Explained: How monkeypox is leading to the stigmatisation of gay, bisexual men

Even as the world continues to reel under the effects of COVID-19, concerns are rising over the recent outbreak of rare monkeypox infection in different parts of the world.

As of Saturday, 92 confirmed cases and 28 suspected cases of monkeypox have been reported from 12 countries, the World Health Organization (WHO) said.

The United Nations health agency also added that it would provide further guidance and recommendations in coming days for countries on how to mitigate the spread of monkeypox.

Monkeypox cases have already been detected in the United States, United Kingdom, Spain, Portugal, Canada, France, Germany, Italy, France, Belgium, Sweden, Spain, and Australia.

Also read: How prepared is India for a monkeypox outbreak as world sees 92 cases?

As the cases continue to increase, the WHO is investigating whether some outbreaks spread within the gay community.

A leading adviser to the WHO described the unprecedented outbreak as a “random event” that might be explained by risky sexual behaviour at two recent mass events in Europe.

What is monkeypox?

Monkeypox is a rare disease caused by monkeypox virus, which belongs to the same Orthopoxvirus genus that also includes smallpox-causing variola virus.

Monkeypox is a zoonosis, a disease that is transmitted from infected animals to humans.

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, hence the name ‘monkeypox’, according to the US Centers for Disease Control and Prevention (CDC).

The WHO says that cases occur close to tropical rainforests inhabited by animals that carry the virus.
The infection has been detected in squirrels, Gambian pouched rats, dormice, and some species of monkeys.

Also read: After UK and Europe, rare monkeypox case found in US: What you must know about the virus

Why is monkeypox being connected to gay, bisexual men?

In an interview with The Associated Press, Dr. David Heymann, who formerly headed WHO’s emergencies department, said the leading theory to explain the spread of the disease was sexual transmission among gay and bisexual men at two raves held in Spain and Belgium. Monkeypox has not previously triggered widespread outbreaks beyond Africa, where it is endemic in animals.

“We know monkeypox can spread when there is close contact with the lesions of someone who is infected, and it looks like sexual contact has now amplified that transmission,” said Heymann.

A German government report to lawmakers, obtained by the AP, said it expected to see further cases and that the risk of catching monkeypox “mainly appears to lie with sexual contacts among men.”

The four confirmed cases in Germany have been linked to exposure at “party events including on Gran Canaria and in Berlin, where sexual activity took place,” it said.

Madrid’s senior health official said on Monday that the Spanish capital has recorded 30 confirmed cases so far. Enrique Ruiz Escudero said authorities are investigating possible links between a recent Gay Pride event in the Canary Islands, which drew some 80,000 people, and cases at a Madrid sauna.

On Sunday, the chief medical adviser of Britain’s Health Security Agency, Dr. Susan Hopkins, said she expected more monkeypox cases to be identified in the country “on a daily basis.”

U.K. officials have said “a notable proportion” of the cases in Britain and Europe have been in young men with no history of travel to Africa and who are gay, bisexual or have sex with men. Authorities in Portugal and Spain also said their cases were in men who mostly had sex with other men and whose infections were picked up when they sought help for lesions at sexual health clinics.

The fear of stigmatisation

The monkeypox infection spreads just like any pox infection, through extremely close contact. However, scientists are also looking at whether this version of monkeypox is spreading in a new way.

The virus is generally picked up on surfaces, from bedding, clothes, or respiratory excretions, but it is especially easy to get it through skin to skin contact.

“You could imagine that a female person living in the same house, sharing utensils and so on with somebody who’s incubating it could get it, but we haven’t seen that so far,” Professor Jimmy Whitworth, an infectious disease expert at the London School of Hygiene and Tropical Medicine, told Insider.

“That’s what makes us a bit suspicious that maybe this is transmitting sexually, and we need to find that out. Because if so, that’s new — that’s not been seen before.”

The increasing cases of monkeypox connected to sexual activities have LGBTQ advocacy groups concerned about discrimination against the community.

Talking to CBC, David Hawkins, the executive director of Montreal’s West Island LGBTQ2+ Centre, said, “The risk and the fear that this is going to be used to stigmatize against the LGBTQ2+ community further, I think that that fear is very real for a lot of people, and I think it’s very well-founded in history.”

“We’re still recovering from the stigma that came with HIV and AIDS as a community … This risk is also potentially there for monkeypox if that continues to be a trend,” he said.

In a ray of hope for the LGBTQ community, epidemiologist Andrea McCollum, with the US Centers for Disease Control and Prevention, said that so far nothing strikes her as odd about how the disease is spreading.
Over the years, McCollum has been dispatched to investigate monkeypox outbreaks in at least four different African countries.

“Even though there’s a lot of questions right now surrounding specific populations of concern, and how this may be spreading, I think it’s entirely consistent with what we know about the virus,” she told Insider.

“We know this virus spreads via very close contact.”

That contact can be with another person’s saliva, blood, or the pox themselves — the rashes people get with monkeypox are incredibly infectious.

The WHO also chimed in by stating that anyone who closely interacts with an infectious person can be at risk of catching monkeypox.

“This includes health workers, household members and sexual partners,” the WHO said.

“Stigmatizing groups of people because of a disease is never acceptable. It can be a barrier to ending an outbreak as it may prevent people from seeking care, and lead to undetected spread.”

With inputs from agencies

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