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With the uptick in discussions surrounding the monkeypox virus, there’s ongoing concern about the health and safety of the LGBTQ+ community.

This in part is because a majority of the individuals affected were assigned male at birth (or AMAB) who have sex with other AMAB folks.

Because of this, the ongoing stigma around Queer sexual practices, the lack of comprehensive information regarding the virus, and remnants from past diseases with demographic disparities have understandably stirred fear within the community.

Monkeypox is a disease triggered by the monkeypox virus.

Largely characterized by a fever, swollen lymph nodes and a widespread rash, the virus is a member of the Orthopoxvirus genus (which includes the virus that causes smallpox.)

History

Monkeypox was originally detected in several laboratory apes as early as 1958, with a Public Health Emergency of Concern declared by the World Health Organization on July 23, rendering the disease a threat that necessitates a worldwide response.

Symptoms

@thatgaydoctor, a physician and LGBTQ+ advocate, was recently diagnosed with monkeypox. In an effort to combat the misinformation connected with the virus, he shared his insight on social media to help further social understanding and acceptance of the disease.

“A couple of days ago, I woke up with some swollen lymph nodes and then throughout the day started becoming increasingly fatigued, got some chills and then started to break out into some weird spots,” he shared.

Though similar to smallpox symptoms, those of monkeypox are typically milder. “I was sent home [from the ER] because treatment is mostly supportive care unless you’re immunocompromised,” the doctor said.

There’s no cure or official medication for the virus itself, but instead there are different methods of treating the symptoms while the virus takes its course, including pain medication and wound care for the lesions.

We can look to both previous and recent history to understand the concerns surrounding monkeypox and the potential for increased stigma and shame around Queer sex.

One of the prevailing fears is that this virus will embolden folks outside of the community to amp up their discrimination.

Connection To The US HIV/AIDS Crisis

In the 1980s and 1990s, the HIV/AIDS crisis – which disproportionately impacted folks who identified as gay and bisexual men – generated vast amounts of stigma towards the LGBTQ community.

Despite the rampant numbers of affected individuals, Ronald Reagan initially refused to discuss it.

The CDC didn’t even use the acronym AIDS until 1982 — medical practitioners had previously termed it Gay Related Immune Deficiency, colloquially known as a “gay cancer” or a “gay disease.”

Deemed a “gay plague,” both everyday people and government bodies failed to understand the risks involved.

Health campaigns were rolled out too late: in the UK, the AIDS: Don’t Die Of Ignorance public health campaign wasn’t launched until 1987, six years after the first cases arose globally.

A combination of inaction and a lack of medical understanding resulted in over 100,000 people in the US dying from illness related to the disease by 1990.

Ongoing Effects

The stigma and its effects continue to have a detrimental impact on LGBTQ+ people.

This looks like internalized biases and stigma around gender identity, expression, and sexuality.

Lasting effects also leave room for shame around sexual desires and practices, especially when a lot of popular culture and mainstream medical information considers inclusive sex education taboo.

For example, in addition to the healthcare systems, the varied parts of the judicial and legal system aren’t supportive of gender and sexuality variances.

Biases at this level undoubtedly have a domino effect, as Queer folks are subject to high rates of assault, are more likely to be uninsured, and often navigate mental and physical illnesses without treatment.

Queer Community Supporting Itself

Michael Donnelly, data scientist and queer community health advocate, discussed how the timeline of the HIV/AIDs crisis and continued healthcare disparities have pushed the Queer community to ask continued questions among itself about what care could look like, both then and moving forward.

“I think that conversation that I was a part of 10 years ago, is a descendant of the conversation started by the earlier AIDS activism that happened within the community,” he said.

“That forced us to have a conversation about: What does personal care look like in an era of HIV? What does Community Care look like? What does safer sex look like in the community?”

Institution-Level Stigma

A recent example was in September 2022 when a federal judge in Texas ruled that a provision of the Affordable Care Act that necessitates free coverage of certain drugs that prevent HIV infections undermine the religious beliefs of a Christian-owned company.

The lawsuit, overseen by US District Judge Reed O’Connor, argued that insurance plans that include STI screenings and HIV prevention drugs “facilitate and encourage homosexual behaviour, prostitution, sexual promiscuity, and intravenous drug use.”

Considering this harmful messaging that surrounded HIV/AIDS throughout the 1980s and 1990s, there is concern around the contemporary monkeypox messaging and the potential for ongoing LGBTQ+ stigmatization.

