We Must Stop Stigmatizing Diseases

The World Health Organization reported on June 23 that there were more than 3,000 cases of Monkeypox, or MPX, in 47 countries.

U.S. Centers for Disease Control and Prevention Data reported more than 5,000 cases in 51 countries on June 29, with a majority of cases arising in Europe and 350 cases in the U.S.

MPX is an orthopoxvirus similar to smallpox that has historically been seen in western and central Africa. The virus was first identified in humans in 1970 when a nine-month-old boy fell ill in the Democratic Republic of Congo.

The U.S. had its first outbreak in 2003 when infected Gambian rats, who had been imported to an exotic pet store, infected pet prairie dogs, resulting in 47 confirmed cases of MPX.

In recent years, officials have witnessed more human to human transmissions. MPX is typically transmitted due to extended close contact and direct contact with bodily fluids or infected lesions.

The virus’s incubation period ranges from 5-21 days and can result in fever, swelling of lymph nodes and skin blisters, with symptoms lasting 2-4 weeks. Mortality rates range from 0-11% among the general population, according to a WHO fact sheet.

There is currently neither a cure for MPX nor a targeted vaccine, though the smallpox vaccine provides significant protection from mild exposure. The U.S. Department of Health and Human Services announced on June 28 that it “is rapidly expanding access to hundreds of thousands of doses of the JYNNEOS vaccine for prophylactic use against monkeypox in areas with the highest transmission and need, using a tiered allocation system.”

In May 2022, there was an unprecedented rise in MPX outside of Africa, with epicenters in Western Europe and the United Kingdom. These recent outbreaks have not been directly linked to endemic areas and investigators have not determined the cause.

On May 23, WHO announced that the spread of MPX in Europe appears to be a “random event” linked to sexual activity at two recent raves.

Officials announced that most of the European cases were among men who have sex with men, and WHO released a public advisory statement warning gay and bisexual men to take precautions.

June 23 remarks from WHO’s Director-General reaffirmed this position, stating: “The outbreak in newly affected countries continues to be primarily among men who have sex with men, and who have reported recent sex with new or multiple partners.”

MPX has historically been both under-reported and misunderstood. As the general public becomes more aware of the disease, we are seeing more and more misinformation being circulated.

Irresponsible individuals have promoted conspiracy theories, similar to those circulated about COVID-19. The most dangerous assertions are that MPX is directly related to the LGBTQ+ community.

WHO sought to counter such anti-LGBTQ+ rhetoric by emphasizing in late May that “available evidence suggests that those who are most at risk are those who have had close physical contact with someone with monkeypox, and that risk is not limited in any way, to men who have sex with men.”

A mid-June headline in The Washington Post summarized the challenge facing public health officials related to this MPX outbreak: “How to Warn Gay Men About Risk Without Fueling Hate?”

As public health officials continue to follow the global expansion of MPX, we need to consider the problem of stigmatizing diseases.

We saw the first statements about what would be called acquired immunodeficiency syndrome, AIDS, in the CDC’s Morbidity and Mortality Weekly Reports in the summer of 1981. Officials noted that the novel disease was most seen in communities where men have sex with men, as well as among intravenous drug users and those who exchange money for sex.

While the human immunodeficiency virus, HIV, would not be isolated and researchers would not fully understand the path of transmission until 1984, the damage was done. HIV was seen as the “gay virus” and AIDS as an LGBTQ+ disease.

Well-known preachers like Billy Graham and Jerry Falwell implied that AIDS was God’s judgement for sin. Graham later retracted his statement, but groups like Westboro Baptist Church are still promoting the idea.

Over-emphasizing the sexual orientation of early AIDS victims generated public health problems that still impact us today.

By stigmatizing diseases, we discourage patients from seeking treatment or screenings, as Matthew Kavanagh, UNAIDS Deputy Executive Director, noted in his May 22 remarks about MPX.

I have seen this with cervical cancer which is frequently linked to human papillomavirus, or HPV. Because HPV is a common sexually transmitted disease, the public often has the false assumption that cervical cancer is only caused by sex.

Fear of judgment has caused countless people to avoid screening or ignore symptoms. The American Cancer Society has battled this misconception for years, emphasizing that, like AIDS and MPX, there are other causes for cervical cancer than sex.

When disease is stigmatized, patients will not be truthful during screenings and assessments. Without a complete and accurate patient history, health care providers cannot provide the best therapies.

I have known patients who hid their HIV status for fear that their community would judge them, only to miss out on life-enhancing or life-extending therapies. This need not happen.

The stigmatization of disease also distracts the public and creates a false sense of security.

Because AIDS was stigmatized, sexually active individuals outside of the LGBTQ+ community did not worry about the virus, assuming HIV couldn’t affect them. It was not really until the late 1990’s that the public saw HIV as a nondiscriminatory virus that does not care about sexual orientation.

The stigmatization of HIV unnecessarily caused heterosexual individuals to ignore warnings and decline testing, putting countless lives at risk.

All of this brings us back to MPX.

While early epicenters of this latest outbreak were linked to men who have sex with men, public health officials are still unclear as to why. In addition, WHO noted on June 23 that “in Nigeria, the proportion of women affected is much higher than elsewhere, and it is critical to better understand how the disease is spreading there.”

While public health officials are seeking to communicate trends based on the available data, too much focus on the sexual orientation of those impacted by MPX could have a similar effect to what we saw with HIV and AIDS.

We must stop stigmatizing diseases.