Monkeypox is overwhelmingly affecting men who have sex with men in western countries. 

This has led to misinformation and misleading narratives that it’s a “gay virus” when it’s not. 

Monkeypox is a poxvirus that is closely related to the smallpox virus. 

It’s less severe than smallpox and is spread through skin-to-skin contact with lesions as well as through droplets, bodily fluids and saliva. 

As of today, there have been over 20,000 confirmed monkeypox cases worldwide.

Why does monkeypox mainly affect gay and bisexual men?

About 99% of monkeypox cases in the United States, Spain, the United Kingdom and Canada are related to men who have sex with men (MSM), according to the World Health Organisation

One reason there’s a high number of cases among gay and bisexual men is because of stigma and discrimination, infectious disease and sexual health physician Dr Massimo Giola says. 

Giola says monkeypox is not a disease that only affects gay and bisexual men.

“It's not a gay virus. Anyone can catch it, but for some reason it's spreading among the sexual networks of gay and bisexual men.”

And the reasons for that are complex, Giola says.

“Gay and bisexual men still suffer from stigma, discrimination and bullying.” 

“And so we tend to congregate in safe places, which might be gay bars, gay saunas, pride parties and cruises.

“There will be places where there will be a lot of gay men congregating in a small place because that's where we feel safe. Obviously, that gives infections and particularly STIs the best opportunity to spread,” Giola says.

Burnett Foundation Aotearoa (formerly known as the NZ Aids Foundation) chief executive Joe Rich says the organisation was starting to see an increase in misinformation and stigma surrounding the outbreak.

“We're seeing judgement and poor attitudes around what's actually happening, particularly surrounding the fact that gay men are increasingly affected.” 

“We're asking people to understand a little bit more about what's happening. There's nothing wrong with something that's being transmitted through sex,” Rich says.

One reason why MSM are being disproportionately affected is because the gay community is small and well connected, meaning diseases can spread much easier, Rich says.

“The general population has about six degrees of separation, whereas with gay and bisexual men, it's more like two degrees of separation.

“Because everyone's so much more closely connected, when an infection gets into our community, it can spread around very quickly.”

The stigma that exists for gay and bisexual men during this time is something everyone can take responsibility for, Giola syas

“There will be someone who's got a political agenda to use this as a discrimination tool against gay and bisexual men, and the rest of society needs to be aware and not allow that to happen.”

How serious is monkeypox?

In most cases, people can treat monkeypox at home and make a full recovery within three to four weeks. But the infection can be very unpleasant.

Under current protocol, if you get monkeypox you will need to isolate for up to three weeks.  

Rich says this could be a big issue, especially for those who are not out to their employers. 

“Not everybody's out to their employer and if somebody's needing to isolate for three weeks and explain to their employer what's going on, it's going to be problematic.

“It's something we should absolutely be concerned about and do everything we can to avoid it becoming endemic, which means something that is always circulating.”

Giola says some people have experienced serious reactions to the virus.

“There has been a person who had monkeypox where the virus punched a hole in their rectum causing, what we call in medicine, a fistula. So a hole going from the rectum to the skin, and that had to be fixed with surgery.

“It's not nice. It's a really nasty infection and you really want to avoid it if possible.”

Just like with Covid-19, the more people the virus infects, the more the virus mutates. 

This means the seriousness of the disease and the way it transmits between people could change over time. 

“The virus is mutating and might actually be adapting to be transmitted more efficiently during sex. For example, there have been some cases where the virus has been found in semen.”

“But you have to remember, we still know very little about this outbreak, and still very little about the virus,” Giola says. 

Is there a cure for monkeypox?

The good news is that monkeypox is a vaccine-preventable disease.

A smallpox vaccine that should work against monkeypox is estimated to be around 85% effective

The problem is there is very little stock of the vaccine available worldwide. 

New Zealand will not be at the front of the queue but the Burnett Foundation and the sexual health sector are actively advocating for the Government to get as much of the vaccine as possible.

“It's really important that New Zealand does get hold of the vaccine and that the vaccination strategy is targeted to people at the highest risk and who need it the most,” Rich says.

What should you do if you are a sexually active gay or bisexual man?

The main message for gay and bisexual men during this outbreak is to stay calm and look out for symptoms. 

Giola says gay and bisexual men should check in with their sexual partners to make sure they are well.

“There's no need to panic. But definitely, there's a need to be vigilant.” 

“If you are planning to have sex with someone, make sure they are well and make sure you have a look and check there are no nasty looking skin lesions that could be monkeypox,” Giola says.

“If you think you might have monkeypox, get checked and don't have sex or any sort of intimate skin to skin contact until you have been checked out and given the all clear.”

Top Image credit: Getty

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