Monkeypox infects more men who have sex with men? Understand

The current outbreak of monkeypox has an intriguing feature: cases are more common in men who have sex with men (MSM). There are doubts as to why this happens, and a major concern is not to stigmatize the community.

Monkeypox, caused by the monkeypox virus, is endemic in countries in central and western Africa. Outbreaks in other countries have already occurred, as in 2003 in the United States, with 70 diagnoses. None of them, however, are as large as the one seen now, with more than 5,000.

The fact that the disease is more common in men and boys was known, says a report by the WHO (World Health Organization) published on June 24. According to the document, the highest number of cases in these populations was already observed in countries affected by the disease previously.

However, the organization says the cases were associated with contact with hunting animals that are hosts of the virus — rodents, for example. The peculiarity now is that diagnoses are concentrated in the MSM community, and transmission is concentrated in contact with people already infected.

One example was the UK Health Safety Agency (UKHSA) which collected data on monkeypox patients in the country. Since May 26, 152 have responded to a questionnaire with information about their sexual practices. Of these, 151 reported being part of the MSM community or having had sex with partners of the same sex.

Other data from the UK was also used in a study published on June 13 as a preprint — that is, without peer review. The researchers analyzed the spread of the disease in the country’s population. Based on statistical models, the authors suggest that a small number of cases among MSM are sufficient to cause a substantial increase in diagnoses in this community.

The reasons for the high prevalence among men who maintain relationships with same-sex partners remain open. One of the hypotheses is based on the fact that the virus is transmitted by touching wounds caused by the infection or by close and prolonged contact with respiratory secretions from infected people.

This could justify the greater transmission in a sexual relationship. However, this does not explain why the virus has a higher rate especially in the MSM community.

“All the situations that we can imagine in which a person with an injury can find another is potentially transmissible. So, it is not restricted to any population”, says Maria Amélia Veras, professor at the Department of Collective Health at the Faculty of Medical Sciences at Santa Casa de São Paulo. Paul.

Veras is also coordinator of the research group Nudhes (Health, Sexuality and Human Rights of the LGBT+ Population). It indicates that another explanation for the situation may be linked to a detection bias.

In this case, the greater number of cases among MSM is related to a greater concern of this population with diseases related to sexual activities. “It’s a group that’s much more attentive to issues of infections that are sexually transmitted and, therefore, may have sought more [os serviços de saúde]”, it says.

Transmission of monkeypox through vaginal fluids and semen is another possibility. The CDC (United States Center for Disease Control) says that this hypothesis is open and needs to “be better understood”.

A study conducted at Spallanzani Hospital and Research Center in Italy reported evidence of the presence of monkeypox in the semen of men in a June 2 report. For AFP, the director of the institution said that the result was not random because the DNA of the virus was found in the semen of 3 out of 4 men diagnosed with the disease.

But this does not indicate that transmission occurs through sexual intercourse or that monkeypox is an STI (Sexually Transmitted Infections). The evidence is also early and needs further investigation, which is common in early situations of new disease outbreaks, says Veras. “It is necessary to carry out well-conducted studies with rigorous designs.”

stigmatization

One fear raised by organizations is that increased reporting of monkeypox among MSM could lead to community stigmatization. Unaids (Joint United Nations Program on HIV/AIDS) said in a May 25 note that it was concerned about language to address monkeypox that reinforces racist and homophobic stereotypes.

“Lessons from the AIDS pandemic response show that stigma and blame directed at certain groups of people can quickly undermine the response to outbreaks,” the agency said.

In a similar way, Veras reports the concern. “You will increase a stigma that already exists against sexual and gender minorities.”

She also points out that this can create a problem in which people who are not part of the group with the highest transmission may understand that they are not at risk – something that is not true.

“The fact that it is being detected in the group of sexually active MSM and with multiple partners explains why there are more cases in these groups. It doesn’t explain or say that it’s just these people”, he concludes.