Let’s be transparent and declare 3 facts.
First of all, you can get monkeypox.
Second, the existing epidemic is concentrated among men who have sex with men.
And third, a framework of developing evidence and knowledge suggests that sex in those men is the number one medium through which ape smallpox is spreading lately.
While it is true that there are other tactics to transmit the virus, recognizing and reporting those facts is anti-gay or anti-science, and the recommendation addressed to members of this network is also the one that lately is at maximum risk.
More than 31,000 people worldwide have contracted monkeypox, nearly a third of them in the United States, where Biden’s leadership has declared a public health emergency. All states in Wyoming have detected at least one case.
And yet, whether it’s out of concern to perpetuate stigma or simply a general reluctance to use the words “anal sex” in headlines, fitness officials and the media have been incredibly reluctant to speak candidly about sex who is most at risk. In Washington, D. C. , officials have even expanded eligibility for the vaccine to come with other people of all genders, in part because of a preference for “[destigmatizing] other people who want a vaccine. “
The public is also concerned about contracting monkeypox by looking at garments in retail stores or through rats in sewers through medical experts who have presented themselves online as pseudo-influencers of ape pox who have COVID. (For the record, experts say none of those scenarios are cause for concern. )
Experts say all of this can do more harm than good, according to Angie Rasmussen, a virologist at the Canadian Centre for Pandemic Research, the University of Saskatchewan’s Vaccine and Infectious Diseases Organization.
“The communication around this is so exhausting: seeing my friends, who are gay fitness advocates, seeking information and vaccinations/treatments for others in danger, being confronted through armchair experts and influencer hunters shouting ‘AIRBORNE!’and they wring their hands for their children. Contract ape smallpox in kindergarten,” Rasmussen wrote in a message to BuzzFeed News. “The other people are hurt by the threat to the maximum NOW. “
People inflamed with monkeypox at this time are most commonly gay, bisexual, or gay men. And when we say massively, we mean it.
In an update last week, the WHO said that of the more than 8,400 cases with known knowledge of sexual orientation, 97. 2% were men who have sex with men. Additionally, of the nearly 6,000 types of transmission reported, 91. 5% of cases were from sexual intercourse.
“With the exception of countries [in] the West and Central African regions, the existing monkeypox outbreak continues to primarily affect men who have sex with men who reported having recently had sex. with one or more partners,” the WHO said. Right now, there are no signals to suggest sustained transmission beyond those networks. “
In a New England Journal of Medicine published last month that analyzed more than 500 cases of monkeypox in 16 countries, 98 percent of patients were gay or bisexual men. fitness clinic. All, however, one of those men, and they were all men, known as homosexual, bisexual or having sex with men.
In the United States, the knowledge is the same. CDC data from July 25 show that 99. 1% of cases involve male patients designated at birth, and 99% of men reported recent sexual contact with a man.
For the concentration of monkeypox among those men, experts say it’s important to think of them not as individuals, but as communities or networks of other people coming into close contact with each other.
In other words, the virus is no more contagious, it just made its way into a new network of people.
“I think it’s about the ability of the virus to exploit the effects of the network and close contact between people,” said Amesh Adalja, a principal investigator at the Johns Hopkins University Center for Health Security, “and use amplification occasions like raves, where many other people might have had multiple close contacts with multiple partners. and some of them unnamed, and this allowed the virus to spread in tactics I hadn’t had the opportunity to do before.
“It probably had that potential,” Adalja said. I just needed to get into a network like this. “
According to the CDC, there are 3 main tactics for contracting monkeypox: direct skin-to-skin contact with an inflamed person; touching infected surfaces, articles or tissues (i. e. passive vectors); and touch with respiratory secretions such as mucus (aerosols).
But since this existing epidemic is spreading so basically among those networks of men sleeping together, experts say prolonged skin-to-skin contact is the cause of most of those cases.
