though no studies substantiated that claim. The video also said that face masks do not slow the virus’s spread and that COVID-19 is less deadly than the flu. Both claims are untrue.
The video also featured Dr. Stella Immanuel, a pediatrician and religious minister who gained notoriety in 2020 for her bizarre theories, including that “demonic seed” causes endometriosis and ovarian cysts. Immanuel explained on her church’s website that demons insert sperm into sleeping individuals when they have sex in their dreams.
The doctors’ recorded speech was organized by the Tea Party Patriots, a right-wing group backed by wealthy Republican donors. Lapado has written numerous op-eds repeating the video’s false claims.
The video received millions of views when then-President Donald Trump, his son Donald Trump Jr. and other right-wing media figures shared it on social media. Facebook, YouTube, and Twitter all removed the video for violating their policies on sharing COVID-19 misinformation.
In October 2020, Ladapo signed the Great Barrington Declaration, a statement that called for developing societal herd immunity to COVID-19 through natural infection. In response, 80 medical researchers signed an open letter published in The Lancet, a leading medical journal, calling the declaration’s theory “a dangerous fallacy unsupported by scientific evidence.”
Florida ranks third among U.S. states with the highest numbers of COVID-19 infections and related deaths. DeSantis has signed orders expanding exemptions for people who don’t want to get vaccinated against COVID-19 vaccines and to prevent schools and local governments from instating face mask mandates in Florida.
The Biden administration declaredmonkeypox a public health emergency on Thursday as cases topped 6,600 nationwide.
The declaration could facilitate access to emergency funds, allow health agencies to collect more data about cases and vaccinations, accelerate vaccine distribution and make it easier for doctors to prescribe treatment.
“We’re prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” Department of Health and Human Services Secretary Xavier Becerra said in a Thursday briefing about the emergency declaration.
A quarter of U.S. cases are in New York state, which declared a state of emergency last week. California and Illinois followed suit with emergency declarations Monday.
The World Health Organization declared monkeypox a public health emergency of international concern last month, a designation reserved for the most serious global disease outbreaks. It has previously been used for Covid-19, Zika, H1N1 flu, polio and Ebola. At least 26,200 monkeypox cases have been confirmed worldwide this year, according to the Centers for Disease Control and Prevention.
The WHO recently advised men who have sex with men to reduce their number of sexual partners and reconsider sex with new partners while the outbreak is ongoing.
The average U.S. monkeypox patient is around 35 years old, but people of all ages can be infected. The CDC has recorded five cases in children: two in California, two in Indiana and an infant who is not a U.S. resident who tested positive in Washington, D.C.
The California and Indiana health departments declined to provide details about their pediatric cases, but Jennifer Rice Epstein, the public affairs officer at the Long Beach Department of Health and Human Services, said the patient in her city was exposed via a close contact.
As of last week, white people represented 37% of U.S. monkeypox cases, followed by Hispanic or Latino people (31%), Black people (27%) and Asian people (4%), according to HHS.
U.S. officials still think the outbreak can be contained
HHS officials still hope to prevent monkeypox from becoming endemic in the U.S.
“We continue to marshal forward the tools that we need to make sure that we can take on monkeypox and keep it from spreading to the point of becoming endemic,” Becerra said Thursday.
“There should be no reason why we can’t stay ahead of this if we all work together,” he added.
That work relies primarily on testing, targeted vaccinations and treatment.
As of Thursday, the U.S. had distributed 600,000 of the 1.1 million available doses of the Jynneos vaccine, which is administered as a two-shot regimen. In total, the country has ordered 6.9 million doses. HHS said a shipment of 150,000 doses will arrive in the U.S. in September to then be distributed.
The shot can prevent monkeypox if given before or within four days of exposure. If given within 14 days after exposure, it can ease symptoms.
U.S. testing capacity has also increased, from 6,000 weekly tests in May to 80,000 now.
“Right now we’re really only testing at about 10% of the capacity we have. We are encouraging anyone who has a rash that could be monkeypox to present for testing,” CDC Director Rochelle Walensky said Thursday.
Around 14,000 people in the U.S. have received TPOXX, an antiviral drug that is authorized for use against smallpox but can also be used to treat monkeypox. The Strategic National Stockpile contains 1.7 million of the treatments, HHS said. But the drug’s use is for now limited to people with severe disease or a high risk of becoming severely ill. Physicians must also complete extensive paperwork to prescribe it for monkeypox.
Expanded access to TPOXX was among the many reasons that sexual health providers called on HHS to declare a public health emergency.
