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Monkeypox manners: Navigating a virus disrupting how we live and love

Health-care worker Charles Liu, left, administers a dose of the monkeypox vaccine at a clinic in West Hollywood, Calif., on Aug. 3. (Caroline Brehman/EPA-EFE/Shutterstock)

This story has been updated.

Last week, I was on one of those dating apps when I noticed a new hashtag, #monkeypoxvaccinated, on a growing number of profiles. (Hashtags help people find like-minded individuals — in this case, folks who have been vaccinated against monkeypox.) On one profile, a North Carolina educator (who asked for anonymity because he’s not fully out to his family) posted, “I’m happy to assist anyone who needs info or help with regard to the monkeypox vaccine.”

“Here we go again,” I thought to myself. I remembered how frightening the coronavirus had been only two years ago, especially to those of us seeking intimacy. Suddenly, a kiss was not just a kiss, but a potential vector for a potentially fatal disease. And for those of us who’d lived through the 1980s and 1990s, the intersection of sex and HIV/AIDS remains embedded in our DNA. So, too, does the stigma and bias leveled at those with HIV disease, especially queer men.

Monkeypox is ‘a public health emergency,’ U.S. health secretary declares

Monkeypox is a virus similar to smallpox, with nearly 11,200 cases (a likely undercount) reported in the United States as of Aug. 12. Cases are surging in New York, San Francisco and Los Angeles (and have been reported in all but two states, Montana and Wyoming). Nearly all cases to date have been among men who have sex with men, according to the Centers for Disease Control and Prevention, although the virus is not classified as a sexually transmitted disease because it’s also spread by skin-to-skin contact, among other nonsexual ways.

I was in a stunned San Francisco when the state announced a public health emergency. Among the concerns I heard: How do I protect myself? How do I protect others? How do we stop the stigma?

Even though there have been a minuscule number of deaths from monkeypox to date (just six worldwide as of early August), people at risk — and not at risk — are frightened by it. The disease is not a minor one. The lesions are often excruciatingly painful, sometimes compared to glass shards scraping against the skin, may require lengthy hospitalization and can take weeks to heal.

Since frightened people don’t always behave well, it’s time for a primer in monkeypox manners.

I know it may sound odd to cite Emily Post, but etiquette at its core is about how we interact with others, and her original principles of consideration, respect and honesty are as applicable to a health emergency as to any wedding brouhaha. Underpinning any such discussion is the importance of getting informed, reducing opportunities for transmission and caring for — and not condemning — those who become ill.

Stay up-to-date: It was only two weeks ago, when I heard that a colleague had gotten vaccinated for monkeypox, that I started to pay attention — and I am a gay man. I quickly came to understand that, as The Washington Post has previously reported, “sexual activity is a major driver of the current surge.” But the CDC warns that it also can be spread by any kind of close contact, such as dancing shirtless, cuddling or sharing sheets and towels. Respiratory spread is also possible, but usually over prolonged periods of time (for instance, if you live with someone infected with monkeypox). Read up and keep up on the latest guidance from reputable news sources.

What to know about monkeypox symptoms, treatments and protection

Talk about your health status: Some health experts have advocated for abstinence, at least for a while. But Hyman Scott, medical director of the San Francisco AIDS Foundation, told me, “It doesn’t work … telling people to not have sex is not effective.” Instead, public health advocates like those at the San Francisco AIDS Foundation recommend reducing the number of intimate contacts and asking questions before sex: Talk with potential partners about any recent illness, ask about their (and disclose your) number of recent partners, and whether anyone has had new lesions or rashes. “One thing we can do is be frank about our sex lives, report on who we’ve had sex with and what kinds of sex and when,” one man on a dating app told me after his first monkeypox vaccination. “That will help people make informed decisions.”

Practice safer sex: This is a lesson many of us learned in the earliest days of covid-19, the disease caused by the coronavirus, when almost any kind of intimacy, from a handshake on up, was fraught with the possibility of infection. Although monkeypox is much less infectious than covid-19, the CDC and other experts recommend caution. Those who may be at risk should avoid kissing — and find ways to have sex or be intimate that avoids going skin-to-skin. Cover up rash or lesions with clothes (or a bandage), avoid touching them, which can spread them to others and other body parts, and wash everything — hands, bedding, towels and sex toys — afterward. Good hygiene protects everyone.

Create a “pod”: Remember the friend pods many of us developed at the height of the pandemic? To keep our sanity, we socialized with small groups of people we knew and trusted. The same idea applies here with sexual partners if you are not coupled off or in a monogamous situation. An opinion piece in Poz.com suggested that “Pod members should monitor for symptoms for a few days … after [their] last potential exposure before engaging in sex within pods, and sexual activity should be limited to those within the group.” Again, trust and open communication is crucial.

Get vaccinated: I know, I know, another vaccine. The good news: The Jynneos vaccine is approved by the Food and Drug Administration to protect against monkeypox. The bad news: It is in short supply. Two shots are required, about four weeks apart, and the vaccine is considered at least 85 percent effective in preventing monkeypox. If you’ve been exposed, get the vaccine as soon as you can. The CDC recommends getting the vaccine within four days of exposure to prevent transmission. “If given between 4-14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease,” the CDC says. Because of a shortfall of Jynneos, some experts are advocating that people be encouraged to take a less desirable vaccine, ACAM2000, which was approved for the related virus of smallpox but not for monkeypox.

Isolate if infected (or if you start to show symptoms): A 50-something widower on the West Coast, who asked me not to identify him because of possible stigma, self-isolated as soon as he felt and then saw “a very ugly lesion” in his throat, although it took him a full week to get diagnosed. During that interval, he declined various invitations and started telling friends that he suspected he had monkeypox. “I didn’t want to be a spreader in my community.” He did the right thing — isolating from the time he experienced symptoms until he was no longer infectious several weeks later.

Disclose your infection only on a need-to-know basis: “I chose who I told carefully [because] I didn’t want everybody to know immediately,” explained one man I know. “I was trying to avoid stigma and feeling diseased.” Among those he told was a recent date, who as it turned out, also had been diagnosed with monkeypox. Arthur Caplan, professor of bioethics at New York University, acknowledged that fear: “There is stigma. The community of gay men already bears that, the political climate in much of the nation is overtly hostile, and another ‘gay’ disease reinforces that.” Nevertheless, Caplan recommended informing your health-care providers, such as dentists and massage therapists, about possible infection, although it may result in their deciding not to treat you. “We have an obligation not to harm others or put them at involuntary risk,” Caplan said in an email.

Be kind: Offer assistance. Do not judge. As with anyone you might know who becomes ill, ask what you can do to help, keep conversations private and don’t let fear get the better of us. There are no “gay” viruses or “straight” ones. Scott put it this way, “Currently, the LGBTQ+ community is experiencing the brunt of this outbreak but anyone can be at risk for monkeypox given how it’s spread.” In other words, a virus is a virus is a virus.

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