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Men who have sex with men are still, overwhelmingly, the people most affected by monkeypox, according to the World Health Organization. And that has created some hurdles when it comes to public health messages about how people can protect themselves. Everything from what we call the virus to giving advice on how to prevent transmission risks further stigmatizing gay and bisexual men.
But experts said that despite that risk, it’s important to keep sex at the center of the monkeypox conversation.
“You have to be specific about who is actually at risk and what the transmission routes are,” said epidemiologist Chris Beyrer, incoming director of Duke Global Health Institute.
While it is possible to get monkeypox through ways other than sex, such as touching substances used by someone with monkeypox, those cases remain extremely rare. Until now, sexual contact between men remains the primary mode of transmission in the current outbreak, What’s? important to keep in mind, especially during a vaccine shortage. “In a period of vaccine scarcity, you should try to use vaccines to disrupt transmission chains,” Beyrer said. “It’s important to try and contain the outbreak by getting higher population immunity in the networks where it spreads.”
One of the biggest public health challenges is limiting risky behaviors with sex, Beyrer said. That is, advising gays and gays to reduce the number of sexual partners and avoid close contact with strangers.
Messages that hark back to the messages of early HIV/AIDS.
“And people thought it was kind of like elements of homophobia and anti-sex when sexuality is a very big part of identity,” Beyrer said.
How to have sex during an epidemic
Jennifer Brier is an HIV/AIDS historian at the University of Illinois Chicago. While the discussions about how to talk about monkeypox have been going around – does monkeypox count as an STD, for example? What should we think about bad faith actors calling it a “gay disease” – she referred back to one of the formative texts on public health entitled How to have sex during an epidemic. Written by two men Michael Callen and Richard Berkowitz, in response to a lack of information from the government.
Although the booklet contained direct and detailed information about the dangers of sex during the HIV/AIDS crisis, it first started as a screed entitled ‘We Know Who We Are: Two Gay Men Declare War on Promiscuity’.
“And people went in banana pants with that article,” Brier said. “Like, ‘You attack gay liberation, that’s who we are.’ And I understand that to some extent. But they were also trying to come up with a damage mitigation model before it existed.”
It’s a script that people are still learning from. Nick Diamond is a co-investigator of RESPND-MI, a community-led effort to anonymously collect data on queer-transgender sexual networks in New York City. And in July, in response to a lack of information about monkeypox from local, state and federal officials, Diamond wrote a document titled “Six Ways We Can Have Safer Sex in Times of Monkeypox.”
“I’ll be the first to say that we’ve leaned on AIDS activists to develop these actions around our response to monkeypox,” Diamond said.
But he adds that it’s an imperfect line to draw. HIV/AIDS was a much more deadly disease and broke out at a politically different time. That said, Diamond says people still have a hard time talking about queer and trans sex.
“We have to talk about sex when we talk about monkey pox. I think these are uncomfortable conversations, but it’s one of the determinants of our health and rights,” Diamond said.
And it is important to talk about the totality of human sexuality. While men who have sex with men are currently at the center of the monkeypox outbreak, HIV/AIDS historian Jennifer Brier says one specific phrase can be limiting. Men who have sex with men don’t just have sex with men, and vice versa.
“Our sexual desires and our sexual practices are much more complicated than any sentence,” she said.