“It’s unconscionable not to further make changes to make TPOXX accessible to all that need it,” David Harvey, executive director of the National Coalition of STD Directors, said Tuesday on a news call.
Most U.S. monkeypox patients have reported a rash
The most common monkeypox symptoms include a rash — reported in 99% of U.S. cases so far — malaise, fever and swollen lymph nodes. Some patients have also reported chills, headache and muscle pain.
Some people with monkeypox develop just one or two lesions in their rash, while others can develop several thousand, according to the WHO.
A study published last month, which examined monkeypox cases in 16 countries from April to June, found that nearly 65% of people had fewer than 10 lesions. The lesions were most commonly found in the anus or genital area, followed by the torso, arms or legs. A smaller number of people saw lesions on their face, palms or soles of the feet.
Symptoms usually appeared within a week of exposure, the study found. Around 13% of people studied were hospitalized, mostly for pain management.
As cases of monkeypox surge around the globe, four pioneers of the AIDS activist movement watch in awe and with a sense of nostalgia.
Some of the similarities between the two viruses speak for themselves. Like the HIV strain that started the AIDS pandemic in the late 1970s, the current monkeypox outbreak has emerged from sub-Saharan Africa and has been found overwhelmingly in men who have sex with men who live in the world’s metropolises. And while epidemiologists have not reached a complete understanding of how the current outbreak of monkeypox spreads, recent research points to sexual transmission.
Four pioneering AIDS activists of the 1980s and ‘90s contend that there are other, consequential yet less obvious parallels playing out in real-time.
People hold up signs representing the number of AIDS victims in a demonstration in Central Park in New York City on Aug. 8, 1983. Allan Tannenbaum / Getty Images file
As in the early days of the AIDS crisis, they argue, government messaging around the outbreak has been flawed, gay men have been blindsided and public health officials have failed to defeat a severe disease plaguing the LGBTQ community.
“It feels like déjà vu,” said gay rights activist Peter Tatchell, who was a leading member of the Gay Liberation Front in the United Kingdom. “The lessons from the AIDS crisis and Covid have clearly not been learned.”
Public health officials around the world were slow to combat AIDS when it first began to emerge in men who have sex with men during the late 1970s. It wasn’t until June 5, 1981, that the United States released the world’s first government report on the infectious disease in the Morbidity and Mortality Weekly Report, a government bulletin on perplexing disease cases.
“In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California,” the report read. “Two of the patients died.”
Three years later, the U.S. government announced the development of an AIDS test, in addition to a vaccine, which never came to fruition. By 1985, an estimated 12,000 Americans had died of the disease.
Similarly, activists argue that the global response to tame monkeypox has been too slow to curb ballooning case numbers — more than 20,500 cases of the current monkeypox outbreak have been reported globally across 77 countries and territories since the start of May, according to the Centers for Disease Control and Prevention.
No one has died from monkeypox outside the 11 African nations where the infectious disease has become endemic since it was discovered in 1970. However, a substantial proportion of patients infected with monkeypox have been hospitalized for severe pain caused by pimple-like sores that commonly develop.
Since the first cases were discovered in May, the United States has distributed nearly 200,000 Jynneos vaccines — a two-dose vaccine to prevent smallpox and monkeypox — to the most at-risk population, which falls far short of its roughly 3.8 million gay men. In France, only an estimated 6,000 people have been vaccinated across more than 100 vaccine centers in recent weeks, French Minister of Social Affairs and Health François Braun said on Monday. And in the United Kingdom, health officials ordered an additional 100,000 vaccine doses last week to keep up with burgeoning demand.
Last Saturday, the World Health Organization declared monkeypox a public health emergency of international concern, a designation reserved for the most threatening global disease outbreaks, after initially forgoing to do so last month. More than two months after the first U.S. case of monkeypox was detected in mid-May, on Thursday public health officials in New York City issued a declaration that the infectious disease posed an imminent threat to public health, and officials in San Francisco declared a state of emergency.
“What’s interesting is that many of the scientists and clinicians who were trained during the AIDS epidemic or were there at the beginning, people like Tony Fauci, know this history, but the response to monkeypox has been alarmingly slow and chaotic,” said Gregg Gonsalves, who joined Act Up — the leading group that fought for action to combat AIDS — in 1990 and is now a professor of epidemiology at the Yale School of Public Health. “As an individual, it’s like, ‘Three strikes you’re out, man.’ HIV, Covid and now monkeypox? How many times can you make the same mistakes over and over again?”