Shame and Misinformation

Harmful rhetoric surrounding “promiscuity” in gay men has facilitated negativity surrounding sexual freedom, and monkeypox’s prevalence in Queer AMAB communities has added fuel to that fire, particularly in relation to STI testing.

Donnelly spoke of how activists in the 1980s and 1990s were the reason behind HIV and AIDS entering and remaining in discussion, ultimately leading to government action that included the creation and FDA approval of antiviral medications like PrEP — Pre-exposure prophylaxis — used to protect the community from the virus.

“That, I think, had a really revolutionary impact on on gay men, and our relationship to sex and on health I think it really ushered in great, greater sexual liberation within the community,” he said.

Misinformation around diseases and viruses have the ability to not only contribute to stigma, but undo the work done towards healthy sexual liberation within the Queer community. For example, one woman informed a doctor in Spain that she couldn’t catch monkeypox from an infected man next to her as she is “not gay.”

This not only continues shame around open sexuality, but further places individuals at risk of contracting the virus.

“I want to do away with any stigma or embarrassment that anybody might have about getting any form of disease,” @thatgaydoctor said. “These things happen.”

While monkeypox has disproportionately affected folks from the Queer community, it has the ability impact anyone irrespective of sexuality or identity.

The Biden-Harris Administration launched the first phase of its monkeypox vaccine strategy on June 28, 2022.

As part of this, it committed itself towards making testing easier, scaling and delivering vaccines to mitigate new infections and activating community leaders and stakeholders.

On August 4 2022, monkeypox was declared a Public Health Emergency by the US Department of Health & Human Services Secretary Xavier Becerra.

At this juncture, more than 602,000 doses of the JYNNEOS vaccine had been shipped to states and jurisdictions, increasing by 266,000 in the week prior.

According to reports, however, US efforts to address the virus outbreak on a large scale came two months after cases in the country began to spread, stirring uncomfortable memories of government inaction during the HIV/AIDS crisis.

Donelly discussed the lack of action when it came to testing and vaccinations in the New York area saying, “Some of the worst missteps, particularly with the FDA, were that the reasons they gave for slow response was that the case numbers were low at the time,” he said.

“And case numbers specifically mean test results. They don’t mean infections. So if you’re only testing 10 people per day for the country’s largest metro area, of course, the numbers are, by definition, going to be small.”

Accessibility Concerns

Even though the vaccines themselves are free, supportive treatment after contracting the virus likely isn’t.

Because LGBTQ+ community is hugely diverse in terms of financial stability, Donelly expresses how this leaves room for concern about marginalized communities’ ability to access what they need.

“Parts of our community enjoy really privileged access to strong healthcare systems. New York City has some of the best network of sexual health clinics in the country in terms of public-run sexual health clinics,” he said.

“Not everyone in the community has equal access to all of those clinics. New York City has closed a significant number of its sexual health clinics nominally because they closed them during the COVID pandemic, but they haven’t reopened them.”

Thus, providers that were open to all irrespective of income have – in their disappearance – rendered many unable to access monkeypox care. “We, as a community, have had to take care of ourselves.”

Similarly, Jeffrey Gallaise has experienced government failure in accessing monkeypox services. Gallaise, a member of the LGBTQ+ community, has spoken openly about his experience with the virus and the difficulty in receiving treatment.

“I think, from the get-go, there was a lack of education around the potential impact,” he shared with Healthline, discussing how he had to cancel one appointment due to a COVID contraction.

He later ended up contracting monkeypox, 2 days before his rescheduled appointment. His doctor couldn’t access the treatment he needed, and by the time he’d been able to see his primary care physician, he was “basically crying on the floor,” due to the painful symptoms.

In the end, it took him 8 days to access. Gallaise acknowledged that despite his suffering, he was in a position better than many, because an under-advertised clinical trial in New York is what allowed him access to medication.

He also spoke about the privilege of having a job that allowed him PTO, sharing stories of others he’d connected with that lacked these benefits.

“And then people are dealing with their employers, and their employers being like, ‘There’s no policy for that so you’re going to have to either come to work or we have to not pay you,’” he said.

Donnelly spoke to this as well, sharing that there’s much left to be desired in terms of sick leave for workers. “New York City does better than most places in the country, but it is far from perfect. On top of that, there are a lot of people — even in New York City — who are not eligible to receive paid sick leave,” he said.

“I have friends who’ve had to take weeks off of work unpaid in order to isolate themselves because of a positive monkeypox diagnosis, and that’s clearly impacting non salaried workers.”

Because the virus is still relatively new, there’s not a lot of information or help available for folks currently experiencing symptoms and connected complications.

