What queer people need to know about mpox

After more than two years of COVID-19 information taking over our social media feeds, it’s hard to imagine a new viral infection not going, well, viral. 

Such is the case with mpox, an illness endemic to central and western Africa that is best characterized, symptom-wise, by raised spots and blisters on the skin. 

Following the mid-May confirmation of dozens of cases outside Africa, a flurry of headlines, commentary and social posts began to circulate—many of which suggested that the disease is primarily infecting queer people in North America, Europe and Australia. As of May 25, the World Health Organization has confirmed more than 237 mpox cases in countries where it doesn’t usually spread.

From the jump, mpox had all the ingredients of a trending topic. An eye-catching name. Visceral symptoms. The threat of an encroaching “foreign” threat. A collective interest in what the next COVID-19 could be. Reports that it was circulating in already marginalized communities. 

But parsing the real truths and half truths about mpox reveals the hard line to walk when sharing health information.

What we know about mpox

Fortunately, there’s a lot that we do know about the virus, which was first discovered more than six decades ago (in a group of monkeys, as the name suggests)—a virus that typically spreads from animals to people. 

We know that, at this stage, there’s not much cause for panic. Mpox is more difficult to spread than COVID-19. While it can spread in a sexual context, it is not considered sexually transmitted—that is, it’s not known to spread through vaginal or seminal fluids. The virus can be transmitted through close bodily contact, however, as well as contact with body fluids and sores, and through respiratory contact. 

Symptoms are mild—fever, body aches, coarse bumps—in the vast majority of cases, and most people recover on their own after a few weeks. The smallpox vaccine is a largely effective preventative measure, as are medications for this family of viruses. While the Canadian government stopped vaccinating people for smallpox in 1972, the country did order a stockpile of smallpox vaccines earlier this year. 

Global health agencies have been cautious about making definitive declarations about these recent cases. The overall number of cases is not high, but the rate of transmission is not clear, and of course, there are mutations to keep an eye on. 

Some elements of the virus’s nature do demand close attention. The incubation period is long, with symptoms taking as many as 21 days to appear, and people being contagious days before any rash develops. As well, some people with mpox have become very sick and died, even though that hasn’t yet happened in any of the recently detected cases outside Africa, or in any case outside of Africa for years.

Connection to the queer community

Mpox cases outside endemic countries have usually been linked to travel. During this outbreak, however, confirmed cases have disproportionately been traced back to queer spaces, specifically those for gay and bisexual men.

For instance, a gay sauna in Madrid, Spain, has been linked to mpox cases, as has a Canary Islands Pride celebration. In Belgium, some cases are being connected to a gay fetish festival. The first mpox case in Toronto was reported in someone who had visited two queer venues. The U.S. Centers for Disease Control confirmed that gay and bisexual men make up a disproportionate number of U.S. cases, and issued a warning ahead of Pride month. 

However, the more gayness dominates the mpox narrative, the more the virus, in the public imagination, warps into something it’s not.

“This is not a gay disease,” says Gregg Gonsalves, an AIDS activist and epidemiologist at Yale University. “It’s not a sexually transmitted disease in the classical sense, either, as it can be transmitted skin-to-skin, object-to-object.” Focusing too much on queer sex and venues, then, warps the percieved risk levels for everyone, gay or straight.

“This is not a gay disease.”

Likewise, many of the confirmed mpox cases are being reported to WHO by sexual health services for men who have sex with men, as mpox lesions could appear on genitals and be mistaken for an STI.

As a community that has lived through—and is still living through—an HIV epidemic as they also grapple with high rates of other STIs, queer men have a lot of experience engaging with testing, treatment and being open with sexual partners when they notice anything unusual about their health.

“With the current situation, gay men have been overrepresented, but that may be reflective of the fact that they are more likely to show up and be assessed,” says Dane Griffiths, director of the Ontario-based Gay Men’s Sexual Health Alliance. This behaviour should be upheld as an example, not punished with false correlations and causations, he says.

“Shame is bad for our health, and blame is never appropriate in these situations.” 

How to protect ourselves and others from mpox

Characterizing mpox as a queer virus isn’t accurate, and global health agencies came out this week to make that point more clear. Still, the reality is that transmission has been linked to queer spaces. While queer people shouldn’t be blamed or judged, there are things we can do to better protect ourselves.

To start, be aware of the symptoms and speak to a medical professional if those symptoms appear. Also, try to keep a sense of who you’ve had close contact with if you need to go back and inform them of potential exposure. These steps become harder to follow, though, when stigma is involved.

“If we want to deal with this quickly, efficiently and humanely, we have to let people with symptoms safely come forward—that there’s not going to be retribution or recrimination,” says Gonsalves. He points to former U.S. president Donald Trump’s references to COVID-19 as the “China virus”—a disease he characterized as being spread by “foreigners” who needed to be controlled—as an example of exactly what to not do with mpox.

“We should reject any stigmatization, discrimination or violence here, because it’s very easy to scapegoat people like us for diseases like this.”

So, should queer people rush out to get a vaccine? Not right now. Smallpox vaccines aren’t widely available, so it’s important to reserve them for populations that are most at risk (though WHO and national health agencies are exploring a ramp-up in production). 

Should we be avoiding the large gatherings that accompany summer Pride festivals? Not necessarily. Walking through a large Pride gathering doesn’t allow the prolonged skin-to-skin or skin-to-object contact that best facilitates mpox transmission. As for respiratory droplets—say, if you’re in a crowded indoor club—the risk of contracting COVID-19 is greater right now. Masking, while not the primary defence against mpox, can protect people from an assortment of airborne viruses and bacteria.

Beyond self-screening for mpox symptoms, people not feeling well—for whatever reason—should avoid social gatherings to protect themselves and others. 

“Like every other Pride, we can ask ourselves questions and take steps to maintain our health. That’s with mpox, COVID-19, sexual health and more,” says Griffiths.