Representatives from the National Institute of Allergy and Infectious Diseases, which Dr. Anthony Fauci has directed since 1984, and officials from the White House, where Fauci serves as the chief medical adviser to the president, did not immediately respond to NBC News’ requests for comment.
Images of men waiting in long lines outside clinics around the world to get vaccinated, technical issues with online vaccine portals and reports that accused the U.S. government of developing a “wait-and-see” response to the outbreak — reportedly calling for shipments of vaccines only as cases surged in the last handful of weeks — have piled on to activists’ fears that the public health response to monkeypox is shaping up to be a repeat of its flawed strategy to combat AIDS.
People lined up outside a Department of Health and Mental Hygiene clinic on June 23, in New York.Tayfun Coskun / Anadolu Agency via Getty Images
Although the virus started spreading in May, the U.S. didn’t order more doses of the monkeypox vaccine to add to its stockpile until June. Regulators also had not finished inspecting a key Denmark facility manufacturing monkeypox vaccines until July, leaving 1.1 million ready-to-distribute doses stuck in Europe.
“Just like during the AIDS pandemic, it seems that some governments care very little so long as monkeypox is just affecting men who have sex with men,” said Tatchell, who was turned away from a hospital in London that had run out of monkeypox vaccine last Sunday. “What other explanation can there be? Governments should have been rolling out emergency vaccination programs for gay and bisexual men two or three weeks ago.”
Some veteran AIDS activists also argue that as during the AIDS crisis, the messaging to combat monkeypox has not been tailored enough to reach the LGBTQ community.
Ron Goldberg, an early AIDS activist who joined Act Up in 1987, points to the “America Responds to AIDS” public service announcement campaign, which the government launched at the height of the crisis in the late 1980s. Many of the commercials featured heterosexual couples and displayed messages including “AIDS Is Everyone’s Problem.”
“At that time, they were so afraid of talking about gay sex, or anything like that, they had to bland out the message when they were trying to give some information,” Goldberg said. “If it’s happening within a certain population, you have to direct your messaging to that certain population.”
Activists have largely applauded public health officials’ efforts to not link monkeypox directly to the LGBTQ community — as many believe they did with AIDS — and thereby create stigma. However, some argue that repeated statements from public health officials that “anyone can get monkeypox” mirrors AIDS messaging that “anyone can get the AIDS virus” and also circumvents efforts to alert the demographic most at risk.
Research overwhelmingly suggests that the current outbreak of monkeypox is being driven overwhelmingly by men who have sex with men. A study in the New England Journal of Medicine published last week found that of the 528 cases of monkeypox researchers analyzed, 98% were found in men who identified as gay or bisexual. Another recent report by the the British Health Security Agency finding that of the 699 monkeypox cases for which there was available information, 97% were in gay, bisexual or other men who have sex with men.
“The numbers are there,” said Didier Lastrade, who founded the first French chapter of Act Up in 1989. “We shouldn’t shy away from this. … We’re big people, we’re grown-ups, we can take it. The stigmatization is happening either way.”
On Thursday, the WHO recommended that gay and bisexual men limit their number of sexual partners to protect themselves from monkeypox and contain its spread.
But compiled with two years of pandemic isolation and big summer events, such as last weekend’s annual Pines Party on Fire Island, some activists fear it will be difficult to get gay and bisexual men to curtail their sexual behaviors.
“You want to be able to reach people in their 20s and 30s and say, ‘Look, this is no joke. You’ve all seen the pictures. You’ve all had friends who have had monkeypox. You don’t want it,’” Gonsalves said.
More broadly speaking, Lastrade argued, the advent of pre-exposure prophylaxis, the HIV prevention pill (also known as PrEP), along with scientific proof over the past decade that treating HIV can prevent transmission, have caused gay and bisexual men to fall asleep at the wheel when it comes to their sexual health.
“The new generation totally forgot about the story of AIDS. I keep on writing books about AIDS but nobody reads them,” said Lastrade. “When s— happens, they forget their reflexes that we used to have because it was a question of life or death.”
Regardless of the messaging, with a lackluster global vaccine rollout, the activists fear the virus will become an infectious disease the LGBTQ community has to permanently live with, as it did with AIDS decades ago.
“Many people are saying we’re past the point of containment, that we already missed our chance,” Gonsalves said. “If that’s true, that is incredibly serious because this disease doesn’t necessarily kill, but the enormous suffering and expense of all of this is going to put a burden on many, many people, many, many health systems and many, many communities who have been already plagued.”
