International monkeypox outbreak: Who is at risk?

There are communities most at risk of contracting monkeypox during the current outbreak. World Health Organisation’s ANDY SEALE explains how people can support those communities.

• Question: It seems that certain communities are more affected than others. Who are these communities

Seale: We are seeing nearly 70 countries affected by this outbreak.
In previously affected countries, which are largely in West Africa, we are seeing communities of diverse backgrounds and ages.
In newly affected countries, we are seeing cases largely focused on men.
We are noticing that these are men who have sex with men.

So men who are gay, bisexual or who have sex with other men, reported cases to sexual health clinics or as part of efforts to reach cases through contact tracing.
There have been some cases reported in women and children, but these have been very limited.
So we have to respond to the data. We have to really look at targeting our resources where we know the infections are happening.
At the moment, it’s really happening within this particular group.
But remember, anyone can get infected if they are in contact with the virus.
And so for the moment, while we are concentrating our efforts on gay, bisexual and other men who have sex with men, we are also keeping a strong eye on the data to see whether the outbreak will evolve into other communities.

Why does this particular community seem to be affected
There are multiple modes of transmission for monkeypox, including skin to skin contact, kissing or touching infected materials such as bed linen.
What we know and what evidence tells us is that sexual networks within communities of gay, bisexual and other men who have sex with men played a role in transmitting the virus in the context of this outbreak.
Some gay and bisexual men are connected to these dynamic sexual networks that connect cities and countries.
In the early days of the outbreak, international travel seemed to play a significant role in further amplification of this outbreak.
This community is active in managing its health.
We know that many gay men actively seek sexual health services, for example, many of them will take HIV medications as pre-exposure prophylaxis to prevent HIV infection.
Of course, some men are also HIV positive.
So these men are in constant contact with health services.
Through that, regular contact and access to services give them the opportunity to check up on any symptoms or any health issues that they might be concerned about.
This has probably also played a role in the identification of cases within this community.

Explain the stigma and damage it can do, and how we can support these communities.
Stigma essentially stops people from accessing services. It helps no one. So we need to really be robust in addressing and identifying stigma and discrimination when we understand that it’s happening.
And the best way to do that is working with these communities.
Gay, bisexual men and other men who have sex with men are providing tremendous leadership in the context of this outbreak.
We are seeing great advocacy on testing, access to vaccines, and promoting prevention messages to stop the spread of monkeypox.

How can monkeypox affect communities
Having monkeypox can be distressing and people need support. We must not stigmatise anybody exposed to monkeypox.
Perhaps they have been identified through contact tracing or indeed for having the virus itself. We need to support people in this situation.
Hopefully, for most, it will be a short-lived, mild infection.
But we know that for some people, it can be very painful and require hospital care.
There are practical things that we can do not only to fight the stigma but also to offer practical support.
Do their shopping if they are isolating, for example, and offer a friendly shoulder if they need to talk about their experiences.
There is a lot of misinformation about monkeypox, much of it fuelled by homophobia and racism.
We have to challenge this.
We must work more closely with the communities affected.
Really inspired by their leadership, their advocacy around access to testing, to vaccines and to services in general.
And really strengthen those links between public health agencies and communities of gay, bisexual and other men who have sex with men.
Fighting stigma and getting this response right come hand in hand.

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