Days after the World Health Organization declared monkeypox a global emergency, the U.S. has reported more than 3,000 confirmed cases of the virus. The Biden administration is likely to follow the WHO’s lead by the end of the week in a move that would expand the nation’s ability to respond to the virus.

STELLA SAFO, MD, MPH; stella@justequityforhealth.com, @AmmahStarr
    Safo is an HIV primary care physician and the founder of Just Equity for Health.

Safo wrote this week that in the early years of the HIV pandemic, HIV/AIDS was framed “as a ‘gay man disease.’ Women, and especially Black and brown heterosexual women, suffered from this narrow framing. Even now, the rates of preexposure prophylaxis (PrEP) use among high-risk women are lower than they should be.” Safo writes that “we can’t fail” by framing monkeypox the same way. 

Safo told the Institute for Public Accuracy today: “There are men who have sex with men [MSM] who have HIV who are in my clinic who have had HIV for 30+ years. And there are Black and Latina women who have HIV who are in my clinic who talk about how they didn’t think they could get HIV because they always thought of it as a ‘gay disease.’ I see the consequences of the framing around an infectious disease day-to-day when I’m taking care of my patients, which is why it’s so important that we think about how to get this right.

   “Monkeypox is interesting. When monkeypox came to the U.S., we expected it to spread population-wide. It surprised us in that it is primarily affecting men who have sex with men at this point. But we know that’s just the harbinger group and that it’s going to start spreading. The challenge is that if you only test certain individuals, like MSM, you’re going to find the disease more among them. It’s likely that MSM have it at a higher rate, but it’s also the reality that some individuals that don’t fall into this demographic category are being ignored. 

   “If you think about the way monkeypox spreads––through skin-to-skin contact, fluids, materials like bedding and towels––there’s no way it will just stay among MSM.” Safo notes that young children may be at particular risk once the virus begins spreading more widely. “If you think about the ways that young children interact in schools and in other settings, there is that constant skin-to-skin contact. Especially as school starts up again, we’re particularly worried about the pediatrics population. 

    “The other population that is at high-risk is pregnant people, who have a higher risk of complications if they get monkeypox. That’s another population that we’re going to be looking at very closely.”

The New York Times wrote on Thursday that “disagreements within the New York City Department of Health about how to communicate the risks of the disease spilled into public view last week. Some epidemiologists have argued that officials should more explicitly advise men who have sex with men to reduce their number of partners, or even consider short-term abstinence. (The director general of the W.H.O. made a similar recommendation this week, including that men should reconsider having ‘sex with new partners,’ according to STAT News.)” Others have expressed concerns that the disease could make gay people scapegoats in the event of a larger outbreak.