South Carolina became the seventh state last month to permit health care providers to decline to serve people if they feel doing so would violate their religious beliefs.
As a result, more than 1 in 8 LGBTQ people now live in states where doctors, nurses and other health care professionals can legally refuse to treat them, according to the Movement Advancement Project, an LGBTQ think tank. In addition to South Carolina, Mississippi, Alabama, Arkansas, Tennessee, Ohio and Illinois have similar measures in effect.
“The conflict between patient needs and religious directives has been a serious problem in the past, and I don’t see any sign of that issue being resolved quickly and easily.”
JENNY PIZER, LAMBDA LEGAL
Advocates and legal experts say the laws will further raise the barriers to health care for lesbian, gay, bisexual, transgender and queer patients.
“We often are worried that the expansion of religious rights in these contexts will be taken as a license to discriminate,” said Jenny Pizer, the law and policy director for the LGBTQ legal advocacy group Lambda Legal.
Proponents of such legislation, however, say the measures don’t allow providers to discriminate against or target LGBTQ people.
South Carolina state Sen. Larry Grooms, who supported his state’s law, the Medical Ethics and Diversity Act, told NPR in June that “it’s based on procedure, not on patients.”
“This is America, where you should have the freedom to say no to something you don’t believe in,” he told NPR.
Although “religious freedom” or “conscience” measures, as they’re often called, don’t explicitly list LGBTQ people among those who may be refused treatment, advocates say that in practice they are affected disproportionately.
Ivy Hill, the community health program director for the Campaign for Southern Equality, which promotes LGBTQ equality across the South, said transgender people are among those who will be the most negatively affected.
“When we have laws in place that make it easier for providers to discriminate, of course it’s not going to do anything but make it worse,” said Hill, who uses gender-neutral pronouns. “The people who are already on the margins of the margins are going to be the ones who are most deeply impacted by stuff like this.”
Even before the new law went into effect,they said, many trans people they work with in South Carolina struggled to find gender-affirming health care providers in the state willing to help them gain access to hormone therapy, leading some of them to travel to North Carolina to get care.
Hill said doctors usually don’t tell trans people that they won’t treat them for religious reasons, which makes it hard to know how often it happens. Research has found that LGBTQ people, particularly transgender people, are more likely to face medical discrimination.
A study published in 2019 found that 16 percent of LGBTQ adults, or about 1 in 6, reported experiencing discrimination in health care settings. A 2020 survey from the Center for American Progress, a liberal think tank, found that 16 percent of LGBTQ people, including 40 percent of transgender respondents, reported postponing or avoiding preventive screenings because of discrimination.
Maggie Trisler, who works in tech, said she had a great relationship with her primary care provider in Memphis, Tennessee, for about a year and a half in 2016 and 2017. He asked her in-depth questions about her health and the band she plays in, and he said he was going to take his wife to see her play.
Then, in March 2017, Trisler came out to him as transgender, and she said he suddenly became very cold and told her he doesn’t “know anything about the standards of care” for transgender people. He began to blame pain she was having on her weight, she said.
“It suddenly went from the best doctor-patient relationship I’ve ever had to just the absolute least helpful, most frustrating that I’ve had,” she said.
Three months later, Trisler said, the doctor effectively — although not explicitly — told her he couldn’t see her anymore.
“He did say that he was deeply uncomfortable treating me with [hormone replacement therapy], he wasn’t comfortable providing HRT, and if I was seeking that elsewhere, then maybe I should seek medical care elsewhere,” she said.
Trisler added that she was lucky to have good insurance and that it was easy for her to change doctors, although she acknowledged that she is “coming from a rather privileged position” and that what was just a nuisance for her could have been a “critical roadblock” for others.
While LGBTQ people have long faced barriers to health care because of religious refusals, Pizer said, such religious objections can violate both state and federal law in some cases.
Pizer pointed to a 2005 case in which the North Coast Women’s Medical Care Group in Southern California denied infertility treatments to her client Guadalupe “Lupita” Benitez because she is a lesbian. The providers argued that it was within their religious rights to refuse to offer treatment to Benitez, but the California Supreme Court decided that religious rights protected under California law don’t excuse violations of the state’s nondiscrimination law.
The court found that when doctors are “practicing in a particular field and offering services generally, according to patient needs in their field, they can’t pick and choose among patients in ways that violate the nondiscrimination law,” Pizer said.
