As monkeypox continues to make its way through the developed world, it brings back ghosts from the past for many.
For HIV/AIDS researchers, people in the LGBTQI+ community and global health workers across the world, the current discourse around monkeypox reminds them of the early days of HIV.
Monkeypox is a viral disease that is primarily spread through close contact with the infected person. The symptoms of the disease, which includes fever, rash, swollen lymph nodes, can last anywhere between two and four weeks and the current fatality ratio is around three to six per cent, according to the World Health Organization (WHO).
Most of the infections have been recorded among men who have sex with men, which prompted the WHO to issue an advisory to gay, bisexual and other men who have sex with men, on how to be safe. However, this has led to discussions in social media and among the public marred by stigma and discrimination against them.
“Stigma and discrimination can be as dangerous as any virus,” Dr Tedros Adhanom Ghebreyesus, WHO’s director general, said as he declared monkeypox a global health emergency on 23 July 2022.
Stigma leads the discourse
The fact that monkeypox has been majorly reported amongst men who have sex with men (MSM) has resulted in gay people facing profound stigma, LGBTQI+ community leaders from Geneva told Geneva Solutions. The pattern of blaming the infected person and making them feel guilty has made things worse for the historically marginalised community.
“The first question asked to people living with HIV is how they got infected. This is the same for monkeypox too,” Florent Jouinot, regional coordinator at Association 360, told Geneva Solutions.
“There is this perception that if you contract monkeypox, you deserve it because you have a deviant sexuality. This was the case for HIV and it is the case now for monkeypox infections too. Contracting this disease is seen as a punishment.” They, as Jouinot wants to be referred to, accused the Swiss authorities of treating monkeypox as a “gay problem”, fanning the exclusionary discourse.
Gurchaten Sandhu, director of programmes at the Geneva-based International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA), pointed out that monkeypox can infect anybody regardless of their sexual orientation and that the words used around monkeypox and people at high-risk of contracting it must be chosen with caution.
Sandhu added that it is imperative to stick to evidence and move away from identifying “guilty” people. “This exacerbates hate and further hinders people from access to health services,” he said.
Unlike in the 1980s when HIV was discovered, the acknowledgement of the risk of stigma is a good first step, said Dr Stella Safo, HIV primary care physician and assistant professor at the Icahn School of Medicine at Mount Sinai in New York. She flagged how those in the public health response realm against monkeypox are asking questions to understand more about the disease and how the WHO wants to rename it altogether, in an attempt to address issues around stigma.
“Monkeypox is interesting because there is a desire to not only rename it to make it an appropriate name but also people are calling out the places in which there is likely to be stigma ahead of time. And it matters because then we can start to get ahead of just the kind of mistakes we made with HIV all those years ago,” Safo said.
She added that the only issue right now is framing monkeypox as something that will only affect men who have sex with men. “That is wrong. The framing needs to be that right now it is targeting this particular population but it is going to have more of a community spread and all of us are going to be at a higher risk of getting monkeypox,” she said.
Monkeypox is not a new disease. It has been around since the 1970s in Africa, but it wasn’t until the disease started spreading in the global north that the world took note of it. Safo termed this a “failure”.
“Many of us who are western clinicians have not had to treat monkeypox and so it is a brand new disease for us but it is not a brand new disease altogether,” she said, adding that it is crucial to take seriously the different diseases that affect people in different parts of the world, especially sub-Saharan Africa, so that health workers in the global north need not have to worry about the spread reaching them.
Sandhu also echoed Safo’s remarks and added that the way in which different populations across the world are treated and the divide between borders need to be addressed. “All of a sudden, because the alarm has been raised outside Africa, it becomes a global issue. Why hasn't this been given importance when it was an issue in Africa?” he asked.
Incidents have also been reported in the United States, where people from ethnic minorities have struggled to access the monkeypox vaccine. "Trans, black and brown MSM are reporting they are having a harder time getting the vaccines even in places where they primarily live. This matters again because if we don't eradicate the spread among all of the groups, all of us are at higher risk. So, it is really important that historically marginalised individuals are specially targeted so that we make sure we get ahead of this virus,” Safo pointed out.
Need for political action
Jouinot was scathing in calling out the alleged inaction of the federal authorities in Switzerland to address the spread of monkeypox within the MSM communities.
For now, we need real political engagement, they said. “The attitude of the authorities seems to be ‘if infection grows and affects other groups of people like children, pregnant women and old people then we'll see. For now it is just young men and gay young men’,” they added.
As on 2 August 2022, Switzerland had 298 confirmed cases of monkeypox.
Jouinot also highlighted another risk that queer men are exposed to due to the government’s inaction in this regard: “If you contract monkeypox today and you are gay or MSM, you need to out yourself to your family, personal network, professional network because you should be isolated for three weeks.”
The federal government of Switzerland, meanwhile, said that it is working on strategies, including on procuring vaccines, to address the concerns of the MSM community. The Federal Office of Public Health (FOPH) added that it is working with the Swiss AIDS Federation to spread awareness among the most vulnerable groups and strongly advised those in the MSM community to follow the recommendations on Dr Gay website.