“Based on the knowledge we have, I find it quite convincing that sex plays a dominant role in the spread of ape pox, as well as the fact that those patients may have had sex with their partners,” said Gerardo Chowell, an epidemiologist. at the Georgia State. Atlanta College School of Public Health, he told BuzzFeed News. “And that’s probably why we haven’t noticed as many cases in heterosexuals. “
Rasmussen said that if fomites and aerosols were big drivers of ape pox, knowledge would show many outdoor cases of gay men, bisexual men or men who have sex with men (GBMSM). “Not all broadcasts are sex-related, yet the maximum is,” Rasmussen said. “If this were more commonly transmitted through aerosols, fomites or accidental contacts, we would see much more domestic transmission and spread in the wider community.
“The WBGMS do not live in isolation: they have children, families, colleagues. We would see more cases in those other people if the spread wasn’t primarily due to gender,” Rasmussen added. sexual transmission, but not so much.
“It will most likely also spread among heterosexuals if it were established within those sexual networks. “
For its part, the New York Department of Health, which has known more than 2,000 cases of monkeypox, lists the 3 imaginable modes of transmission on its website, but first obviously states: “In the existing outbreak, the ape pox virus is basically spread through oral and vaginal sex and other intimate contacts, such as anulingus, hugs, kisses, bites, hugs and massages.
Experts, it takes much more than a gentle touch on the skin or a handshake with an inflamed user to contract monkeypox; what is required is constant friction against a user who has rashes, scabs or injuries, or physical fluids from that user. The most apparent and undeniable way for this to happen is during sex, but dancing or rubbing against a shirtless wearer at a circuit party also carries some risk.
The role of sex in the spread of ape pox has been evident for several years.
This existing monkeypox outbreak appears to be similar to the one known in 2017 in Nigeria, which it now appears to have globally.
At that time, without words, scientists wondered why so many men between the ages of twenty and thirty are in poor health and do not have rashes on their face and limbs, but on their genitals. They soon discovered that many of those patients had high-risk sexual behaviors, in addition to sleeping with multiple partners and sex workers.
“Although the role of sexual transmission of human apepox has not been established, sexual transmission is credible in some of those patients through close contact, skin-to-skin sexual sex or transmission through genital secretions,” said Dimie Ogoina, a professor of medicine and infectious diseases at the University of the Niger Delta. wrote with colleagues in a 2019 medical journal.
Other studies similar to this existing global outbreak have reinforced this idea, Ogoina wrote in new research published in the medical journal Lancet last week.
Ogoina made a special mention of the Lancet study published earlier this month by Spanish scientists on 181 patients with monkeypox, 92% of whom had GBMSM. their breathing samples.
In addition, more than three-quarters of patients had lesions around the anus or genitals, while more than 40% had lesions in or around the mouth. Forty-five patients also had proctitis or inflammation of the lining of the rectum, and all of those men had still had receptive sex.
Photos from the team of researchers in Spain and in their Lancet article show pustules and lesions on the genitals, mouth and body of patients.
The researchers hypothesized that anal sex could damage the outer layer of the body’s tissues, allowing the virus to enter the bloodstream.
“In addition, mild trauma to the pubic, inguinal, and perianal regions may result in local vasodilation and an increased density of skin lesions in that specific region,” they wrote.
“All of those findings suggest that skin-to-skin sexual contact is most likely the dominant direction of transmission in the existing epidemic,” Andrea Alemany, one of the study’s authors, told BuzzFeed News.
There’s even evidence that ape pox can only spread semen, with another Lancet study through Italian researchers locating samples of infectious viruses in a patient’s semen 19 days after the onset of their symptoms.
As summarized by Jeffrey Klausner, a professor at the Keck School of Medicine at the University of Southern California, and Lao-Tzu Allan-Blitz, a physician at Brigham and Women’s Hospital and Boston Children’s Hospital, in an article published Saturday in Medium, “Taken in context, the temporal and anatomical arrangement with sexual practices, the maximum prevalence of dicy sexual behaviors in patients with human ape pox, and the in vitro infectivity of human apepox. apepox. Humans away from sperm strongly recommend that human apepox be transmitted through sexual activity.