Pizer said the problem with laws like South Carolina’s Medical Ethics and Diversity Act is that they use broad language that doesn’t give examples of situations in which a religious objection in medicine would violate medical standards or federal law. Many hospitals, including some that are religiously affiliated, receive federal funding. As a result, if they were to provide fertility treatments to heterosexual people and not to LGBTQ people, they would violate Section 1557 of the Affordable Care Act, which the Biden administration hopes to strengthen to better protect access to abortion and gender-affirming services.
Pizer said the issue is becoming more prominent and contentious as Catholic-affiliated institutions control an increasing proportion of the U.S. hospital system. As NBC News reported recently, more than 1 in 7 U.S. hospital patients are cared for in Catholic facilities.
“The conflict between patient needs and religious directives has been a serious problem in the past, and I don’t see any sign of that issue being resolved quickly and easily,” Pizer said. “A hospital that’s operating in a community to serve the community more broadly should not be imposing their religious beliefs on people that are not part of that faith or that are at the hospital for medical services, not religious services.”
In March 2020, when the COVID-19 pandemic was ravaging the world, a poster appeared in several places in Hyderabad, India. The poster warned, “Do not allow Kojjas, Hijras [an Indian transfeminine community] near the shops. If you talk to them or have sex with them, you will be infected with CoronaVirus. Beat & drive them away or call 100 [the emergency police contact in India] immediately. Save people from CoronaVirus Hijras. [sic]”
Several transgender-rights activists took note, and eventually, the police responded by removing the posters and launching a probe to identify the miscreants. But, this was not the first time that marginalized communities – especially queer and trans communities – were wrongly held responsible for the spread of a global pandemic and had violence instigated against them.
Unfortunately, it wasn’t the last time either. With the monkeypox virus (MPXV) having recently been declared a Public Health Emergency of International Concern by the World Health Organization (WHO), queer people are once again being discriminated against and stigmatized. Experts believe this will prevent successful public health interventions from controlling the spread of the disease.
Monkeypox Is Not A “Gay Disease”
MPXV is a viral disease that spreads through close contact. According to the Centers for Disease Control and Prevention (CDC), the infection spreads through:
Direct contact with MPXV rash, scabs, or body fluids from a person with MPXV,
Indirect contact, i.e., by touching objects or surfaces that have been used previously by somebody with MPXV,
Through respiratory droplets and secretions.
Although MPXV is not as infectious as COVID-19, more than 16,000 cases have been recorded worldwide, and the number continues to grow.
A July 21 paper published in the New England Journal of Medicine, which analyzed demographics of MPXV infections from April to June 2022, reported that “98% of the persons with infection were gay or bisexual men.”
Similarly, in a tweet dated July 23, WHO chief Tedros Adhanom Ghebreyesus mentioned that “this…outbreak is concentrated among men who have sex with men, especially those with multiple sexual partners.” Ghebreyesus added, “That means that this outbreak can be stopped with the right strategies in the right groups.”
Does this mean queer men are at a higher risk of MPXV infections? Gagandeep Kang, an acclaimed virologist at the Christian Medical College, Vellore, India, told LGBTQ Nationthat ‘men who have sex with men’ are not the only group affected by the disease. “If MPXV was a ‘gay’ disease,” she added, “children would not be infected – which they have been in previous outbreaks of MPXV and this one.”
Kang pointed out that while the MPXV virus has been detected in the semen of affected individuals, it is “not strictly speaking a sexually transmitted disease. It is more of the respiratory and skin-to-skin contact routes that lead to transmission.”
A report by The Mint suggests that most MPXV cases are reported in queer men because of the “demographic’s positive health-seeking behavior.”
Adding to Kang’s comments, Aqsa Shaikh, an associate professor of community medicine at the Hamdard Institute of Medical Science and Research (HIMSR), New Delhi, India, and a public health researcher, told LGBTQ Nation that the data on which current conclusions about MPXV transmission are based is a “very weak level of evidence in epidemiological studies.”
Further, Shaikh cautioned that it is essential to distinguish between “association and causation.”
“Just because two things occur together does not mean one causes the other,” she said. So, according to Shaikh, even if we were to go by the reports that say queer men are disproportionately affected by MPXV, it does not mean “having gay sex or being a man who has sex with a man increases your risk of transmission of the disease.”
However, none of this has stopped people from wrongly touting MPXV as a disease that disproportionately affects queer men. For instance, Muqtada al-Sadr, an influential Shia cleric in Iraq, took to Twitter on May 23 to suggest that MPXV resulted from same-sex behavior.
