Warning Vulnerable Populations About Monkeypox Without Stigmatizing Them : Consider This from NPR Many of the people affected by the current global monkeypox outbreak are reported to be men who identify as gay or bisexual, or men who have sex with men.

The virus can affect anyone, but in response to where the majority of cases are, public health officials are gearing their information toward communities of gay and bisexual men. And that has some saying that the messaging echoes back to the HIV/AIDS crisis and has the potential to stigmatize the gay community while missing others who are susceptible to the disease.

We speak with Dr. Boghuma K. Titanji, physician and clinical researcher in infectious diseases at Emory University, about the lessons public health officials can learn from the HIV/AIDS crisis of the 80s and 90s.

And Northwestern University journalism professor Steven Thrasher talks about his recent article for Scientific American, "Blaming Gay Men for Monkeypox Will Harm Everyone."

In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

Warning Vulnerable Populations About Monkeypox Without Stigmatizing Them

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TEDROS ADHANOM GHEBREYESUS: The virus is behaving unusually from how it used to behave in the past. We are encouraging countries to do surveillance, contact tracing.

PARTHA NANDI: It causes flu-like symptoms, like fevers, chills, muscle aches and headaches. Then, a rash...


A virus behaving unusually - contact tracing, flu-like symptoms. It all sounds familiar, but these reports are not about the coronavirus. They're about monkeypox, also known as MPX. Stephen Thrasher is a professor at Northwestern University, at the Medill School of Journalism, and he's the author of the forthcoming book, "The Viral Underclass: The Human Toll When Inequality And Disease Collide." He says monkeypox, or MPX, was identified decades ago, first seen in animals, with the first known human infection in 1970 in the Democratic Republic of Congo. Most outbreaks have popped up in Central and Western Africa until recently.

STEVEN THRASHER: We should be concerned that it has affected people on the African continent for a long time. We shouldn't dismiss it because of that. It's had this spill-over into Europe and North America in the past few months.

MARTIN: Now, after two-plus years of dealing with COVID, you might be thinking, oh, no, not another virus. But to be clear, there are big differences between monkeypox and COVID. COVID is airborne. Monkeypox is not. It is spread by close physical contact. It's much less contagious, and the strain currently spreading around the world is so far less deadly than COVID, and there's already a vaccine. But doctors and researchers are taking note - keeping an eye on how the disease spreads and to whom.

THRASHER: It's moving right now between communities of men who have sex with men - gay men and bisexual men.


UNIDENTIFIED PERSON #1: It is now believed some of the monkeypox cases can be traced back to gay events and saunas in Europe, but health officials stress anyone can get the disease.

MARTIN: And this is where people like Steven Thrasher get concerned - as the conversation moves from the scientific and medical worlds to the general public through the media, as it eventually has to. For some, these messages bring uncomfortable reminders of a different global disease. Listen to these reports from 1980.


UNIDENTIFIED PERSON #2: Do you suspect that it's possible that this disease could be spreading from the gay population in San Francisco to non-gays in San Francisco and thence on to other cities?

UNIDENTIFIED PERSON #3: I suspect it is spreading, and I suspect it will continue...

DAN RATHER: At first, it seemed to strike only one segment of the population. Now, Barry Peterson tells us this is no longer the case.

MARTIN: They're talking about HIV/AIDS.

THRASHER: It's good not to think of monkeypox or even HIV as sort of LGBTQ viruses because there's a specificity to men who have sex with men.

MARTIN: That's Steven Thrasher again. He recently wrote an article for Scientific American titled, "Blaming Gay Men For Monkeypox Will Harm Everyone." Thrasher and other experts, doctors and journalists have emphasized that monkeypox is not a, quote, "gay virus," unquote. Anybody, as we said, can get the disease, but the CDC says, at the moment, that they are targeting their public health messaging to communities of gay and bisexual men because that's where the majority of cases are right now.

THRASHER: It is a conundrum - right? - to kind of figure out - how do we get information out about MPX without stigmatizing the people who are most likely to be affected about it?

