How monkeypox spreads : NPR Public Editor Not repeating the mistakes of the past

How monkeypox spreads

Not repeating the mistakes of the past

Carlos Carmonamedina for NPR Public Editor
Illustration by Carlos Carmonamedina
Carlos Carmonamedina for NPR Public Editor

Even if you've never read And The Band Played On (read the book or see the movie), you know that many, many people died needlessly because of the mistakes made by politicians, public health officials and journalists during the first decade of the AIDS crisis.

It was pejoratively called the "gay plague." In the first years of the crisis, when newsrooms weren't ignoring the emergency (except for the San Francisco Chronicle), they made other mistakes. They marginalized those who had the virus, and they didn't educate the public or hold government officials accountable for their failures.

Because the then-fatal virus was spreading predominantly among "men who have sex with men," the public response was hampered by prejudice and moral judgment. Seeing that phrase emerge now, in relation to the spread of the monkeypox virus, has many people questioning whether we are making the same mistakes.

An audience member objected to the phrase, suggesting that there must be better language available to describe a particular monkeypox risk group.

We wondered about that phrase too, because the description seems particularly specific. After all, the virus itself doesn't target a particular gender. What we found is a complex web of advice from experts in both journalism and medicine. Read on to see why this phrase is important and accurate in many news stories — at this moment. It might not be relevant forever.

In contrast to that elaborate exploration of language and epidemiology, we also address a simple request for a correction. A recent NPR story about food expiration dates gave two different numbers for the official shelf life of milk in Idaho. A listener asked for clarity.

Finally, we thought that readers of the Public Editor newsletter should meet the new co-host of Code Switch, so we are spotlighting her introduction.

FROM THE INBOX

Here are a few quotes from the Public Editor's inbox that resonated with us. Letters are edited for length and clarity. You can share your questions and concerns with us through the NPR Contact page.

How NPR reports on monkeypox

Zachary Braun wrote on Aug. 1: I am not LGBTQIA+, so maybe my opinion doesn't matter here, but I wanted to file a general complaint to NPR on the reporting of [monkeypox]. So much of the reporting uses the phrase "men who have sex with men" which is a "medical" phrase with an ugly past. It has been used to blame, stigmatize, dehumanize and marginalize people.

Even if we ignore the history of the phrase, it doesn't reflect the current diversity of gender and sexuality within the LGBTQIA+ community. Yet, the reporting I have heard on NPR focuses heavily on the spread within that community. Even when the reporting is trying to be helpful, for example by pointing out that it isn't just the "men who have sex with men" that are being affected, the reporting is still hyper focused on that grouping.

Please find a different phrase ...

One of NPR's journalistic goals in reporting on monkeypox is to document what's known about this evolving contagious disease so that listeners and readers can make informed choices. Science Desk editor Will Stone addressed questions in guidance issued this week on appropriate language, created in collaboration with the newsroom, public health officials and LGBTQ+ journalist groups. Specifically, he suggested that writers and reporters use the following phrases, or variations on this language: "Monkeypox is spreading mostly among gay and queer people, primarily men who have sex with men," or "the majority of cases are occurring in gay and queer sexual networks," or "currently the risk is highest for gay and bisexual men."

That's because the monkeypox virus is transmitted mostly by skin-to-skin contact. Although it is not considered a sexually transmitted disease, most documented cases in the United States are among men who have had sexual contact with men.

This may change, which is why the guidance says a story should ideally include both gendered and non-gendered language about who's most at risk. That's important because not all those most at risk identify as men.

"If our coverage does not specify those who are disproportionately contracting the disease, it runs the risk of erasing the impact of the virus on what is already a historically marginalized group," the guidance says. "It could also leave LGBTQ+ people uninformed about their heightened personal risk and the steps they can take to protect themselves from monkeypox."

We looked to a variety of medical and journalism sources outside of NPR to ask whether the term "men who have sex with men" is appropriate. The phrase is often used for clinical purposes, but it's also meant to be more inclusive than "gay men" because not every man who has sex with a man is gay.

Bara Vaida is a member of the Association of Health Care Journalists and leads a group that offers guidance on covering infectious diseases. She told us that public health folks have wrestled with this same challenge: How to sound the alarm on the particular risk with the spread of monkeypox while not stigmatizing LGBTQ+ communities.

The CDC is another place to look for guidance. The agency says monkeypox spreads through close personal contact and lists sex as one way but not the only way. When describing the spread through sex, it does not specify who can spread the disease and lists both specific male and female genitals in its explanation. Likewise, NPR's newsroom guidance also encourages journalists to point out that monkeypox is not classified as a sexually transmitted infection.

Epidemiologist Katelyn Jetelina points out that while monkeypox is prominent among men who have sex with men right now, she warns that it could spread to other social networks. She says a similar transmission between networks happened with staph infections in 2008. There's chatter about "spread in colleges and schools, which isn't too far-fetched given tight-knit social and sexual networks on campuses. This doesn't mean there should be panic, but institutions should absolutely prepare," she wrote.