He also called MPXV “homosexual-pox” and asked that queer people “repent”, Middle East Eye reported.
Al-Sadr is not the only one guilty. Stand-up comedian Dave Chappelle has also been accused of calling MPXV a “gay disease”.
Interestingly, the CDC page on “Monkeypox Facts for People who are Sexually Active” mentions that “[the disease] can spread to anyone through close, personal, often skin-to-skin contact” [emphasis added]. However, the representative picture on the page shows two presumably male bodies in a sexualized position.
A screen grab of the CDC page as of July 25 2022
Remember COVID, AIDS, and SARS
Shaikh alluded that MPXV being portrayed as a ‘gay disease’ is one example of several instances where entire communities have been wrongly shown as carriers of disease and death. As an example, she pointed out how the SARS-COV-2 virus – the causative agent of the COVID-19 pandemic – was colloquially referred to as the ‘Wuhan virus’ in the initial days of the pandemic. This subjected Chinese people to discrimination and xenophobia.
Similarly, Muslims in India were subjected to severe discrimination and islamophobia when a large international gathering of Islamic preachers – the Tablighi Jamaat – in the country’s capital was blamed for a sudden rise in COVID-19 cases across the country. The Printreported, “For days, ‘Tablighi virus’ and ‘Corona Jihad’ trended on Twitter.” A politician from India’s right-wing Hindu-fundamentalist ruling party warned people not to buy vegetables from Muslims.
Perhaps one of the worst instances where queer and transgender persons were stigmatized and discriminated against while losing their lives to deliberate queer- and transphobia was when the HIV/AIDS infection was first identified worldwide.
It has been well-documented how queer and transgender people – along with other marginalized groups like people of color, sex workers, and migrant workers – were portrayed as the key carriers of the virus.
Further, as The New Statesmanhas reported recently, “there was little public will to tackle the virus until people realized that HIV infected everyone, including heterosexuals [sic], equally.”
Shaikh told LGBTQ Nation that this ostracization of marginalized groups negatively affected public-health interventions to control the spread of HIV.
“It doesn’t help because queer and trans people are already stigmatized, and they eventually go further into hiding,” she said, talking about how such stigma discouraged people from getting tested.
Discrimination against queer and trans people resulting from their stigmatization during the early years of the HIV/AIDS pandemic has left marks that are difficult to erase even today.
Science Over Stigma
Shaikh and Kang agree that touting MPXV as a ‘gay disease’ endangers both queer and non-queer people. In the case of queer people, Kang told LGBTQ Nation, “stigmatization leads to lack of or delayed access to care.” On the other hand, she added, “If MPXV is labeled as a ‘gay disease’, then straight people will consider themselves not at risk and be at a higher risk.”
According to Shaikh, tagging MPXV as a ‘gay disease’ is a “distraction.”
“Rather than researching MPXV, we appear to be keener to prove whether it is a ‘gay disease’ or not. A lot of crucial time and resources that could have been utilized in other aspects of epidemiology are getting wasted in this debate,” she said.
San Francisco has declared a state of emergency, with the city in “desperate need of vaccines” as monkeypox cases skyrocket.
The US has seen around 4,600 confirmed cases of monkeypox across the country. Of these cases, 261 have been detected in San Francisco, representing around 30 per cent of all cases in California.
On Thursday (28 July), San Francisco mayor London Breed said: “We are at a very scary place. And we don’t want to be ignored by the federal government in our need. So many leaders of the LGBT community have also, weeks ago, asked for additional help and support and assistance.”
By declaring a state of emergency, San Francisco will be able to allocate more resources to fight the virus. Breed added that the city was in “desperate need of vaccines”.
San Francisco’s emergency declaration comes as earlier this week World Health Organization (WHO) said the accelerating monkeypox outbreak was a global health emergency, the health agency’s highest level of alert.
Monkeypox has spread around the world in recent months, however the outbreak is concentrated in Europe, and gay and bisexual men are disproportionately affected.
The health department of San Francisco, arguably the LGBTQ+ capital of America, has faced criticism for its response to the monkeypox outbreak because of a lack of public messaging and vaccine information.
The queer community and LGBTQ+ organisations have had to pick up the slack, with the San Francisco AIDS Foundation setting up a monkeypox advice hotline, and creating a vaccine waiting list, rather than forcing those at risk to queue for hours.
But state senator Scott Wiener, who represents the city, said: “San Francisco was at the forefront of the public health responses to HIV and COVID-19, and we will be at the forefront when it comes to monkeypox. We can’t and won’t leave the LGBTQ community out to dry.”
