Benjamin Ryan has been covering infectious disease and LGBTQ health for two decades and contributes to the New York Times, NBC News, the Guardian and Thomson Reuters Foundation.
This broad-strokes maxim — that everyone on Earth is susceptible to this troubling viral infection — might be factual on its surface. But it is so egregiously misleading it amounts to misinformation.
Those who make such statements don’t intend harm. On the contrary, leaders at the Centers for Disease Control and Prevention, the World Health Organization and elsewhere repeat them because they commendably want to combat the societal stigma faced by gay and bisexual men, who have been disproportionately impacted by monkeypox. They know that stigma harms public health, including by discouraging infectious-disease testing. And they don’t want the rest of the public to be complacent in the face of a potential new pandemic.
But as these public health experts know well, epidemiology is less concerned with whether someone could contract an infection; instead, the much more vital questions focus on which groups of people are most likely to be exposed to a pathogen, to contract it and why. In public health statistics, this is the study of relative risk.
By reducing monkeypox risk to a simplistic binary equation, public health leaders are prioritizing fighting stigma over their duty to directly inform the public about the true contours and drivers of this global outbreak. In particular, they are failing to properly convey the seriousness of this burgeoning crisis to gay and bisexual men.
Here is what we can discern from data collected about monkeypox so far: This viral outbreak isn’t just mostly occurring among men who have sex with men. The confirmed cases, at least to date, have consistently almost entirely occurred among this demographic, which accounts for 96 percent or more of diagnoses where data are available.
Per capita, the few monkeypox cases in women and children remain minuscule compared with the rate among gay and bisexual men. Of course, substantial transmission could always occur among such other groups. But researchers at the WHO and elsewhere have speculated that the monkeypox reproduction rate will likely remain significantly lower in such demographics — meaning the virus will more likely hit transmission dead ends among them than among gay and bisexual men.
An uncomfortable truth, one documented in peer-reviewed papers, is that sexual behaviors and networks specific to gay and bisexual men have long made them more likely to acquire various sexually transmitted infections compared with heterosexual people. This includes not only HIV, but also syphilis, gonorrhea, chlamydia, hepatitis B and sexually transmitted hepatitis C.
Global public health experts agree that skin-to-skin contact in the context of sexual activity between men has been the principal driver of the monkeypox outbreak, at least thus far.
Such experts have also asserted that the risk of monkeypox to the broader population not having multiple sex partners remains low — even “very low.” This is hopeful news, and the wider public deserves to be reassured accordingly. Assuaging fears of contagion will help fight unhelpful hysteria and prevent gay and bisexual men from being subjected to even greater stigma should they be painted as culprits of the spread of virus to others.
Such enmity devastated the gay community during the height of the AIDS crisis, when the CDC waged a long-running, misleading public service campaign with variations of the slogan “anyone can get HIV/AIDS.” Those claims belied the truth about the relative risk of HIV, which in Western nations has always predominantly affected gay and bisexual men.
Because the same is true of the monkeypox outbreak, newly launched vaccination campaigns appropriately target this group — in particular, those reporting multiple recent sex partners, which data indicate is associated with monkeypox acquisition. Sadly, state and local public health departments in the United States are failing to report to the CDC vital demographic details about people diagnosed with monkeypox. This stymies the nation’s capacity to respond to the outbreak with impactful interventions, such as targeted vaccines, and to promote health equity.
By contrast, the rich data collection in Britain helps address the question of whether monkeypox only appears to be occurring predominantly among gay and bisexual men because the vast majority of testing is being conducted among them. As we know from covid-19, differences in test-positivity rates help control for differences in testing rates. And those figures in Britain are stark: The U.K. Health Security Agency reported that half of men screened for monkeypox tested positive; women, by contrast, tested positive only 0.6 percent of the time. No one under the age of 18 tested positive.
Tragically, the monkeypox outbreak is occurring just as a shocking resurgence of anti-LGBTQ sentiment grips the United States. But public health officials cannot be expected to police the public’s reactions to epidemiological facts.
Gay men deserve to hear the unvarnished truth about monkeypox so we can take action accordingly. We’re adults. Please be honest with us.