As cases of monkeypox start to appear around the world, the news cycle has erupted with commentary on the disease, some of which stigmatise men who have sex with men.
You would think that we learned our lessons from HIV/Aids and Covid-19 about the dangerous intersection between stigmatisation and preventing infectious diseases. Blaming groups of marginalised people hampers an effective response to an outbreak.
The first case of monkeypox in South Africa was identified on 22 June. During the National Institute for Communicable Diseases (NCID) announcement, Professor Kholeka Mlisana linked the outbreak to men who have sex with men by stating that the cases have mainly been among “people who self-identify as men having sex with men”. But Mlisana did add that cases of transmissions are not limited to gay and bisexual men.
These statements took to social media like a flame to dry grass. As a result, bigotry and misinformation has risen online about monkeypox, with the moniker “gaypox” becoming prevalent among homophobes who want to pin the blame on men who have sex with men.
For example, a recurring piece of misinformation online suggests that monkeypox is a sexually transmitted disease (STD).
The World Health Organisation (WHO) has repeatedly stressed that the disease is not an STD but can be transmitted through any intimate contact. This is because it can spread through large respiratory droplets, contacts with the blister-like sores that are symptomatic of the disease or sharing things such as bed sheets or clothing with someone who has the virus.
The disease is seldom fatal and people usually recover within two to four weeks.
Because the public has limited knowledge about monkeypox, this creates conditions for spreading misinformation.
The NCID has distanced itself from the bigotry and misinformation concerning queer people. But the institute has still negligently placed a target on the back of gay and bisexual men, not to mention the plethora of people who identify as non-binary or gender-diverse.
The stigmatisation of men who have sex with men regarding monkeypox is not a uniquely South African problem. The WHO’s communication pointed fingers at men who have sex with men. In addition, the organisation has published numerous statements on which the NCID based their statement, linking monkeypox to gay people.
The WHO is in the process of doing damage control. It has hosted numerous question and answer sessions about monkeypox, aiming to quell the panic. Andy Seale, an adviser specialising in HIV at the WHO, has stated that it should not be viewed as a “gay disease”.
The United Nations Programme on HIV/Aids also stressed the need to avoid racist and homophobic stereotypes.
The stigma about the disease can create moral panic. Data and science is ignored. Public health officials have learned hard lessons from the Aids epidemic about the consequences of stigma on public health responses.
At the start of the epidemic in the 1980s, policymakers made assumptions that did not support the health of men who have sex with men, leading to more people acquiring and transmitting the virus.
South Africa is especially guilty of this. Homosexuality was practically erased from epidemiological research into HIV/Aids for many decades.
With this in mind, there is an irony to the NCID claiming that its statement was necessary for epidemiological context. It is hard to read its statement without thinking about how men who have sex with men have been left behind in the fight against HIV/Aids.
This is largely attributed to pervasive homophobia in South Africa, which creates a culture of denial and criminalisation and fuels the erasure of same-sex desire.
This pervasive homophobia greatly enhances the vulnerability of queer people. For all our posturing about being a progressive rights-based society, South Africa repeatedly does not protect the rights of queer people. This is obvious from the little effort that is put into reducing the effect of HIV/Aids on queer people. Granted, the department of health does have an opportunity to update the LGBTQIA+ HIV plan, because the five-year plan began in 2017 and is drawing to a close.
In addition, we need to start considering public health responses that eradicate the stigma attached to infectious diseases.
The stigma linked to HIV/Aids creates an environment in which many gay men are reluctant to comment on whether they are HIV-positive. A 2018 study published in the South African Journal of HIV outlines a depressing reality — men who have sex with men experience widespread discrimination in the healthcare system.
The researchers collected responses from participants in the North West and Free State, which reflect a healthcare system that neglects the health of gay men, invalidates their identity, and perpetuates the shame and stigma linked to HIV/AIDs.
Placing the blame for monkeypox on men who have sex with men creates similar conditions, enhancing the stigma against gay and bisexual men.
The possible result? Gay people will be driven further underground, creating conditions ripe for spreading the disease.
A prime example of discrimination from the Covid-19 pandemic is the widespread travel bans imposed on South Africa after the country released its sequencing of the Omnicron B variant.
Some people are at higher risk of contracting monkeypox, but this does not mean the virus only infects them.
If anything, research shows that infection vectors are more closely tied to social determinants such as age, financial status and environment rather than sexual or gender identity. We therefore need to ensure that the conversation about monkeypox is about a public health approach focused on the social determinants of health, which places marginalised people at a higher risk for the spread of the virus.
We need a compassionate human response to the outbreak that emphasises solidarity and knowledge sharing.
Monkeypox is nothing like HIV/Aids but the knowledge of organisers in the gay community is incredibly valuable for managing the response.
In addition, public health officials need to ensure that sexual health clinics have supplies of smallpox vaccines, while ensuring that affected people are equipped with the knowledge required to limit the infection.
We learned from the Covid-19 restrictions that limiting large public gatherings has an enormous toll on people’s mental health. We are emerging from two years of restriction and reinstating similar restrictions will be soul-crushing.
People are social creatures. We have an innate desire to celebrate, eat and have sex. Any public health response needs to be cognisant of these basic cultural tenets.
We need to create an environment where people feel safe to report their symptoms, get tested and receive appropriate care.
A culture of stigma will cause people to avoid getting tested, resulting in potential harm to the collective public body.
Assigning blame to specific groups of people is easy, but this adds zero value. Rather, we need to harness the collective knowledge of how we’ve responded to epidemics and pandemics in the past.