The most visible monkeypox symptom is a red rash with flat marks, with lesions soon rising and filling with puss, before falling off.
According to the NHS, other symptoms include a fever, body aches, chills and swollen glands. Symptoms can take between 5 and 21 days to show and bouts of monkeypox can last for weeks.
The head of the World Health Organization on Wednesday advised men at risk of catching monkeypox to consider reducing their sexual partners “for the moment” following the U.N. health agency declaring the escalating outbreaks in multiple countries to be a global emergency.
WHO Director-General Tedros Adhanom Ghebreyesus said 98% of the monkeypox cases detected since the outbreaks emerged in May have been among gay, bisexual and other men who have sex with men. He called for those at risk to take steps to protect themselves.
“That means making safe choices for yourself and others, for men who have sex with men,” Tedros said. “This includes, for the moment, reducing your number of sexual partners.”
Infectious individuals should isolate and avoid gatherings involving close, physical contact, while people should get contact details for any new sexual partners in case they need to follow up later, the WHO chief said.
The U.S. Centers for Disease Control and Prevention has not suggested that men who have sex with men reduce their sexual partners, only that they avoid skin-to-skin contact with people who have a rash that could be monkeypox.
WHO officials emphasized that monkeypox can infect anyone in close contact with a patient or their contaminated clothing or bedsheets. The U.N. health agency has warned that the disease could be more severe in vulnerable populations like children or pregnant women.
To date, more than 19,000 cases have been reported in more than 75 countries; deaths have only been reported in Africa.
“We know very clearly that one of the main modes of exposure for this particular illness is through direct contact, close contact, skin to skin contact, possibly even face to face contact, exposure to droplets or virus that may be in the mouth,” Dr. Rosamund Lewis, WHO’s technical lead for monkeypox, said.
Andy Seale, a WHO adviser on HIV, hepatitis and sexually transmitted infections, said experts have determined the current monkeypox outbreak is “clearly transmitted during sex,” but he said they have not yet concluded whether it’s a sexually transmitted infection.
Dr. Hugh Adler, who treats monkeypox patients in the U.K., said monkeypox was being transmitted during sex and that sexual networks and anonymous sex with untraceable partners were facilitating its spread.
“It’s just as likely that monkeypox was always capable of transmitting and presenting like this, but it hadn’t been formally reported or so widespread before,” he said.
Last week, British authorities issued new guidance advising doctors that people with just one or two lesions might be infectious with monkeypox, potentially complicating efforts to stop transmission.
The European Union’s health commissioner urged the bloc’s 27 member nations Wednesday to step up their efforts to tackle outbreaks in the EU, which she called “the epicenter of detected cases.”
In a letter to European health ministers obtained by The Associated Press, EU Health Commissioner Stella Kyriakides called for a “reinforced, concerted and coordinated action.”
“There is no time for complacency and we need to continue working together to control the outbreak,” she wrote.
On Saturday, July 23, World Health Organization Director General Tedros Adhanom Ghebreyesus declared the spread of monkeypox to be a public health emergency of international concern (PHEIC), the organization’s loudest alarm bell signifying an emerging outbreak.
Since early May, more than 15,000 cases of monkeypox have been identified across more than 60 countries. Disease caused by the monkeypox virus typically involves a few days of fever and lymph node swelling followed by a rash, which can leave scars. Most cases in the current outbreak have resolved without hospitalization or the need for medication. As of July 7, there have been three deaths, all of them in Africa.
When the WHO first convened a committee in late June to determine whether monkeypox was a PHEIC. As cases have continued to rise worldwide, the committee reconvened on July 21 — and this time, the outcome was different.
“We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little and which meets the criteria in international health regulations,” Tedros said when announcing the emergency.
Tedros made the declaration despite the the WHO’s emergency committee for monkeypox, which did not come to an unanimous consensus on whether to declare an emergency. “There are uncertainties on all sides,” said Michael Ryan, executive director of the WHO’s health emergencies program, explaining Tedros’s reasoning in deciding to declare a PHEIC. “He sees a window of opportunity to to bring this disease under control,” said Ryan. The committee offers a recommendation, but ultimately it was Tedros’s decision.
The last time the WHO declared an international emergency was in early 2020, for Covid-19. While the disease caused by the currently spreading monkeypox virus is much less severe than Covid-19 and spreads far less easily, there are good reasons for the WHO to declare an emergency.
