Australia is in a good position to avoid a significant monkeypox outbreak by the time of WorldPride in Sydney in 2023 if state and federal governments harness the capability of sexual health organisations and appropriately target vaccines to gay and bisexual men over the coming months, experts say.
As cases climb into the tens of thousands in the northern hemisphere, Australia on Thursday declared monkeypox a “communicable disease incident of national significance”.
There were 44 reported cases in Australia by Thursday, mostly in returned international travellers, people aged 21 to 40 years and men who have sex with men.
The global rise in cases coincided with pride events in the northern hemisphere, where there are often large parties and travellers from across the globe.
But the stigmatisation of the gay community during the Aids crisis in the 80s and 90slingers in public memory. This has led to some reluctance in media outlets globally to discuss monkeypox as something where 98% of cases globally are currently men who have sex with men.
“Any health issue, scare, outbreak in which gay, bisexual men or queer people in general are targeted immediately brings up a lot of feelings given the last four decades of HIV responses in this country,” activist and co-founder of The Institute of Many, Nic Holas, said. “So whatever we’re doing, we’ve got to acknowledge that there’s going to be a lot of feelings about this in the mix with the science and the data and the facts.”
Heath Paynter, deputy CEO of the Australian Federation of AIDS Organisations, told Guardian Australia that monkeypox is a very different virus from HIV clinically, but it has a lot of similarities to HIV culturally.
“That’s because it’s a virus that’s been transmitted through sexual contact and through interconnected sexual networks of gay and bisexual men at the moment in the northern hemisphere,” he said.
“But it’s only a matter of time before that starts to happen in Australia with community transmission.”
The World Health Organisation director general, Tedros Adhanom Ghebreyesus, said this week that gay and bisexual men should consider reducing the number of sexual partners they have. But Prof Andrew Grulich, head of the HIV epidemiology and prevention program at the Kirby Institute, said that advice would not be effective unless people knew exactly when they would be able to be vaccinated.
“I think you could argue that that’s what most gay men did during the Covid lockdowns, they stopped having casual sex, as [did] young heterosexual people for a few weeks,” he said. “That’s sustainable provided it’s not a long-term thing.”
The Australian Technical Advisory Group on Immunisation (Atagi) this week updated its clinical guidance on vaccination against monkeypox to include the use of a MVA-BN vaccine named Jynneos, and experts believe a government deal to secure a supply of the vaccines is imminent.
‘Queer people are the architects of safe sex’
Holas said Australia has a chance to get ahead of the outbreak in the next few months, but it will take the right strategy to get on top of it, with a community-led response.
“Queer people are the architects of safer sex – we invented safer sex. It wasn’t a clinician or a politician – we came up with those strategies, and we rolled them out at a community level,” he said. “So we hopefully see similar things here when it comes to monkeypox.”
Paynter said the conversation about disease prevention should be led by people who can speak the language of the queer community, and targeted advertising on social media and through dating apps such as Grindr.
“If the messaging is too broad, then what you might end up with is people being worried about the virus who actually aren’t a target or priority population, and then the resourcing ends up going towards the wrong population,” he said.
“We must avoid a situation where people weaponise something like monkeypox, and this happened with HIV in many places around the world. We must have a language that is very respectful because we don’t want people being turned away, or at least not engaging in health services, for fear of being stigmatised, for fear of being judged.”
Colin Batrouney, Thorne Harbour Health’s director of health promotion, policy and communications, said public health messaging needs to strike a balance between raising awareness and not causing panic.
“Our focus has been on what monkeypox is, how it is contracted, symptoms, treatment and prevention,” he said. “Our approach to sexual health and wellbeing has always been one of non-judgemental, clear information and positivity.”
“The only moral dimension to the disease will be the inability or unwillingness of systems and governments around the world to deal with it.”
Atagi has identified gay, bisexual and other men who have sex with men as at highest risk, as well as sex workers. Grulich said it would make sense to prioritise gay and bisexual men who have travelled internationally for vaccination, followed by all highly sexually active gay and bisexual men.
“Australia is a little bit fortunate that this has happened in the depths of winter when there’s not a lot in the way of great big gay gatherings for gay men,” he said.
That will change when Sydney hosts WorldPride in February and March next year, and people will travel from all across the world.
“It’s utterly critical that sexually active gay men be vaccinated. We’ve got a few months for that, we mustn’t lose sight of that, Grulich said.
“It’s quite conceivable that we could get the great majority of sexually active gay men vaccinated in that time.”
Paynter agreed.
“I think we could really go close towards herd immunity through vaccination, subject to having enough supply of the vaccine.”
