Sexually transmitted infections are nothing new. But has a new one surfaced?
Caused by a virus in the same family as smallpox, monkeypox is transmissible through person-to-person contact with rashes, scabs or bodily fluids, touching infected items like clothing as well as contact with respiratory secretions. Symptoms, which can begin to appear seven to 14 days after exposure, include fever, muscle aches, exhaustion and a rash that can appear on the body.
And while the majority of cases reported have been with 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 it's inaccurate and misinformation could worsen the spread, but because it can perpetuate stigma against marginalized communities.
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Dr. Stella Safo, an HIV primary care physician and founder of Just Equity For Health, says it matters greatly that we get transmission messaging correct in relation to monkeypox. If it's framed as an STI when it's not, the general public may:
Think they're at lower risk when they might not be.
Won't know how to prevent themselves from getting sick.
Won't know if or when to get help if they start showing symptoms.
"Many people (may) think: 'Well, I'm not having sex. I'm not a gay man. So I'm good no matter what.' When in reality, monkeypox is a contact-based disease," Safo says.
What doesn't help, Safo adds, are public officials who aren't "super-clear" in their framing, especially with the history of the HIV/AIDS epidemic. At that time, hundreds of thousands died from a virus that seemed to target certain communities though no one was immune – all worsened by a lack of action to help stop the spread. Despite progress in medicines and awareness around HIV today, the disease continues to more severely afflict gay and bisexual men who are Latino and Black.
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"When public health bodies are saying we're seeing men who have sex with men have monkeypox at a higher rate, people are hearing this as, 'Oh, this is a gay disease' or 'This is another sexually transmitted disease.' It's getting conflated in people's minds," Safo says.
Even if public health bodies are not calling monkeypox an STI or "gay man disease," people may make assumptions that could lead to more infections.
"There needs to be a really heavy-handed effort to make it very clear that while this group is affected more right now, we anticipate as this unfortunate virus becomes more prevalent in the community, that other groups will be impacted because of the way it spreads," she says, adding this messaging is important to help inform and therefore reduce panic.
"We end up panicking people more when they don't have a sense of what's coming, as we saw with COVID. So I think giving that information could be very helpful."
As monkeypox cases increase, so will stigma
Viruses like monkeypox are "totally neutral" and "don't make any kind of judgment" on the affected group, Safo explains. Society is the opposite.
"What we're seeing is the continued denigration 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 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 U.S., experts worry monkeypox will fall into the same narrative.
"(This) is why people are being so strong about saying it's not a sexually transmitted infection," Safo adds. "There's a natural inclination to ascribe to gay men a kind of wild lifestyle that leads to more disease. And so monkeypox happening more in that population (at this time) really reads into that stereotype."
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Even calling something an STI can have a certain stigma as something "dirty," says Benjamin J. Goldman, a mental health therapist based in New York.
"We have this acute judgment around consenting adults engaging in consenting sexual behavior because of internalized and systematic homophobia and heteronormativity," he says. "The idea that an STI is dirty or makes you less-than or makes you wrong in some way is already feeding into this heteronormative patriarchal narrative before we even begin to touch on the fact that monkeypox is not an STI."
Shame also plays a role in the stigma conversation.
"There is a lot of shaming especially from outside of the gay and queer community around the idea of sexual density (in the community)," he explains. "When people are being asked to change their sex patterns and behaviors, it harkens immediately to this hyper-traditional notion of 'you having sex is wrong. ... If you had monogamous sex with one person as the Lord ordained it, you wouldn't be getting such a disease,' which of course, lacks nuance in itself."
Goldman also worries about the mental health impact this can have on marginalized communities.
"There's a unique suffering happening for the gay and queer communities right now," he says, adding there's a re-traumatization aspect for people who lived through the HIV/AIDS epidemic. Who experienced judgment or loss of community, as well as fear around the coming out experience due to the idea that "their sexuality once again makes them dirty."
As monkeypox spreads, so will stigma.
"When we start to see monkeypox in certain populations of children – and unfortunately, probably more among certain demographics of children – if that starts to mean that we have higher cases of monkeypox infection among Black and brown children, that will speak (to) the unconscious bias that Black or brown people spread disease," Safo says.
We shouldn't allow prejudices to show through the way we're describing and informing the public on the disease, Safo adds.
"When we start to see it really affect certain racial ethnic groups more – not because they are more likely to get it by any biological means, but just because of the social political realities that they're in. ... If you have people packed into a home, and monkeypox is spreading, it's more likely that you'll get it," she says, pointing to the same disproportionate numbers seen across racial groups with COVID-19.
If framing isn't cleared up, Safo worries the narrative that queer people, Black and brown people and those who identify as both are "dirty" or promiscuous will be reinforced.
The best way forward, Safo advises, is not panicking but equipping ourselves with information. Any infectious disease is something we all must think about in order to protect us and our loved ones.
"Honestly, none of us are OK until we're all OK."
This article originally appeared on USA TODAY: Monkeypox is not an STI. Why calling it one is dangerous, adds stigma