- Medical professionals bust myths about the disease
(This is the second of a two-part series on the stigmatisation of monkeypox. Read about what the LGBT community has to say about the topic in yesterday’s (11) issue of The Morning Brunch)
On 23 July, World Health Organisation (WHO) Director General Dr. Tedros Adhanom Ghebreyesus declared monkeypox a public health emergency of international concern, but added: “…for the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners.”
According to Health Ministry Policy Analysis and Development Director and Community Medicine Consultant Dr. Janaki Vidanapathirana, monkeypox is a viral disease that can spread from animals to humans or humans to humans.
“Monkeypox has caused a range of signs and symptoms; fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes,” she told Brunch, adding that patients may develop a rash that lasts two to three weeks. Evidence shows 1-10% people can die when they develop serious disease.
Fortunately, people who have been immunised against smallpox have 85% immunity, but Dr. Vidanapathirana pointed out that people born after 1980 have not been immunised against smallpox.
She explained that monkeypox can spread through close contact of any kind.
“It can be spread via face-to-face, skin-to-skin, mouth-to-mouth, or mouth-to-skin contact, including sexual contact. This includes very close contact including kissing, touching, and oral and penetrative vaginal or anal sex with someone who is infectious.”
High risk groups
Dr. Vidanapathirana went on to say that there are high-risk groups, like people who associate with monkeypox patients, people working with animals, and people in environments contaminated with the monkeypox virus.
“For example, when an infectious person touches clothing, bedding, towels, objects, electronics, and surfaces, someone else who touches these items can then become infected. It is also possible to become infected from breathing in skin flakes or the virus from clothing, bedding, or towels. This is known as fomite transmission.”
She added that there is not yet enough evidence on asymptomatic transmission.
However, in terms of the MSM (men who have sex with men) community, Dr. Vidanapathirana said that not just MSM persons, but any person having close contact with an infected person can get the disease. This includes any sexual contact with an infected person.
“MSM practice is already related to stigma amidst society, due to a lack of knowledge on sexuality. This can be prevented by community education on the transmission modality of monkeypox, and community empowerment should be accelerated to reduce the stigma.”
Dr. Vidanapathirana went on to add that when we say the MSM community has a higher risk of monkeypox, it creates a negative impact, discouraging people from accessing health services. “If people do not obtain health services due to stigma, it will lead to an epidemic.”
She made a comparison to the HIV/AIDS pandemic, where a similar scenario with stigma against the MSM community took place when the disease was discovered in the early 1980s.
“Later, it was revealed that any kind of unprotected sex with an infected person leads to HIV infection spread,” she said.
Dr. Vidanapathirana added that it is important that persons who have any signs or symptoms and suspect infection get medical advice without any issues. She went on to say that health workers are ready to support and treat people.
Harmful labelling
Brunch also spoke to Dr. Gowin Sanjula, who is an international medical graduate from the West China School of Medicine, Sichuan University.
We asked him if he has seen how stigma around diseases have had a negative impact on patients and communities, to which he responded: “While dealing with patients, there are many things to be mindful of, and the stigma that revolves around certain diseases/conditions makes it difficult for healthcare providers to give the patient the optimum care/treatment they require. This is a result of miscommunication and the inability to get a proper history of the patient, as vital key information is missed out or omitted in fear of the patient being judged, or because they feel ashamed.”
Following the WHO’s statement that the MSM community is at higher risk of infection, monkeypox was soon labelled a “gay disease”. Dr. Sanjula said that, as a medical professional, he does see negative impacts to such labelling, as it not only affects the LGBT+ community, but also adversely affects disease progression within a given population.
“The World Health Organisation poorly worded its statement regarding monkeypox. The article by the New England Journal of Medicine states that an overwhelming number of individuals infected by monkeypox are gay. This is not to say it exclusively infects gay individuals, but only that it observed a large number of individuals infected that are gay. There is still much to learn regarding this disease and to understand its transmission; hopefully in the coming days, more light will be shed on this matter.”
Going into detail about the impact of such labelling, Dr. Sanjula said persons who identify as gay could be said to have the disease despite being uninfected, while those who are not gay or are not comfortable disclosing their sexuality may be reluctant to receive medical treatment, thus jeopardising their own life, as well as that of those around them and the general public.
The adverse effects of such labelling are worsened in a country like ours, where homosexuality is still considered taboo or immoral in many communities.
“Labeling it a ‘gay disease’ would also create a false sense of security to anyone that is not gay; these individuals, who would not take precautionary measures, being under this belief, would inadvertently be super-spreaders of the disease, possibly leading to a sudden rise in the number of cases.”
Dr. Sanjula explained that the pathogen of the disease does not discriminate based on gender, race, sexual orientation, or individuals specifically, and it is society that is responsible for that thought process.
“Now if the majority believed ‘I can’t get it because I’m not gay’ then anyone that’s ‘not gay’ would barely or most probably would not adhere to the safety precautions for monkeypox, whereas the truth is that everyone is susceptible to the disease if exposed,” he explained.
This thought process would cause a catalytic effect on the rate at which the disease spreads, and would result in a surge in cases.
“This is precisely why we must educate the public on the disease, ensure accurate information is provided, and also debunk some of these misconceptions, thereby hopefully leaving minimal room for error or misinterpretation.”
Incidences of monkeypox are yet to be detected in Sri Lanka, but we inquired if there are concerns within the medical community about how the disease may become stigmatised among our people in the event cases are detected. Dr. Sanjula explained that such concerns are valid, given how people reacted to the Covid-19 pandemic, especially during the early stages of the outbreak.
“The amount of misinformation circulating on social media and how so many people were manipulated into conspiracy theories about the vaccine causing harm resulted in a considerable amount of damage in terms of reporting symptoms to the authorities, vaccination programmes, and families being ostracised from the community after an individual in the house contracted the virus. Therefore, with monkeypox, it is expected for people to behave in a similar or more atrocious manner.”
Protecting vulnerable communities
Public awareness is one of the key ways of protecting vulnerable communities against any sort of discrimination that may arise. It is also important for medical professionals to be mindful when making statements that reach the public. Dr. Sanjula added that misinformation online should also be monitored very closely and possibly taken down as soon as possible.
“Public awareness is of utmost importance when it comes to highly transmissible diseases such as monkeypox or Covid-19, as prevention is always better than cure. Only with effective public awareness, and educating the public regarding the disease and how it’s transmitted, can we truly achieve proper prevention for the majority of the people,” he said, adding that many have already mislabelled monkeypox as a sexually transmitted infection (STI).
