First, anyone can get smallpox. Second, the current epidemic is overwhelmingly concentrated among men who have sex with men. And third, a growing body of evidence and data suggests that sex between these men is the primary means by which monkeypox is currently being spread. While it’s true that there are other ways to transmit the virus, acknowledging and reporting these facts is not anti-gay, and neither is targeting advice to members of that community since they are currently most at risk. More than 31,000 people worldwide have contracted monkeypox – nearly a third of them in the US, where the Biden administration has declared a public health emergency. Every state except Wyoming has identified at least one case. And yet, whether due to fears of perpetuating stigma or a general reluctance to use the words “anal sex” in headlines, health officials and the media have appeared extremely reluctant to talk frankly about sex to those most at risk. In Washington, officials even expanded vaccine eligibility to include people of all genders, in part out of a desire to “[destigmatize] people who may need a vaccine.” Public fears have also been raised about monkeypox being contracted through trying on clothes in shops or through rats in sewers by medical experts who have branded themselves online as pseudo-pox-turned-monkeys. (For the record, experts say neither of these scenarios is anything to worry about.) All of this, experts say, may actually be doing more harm than good, according to Angie Rasmussen, a virologist at Canada’s pandemic research centre, the Vaccine and Infectious Diseases Agency at the University of Saskatchewan. “The conversation around this has become so exhausting: watching my queer health advocates trying to get information and vaccines/treatments to at-risk people, coming up against armchair pundits and lobbyists screaming, ‘AIRBORNE!’ and wringing their hands about their kids getting monkey pox in kindergarten,” Rasmussen wrote in a message to BuzzFeed News. “It does great harm to the people who are most at risk NOW.”
So what does the data say about who gets monkeypox?
People infected with monkeypox right now are overwhelmingly gay, bisexual, or queer men. And when we say overwhelming, we mean it. In an update last week, the WHO said that among more than 8,400 cases with known sexual orientation data, 97.2% were men who had sex with men. In addition, of the nearly 6,000 reported types of transmission, 91.5% of cases resulted from sexual contact. “With the exception of countries [in the] regions of West and Central Africa, the ongoing outbreak of monkeypox continues to primarily affect men who have sex with men who have reported recent sex with one or more partners,” WHO said. “At present, there is no signal to suggest continued transmission beyond these networks.” In a New England Journal of Medicine study published last month that looked at more than 500 cases of monkeypox in 16 countries, 98% of the patients were gay or bisexual men. Another study published July 28 in the British medical journal BMJ included 197 monkeypox patients at a sexual health clinic in London. All but one of those men—and they were all men—identified as gay, bisexual, or a man who has sex with men. In the US the data is the same. CDC data as of July 25 show that 99.1% of cases are among patients assigned male birth, and 99% of those males reported recent sexual contact with another male. To explain the concentration of monkeypox among these men, experts say it is important to think of them not as individuals, but as communities or networks of people coming into close contact with each other. In other words, the virus hasn’t become more contagious – it’s just entered a new network of people. “I think it’s really about the virus being able to take advantage of network effects and close contacts between people,” said Amesh Adalja, a senior researcher at the Johns Hopkins University Health Center, “and use amplification events like raves — where many people may have had many close contacts with many partners, and some of them anonymous — and that allowed the virus to spread in a way that it really didn’t have a chance to do before. “He’s probably always had that potential,” Adalja said. “I just needed to get into a network like this.”
What does this data tell us about the way is monkey pox spreading?
According to the CDC, there are three main ways you can catch monkeypox: direct skin-to-skin contact with an infected person; touching contaminated surfaces, objects or fabrics (e.g. and contact with respiratory secretions such as mucus (aerosols). But since this current epidemic is spreading so primarily among these networks of men who sleep with each other, experts say prolonged skin-to-skin contact during sex is what’s driving most of these cases. “Based on the data we have, it seems pretty convincing to me that sex plays a dominant role in the spread of monkeypox, along with the fact that maybe these patients had sex with multiple partners,” Gerardo Chowell, an epidemiologist at Georgia State. University School of Public Health in Atlanta, told BuzzFeed News. “And that’s probably why we haven’t seen as many cases among heterosexuals.” Rasmussen said that if fomites and aerosols were huge drivers of monkeypox, the data would show many cases occurring outside of gay men, bisexual men or men who have sex with men (GBMSM). “Not all transmissions are sex-related, but most are,” Rasmussen said. “If this was more commonly transmitted by aerosols, fomites or casual contact, we would see way greater household transmission and spread to the wider community. “GBMSM do not live in isolation: they have children, families, colleagues. We would see more cases in these people if the spread wasn’t primarily due to sex,” Rasmussen added. “Though again, there is some non-sexual transmission that does happen, just not as much. “It would probably spread among heterosexuals if it became established within these sexual networks.” For its part, the New York Department of Health, which has recorded more than 2,000 cases of monkeypox, lists the three possible methods of transmission on its website, but first states clearly: “In the current outbreak, the monkeypox virus mainly spreads. during oral, anal and vaginal sex and other intimate contact such as kissing, cuddling, kissing, biting, cuddling and massaging.”
How is monkeypox transmitted through sex?
Experts believe it takes much more than a light brush of skin or a handshake with an infected person to catch monkeypox. What is required is constant rubbing on a person who has rashes, scabs or lesions or on that person’s bodily fluids. The most obvious and easy way for this to happen is during sex, but dancing or grinding against a shirtless person at a carousel party also carries some risk. The role of sex in the spread of monkeypox seems to have been evident for several years. This current outbreak of monkeypox appears to be linked to an outbreak identified in 2017 in Nigeria, which now appears to have spread globally. At the time, puzzled scientists there had wondered why so many men in their 20s and 30s were getting sick and showing rashes not on their faces and limbs, but on their genitals. They soon discovered that many of these patients had exhibited high-risk sexual behaviors that included sleeping with multiple partners and sex workers. “Although the role of sexual transmission of human monkeypox has not been established, sexual transmission is plausible in some of these patients through close skin-to-skin contact during intercourse or transmission through genital secretions,” Dimie said. Ogoina, a professor of medicine and infectious diseases at Niger Delta University, wrote with colleagues in a 2019 medical journal. Further studies related to this current global outbreak have given further strength to this idea, Ogoina wrote in a new piece of analysis published in the Lancet medical journal just last week. Ogoina made special mention of another Lancet study published earlier this month by scientists in Spain of 181 monkeypox patients there, 92% of whom were GBMSM. The researchers found “significantly higher” viral loads, or amounts of the monkeypox virus, in swabs from patients’ lesions than in their respiratory samples. In addition, more than three-quarters of patients had lesions around their anus or genitals, while more than 40% had lesions in or around the mouth. Forty-five patients also had proctitis, or inflammation of the lining of the rectum, and all but four of these men had engaged in anal sex.
