Having lived with HIV now for over a decade, I can faithfully attest to the fact that sometimes allies to the HIV-positive community can get a little into “saving” those of us actually living with the virus. Lately, that’s come up in the context of monkeypox, with some people making pretty wild comparisons to the mistakes made during the early years of the AIDS crisis.

Invoking this chapter in history is serious. It shouldn’t be done lightly or as a tool of shrill hyperbole, either.

As it goes, these otherwise sensible people insist, labeling monkeypox in any way “gay” or sexually-transmitted will condemn the virus to echo the early days of HIV when it was called a “homosexual disorder” by the New York Times and GRID, shorthand for Gay Related Immunodeficiency.

After all, that small, three-letter word was the justification many used to do nothing and care little about HIV as it left its footprint on American history. Not gay? Doesn’t apply to you. Homophobic? You don’t care about it affecting others.

But this isn’t 1984. And monkeypox isn’t HIV. But it sure does disproportionately affect men who have sex with other men (MSM). Really, it’s OK to say that.

Acknowledging that sex is a component of almost all monkeypox cases isn’t stigmatizing. It’s factual.

Reporting for BuzzFeed, David Mack outlines that the World Health Organization tallies 8,400 cases “with known data on sexual orientation” and over 97 percent of them were MSM. “Furthermore,” Mack adds, “of the almost 6,000 reported types of transmission, 91.5 percent of cases stemmed from sexual encounters.”

Acting like a celibate senior citizen or a child is at equal risk of acquiring monkeypox as a sexually active gay man certainly is a quaint notion in a We Are The World sense, but it’s wildly inaccurate. Yet, this doesn’t stop people from claiming the universality of this anything but universal pox. Don’t want it to be perceived as just a gay thing, right?

Aren’t we beyond this? Shouldn’t it be a given at this point that gay men are by definition human beings deserving of care and concern and not only human beings when compared to straight people? What if something is a gay thing, does that make it less worthy of treatment or prevention?

We need science, not politics

We’ve seen the destructive nature of obfuscating science or mishandling facts and replacing them with fear. This is why some jurisdictions view an HIV-positive person’s spit as a deadly weapon despite saliva not transmitting HIV.

Trying to fuse public health and politics got us absurd indoor dining diktats, frenetic masking policies nationwide, and probably a lot more death than we had to endure as a country during the Covid pandemic — which is still raging on, I should note, even as all the accessibility features of your workplaces that enabled people living with disabilities to participate more fully are fading away.

Even from a more political or rhetorical perspective, doesn’t claiming universality of a niche issue erase the experience of those actually affected? Should everyone really be concerned about monkeypox?

Let’s put politics aside and just talk science.

It’s true that monkeypox isn’t just a “gay” disease. Anybody can acquire monkeypox, just like anybody can acquire HIV or syphilis. But all three of these disproportionately and overwhelmingly affect MSM. To be clear, there are thousands of straight people and women living with HIV. But in a raw numbers sense, these populations are dwarfed by the MSM cohort.

“… many people who we’ve found to be at highest risk, African American men who have sex with men — many of whom may not think of themselves as gay or bisexual — aren’t served by those providers,” says City spokesperson Jim Garrow.

The most problematic aspect of calling monkeypox a gay disease isn’t its stigmatizing effect on gay men but rather the chilling effect it might have on prevention, testing, and treatment amongst men who have sex with other men who do not identify as gay.

And, in a revealing example of how monkeypox practically only affects a specific population, NBC News whimsically dropped the L from LGBTQ in some of its reporting about those affected by the outbreak and used shorthand GBTQ. Sorry (congrats?) lesbians!

Acknowledging that sex is a component of almost all Monkeypox cases isn’t stigmatizing, either. It’s factual.

In one public example, Vox journalist Alex Abad-Santos, himself a member of the LGBTQ community, lamented that monkeypox “is coming after gay sluts — it’s almost personal to me. I had so many plans for a slutty summer. And that’s not happening.”

In my case, when I had appendicitis recently, the nurses asked me about my vaccinations. I recited my Covid record and then added, “Oh, and monkeypox earlier this month,” before chuckling and describing myself in a way more appropriate for a Dave Chappelle bit than Pennsylvania Hospital.

Trauma is still the inspiration for, often self-deprecating, humor. Though, don’t jokes typically speak to some truth?

