The spread of monkeypox brings worries of bias against gay men

Forty years ago, AIDS was pejoratively called a “gay disease” because the initial outbreaks were primarily among gay men.

Monkeypox has hit the population of men who have sex with men (not all of whom are gay) much more than other communities.

So far.

Like HIV, monkeypox, which spread through sexual contact but also in other ways, will spread to other populations eventually, say those familiar with how the HIV epidemic evolved.

But they are worried not only about the spread of monkeypox, but that the high number of cases among gay and other MSM, or men who have sex with men, are reviving the discrimination and stigma those with AIDS endured.

“I’m very concerned,” said Dr. Javeed Sukhera, who heads the psychiatry departments at the Institute of Living and Hartford Hospital. “We’ve seen patterns of how hate crimes and hate speech perpetuate the harm,” such as that recently experienced by Asian Americans because COVID-19 was originally found in China. Ebola was another illness that brought a backlash against people of African descent.

“What we choose to label the illness matters because of how the public perceives whether or not their loved ones are at risk,” Sukhera said. “It can ascribe blame to certain groups and populations that goes beyond the harm of the actual infection itself.”

Sukhera said he has seen how young LGBTQ people have greater stress on their mental health and that “they have a much greater risk of suicide.”

“I definitely think there’s aspects to the kind of stigma related to HIV that are happening again, but the differences are we are living in an age where information and disinformation are spreading much more rapidly,” he said.

“Its mode of spread is through close personal contact,” said Dr. Ulysses Wu, assistant director of infectious diseases at Hartford HealthCare, said about monkeypox. “The reality of this is the majority of this is spread through sexual contact.”

However, “people need to understand that you can get it through other ways,” he said. “Everybody’s at risk, and that’s why we need to not make this just an MSM problem.

“I don’t want that group marginalized, and I don’t want other people [to think] that this public health crisis does not pertain to them. It pertains to them or somebody that they know.”

As of Thursday, there were 4,639 cases of monkeypox confirmed in the United States, with 28 in Connecticut, according to the Centers for Disease Control and Prevention.

Monkeypox spreads through close personal contact of any kind, including touching the skin of an infected person, or even coming into contact with contaminated objects, said Dr. Michael Virata, an associate professor at the Yale School of Medicine and program director for the AIDS/HIV Care Program at Yale New Haven Hospital.

According to the CDC, the “high proportion of initial cases diagnosed in this outbreak in persons who identify as gay, bisexual or other MSM, might simply reflect an early introduction of monkeypox into interconnected social networks.”

Gay men also are “screened more than others,” Virata said.

While HIV began among gay men, “later on the general population caught up,” he said. “Heterosexual sex became the No. 1 risk factor.” Mother-to-baby transmission also increased.

Monkeypox can spread by coming into contact with “clothing, touching objects such as doorknobs, if you’re taking down the bedsheets,” he said.

While men having sex with men is the predominant group, “now they’re seeing a few women, although the numbers are still small, and even some children,” Virata said.

While both HIV and monkeypox can be spread through sexual contact, HIV also can be caught by contact with infected blood, Virata said.

There are differences between HIV and monkeypox. While there still is no vaccine for HIV, one is available for monkeypox, but much of it is in Denmark, said Dr. Frederick Altice, who worked at the CDC when the AIDS crisis began and is a professor of epidemiology, specializing in HIV/AIDS, at the Yale schools of Medicine and Public Health.

“This is preventable, because we have a vaccine if we could just get it out and get it into everyone,” Altice said. “There are issues of customs and transportation that have made it difficult to get it to the U.S.” The vaccine is 85% effective after two doses, given one month apart, he said.

He too said the way monkeypox is concentrated in the MSM population “can be a vehicle for extreme stigmatization.”

In the 1980s, “homosexuality was illegal, based on the sodomy laws, and most of [the] assault on homosexuals was thinly veiled then,” he said. “But even now it would be potentially a challenge because there are people in marginalized communities who would be stigmatized, and I think they would potentially feel discriminated against if they were thought to have monkeypox.”

Altice said there will be some people, “especially the very conservative communities, that are going to look at this as a way to stigmatize people, especially gay men.”

This is unfair, he said, because someone could easily pick up monkeypox at a dance club. “I think it will expand sexually beyond the MSM community,” he said.

When and if that happens, it will be public knowledge quickly because a monkeypox rash and lesions show up right away, and then fade over three to five weeks. “HIV was silent for 10 years until people would succumb to advanced complications,” Altice said.

When gay men in New York began reporting cases of Kaposi’s sarcoma, a type of cancer, because their immune system had been depleted, no one knew what HIV was. “We couldn’t even test for it until 1985,” Altice said. There is a simple test for monkeypox. Advances in treatment of HIV have greatly reduced the virus advancing to AIDS in the last 40 years.

Wu said, “”This is a very different disease, and one of the biggest differences is that the mortality for this disease is not the same” as AIDS.

“People shouldn’t be worried” about catching monkeypox, he said. “People just need to be vigilant and educated. If you take the precautions, no one needs to be worried at all.” Prolonged close contact, including risky sexual behavior, is what will spread the disease further, he said.

Contact Ed Stannard at estannard@courant.com, 203-993-8109.