Gallaise spoke about the necessity of community but the lack of ways to plug in.“I was looking for resources and there was nothing — there’s no support groups, no nothing,” he said.

“People are dealing with PTSD from the AIDS [crisis] on top of this illness, and then the stigma that’s attached…I created this support group that’s been meeting every day at six. Anybody that’s suffering from the disease can go to the support group and we kind of talk about the strategies that we’re using to kind of get through.”

The JYNNEOS vaccine is approved for prevention of smallpox and monkeypox, and is the primary vaccine being used as part of the US outbreak. The ACAM2000 vaccine is an alternative, originally developed to protect against smallpox.

The CDC recommends vaccination if you have either been identified as a close contact of someone with monkeypox or you learn that one of your sexual partners from the last 2 weeks has been diagnosed.

The center also recommends vaccination if:

  • You’re an AMAB, transgender, or gender-diverse individual and have had sex with AMAB people (or engage sexually with AMAB people who have)
  • You have had sex with multiple partners or engaged in group sex in the last 2 weeks
  • You have had sex at a commercial sex venue – including a sex club or bathhouse – in the last 2 weeks
  • You have had sex at an event, venue or area in which monkeypox transmission is understood to be occurring

In large cities, monkeypox vaccines are often available at the health department, public health clinics, hospitals or even large social gatherings at venues in which monkeypox transmission is understood to be occurring.

In other areas, monkeypox vaccines may only be available from the health department. If you’re unsure, contact your local health department for more information.

How Much Do Vaccines Cost?

Monkeypox vaccines are free.

An administration fee is charged in some medical settings, but providers must administer the vaccine irrespective of your ability to pay this fee where it is enlisted.

Providers may also bill a program or plan covering the monkeypox vaccine administration fee.

The current crisis doesn’t mean you have to be abstinent or that you have to be isolated if you aren’t sick. However, an extra layer of precaution could be useful.

Monkeypox Transmission And Risk Factors

To take steps to protect yourself against monkeypox, avoid contact with people that have been diagnosed alongside the objects they have touched.

Similarly, avoid contact with people that have a rash that looks like it could be monkeypox. Wash your hands often with soap and water or use an alcohol-based hand sanitiser.

Monkeypox can spread through skin-to-skin contact with two or more people, which can include:

  • Direct contact with monkeypox rash, scabs or bodily fluids from a person with monkeypox
  • Touching objects or fabrics used by a person with monkeypox
  • Contact with respiratory secretions

Safer Sex

While Monkeypox can and has been primarily spread during intimate contact, it’s important to note that monkeypox hasn’t been classified as an STI.

Even so, taking adequate precautions for yourself and potential partners starts with understanding what high behavior can look like.

According to the CDC, high risk behaviors include:

  • Oral, anal and vaginal sex or touching the genitals or anus of a person with monkeypox
  • Hugging and kissing
  • Prolonged face-to-face contact
  • Touching fabrics and objects used by a person with monkeypox during sex that have not been disinfected (including bedding, towels, and sex toys)

For the time being, consider limiting sexual partners and opting out of sex events or gatherings where you may come in contact with larger numbers of people or others you aren’t as familiar with.

Just as importantly, have open and candid conversations with your partners about getting vaccinations and what your plans are for keeping each other safe.

Be Diligent About Information Sources

Significantly, the CDC is currently warning against misinformation and is encouraging fact-based, inclusive communication.

It encourages avoiding marginalizing groups susceptible to monkeypox, instead focusing on promoting it as a public health concern that can impact anyone.

“With this being a relatively new thing, the recommendations on treatment and isolation will likely be evolving and so make sure [you’re] keeping an eye on the news and watching out for case rates in your area,” @thatgaydoctor said.

Remember: anyone can be impacted by monkeypox, and it’s a public health concern in equal measure.

For folks within the LGBTQ+ community, hesitation to speak openly about the virus is understandable, but it’s also vital.

Have conversations with your partner(s) about amping up the ways to ensure everyone’s safety and be sure to gather your info from credible sources.

If you’re outside of the community, be mindful of your internal biases and where they could possibly come from.

Rather than ignoring their existence, make a point to challenge those thoughts as soon as they pop-up.

Do the work of educating yourself on not only the current Monkeypox epidemic, but the history of the HIV/AIDS crisis and the ways that marginalized communities are often left to fend for themselves when it comes to healthcare.

Not having a ton of information about health-related topics can be scary, but we can work together to share fact-based information and support one another in the best ways we know how.