Thread by @LizHighleyman

I don’t know how to say this without offending anyone, but acknowledging that #monkeypox is spreading within gay networks – & some gay & bi men have a lot of sex – is not inherently homophobic. 1/

All but 1 of ~150 confirmed or suspected #monkeypox cases compiled by @globaldothealth are young or middle-aged men. Many known to be gay or bi, diagnosed at STD clinics or reportedly attended gay venues (saunas) or events (fetish festival). 2/
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As @angie_rasmussen says in this🧵, viruses are opportunists. Initial genomic analysis done so far suggests that #monkeypox has not evolved to become more transmissible. Rather, it’s taking advantage of niches & conditions that facilitate its spread. 3/

@mugecevik has also done a nice🧵on the topic. 4/

Compared with the population at large, more gay & bi men have sex with multiple partners & attend congregate venues & circuit-type events -- & they frequently travel to such events in other cities. 5/

These venues/events commonly feature sex & other intimate activity involving skin-to-skin contact, fluid exchange & breathing on each other (all known to transmit #monkeypox). As @ENirenberg notes, “sexual transmission” doesn't only mean intercourse. 6/
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#Monkeypox outbreaks may have been first identified among gay & bi men because they’re diligent about their sexual health & accustomed to getting unusual rashes checked out at STD clinics. (Some cases presented with genital rashes resembling chancroid, herpes or syphilis.) 7/

Outbreaks of diseases within gay sexual networks aren't uncommon – but due to COVID, the world is now paying attention. 8/

This might be somewhat comparable to outbreaks of hepatitis C. Mostly associated with injection drug use, for several years there have been clusters of sexually transmitted #hepC among gay & bi men who don't inject drugs in numerous cities. 9/
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It’s possible to manage such outbreaks without demanding abstinence or monogamy. Networks facilitate education, contact tracing & focused resources for testing, prevention & treatment for those at risk. For #monkeypox, this could mean ring vaccination using smallpox vaccine. 10/

The predominance of #monkeypox among gay men made me wonder about their #HIV status & antiretroviral treatment & whether compromised immunity might be playing a role. Luckily, @sciencecohen is on the case & that doesn’t appear to be a factor so far. 11/
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Yes, homophobes are going to homophobe & the right will use #monkeybox outbreak to blame & shame gay men – that’s what they do. As @Boghuma says, there’s no such thing as an exclusively “gay disease” & other groups shouldn’t think they’re in the clear. 12/
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We don’t want to repeat the kind of stigma we still see around #HIV. But being upfront is important for individual awareness & public health. And shaming people for having sex only works if we think sex is shameful. 13/

(Obviously, I’m not a gay man, though I’ve been in on discussions about #HIV & sex in gay community for 30 years. I haven’t seen much #monkeypox commentary from gay & bi men yet. Thoughts, @MyFabDisease, @DamonLJacobs, @Neurofourier? Happy to be schooled if I’m off base!) /end

I should clarify, while only one of the compiled cases is a woman, some of the suspected cases don’t list a gender. And we don’t know how many of the men were gay or bi.

There's a media report today -- though I haven't seen confirmation from more reliable sources -- that a child in London has monkeypox. This would not be surprising, as young children have close physical contact with caregivers.
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Here's a nice summary put together by @PrathitKulkarni, @Boghuma & @TxID_Edu

Another good #monkeypox thread from @profhelenward. She points out that control of monkeypox will be different from COVID control & urges against homophobia & racism that lead to blame & stigma.

.@gregggonsalves also offers a good thread, noting that we have experience managing outbreaks within gay men's communities.

Nice background thread on poxviruses, including #monkeypox, written in easy-to-understand language.

My latest #monkeypox story in the Bay Area Reporter (@eBARnews), with comments from @PCH_SF (@UCSF), John Brooks & Jennifer McQuiston (@CDCgov), @SF_DPH & @Boghuma. There's now a suspected case in Sacramento.
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