Medical experts fear that stigma and discrimination perpetuated by the monkeypox virus against gay men and people of African origin, could prompt underreporting of the disease as was seen when HIV/Aids first emerged.
A new research paper published in the Annals of Medicine and Surgery, which includes the insights of doctors from the Middle East, Tanzania and SA, examines, among other issues, the consequences of stigma and discrimination in the face of the virus.
The National Institute for Communicable Diseases said since June 22 up to July 19, there have been three laboratory-confirmed monkeypox cases in SA, with no deaths reported.
The cases of monkeypox were reported from Gauteng, Western Cape and Limpopo and were males aged 30, 32 and 42 years, respectively.
The virus is transmitted from one person to another by close contact with lesions, bodily fluids, respiratory droplets and contaminated materials such as bedding.
According to the researchers, many of the cases confirmed across the world since May “are linked to men who have sex with men (MSM) networks, a demographic that is already stigmatised through the emergence of Aids”.
“Transmission of monkeypox disease remains primarily skin to skin and the possibility of sexual transmission is yet to be determined. The close contact required during sexual contact is likely to be a key factor for transmission — there is no current evidence that the virus is in itself a sexually-transmitted infection such as HIV or herpes simplex virus.”
The researchers said some of the claims “are likely to be discriminatory, homophobic, unfounded, and blatantly infringing the human rights of the LGBTI community that has consistently faced abuse.
“These concerns prompted the UN and the World Health Organisation to release statements, highlighting that these claims could lead to underreporting of cases if they were to be reinforced by the public.
2 to 4 weeks — duration of Monkeypox symptoms
1970 — the year the first case of monkeypox was identified in humans
95% of cases monkeypox affect the face
— IN NUMBERS:
“Monkeypox virus can affect anyone and is not linked to a particular sexual orientation. There are various reasons for this increase — some cases were from people who attended festivals, saunas and parties, and the lack of social distance, which is known to increase the likelihood of viral infections,” said the researchers.
“Additionally, while cases of monkeypox disease have been reported in over 30 countries in Europe, the UK, Australia, Canada, and the Middle East, images of the typical skin presentation have sometimes been from Africa, incorrectly suggesting the outbreak is an African disease.
“This can be seen to be reinforcing discrimination and racism in global health and once again exposing the colonial mindsets of public commentators.
“Such discrimination poses immense barriers to health equity, worsening the existing health challenges and access to treatment for these populations that are already overburdened with stigma. It is important that public health messaging highlights the individuals at highest risk while remaining free of discrimination,” said the researchers.
Dr Kapil Narain, one of the research authors based at a state hospital in SA, told TimesLIVE Premium: “Monkeypox is not scientifically linked to any particular sexual orientation. Statements and rhetoric that stigmatised the LGBTI community in light of the outbreak are baseless, homophobic, immoral and unethical. Anyone can contract the disease if health measures are not adhered.”
Matthew Kavanagh, UNAIDS deputy executive director, said stigma and blame undermine trust and capacity to respond effectively during outbreaks.
“Experience shows that stigmatising rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases and encouraging ineffective, punitive measures.”
Bulelwa Ngewana, executive director of the Open Society Foundation for SA, said it was “abhorrent that people are still being stigmatised due to their sexual orientation or for succumbing to an illness”.
Experience shows that stigmatising rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases and encouraging ineffective, punitive measures.
— Matthew Kavanagh, UNAIDS deputy executive director
“As someone who’s lived through the HIV/Aids hysteria of the 1980s, 1990s and even 2000s here in SA, and can recall the stigma and false equivalencies about the disease, it’s concerning to see how monkeypox is being framed in many circles.
“I fear that misinformation and disinformation regarding how monkeypox is spread, will further jeopardise people with a gay male sexual orientation or a bisexual orientation, groups that continues to face immense discrimination in Africa and many parts of the world.
“I think it’s important to iterate that monkeypox is not a sexually transmitted disease and that anyone can be affected by it.”
Pretoria-based organisation OUT LGBT Well-being said on social media that the disease is being spread by men who have sex with men (MSM) and “has been used to target members of this community”.
“We have seen this before, where gay and bisexual men were shamed, stigmatised and shunned in the early days of the HIV/Aids epidemic in the US,” said Dawie Nel, director of OUT LGBT Well-being.
“This cannot be allowed to happen again. The outbreak of a disease should never be accompanied by judgment and condemnation, but rather with compassion and the sharing of medical facts.
“OUT calls for rational and informed discourse on media platforms, without the blaming or shaming of any community,” said Nel.
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