British health authorities said Friday the monkeypox outbreak across the country may be peaking and that the epidemic’s growth rate has slowed.
The U.K.’s Health Security Agency said in a statement there were “early signs that the outbreak is plateauing,” with 2,859 cases detected since May. No deaths have been reported. Last month, authorities estimated the outbreak was doubling in size about every two weeks, but the number of new infections has dropped in recent weeks.
“While the most recent data suggest the growth of the outbreak has slowed, we cannot be complacent,” said Dr. Meera Chand, Director of Clinical and Emerging Infections at the Health Security Agency. She said anyone who thought they might have monkeypox should skip meeting friends, social gatherings and avoid sexual contact.
The Health Security Agency said its most recent analysis of the outbreak “shows that monkeypox continues to be transmitted primarily in interconnected sexual networks of gay, bisexual, or men who have sex with other men.” More than 70% of the U.K.’s cases are in London.
British officials noted a small number of infections among women, but said there was not enough evidence to suggest there was sustained spread of monkeypox beyond gay and bisexual men; 99% of all cases in the U.K. are in men.
Scientists who analyzed monkeypox viruses in the U.K. noted a number of mutations compared to viruses circulating in Africa, but said there was no evidence those genetic changes made monkeypox any more transmissible.
The World Health Organization said this week that 92% of monkeypox cases beyond Africa were likely infected through sex and its Director-General recently appealed to vulnerable gay and bisexual men to consider reducing their sexual partners “for the moment.”
To date, more than 26,000 monkeypox cases have been reported in nearly 90 countries, with a 19% increase in the last week.
In June, British authorities expanded their vaccination strategy, offering vaccines not only to health workers treating monkeypox patients and high-risk contacts of patients, but to some men who are gay or bisexual and at high risk of catching the virus, including those with multiple sexual partners or who participate in group sex.
Last month, the U.K. downgraded its assessment of the monkeypox outbreak and dropped a recommendation for the contacts of monkeypox cases to isolate for three weeks unless they have symptoms. The change was prompted by data showing that only a small number of contacts are ultimately sickened by monkeypox and a lack of evidence that the disease spreads without close, intimate or sexual contact.
Monkeypox spreads when people have close, physical contact with an infected person’s lesions, their clothing or bedsheets. Most people recover without needing treatment, but the lesions can be extremely painful and more severe cases can result in complications including encephalitis and death.
The Australian government is to import 450,000 monkeypox vaccine doses to help tackle a rise in cases.
Health minister Mark Butler told reporters on Thursday (4 August) the government had negotiated at least 450,000 doses of the third-generation Bavarian-Nordic vaccine to be prioritised for specific at-risk groups including gay and bisexual men.
The government began negotiating vaccine distribution on 20 May, according to Butler, just one day after the first confirmed case in Australia.
At the current time of reporting, the US Centers for Disease Control and Prevention (CDC) estimates that at least 53 cases of the disease have been reported in Australia
While cases may seem low right now, Butler assured the public numbers had “increased quite quickly” around the world, with countries like the US currently seeing cases reach more than 6,000, and more than 4,000 in Spain.
While Australia has secured 450,000 doses, other countries are struggling to roll out the vaccine. The EU has purchased just 163,000 vaccines through its central Health Emergency Preparedness and Response Authority (HERA). France has purchased 250,000, with the UK having purchased just over 100,000.
Australia declared monkeypox a “communicable disease incident of national significance” on 28 July, just days after the World Health Organisation declared it a global health emergency.
Butler said that the first 100,000 doses are expected to reach Australia over the remaining months of 2022, with 22,000 arriving this and next week. The remaining 350,000 will be distributed in 2023.
He said the vaccine was “by far the most effective and user-friendly for patients with compromised immunity” and could also be administered in vulnerable groups such as pregnant women, children, and those with pre-existing conditions.
“I’m very pleased with the work the chief medical officer and the department have been able to do in a short period of time, particularly to secure the supply of vaccines in a highly contested global market,” he continued.
Patient receives a dose of the monkeypox vaccine at a pop-up vaccination clinic. (Mario Tama/Getty)He also warned against “stigma and discrimination” after several misinformed pundits had suggested monkeypox was a “gay disease” and is only sexually transmitted. The CDC reports researchers arestill determining whether the disease can transmit sexually and have not referred to it as an STI.
UK Health Security Agency (UKHSA) epidemiologist Mateo Prochazka toldPinkNews in May that the “discourse around this infection is going to become more prevalent and intersect with discourses that are homophobic”.
“Gay and bisexual men usually have larger numbers of sex partners and are more likely to have anonymous sexual partners as well,” he said, “and this can lead to direct contact that may not be seen in other sexual networks with the same frequency”.
“It might be that the pathogen has now entered those networks and is being spread that way. It does not mean that gay or bisexual men are doing anything inherently wrong, or that the virus has changed or that it’s sexually transmitted, it just means that this behaviour facilitates transmission in these networks.”
