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New WHO monkeypox advice urges men who have sex with men to limit partners

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The head of the World Health Organization has suggested that men who have sex with men temporarily limit their number of sexual partners while monkeypox cases increase within their community — a shift in messaging from the global health agency, days after it raised its threat-alert level for the monkeypox outbreak.

WHO Director General Tedros Adhanom Ghebreyesus made the comments Wednesday during a news briefing in which he said 98 percent of monkeypox cases have been reported in men who have sex with men.

Tedros said “this is an outbreak that can be stopped,” as long as governments take the appropriate measures and individuals stay informed and protect themselves from the virus.

“For men who have sex with men, this includes, for the moment, reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up if needed,” Tedros said.

Since the monkeypox outbreak was first reported by the WHO in May, public health officials have sought to balance the need for outreach to the community experiencing the bulk of transmission — men who have sex with men, including gay and bisexual men — and the desire not to stigmatize members of that community, or give the impression that monkeypox exclusively affects men who have sex with men.

“Anyone exposed can get monkeypox,” Tedros said Wednesday, as he urged countries to “reduce the risk of transmission to other vulnerable groups,” including children, pregnant people and those with weak immune systems.

Still, as it has become clear that monkeypox is, for now, mostly spreading among men who have sex with men, calls have grown for health agencies and governments to do more specific outreach to members of that community.

What to know about monkeypox symptoms, treatments and protection

Monkeypox mainly spreads through close physical contact between humans, although it can also be spread by a pregnant person to their fetus through the placenta, and when a person touches contaminated clothes and other items, according to the US Centers for Disease Control and Prevention (CDC ). Symptoms of monkeypox infection include fever, muscle pain and a rash or pox-like blisters.

More than 18,000 cases of monkeypox have been reported to the WHO from 78 countries, although the bulk of the cases are in Europe, the epicenter of the outbreak. Five of those cases have resulted in death, the WHO said.

More than 18,000 monkeypox cases have been reported in over 70 countries as of July 2022. Here’s what you need to know about how it spreads. (Video: Joy Yi, Fenit Nirappil/The Washington Post, Photo: CDC/The Washington Post)

More than 4,600 monkeypox infections have been reported in the United States, where President Biden is weighing whether to declare the outbreak a public health emergency.

For its part, the WHO declared monkeypox a “public health emergency of international concern” — its highest level of threat — over the weekend, after an emergency committee convened by the global health body declined once last month to recommend the WHO take that step.

Tedros, the WHO chief, said Saturday he made the final call after members of the committee remained split on whether the high-alert declaration was warranted. One of the reasons for the hesitation was a lack of evidence that monkeypox is spreading among the wider population.

Although monkeypox has spread mostly among men who have sex with men in this outbreak, it has been endemic for decades outside that community in West and Central African countries. As The Washington Post has reported, experts believe the latest outbreak could have spread first through gay social networks and at locations frequented by men who have sex with men, including European saunas and festivals.

WHO declares monkeypox a global health emergency as infections soar

The monkeypox outbreak has highlighted disparities in access to health care for gay and bisexual men in the United States, where there are not enough vaccines and providers able to administer anti-viral treatments to help all those seeking to protect themselves from infection.

As the country’s health-care system scrambles to respond, many experts have in mind the public health response to the AIDS epidemic of the 1980s, when gay men were scapegoated and died of the disease in large numbers when effective treatments were not yet available.

“Experience shows that stigmatizing rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures,” Matthew Kavanagh, the deputy executive director of the Joint United Nations Program on HIV/AIDS, said in May as he called for caution in monkeypox messaging.

Struggle to protect gay, bisexual men from monkeypox exposes inequities

In its guidance for public health messaging on monkeypox for gay and bisexual men, the CDC said, “It’s important to reach any disproportionately affected community with non-alarmist, fact-based messaging about monkeypox that provides people with tools they can use to protect themselves and others.”

Tedros — whose Wednesday recommendations appear to be more specific than past WHO guidance — said any effective response to the outbreak must empower “communities of men who have sex with men to reduce the risk of infection and onward transmission.” But the response must be shaped, he said, in ways that “safeguard human rights and dignity.”

“Stigma and discrimination can be as dangerous as any virus, and can fuel the outbreak,” he added.

Fenit Nirappil contributed to this report.

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