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Monkeypox: Why we shouldn’t tiptoe around who is at highest risk

A sign announcing monkeypox vaccination is set up in Tropical Park by Miami-Dade County and Nomi Health, August 15, 2022.

The Biden administration this month declared the outbreak of monkeypox, a virus spreading disproportionately among men who have sex with men and their sexual networks, a public health emergency.
Not wanting to reproduce the kind of anti-gay stigma seen during the early AIDS crisis, some argue that articulating which group is at highest risk for monkeypox infection might be dangerous.

Yet experts say that the insistence on generalizing warnings both hurts outreach to the most vulnerable people, including Black and Latino men, and oversimplifies the lessons of the AIDS crisis, which illuminated the importance of battling stigma and pushing for care for those who needed it.

“We don’t want to add stigma to a delicate situation, but then our messaging becomes so broad that nobody knows which people we’re speaking to — and that becomes a real problem,” Robert Fullilove, a professor of clinical sociomedical sciences at the Columbia University Medical Center, told CNN.

In short, experts say that we shouldn’t tiptoe around the issue. Instead, we should face it directly, and keep an eye toward expanding access to care.

What the early data show

Part of the issue with talking about monkeypox in oblique terms is that we end up overemphasizing who can get the virus and downplaying who does get it, according to Melanie Thompson, an Atlanta-based HIV physician and researcher.

Take a detailed breakdown of monkeypox case records that the US Centers for Disease Control and Prevention published this month. Anyone can get the virus, yes, but the CDC analysis shows that 94% of cases were among men who had recent sexual or close intimate contact with another man. Further, 54% of cases were among Black Americans and Latinos.
Early data from the Georgia Department of Public Health and the North Carolina Department of Health and Human Services show a similar pattern: In both states, monkeypox is overwhelmingly affecting Black men.

Thompson underscored the importance of clarity, of communication that spells out where, precisely, the virus is.

“The purpose of data isn’t just to crunch numbers — but to ensure that the people most impacted by monkeypox or any other disease entity are getting the services that are required,” she said.

Thompson added, “The message that anybody can get monkeypox spreads fear among the general population. It distracts from the messaging we need to get to people at risk for monkeypox infection.”

And this kind of obfuscation doesn’t merely distract. It…

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