The Philadelphia Department of Public Health has strict eligibility criteria for monkeypox vaccines. They include being a man who has sex with other men, transgender people, or non-binary people and meeting at least one of the following criteria: having multiple or anonymous sex partners in the past 14 days; having a newly diagnosed STI in the past 12 months; having recently attended or plans to attend any venue featuring anonymous sex or sex with multiple partners; or, having met recent partners or plans to meet new partners in the next 30 days through social media platforms like GrindR or at clubs, raves, sex parties, or like venues.

Along with us, sex workers of any gender as well as any person with known skin-to-skin contact with someone with monkeypox in the past 14 days are also eligible for vaccines.

These criteria sure do sound like monkeypox is overwhelmingly affecting men as a sexually transmitted disease, right? Isn’t it smart to target our precious few vaccines and post-quarantine public health resources and remaining brain cells toward those at greatest risk?

These criteria sure do sound like monkeypox is overwhelmingly affecting men as a sexually transmitted disease, right? Isn’t it smart to target our precious few vaccines and post-quarantine public health resources and remaining brain cells toward those at greatest risk? Isn’t it a waste to claim we should crack open a few fire hydrants and spray the entire city with the Monkeypox vaccine?

Doesn’t erasing the reality here also run the risk of making prevention and treatment even harder?

And doesn’t the reflexive way some bristle at gayness being mentioned alongside a virus reveal just as much about their own associations with being LGBTQ as it does society’s?

What we know about Philly

Since the outbreak started a few months ago, there have 420 diagnosed cases of monkeypox here in Philadelphia, according to the Health Department. Of these, 320 or 76 percent are amongst cisgender men. Across all 420 cases, 97 percent are among people in the most sexually active stages of life, ages 20 to 59.

When asked whether or not it was “unequal” to target public health resources toward groups disproportionately affected by any ailments including monkeypox, the Health Department countered that “if we do not acknowledge that the healthcare system makes accessing care easier for [White cisgender men especially] and actively work to facilitate access to groups [like African Americans and LGBTQ people] that have been shut out historically, we would be perpetuating that racism and homophobia.”

To put it in plainer terms, the system has for years focused on the experience of cisgender, straight White men more than any other group. As a result, those not in this group will experience health and sickness differently and in a way that the system doesn’t serve adequately. Not targeting health services defaults to the historical, and problematic, norm.

I’ll take it another step further: To me, simpering platitudes about the universality of a virus that isn’t universal but instead affects specific groups is an insidious form of erasure that threatens those very populations. Without special focus on those most affected, we are both lying to a society that tunes out lies as a reflex as well as depriving community and other organizations precious, targeted resources. And we’re asking an already overwhelmed, attention-scarce general population to expend care, time, and energy on something that isn’t a crisis for them whatsoever.

To me, simpering platitudes about the universality of a virus that isn’t universal but instead affects specific groups is an insidious form of erasure that threatens those very populations.

How we specifically address this is a matter of debate. The conventional wisdom in public health settings is that the clunky, reductive phrase men who have sex with other men is preferrable to the word gay or acronym LGBTQ since it includes those who do not identify as gay. Fair enough. But the limitations of MSM are legion and just as problematic data-wise as they are for the word “gay.”

Whatever you want to call it, the MSM population here in Philadelphia is about 6 percent of the overall population or 33,000 or so, according to one estimate. Determining and catering to how each of them identifies is an impossibility, so focusing on the behavior itself probably is smarter than saying it’s a gay problem — even though it’s totally a gay problem akin to having the GrindR notification sound stuck in in your head. (And if you don’t know what that sounds like, you just proved my point.)

“The Health Department’s initial response,” explains City spokesperson Jim Garrow, “to the monkeypox outbreak began with making vaccines available in clinics that cater to the LGBTQ community. But many people who we’ve found to be at highest risk, African American men who have sex with men — many of whom may not think of themselves as gay or bisexual — aren’t served by those providers.

“As we learned that the initial response was not adequately reaching those at highest risk, we changed it and continue to do so,” Garrow adds. In fact, the City is now rolling out a grant program for community-based organizations deft at engaging specific populations that the current system might fail to reach.

“Since we’ve been changing our outreach and vaccine administration plans, we’ve seen the demographics of who has been vaccinated get closer to matching who is at risk,” Garrow concludes. “We are helping to contain the outbreak by targeting our response to those who are most likely to be exposed.”

Is it working in practice? The rate of diagnosed infections has in fact gone down. But that could be the natural ebb and flow of contagion.

Is it at least a better approach than squandering vaccines and outreach on monogamous people or lesbians? Or scaring parents of toddlers thinking their baby is at risk of something that really only affects grown men?

Absolutely. And there’s nothing wrong with saying that.

Josh Kruger, a former City staffer, is an award-winning (and losing) writer in Philadelphia.

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