Just Want To Monkey Around


HEY BRYAN, 

I live in a city where monkeypox cases are going up. Our COVID restrictions got lifted a few weeks ago and I want to go out and party and do all the things we had to cancel last year (and the year before that). But I’m really worried about monkeypox. Parties are still happening, Pride is happening, Pride parties are still going to go ahead as scheduled. I want to have fun, but I heard you have to quarantine for up to 4 weeks if you get it and I’m worried about what my job and friends will think if I get it.

 

Just Want To Monkey Around


For better or for worse, the reporting around monkeypox has been mentioning that most cases are involving MSMs (men who have sex with men). This has triggered many within our community who lived through the last infection that had a similar story—AIDS. The stories of MSMs getting sick from an infection, being ignored by governments, and basically left to fend/die on their own is not lost on these communities.  The major difference in the case of monkeypox is that so far, no one has died from it.

But also, the very information that warns us of higher risk is also the information that potentially stigmatizes us. A man who has to take sick-time off work may have to deal with the social stigma (and consequences) of homophobia, slut-shaming, kink-shaming, and other social shaming that comes with the idea that many monkeypox cases are from skin-to-skin contact that happens to be occurring during sex. You do not need to be a slut to get monkeypox.

There are a couple of things I think everyone needs to understand about monkeypox that aren’t always talked about:

1) Incubation period: It takes 2-3 weeks for lesions/bumps to appear after someone is infected. BUT they can pass the virus to other people during this time if they have other symptoms that come before the bumps (fever, muscle aches/backache, swollen lymph nodes, chills—so basically mostly flu symptoms with lymph node enlargement.) Because of this, avoiding guys who have visible lesions isn’t really that much of a useful risk reduction strategy. Avoiding guys who have flu-like symptoms is probably better, which you should pretty much be doing anyways.

2) Not just skin-to-skin contact: Monkeypox is most common spread by skin-to-skin contact but it is possible to be infected with prolonged face-to-face contact (less than 2 meters). This includes activities that seem obvious like kissing and cuddling, but also just talking with someone close-up at a party for a “long time”.

3) If you can find a vaccine (the most common is called, “modified vaccina Ankara”, called Jynneos in the US, Imvanex in Europe and Imvamune in Canada)), it takes 2 weeks after the second dose to achieve long-standing immunity. Each dose is separated by 4 weeks. But there is evidence that even a single shot provides protection, with the second dose ensuring longer protection than one shot alone. However, it STILL takes 14 days to get the benefit of a first dose.  This vaccine is for smallpox but works against monkeypox (they are similar enough).

Given all this information what can YOU do?

1) Decide if this is a risk worth taking. We take risks whenever we go out or have sex with people—risks of physical safety, risks of contracting an infection like herpes, gonorrhea, COVID or even just a regular common cold. If getting monkeypox is something you simply cannot afford to get, and you cannot get a vaccine 14 days before an event, you might reconsider any level of participation.

Pre-event planning:

Before you decide whether to go to an event, check what the rates of monkeypox are in your city/town. Are they going up or not? This gives you a better rough idea of whether going to an event is actually risky. If the rate of monkeypox is in the single digits, it’s less risky than if it’s in the triple digits. Venue organizers are NOT considering monkeypox in their planning. This sort of thing is falling to individuals to decide if the risk is worth taking.

1) Choose where, or even if you are going to go to crowded places. Is it an indoor or outdoor venue? Is an event where everyone is generally shirtless? Will YOU be shirtless? How much talking do you expect to do with people you don’t know?

2) What are your friends, or the people you might be going to events with, and the people you hang out with, planning for their risk reduction?

3) If you decide to engage in kissing, cuddling, sexual contact, or prolonged contact, ask your prospective partner/partners about whether they’ve had symptoms of anything in the last 2-3 weeks. Your partners probably want to know about you too, to protect themselves!

4) Be suspicious of skin lesions. Look at the photos online of monkeypox bumps. They can be anywhere on the body, including the penis and anus.

If you get it:

1) Remember, in most countries, WHY you are off sick is not actually something you must reveal to your job/employer. If you need physician documentation (like a letter or note), it does not have to state your diagnosis, but only that you must be off work.  It’s okay to say, “I am not comfortable sharing my diagnosis with you,” or “It is a very personal medical matter, thanks for asking.” Assume that if someone asks, that they are usually curious or concerned with good intentions. The more flustered or upset you get (because they are technically asking you for information to which they do not have the right to know), the more suspicious they will get.

2) In some countries, there is better access to vaccines if you have contracted monkeypox, or if you have come into contact with someone who has monkeypox. Not all countries are being proactive about vaccinating people before they are exposed to the virus. And even within countries, not every city/area/state/province has the same access depending on what local monkeypox rates are and what they are doing. If you know you have come into close contact (even if it is not sexual in nature) with someone who has gotten monkeypox, ask your local health care system if you can get a Post-Exposure vaccine.

3) Although it is your personal choice to reveal your infection, it is the more responsible thing to do to let people know that you have monkeypox so that THEY can get a Post-Exposure vaccine. In many countries, monkeypox is a reportable infection that gets reported to public health (just like gonorrhea and syphillis are also reportable infections) to track the infection rate. This helps not only to decide what resources need to be redirected torwards an outbreak but also gives people an idea of how risky an activity might be since they can also check the reported rate in their city.

It is important to stress that monkeypox is not a gay, or even an MSM disease, but a coincidence that it has affected us in this population first (in this current outbreak). It is important to remember that so far, no one has died from monkeypox and that while it can be a painful and very inconvenient infection, that most people do not have any long-term effects from it. Erasing or lessening stigma shame only happens when we choose not to receive the stigma in the first place.

 


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