The United States’ response to the 2022 human monkeypox (hMPX) outbreak has been a lackluster and consequential effort due largely to hand-wringing over who is most affected by the expanding health emergency. For public health officials it appears to have been more important to avoid triggering homophobia than using the most compelling data available that could effectively get the attention of persons most at risk.
Approximately 94% of hMPX infection worldwide and in the U.S. have occurred in men who have sex with men (MSM).
The first U.S. case of hMPX infection during the 2022 outbreak was reported on May 17. As of September 14, there have been 22,773 cases reported in the U.S. and 59,606 cases worldwide. Over the course of the 2022 outbreak, the cases have consistently remained in the MSM demographic.
The sudden and explosive hMPX epidemic in the U.S. appears to be slowing. However, there should be no relaxation of the effort to reach the persons most at risk if the spread of this serious infection is going to be extinguished.
Gay men, bisexual men, trans men and women, any men who have sex with men, and gender non conforming/non-binary individuals, who have had multiple sexual partners in the last 14 days are collectively the group with the highest risk of exposure.
Recent data on the U.S. racial and ethnic distribution of hMPX cases revealed 33% are white, 31% are Latino, 31% are Black, 4% are Asian, and > 1% Native American and Alaska Native. U.S. Census Bureau estimates that the U.S. population is 59% white, 19% Latino, 14% Black, 6% Asian or Pacific Islander, and 1% Native American and Alaska Native. The 2022 hMPX outbreak is disproportionately affecting Black and Latino men who have sex with men. The public health system should disproportionately respond to the need for education, prevention and treatment aimed at the most affected communities.
No one has innate greater susceptibility to the human monkeypox virus (hMPXV) because of their race, ethnicity, gender, sexual orientation, gender identity or expression. However, public health officials and the media’s over-emphasis on the fact that hMPXV can infect anyone while often avoiding the startling statistics on who actually is becoming infected and why, may be muting the effectiveness of the needed outreach to those communities.
The CDC’s inability to quickly and efficiently distribute the vaccine to affected communities, and the delay in starting clinical trials for the promising anti-viral therapeutic, TPOXX, increases the urgency to educate those at high risk. The hMPXV transmits very effectively via sexual contact. Men who have sex with men and have multiple sex partners are at very high risk for becoming infected because the virus is currently in this population.
Additionally, the 2022 hMPX outbreak would not have happened if the international vaccine and treatment response that is currently being marshaled (including the U.K. and the U.S. clinical trials for TPOXX) had been launched in prior years to address the agony and suffering in west and central Africa caused by hMPX outbreaks.
The leading refrain, “anyone can get monkeypox” may have the well-intended purpose of short circuiting a new stigmatization of the LGBTQIA+ community. The “gay plague” — a horrific early name for AIDS is not easily forgotten. However, it is far better to decisively act with honest, competent, equitable, and efficient public health services, unafraid of what ignorance and indifference will attempt than to be controlled by them. When those forces arise, we know how to ACT UP and Fight Back.
Adopted September 15, 2022
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