In the past week, several cases of monkeypox, a virus with flu-like symptoms that is rarely seen outside the African countries where it is endemic, were reported in the United States. As of May 18, the first United States-based case was confirmed in a Massachusetts man who had recently traveled to Canada. On Saturday, a New York City resident tested positive for the virus that causes monkeypox. These cases represent just a small fraction of the 80 global cases that have been recently identified, mostly concentrated in European countries.
Early identified cases of these instances of monkeypox were concentrated in gay and bisexual men, according to the Associated Press, which later reported that World Health Organization (WHO) officials had linked the cases to two queer events in Europe, one a Canary Islands Pride celebration in Spain and the other a Belgian fetish festival called Darklands. Though the WHO says the outbreak is primarily spreading through sex, and infections could be traced back to what some outlets have sensationally described as “sex at two European raves,” the organization has been trying to stem the potential for homophobic coverage by reminding people of two things: Monkeypox is not a sexually transmitted disease — it is spread by very close contact — and just because an illness affects a population, does not mean that population should be blamed.
In a statement, the United Nations’ health officials lambasted some coverage of the monkeypox virus, saying that though a “significant proportion” of cases have been in gay and bisexual men, portrayals of African people and LGBTQ+ people as being more susceptible to the virus “reinforce homophobic and racist stereotypes and exacerbate stigma.”
“Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one,” said UNAIDS deputy executive director Matthew Kavanagh. Kavanagh further warned that stigma can help in “stoking cycles of fear, driving people away from health services, impeding efforts to identify cases and encourages ineffective, punitive measures.”
The effects of these incomplete narratives harken back to the beginning of the AIDS epidemic as well. Many consider the anniversary of the HIV epidemic to be the CDC’s 1981 report identifying five white gay men with pneumocystis pneumonia. Even that beginning is not true, given that the first recorded AIDS-related death in the United States was the death of a Black gay teen named Robert Rayford in 1969, an account that has received relatively little attention compared to the CDC's official report. Nor were those five white gay men the full story of the epidemic's beginning: According to the doctor who recorded those cases, Michael Gottlieb, the CDC completely excluded two other patients with the same symptoms — a Black gay man and a Haitian man. In 2012, Gottlieb told PBS called the decision not to mention race was “an omission on our part,” which understates how monumental it truly was. That perception of HIV as a white gay illness remains with us to this day, as the majority of HIV-related media continues to highlight white gay men.
This misperception can cut both ways. Because white gay men were a highly stigmatized and marginalized group in the early days of the ongoing AIDS epidemic, the idea that HIV only affected a specific population did hurt public health efforts and drive people away from accessing services, as Kavanagh portends could happen with the monkeypox epidemic. But this narrative also meant that institutions meant to serve people with HIV didn’t think about reaching out to or including communities who were further marginalized than gay men. The CDC did not include many gynecological conditions in its official definition of AIDS until 1992, more than a decade after AIDS had become a public health crisis. That meant many women and people with vaginas were not allowed to participate in trials for life-saving medication and could not get access to it.
As with all viruses, it’s not only our duty to understand how narratives about them shape our public understanding of them, it’s important to find out all that we can about the virus, as well.
Monkeypox belongs to the same virus of families as smallpox and was first discovered among lab monkeys in 1958. The first case in humans was diagnosed 12 years later in 1970. Person-to-person exchange of the virus can occur through respiratory droplets during “prolonged face-to-face contact,” according to NBC News. Transmission can also occur from direct contact with bodily fluids, lesions or contaminated items including clothing and bedding. In a conference call on Monday, officials at the CDC emphasized that close physical contact led to transmission and disavowed the idea that casual proximity, such as the kind that might happen in a grocery store, could not facilitate transmission. Symptoms include fever, headache, muscle aches and exhaustion for a few days after infection. Those infected often experience a rash one to three days later. The rash typically begins as small bumps on the skin and progresses to blisters filled with a white fluid.
While some media reports of the current outbreak might tie the spread to gay and bisexual men, it’s important to note that, as recently as 2003, the United States experienced a monkeypox outbreak related to the handling of prairie dogs in mostly midwestern states like Wisconsin, Illinois and Indiana.
There is currently a strategic national stockpile of vaccines for the family of viruses that cause monkeypox, with two different vaccines available, a CDC official named Jennifer McQuiston told reporters on Monday’s conference call. The CDC currently has about 1,000 doses of a two-dose vaccine to prevent monkeypox infection, though they will be building up that stockpile in the coming weeks. A second vaccine, ACAM2000, is an older smallpox vaccine that holds some potentially significant side effects. Though they have over 100 million doses of that vaccine, McQuiston said, they would be less likely to use that at scale given its side effect profile.
In response to a question from a conference call guest, John Brooks, leader of the CDC’s epidemiology research team, emphasized that anyone can develop and spread monkeypox infection. While a large fraction of those infected in current global outbreak identify as gay or bisexual men, Brooks noted that there is no correlation between the identity and the illness. He also mentioned that the CDC will be working with community partners, including gay community-affiliated apps, to ensure that members of the queer community will be safe during upcoming Pride Month celebrations.
The larger takeaway? Blaming anyone for the spread of something like monkeypox, especially blaming the gay community or gay behavior, is not sound public health. Viruses, after all, don’t discriminate — and when we do, we only create a better environment to facilitate their spread.
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