Here we go again, I thought. I remembered how scary the coronavirus had been just two years ago, especially for those of us who were looking for privacy. Suddenly, a kiss was no longer just a kiss, but a potential vector for a life-threatening disease. And for those of us who lived through the 1980s and 1990s, the intersection of sex and HIV/AIDS remains embedded in our DNA. The same goes for the stigma and prejudice faced by people with HIV, especially gay men.
Monkeypox is ‘a public health emergency,’ says US health secretary
Monkeypox is a virus similar to smallpox, with more than 6,600 cases (a likely undercount) reported in the United States as of August 1. Cases are rising in New York, San Francisco and Los Angeles (and have been reported in all but two According to the Centers for Disease Control and Prevention, almost all cases to date have been in men who have sex with men, although the virus is not classified as a sexually transmitted disease because it is also transmitted through skin-to-skin contact, among other non-sexual means.
I was in a stunned San Francisco when the state announced a public health emergency. Among the concerns I heard: How can I protect myself? How to protect others? How to stop the stigma?
Even though there have been a tiny number of deaths from monkeypox so far (just six worldwide as of early August), those at risk — and not at risk — are scared of it. The disease is not minor. The lesions are often excruciatingly painful, sometimes compared to shards of glass scratching the skin, can require lengthy hospitalization and take weeks to heal.
Since frightened people don’t always behave well, it’s time to get familiar with the ways of monkeypox.
I know it might sound odd to quote Emily Post, but etiquette is the foundation of how we interact with others, and its original principles of consideration, respect and honesty apply just as well to a health emergency than any wedding hubbub. Any such discussion hinges on the importance of being informed, of reducing the possibility of transmission, and of treating – not condemning – those who fall ill.
Keep up to date: It wasn’t until two weeks ago, when I heard that a colleague had been vaccinated against monkeypox, that I started to take notice – and I’m a gay man. I quickly realized that, as the Washington Post previously reported, “sexual activity is a major driver of the current surge.” But the CDC warns that it can also be spread through any type of close contact, such as dancing shirtless, cuddling or sharing sheets and towels. Respiratory spread is also possible, but usually over prolonged periods (for example, if you live with someone infected with monkeypox). Read and stay up to date with the latest advice from reputable news sources.
What to know about monkeypox symptoms, treatments and protection
Talk about your state of health: Some health experts have advocated abstinence, at least for a while. But Hyman Scott, medical director of the San Francisco AIDS Foundation, told me, “It doesn’t work… telling people not to have sex doesn’t work. Instead, public health advocates like those at the San Francisco AIDS Foundation recommend reducing intimate contact and asking questions before sex: Talk with potential partners about any recent illnesses, ask questions about their (and disclose your) number of recent partners, and if anyone has had any new sores or rashes. “One thing we can do is be candid about our sex life, say who we’ve had sex with, what types of sex and when,” a man on a dating app told me after his first vaccination against monkeypox. “It will help people make informed decisions.”
Practice safer sex: It’s a lesson many of us learned in the early days of covid-19, the disease caused by the coronavirus, when nearly every type of intimacy, from a handshake, was fraught with possibilities of infection. Although monkeypox is much less infectious than covid-19, the CDC and other experts advise caution. Those who might be at risk should avoid kissing — and find ways to have sex or be intimate that avoid skin-to-skin contact. Cover rashes or sores with clothing (or a bandage), avoid touching them, which can spread them to other people and other parts of the body, and wash everything – hands, bedding, towels and sex toys – afterwards. Good hygiene protects everyone.
Create a “pod”: Remember the friend pods many of us developed during the height of the pandemic? To keep our sanity, we socialized with small groups of people we knew and trusted. The same idea applies here with sexual partners if you are not in a relationship or in a monogamous situation. An opinion piece on Poz.com suggested that “Pod members should monitor for symptoms for a few days…after [their] last potential exposure before having sex in groups, and sexual activity should be limited to those in the group. Again, trust and open communication are crucial.
To get vaccinated: I know, I know, another vaccine. The good news: The Jynneos vaccine is approved by the Food and Drug Administration to protect against monkeypox. The bad news: there aren’t many. Two injections are required, approximately four weeks apart, and the vaccine is considered to be at least 85% effective in preventing monkeypox. If you have been exposed, get vaccinated as soon as possible. The CDC recommends getting vaccinated within four days of exposure to prevent transmission. “If given between 4 and 14 days after the date of exposure, vaccination may reduce symptoms of disease, but cannot prevent disease,” the CDC states. Due to a lack of Jynneos, some experts advocate encouraging people to take a less desirable vaccine, ACAM2000, which has been approved for the related virus smallpox but not monkeypox..
Isolate if infected (or if you start showing symptoms): A widower in his 50s on the west coast, who asked me not to identify him because of possible stigma, isolated himself as soon as he felt and then saw “a very nasty lesion down his throat, even though it took him an entire week to get diagnosed. During this interval, he declined various invitations and began telling friends that he suspected he had monkeypox. “I didn’t want to be a spreader in my community.” He did the right thing – self-isolate from the time he had symptoms until he was no longer contagious several weeks later.
Only disclose your infection if absolutely necessary“I chose who I told carefully [because] I didn’t want everyone to know immediately,” said a man I know. “I was trying to avoid the stigma and feeling sick.” Among those he spoke to was a recent appointment, who also ended up being diagnosed with monkeypox. Arthur Caplan, professor of bioethics at New York University, acknowledged this fear: “There is stigma. The gay male community already carries this, the political climate in much of the country is openly hostile, and another “gay” disease reinforces this. Still, Caplan recommended telling your health care providers, such as dentists and massage therapists, about a possible infection, though it may lead them to decide not to treat you. “We have an obligation not to harm others or expose them to unintended risk,” Caplan said in an email.
Be kind: Offer help. Do not judge. As with anyone you may know who gets sick, ask what you can do to help, keep conversations private, and don’t let fear get the better of us. There are no “gay” or “straight” viruses. Scott put it this way, “Right now the LGBTQ+ community is bearing the brunt of this outbreak, but anyone can be at risk for monkeypox given how it spreads.” In other words, a virus is a virus is a virus.