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By Ina Park and Dan Savage
Dr. Park is Professor of Family and Community Medicine at the University of California, San Francisco. Sr. Savage is an author.
For weeks, the same shameful scene has been repeated over and over again in sexually transmitted infection clinics across the United States. Half-naked homosexuals stood with pants around their ankles as doctors crouched between their legs, swabs at the ready. down to the feet with stylish hazardous materials: gowns, gloves, face shields and N95 respirators. The men were covered in much worse things: painful lesions on the genitals, anus, and even on the face and limbs.
It was July 2022, last summer, and an outbreak of mpox, formerly known as monkeypox, was in full swing. From a handful of cases in some cities in early May, the outbreak rose to more than 16,000 cases in 75 countries and territories in two months. Later. It’s terrifying.
The sudden appearance of so many cases of mpox and all at once was shocking. Aside from a single case in travelers from West or Central African countries, where the virus is endemic, mpox was incredibly rare in Europe or North America. The United States had noticed only one outbreak, in 2003, among Midwesterners with prairie dog puppies that had been housed with inflamed African rodents. There were 47 cases and no documented cases of human-to-human transmission.
This time different. In early May 2022, mpox discovered its way into gay raves in Spain and Belgium, massive annual parties that attract men from all over the world. , cases of MPOX, as a result of human-to-human transmission, began to appear in cities around the world.
As the outbreak caught the public off guard, public fitness officials were warned. Five years earlier, Dr. Dimie Ogoina had observed cases in Nigeria, first in an 11-year-old boy, then in young men who had reported having multiple sexual partners. or met sex workers. He soon learned that it was not the “ordinary monkeypox we know” and tried to alert the clinical network about the option of sexual transmission.
And just as we were dealing with the evidence that Dr. Ogoina was right about everything, only that something had changed, only that mpox was sexually transmitted and he had reason to sound the alarm, tests revealed that the mpox virus can be only in sheets or clothes for more than two weeks. While we were primarily concerned about those already suffering from mpox and those with the highest threat of contracting the virus, we feared what might happen if mpox made its way into hotel rooms, cruise ships, and school. campus. (Think of all the fraternity couches that are rarely cleaned. )This epidemic can become an epidemic, maybe even a pandemic.
Fortunately, we were wrong.
Although mpox can live on surfaces, it turned out that it did not spread in this way. The virus required close and sustained contact to spread, so it spread massively through sex. So, this epidemic that in gay and bisexual communities most commonly remained in those communities, but not for long. On January 31, 2023, the government declared the end of the mpox emergency, and the average number of cases fell from a peak of more than 450 in one day in early August to fewer than five. in the last week of January. While the outbreak in the United States lasted just under nine months, it caused a lot of damage, resulting in more than 30,000 cases and 42 deaths.
Although the epidemic ended faster than many thought, it was much worse than necessary, representing both a triumph and a failure of public health. Health officials and the media did not immediately notice or interact with the homosexual network in the first major weeks of the outbreak.
When the first cases were reported among gay and bisexual men in the West, the fitness government and media may simply not dare utter the word “homosexual. “To avoid stigmatizing gay and bisexual men, early reports have buried the trail. The Associated Press did not mention that this epidemic was noticed almost exclusively among gay men for up to 15 paragraphs in one report; Other reports did not mention gay and bisexual men at all. A gay boy he headed in May last year might have heard of an outbreak; however, unless you have recently traveled to West Africa or been in contact with inflamed rodents or primates, you may have simply had no problem concluding that you were not at risk.
While this preference for stigmatizing gay and bisexual men is understandable, it hasn’t helped. We know that gay sex has been unfairly blamed for everything from herbal blunders to the fall of Rome. But in their efforts to stigmatize the community, the fitness government and media have failed to warn gay and bisexual men well. Ignoring the risk as the virus spreads, gay and bisexual men may simply not take steps to protect themselves and their partners.
Unfortunately, stigma and discrimination still uncovered the community. Gay men with mpox have been turned away from urgent care clinics and emergency rooms. Phlebotomists refused to draw blood from them. Like its predecessors Covid-19 and H. I. V. /AIDS, mpox had all the ingredients. for a public fitness disaster. It took only about two months after the outbreak for tests to be widely available. Vaccine shortages have created “Hunger Games” scenarios in cities across the country, with vaccination clinics open and then closed for lack of supplies. Cases began appearing in a small handful of transgender people and cisgender women and children, alarming further spread.
