- Calling monkeypox an STI is inaccurate and can create other problems, experts say, like stigma.
- Experts suggest clear messages about how monkeypox can spread to inform, not alarm.
Sexually transmitted infections are nothing new. But is there a new one?
There are 6,326 cases and counting of monkeypox in the United States. Most were exposed to the virus through close contact during sex, but this does not mean that monkeypox is a sexually transmitted infection.
Caused by a virus from the same family as smallpox, monkeypox is transmissible through person-to-person contact with rashes, scabs, or bodily fluids, contact with infected objects such as clothing, and contact with respiratory secretions. Symptoms, which may begin to appear seven to 14 days after exposure, include fever, muscle aches, exhaustion, and a rash that may appear on the body.
And although the majority of reported cases are in men who have sex with men, anyone can get monkeypox.
That’s why experts say it’s a problem to call monkeypox an STI. Not only because they are inaccurate and misinformation could worsen the spread, but also because they can perpetuate the stigmatization of marginalized communities.
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Dr. Stella Safo, primary care HIV physician and founder of Just Equity For Health, says it’s very important that we get the correct transmission messages when it comes to monkeypox. If it’s being presented as an STI when it’s not, the general public can:
- Thinks they are less at risk when they may not be.
- Will not know how to keep from getting sick.
- Will not know if or when to get help if he starts showing symptoms.
“A lot of people (may) think, ‘Well, I’m not having sex. I’m not a gay man. So I’m fine no matter what.’ When in reality, monkeypox is a contact-based disease.”
What doesn’t help, Safo adds, are officials who aren’t “super clear” in their framing, especially with the history of the HIV/AIDS epidemic. At that time, hundreds of thousands of people died from a virus that appeared to target certain communities when no one was immune – all compounded by a lack of action to help stop the spread. Despite advances in medication and awareness of HIV today, the disease continues to affect gay and bisexual men who are Latino and Black more severely.
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“When public health agencies say we’re seeing men who have sex with men have monkeypox at a higher rate, people hear that like, ‘Oh, it’s a gay disease’ or ‘C “is another sexually transmitted disease. It gets confused in people’s minds.”
Even though public health agencies don’t call monkeypox an STI or a “gay man’s disease,” people can make assumptions that could lead to more infections.
“There has to be a very heavy effort to make it very clear that even though this group is more affected at the moment, we anticipate that this unfortunate virus will become more widespread in the community, that other groups will be affected due how it spreads,” she says, adding that this message is important to help inform and therefore reduce panic.
“We end up panicking people more when they don’t have an idea what’s coming, like we’ve seen with COVID. So I think giving that information could be really helpful.”
As monkeypox cases increase, so will the stigma
Viruses like monkeypox are “totally neutral” and “non-judgmental” about the affected group, Safo says. Society is the opposite.
“What we see is the continuous bashing of a group,” she explains. “Men who have sex with men, certain other historically marginalized communities… tend to be targeted as the cause of the spread of the disease. There’s a historical belief in that.”
And just as HIV reinforced this unconscious (or conscious) bias when it was first discovered in the United States, experts fear that monkeypox may fall into the same narrative.
“(That’s) why people say so loudly that it’s not a sexually transmitted infection,” Safo adds. “There’s a natural tendency to attribute to gay men some sort of savage way of life that leads to more disease. And so the monkeypox that’s happening more in that population (at the moment) really reads into this stereotype.
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Even calling something an STI can carry a certain stigma as something “dirty,” says Benjamin J. Goldman, a New York-based mental health therapist.
“We have this acute judgment about consenting adults who engage in consenting sexual behavior because of internalized and systematic homophobia and heteronormativity,” he says. “The idea that an STI is dirty or hurts you less than or harms you in some way already feeds into this heteronormative patriarchal narrative before we even begin to address the fact that monkeypox does not is not an STI.”
Shame also plays a role in the stigma conversation.
“There’s a lot of shame, especially from outside the gay and queer community, around the idea of sexual density (in the community),” he explains. “When people are asked to change their sexual habits and behaviors, it immediately goes back to this hyper-traditional notion of ‘you’re having sex is wrong… If you were having monogamous sex with someone as the Lord commanded, you would “not contract such a disease”, which, of course, lacks nuance in itself.”
Goldman is also concerned about the impact this can have on the mental health of marginalized communities.
“There is unique suffering for the gay and queer communities right now,” he says, adding there is a problem–traumatic aspect for people who have lived through the HIV/AIDS epidemic. Who experienced judgment or loss of community, as well as the fear around the experience of coming out due to the idea that “their sexuality makes them dirty again”.
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As monkeypox spreads, so does the stigma.
“When we start to see monkeypox in certain populations of children – and unfortunately, probably more among certain demographic groups of children – if that starts to mean that we have higher cases of monkeypox infection in black and brown children, it will speak to (the) unconscious bias that black or brown people spread disease,” Safo says.
We must not let bias show in the way we describe and inform the public about the disease, adds Safo.
“When we start to see that it affects certain racial ethnic groups more – not because they’re more likely to get it through biological means, but simply because of the social and political realities they find themselves in… If you have people packed into a house and monkeypox spreading, you’re more likely to catch it,” she says, pointing to the same outsized impacts we’ve seen on racial groups with COVID-19.
If the framing isn’t clarified, Safo worries that the narrative that queer people, black and brown people, and those who identify as both are “dirty” or promiscuous will only be reinforced.
The best way forward, advises Safo, is not to panic but to equip yourself with information. Any infectious disease is something we all need to think about in order to protect ourselves and our loved ones.
“Honestly, none of us are OK until we’re all OK.”