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World Sexual Health Day: from syphilis to monkeypox, a history of 'gay disease'

© Illustration by INJECTION - Laura Holtslag-Alvarez

Homophobic stigma surrounding sexually transmitted infections isn't new - but it is evolving.

The recent conversation about monkeypox has mirrored many aspects of the decades older conversation about HIV/AIDS: real risk factors have blended with anti-gay stigma to create an association between the disease and men who have sex with men. But neither of them is the first sexually transmitted infection to be associated with queer men by a homophobic public or academic community.

Long before the first cases of HIV/AIDS were observed, syphilis was associated with gay men, and just like HIV/AIDS, this relationship came from a combination of genuine vulnerability and prejudice against behaviours seen as ‘perverse’. As early as the nineteenth-century, syphilis infection was considered by the legal establishment to be a sign of homosexual behaviour. Gay men were at risk because they often had sex with sailors and soldiers, whose other partners tended to include sex workers, an even more at risk group. Due to a reluctance among health professionals to discuss homosexuality, there was also widespread ignorance about the possibility of same-sex transmission of syphilis and other STIs. The lack of safe access to treatment was another factor: an early gay magazine, ‘ONE’, wrote in 1962 ‘under no conditions, or for any reason, should a homosexual set foot inside a public health office’. Gay men were understandably concerned that the information required by early clinics to treat STIs (such as names and contact details of former lovers) might be used to persecute members of the community, legally or otherwise. In 1978, gay men accounted for more than half of syphilis cases in the UK, but this number, alongside overall instances of the disease, fell steeply over the next two decades.

Next, comes the part of the story that most of us know at least something about. The first case of HIV/AIDS was reported in ‘The New York Native’, a gay newspaper, in 1981. Due to early clusters of infection among gay men, the media and public health establishments initially labelled it ‘GRID’, or gay related immune deficiency. However, it quickly became clear that the disease affected other populations, and the name AIDS came to replace GRID. But homophobic stigma against the disease continued, just as it does to this day. Some AIDS denialists have even tried to claim that queerness itself, and not HIV, was the cause of AIDS. Homophobia also caused deliberate neglect of HIV/AIDS among politicians and public health professionals, and it was only through years of activism and civil disobedience by queer communities that things improved.

So, how has monkeypox been different? From early on in the outbreak, organisations such as UNAIDS have urged media to avoid stigmatising language, and even praised the LGBTQ+ community for helping to raise early awareness about the disease. Vaccine rollouts for vulnerable people, particularly men who have sex with men, have also been initiated - although the UK is now running low on supplies of the vaccine. Anecdotally, uptake of the vaccine seems to be high. Besides, monkeypox, quite unlike HIV/AIDS, is mild in most patients, and there have been relatively few deaths.

However, right-wing commentators have still leapt on the opportunity to perpetuate vile homophobia and stereotypes about gay men’s promiscuity. A recent essay by ‘Queer Eye’ star Jonathan Van Ness has also suggested that homophobia is slowing the legislative response to the disease.

But we mustn’t let concerns about stigma and homophobia obscure the truth: monkeypox is affecting men who have sex with men disproportionately, at very high rates. Just as with HIV/AIDS, queer communities may not be well served by politicians and public health authorities, and we should push for more support, but we can also take steps within our community to reduce risk. Spreading awareness about monkeypox and the safety measures we can take, as well as taking the vaccine as soon as we are offered it, are vital acts of community care in the face of a still-growing outbreak.

For World Sexual Health Day, take the opportunity to learn more about monkeypox and help to stop its spread. The following links are a good place to start:


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