Since the onset of the current global epidemic of monkeypox in Europe, the majority of cases have been detected in men who have sex with men (MSM), and particularly those with multiple and often anonymous partners – met in places such as saunas, cruise bars and sex clubs, or via dating apps and sex parties.
As the outbreak continues in Europe, providing factual information about where the virus is spreading, without judgement, is key to helping individuals take action to reduce their risk of exposure. While it is important to avoid stigma and discrimination of affected communities, the most affected groups – currently MSM – must be involved in solutions to stop its spread, not excluded.
With the epidemic having been declared a public health emergency of international concern at the end of July, the important thing now is to focus on ending this epidemic, as emphasized by Dr. Hans Henri P. Kluge, Director WHO Regional for Europe in its Statement of July 26: “the responsibility to stop this epidemic is necessarily a joint responsibility, shared between health institutions and authorities, governments, affected communities and individuals themselves. same”.
With that in mind, we spoke to 5 men who interact sexually with other men through a range of venues or platforms to hear their thoughts on the monkeypox outbreak and its impact on their lives.
All had a good knowledge of monkeypox and the symptoms to look out for – such as rashes and blister-like lesions – and knew that in this outbreak it was mainly caught from skin-to-skin contact during the sex.
John, 52, from London, UK, explains how he felt when he learned more about the current outbreak: “At first I wasn’t too worried as I thought you had to have traveled to one of the countries where the disease is endemic but as I heard more I realized that was not the case – it was spreading between people with no travel history in Africa. It really made me sit up and realize that, especially since in Europe the cases were mostly in gay men and it was spread through sex.”
Changing behaviors due to increase in cases
The men interviewed explained how the rising number of cases had prompted them to seriously reconsider their sexual behavior – at least while monkeypox was widespread.
Alessandro, 34, from the Milan area of Italy, was candid about his usual sexual habits: “I used to go to a bar or a sauna almost every weekend and chat with people on Grindr.[a dating app]several times a day. With the monkeypox outbreak, I haven’t had sex for a month and stopped logging into the app.”
“Right now, I think all MSM who have multiple partners need to be more responsible to help reduce the number of cases significantly. Everyone should rethink their sexual habits and do what they can to protect themselves and others.
Ryan, 49, lives in Birmingham, UK and has also decided to abstain from sex when the virus is so widespread. “At first, I didn’t think the outbreak would have much of an impact on me, but as the number of cases increased, it became more scary and real, and it made me reevaluate what I do. I used to use sex venues regularly, but on my last visit I noticed a decrease in attendance. For now, I’ve decided the best thing to do is to stop going.
Giacomo, 31, from Brescia, Italy, expresses a similar sentiment, but for very personal reasons: “Two of my friends had monkeypox, so I saw it with my own eyes. I live at home and would hate for my parents to find out I had it too. So, for now, I’ve stopped going to sex clubs and having sex completely.”
Be pragmatic that these are temporary measures
However, given that this international public health emergency came so soon after restrictions and venue closures during the height of the COVID-19 pandemic, Giacomo – like many of the men we spoke to – is also honest about how much time he thinks he can save this for: “After two years of social restriction due to COVID-19, we all want to get back to more of the life we had before, and have the freedom to be able to visit places to have sex whenever we want is a big part of that for me”.
WHO/Europe does not advocate permanent sexual abstinence, but recommends that members of the MSM community seriously consider limiting their sexual partners and their interactions at this time, as a means of avoiding catching monkeypox and to limit its effects on individuals and on the population as a whole. community.
The sites play their role in the fight against the epidemic
WHO/Europe does not recommend closing on-site sex venues. These places must remain open and can themselves be part of the solution to controlling the epidemic. They can help deliver messages to those most at risk, informing them of the risks, prevention strategies, and health services available for testing. Indeed, many are already playing this vital role.
“I’ve seen information about monkeypox in many places I’ve been – it’s good and it’s the right thing to do,” says John. “Hopefully this will make people think twice about leaving, especially if they have unexplained lesions or a rash.”
Get the Monkeypox Vaccine
The 5 men we spoke to wanted to be vaccinated to be better protected against the disease. However, although a new vaccine has been approved for the prevention of monkeypox and the traditional smallpox vaccine is believed to offer a high degree of protection, these vaccines are still not widely available. This means that many countries currently do not offer vaccines to MSM and other high-risk groups.
Ryan was lucky though: “I’m planning on getting the shot this week,” he told us. “Although I am not visiting saunas at the moment, I suspect that once I get the shot I will be back.”
Although Alesandro is originally from Italy, he managed to get vaccinated against monkeypox while on vacation in France: “I am gay and HIV-positive and I personally know 10 people who have had monkeypox – some of them ‘among them suffering from very strong pain in the anus and urethra. This worried me a lot about the disease. I managed to get vaccinated Imvanex [a vaccine approved by the European Medicines Agency for use against monkeypox] at the beginning of the month of August. For me it is very important because I want to have sex again and reduce the symptoms of the disease if I catch it. I will still wait before having new sexual relations, because I know that my body needs to accumulate the antibodies to build its defenses well”.
Vaccination is an important part of the response to monkeypox; however, it is not a silver bullet. The global supply of available vaccines is currently limited and, through community engagement, countries must devise effective mechanisms to deliver vaccination to the most-at-risk target populations, without generating stigma or discrimination. Additionally, while studies suggest that available vaccines are effective in preventing monkeypox infection, data on actual effectiveness continues to emerge.
Fear of stigma from the MSM community
As the epidemic continued to grow – in terms of case numbers and geographic spread – many of those we interviewed feared there would be a backlash against the MSM community, with those who catch the virus being particularly stigmatized.
“It echoes the HIV/AIDS crisis in the 1980s and 1990s,” says John, “and I fear there is a stigma against MSM – even though it is a disease that anyone can potentially catch”.
“How do you explain to your employer, partner, or family that you have monkeypox,” Ryan asks, “especially if you’ve been in close contact with one of them? It could ruin relationships and jeopardize people’s livelihoods. We need to bring this out into the open and make it a disease free from blame and judgment. »
Message from WHO/Europe to those most at risk of infection
To men who have sex with men and especially those who have multiple sex partners, WHO/Europe says:
- Get the facts – we know how the disease spreads and also what people can do to protect themselves.
- Consider limiting your sexual partners and interactions at this time. This may be a difficult message, but exercising caution can protect you and your wider community.
- Although vaccination may be available for some people at higher risk of exposure, it is not a silver bullet and you should consider taking steps to further reduce this risk at this time.
- If you have or think you have monkeypox, you may be contagious. So please do all you can to prevent the spread of the disease, including isolating yourself if you can, taking a break from sex, and attending social events in person.
Ending this epidemic is possible, but only with the full involvement and commitment of the individuals and groups most affected. Although the responsibility to act is shared, health authorities and governments must target resources and support where they will have the most impact.
NOTE: The names of the people we interviewed have been changed to protect their identities. We appreciate the openness of all the men who agreed to speak to us.