When news broke that monkeypox appears to be disproportionately affecting gay and bisexual men, Jih-Fei Cheng, an associate professor of feminist, gender and sexuality studies at Scripps College, thought, “Here we go again.” For Cheng and many others, the association of an emerging infectious disease with gay and bisexual men was vividly reminiscent of the early days of the HIV/AIDS epidemic, when little was known about the condition beyond its impact on the queer community. an observation that led to it being called “gay cancer” for a time.
As of Friday, about 300 cases have been reported in the US and Europe, with many countries reporting that all or nearly all of these cases have been in gay and bisexual men. Many of the affected men appear to have contracted monkeypox at events initially reported as “raves”, but which were actually a 10-day gay pride event in the Canary Islands and a five-day fetish festival in Belgium. A gay sauna in Madrid may also have been a major streaming site.
When this link became clear, health officials responded quickly. On Monday, John Brooks, chief of the Epidemiology Research Team in the CDC’s Division of HIV/AIDS Prevention, made an explicit appeal to gay and bisexual men at a press conference. On Tuesday, gay dating app Grindr, in partnership with local health agencies, displayed a monkeypox warning to users across Europe; Brooks suggested at the press conference that similar warnings may soon be coming to US users.
There is an obvious point to this approach: if an infectious disease is disproportionately present in a particular community, reaching that community directly may be the most effective way to contain its spread. But some experts worry that linking monkeypox to gay and bisexual men risks repeating the mistakes of the early days of the HIV/AIDS epidemic.
First, the facts: There is absolutely no evidence to suggest that monkeypox is transmitted through sex specifically, or through gay sex in particular. It’s it is it spreads through skin-to-skin contact, and sex (gay, straight, or otherwise) tends to involve a lot of skin-to-skin contact. Although the possibility of sexual transmission cannot yet be definitively ruled out, there is no strong reason to think it is occurring when skin-to-skin contact can easily explain patterns of infection, says Kartik Cherabuddi, associate professor of global and infectious diseases. medicine at the University of Florida.
According to experts, monkeypox is disproportionately affecting gay and bisexual men as a direct result of events in which large numbers of men were repeatedly in close contact, sexual or otherwise, over the course of several days . “All it takes is one person who might have monkeypox” to cause an outbreak in such an environment, says Ronald Valdiserri, a professor of epidemiology at Emory University’s Rollins School of Public Health.
And once the virus circulates within a particular community, members of that community are more likely to catch it; after all, gay and bisexual men are more likely to be in close physical contact with other gay and bisexual men. That, in Valdiserri’s opinion, is reason enough for public health organizations to work to raise awareness of monkeypox among gay and bisexual men. “The decisions they make are their own decisions, but you like to make sure people have the proper information up front,” she says.
But Tonia Poteat, an associate professor of social medicine at the University of North Carolina, isn’t convinced there’s a strong public health imperative to reach gay and bisexual men in particular, at least not right now. Monkeypox is much, much less transmissible than SARS-CoV 2, and as of Thursday, the US had reported just nine cases. She also points out that the preponderance of gay and bisexual men among known cases does not necessarily translate into a similar bias between everybody cases. Because of HIV/AIDS, she says, gay and bisexual men are more likely to come into contact with the health care system, and are likely to seek immediate medical attention for a new, unexplained rash.
Given those facts, Poteat says, the message could have been quite different. “What we do know is how monkeypox is transmitted,” she says. “That’s what people really need to know. They don’t necessarily need to know the sexual behavior or sexual orientation of the people who might have been identified.” After all, scientists believe that monkeypox can be spread through any type of close contact: hugging, contact sports, touching someone’s bedding or towels, not just sex.
But the statistical association between monkeypox and gay and bisexual men has become a focus of attention, and now that it has, Valdiserri says he is concerned about the risk of compounding stigmas. Infectious diseases and sex, and sexually transmitted diseases in particular, are already heavily stigmatized. Although monkeypox does not appear to be transmitted sexually in the traditional sense (via semen and vaginal secretions), sex is a likely cause of its spread, and has now been publicly linked to events and venues such as a fetish festival and a gay party sauna, which could push the margins of acceptability for some people. And the discomfort and fear that people may feel about a new disease outbreak, and about certain types of sex, can stick with gay and bisexual men as a group.
“In a way, it feeds into this message that men who have sex with men are somehow more infectious than other people, and that’s a dangerous subtext,” says Poteat.
Another is that sexual behaviors could become the focus of blame for monkeypox. That blame can be dangerous when directed toward a marginalized group, as has been the case with Asian Americans during the COVID pandemic, and it can mask other roots of disease spread, such as global inequality. “We have to be very careful not to stigmatize sexual behavior precisely because that prevents us from understanding that structural violence is at play,” says Cheng. She points out that activists during the early days of the HIV/AIDS epidemic called for structural remedies like universal health care and housing, and that the continued lack of those remedies today played a significant role in the spread of COVID in the US. USA
Cheng sees another link between today’s monkeypox and HIV/AIDS activism: solidarity with women fighting for reproductive rights. Both he and Poteat pointed out that this monkeypox outbreak is partially attributed to individual sexual behavior at a time when bodily autonomy is steadily being eroded in the US. Roe vs. Wade seems poised to fall, with a growing number of states criminalizing trans children’s right to gender-affirming care. Recent months have also seen a rise in rhetorical attacks against gay and bisexual men, from Florida’s so-called “Don’t Say Gay” bill to the increasingly widespread use of the term Barber to suggest that homosexual men are a danger to young children.
It is true that there are some important differences between 2022 and 1981, when HIV/AIDS cases were first reported. For now, same-sex marriage remains legal in the US, and certain gay and bisexual men, though typically wealthy white men, are extremely visible in public life. But it would be a mistake to conclude on that basis that gay and bisexual men, especially men of color and poor men, are not vulnerable to discrimination. “Homophobia has not evaporated,” says Valdiserri. “It is better in some areas than in other areas. But it hasn’t gone away.”
Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.