For starters, said Ana B. Amaya, an expert in global health governance at Pace University in New York, this monkeypox outbreak is just very different from past outbreaks of the disease. The vast majority of the latest cases have been identified among gay and bisexual men, and sexual contact with multiple sexual partners has emerged as an important risk factor. Scientists are now trying to determine if the virus spreads through sexual fluids like semen and vaginal fluid in addition to the ways it’s already known to spread: via skin-to-skin contact and, to a lesser degree, by respiratory transmission.
Prior to the current outbreak, monkeypox often spread throughout households via close contact and, possibly, shared items like utensils and linens. In the past few weeks, isolatedreports of infections in children, who are thought to be at higher risk for severe outcomes of monkeypox infection, reinforce the worry that without containment, outbreaks often spread beyond the populations where they start.
The prospect that the virus might be spreading in ways not seen before raises the concern that it will surprise us in other ways — for example, by causing severe disease if it reaches certain populations it has not yet reached, like large groups of immunocompromised people, said Amaya. “All of that is really alarming. And that’s why it’s very important for us to have a coordinated response that starts from the WHO level,” she said in a late-June interview, before the WHO’s first meeting to discuss issuing an emergency declaration.
But beyond that, this kind of declaration encourages countries to coordinate to stop the virus’s spread in a few different ways. Here’s how that works.
A public health emergency is not the same thing as a pandemic
To be resoundingly clear: The WHO did not declare monkeypox to be a new pandemic. There’s a difference between a pandemic and a PHEIC.
A pandemic is squishily defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people,” according to A Dictionary of Epidemiology. Public health experts use the phrase “pandemic” to emphasize the global reach of an outbreak. They seem to agree that calling something a pandemic means it demands a coordinated international response — and potentially, that it’s too big to contain.
On the other hand, a PHEIC is a more carefully defined term. It describes a situation that has not necessarily grown out of control, but has the potential to do so.
According to the WHO’s International Health Regulations, an outbreak qualifies as a PHEIC if 1) it’s unusual or unexpected, 2) has potential for international spread, and 3) requires an immediate international response.
The WHO has only declared six PHEICs to date, including Ebola, Zika, and Covid-19.
The monkeypox outbreak easily meets the first two criteria for an emergency: the virus’s spread outside West and Central Africa and among sexual networks are both unusual patterns, and the virus has already spread internationally, with cases now present in about 60 countries. And given that spread, containing monkeypox will clearly require an international response.
Why did the WHO wait to declare an emergency?
Some experts think this outbreak easily met the PHEIC criteria when the WHO first addressed the question about a month ago. Why didn’t it declare an emergency then?
Nearly 50 percent of transgender people travel outside of their state of residence to get gender-affirming genital surgeries, according to a new study from Oregon Health and Science University (OHSU). The percentage could increase as more states put bans against gender-affirming healthcare for trans people in place, the study’s authors say.
The study, published Wednesday in JAMA Surgery, looked at 771 transgender patients who had a vaginoplasty or phalloplasty between 2007 and 2019. It found that 49 percent left their state of residence to get the procedure. People who lived in southern states were more likely to have to leave their home states in order to receive the surgery.
That’s because there’s a lack of surgeons who provide such care in the South. A 2020 studyfound that just 11 doctors in the South could provide such surgeries, and four of the doctors resided in Florida.
The number of such doctors could decrease as more Southern states ban gender-affirming care for trans youth. Genital surgeries aren’t typically performed on young trans people, but some doctors could choose to locate their practices outside of states with such bans in place because the bans increase doctors’ legal and financial liabilities if they treat young patients.
Of additional concern, the OHSU study found trans people who left their states to get surgery ended up paying up to 50 percent more in out-of-pocket medical expenses than those who were able to obtain surgeries in their home states. This included costs for post-surgical visits and foll0w-up care.
Only one of the 771 patients included in the study had their surgery paid for by their commercial health insurance provider, The Hill noted. This suggests that the life-saving surgical procedures may not be affordable for many trans people. Trans people living in transphobic states will face even greater financial and time costs just to receive gender-affirming care.
“We already knew that traveling for health care requires patients to take time off work and pay for travel and lodging on their own, and that it can make receiving follow-up care from qualified providers who are familiar with each patient’s unique needs challenging,” Jae Downing, the study’s lead author, said in a press release.
“This study helps quantify how severely we need more gender-affirming surgeons,” Geolani Dy, an assistant professor of urology and plastic and reconstructive surgery at OHSU School of Medicine, added.