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Amid growing concerns over the potential threat of monkeypox, executives from Moderna said Wednesday they have initiated a research program to consider whether the company could create a monkeypox vaccine with mRNA technology. “We’re obviously very aware of the monkeypox concern and obviously very sensitive to recent announcements,” Moderna President Stephen Hoge said during an investor call.
“Our platform is pretty well established and our ability to rapidly scale has been demonstrated. If we were to go after a monkeypox clinical development program, it would be to very quickly progress toward an approvable set of endpoints in a clinical study,” he explained. As seen with the rollout for the COVID-19 vaccines, any new vaccine would still need to go through the regulatory authorization process, which can take weeks to months, even in special circumstances.
CDC Director Rochelle Walensky told reporters on a call Thursday that gay and bisexual men who are HIV positive or who are taking medicines, called PREP, to reduce their chance of contracting HIV face the greatest health risk from monkeypox.
“That’s the population we have been most focused on in terms of vaccination,” Walensky said.
The U.S. has secured 1.1 million doses of the two-dose vaccine Jynneos so far, according to the Health and Human Services Department. The federal government has delivered more than 600,000 doses of the vaccine since May, according to HHS.
As monkeypox continues to spread worldwide, health officials have recommended high-risk individuals get vaccinated as soon as possible—but research is limited on just how effectively the available vaccines prevent infection, Randy Dotinga writes for MedPage Today.
CDC has confirmed 6,326 cases of monkeypox across 48 U.S. states, the District of Columbia, and Puerto Rico. The states most impacted by the outbreak so far are New York with 1,617 cases, California with 826 cases, and Illinois with 533 cases.
To reduce the risk of viral transmission, health officials have recommended high-risk individuals be vaccinated against monkeypox. So far, the United States has purchased 7 million doses of Bavarian Nordic‘s Jynneos vaccine, the preferred vaccine against monkeypox, and the entire supply is expected to be available by mid-2023.
So far, the supply of vaccines has been limited, with many jurisdictions, including San Francisco and New York City, saying that they do not have enough to meet demand. Last week, FDA announced it had cleared an additional 786,000 vaccine doses for use.
How well does the monkeypox vaccine actually work?
While health officials continue to emphasize the value of vaccination, there is limited evidence to show that the monkeypox vaccine is effective at preventing infection from the virus. CDC has acknowledged that “no data are available yet on the effectiveness of these vaccines in the current outbreak.”
According to Jay Varma, director of the Cornell Center for Pandemic Prevention and Response, “It is absolutely critical that public health officials work on messaging this uncertainty to people about being vaccinated.”
So far, much of the data on the monkeypox vaccine is from a retrospective analysis published in 1988, which examined whether a smallpox vaccine could also prevent monkeypox. In the study, researchers followed household contacts of 209 people in Zaire who had been infected with monkeypox and found that those who had scars from prior smallpox vaccination were 85% less likely to be infected.
According to Ira Longini, a biostatistician at the University of Florida, the study’s conclusions are limited, since its statistical analysis has no reported confidence interval and did not adjust for other factors, such as age. In addition, the data was based solely on physical signs of vaccination.
The study “is the only shred of evidence we have (in regard to vaccine effectiveness), which is pretty weak,” he said. “In principle it should work, but we don’t know.”
Richard Kennedy, co-director of the Mayo Vaccine Research Group, agreed, saying that the Jynneos vaccine and an older smallpox vaccine ACAM2000 “have not been tested directly against smallpox or monkeypox” and that “[t]he immune responses they create are very close to first- or second-generation vaccines: A little weaker, but not much.”
However, Kennedy noted that the vaccines have been tested against monkeypox in several animal studies. “These data are also clear and consistent with very good protection against disease with animals showing very few or no symptoms of illness after challenge,” he said. “The animal data was strong enough that the FDA approved Jynneos to be licensed for prevention of monkeypox.”
How can people protect themselves against monkeypox?
In addition to vaccination, health officials have advised those who are most at risk, particularly men who have sex with men (MSM), to take steps to reduce their risk of infection, including adjusting their sexual behavior during the current outbreak.
For example, World Health Organization Director-General Tedros Adhanom Ghebreyesus last week recommended “reducing your number of sexual partners, reconsidering … sex with new partners, and exchanging contact details with any new partners to enable follow up if needed.”
Similarly, CDC offered advice for lowering the potential risk of infection during sex, including not kissing and avoiding sharing towels and other items.
“The prevention messaging should be that vaccinations will be an essential part of getting this outbreak under control, and we need everyone to get vaccinated as soon as possible,” said Michael Donnelly, a data scientist and LGBT health advocate. “But even if you’re vaccinated, you’re still at risk, and unprotected anal sex may be the highest risk.”
“Even after vaccination, you may want to consider reducing the number of your sex partners and using condoms or pursuing other safer sex approaches,” he added. (Dotinga, MedPage Today, 8/1)
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.
