The emergence of the monkeypox virus in the United States in the past two weeks has stoked fear of a second pandemic and prompted widespread, often fearful news coverage regarding the unfamiliar virus. Currently, cases of monkeypox, a relative of smallpox, are rare outside some parts of West and Central Africa. Occasional outbreaks in endemic areas typically stem from animal populations such as rodents, presumed to be reservoirs of the monkeypox virus. Unlike COVID-19, poxviruses like the monkeypox virus do not rapidly mutate; hence, vaccines effective against the virus already exist as do treatments, and the mortality rate ranges from one to ten percent.
Yet in the way the media discourse has shaped itself around monkeypox, some public health advocates fear that falsehoods about how the virus spreads may stoke discrimination among certain groups. Specifically, among members of the LGBTQ+ community, misinformation regarding monkeypox has become reminiscent of the stigma surrounding HIV. Part of this is because much recent reporting has cited health experts who claim that monkeypox has some connection to the LGBTQ+ community, and that such groups are at higher risk.
Now, experts are pushing back against framing the narrative on monkeypox this way — stating that it is both untrue as well as potentially damaging and discriminatory.
"If we learned anything from the early years of HIV, it is that when you say that any particular group is the high-risk group you drive people underground, you drive them away from healthcare, and you stigmatize an already underserved and stigmatized group," HIV specialist Dr. Howard Grossman told Salon.
"If we learned anything from the early years of HIV, it is that when you say that any particular group is the high-risk group you drive people underground, you drive them away from healthcare, and you stigmatize an already underserved and stigmatized group," HIV specialist Dr. Howard Grossman told Salon, emphasizing that "there's no such thing as a gay disease."
One story that gained particular traction went a step further. AP News reported that sex at Pride-related events in Spain's Canary Islands and in Berlin was to blame for the monkeypox outbreak. Citing an interview with Dr. David Heymann, former head of the WHO emergencies department, the author asserted that sexual transmission was the leading theory for the spread.
In an interview with Salon, Heymann told a very different story, indicating that it appears he was misquoted for the sake of a sensational headline.
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"Transmission is not sexual," he told Salon, explaining that while transmission can occur from sexual contact "it's not a sexually transmissible disease. Transmission occurs when there's skin to skin contact in the genital area or in any other area on the body where there is an open sore caused by the monkeypox virus."
Claims from the AP story continue to circulate in other news outlets despite corrected statements appearing on the website of the London School of Hygiene and Tropical Medicine. One particular bolded quote appears at the top of the page, highlighted in an orange block: "It is important not to jump to conclusions or stigmatise certain groups or individuals."
Researchers like Dr. Gregg Gonsalves, a professor of epidemiology at Yale University specializing in policy modeling of infectious diseases, were quick to denounce claims that monkeypox was spread this way.
"It's certainly not a gay disease," Gonsalves asserted. "WHO and CDC and others have been sort of pretty clear about this. What is true is that the initial cases have been in a lot of men who have sex with men. The accident of history is that, whatever the chain of transmission, it showed up in a party in the Canary Islands. Gay men, who were at those initial events are at risk. Now the infection is disseminated across several different countries."
Later in the same AP story, the author even noted that "scientists say it will be difficult to disentangle whether the spread is being driven by sex or merely close contact" and stated that health officials in Germany only linked four cases to Pride events "where sexual activity took place" while health officials in Spain had yet to confirm any links to these events.
As a professor at the school and one of the world's leading tropical disease epidemiologists, Heymann's words carry significant weight. According to the statements from Heymann, the "leading theory" or rather a hypothesis AP noted "is not proven," though it is being studied. Relatively little is known about this virus.
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"We've known about this infection for over 50 years," Tropical disease specialist Dr. Isaac Bogoch told Salon. "It's obviously existed for millennia, There are some very good studies out there looking at disease, transmission and prevention, ... so it's not like we're starting from scratch. On the other hand, this is what's called a neglected tropical infection."
Because it does not often impact high-income countries to the extent that heart disease or cancer does, funding for research is minimal, he added.
With almost 300 confirmed cases in Europe, North America, and Australia, in their latest situation report WHO reiterated that while the outbreak has been prevalent in the LGBTQ+ community, anyone in contact with an infected individual can contract monkeypox. Human exchange of the virus can occur through respiratory droplets but generally requires actual contact with lesions or contaminated items including clothing and bedding.
"What we know today is that the biggest risk factor is close or direct contact with an infected individual," Dr. Bogoch emphasized. "We don't know if there's a monkeypox sample in semen. We don't know that."
"The way it's being talked about is in a way, the direct result of the way we talked about HIV and AIDS — and that was in an appallingly judgmental, dehumanizing way that led to such misery and suffering and still haunts us."