BOGHUMA K TITANJI: One of the key pieces of being able to get on top of the situation is empowering the public with information. That gives me hope.


MARTIN: CONSIDER THIS - how do you get health information to vulnerable groups without causing panic or stigma, but also without letting other people think they have nothing to worry about? Learning from mistakes of the past - that's coming up.


MARTIN: From NPR, I'm Michel Martin. It's Saturday, June 18.

It's CONSIDER THIS FROM NPR. We started our conversation with a brief primer on monkeypox, or MPX, earlier. But let's get the big picture now - what it is, what it isn't and why it's a concern.

TITANJI: It is what we call a zoonotic virus, which means it's a virus that normally circulates in wild animals, but on occasion can cross over from wild animals and infect humans.

MARTIN: I spoke with Dr. Boghuma K. Titanji. She is a physician and clinical researcher in infectious diseases at Emory University. She says symptoms of MPX can include a fever, skin rash and painful lesions that are similar to smallpox. And like smallpox, in some cases it can be fatal, but it is a very different disease.

TITANJI: Most individuals who have an infection from monkeypox virus will not need to be hospitalized for treatment, and a lot of people tend to do well just by receiving supportive care and hydrating properly, staying at home and isolating until their skin lesions recover.

MARTIN: Given that monkeypox is treatable and has been for some time, I asked her why it's in the news.

TITANJI: Over the past month and a half or so, there have been reported cases of monkeypox happening in countries that are not endemic for the infection, simply meaning that we are identifying cases of monkeypox in countries that we have not known in the past to be countries where the virus is circulating in wild animals. And obviously, that raises the concern of - why are we seeing so many cases happening in so many non-endemic countries at the same time?

MARTIN: I asked Dr. Titanji if she's seen monkeypox, or MPX, talked about in a way that concerns her.

TITANJI: One of the features that have been quite notable in the current outbreaks is that a lot of these cases have been in men who identify as gay, bisexual, or men who have sex with other men. And what that has done is that the messaging to the general public may have been such that individuals who do not belong or identify as part of this group may feel that this is not a concern to them and may feel that this is an infection that can only affect gay men or bisexual men or other men who have sex with men. Now, obviously, that is dangerous because such messaging breeds stigma, which is not helpful. And when we are trying to contain an outbreak, what we want is we want people to seek medical care when they see suspected lesions so that they can get tested and be offered the treatment they need.

MARTIN: Talk a little bit more, if you would, about that because I think that, as a public health person, maybe it's obvious to you why it is that you don't want to stigmatize people, but some people may not. They might think, well, you know what? That's a corrective of behavior. It'll, you know, help people - if something is, you know, shameful, they won't do it. So could you just talk a little bit more about why, from a public health perspective, stigma is not helpful?

TITANJI: We have a lot of experience from the HIV epidemic, which has been with us now for 40 years. We know that in the very early days of the HIV epidemic in the United States. Some of the first cases of a particular type of pneumonia that is associated with having a weakened immune system was first identified in gay men, and in the early days of that response, that led to HIV being labeled a gay disease. And we now know, 40 years later, that that is very far from the case. And what that did, in terms of the response to HIV in the early '80s, is that it wasn't prioritized because groups of individuals were stigmatized and blamed for having a viral infection. And also, the resources weren't channeled to address the outbreak when it first started. Lots of people had to live in hiding, and this really led to a lot of pain and suffering in the gay and bisexual community at that time.

Now, in hindsight, we know that the impacts of that stigma that was present in the early days of the HIV response lingered for multiple years later on. And we have essentially been playing catch-up to destigmatize HIV since that time. So when I think about the ongoing situation with monkeypox, I immediately see parallels, in terms of how incredibly damaging stigmatizing the messaging around the ongoing outbreaks could be, in terms of the response. The last thing we want is for people to be blamed if they have an infection. We want to encourage people to come forward so that they can get tested. And I also think that it's very important to highlight to the general public that, while we may be seeing clusters primarily in certain groups of people, viruses do not discriminate by race, by religion or by sexual orientation. And a virus can infect absolutely anyone.

