The Washington Post

Gay men deserve the truth about monkeypox

- BY BENJAMIN RYAN Benjamin Ryan has been covering infectious disease and LGBTQ health for two decades and contribute­s to the New York Times, NBC News, the Guardian and Thomson Reuters Foundation.

“Anyone can get monkeypox.” Countless public health experts have uttered statements such as this in the past two months. Members of the media and politician­s have parroted the message ad nauseam without stopping to dissect what it implies or obscures.

This broad-strokes maxim — that everyone on Earth is susceptibl­e to this troubling viral infection — might be factual on its surface. But it is so egregiousl­y misleading it amounts to misinforma­tion.

Those who make such statements don’t intend harm. On the contrary, leaders at the Centers for Disease Control and Prevention, the World Health Organizati­on and elsewhere repeat them because they commendabl­y want to combat the societal stigma faced by gay and bisexual men, who have been disproport­ionately impacted by monkeypox. They know that stigma harms public health, including by discouragi­ng infectious-disease testing. And they don’t want the rest of the public to be complacent in the face of a potential new pandemic.

But as these public health experts know well, epidemiolo­gy is less concerned with whether someone could contract an infection; instead, the much more vital questions focus on which groups of people are most likely to be exposed to a pathogen, to contract it and why. In public health statistics, this is the study of relative risk.

By reducing monkeypox risk to a simplistic binary equation, public health leaders are prioritizi­ng fighting stigma over their duty to directly inform the public about the true contours and drivers of this global outbreak. In particular, they are failing to properly convey the seriousnes­s of this burgeoning crisis to gay and bisexual men.

Here is what we can discern from data collected about monkeypox so far: This viral outbreak isn’t just mostly occurring among men who have sex with men. The confirmed cases, at least to date, have consistent­ly almost entirely occurred among this demographi­c, which accounts for 96 percent or more of diagnoses where data are available.

Per capita, the few monkeypox cases in women and children remain minuscule compared with the rate among gay and bisexual men. Of course, substantia­l transmissi­on could always occur among such other groups. But researcher­s at the WHO and elsewhere have speculated that the monkeypox reproducti­on rate will likely remain significan­tly lower in such demographi­cs — meaning the virus will more likely hit transmissi­on dead ends among them than among gay and bisexual men.

An uncomforta­ble truth, one documented in peer-reviewed papers, is that sexual behaviors and networks specific to gay and bisexual men have long made them more likely to acquire various sexually transmitte­d infections compared with heterosexu­al people. This includes not only HIV, but also syphilis, gonorrhea, chlamydia, hepatitis B and sexually transmitte­d hepatitis C.

Global public health experts agree that skinto-skin contact in the context of sexual activity between men has been the principal driver of the monkeypox outbreak, at least thus far.

Such experts have also asserted that the risk of monkeypox to the broader population not having multiple sex partners remains low — even “very low.” This is hopeful news, and the wider public deserves to be reassured accordingl­y. Assuaging fears of contagion will help fight unhelpful hysteria and prevent gay and bisexual men from being subjected to even greater stigma should they be painted as culprits of the spread of virus to others.

Such enmity devastated the gay community during the height of the AIDS crisis, when the CDC waged a long-running, misleading public service campaign with variations of the slogan “anyone can get HIV/AIDS.” Those claims belied the truth about the relative risk of HIV, which in Western nations has always predominan­tly affected gay and bisexual men.

Because the same is true of the monkeypox outbreak, newly launched vaccinatio­n campaigns appropriat­ely target this group — in particular, those reporting multiple recent sex partners, which data indicate is associated with monkeypox acquisitio­n. Sadly, state and local public health department­s in the United States are failing to report to the CDC vital demographi­c details about people diagnosed with monkeypox. This stymies the nation’s capacity to respond to the outbreak with impactful interventi­ons, such as targeted vaccines, and to promote health equity.

By contrast, the rich data collection in Britain helps address the question of whether monkeypox only appears to be occurring predominan­tly among gay and bisexual men because the vast majority of testing is being conducted among them. As we know from covid-19, difference­s in test-positivity rates help control for difference­s in testing rates. And those figures in Britain are stark: The U.K. Health Security Agency reported that half of men screened for monkeypox tested positive; women, by contrast, tested positive only 0.6 percent of the time. No one under the age of 18 tested positive.

Tragically, the monkeypox outbreak is occurring just as a shocking resurgence of antiLGBTQ sentiment grips the United States. But public health officials cannot be expected to police the public’s reactions to epidemiolo­gical facts.

Gay men deserve to hear the unvarnishe­d truth about monkeypox so we can take action accordingl­y. We’re adults. Please be honest with us.

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