This is part one of a two-part series on the stigmatisation of monkeypox. Read about the opinions of the medical community in The Morning Brunch tomorrow)
It was chilling to hear the World Health Organisation (WHO) declare monkeypox a public health emergency of international concern a few weeks ago, especially given the gradually rising Covid-19 numbers in the country, and the shortage of medicines that hospitals have been facing. While monkeypox is yet to be detected in Sri Lanka, health officials have taken steps to prepare against a possible outbreak.
Looking at the disease itself, human monkeypox was first identified in 1970 in the Democratic Republic of the Congo (DRC). According to the WHO, the patient was a nine-month-old boy from a region where smallpox had been eliminated in 1968. Monkeypox is a viral zoonosis (a virus transmitted to humans from animals), with symptoms similar to those seen in the past in smallpox patients, but it is clinically less severe.
The World Health Organisation (WHO) stated that with the eradication of smallpox in 1980, and subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health. The disease mainly occurs in central and west Africa, often in proximity to tropical rainforests, and has been increasingly appearing in urban areas.
The 2022 outbreak
Since early May 2022, however, cases of monkeypox have been reported from countries where the disease is not endemic.
A total of 3,413 laboratory confirmed cases, and one death were reported between 1 January and 22 June from 50 countries or territories, in five WHO regions. However, the WHO stated that since the Disease Outbreak News of 17 June was published, 1,310 new cases were reported. Eight new countries have reported cases as well.
On 23 July, WHO Director General Dr. Tedros Adhanom Ghebreyesus declared monkeypox a public health emergency of international concern. However, he went on to add: “…for the moment, this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners”.
Dr. Ghebreyesus added: “That means that this is an outbreak that can be stopped with the right strategies in the right groups.”
The statement was criticised for being harmful to the LGBT+ community, but also people in general, as it stigmatises the disease, despite the WHO also saying measures must be adopted to protect the health, human rights, and dignity of affected communities.
In Sri Lanka, concerns about monkeypox have been raised, especially after two cases of the A.2 strain were detected in neighbouring India. According to Health Ministry Chief Epidemiologist Dr. Samitha Ginige, the transmission rate of monkeypox is low compared to diseases like chickenpox. This means there is no need for unnecessary fear, but there is still a need to be prepared for an outbreak.
“We are constantly studying the global situation and the regional situation,” Dr. Ginige said during a Health Promotion Bureau press briefing, adding: “We have launched a hotline through the Epidemiology Unit for persons to inform us of any patients with symptoms.”
According to a circular issued by the Health Ministry, healthcare institutions must report any suspected cases immediately to its Epidemiology Unit.
Stigmatisation
While Sri Lankan health officials may take steps towards containing any spread of the disease, The Morning Brunch reached out to Equite Sri Lanka Chairman and LGBT+ activist Thushara Manoj to inquire if the LGBT+ community in Sri Lanka has any concerns about the stigmatisation of monkeypox.
“This is something similar to when HIV/AIDS came to Sri Lanka, as there was a discussion that was similar to this,” Thushara Manoj said, explaining that health professionals studying HIV/AIDS found that the MSM (men who have sex with men) community was vulnerable because they engaged in risky sexual behaviours.
“When it comes to the term MSM, people used it to say the disease is carried among gay people, but this is not true. Not all gay people have sex with multiple partners.”
Thushara Manoj explained that within the MSM community, there are men who have sex exclusively with men, but there are also bisexual persons, as well as those who have opportunistic sex with other men.
There was thus a misconception about the gay community as a whole, and their sexual behaviours. “Now with monkeypox, I see similar rumours going on here and there,” he said. According to the LGBT+ activist, statements such as those made by WHO about vulnerable communities are based on small samples from specific areas.
He explained that this was the same assumption made by WHO during the HIV epidemic, where results from a small sample were generalised among MSM communities across regions. Thushara Manoj went on to say that there are health officials and professionals, media personnel, and fundamentalist groups that are trying to spread the WHO statements, which can hugely affect the LGBT+ community.
This could be further aggravated by the misconceptions about the LGBT+ community in Sri Lanka. For instance, Thushara Manoj explained that most people still think all transgender people are gay, and that all gay people are effeminate.
“So the entire community could be stigmatised and discriminated against because of the statement,” Thushara Manoj said, sharing that it is his belief that observations made based on communities in the African or American continents, cannot be generalised to include South Asian communities.
Thushara Manoj added that they are still waiting for a statement from the Health Ministry, or engagement from the World Health Organisation’s office in Sri Lanka. However, he added that a statement from health officials must ideally come from the Epidemiology Unit or the National STD/AIDS Control Programme.
Strong community
Fortunately, Thushara Manoj was confident of the local LGBT+ community in the event that misinformation is spread about monkeypox in Sri Lanka.
“We are strong as a community and a collective of organisations. Compared to the HIV discussion which came about in 1995, we are really strong now. We are waiting to do something. And we have a really good network and support,” Thushara Manoj said, adding that they now have the resources, evidence, and information for advocacy, lobbying, and consultations/discussions with relevant authorities.
“We have really good stakeholders now, compared to 10 or 15 years ago,” he said, listing stakeholders like the Health Ministry, the National STD/AIDS Control Programme, Family Health Bureau, Health Promotion Bureau, and Family Planning Association. Thushara Manoj added that the support of these stakeholders can be relied upon if needed. He added that there has also been an improvement in the way the media talks about the LGBT+ community.
He was thus of the opinion that the community is ready to handle any misinformation and stigma that could spread about monkeypox in Sri Lanka.
