The first case of smallpox in the current outbreak was reported to the World Health Organization (WHO) on 7 May. The person in question had recently returned to the UK from Nigeria, where he is believed to have contracted the infection. Since then, more cases have been reported in more than a dozen countries where the disease is not normally present, including several European countries, Israel, the US and Canada, as well as Australia.
It has aroused morbid interest from the public and the media. Strange new infectious diseases that the public is unaware of, such as monkeypox, can cause a disproportionate degree of fear in the population. This is partly due to its “exotic” nature, fear of contagion and the perception that it is spreading rapidly and invisibly to the population.
This “germ panic” is further exacerbated by the unpleasant visible disfigurements caused by the infection, even if only temporarily. In addition, the required public health measures, such as isolation procedures, health workers equipped with personal protective equipment, and rigorous investigations and contact monitoring, recall interventions that an authoritarian police state could use for a crime. . Misleading information in the media, and especially on social media, could further fuel public anxiety, as was the case with Ebola in 2014.
Highly visible disfigurement caused by the smallpox virus can lead to stigmatization of already vulnerable groups. RGB Ventures / SuperStock / Alamy Stock Photo
The most recent cases of smallpox in the monkey did not have travel links to countries where the disease is endemic, which raises the possibility that the disease may have spread silently to the population for a time before it was detected. Many cases, but not all, that were reported recently were in gay, bisexual, and other men who have sex with men. This is unfortunate, as there is a real danger here that more stigma will be generated towards this group.
They have suffered greatly over the years from the stigma associated with infectious diseases, especially the HIV / AIDS pandemic, and there is still a strong current of homophobia even in countries with strong LGBTQ + rights. This is despite the great efforts of the LGBTQ + community, public education programs, and equal rights legislation to address stigma.
There are lessons to be learned from the HIV / AIDS pandemic. Part of the stigma was driven by deep-rooted religious and cultural beliefs in society that unfairly equated their sexuality with notions of immorality and negative stereotypes of promiscuity. Gay and bisexual men were blamed as the source and cause of the spread of HIV, although it also spread through other channels such as heterosexual sex, from mother to child, puncture injuries and contaminated blood products. The situation was worse for men from an ethnic minority, where racial prejudice and stereotypes add to the stigma.
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This, in turn, had serious consequences for those affected, especially in their mental and emotional well-being. It affected their social and sexual relationships, leading to the rejection of their partners and social isolation. It caused some to change their health behavior which caused delays in seeking health care. It meant that some were unwilling to reveal who their contacts were; this would hamper outbreak investigations and control efforts by public health teams trying to track the disease and stop its spread.
So how do we deal with this outbreak? First, public health initiatives, such as clear, timely, and transparent public education about the disease, can help alleviate public fears. It would also help increase public access to reliable sources of health information. But we need to get the message across about the smallpox of the monkey with sensitivity, without stirring up fear and mistrust and inadvertently alienating men who have sex with men.
We need to help citizens put the risk of this disease in perspective: it is usually a mild, self-limiting disease that usually goes away on its own in a few weeks and does not spread so easily. We need to reassure the public that this is not a new disease: scientists have been studying it for years and have a good understanding of how it spreads and its health consequences. We can also assure those who have been exposed that there is an effective vaccine against this.
No sexuality
We need to get the message out that monkeypox is not a disease of men who have sex with men. It’s not about sexuality – people tend to get infected through close physical contact and it doesn’t have to be sexual in nature. Infected people will tend to infect people with whom they have close contact, so the risk of spreading is high in affected households.
Thus, although so far there has been a high proportion of cases between men who have sex with men, in part this reflects their social media. It could just as easily have been an outburst in a heterosexual friendship network, or a group of athletes, or an occupational group, or other social groups. Would it have involved so much stigma risk then?
Another danger of misrepresenting the smallpox outbreak as a phenomenon that only affects men who have sex with men is that other people who are at risk, such as members of the household, are unaware of this. and are not protected. We must also warn and inform travelers in the endemic areas of West and Central Africa, as they may not realize that there is a risk.
Our best chance of eliminating this outbreak quickly is by early detection and quarantine of infected people and protection of their close contacts by vaccination, to break the chains of transmission. As we know all too well from our experience with HIV, stigma will not help.