ANALYSIS | Why we shouldn't tiptoe around who is most at risk of getting monkeypox

More cases of monkeypox in blacks and Hispanics in the US 2:11

(CNN) --

The Joe Biden administration declared this month that the outbreak of monkeypox, a virus that spreads disproportionately among men who have sex with men and their sexual networks, is a public health emergency.

In an attempt not to reproduce the kind of anti-gay stigma that occurred during the first AIDS crisis, some argue that saying which group is most at risk of monkeypox could be dangerous.

However, experts say the insistence on blanket warnings hurts the most vulnerable people, including Black and Latino men, and oversimplifies the lessons of the AIDS crisis, which highlighted the importance of fighting stigma. and press for care for those in need.

Doses of monkeypox vaccines increase due to spread in the US 4:33

"We don't want to add stigma to a sensitive situation, but then our messages become so broad that no one knows who we're targeting, and that becomes a real problem," Robert Fullilove, a professor of clinical sociomedical sciences at the Columbia University Medical Center.

In short, the experts say that we should not tiptoe over the issue.

Instead, we should tackle it head-on and consider expanding access to health care.

What the first data on monkeypox show

Part of the problem with talking about monkeypox in a roundabout way is that we end up overemphasizing who can get the virus and downplaying who gets it, according to Melanie Thompson, an Atlanta-based physician and HIV researcher.

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Take, for example, a detailed breakdown of monkeypox case records that the Centers for Disease Control and Prevention (CDC) released this month.

Anyone can get the virus, yes, but CDC analysis shows that 94% of cases occurred among men who had recent sexual or intimate contact with another man.

Additionally, 54% of the cases occurred among Blacks and Latinos.

This is what gay men think of handling monkeypox 3:35

Early data from the Georgia Department of Public Health and the North Carolina Department of Health and Human Services show a similar pattern.

In both states, monkeypox attacks predominantly black men.

Thompson stressed the importance of clarity, of communication that explains precisely where the virus is.

"The purpose of the data is not just to make numbers, but to ensure that the people most affected by monkeypox or any other disease receive the necessary services," he said.

"The message that anyone can get monkeypox spreads fear in the general population. It distracts from the messages we need to get out to people at risk of getting monkeypox," Thompson added.

And this kind of unclear information is not only distracting, it marginalizes in another way, he noted.

Jim Downs, a Gettysburg College historian of epidemic diseases and author of "Maladies of Empire: How Colonialism, Slavery and War Transformed Medicine," agrees with some of Thompson's views.

"Evidence shows that men who have sex with men are at greater risk than any other population or group," he said.

"So when we talk about targeting messages and, more importantly, targeting vaccines, we have to make sure that those efforts are deliberately targeting people most at risk, as opposed to people who might think 'well, why not get vaccinated? It's a good idea.'"

It's worth noting, experts say, that while the majority of cases appear to be among black men, it's not because they're black.

"When we use race as a way to identify an important characteristic of a sick person, some people think that race is biologically active, (that) there must be something about brown skin that makes it more likely to get monkeypox," Fullilove commented.

"But that's not the case. What you're looking at is the dynamic of who hangs out with whom and where they socialize."

Thompson also added a dose of caution to the conversation.

"There is no kind of racial predilection for monkeypox," he noted.

"It has to do with structural racism and the nature of communities and cultural practices."

Does a lower dose of monkeypox vaccine work?

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He says that Georgia, for example, is still highly segregated based on race and sexuality.

"This means that people who are black are more likely to have sexual partners who are also black," Thompson explained.

"And since they are a smaller proportion of the population, there is a higher chance of coming into contact with the virus."

If there is a silver lining, it is that it should be easier to contain and eradicate monkeypox because we have a better idea of ​​where the bulk of the infection is.

"AIDS activism didn't just say the right thing"

The push by some for broader messages about monkeypox is well-intentioned and seeks to avoid the fierce anti-gay stigma that occurred during the AIDS crisis in the 1980s and 1990s.

However, this approach strips the period of complexity.

"I think there's a very well-intentioned attempt not to contribute to anti-gay stigma. A lot of people have a general idea of ​​how that worked in the context of the first AIDS epidemic. I don't think it's necessarily a nuanced understanding of how it happened, but there's an awareness that it happened and a sense that we shouldn't do it again," said Dan Royles, associate professor of history at Florida International University and author of "To Make the Wounded Whole: The African American Struggle Against HIV/AIDS ", adding that this whole situation occurs in the context of a right-wing attack on the rights of the LGBTQ community.

Royles points out that the ambitions of activists at the beginning of the AIDS epidemic were great and extended beyond the realm of messages.

"AIDS activism wasn't just about saying the right thing," he explained.

"It was about getting care to the people who needed it."

ACT UP members in Kennebunkport, Maine, protest the AIDS policy of then President George HW Bush, on September 1, 1991.

Consider some of the work of the AIDS organization ACT UP.

On May 21, 1990, more than 1,000 protesters stormed the National Institutes of Health (NIH) in Bethesda, Maryland.

His goal: to urge the NIH to correct what activists saw as a slow pace in AIDS research and treatment efforts.

In other words, faced with the government's inadequate response to the epidemic, the activists took justice into their hands and fought for a more humane health system.

(Current

communities are doing something similar as they grapple with slow state efforts to counter monkeypox.)

This is not about detracting from a careful message.

Thompson believes that monkeypox is highly stigmatized.

He said doctors listen to some patients who are ashamed of having the virus.

Complicating matters further, he added, is the fact that there are health care providers who don't want to see people with monkeypox, which means those with the virus have fewer places to get treatment.

Clearly, non-shaming messages matter a great deal, and this plays into the current debate about whether to call monkeypox a sexually transmitted disease, as my CNN colleague Jacqueline Howard recently reported.

However, Royles' deepest point is crucial.

As we continue to deal with monkeypox, we must not lose sight of the primary goal of expanding access to health care.

"Our politics often boils down to debates about speech and messages that are divorced from the material reality of people's lives," Royles said.

"Like HIV and AIDS, monkeypox has significant material consequences on the body if contracted. It is so embodied that it is deeply ironic that much of the conversation focuses on speech, which is disembodied in many ways." ".

Or as Joseph Osmundson, Associate Clinical Professor of Biology at New York University, aptly summed up when referring to the difficulty of accessing health care: "You can't get rid of an infectious disease with messages. We need tests, treatments and vaccines, and None of them have arrived on time."

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