For pioneering AIDS activists, the monkeypox outbreak evokes deja vu

1st August, 2022.      //   Health  // 

As monkeypox cases rise around the world, four pioneers of the AIDS activist movement watch with awe and nostalgia.

Some of the similarities between the two viruses speak for themselves. Like the strain of HIV that started the AIDS pandemic in the late 1970s, the current monkeypox epidemic originated in sub-Saharan Africa and has been found overwhelmingly in men who have sex with men in the world’s metropolises. Although epidemiologists do not fully understand how the current outbreak of monkeypox spread, recent research points to sexual transmission.

Four leading AIDS activists of the 1980s and ’90s argue that there are other, consistent, but less obvious real-time parallels.

 

As in the early days of the AIDS crisis, they argue, government messaging about the epidemic has been flawed, gay men have been blindsided, and public health officials have failed to address the dire disease plaguing the LGBTQ community.

“It feels like deja vu,” said Peter Tatchell, a gay rights campaigner who is a leading member of the Gay Liberation Front in the United Kingdom. “Lessons from AIDS crisis and Covid clearly not learned.”

When AIDS first began to appear in men who had sex with men in the late 1970s, public health officials around the world fought back. It wasn’t until June 5, 1981 that the United States published the world’s first government report on infectious disease in the Morbidity and Mortality Weekly Report, a government bulletin on puzzling disease cases.

“Between October 1980 and May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. “Two of the patients died”

Three years later, the US government announced that it was developing an AIDS test in addition to the vaccine, which failed. By 1985, nearly 12,000 Americans had died from the disease.

Similarly, activists argue that the global response to monkeypox has been too slow to contain the ballooning numbers – more than 20,500 monkeypox outbreaks have been reported globally in 77 countries and territories since early May. Disease Control and Prevention.

Since its discovery in 1970, there have been no deaths from monkeypox outside of the 11 African countries where the infectious disease is endemic. However, a significant number of monkeypox patients are hospitalized due to severe pain caused by the often developing acne-like sores. .

After the first cases were detected in May, the United States distributed about 200,000 Jynneos vaccines — a two-dose vaccine to prevent chicken pox and monkeypox — to the most at-risk population, some 3.8 million gay men. French Social Affairs and Health Minister Francois Brown said on Monday that only about 6,000 people had been vaccinated in more than 100 vaccination centers in France. Health officials in the UK ordered an extra 100,000 doses of the vaccine last week to meet rising demand.

Last Saturday, the World Health Organization declared monkeypox a public health emergency of international concern, which is reserved for the most dangerous global disease outbreaks after declining to do so last month. More than two months after the first case of monkeypox was discovered in the United States in mid-May, public health officials in New York City issued a statement Thursday that the infectious disease poses an imminent public health threat, and San Francisco officials declared a state of emergency. emergency situation.

“What’s interesting is that many scientists and clinicians who trained during the AIDS epidemic or were there at the beginning, people like Tony Fauci, know this history, but the response to monkeypox has been alarmingly slow and chaotic,” Gregg Gonsalves said in 1990’s AIDS- He joined Act Up, a leading group fighting to fight AIDS, and is currently a professor of epidemiology at the Yale School of Public Health. “Individually, it’s like, ‘You’re three strikes out, man.’ HIV, Covid and now monkeypox? How many times can you repeat the same mistakes?”

Representatives of the National Institute of Allergy and Infectious Diseases, which Dr. Anthony Fauci has led since 1984, and officials at the White House, where Fauci serves as the president’s chief medical adviser, did not immediately respond to inquiries from the news.

Male pictures they wait in long queues outside clinics around the world to get the vaccine, technically issues with online vaccine portals and reports accusing the US government of developing a “wait-and-see” response to the outbreak – reportedly requiring vaccinations to be sent only in cases that have surged in the past few weeks – have fueled activists’ fears. the public health response to monkeypox is shaping up to be a repeat of its flawed AIDS strategy.

 

Although the virus began spreading in May, the United States did not order more doses of the monkeypox vaccine to add to its stockpile until June. Regulators also did not complete an inspection of the main monkeypox vaccine manufacturing facility in Denmark until July, leaving 1.1 million doses ready for distribution in Europe.

“Just like during the AIDS pandemic, some governments seem to care very little about monkeypox as long as it only affects men who have sex with men,” said Tatchell, who was rushed from a London hospital where the monkeypox vaccine had run out. last Sunday. “What other explanation could there be? Governments should have rolled out emergency vaccination programs for gay and bisexual men two or three weeks ago.

Some veteran AIDS activists also argue that, as was the case during the AIDS crisis, the messaging to combat monkeypox has not been sufficiently tailored to reach the LGBTQ community.

Ron Goldberg, an early AIDS activist who joined Act Up in 1987, points to the “America Responds to AIDS” public service announcement campaign the government launched at the height of the crisis in the late 1980s. Many of the ads featured heterosexual couples and the message “AIDS is everyone’s problem.”

“At the time, they were so afraid to talk about gay sex or anything like that that they had to soften the message while trying to give some information,” Goldberg said. “If it’s happening within a specific population, you need to target your messaging to that specific population.”

Activists have largely applauded efforts by public health officials not to directly associate the monkeypox with the LGBTQ community — as many believe they do with AIDS — and thereby stigmatize it. However, some argue that repeated statements by public health officials that “anyone can get monkeypox” reflect the AIDS message that “anyone can get the AIDS virus” and also undermine efforts to warn the demographics most at risk. avoids

Research overwhelmingly suggests that the current monkeypox epidemic is largely driven by men who have sex with men. A study published last week in the New England Journal of Medicine found that 98% of the 528 monkeypox cases the researchers analyzed were found in men who identified as gay or bisexual. Another recent report by the British Health Safety Agency found that 97% of the 699 monkeypox cases for which information was available were in gay, bisexual or other men who have sex with men.

“The numbers are there,” said Didier Lastrade, who founded the first French chapter of Act Up in 1989. “We should not shy away from it. … We are big people, we are big people, we can accept it. Stigma goes both ways.”

The WHO advised gay and bisexual men to limit the number of sexual partners they have to protect themselves from monkeypox and prevent its spread.

But framed by two years of pandemic isolation and big summer events like last weekend’s annual Pine Party on Fire Island, some activists fear it will be difficult to curb the sexual behavior of gay and bisexual men.

“You want to appeal to people in their 20s and 30s and say, ‘Look, this is no joke.’ You’ve all seen the pictures. You’ve all had friends who have contracted the monkey. You don’t want that,” said Gonsalves.

More broadly, Lastrade argued that the advent of pre-exposure prophylaxis, the HIV prevention pill (also known as PrEP), and scientific evidence over the past decade that HIV treatment can prevent transmission have caused gay and bisexual men to fall asleep. it happened at the helm when it comes to their sexual health.

“The new generation has completely forgotten the story of AIDS. I keep writing books about AIDS, but no one reads them,” says Lastrade. “When S- happens, they forget the reflexes we used to have because it was a matter of life or death.”

Regardless of the messaging, with the global rollout of a vaccine, activists fear that the virus will become an infectious disease that the LGBTQ community must live with permanently, as it did with AIDS decades ago.

“A lot of people are saying that we’ve passed the tipping point, that we’ve missed our chance,” Gonsalves said. “If this is true, it’s incredibly serious because this disease doesn’t necessarily kill, but the enormous suffering and cost of it all will put a burden on many people, many health systems and many communities. those who are already suffering.”

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