The monkeypox trajectory is like that of AIDS in that AIDS started out primarily afflicting men who had sex with men, but as it turns out some men who have sex with men also have sex with women. Jeez, who knew?! So it's more accurate to say that the people most at risk for monkeypox are people who have sex with men. And given that the av…
The monkeypox trajectory is like that of AIDS in that AIDS started out primarily afflicting men who had sex with men, but as it turns out some men who have sex with men also have sex with women. Jeez, who knew?! So it's more accurate to say that the people most at risk for monkeypox are people who have sex with men. And given that the average gay man has more sex than the average human, it stands to reason that men who have sex with men are most at risk. In general, at this point, and other caveats. (Why do I employ the tedious "men who have sex with men" instead of the snappier "gay men"? Because like AIDS, monkeypox is about behavior, not identity.)
I think for most people "gay," "straight," and "bisexual" are behavioral descriptors. "Straight man who occasionally sleeps with men" has the same dissonance as "vegan that occasionally enjoys a steak."
Using those words as identities is relatively new, isn't it?
I would say that gay as an identity made sense when there were common external threats affecting us all, be it illegality, discrimination, targeting by law enforcement or the AIDS epidemic. Once those common external threats were subdued or eliminated, the common behaviour (at least in a broad sense) remained the only thing shared bye people who could otherwise just get on with their lives in peace. This is why the LGBT queue identity movement was always doomed to fail, whatever external threats remain R entirely different across the constituent parts and there aren’t even common behaviours two define a larger community identity.
I think it can be ambiguous even if you assume they're behavioral descriptors. It can be hard to draw the line between gay/straight and bisexual. Sure, people who are equal opportunity for both sexes are bi, but what about people who prefer one sex over the other 9 out of 10 times? They're technically engaging in bisexual behavior over time, but I get why they wouldn't call themselves that since their general behavior is skewed in one direction.
As I type, I'm also realizing I've seen this more in the gay community. I have gay and lesbian friends who will occasionally find a woman/man that strikes their fancy and go for it, without calling themselves bisexual. I feel people who are mostly straight will call themselves bi if they occasionally sleep with the same sex. Or heteroflexible, if people still say that ever.
Yup. When I worked in sexual health, it was about men who have sex with men. MSMs. MSWs. And WSWs.
But now there are trans men who.are of course men. Now. If they are having sex with gay men, Inam guessing they are at the same risk as gay males. And then of course what percentage of trans men have sex with men, versus with women
Same for trans women. I am betting the trans women, who are woman, who have sex with men are at the same risk as gay men
In 2019, 69% of new HIV infections were in MSM. If monkeypox becomes endemic and follows the same trajectory as AIDS, it will never stop being a disease that primarily affects gay dudes.
It seems like the crucial empirical question is, what is the reproduction number R for monkeypox outside of the MSM community? If it's lower than 1, we would expect some cases on the fringe of the community (those who have sex or other close contact with an MSM) and a few beyond that, but not a wider epidemic. In that case it seems reasonable to focus the public health messaging primarily on the MSM population and actively avoid spooking people outside that population (but not claiming there's zero risk, of course).
If instead the R value outside the MSM population is greater than one, we would expect a wider epidemic of some sort, and the messaging should be different.
I haven't seen anyone addressing this empirical question yet in the general media. It might well be too early to tell. Any thoughts from PH experts?
As I understand, its spread by close contact. So sex among adults but children have closer physical contact with both family adults and other children for completely innocent and developmentally necessary reasons.
Yes - exactly this. They are vulnerable to catching it because kids are more inclined to get physically close to their caregivers, teachers, parents, peers etc in a way adults do not. Nothing more sinister than that.
I'm not aware of any children catching it - this is hypothetical. Where they have caught it, in other countries mainly, they are likely to spread it purely for the reason that kids generally have lots of close contact with other kids.
I keep reading that those of us who were vaccinated for smallpox (which US govt routinely did until 1972 and US military did until 1991) are protected. I am not in a high-risk category anyway, but shouldn't this get more press? I hear people worrying about this who were probably vaccinated.
I didn't know this. I bet it would be getting a lot more press if it weren't just we geezers who are affected. Maybe the assumption is that if you're old enough to have gotten the smallpox vaccine, you probably aren't having a lot of sex. ;)
The monkeypox trajectory is like that of AIDS in that AIDS started out primarily afflicting men who had sex with men, but as it turns out some men who have sex with men also have sex with women. Jeez, who knew?! So it's more accurate to say that the people most at risk for monkeypox are people who have sex with men. And given that the average gay man has more sex than the average human, it stands to reason that men who have sex with men are most at risk. In general, at this point, and other caveats. (Why do I employ the tedious "men who have sex with men" instead of the snappier "gay men"? Because like AIDS, monkeypox is about behavior, not identity.)
