Australia is in a good position to avoid a major outbreak of monkeypox by WorldPride in Sydney in 2023 if state and federal governments harness the power of sexual health organizations and appropriately target gay and bisexual men with vaccines in the coming months, experts say.
As cases in the northern hemisphere climb into the tens of thousands, Australia on Thursday declared monkeypox a “communicable disease of national concern”.
By Thursday, 44 cases had been reported in Australia, mostly among returning international travelers, people aged 21 to 40 and men who have sex with men.
The global surge in cases has coincided with pride events in the Northern Hemisphere, which often host large parties and travelers from around the world.
But the stigmatization of the gay community during the AIDS crisis of the 1980s and 1990s remains in the public memory. This has led to some reluctance in the media worldwide to discuss monkeypox as something where 98% of cases worldwide are currently men who have sex with men.
“Any health issue, scare, outbreak that targets gay men, bisexual men, or queer people in general immediately raises a lot of feelings given the past four decades of responses to HIV in this country,” activist and co-founder of The Institute of Many, Nic Holas, he said. “So whatever we do, we have to recognize that there’s going to be a lot of feeling about it, coupled with the science, the data and the facts.”
Heath Paynter, deputy chief executive of the Australian Federation of AIDS Organisations, told Guardian Australia that monkeypox was clinically a very different virus to HIV, but culturally it had many similarities to HIV.
“That’s because it’s a virus that’s currently transmitted in the northern hemisphere through sexual contact and through interconnected sexual networks of gay and bisexual people,” he said.
“But it’s only a matter of time before it starts happening in Australia with community transmission.”
The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, said this week that gay and bisexual men should consider reducing the number of sexual partners they have. But Professor Andrew Grulich, head of the HIV epidemiology and prevention program at the Kirby Institute, said the advice would not be effective unless people knew exactly when they could be vaccinated.
“I guess you could argue that’s what most gay men did during the Covid lockdown, they stopped having casual sex because [did] young heterosexuals for a few weeks,” he said. “That’s sustainable, provided it’s not a long-term thing.”
The Australian Technical Advisory Group on Immunization (Atagi) this week updated its clinical guidelines on monkeypox vaccination to include the use of The MVA-BN vaccine named Jynneos and experts believe that the government’s agreement to secure vaccine supplies is about to collapse.
“Amazing people are the architects of safe sex”
Holas said Australia had a chance to get ahead of the epidemic in the next few months, but it would require the right strategy to seize it, with a community-led response.
“Amazing people are the architects of safer sex – we invented safer sex. He was not a doctor or a politician – we came up with these strategies and implemented them at the community level,” he said. “So we’re hoping to see similar things here in terms of monkeypox.”
Paynter said the disease prevention conversation should be led by people who can speak the language of the queer community and targeted advertising on social media and through dating apps like Grindr.
“If the message is too broad, then you could end up with people fearing the virus who are not really the target or priority population, and then resources end up going to the wrong population,” he said.
“We have to avoid a situation where people are using something like monkeypox, and that’s happened with HIV in many places around the world. We have to have language that is very respectful because we don’t want people to be turned away, or at least not to engage with health services for fear of being stigmatized, for fear of being judged.”
Thorne Harbor Health director of health promotion, policy and communications Colin Batrouney said public health messaging needs to strike a balance between raising awareness and not causing panic.
“We focused on what monkeypox is, how it is contracted, symptoms, treatment and prevention,” he said. “Our approach to sexual health and well-being has always been based on non-judgmental, clear information and positivity.”
“The only moral dimension of the disease will be the inability or unwillingness of systems and governments around the world to deal with it.”
Atagi identified gay, bisexual and other men who have sex with men as most at risk, as well as sex workers. Grulich said it would make sense to prioritize gay and bisexual men who have traveled abroad for vaccinations, followed by all highly sexually active gay and bisexual men.
“Australia is a bit lucky that this happened in the dead of winter when there’s not much in the way of big big gay gatherings for gay people,” he said.
That will change when Sydney hosts WorldPride in February and March next year, with people traveling from all over the world.
“It is absolutely essential that sexually active gay men are vaccinated.” We have a few months to do it, we mustn’t lose sight of that, Grulich said.
“It’s quite conceivable that we could have the vast majority of sexually active gay men vaccinated at that time.”
“I think we could get really close to herd immunity through vaccination if we have enough vaccine.”
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