While one expert argues the response from Toronto to monkeypox spreading through a marginalized queer community has been ideal, another thinks more support is needed. Both agreed a flashback to historical HIV stigma toward sexual minority men should be avoided.
The disease, which is endemic to many African countries, spreads through respiratory droplets and physical contact. It has infected 194 people in Toronto, with the first Canadian case reported on May 19 in Montreal.
According to Darrell Tan, a clinician and scientist at the division of infectious diseases at St Michael’s Hospital, municipal public health data combined with international research collaboration, indicates 99 per cent plus of monkeypox infections in nonendemic countries are of men who have sex with men (MSM).
Following Ontario Ministry of Health guidelines, Toronto has been providing vaccine clinics to just sexual minority men. However, it’s aftercare support where the city falls flat, Michael Kwag, director of knowledge exchange and policy development at Community-Based Research Centre, said.
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“We’re seeing on social media that sometimes monkeypox can be referred to as mild, which makes sense in comparison to smallpox, but many people with monkeypox are reporting symptoms that would be hardly considered minor,” Kwag said. For instance, he continued, people can get extremely painful lesions, and when sent home to isolate and wait out the disease they only have access to over-the-counter medication and self-dressing of open sores.
“There’s a lot of concern within the (queer) community as a whole … that this is a health issue that isn’t getting the attention it deserves.” Kwag argued there needs to be greater support — in better treatment of the illness, and in providing economic and financial support, similar to the Canada COVID-19 benefits, to those infected.
Tan noted the antiviral tecovirimat used for serious cases — a decision Kwag expressed frustration with — has only a “tiny availability.”
On the other hand, Isaac Bogoch, infectious diseases specialist at Toronto General Hospital, was positive on city responses such as engagement with community organizations, like with The 519, to provide vaccine clinics in areas easily accessible for MSM and dedicated communication strategies for that same community. He’s not sure how that will play out and emphasizes, the disease should be taken seriously. But Bogoch said, “if we were to take a 30,000 foot-wide — ‘is Toronto doing the right thing?’ — then yes, those are the fundamental pillars of an outbreak response.”
Kwag said around 10,000 doses of the vaccine have been given out in the city thus far.
Aaron Clarke, a gay men’s community education and resource co-ordinator at the AIDS Committee of Toronto (ACT), said there exists “a stigma that monkeypox is only affecting the [MSM] community. Yes, it is affecting MSM in a disproportionate way, but it should be a health concern for everyone.”
Bogoch explained the imbalanced community infections. “Without moralization, without stigma, without any discrimination, we know that there may be more [direct and close] contacts within some segments of the [MSM] community.”
As a gay man who has worked in HIV and sexual health for almost two decades, Kwag understands the bias his community faces and how these sentiments can be used to “stoke ignorance and prejudice against people in our community.” He added, “I think ultimately one of the most important ways in which we can counter the stigma … is by properly addressing it, ensuring that this doesn’t get out of control.”
And on that note, Bogoch agrees, though he doesn’t think more needs to be done. Right now, in July of 2022, he said, the vast majority of the general public has a “negligible risk for this infection,” and even among the queer community, the risk of infection is only low to moderate.
For more about monkeypox in Toronto, see the city’s webpage here.