And vaccine doses should probably be reserved for gay men until there are more doses. And gay men should be encouraged to get the vaccine.
I think for most people "gay," "straight," and "bisexual" are behavioral descriptors. "Straight man who occasionally sleeps with men" has the same dissonance as "vegan that occasionally enjoys a steak."
Using those words as identities is relatively new, isn't it?
I would say that gay as an identity made sense when there were common external threats affecting us all, be it illegality, discrimination, targeting by law enforcement or the AIDS epidemic. Once those common external threats were subdued or eliminated, the common behaviour (at least in a broad sense) remained the only thing shared bye people who could otherwise just get on with their lives in peace. This is why the LGBT queue identity movement was always doomed to fail, whatever external threats remain R entirely different across the constituent parts and there aren’t even common behaviours two define a larger community identity.
I think it can be ambiguous even if you assume they're behavioral descriptors. It can be hard to draw the line between gay/straight and bisexual. Sure, people who are equal opportunity for both sexes are bi, but what about people who prefer one sex over the other 9 out of 10 times? They're technically engaging in bisexual behavior over time, but I get why they wouldn't call themselves that since their general behavior is skewed in one direction.
As I type, I'm also realizing I've seen this more in the gay community. I have gay and lesbian friends who will occasionally find a woman/man that strikes their fancy and go for it, without calling themselves bisexual. I feel people who are mostly straight will call themselves bi if they occasionally sleep with the same sex. Or heteroflexible, if people still say that ever.
Yup. When I worked in sexual health, it was about men who have sex with men. MSMs. MSWs. And WSWs.
But now there are trans men who.are of course men. Now. If they are having sex with gay men, Inam guessing they are at the same risk as gay males. And then of course what percentage of trans men have sex with men, versus with women
Same for trans women. I am betting the trans women, who are woman, who have sex with men are at the same risk as gay men
In 2019, 69% of new HIV infections were in MSM. If monkeypox becomes endemic and follows the same trajectory as AIDS, it will never stop being a disease that primarily affects gay dudes.
It seems like the crucial empirical question is, what is the reproduction number R for monkeypox outside of the MSM community? If it's lower than 1, we would expect some cases on the fringe of the community (those who have sex or other close contact with an MSM) and a few beyond that, but not a wider epidemic. In that case it seems reasonable to focus the public health messaging primarily on the MSM population and actively avoid spooking people outside that population (but not claiming there's zero risk, of course).
If instead the R value outside the MSM population is greater than one, we would expect a wider epidemic of some sort, and the messaging should be different.
I haven't seen anyone addressing this empirical question yet in the general media. It might well be too early to tell. Any thoughts from PH experts?
This is a really great assessment by demographic and one I’m almost embarrassed to say I had never thought of.
Are the children catching it through means other than the very depressing ones I assume?
As I understand, its spread by close contact. So sex among adults but children have closer physical contact with both family adults and other children for completely innocent and developmentally necessary reasons.
Yes - exactly this. They are vulnerable to catching it because kids are more inclined to get physically close to their caregivers, teachers, parents, peers etc in a way adults do not. Nothing more sinister than that.
I'm not aware of any children catching it - this is hypothetical. Where they have caught it, in other countries mainly, they are likely to spread it purely for the reason that kids generally have lots of close contact with other kids.
https://abcnews.go.com/Health/7th-child-us-tests-positive-monkeypox/story?id=88417787
The Economist has a brief take on a paper that predicts little chance of general spread:
https://www.economist.com/graphic-detail/2022/08/18/monkeypox-has-spread-rapidly-in-male-sex-networks-will-it-spread-further
I keep reading that those of us who were vaccinated for smallpox (which US govt routinely did until 1972 and US military did until 1991) are protected. I am not in a high-risk category anyway, but shouldn't this get more press? I hear people worrying about this who were probably vaccinated.
I'm afraid not as the smallpox vaccine only gives protection for 3-5 years so this would only apply if you had them regularly, and recently.
I didn't know this. I bet it would be getting a lot more press if it weren't just we geezers who are affected. Maybe the assumption is that if you're old enough to have gotten the smallpox vaccine, you probably aren't having a lot of sex. ;)