Officials from UNAIDS, the United Nations joint program to address the threat of AIDS, denounced the spread of misinformation regarding the virus, stating that portrayals of African people and LGBTQ+ people as being more susceptible to the virus "reinforce homophobic and racist stereotypes and exacerbate stigma." Instead, UNAIDS Deputy Executive Director Matthew Kavanagh emphasized a rights- and evidence-based approach.
"Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one," Kavanagh stated. "Experience shows that stigmatizing rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures."
Reiterating that this virus can affect anyone, Kavanagh emphasized the effort of the LGBTQ+ community to bring awareness to the outbreak. Likewise, Dr. Grossman and other health experts have applauded the level of care health officials have taken to avoid misinformation and get information out to high-risk groups without fomenting stigma.
Over 40 years ago at the onset of the HIV epidemic, health officials were silent, and the media filled the gap with a more damaging narrative, according to Dr. Larry Mass, one of the doctors at the front lines early in the HIV epidemic.
"People in the media and elsewhere leapt to the conclusion that gays were spreading this major disease, and they were saying two things out of both sides of their mouth," Mass said. "They were saying it was a serious threat to everybody. At the same time, they were saying only the gays are getting it, so it's not such a big deal. These are the people who were ignorant, who ignored certain facts, who didn't acknowledge different risk groups, they just focused on gays."
"Clearly we have learned lessons," Grossman said. "The WHO keeps saying anyone could get this. That would not have happened. There is progress."
Grossman did however question the relevance of "safe sex practices" WHO lists in its report as a means of preventing spread.
"Being careful about say party venues, clubs, to me is a better warning than worrying about safe sex," Grossman added. "Condoms aren't gonna protect you from monkeypox unless somebody only has it on their genitals."
According to Dr. Gonsalves, the emphasis on sexual behavior is counterproductive.
"Telling people they should stop having sex and that they should stop doing this and that," he said. "Suggesting that they're spreading disease creates climates of fear and shame and makes people draw away from the public health people that they need to be confident are on their side right now."
When Randy Shilts, a journalist and a gay man, broke the cultural silence around HIV when he published "And the Band Played On." The book capitalized on public fascination with alleged "patient zero" for HIV, Gaëtan Dugas. According to Dr. Mass, centering a narrative around perceptions of promiscuous behavior was a problem then, even in the LGBTQ+ community.
"The sound-bite level of misinformation that got out there — that the public latched onto — was that this whole epidemic basically emerged from this one promiscuous gay man who had had all these contacts in different nations and different localities all over the world," Mass explained. "The simple concept, in translation, that the public grabbed onto was that promiscuous gays are spreading this disease."
Former collaborating researcher with United Nations Research Institute for Social Development Tadzio Müller described hearing about monkeypox from his husband, who described an unsettling reminiscence to the way HIV was reported. At first, Müller brushed it off. Then he saw the news reports. To him, the potential damage of their rhetoric represents a far larger problem than the disease itself.
"Even to those who are not consciously against gay men or MSM in any way, shape or form will start telling the story," described Müller. "They see it through the lens that's been shaped by this story of AIDS as the gay plague, the plague that kills the amoral."
"The way it's being talked about is in a way, the direct result of the way we talked about HIV and AIDS, and that was in an appallingly judgmental, dehumanizing way that led to such misery and suffering and still haunts us — haunts every man who has sex with men," Müller described. "We are talking about it in terms that evoke Sodom and f***ing Gomorra.
It is not surprising to Müller, political scientist and LGBTQ+ activist, that the spread is attributed to promiscuous sex among gay men.
"Even to those who are not consciously against gay men or MSM in any way, shape or form will start telling the story," described Müller. "They see it through the lens that's been shaped by this story of AIDS as the gay plague, the plague that kills the amoral."
Müller was still a child in the early days of the HIV epidemic but remembers coming into his own in Berlin during that time.
"There was literally a discourse about putting us in camps in Germany, and that memory is fresh," Müller expounded. "German politicians debated putting us — HIV/AIDS victims — into concentration camps."
In the United States, prominent conservative commentator William F. Buckley pushed similar rhetoric, advocating in one New York Times piece to "tattoo gay men's buttocks" and spoke of "quarantining" the HIV-positive, as Dr. Gonsalves, noted.
"The way we approach lesbian/gay health right now is about information, about meeting people where they're at, trying to create sort of the conditions for people to make better health choices because coercion and the heavy fist of public health generally drive people underground," Gonsalves explained.
Dr. Mass, physician and co-founder of Gay Men's Health Crisis, said this kind of targeted stigma surrounding the emergence of a new disease is to be expected.
"Anti-science, ignorance, prejudice are endemic to the human race," Mass concluded. "That's a kind of chronic infection of humanity that just keeps erupting all the time like a plague."
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