Why we need to be straightforward about who is at risk from monkeypox

The government of Joe Biden declared the monkeypox outbreak this month a public health emergency. Not wanting to reproduce the kind of stigma about homosexuals seen during the onset of the AIDS crisis, experts argue that articulating which group is most at risk for smallpox infection can be dangerous.

However, analysts say the insistence on generalizing warnings undermines outreach to the most vulnerable, including black and Latino men, and oversimplifies lessons learned during the AIDS crisis, which has illuminated the importance of combating stigma and demand for care for those in need.

“We don’t want to add stigma to a sensitive situation, but then our message becomes so broad that no one knows which people we’re talking to — and that becomes a real problem,” Robert Fullilove, professor of clinical sociomedical science at the University of California Medical Center. Columbia, at CNN .

In short, experts say we shouldn’t be discreet on the subject. Instead, we must face it directly and keep an eye on the expanding access to care.

What the preliminary data show

Part of the problem with talking about monkeypox indirectly is that we’ve overemphasized who can get the virus and downplaying who actually gets it, according to Melanie Thompson, a physician and HIV researcher in Atlanta.

See a detailed analysis of the monkeypox case records that the US Centers for Disease Control and Prevention published this month. Anyone can catch the virus, yes, but CDC analysis shows that 94% of cases were among men who had recent intimate or sexual contact with another man. In addition, 54% of the cases occurred among black Americans and Latinos.

Initial data of Georgia Department of Public Health It’s from North Carolina Department of Health and Human Services show a similar pattern: in both states, monkeypox is predominantly affecting black men.

Thompson highlighted the importance of clarity, of communication that explains where, precisely, the virus is.

“The purpose of the data is not just to crunch numbers – but to ensure that the people most affected by monkeypox or any other disease are getting the services they need,” she said.

Thompson added: “The message that anyone can get monkeypox spreads fear among the general population. This distances them from the messages we need to reach people at risk of monkeypox infection.”

And that kind of obfuscation isn’t just distracting. It also marginalizes the issue in a different way, she said.

Jim Downs, historian of epidemic disease at Gettysburg College and author of “Maladies of Empire: How Colonialism, Slavery and War Transformed Medicine“, echoed some of Thompson’s sentiments.

“Evidence shows that men who have sex with men are at greater risk than any other population or group,” he said.

“So when we talk about targeting messages and, more importantly, targeting vaccines, we need to make sure these efforts are purposefully aimed at the people most at risk, as opposed to people who might think, ‘Well, why not get vaccinated? It’s a good idea.””

It’s worth noting, experts say, that while black men seem to have the majority of smallpox cases, it’s not because they’re black.

“When we use race as a way to identify an important characteristic of a person who is sick, some people think race is biologically active — there must be something about black skin that makes monkeypox infection more likely,” Fullilove said.

“But this is not the case. What we’re seeing is the dynamics of who hangs out with whom and where they socialize.”

Thompson also included a note of caution in the conversation.

“There is no sort of racial predilection for monkeypox,” she said. “It has to do with structural racism and the nature of cultural communities and practices.”

She said Georgia, for example, is still very segregated in terms of race and sexuality.

“That means black people are likely to have sexual partners who are also black,” Thompson explained. “And because they are a smaller proportion of the population, they are more likely to come into contact with the virus.”

If there’s a silver lining, it should be easier to contain and eradicate monkeypox because we have a more concrete sense of where most of the infection is.

‘AIDS activism wasn’t just about saying the right thing’

Pressure from some for broad messages about monkeypox is based on good intentions and seeks to avoid fierce anti-gay stigma seen during the AIDS crisis in the 1980s and 1990s.

However, this approach erases some of the complexity of the subject.

“I think there is a very well-intentioned attempt not to contribute to the anti-gay stigma. Many people have a broad sense of how this worked in the context of the early AIDS epidemic. I don’t think it’s necessarily a shallow understanding of how it happened, but there is an awareness that it happened and a sense that we shouldn’t do it again,” Dan Royles, associate professor of history at Florida International University and author in “To Make the Wounded Whole: The African American Struggle Against HIV/AIDS “, I told CNN adding that all this is taking place in the context of a right-wing attack on LGBTQIA+ rights.

Royles said the ambitions of AIDS activists were vast; they extended beyond the field of communication.

“AIDS activism wasn’t just about saying the right thing,” he explains. “It was about taking care of people who needed it.”

Consider some of the work of the AIDS organization ACT UP (the AIDS Coalition to Liberate Power). On May 21, 1990, over 1,000 protesters raided the National Institutes of Health in Bethesda, Maryland. Its purpose: to encourage the NIH to correct what activists saw as the extremely slow pace of AIDS research and treatment efforts.

In other words, in the face of the government’s inadequate response to the epidemic, activists took the reins of the situation and fought for a more humane health system.

This does not diminish the value of careful messaging.

Thompson thinks there is a high level of stigma associated with monkeypox. She said doctors are hearing from some patients that they are ashamed of having the virus.

Complicating matters further, she added, is the fact that there are caregivers who don’t want to see people with smallpox — meaning those with the virus have fewer places to get treatment.

Clearly, non-shaming messages are very important and are partly influencing the ongoing debate about calling monkeypox a sexually transmitted disease, as reported by Jacqueline Howard, recently in CNN.

Still, Royles’ deepest point it’s crucial. As we continue to tackle monkeypox, we must not lose sight of the fact that the main objective is expand access to care.

“Our politics often boils down to debates about speeches and messages that are detached from the material reality of people’s lives,” Royles said.

“Not unlike HIV and AIDS, monkeypox has significant material consequences on your body if you catch it. It’s so embedded that it’s deeply ironic that so much of the conversation is focused on speech, which is disembodied in so many ways.”

Or as Joseph Osmundson, clinical assistant professor of biology at New York University, aptly summarized the difficulty of gaining access to care: “You cannot neglect an infectious disease. We need tests, treatments and vaccines, and none of them arrived in time.”