CHARLOTTE, N.C. — Scrolling through his Twitter feed, Robert Randolph Jr. came across a July 22 tweet by The Associated Press that bothered him.
“The spread of monkeypox in the U.S. could represent the dawn of a new sexually transmitted disease,” it read.
He clicked the link to the article in the tweet and read it. Then, he says, he read the comments and replies.
“What I saw were a bunch of, particularly, Black queer men, who were questioning the rhetoric of this article,” said Randolph, a 44-year-old Black queer writer from Greensboro. “They were critiquing it as — you know, rightfully so in my opinion — click bait.”
Monkeypox is a viral illness that typically involves flu-like symptoms, swelling of the lymph nodes and a rash that includes bumps that are initially filled with fluid before scabbing over.
Those saying monkeypox is a sexually transmitted infection point to data that show the outbreak has disproportionately affected men who have sex with men.
While it can affect anyone through close, skin-to-skin contact, the N.C. Department of Health and Human also notes this trend.
“Currently almost all cases in North Carolina and across the country have been in gay, bisexual and other men who have sex with men,” DHHS Secretary Kody Kinsley, who is gay, said in a press release Monday.
This kind of messaging on monkeypox is being criticized by some in the LGBTQ community and its allies. They fear it will stigmatize gay, bisexual and transgender people who have sex with other men, as early language about HIV/AIDS did in the 1980s and ‘90s.
Still, most public health leaders insist the language being used is fair and will help reduce the number of cases among men who have sex with men.
The STI stigma
In 1992, Randolph was a freshman at Southwest Edgecombe High School in Pinetops, about 70 miles east of Raleigh.
Randolph “very vividly” remembers a teacher who had lesions on his skin and used makeup to conceal them. No one knew his diagnosis, he said, but that did not stop people from spreading a rumor he had HIV, the virus that causes AIDS.
“This notion that monkeypox may become a new STI or STD is ... dredging up those memories,” Randolph said. “We’re seeing the same rhetoric occurring again. And that’s not only dangerous and problematic, but it’s sad.”
Joaquín Carcaño of Durham agrees and is talking with public health leaders as director of community organizing of the Latino Commission on AIDS.
A queer and transgender man, Carcaño says LGBTQ people in his circles are mobilizing around monkeypox, whether to debunk misinformation or help people get tested and vaccinated.
“But then, you know, you go on social media, like Twitter or something, where you don’t have that sort of bubble of your own community and you see all the really harmful messaging,” he said. “As we know through HIV — and even through COVID — shame-based messaging does not help. And I think we very quickly fell into it.”
Carcaño points to comments on social media that place the blame on gay people.
“It’s that sort of villainizing language of, ‘Well, if gay people just stopped having so much sex, you know, it wouldn’t affect the rest of us,’ or, you know, things like that,” he said.
When the first monkeypox case was confirmed out of Massachusetts on May 18, Elizabeth Finley of Durham says the National Coalition of STD Directors got involved. She is the communications director for the coalition, a group that regularly convenes state-level STD program directors and community leaders.
Monkeypox was lumped into STD prevention measures even as the Centers for Disease Control and Prevention worked to determine how to classify the outbreak, since the virus isn’t only transmitted through sex.
“To be technically categorized as an STD or STI, you know, it has to be transferred through ejaculate, pre-ejaculate or vaginal fluid,” she said. “And [monkeypox] is coming through, to our knowledge, close contact.”
Condoms and other barrier methods can “dramatically reduce that risk of (STI) transmission,” according to Dr. Dave Wessner, a biology professor and HIV educator at Davidson College.
That’s not quite the case with monkeypox.
“The virus is getting transmitted from skin to skin contact involving the pustules, the poxes themselves,” he said. “Wearing a condom is not necessarily going to stop the transmission.”
That’s why Wessner says the focus should be that the virus is transmitted primarily through close bodily contact regardless of sexual orientation or gender.
“Yes, most of the cases have been in gay men,” he said. “But that’s really a secondary point, as far as I’m concerned.”
It’s also what Carcaño believes.
“When we talk about monkey pox, we need to really focus on the exposure part,” he said. “When we say ‘men who have sex with men,’ just putting sex into that framing of it, you know, again, leads people to think about promiscuity ... sinful behavior, and like, all of this stuff that they’re really focusing on”
Government response
Just days after the World Health Organization declared the monkeypox outbreak a global public health emergency and the CDC confirmed the first two cases of monkeypox in children, the White House held a COVID-19 and monkeypox briefing.
Dr. Ashish Jha told McClatchy DC on Monday that the government has been “deeply engaged” with the LGBTQ community “both to share information, also to make sure that everybody is communicating in a way that’s both scientifically accurate and respectful.”
“It’s really important that we do not use this moment to propagate homophobic or transphobic messaging,” he said.
DHHS describes monkeypox as a rare disease caused by an orthopox virus that spreads through close contact with skin, clothes, linens and body fluids, including saliva and lesion fluid and crusts.
The department is stressing that most monkeypox cases in the state so far have been among gay, bisexual and other men who have sex with men so “people know exactly how this current outbreak is playing out” and so that “individuals most at risk can protect themselves,” Kinsley said.
“It’s not uncommon for diseases, to take root in social networks,” he added. “Especially social networks that are closely and tightly connected like (men who have sex with men).”
The department has not shared data on sexual orientation and gender identity. In fact, it did not share other demographic data like race and age until the state reached 20 cases. And it’s not for lack of transparency, Kinsley said, but rather, privacy.
“I think it’s important to remember that for any sort of data release, we have to protect — and we want to protect — the privacy of individuals,” he said. “I’m not in the business of outing anyone.”
While not perfect, Finley said the current monkeypox messaging has been well thought out and that members of the LGBTQ community have had a seat at the table in those discussions.
A big problem, Finely said, is that many cases are likely not being reported because of barriers in access to health care, emphasizing that STD and STI clinics are not federally funded in the United States.
“We know there isn’t enough testing that’s happening. We know that a lot of providers don’t have the supplies, or appointment availability, or means to be able to test,” she said. “We have clinicians who have just not been fully aware of what to look for.”
North Carolina had administered 533 doses of the vaccine at no cost as of Monday. That’s just a fraction of the 4,548 doses allocated by the federal government, enough to fully vaccinate approximately 2,300 people with the recommended two-dose series.
Most doses have been distributed to nine county health departments offering the vaccine, including Durham and Wake.
More vaccine is expected in the coming weeks, according to NCDHHS.
Equality NC and the N.C. Department of Health and Human Services will hold a virtual town hall at 6:30 p.m. ET on Thursday to share information on how to get checked, treated and tested for monkeypox. Watch at https://www.zoomgov.com/j/1600523673. Or One tap mobile: US: +16692545252,,1600523673# or +16468287666,,1600523673#
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