Misinformation, public sentiment and the emergence of the monkeypox virus have all contributed to the stigmatization of gay communities in the United States.
AIDS sentiments were dangerously close to the beginning of the last 40 years. Health responses have improved but stigmatization around sex, especially in queer communities, persists, making it difficult to receive necessary care.
Red Door Clinic serves a large LGBTQ population and has been focusing its efforts on monkeypox education. It reaches out to those who are more at risk and are eligible for vaccinations.
“In general, when you think about sexual health, there has been a lot of stigma and shame that some patients have had with it.” James Flowers, a community specialist at the clinic, said that they want to provide a refuge for them.
The Minnesota Department of Health (MDH), which funds the clinic’s Pre-Exposure Prophylaxis program (PrEP) medication, Flowers leading a program to lower HIV risk. The clinic is experiencing a revival in activity now that monkeypox has been brought to the forefront of people’s attention.
“We are seeing some patients who haven’t seen us in a while come back to the clinic,” Flowers said. Flowers stated that monkeypox is a major focus of a lot our work here.
According to the clinic, cases have increased since Red Door’s first case in June 24. There were 87 cases of monkeypox in Minnesota as of Aug. 18. The case count stood at 130 as of Friday, Sept. 2.
Priority vaccination
There is also a shortage of vaccines. According to MDH, there are two vaccines available in the United States to prevent monkeypox. They are being distributed in Minnesota to healthcare systems that care for those most at risk.
Red Door is determined to ensure that the vaccine is available to all people at risk of monkeypox. This should not be confused with gay men as some right-wing media outlets may have promoted. Red Door patients are well aware of the stigma surrounding sex and sexual orientation, and the effects monkeypox had on gay communities.
Red Door supplies vaccines to people who don’t have symptoms of monkeypox and have been exposed within the last 14 days to someone who has been tested positive for monkeypox.
It’s also available to people who are involved in sexwork, people who identify gay, bisexual, or other men who have had sex with more than one man in the last 90 days, and those who have been deemed at greater risk by their health care provider.
“Most patients I have spoken to recognize the need to protect themselves and are well aware of the existence of monkeypox in their community. Flowers stated that they are reaching out to others to find ways to lower their exposure and transmission.
Flowers stated that part of this response includes addressing historical distrust of the health care system. Another strategy is to make use of technology tools to determine which zip codes, communities and populations the clinic might not be serving.
The problem is the scarcity of vaccines.
“We are, as other providers, at the mercy the available vaccine. From an equity perspective, we know that this is something we must do. James and his colleagues are doing this work. This is part of our strategy to hopefully slow down the outbreak,” stated Allison Thrash, communications manager at Hennepin County Public Health.
Thrash reports that Red Door had administered 2,693 doses (or 2.1 million) of the JYNNEOS vaccination as of August 31.
Priority is given to those who have HIV or an immune-compromising condition. They are also eligible for PrEP or who are at higher risk of infection by a clinical source.
Social ties to HIV/AIDS epidemic
Kumi Smith, University of Minnesota epidemiologist, says that monkeypox stigma is unavoidable. Smith stated that monkeypox is similar to HIV/AIDS in how society and the media have treated it. She considers this one of the most politically charged diseases in the world.
Smith stated that one reason is that people who engage in taboo behavior, such as commercial sex and same-sex, are more at risk of infection. He also said that injection drug abuse can be a contributing factor. It’s been highly politicized since that time.”
Smith stated that how the disease is presented in media and society can have a significant impact on who is impacted first. In the U.S., this was gay men and those who inject drugs.
Smith stated that Smith believed it was because it was more common in men who had sex with women, making it synonymous with the so-called “gay disease.” “There was a stigmatization of gay people, and then there was more marginalization when they started to get this fatal disease (HIV/AIDS). They felt that it was something they could pass to the rest.
Because of the taboos surrounding queerness, Monkeypox is also stigmatized. It was the gay community that was first to get impacted.
Smith says that this is due to epidemic patterns, where the epidemic occurs first and then the spread of the epidemic is dictated by the population.
Smith said that there is no gay disease. Smith said that there are sexually transmitted diseases. However, that does not mean that all sex is at risk. However, it is possible to see certain groups more susceptible to them. But, there is no disease that can only be transmitted between gay men and gay people. It’s possible that the disease will spread to other groups if we don’t address it quickly.
Kat Rahn, OutFront Minnesota’s executive director, believes that stigmatization is particularly prevalent in the health care system.
“I believe that one of the dangers in monkeypox discourse is that it stigmatizes behavior that’s considered more risky. Rahn stated that some people might feel that the messages are making them more dangerous or risky. They might also be less likely to tell others about their status or engage in helpful and necessary conversations with health care professionals.
Flowers claims he hasn’t heard patients express concern about the stigma. However, that doesn’t mean that there isn’t a stigma associated monkeypox.
Flowers stated, “That’s part of the nature stigma too is they… might not just come in.”
Response
Providers are focused on the way the government dealt with the AIDS epidemic.
Flowers stated that “that kind of level of neglect by the government back then, in the ’80s, and early ’90s… I think it has had a ripple effect that we must be aware of as providers as well as as people in medical professions, as well as in sexual health care,” Flowers added. It is important to be aware and aware of the history of this country and to take steps to avoid biases in our work.
Smith stated that the association between monkeypox, gay men and society today is a sign of a complex society.
It shows that there is still a stigma attached to gay sex. Smith said that some people have misunderstood the early profiles of early affected people, and assumed it was because of their behavior. “And so people start to cite these hypotheses even though they don’t have any evidence. That’s where I believe the stigma’s really showing up.”
HIV can be sexually transmitted while monkeypox is not. Because it can be spread by nonsexual skin-toskin contact or face-toface contact, monkeypox is much more transmissible. Smith stated that this difference should be recognized in public policy.
“(During the AIDS epidemic), there were a lot resisting to even talk about gay sex. That was a big problem. This is not a discussion about sex, or the type of sex that should be had. This is Disease Prevention 101. Smith stated that we need to tell people how it is transmitted.”
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