India’s anti-gay stigma drives its monkeypox cases underground
- Monkeypox infections are currently occurring mostly via sexual networks, making contact tracing a sensitive issue where homophobia is rife
- Health experts have warned against mislabelling monkeypox as a ‘gay disease’, comparing it to the demonisation of LGBT people for HIV/Aids
Gilada, who opened India’s first Aids clinic in 1986, understood the challenges that lie ahead. In parts of the world where LGBT people face stigma and bias, patients are reluctant to seek testing or treatment for a disease that has recently afflicted gay and bisexual men. They didn’t want to be the first monkeypox cases in India, Gilada recalled. “They are going underground.”
As India’s LGBT community stays locked in, some yearn to come out
Priya Abraham, director of India’s National Institute of Virology, said that the patient’s prior health has to be investigated and other causes of death ruled out before the case can be considered a monkeypox fatality.
In the context of monkeypox, where infections are currently occurring mostly via sexual networks, identifying contacts is a sensitive issue, especially if it forces people to disclose their sexual orientation, Gilada said. “They’re contact tracing every ‘Tom, Dick and Harry’ they have come in touch with,” he said. “You are identifying people indirectly.”
Genetic sequencing of virus specimens from other patients in Kerala indicated that monkeypox might have been circulating in the state for some time before it was reported.
In India and other countries where men who have sex with men, or “MSM”, face discrimination, sensitive and non-judgmental public health campaigns are needed to help persuade people to come forward for testing, said Sanjay Pujari, director and chief consultant at the Institute of Infectious Diseases in the west Indian city of Pune.
Cases will be reluctant to provide information about their contacts unless a “trusted relationship” has been established, he said. “Community involvement, including MSM organisations, need to be included in the planning and implementation of the entire public-health response to monkeypox.”
Many nations haven’t yet factored this into their testing strategies or public awareness campaigns, even though the outbreak is almost certain to spread, according to Nikolay Lunchenkov, health coordinator at the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity, which works on access to health treatment for gay men, other men who have sex with men and transgender people.
An edge over China? India’s WHO-backed traditional medicine centre ‘a victory’
“Stigma is only likely to make things worse and stop us from ending this outbreak as fast as we can,” Lunchenkov said.
What’s more, the mislabelling of monkeypox as a “gay disease” is tragically reminiscent of the demonisation gay men were subjected to when HIV emerged more than 40 years, Milka Sokolovic, director general of the European Public Health Alliance, wrote last month.
“This leads to an instant branding of us versus them, allowing stigmatisation and discrimination to raise their ugly heads yet again,” she said. “We must not forget how labelling HIV infection a homosexual disease during the HIV/Aids pandemic in the 1980s led to indescribable suffering in gay communities.”