Although knowledge and studies suggest that ape pox is spreading massively through sex in this epidemic, researchers are still not comfortable classifying it as a sexually transmitted infection, or STI, which would mean it is transmitted through physical fluids.
Alemany, one of the researchers on the Spanish study, said this because of what scientists know about how the virus has spread before. Also lately there is a minority of patients, adding a few children, who have become inflamed without having had sex.
“Direct skin-to-skin contact has promoted the spread of the disease through sexual networks in the existing epidemic,” Alemany said. have played a role in past outbreaks. More studies are needed on its role in the existing epidemic.
Last month, the WHO convened an organization of STI experts to discuss this possible classification, but those scientists don’t do so at this stage.
“They concluded that this is obviously transmitted sex, so they are kind to describe it as sexually transmitted, but they have not yet felt able to conclude that it is an STI,” said Andy Seale, WHO advisor on sexual intercourse and communicable infections. Reporters
Still, Klausner and Allan-Blitz said that “the dynamics of transmission of human monkeypox, at least in the United States and Europe, appear to be very consistent with a sexually transmitted infection. “
According to experts, there would be negative ramifications in labeling ape smallpox as an STI.
Stigma can deter others from seeking remedy or alerting their partners, but it can also cause other members of the public to minimize the threat.
“The danger of calling something like monkeypox a sexually transmitted infection is that a lot of other people go extinct,” Matthew Hamill, a professor of infectious diseases at Johns Hopkins, told Gothamist. “Because they think, ‘Well, it has nothing to do with me. This does not apply to me.
But it can also help high-risk teams make informed decisions about their sexual activity, which can help reduce the number of cases, perhaps by reducing the number of partners (as temporarily requested by the WHO). It can also allow some other people to miss exams or reduce the time they might have to spend away from others and unable to work.
“Instead of vaccination, we want to think about harm reduction and we’re eliminating the threats of many infectious diseases,” Adalja told Johns Hopkins. “I think it’s vital to provide tools to other people, tell them that having a new sexuality spouse right now is anything that is a threat to monkeypox, and maybe you think about temporarily reducing the number of spouses until you’re vaccinated or immune, or be sure to exchange information with other people to make contact tracing easier.
Fearful of perpetuating the stigma against homosexuals, fitness officials have gone out of their way to express the dual concept that while you can get monkeypox, it’s MSWB that’s most at risk lately.
“This is a very difficult message to convey,” Rosamund Lewis, an ape smallpox technical officer at WHO’s Health Emergencies Programme, told reporters.
Experts say it’s vital to tailor public fitness messages to those most at risk, but this will inherently lead to a safe point of public stigma.
“Labeling the epidemic as a disease in gays, bisexuals and other men who have sex with men is mandatory from a harm relief perspective, but it’s also a stigmatizing message at the same time,” said Jason Farley, director of the Johns Hopkins Center. of Infectious Diseases and Innovation in Nursing.
Rasmussen, Canada’s virologist, said the public health government wants to give frank and practical advice to alleviate harms, such as data on sex, aimed at gay men. At the same time, experts will have to leave open the option for their recommendations to be replaced again if the virus spreads on other social or sexual networks.
“What’s tricky is communicating that even if it’s not a ‘gay disease,’ our limited resources have to move to the maximum threat from other people, lately the WBGMSM,” Rasmussen said. “And it’s also vital that the threat is higher with sexual activity without embarrassing the queer network that has already been deeply damaged by medical stigma. “
And while other well-meaning people would possibly wish the media or public health government weren’t on the LGBTQ network for fear of spreading stigma, allowing the virus to spread can cause much greater harm.
Gettysburg College history professor Jim Downs argued in an article published in the Atlantic this weekend, titled “Asking gay men to be careful is not homophobia,” that officials don’t “tiptoe” about how the virus spreads and instead clarify that gay men have to abstain from high-risk sex until they are fully vaccinated.
“As a gay and infectious disease historian, I know the evil that happens when public policy is imbued with homophobia,” he wrote. recently broadcast. ” ●