The monkeypox texting controversy divides the NYC Department of Health

The spread of monkeypox has sparked a debate within the New York City Department of Health about whether the agency should encourage gay men to reduce the number of their sexual partners during the outbreak. this summer or not.

Inside the department, officials are fighting for public messaging as the number of smallpox cases in monkeys nearly tripled in the last week, nearly all of them in men who have sex with men. gender. Some epidemiologists say the city should encourage gay men to temporarily change their sexual behavior while the epidemic spreads, while other officials say the approach would be discriminatory. gay men and would be counterproductive.

Internal divisions culminated when the health department issued a recommendation last week suggesting that sex while infected with monkeypox could be safer if people avoid kissing and cover their sores. . According to several epidemiologists in the department and a review of internal emails, some officials at the agency expressed outrage, saying that the agency was giving out advice that was wrong and even dangerous to health. .

Dr Don Weiss, supervisory director of the department’s Infectious Diseases Department, said in an interview the advice about safe sex is not medically correct. He believes the department should advise people at risk of monkeypox to temporarily reduce the number of their sexual partners, saying, “We don’t tell people what to do to be safe.”

His concerns are shared by some of his colleagues. the largest such outbreak in the United States – quickly closed.

Monkeypox has been spreading globally since early May. In New York City, where nearly all monkeypox patients are gay or bisexual men, there have been 618 cases of monkeypox recorded in the city as of Monday, despite Dr. Weiss says the true number of infections is much higher, because testing is limited. .

The strategy favored by Dr. Weiss, who has long played a front-line role in the department’s response to disease outbreaks, has received little interest within the department.

In fact, the agency in a statement on Monday argued against such an approach. “For decades, the LGBTQ+ community has been dissected, regulated, and forbidden their sex lives in countless ways, primarily by heterosexuals and gays,” the statement said.

The city’s response to monkeypox is based on the science and history of “how historically abstinence guidelines have underperformed,” the statement said, “with its legacy this shameful.”

The public health sector has long grappled with whether public health officials should tell people to change their sexual behavior during an outbreak.

The debate was influenced by the early years of HIV/AIDS, when persecution and stigma were high. The incidence of monkeypox is much lower, because no one in the United States has died from the disease, treatments and vaccines already exist, and for many people, the disease seems relatively over. fast.

However, some epidemiologists say a positive response now – while transmission has been largely limited to gay and bisexual men – could prevent the virus from becoming a widespread epidemic. in New York or reach a broader population.

Some public health experts say that many gay men are likely to reject advice that could be seen as discouraging or discriminating against gay sex. These experts say such advice blames gay men for the outbreak and can cause them to lose trust in public health authorities.

Longtime AIDS activist Charles King, Housing’s chief executive, said: “Telling people not to have sex or not have many partners or not to have sex anonymously is just a big no-no. , and it won’t work. Activity, housing and social services for the homeless and people affected by HIV

“People will still have sex and they will have it even if it comes with great risks,” he said.

But there could be a middle ground, some experts said, noting that urging people to temporarily reduce the number of sexual partners or avoid sex parties where they can have multiple partners doesn’t sound like a good idea. messages about abstinence or monogamy.

Dr Dustin Duncan, an epidemiologist of infectious diseases in sex and sexual minorities at Columbia University, said: “Name risk factors and behaviors and offer options for treatment. everyone.

He gives an example: telling people they can reduce their risk of monkeypox by “having a consistent normal partner instead of multiple” seems like a reasonable message at the time. this, he said.

Dr. Weiss says that asking people to change their sexual behavior – even if only for a month or so – is the most powerful weapon currently available to reduce transmission of smallpox in monkeys. Vaccine supplies are limited and have been initially dealt with through hard-to-get appointments during daylight hours at some health stations, although in recent days a series of vaccination points have been opened.

He has repeatedly suggested that the ministry should encourage short-term abstinence, a relatively remote position. On several other occasions, he has suggested the ministry should warn gay men to refrain from anonymous sex.

Dr Weiss said his recommendations were largely ignored by the department’s senior leadership, who seemed “paralyzed by the fear of stigmatizing the disease,” he wrote in an email to colleagues. in June of this year.

“If we had a bowling-related outbreak, wouldn’t we warn people to stop bowling?” he wrote.

So far, the health department’s reluctance to openly encourage people to change their sexual behavior, unless they are infected with monkeypox, reflects the broader message of the outbreak. by the federal government.

Department advice, post on it website, noting that “Sexual contact or intimate contact with multiple or anonymous persons (such as those met through social media, dating apps, or at parties) may increase risk of being exposed.”

At an online event at “town hall” last week about monkeypox, the city’s health commissioner, Dr Ashwin Vasan, said the department’s goal was “sexually positive”.

“We don’t want to be sexist in any way,” Dr. Vasan said. “We want to make it clear that there are certain activities and one of them is intimate sex that puts you at higher risk in certain settings.”

Other health professionals, such as Dr Weiss, have publicly called for a temporary change in sexual behavior. At an online press conference last week of the Infectious Diseases Society of America, Dr. Lilian Abbo, associate medical director for infectious diseases at Jackson Health System in Miami, urges people to use condoms and says sex insecure with multiple sex partners “really increases the spread of the virus exponentially”.

“We can all be involved in preventing the spread from continuing and it’s important that everyone has a bit of ownership and understands that you can put others at risk,” she said.

Dr Weiss, who has held the same job for 22 years, investigating and responding to new outbreaks for the Department of Infectious Diseases, said he felt obliged to speak out publicly because he felt the The department’s public statements are sometimes irresponsible. He pointed to a newsletter released Friday that contained some prevention tips for “people who choose to have sex when sick.”

It states that covering smallpox sores in monkeys with clothing or bandages during sex “may help reduce – but not eliminate” the risk of transmission. The statement also said “for those who choose to have sex while sick, it is best to avoid kissing and face-to-face contact.”

Dr Weiss said it was “ridiculous” to suggest these steps would meaningfully reduce risk.

The Department of Health’s guidance to the general public often highlights nonsensical potential transmission routes, such as hugging or bed contact. While those are certainly possible routes of transmission, the outcome – Dr Weiss said – is to create people are too worried about casual physical contact and not enough awareness that most New York monkeypox cases appear to be sexually transmitted.

Dr. Weiss said he has overseen a team of epidemiologists who have looked at the city’s many monkeypox cases. The majority of patients had lesions on the penis, anus or rectum, indicating that the disease is spread primarily through sexual contact.

He also said that reports of asymptomatic spread and the presence of viral DNA in semen should have prompted the department to withdraw its public advice.

Recently, Dr. Weiss wrote to a group of epidemiologists in a Department of Health email series: “I know I sound like a bible preacher.

However, he argued, “If we don’t act soon, that could be the point of no return.”

Sharon Ottermancontribution report.