Even after it became apparent that this painful, potentially disfiguring and even fatal infection spreads through gay sex networks, public health officials and the media were hesitant to give the same recommendation they had freely given at the beginning of the Covid pandemic: Limit your number of sexual partners and explain your sexuality in a socially distanced way.
But while fitness officials and journalists hesitated, gay and bisexual men sprang into action. Young men with injuries covering their faces took to social media and mainstream media, telling the public they are facing “the worst pain I’ve ever felt in my life” and, perhaps most tellingly, “I’d have Covid. Benjamin Ryan, a gay journalist, and Carlton Thomas, a gay doctor, risked being canceled, for example, being yelled at on Twitter, to give their network what Dr. Thomas called “difficult. “”Love advice”: step on the brakes of sex outside of committed relationships; seek immediate medical attention if you experience symptoms; and get vaccinated as soon as possible.
And the homosexual listened.
Gay party promoters have canceled long-planned events, and gay men have temporarily gotten rid of their phones’ hookup apps and reduced sexual contact. The Centers for Disease Control and Prevention verified those behavioral changes, reporting that part of the gay men surveyed reduced their numbers. of sexual partners, unique sexual encounters and dating apps use the outbreak. And gay and bisexual men were vaccinated en masse; two-thirds of other people surveyed through the Pew Research Center in September 2022 said they had already obtained an MPOX vaccine or were making plans to do so. Gay and bisexual men have endured frustrating attempts to get appointments for the first dose, which is very important. of the two-dose, hour-long wait series at emerging vaccination sites. Of the more than one million doses of the Jynneos vaccine (protective against smallpox and mpox) administered in the United States since June 2022, more than 90% have been given to men (presumably gay and bisexual men).
The C. D. C. Communication groups made great strides in this period. They identified the realities of homosexual sexuality and its breadth of expression, employing the actual language that gay men use when discussing sex with each other. The words “fetish team” gave the impression on a CDC website. for the first time; the clinical term “anus” has become the ultimate “user-friendly,” and instead of “public sexual environments,” the CDC spoke candidly about “hindrooms” and “sex parties” and the threat of contracting MPOX in those spaces.
While those who warned gay men to decrease sexual relations until they were vaccinated against MPOX were accused of fostering stigma, echoing the repression suffered by gay men who suggested others avoid hot spring baths and start using condoms early in the AIDS crisis in the early 1980s. Efforts to shoot the messenger were less aggressive than in the past. A key difference between HIV/AIDS and MPOX: many of the messengers were gay and bisexual men, adding gay journalists, doctors and average citizens with access to social media, as well as a generation of gay men who had been encouraged to pursue careers in public health as a result of AIDS.
The spokesperson selected through the C. D. C. To lead national conversations about MPOX and the sexual fitness of gay men, not a straight doctor in a lab coat who squirms at the mention of gay sex. Instead, it’s Dr. Demetre Daskalakis, a gay guy who not only attends raves, but also posts shirtless selfies on social media. to convert it. It’s a messenger that the network would pay attention to.
In the past, gay and bisexual men had written the playbook on activism and advocacy for the HIV/AIDS epidemic, resulting in more than $7 billion in federal investment for HIV research, prevention, remedy, and social services. Furious at the federal government’s initial reaction to MPOX, they mobilized and organized, promoting controls at local Department of Health and Human Services offices and filing a complaint with the Massachusetts State Attorney General for refusing to control and treat MPOX.
So while an early and frankly fair public health reaction may have mitigated the epidemic, resulting in far fewer cases and far less suffering, swift collective action by gay and bisexual men averted catastrophe. If the general American public had reacted to the risk of Covid-19 in the same way that gay and bisexual men reacted to the risk of mpox, we could have noticed fewer cases (there have been a hundred million to date) and a decrease in the number of deaths (1. 1 million and counting). When the next infectious epidemic moves (and indeed will), the public would be wise to channel gay and bisexual men: speak blatantly without stigma, organize and insist on effective prevention, diagnosis and treatment.
There’s another vital lesson about the gay network that fitness officials and journalists want to learn in the future: When it comes to emerging fitness threats, even those that can spread sexually, gay men can grapple with the truth. You can give it to them directly.
Ina Park (@InaParkMD) is a professor of family circle and networked medicine at the University of California, San Francisco and of “Strange Bedfellows: Adventures in the Science, History and Surprising Secrets of S. T. D. s. “Dan Savage has been writing ‘Savage Love’, one of the most widely read sexual recommendation columns in the country, for over 30 years and is also the host of ‘Savage Lovecast’.
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