Thread by @BiomedSelfSoc

Good afternoon, and welcome to the CBSS roundtable on “Is #monkeypox an #STI?” I’m @JamieDWebb, a PhD researcher at CBSS, and I’ll be live-tweeting this event.

@PickersgillM opens the event with a virtual welcome to Edinburgh, and poses the central question of the event: “Is Monkeypox an STI?" This is a public health, intervention, economic, conceptual, and practical question. #monkeypox

@JGarciaIglesias and @NagingtonUoM explain the motivations for the event: the need to consider the central question from a diverse range of disciplinary and geographical backgrounds. Who is called to respond to this crisis, and how?

@drmbrady starts the panel by pointing out that as our understanding of the epidemiology of the virus increases, we are gaining a greater understanding that there can be purely sexual route of transmissions, as well as other types of close bodily contact. #monkeypox

@LizHighleyman argues that public health officials should not confidently assert that monkeypox is not an STI. Definitions of STIs do not require the disease to be transmitted through semen, nor for them only to be transmittable through sex.

The risks of stigmatisation of associating monkeypox with sex are considerable. But doing so would give people a more accurate sense of their risk levels of infection. And we have good resources available to deal with monkeypox as an STI @LizHighleyman

@javimembrillo provides evidence to show that monkeypox has both sexual and non-sexual methods of transmission.

We need to explain to populations what they need to know. For a long time many in the wider population did not understand that heterosexual people could get HIV. What people know about monkeypox will influence how they behave. @javimembrillo

How can we address inequity? @DrWillN has been running UTR (Under The Radar) pop ups for vaccination, prioritising those who are least likely to be at the front of the line. #monkeypox

Honest communication is key: the narrative that ‘anyone can get monkeypox’ creates big inequities in vaccination, especially in conditions of scarcity. Those most at risk should be at the front of the line. @DrWillN

.@engelmal81 points out that from a historical perspective, ‘what is an STI?' was a very different question before and after HIV. Before HIV it was based on Victorian histories of syphilis.

This included the use of fear and ambiguity of transmission as a form of control, ‘moral’ education, compulsory public health measures, and the sense that once a technological fix is available then the problem is solved. @engelmal81

HIV changed this: it created a recognition of the need for open communication, participatory information sharing, voluntariness, and a rejection of technosolutionism. @engelmal81

.@DewsnapClaire points out that the question of ‘what is contact of a sexual nature?’ is quite ambiguous: it is not just insertion and penetration.

Those involved in sexual healthcare know how to destigmatise the sexual act. This knowledge needs to be shared, rather than trying to dodge stigma by claiming monkeypox isn't an STI. The proper funding of sexual healthcare is key. @DewsnapClaire

.@EricUmar8 points out the challenges of monkeypox in Malawi, especially with people with low levels of sexual education and in communities of people with multiple partners. Not everyone has access to protective materials.

We want a proactive rather than reactive public health response. @EricUmar8

.@thrasherxy points out it is clear that HIV can be transmitted non-sexually, especially through drug use. But it is sexually transmissible. And there is currently a higher proportion of transmission of monkeypox through sex than with HIV.

We need to reject the shame that comes around these viruses. There is no good that can come from ceding ground to homophobes or racists. @thrasherxy

Exceptional cases get exceptional coverage. So much coverage currently happens around non-sexually transmitted cases, but there should be a focus on the primary methods of transmission, which is sex. @thrasherxy

@thrasherxy For disease control, as well as for pleasure and sex, we need to have greater research into how exactly the disease can be transmitted through sex. @thrasherxy

Opening the Q&A, @LizHighleyman points out that people are going to notice the way this virus is being transmitted, and this shouldn’t be ignored.

The CDC currently calls monkeypox ‘sexually transmittable’ but don't include it on their list of STDs: but some diseases on their list of STDs currently have lower rates of sexual transmission than this new mutation of monkeypox does. @thrasherxy

You can't silo your messages: the wider public will see all the health messaging you put out, even those tailored to specific communities. And public health messaging has become so politicised in the time of Covid. @LizHighleyman

We won't resolve monkeypox with messaging: we need to be focussing on the structural interventions necessary to get people access to interventions, and targeted and tailored interventions for in need communities. The challenge is not messaging. @DrWillN

We need to get away from a paradigm of only addressing challenges when they are considered a threat to the foundations of society, and move to proper and consistent resourcing for the challenges we face. @engelmal81

We haven't learnt the lessons from HIV and Covid. There was at least some focus on equity in Covid vaccinations. We don't currently have the data on monkeypox vaccinations, but they do seem like similar demographics to those who currently have most access to PrEP. @drmbrady

We have more data in the US: in majority black states it is majority white individuals getting the vaccine. The people who are able to find appointments on the internet and take time off in the middle of the workday currently have greater access to the vaccine. @thrasherxy

We need to empower those organisations who are providing services to LGBTI individuals. @EricUmar8

We need a wide study in the general population to know the prevalence of symptomatic and asymptomatic transmission of disease @javimembrillo

We need attention on where to position monkeypox in the whole history of STIs which needs a wider perspective than just a biomedical one, and how stigma is being experienced in different communities. @engelmal81

LGBTQ people were more likely to suffer from Covid, not because it was sexually transmitted, but because they were less likely to have access to care, were more likely to work in customer service jobs, etc. We need to consider monkeypox in the context of homophobia. @thrasherxy

And that's the event! A huge thank you to all our speakers for such an illuminating discussion. @DewsnapClaire @drmbrady @DrWillN @engelmal81 @LizHighleyman @thrasherxy @javimembrillo @PickersgillM @JGarciaIglesias @NagingtonUoM @EricUmar8