Monkeypox became an emergency because we’ve neglected LGBTQ community health

As gay men working in medicine, watching the monkeypox virus spread through our community has been devastating.

On July 23 the World Health Organization declared monkeypox a global health emergency. But in New York we’ve been seeing the outbreak’s effects for weeks.

Monkeypox is not a novel virus. The infection, which can cause fever, headaches, body aches, fatigue and a painful rash across the body, already has government-approved vaccine and treatment as well as an established lab test. The national scientific community couldn’t have been more primed for a monkeypox outbreak. The U.S. contained an outbreak in 2003 and experts have warned of a potential epidemic for more than a decade. Yet despite our resources and medical knowledge, U.S. case numbers are multiplying rapidly — going from one case reported in May to more than 2,000 in two months and now approaching 4,000 known cases. Data published this week shows the U.S. leading the world in reported cases. (The current strain has caused no known deaths in the U.S. and its fatality rate has been estimated at 1% or less.)

So how did we get here? The answer is simple: Viruses spread fastest among the most marginalized, underserved and under-resourced individuals. Our public health interventions often fail to reach these people, further worsening health care disparities and stigma — and enabling larger outbreaks.

It’s no accident that this virus receiving a weak public health response is one that mostly affects men who have sex with men, many of whom self-identify as gay, bisexual and transgender. In fact, WHO advisers declined to declare a monkeypox emergency in June in part because the disease has not moved out of this primary risk group. With cases rising, WHO Director-General Tedros Adhanom Ghebreyesus overruled advisers to make the declaration. To be clear, nothing about LGBTQ individuals makes them more biologically susceptible to monkeypox. The current outbreak is primarily transmitting via close physical and sexual contact, though it can also spread through respiratory secretions and touching infected materials (such as clothing and linens). The reason this virus continues unchecked among men who have sex with men is that public health authorities have been slow to treat the risk to these individuals as an emergency.

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