MARTIN: Are there lessons that you think public health officials could be taking, or should be taking, from the - from what happened during the era of the - you know, the '80s and '90s, as you were talking about, when HIV and AIDS kind of first appeared, you know, to the general public? I mean, are there lessons that have been learned from that, that people should be applying now?

TITANJI: If you don't address stigma as it emerges and make sure that the public is very aware that, you know, that can be damaging, what happens is that you create complacency in other segments of the population who may not feel concerned by an ongoing public health situation that really needs all of our attention. So it's all about drawing from the lessons and doing so early so that we are putting in place the interventions that allow us to have a better response this time around than we did previously, with other outbreaks. So how do you get the right message out? How do you package that message so that it is clear and restores the trust of the public in public health authorities and those who should be carrying the message on public health when these issues are concerned?

MARTIN: So how should they? Let's fix this thing right now, doctor.

TITANJI: (Laughter).

MARTIN: What should they be doing? What should they be doing? What should everybody who's involved in communicating about this - are there some best practices that people should be engaging in?

TITANJI: I can only speak from my approach to sort of talking about public health issues. I think that it is important to stick to the facts. It's important to acknowledge where there is a paucity of evidence - when you don't know, be able to say we don't know, and always caveat the message with the fact that outbreaks and infectious disease situations or other health concerns can be evolving as the science changes. And as we know more, some of the information that we give could also change.

I think that these, for me, have been lessons that I have learned through the years in terms of, when you lay the groundwork in that way, the public is not surprised when you come back and you say, hey, look, that thing that we said six months ago when this started - actually, we now know more, and it has changed. So this is the updated information, and this is how we should act.

When we message and kind of make the foundation of that messaging be humility, in the sense that not every question around a particular disease situation is resolved and that we may not have all the answers - I think that that vulnerability, in itself, restores some of that trust because it makes the public health officials come across as being human.


MARTIN: Dr. Boghuma K. Titanji is an infectious disease physician and virologist at Emory University. Getting information about a disease outbreak to the most vulnerable groups is key, but often it is not easy. That's coming up.


MARTIN: The World Health Organization is convening its emergency committee next week to decide whether the monkeypox outbreak is a public health emergency of international concern. That's the world's highest health alert. The only two viruses that currently have that designation are COVID and polio.

THRASHER: I study this stuff, and I had a nightmare the other night that I had it. And in the nightmare, I couldn't - like, I didn't know where to go.

MARTIN: Steven Thrasher writes about inequality in health care. He worries that the public health system could be doing more to prevent the spread of monkeypox.

THRASHER: And it's really unfortunate because, where I live in Chicago, and throughout the coronavirus pandemic, I got notices about what the rate was, whether or not to use masks, where to get a vaccine, when I was eligible for a vaccine, when to get a booster. All of that just went straight to my phone.


THRASHER: Nothing like that is happening right now.

MARTIN: Thrasher says that there's still time to make sure the right people get the right information about preventing and treating monkeypox.

THRASHER: Part of what we need to do is have a harm-reduction model for what can be done. Part of that looks like keeping people's contact information, letting them know what they need to look for, in case they get affected after the fact. And there, I think LGBTQ organizations can have a lot of effect.

MARTIN: At the same time, he realizes that information only goes so far. There also needs to be resources in place for testing and vaccinations.

THRASHER: We have to be prepared to support people, as they need, when they're diagnosed.

MARTIN: But he says there's another part, a more difficult and complex problem - the public and private perceptions that come from focusing prevention messaging on men who have sex with other men.

THRASHER: Part of it is not a quick fix, and I won't pretend like I have a quick-fix answer for it. It's to make a society that doesn't have homophobia because as long as there is a homophobic society and people are afraid of what it means to come forward - that this thing will make people think that they're gay - then they're not going to want to come forward. And there's no easy fix for that. That's a long-term problem that needs long-term thinking to undo and make different.



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