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Transmission can occur through close contact with contaminated fomites or bodily fluids from infected individuals and through droplet transmission. In recent years there have been several reports of limited outbreaks with human-to-human transmission in endemic countries and occasional imported cases in returning travelers from these regions. Monkeypox is a zoonosis with incidental infections occurring sporadically in humans living in forested areas of Central and West Africa. These patterns are harmful, dehumanizing and unhelpful in the face of any outbreak response and need to be broken. Census Bureau, Non-Hispanic Asian households were twice as likely as non-Hispanic White populations to report not having enough food during the pandemic due to fear of discrimination or hate crime. In a Household Pulse survey led by the U.S.Initially we saw stigma directed at people of Asian descent following reports of the first cases of SARS-CoV-2 infection from China and more recently unjustified stigma towards southern African countries following the identification of the omicron variant highlighting intersections with racism. Similar patterns of targeted stigma towards a specific group have emerged in the COVID-19 pandemic. It is only recently that we target women of specific age in specific geographies, for example. This not only disappeared gay men from the global HIV responses of the 90s and early 2000s, but IT also created an understanding of the pandemic among heterosexual people that is monolithic and missed opportunities to attend to the particular needs of sub-groups among heterosexual people. The initial homophobia associated with the HIV pandemic led to rhetorical strategies that made HIV appear to affect everyone equally instead of strategies that acknowledge heterogeneity in risk and burden. This is further exacerbated with 47% of the community who believe that homosexual behavior is morally wrong. This discrimination still persists in Black communities where 57% have expressed discomfort of having food prepared by an individual who is HIV-positive. In a 2011 Kaiser Family Foundation Survey of Americans on HIV/AIDS, despite downward trends, 40% of the surveyed population still perceive a good deal of discrimination towards those living with HIV and AIDS.Minority MSM have lower rates of HIV preexposure prophylaxis uptake, frequently present with advanced HIV infection and are less likely to be connected to HIV care when diagnosed. In the Southern United States, the HIV epidemic continues to devastate communities of predominantly Black and Hispanic MSM largely due to enduring stigma.Sadly, the ripple effects of stigma have been more difficult to erase and continue to negatively impact the ongoing response to the HIV pandemic. Four decades later, the dynamic of the HIV epidemic has been completely transformed by highly effective treatment and prevention strategies. It wasn’t until it became obvious that HIV infections were not confined to the gay community that more resources and a political will to seriously tackle the crisis were set in motion. Instead, individuals in the group most affected at the time were blamed for their own suffering and ostracized as purveyors of disease.
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This resulted in many missed opportunities to quickly learn about the infection, understand its transmission and importantly, provide targeted public health interventions to curb its spread. Cases were under-reported in the early days of the epidemic as individuals who contracted the virus went underground instead of seeking medical care. The repercussions of labelling HIV infection a homosexual disease led to untold suffering in gay communities in the 1980s who were blamed for the epidemic. Stigma directed at a particular group of individuals fuels fear and seriously impedes upon outbreak investigation, case identification and public health interventions.
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It is unfortunate that this still needs to be said, highlighting how little we have learned from previous outbreaks. Monkeypox is not a gay disease and neither are any other infectious diseases. The narrative emerging as this outbreak evolves to involve other European countries, Canada and the United States is sadly reminiscent of initial reporting on pneumocystis pneumonia clusters in gay men with AIDS forty years ago. The initial cluster of cases which first appeared in the United Kingdom so far includes four men who identify as gay or bisexual or other men who have sex with men (MSM). Titanji MD PhD, Keletso Makofane, PhD and recent weeks multiple cases of confirmed and suspected monkeypox infections have been reported in three European countries.