The epidemic of monkeypox has ignited debate within the New York City Department of Health as to whether gay men should be encouraged to reduce the number of sexual partners during this summer’s outbreak.
Within the department, authorities are fighting over a public message, as the number of monkeypox cases nearly tripled last week, almost all among men having sex with men. While some epidemiologists say the city should encourage gay men to temporarily change their sexual behavior during the spread of the disease, other officials say the approach stigmatizes gay men. Insists that it will backfire.
Internal divisions last week when the Ministry of Health issued a recommendation suggesting that having sex with monkeypox could be safer if people avoid kissing and hide their pain. Reached its peak. According to several epidemiologists in the department and internal email reviews, some agency officials were outraged that the agency was giving misunderstanding and even dangerous health advice.
The advice on safer sex was not medically appropriate, Dr. Don Weiss, director of surveillance for the ministry’s epidemic department, said in an interview. He believes that people at risk of monkeypox should be advised to temporarily reduce the number of partners.
His concerns have been shared by some of his colleagues, and according to emails and interviews, the health sector ranks as a window to control the monkeypox epidemic in New York City, the largest such outbreak in the United States. It shows that frustration and pessimism within the United States is closing rapidly.
Monkeypox has spread around the world since early May. In New York City, where almost all monkeypox cases are gay or bisexual men, 618 cases of monkeypox have been recorded in the city as of Monday, but Dr. Weiss has limited testing. Therefore, he said that the actual number of infections is much higher.
The strategy backed by Dr. Weiss, who has long been at the forefront of the department’s response to disease outbreaks, is largely undriven within the department.
In fact, in a statement on Monday, authorities opposed such an approach. “For decades, the LGBTQ + community has been analyzed, prescribed, and banned from sex life in a myriad of ways, primarily by heterosexuals and Siths,” the statement said.
The city’s response to monkeypox is based on the science and history of “with this shameful legacy in mind” and “how historically inadequate abstinence-only instruction was.”
The field of public health has long struggled with how and to what extent public health authorities should instruct people to change their sexual behavior in the event of an outbreak.
The debate is influenced by early HIV / AIDS, which was fearful and stigmatized. Given that no one in the United States has died of the disease yet, the risk of monkeypox is much lower, there are cures and vaccines, and for many the disease seems to heal relatively quickly.
Still, some epidemiologists currently limit their positive response to mainly gay and bisexual men, but the virus spreads in New York and reaches a wider population. It says that you can prevent it.
Some public health experts say that many gay men are more likely to reject advice that could be considered discouraging or stigmatizing gay sex. These experts say that such advice could shift responsibility for the outbreak to gay men and lead them to look at public health authorities with distrust.
What you need to know about monkeypox virus
What is monkeypox? Monkeypox is a virus that is endemic in parts of Central and West Africa. Similar to smallpox, but less serious. According to the Centers for Disease Control and Prevention, it was discovered in 1958 after an outbreak occurred in monkeys kept for research.
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“People are still going to have sex, and they will do it even if it carries great risks,” he said.
However, some experts say that temporarily reducing the number of sexual partners or encouraging people to avoid sex parties that may have multiple partners is a message of abstinence and monogamy. Pointed out that it is not the same as.
“Name risk factors and behaviors and give people choice,” said Dr. Dustin Duncan, an infectious disease epidemiologist at Columbia University’s sexual and sexual minority groups.
He gave an example: telling people that “having a consistent and casual partner rather than multiple people can reduce the risk of monkeypox” seems like a reasonable message at this point. He said.
Dr. Weiss said the most powerful weapon currently available to reduce monkeypox infection is to ask people to change their sexual behavior, even for a month or so. Vaccine supply is limited and a large number of vaccination sites have recently been opened, but initially they were offered at some clinics due to the difficulty of making daytime appointments.
He sometimes suggested that the department should promote short-term abstinence, a relatively fringed position. At other times, he suggested that homosexuals should be warned to refrain from anonymous sex.
Dr. Weiss said his recommendations were largely ignored by senior leaders in the “appearing paralyzed for fear of stigmatizing the disease.”
“Would you like to warn people to stop bowling if there is an outbreak related to bowling?” He wrote.
So far, the Ministry of Health’s hesitation to publicly encourage people to change their sexual behavior, unless they are actively infected with monkeypox, reflects a broader message about the outbreak. doing. By federal government..
Department advice, Post to that “Sex and other intimate contacts with multiple people and anonymous people (people I met on social media, dating apps, parties, etc.) can increase the risk of exposure,” the website said. I am.
At an online “city hall” event on monkeypox last week, city health commissioner Dr. Ashwin Vasan said the ministry’s goal was “sex-positive.”
“We never want to stigmatize sex,” said Dr. Vasan. “We want to make it very clear that there are certain activities, one of which is intimate sexual contact that puts you at higher risk in certain situations.”
Other health professionals, like Dr. Weiss, publicly seek temporary changes in sexual behavior.Online Last week’s briefing According to the Infectious Diseases Society of America, Dr. Lillian Abo, Deputy Chief Medical Officer for Infectious Diseases at the Jackson Health System in Miami, encouraged people to use condoms and had unprotected sex with multiple partners “actually an exponential function. It is becoming more widespread. “
“We can all participate to prevent continued spread. It’s important to understand that everyone has a little ownership and can endanger others. “She said.
Dr. Weiss, who has been investigating new outbreaks of the Department of Infectious Diseases and doing the same for 22 years, said he felt obliged to speak publicly because the ministry’s official statement sometimes felt irresponsible. rice field. He pointed out that a news release published on Friday contained some preventative tips for “people who chose to have sex when they were ill.”
Having sex while covering the pain of monkeypox with clothing or bandages “may help reduce the risk of infection, but it cannot be eliminated.” “For those who choose to have sex when they are ill, it’s best to avoid kissing and other face-to-face contact,” the release said.
Dr. Weiss said it was “ridiculous” to suggest that these steps significantly reduce risk.
Health guidance to the public often emphasizes potential nonsexual routes of infection, such as hugging and contact with bedding. These could certainly be transmission routes, but as a result, Dr. Weiss said that people were overly worried about accidental physical contact, as most monkeypox infections in New York were transmitted by sexual transmission. He said he was not fully aware of what he could see.
Dr. Weiss said he oversaw a team of epidemiologists who reviewed many cases of monkeypox in the city. Most often, patients have lesions in the penis, anus, or rectum, suggesting that the disease is predominantly spread by sexual contact, he said.
He also said that reports of asymptomatic spread and the presence of viral DNA in semen should result in a recast of the department’s public advice.
“I sound like a Bible-striking preacher,” Dr. Weiss recently wrote to a group of epidemiologists in the Ministry of Health’s email chain.
But he argued, “If we don’t act immediately, it may not come back.”
Sharon Otterman Contribution report.
