Public health experts must strike a balance between providing crucial information that can stop the viral disease’s spread and worries about stigmatizing homosexual and bisexual males as a result of the swift increase in monkeypox cases in the U.S.
According to the Centers for Disease Control and Prevention, as of August 10 there were around 10,400 confirmed cases of monkeypox in the country. Monkeypox instances have been reported in every state but Wyoming in the U.S., where there have been the most cases of any nation.
Skin-to-skin contact, sharing of towels, bedding, and clothing, as well as exposure to respiratory droplets from a cough or sneeze during extended face-to-face contact, are all ways that monkeypox can be spread. According to the World Health Organization, although monkeypox can affect anybody, over 99% of cases worldwide with data available have involved men, and 97% of cases with data on sexual orientation known have included people who identified as men who have sex with men.
Public health leaders are being forced to concentrate on outreach that is appropriate but not stigmatizing in order to prevent harm to the overall response as a result of the outbreak’s disproportionate impact on this group of people. LGBTQ health clinics across the nation are now on the front lines of this battle.
In the early stages of the monkeypox outbreak, Matthew Kavanagh, deputy head of the U.N. program UNAIDS, stated that “stigma and blame weaken confidence and capacity to respond effectively during outbreaks like this one.” Experience has shown that stigmatizing discourse can quickly undermine evidence-based interventions by inciting fear cycles, discouraging people from seeking out medical care, making it more difficult to find cases, and promoting punitive actions that are counterproductive.
The early stages of the HIV/AIDS pandemic in the United States provide unique insight into the negative effects that the stigma associated with monkeypox can have. Cases of what was once referred to be “gay-related immunological insufficiency” resulted in stigma, exclusion, prejudice, and even violent acts against gay people.
A wider indifference coexisted with homophobia, moral judgment, and anxiety at the same time.
If we don’t do a good job of informing people about the virus, how it spreads from person to person, and what you can do to protect yourself, I think there’s a risk of that kind of apathy happening with monkeypox, too, says Dr. Georges Benjamin, executive director of the American Public Health Association. “There was a great deal of apathy among the broad population early on with HIV/AIDS. We discovered out how to do that better with HIV/AIDS, but it took us some time. With this disease, we can’t afford to wait that long.
The network’s overarching strategy to reduce the transmission of the monkeypox virus, according to Dr. Anu Hazra, a physician with Howard Brown Health in Chicago, the biggest LGBTQ-centric health center in the Midwest and a federally recognized health center. He claims that messaging that is relatable and particular to LGBTQ people is more effective in assisting those who are more at risk in learning the truth about the virus and how to lessen their chance of exposure.
However, Hazra also notes that this type of outreach necessitates a fine line between accuracy and escalating stigma, or even confusing the general public as to who is actually at risk.
Any messaging we use must somehow relate to eradicating any stigma associated with the illness, according to Hazra. To be honest, it’s a hard needle to thread.
Officials in charge of public health have realized the importance of sensitive and specifically tailored messages. For instance, the CDC recently advised utilizing accessible, fact-based, and non-alarmist communications about monkeypox for homosexual and bisexual males while emphasizing to general audiences that anybody can develop monkeypox.
The advisory warns that concentrating on incidents involving gay and bisexual men “may unintentionally stigmatize this demographic and foster a false sense of safety among those who are not homosexual and bisexual men.”
The WHO’s Tedros Adhanom Ghebreyesus made a recommendation last month for men who engage in heterosexual sexual activity to temporarily reduce the number of partners they have, think twice before engaging in sexual activity with new people, and exchange contact information with new people for potential follow-up.
Although he added that “stigma and discrimination can be as harmful as any virus, and can drive the pandemic,” he also issued this warning.
In order to lower the danger of infection and subsequent transmission, to provide care for those already infected, and to protect human rights and dignity, Tedros emphasized that all nations’ attention must be directed toward empowering and involving communities of men who engage in sex with other men.
According to the Chicago Department of Public Health, individuals who identified as gay, lesbian, or bisexual were involved in 97% of the city’s more than 450 cases as of August 10 with data on sexual orientation. According to Hazra, Howard Brown has identified at least two-thirds of the city’s cases. Hazra also claims that much of the outreach for monkeypox has taken place at the local level, with community organizations collaborating to get people to vaccination and testing facilities.
Gay and bisexual males have a special relationship with public health, for better or worse, according to Hazra. In this demographic, “the demand for vaccines and the desire for information on how to stay safe is fairly significant.”
When creating messaging for underrepresented communities, Torrian Baskerville, head of HIV and health equity for LGBTQ rights advocacy group the Human Rights Campaign, says small tweaks in terminology may make a big difference. When reaching out to gay and bisexual males, for example, using the word “prioritize” rather than “target” can help minimize feelings of being attacked.
Nobody I know wants to be a target, says Baskerville. We may express that differently and say that communities do want to be prioritized, centered, and focused on.
Sean Cahill, director of health policy research for The Fenway Institute in Boston, a research, training, and policy center focusing on the wellbeing of sexual and gender minorities and people affected by HIV, says while worries over stigmatizing gay and bisexual men must be acknowledged, they should not overshadow the significance of informing those groups of the threat they face and the precautions they can take.
It’s crucial that the public health messaging targets homosexual and bisexual males and doesn’t hesitate to prioritize them as a key population in this outbreak because they are, according to Cahill.
The COVID-19 pandemic also provides analogies for the nation’s response to the monkeypox outbreak: U.S. officials in both situations have come under fire for moving too slowly on issues like testing, surveillance, and the distribution of vaccines.
Despite an anticipated population at highest risk of up to 1.7 million persons, there were only about 1.1 million vaccination doses allocated for monkeypox. This Monday, American health regulators authorized a strategy that will give people lesser doses and extend the supply of shots.
On August 4, the Biden administration also declared the monkeypox outbreak a public health emergency. This came after cities like San Francisco and New York State made their own declarations of emergencies, but the administration claimed that this action may encourage more jurisdictions to enter into data-sharing agreements with the federal government regarding the administration of vaccines.
A number of lessons from COVID-19 can be applied to the monkeypox outbreak, according to Dr. Amy Ray, medical director of infection control and regulatory affairs at MetroHealth, a safety-net system in Ohio’s Cuyahoga County. She emphasizes that the efforts made by the health system during COVID-19 to swiftly form community partnerships to address gaps in access to care should be applied to the current circumstance.
Four instances of monkeypox had been identified by MetroHealth’s LGBTQI+ Pride Network of primary care clinics as of August 3, according to Ray. But as the number of cases continues to climb, she predicts the need to apply some of the same outreach techniques used during COVID-19.
Ray predicts that there will be extensive community outreach; this was done with COVID-19 and will be done once more with this outbreak.
U.S. News & World Report, copyright 2022
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