It's important for journalists to be cognizant of the mistakes the profession made in the first decade of AIDS coverage. Rae Lewis-Thornton, an AIDS activist and author, reminds us in The Washington Post that news coverage of that era "heaped stigma, shame and blame on gay men like a truckload of garbage dumping at a waste site" but at the same time it also gave anyone who wasn't a gay man a "false sense of security."

"By the time we learned that many men who had sex with men also had sex with women, thousands of women had contracted the virus. ... I was one of them," she wrote.

"Everybody wants to believe it's somebody other than me," she told us in an interview. "And so if I'm not gay, or I don't hang out in the gay community, then I don't really have to worry about monkeypox — when it's not true."

The public health and news messaging should telegraph that men who have sex with men "may be at risk now, but we really don't know if and when and how quickly it will spread to other communities out there," Lewis-Thornton said.

NPR's Stone told us that as the science on monkeypox evolves, so too will the language.

A recent All Things Considered story sought to explain these nuances in a conversation headlined "How to talk about monkeypox effectively, without stigmatizing gay men."

"This is not a gay disease," Gregg Gonsalves of the Yale School of Public Health told ATC. "There should be no stigma and discrimination, but it is affecting gay men right now, and we're going to need to modify our behavior — not out of some sort of moral admonition about our sex lives, but about protecting ourselves and caring for each other and showing solidarity with our fellow gay men."

The Association of LGBTQ Journalists advises using language that considers the audience for a particular story. "If you're reporting on clinical aspects of the outbreak, 'men who have sex with men' may be more appropriate. If you're reporting on the outbreak's effects on LGBTQ communities, other descriptors may be a better choice," the organization says on its website.

We analyzed several NPR stories on monkeypox, and many used the language "men who have sex with men," but the complete story offered more complexity, rather than implying it could be spread only via sex between men.

For instance, an NPR story on monkeypox vaccine supply acknowledges that gay and queer social networks are most affected and are contracting the virus through sexual contact, but also said it's "possible for monkeypox to transmit nonsexually: people can catch the virus through face-to-face interactions with someone via respiratory droplets or by touching a surface that was contaminated. But data from this outbreak show these routes of transmission are extremely rare in public settings." And there were other examples like this.

The language and nuance necessary to educate the public about the science behind the spread of the monkeypox virus is different from the demands of COVID-19. At the moment, the term "men who have sex with men" is accurate, alerting those most susceptible to contracting the virus. As often as possible, this term should be accompanied by other language informing the audience that the virus is likely to spread in particular ways among certain networks of people, that there are still other paths of contagion, and that it's an ongoing public health issue. — Emily Barske

Got milk (cutoff date)?

Tess Dornfeld wrote on Aug. 2: Just a minor error either factual or with the writeup, but the opening line of the print story says Idaho's milk cutoff is 21 days, but at 3:00 in the audio story, Sarah says it's 23 days. If the audio was incorrect, it would be nice to see a correction on the web version to clarify.

The introductory text of this story about food waste originally said, "In Idaho, milk can be sold for 21 days after it's pasteurized." In the audio of the story and in its transcript, Planet Money host and reporter Sarah Gonzalez says, "In Montana, milk has to be sold within 12 days of pasteurization. In Idaho, it's 23 days."

An explanation was needed to clear up any confusion for the NPR audience. After we reached out to the reporter with this note, the story was clarified.

The introductory text was changed to: "In Idaho, milk can be sold more than 20 days after it's pasteurized."

An editor's note dated Aug. 7 was added to the bottom of the story. It reads: "An earlier version of this page gave two different lengths for the amount of time milk can be sold after its pasteurization date in Idaho: 21 days and 23 days. Idaho allows milk manufacturers to set the date for their products. One milk manufacturer uses 21 days, and another uses 20 to 23 days." — Amaris Castillo

SPOTLIGHT ON

The Public Editor spends a lot of time examining moments where NPR fell short. Yet we also learn a lot about NPR by looking at work that we find to be compelling and excellent journalism. Here we share a line or two about the pieces where NPR shines.

Meeting Code Switch's new co-host

Code Switch officially has its new co-host: B.A. Parker. Last month, host Gene Demby gave audience members a proper introduction to Parker, a writer and audio producer from Baltimore who has worked on The Cut podcast and as a film professor. It's a very on-brand introduction, with Demby briefing us on how he got sucked into a This American Life episode that Parker produced. As Demby and Parker chop it up, we learn about her background and the kinds of stories she plans to explore on the show. Meeting Parker is a treat for listeners excited about the future of this beloved NPR podcast. — Amaris Castillo

The Office of the Public Editor is a team. Editor Kayla Randall, reporters Amaris Castillo and Emily Barske and copy editor Merrill Perlman make this newsletter possible. Illustrations are by Carlos Carmonamedina. We are still reading all of your messages on Facebook, Twitter and from our inbox. As always, keep them coming.

Kelly McBride
NPR Public Editor
Chair,
Craig Newmark Center for Ethics & Leadership at the Poynter Institute