We have been bombarded with texts ever since new monkeypox outbreaks began making headlines around the globe. One friend in the Gulf region questioned, “If I get monkeypox, will everyone know I’m gay?” Another, who works for a non-governmental organization in Lebanon, was unsure whether to even share information about the disease for fear of adding to the already intense stigma faced by gay people across the country. We applaud UNAIDS’ recent statement condemning the “racist” and “homophobic” coverage of monkeypox, but much more is required because so much is at stake.
Let’s be clear: monkeypox is not the same as HIV/AIDS. But, as headlines link the disease to outbreaks among men who have sex with men, the lessons we learned about stigma and infectious diseases 40 years ago have resurfaced.
As monkeypox rises to the top of the international news agenda, the world has a narrow window of opportunity to get it right and avoid the same mistakes that fueled HIV/AIDS-related panic, fear, and discrimination for nearly four decades.
So far, we’re on the verge of failing the test. Unlike 40 years ago, any news about monkeypox travels around the world in the blink of an eye, thanks to social media and 24-hour news coverage. For the time being, news reports on the infectious disease suggest a unique link between monkeypox and sexuality, specifically a link between the virus and gay men or men who have sex with men.
Media coverage that obscures these basic facts endangers everyone. Such coverage stigmatizes men who have sex with men while giving a false impression that everyone else is somehow immune or not at risk. It’s a surefire recipe for disaster.
All of this happened 40 years ago. Early media reports linking a new infectious disease to gay men raised alarms and fueled panic at the time. The disease was soon given a name based on that fear: GRID, or gay-related immune deficiency.
Overlooked were the data and science demonstrating that, while certain identities may put certain communities at greater risk, this does not imply that the virus specifically infects these communities. Indeed, HIV taught us that the answer is closely related to the conditions under which people are born, grow, live, work, and age, such as their financial status, education, neighborhood, and physical environment, employment, and social support (aka social determinants of health), rather than sexual or gender identities.
Today, we must learn that lesson quickly and ensure that the conversation focuses on a public health approach to critically synthesize social determinants of health that put marginalized communities at greater risk of virus spread. To avoid repeating past mistakes, we must take a step back and consider a few critical questions.
Does linking this disease and gay men and men who have sex with men stigmatize them? It certainly does. Even in Western countries, gay men and men who have sex with men face discrimination and have poorer health outcomes than heterosexual men. Associating a new lethal disease with these groups will push them further back.
More importantly, in countries where homosexuality is illegal, linking monkeypox to homosexuality can result in humiliation, imprisonment, and even death. This association can be used to “out” people in some cases (irrespective of whether it is true). In countries where homosexuality is still illegal, such an outing can result in death.
So, what are we to do?
First and foremost, we must proceed with extreme caution as we learn more about this disease and fight it together. Labels and judgments have no place in healthcare and should not be the focus of this discussion. At this point, the focus should be on facts and science, with clear messages about symptoms, transmission, prevention, and treatment.
Second, we must make certain that resources, rather than stigma, are directed to communities on the front lines of the disease. Because of social disadvantages, ongoing victimization, and discrimination, marginalized groups such as gay men or men who have sex with men are more vulnerable to negative health outcomes. More resources will level the playing field, allowing these communities to halt the spread. This includes fact-based public health campaigns as well as extensive testing programs when the presence of symptoms has been confirmed.
Third, Western countries and the World Health Organization (WHO) must ensure that their messaging considers the safety and security of LGBTQ people all over the world, particularly in places where they are most vulnerable. The media landscape has changed dramatically in the last 40 years, with information instantly spreading around the world, and information that appears benign in the West can be extremely harmful in other parts of the world.
Finally, interventions that further stigmatize communities must be condemned, such as closing gay saunas or canceling gay events. These will not solve the problem; instead, they will spread hatred and waste time while the virus spreads in other places. The only way forward is to follow the evidence and learn from our experiences. It is critical to believe that we can learn from our most recent pandemic and apply what we have learned to deal with monkeypox. We’ve all been tired and traumatized over the last few years, so we need to stick to the public health measures that have worked and proceed with caution.
The world is watching as monkeypox continues to make headlines. We still have time to make things right. We can ensure that we fight the disease, not the people, by proceeding with caution and focusing on data and science.
