Monkeypox virus. Image by Samuel F. Johanns from Pixabay

Monkeypox: learn from the past, be prepared, act quickly and lose bias

The World Health Organization (WHO) has convened a meeting on June 23 to assess whether the monkeypox outbreak currently affecting dozens of countries represents a public health emergency of international concern (USPPI), the highest level of emergency. global alert.

This is an official WHO statement an “extraordinary event that is determined to pose a risk to the public health of other States through the international spread of disease and potentially requires a coordinated international response”, when a situation arises that is “serious, sudden, unusual or unexpected”, and which “may require immediate international action”.

So far this year, more than 1,600 confirmed cases and nearly 1,500 suspected cases of monkeypox have been reported to WHO, in seven countries where the disease has been known for years and in 32 newly affected countries, according to UN Info.

Dr Hans Kluge, WHO Regional Director for Europe, said a briefing today that Europe remains the epicenter of this growing epidemic and said that its scale posed a real risk. The longer the virus circulates, the more it will spread its reach and the more the disease will establish itself in non-endemic countries.

Kluge urged governments, health partners and civil society to act urgently, through enhanced surveillance, contact tracing and infection prevention and control, as well as effective communications with the general public and clinicians, and intensive community engagement.

In Europe, the majority of reported patients are men who have sex with men. Kluge warned that stigmatizing particular populations will undermine the public health response, as has been seen repeatedly, in settings as diverse as HIV/AIDS, TB and COVID.

Meanwhile, Matthew Vaughan, acting director of the HIV and sexual health division of ACONwrites below that preparations are underway for a surge in cases in Australia, and he stresses the importance of careful messaging and community engagement that does not contribute to fear and prejudice.

Matthew Vaughan writes:

As I write this, there have been over 1,600 confirmed cases of MPXV – I prefer to use that term to reduce the stigma – globally, most of them in Europe, the UK and North America.

Australia has just six cases so far, mostly among returning travellers, but with the northern hemisphere’s summer party season kicking off, we’re bracing for another viral outbreak.

Early media reports of MPXV cases highlighted the association with homosexuals, bisexuals, and men who have sex with men. Particularly among those who had attended large dance parties or sex parties in Europe.

Anyone who lived through the early 1980s might remember similar titles in the media about a previously unknown disease; ‘a rare cancer’the one we will later call the human immunodeficiency virus (HIV).

There was so much we didn’t know about HIV in the early years. We didn’t know what caused it, we didn’t know how it was transmitted, we didn’t know how to test for it, and sadly, we didn’t know how to treat it.

The multitude of strangers caused immense fear and anxiety in the community. The media vilified those most affected and conservative groups blamed it on immoral behavior, claiming that people’s suffering was a punishment from God. Public calls have been made to close bars, clubs and other places frequented by homosexuals. At the height of the HIV epidemic, steps were even taken to cancel Sydney’s annual Mardi Gras celebrations.

As eminent Australian HIV researcher Edwina Wright of the Burnett Institute has noted, in the absence of the known, we look for someone or something to blame. In the case of HIV, these are the people who have been affected. It was even in the clinical name given by doctors when identifying the first cases: Gay-Related Immune Deficiency (GRID).

Some 40 years after the first cases of HIV were identified, people living with HIV still experience the stigma associated with this once deadly disease. A spooky campaign featuring the Grim Reaper rolled out on national television, urging people to be careful because any of us could be devastated.

One need only look to recent events to understand how to blame groups of people for virus outbreaks, especially those historically discriminated against, fuels stigma and impacts communities beyond the virus itself. At the start of the coronavirus pandemic, widespread racially motivated attacks on Asian Australians have increased dramatically and Asian Australians have faced the impact of coronavirus and racial abuse simultaneously.

Unfortunately, the arrival of the MPXV in developed circles and in networks of gay and bisexual men poses similar threats to human dignity.

However, the circumstances are very different. Unlike the early years of HIV, we already know a lot about this virus; we have a pretty good idea of ​​how it is transmitted, we know how to test for it, there are treatment options, and we have vaccines.

A totally different situation.

Matthew Vaughan

prepare now

Nevertheless, we must not be complacent. We should, and are preparing for, an increase in MPXV cases in Australia. We must learn from the past, be prepared and act quickly to contain future outbreaks when they occur.

We can achieve this by working alongside affected communities to inform targeted communications and pragmatic responses. Collaborative efforts between governments and affected communities build trust, community engagement and prevent unintended consequences of fear and prejudice.

Importantly, we must recognize that the risk of MPXV is not limited to gay, bisexual, and other men who have sex with men. Anyone who shares close contact with an infectious person is at risk, regardless of gender or sexuality. Reporting cases of MPXV as a disease that only or largely affects gay and bisexual men prevents people with symptoms from coming forward for testing.

Even in 2022, homophobia is impacting how people interact with health services. Homophobia doesn’t just affect gay and bisexual men, even if a person doesn’t identify as gay. Fear of being perceived or mislabeled as gay in the media or among family friends prevents people from accessing testing and participating in important contact tracing efforts.

The essential key elements of an early response to a viral outbreak are isolating sick people and quarantining close contacts. To do this effectively, health departments use vigorous contract-tracing methods, allowing them to identify and notify potential cases and alert people who are self-isolating or monitoring for symptoms.

For this to be effective, people must be encouraged to note and remember their sexual partners and to disclose them fully and openly to health authorities, without fear of backlash or moral judgment.

MPXV is currently not classified as a sexually transmitted infection. Whether it is transmitted through vaginal fluid, seminal fluid, and ejaculate is still unknown and needs more research. We know it can be transmitted through close contact, which is unavoidable during sex. Transmission can also occur through contact with the clothing or bedding of someone with MPXV.

So even though it’s not an STI, it has the potential to spread via sexual networks, prompting organizations like ACON (and many other LGBTQ organizations around the world) to react quickly. with sensitive messages for our communities.

Currently, a large number of MPXV submissions appear to involve gay, bisexual, and other men who have sex with men. One possible reason for this is the proactive health-seeking behaviors of these communities, particularly when it comes to caring for their own sexual health and that of others.

Once again, we are in another “unprecedented” situation. However, we know that our communities are strong and resilient, and time and time again, gay and bi men have responded and adapted our behavior to protect us, our partners and our communities.

For reliable sources of information on MPXV, we recommend government sources like the NSW Health Fact Sheet or resources published by the Australian Department of Health.

• Matthew Vaughan is Director of HIV Sexual Health and Senior Campaign Planner at ACON, where he leads the strategy and development of the multi-award winning campaign, Ending HIV, which aims to end HIV transmissions in New South Wales. Matthew has worked in the community service industry for 15 years and has held various positions with government, non-government and community organizations at the state, national and international levels.

Resources and reading

Related updates from WHO
WHO publication: Clinical management and infection prevention and control for monkeypox: interim rapid response guidelines, June 10, 2022

From the United States, suggestions on messaging: Experts aim to thread the needle on monkeypox messaging to MSM

See Croakey’s previous articles on monkeypox

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