Stigma Against Gay Men Could Worsen Congo's Biggest Mpox Outbreak, Scientists Warn

Scientists from Africa caution that prejudice against homosexual and bisexual males on the continent may exacerbate an mpox outbreak in the Democratic Republic of the Congo. 

FILE: On August 29, 2022, in the Brooklyn borough of New York, vials containing single doses of the Jynneos vaccine against monkeypox were visible from a refrigerator at a vaccination station. Scientists fear prejudice against homosexual and bisexual males on the continent could exacerbate the mpox outbreak, which is now affecting Congo and is the continent's largest. (AP Photo/File: Jeenah Moon) MOON JEENAH Congo's Kinshasa (AP) Scientists fear prejudice against homosexual and bisexual males on the continent could exacerbate the mpox outbreak, which is now affecting Congo and is the continent's largest.

The World Health Organization revealed in November that mpox, also called monkeypox, was being transmitted through intercourse for the first time in the Congo. This is a big change from earlier outbreaks, when the virus mostly affected humans who came into contact with infected animals.

 

Although mpox has long been present in some parts of central and west Africa, it wasn't until 2022 that it was shown to spread through sexual activity. The majority of the 91,00 cases of mpox that year, which occurred in about 100 nations, were gay or bisexual men.

 

Dimie Ogoina, an infectious diseases expert at the Niger Delta University in Nigeria, stated that a failure to disclose symptoms could push the pandemic underground throughout Africa.

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It's possible that many people do not come forward if they believe they have mpox because homosexuality is illegal in the majority of Africa, according to Ogoina.

The more serious form of mpox was first discovered in the Congo last spring, according to WHO experts. This occurred not long after a Belgian national who "identified himself as a man who has sexual relations with other men" came to Kinshasa, the country's capital. Five other persons who had sex with the man subsequently contracted mpox, according to the U.N. health agency.

In 2019, Ogoina and colleagues published the first paper suggesting that mpox might be spread through sexual activity. "We have been underestimating the potential of sexual transmission of mpox in Africa for years," Ogoina stated.

Estimating the number of mpox cases associated with sex is difficult due to gaps in monitoring, he said. He pointed out that the majority of mpox cases in Nigeria, however, affect individuals who have no known interaction with animals.

Up to the end of November, there were roughly 13,350 suspected cases of mpox in the Congo, with 607 deaths recorded. Only about 10% of these cases had laboratory confirmation. It's unclear, though, how many illnesses were transferred via intercourse. According to the WHO, children under 15 account for around 70% of cases.

WHO investigators discovered during a recent trip to the Congo to evaluate the outbreak that medical personnel "lacked awareness" that mpox could be transmitted sexually, leading to missing cases. According to the WHO, health officials have verified that mpox may spread sexually "between male partners and simultaneously through heterosexual transmission" in some regions of the nation. Symptoms of mpox usually last for up to one month and include fever, rash, lesions, and discomfort in the muscles. The majority of people heal without the need for medical attention, and it is spread through intimate contact.

Mass vaccination campaigns targeting homosexual and bisexual men—those most vulnerable to the disease—were launched in a number of nations, including the United States, Canada, and Great Britain, during the large global outbreak of 2022. However, experts claim that won't likely work in Africa due to a number of factors, including the stigma associated with homosexual populations.

Dr. Boghuma Titanji, an assistant professor of medicine in infectious diseases at Emory University School of Medicine in Atlanta, stated, "I don't think we'll see the same clamoring for vaccines in Africa that we saw in the West last year."

According to her, gay and bisexual males who are most vulnerable to mpox may be afraid to volunteer for a widespread vaccine program. According to her, nations ought to work on developing non-stigmatizing methods for administering vaccinations, if they are accessible.

 

The National Institute of Biomedical Research in Congo's general director, Dr. Jean-Jacques Muyemba, stated that a worrying development had been observed in two areas where clusters of mpox had been transmitted through sexual contact.

 

As there isn't a licensed vaccination program in the Congo, Muyemba said that it would be difficult to obtain enough injections for a significant program. The nation is working to obtain a Japanese mpox vaccine, but obstacles related to regulations are making things more difficult, he said.

There is just one vaccine against mpox approved worldwide, and it is produced by the Danish company Bavarian Nordic. There are extremely few supplies accessible, and even if there were, the WHO or the African countries utilizing them would need to authorize them. Up until now, research has only made the vaccine available in the Congo.

 

According to Oyewale Tomori, a virus researcher from Nigeria who serves on many WHO advisory boards, African governments likely have too many competing priorities to approach donors or the U.N. health agency for assistance in obtaining vaccines.

 

According to Tomori, Mpox is probably viewed as a low-priority annoyance in Africa.

Over 60% of new HIV infections in Africa currently occur in women who are fertile.

 

"I'm concerned that Mpox will now experience the same thing," he stated. "If we don't deal with these outbreaks in Africa, this virus will keep returning."