Monkeypox and gay men: Separating stigma from health advice

A large proportion of monkeypox cases diagnosed in the UK are among gay and bisexual men.

Doctors and public-health experts have spoken to the BBC about the "delicate balance" of keeping those currently most at risk informed, without stigmatising them or letting others become complacent.

The short answer is no. Anyone can be infected by monkeypox.

The virus is not a sexually transmitted infection. It's mostly caught through close physical skin-to-skin contact, which is why it can be spread to sexual partners.

But with most confirmed cases among men who have sex with men, doctors are encouraging this group to be particularly alert to symptoms.

Mateo Prochazka, an epidemiologist from the UK Health Security Agency (UKHSA), said: "The infections are not about sexuality. We are concerned about monkeypox in general, as a public threat. We are worried about everyone's health."

As monkeypox is often caught through direct contact, once it's introduced to a community, it is more likely to spread through that community among those who are in close contact with each other - for example, within a household or among sexual partners.

Dr Prochazka says it's not clear why there is a higher proportion of cases among gay men.

He says: "It just happens that the infection appears to have been introduced in networks of gay and bisexual men and other men who have sex with men. And this is where we're seeing most of the cases."

There is a theory that a return of demand for international travel since Covid lockdowns were eased could have played a part in the initial spread.

But the person-to-person transmission that has been happening in countries outside western and Central Africa in recent weeks is new.

Scientists are investigating whether the infection was introduced via a combination of single transmissions or, whether so-called "super-spreader" events, such as a festival, may have resulted in more people catching it at one time.

Dr Prochazka says another possibility is that the proactive engagement of gay men with sexual-health services may have led to more cases being diagnosed.

What is Monkeypox?

James Gallagher explains what it is and if we should be worried.

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Gay and bisexual people were subject to stigma and homophobia following the Aids crisis in the 1980s and 1990s.

Doctors and charities are keen to ensure this isn't repeated with monkeypox and are concerned it could also prevent others from realising they might have the virus.

HIV and sexual health charity Terrence Higgins Trust is raising awareness alongside the UKHSA and NHS leaders to learn more about monkeypox and how it's affecting people.

Alex Sparrowhawk, from the trust's health improvement team, says they're worried people might mistakenly regard monkeypox as a so-called gay disease and says everyone needs to be aware of the signs and symptoms.

Jaime Garcia-Iglesias, a sociologist at the University of Edinburgh who has studied how Aids and Covid-19 affected certain communities, says there's a "significant risk" that the stigma "comes to the surface again" and might stop people from seeking the help they need.

Dating apps, such as Grindr, are also advising users about what to look out for.

Dr Prochazka says as case numbers are so small, experts aren't advising people to change personal behaviour but to be "hyper-vigilant."

He acknowledges the "delicate balance between achieving freedom of choice and freedom of infection" and says it's important people are well-equipped to make their own decisions.

Condoms protect against sexually transmitted infections, but they do not prevent monkeypox being transmitted.

Mr Sparrowhawk says people shouldn't be overly worried but if someone isn't feeling well and develops symptoms such as "fever, headache, swollen lymph glands and a rash" they should get in touch with their clinic for further advice.

If you don't have any symptoms and you're due to attend a regular sexual-health check-up, you're urged to go ahead as planned.

If you have a new and unusual sore or rash it's advised that you contact your local sexual-health clinic, but don't turn up for an in-person appointment unannounced.

Those who are most at risk after coming into contact with a confirmed monkeypox case are urged to isolate at home for up to three weeks.

Most infections clear up on their own without any treatment but if you think you have monkeypox you're still urged to tell your doctor.

As it can take three weeks for symptoms to appear, it's likely the number of diagnosed cases will grow.

And while the UKHSA acknowledges that the outbreak is "significant and concerning", it says the risk to people in the UK remains low.

It's hoped the virus is rare enough that it can be contained.

Dr Prochazka says when a new threat enters a network of people "we do our best to suppress it. I think we are still at that stage where we can do that and really respond to this".