Early Neglect of Monkeypox is Rooted in Homophobia
Men queuing up in Chicago in the US for the monkeypox vaccine

With COVID still upon us, it is hard to fathom why we have waited so long to address monkeypox. A cardinal rule of public health is to catch an emerging epidemic at the first instance it appears. Monkeypox, which was isolated in a few countries in Africa, leapt to Europe in early May and is now in over 80 countries. But the WHO waited until 23 July, 10  weeks later, to declare a public health emergency and the US government delayed until 4 August.

Much like with AIDS, initially the most affected group has been gay and bisexual men. The cause of the early neglect of this monkeypox pandemic is rooted in homophobia. Even in liberal bastions like Los Angeles, there is a lack of attention to gay men’s health. 

The inadequate, delayed responses to monkeypox and the raging epidemics of syphilis, gonorrhea, and chlamydia among gay men are not ok. Of course, these diseases don’t stay confined to any one geography or group. Thus, the rates of sexually transmitted diseases (STDs) have skyrocketed across the United States. 

Primary prevention for HIV has been completely abandoned by government officials in favor of costly biomedical interventions, a shift that has harmed the condom culture; has not brought down new HIV infections in the most vulnerable populations of men of color; and has left us open to the new scourge of monkeypox. 

If you support gay men, you must take our sexual health seriously.

 No coherent STD plan

STDs also disproportionately affect people in communities of color. Black babies stillborn because of syphilis, in one of the wealthiest cities in the world, is unacceptable. STD services are grossly underfunded and inaccessible to many. Neither the US federal, state nor local governments have coherent plans to address the STD crisis. The basics of public health responses need to be restored – education, prevention, training, treatment, and research. Drug-resistant gonorrhea looms on the horizon. The time to begin addressing it seriously was 21 years ago when syphilis resurged.

STDs are an issue of health, not morality. If we treat STDs like the wages of sin, they will continue to spin out of control 

Monkeypox is serious. Something about it has changed. Why has monkeypox gone from isolation in a few African countries to a pandemic? While it isn’t often deadly, it is not mild. Many men report that their symptoms are excruciating. 

New York and San Francisco have declared states of emergency. By contrast, Los Angeles County—America’s largest county—is still sitting on its hands with a high concentration of cases. Cooperation with the community is sorely lacking. At AIDS Healthcare Foundation (AHF), the largest provider of HIV and STD services in Los Angeles, we only receive our first batch of monkeypox vaccines on 27 July. 

Public health relies on public support and participation. Trusted representatives from the community are the best people to engage that support. Top-down approaches do not work. Why does the government only turn to community as a last resort? It is time to invite the community in. It is our community, and it is our health.

Los Angeles County is responsible for the public’s health here. The $10 million in emergency funding is needed to fight monkeypox and STDs now.  Infectious disease treatment needs to be scaled up immediately and drastically in conjunction with community engagement.

Today is a golden opportunity to build a sustainable public health system for the next 50 years.

Michael Weinstein

Michael Weinstein is the president of AIDS Healthcare Foundation (AHF), the largest global nonprofit AIDS organization, which currently provides HIV/AIDS care and treatment to over 1.6 million people in 45 countries.  Since 1986, Weinstein has been a leader in the fight against HIV and AIDS. As president and co-founder of AHF, he oversees an organization with over 6,900 employees whose mission is to provide “cutting-edge medicine and advocacy regardless of ability to pay.” 

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