As monkeypox (MPXV) cases rise there are increasing concerns about the efforts being made to control the virus and the rhetoric around it. The World Health Organisation has named MPXV a Public Health Emergency of International Concern, and there are now around 35,000 confirmed cases worldwide. In the UK, 95.3% of all confirmed cases are in gay and bisexual men who have sex with men (GBMSM), and a further 95% are estimated to have been transmitted through sexual contact. Though MPXV is a contact-based disease, meaning you can contract the virus by coming into contact with infected skin, cloth or saliva, there has been an extreme focus on the prevalence of the virus in GBMSM. This is eliciting fears that this will perpetuate the stigmatisation of LGBT communities in the aftermath of the virus in a similar way to the HIV/AIDS epidemic.
Considering nearly all MPXV cases have been diagnosed in GBMSM, it is not inaccurate or unhelpful to report on the prevalence of the virus in this group, but the fact that reporting on the virus lacks nuance could be potentially dangerous. The focus on the spread of MPXV through sexual contact is disturbingly reminiscent of language used about HIV/AIDS, which was labelled as the ‘gay plague,’ and might aggravate the stigma that the sexual habits of GBMSM are dirty, wrong, irresponsible, shameful and immoral. Due to the fact that there is already a large amount of stigma around the sexual habits of GBMSM, focusing on the sexual transmission of MPXV reproduces the idea that they are responsible for spreading infectious diseases, and that partaking in their sexual habits puts themselves and wider society at risk. It also ignores the fact that there is not a large amount of research into the sexual transmission of the virus, and that sexual contact is not the only form of contact through which the virus can be spread.
It’s also important to note that GBMSM often discover they have MPXV because they engage in ‘positive health seeking behaviour’ (ie. having regular sexual health screens). Public Health England recommends GBMSM should be screened for STIs every three months if having unprotected sex with casual partners. Due to the aftermath of HIV/AIDS, GBMSM already have some awareness of the importance of screening for sexually transmitted diseases, and it is perhaps because of this focus on testing in specific populations that there has been an increase in the diagnoses of HIV amongst the heterosexual population, with HIV diagnoses in heterosexual people overtaking those in LGBT people for the first time in 2020.
Moreover, labelling any disease as sexually transmitted (unfortunately) prevents people from talking about it as there isn’t a widely accepted social language for discussing sex, and especially casual sex. This is particularly true for those who live in a community or family that disapproves of their sexuality, or those who live in one of the 68 countries where sexual activity with someone of the same sex is criminalised. Even in countries where homosexuality is not criminalised and is largely accepted, this stigma is worse for people of colour and those from a lower socio-economic background. These are the people who have the least access to medical advice and follow-up healthcare; who are least likely to be able to afford to isolate for the recommended 2-4 weeks upon contracting MPXV, or even to wait in line for the (currently very limited) vaccine.
This is why it is so important that the rhetoric lacks any language that might fuel stigma around anyone’s sexual behaviour, and that there is a general understanding that this virus can affect anyone. Evidently, health is not a straightforward issue, and shaming anyone for contracting or spreading a disease is dangerous for everyone. Though there is a need for targeting GBMSM so that they are made aware of the fact that they are currently most at risk, and can therefore take steps to protect themselves from the virus, it is dangerous to only target a specific group, such as GBMSM or sexually active people more generally. We have seen this in the rhetoric around HIV/AIDS, as it leads people outside of these categories to have a false sense of security; some might think that if they do develop symptoms they can’t possibly have MPXV because they aren’t having sex (particularly with a GBMSM). These attitudes will inevitably lead to the spread of the virus in the wider population, which is currently the fear of scientists who say it is unclear why the virus has not yet spread beyond GBMSM and who believe this will not be a short-term battle.
Instead, it would be helpful to look at the reasons why MPXV is able to spread amongst groups of GBMSM, such as the fact that their social habits provide the perfect setting for viruses to spread– GBMSM are a self-socialising group, so spend time in places such as clubs or bars with other GBMSM where there is likely to be contact with exposed skin. The sexual behaviour of GBMSM also contributes to this as they often have sexual encounters with other men they don’t know well, and might not stay in contact with later, something which again comes back to that preexisting stigma around same-sex behaviour and GBMSM’s perceived lack of safety, something which culminates in their socialising amongst their own social group and contributes to the spread of the virus. It could be helpful to take notes from previous health campaigns that have raised the awareness of those most at risk of contracting a virus, such as Chicago’s PrEP4Love, a sex-positive campaign that reframed negative language around HIV/AIDS whilst also promoting the preventative HIV drug PrEP. Whilst MPXV isn’t an STI, as the rhetoric has already been so focused on the sexual transmission amongst GBMSM, a group where stigma around sex is already so pronounced, this type of campaign could work towards raising the general awareness of preventing the spread of the virus with more neutral language.
Thankfully, the COVID-19 pandemic has, in some ways, made people more aware of their health and taught them new ways of speaking about the health of others, though there is still a way to go in the response to health issues from the media and healthcare services. In the meantime, it’s essential not to focus on any one group when it comes to discussing MPXV, both in order to prevent stigma and to ensure we all remain alert and know how to prevent the spread of this, and any future, virus.
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