Opinion

Pandemics as portals: What monkeypox teaches us about medical apartheid and resistance

Infectious disease outbreaks can tell us a lot about ourselves.

Monkeypox has been declared a global emergency by the World Health Organization. Spread through close contact that can include but is not limited to sexual activity, labelling monkeypox a sexually transmitted infection has been politically charged – not only for scientific reasons, but also because of the potential political and legal ramifications for 2SLGBTQIA+ people who are actively being targeted and vilified by some right-wing politicians.

There is justifiable concern that focusing attention on queer communities will further entrench stigma and subject them to harm. But it is essential to look upstream at the factors and conditions that make such scenarios possible. How does the scapegoating of 2SLGBTQIA+ communities connect to contemporary neoliberal agendas? How is science and public health communication subverted to fit these agendas? And most importantly, how can communities simultaneously respond to a public health crisis and resist the conditions that created the crisis in the first place?

“Don’t-say-gay” bills are trying to erase the very existence of 2SLGBTQIA+ people in some jurisdictions in the United States. Public accusations of “grooming” are launched at people who support 2SLGBTQIA+ rights. Populist governments across Europe have passed legislation that actively harms 2SLGBTQIA+ people under the guise of “protecting children and families.” These are pages taken directly from fascist playbooks, with transphobia, for example, described as a “gateway” to far-right ideology. Some may read this as hyperbole, but we feel it is important to accurately name what is happening now and draw connections to what has happened before – we fear that if we do not, we risk history repeating itself. Add to this mix an infectious outbreak that is disproportionately affecting the 2SLGBTQIA+ community, and we have real cause for fear. Kiki Djarin screenshots a Daily Mail headline and tweets “They are going to kill queer people over monkeypox stories being presented like this.” Having recently marked the six-year anniversary of the Pulse nightclub shooting, these threats are not merely imagined.

Scapegoating queer communities is not new, however – we have been here before.

Researchers, activists, the media and members of the community have been making comparisons between monkeypox and HIV. Then, as now, we had a disease that was largely ignored by the international community until it affected White North Americans and Europeans. Even then, it was relegated to a “gay disease” (even briefly and horribly known as Gay-Related Immunodeficiency, or GRID) with widespread media-driven moral panic and judgment. The Centres for Disease Control perpetuated this stigma when it coined the “4 Hs” to describe “at-risk” populations that included hemophiliacs, heroin users, Haitians and homosexuals. These kinds of classifications have power and are used to dictate global movement and migration, erect borders, enact quarantines and police communities. Only when HIV was found to affect the “larger society,” including women and children, did it garner widespread attention and funding to address the needs of those infected with the virus.

Scapegoating queer communities is not new – we have been here before.

This time, while Nigeria has been experiencing a monkeypox outbreak since 2017, the viral disease only captured global attention once there was a multi-country outbreak in “non-endemic” countries. To date, nobody in Nigeria has received a single dose of monkeypox vaccine. This should not come as a surprise to us, having witnessed three years of COVID vaccine apartheid in which countries in the global North have offered booster after booster, while many in the global South have yet to receive a single dose.

Despites decades of advances in HIV treatment options, countries in the global South most affected by HIV are still forced to rely on older drugs prone to side effects and the development of resistance. Imperialism and racism remain the dominant drivers behind how and when certain diseases (and certain humans impacted by those diseases) get attention and resources, and when they do not – yet another form of medical apartheid.

Then, as now, we have an infectious disease primarily transmitted along sexual networks, and among people who have historically and repeatedly been vilified. The stigma associated with sexually transmitted infections and the homophobia people have experienced at the hands of the health-care system means that people may not feel comfortable having conversations about sexual practices. A singular focus on sexual orientation as the primary predictor of monkeypox risk also means those who don’t identify as belonging to a so-called “at-risk community” may be misdiagnosed despite sexual practices that present risk for monkeypox.

Like with HIV, policymakers and health-care providers often misguidedly focus on individual behaviour modification rather than systemic, robust vaccination policies, access to testing and preventive health care and structural supports to allow for safe isolation like adequate housing and workplace protections.

Oni Blackstock, HIV physician and founder of Health Justice, describes how stigma functions as a distraction by design, noting that we must hold institutions and governments responsible for how they handle outbreaks materially and structurally. Stigmatization and placing individual blame are two ways that governments, policymakers and others with institutional decision-making power communicate who is pushed to the margins; they indicate which communities, as author and academic Ruth Wilson Gilmore states, will face both organized violence and organized abandonment, or “the way that people, households, communities, neighborhoods do not have equal levels of support and protection against the pandemic.”

All this is not to say communication, resources and efforts should not be focused on the people and communities most affected. They absolutely should be – while also communicating nuances in transmission and actively combating stigma and attempts to scapegoat those affected. We also need to make sure that resources and efforts are actually directed to communities that are disproportionately impacted while simultaneously being rendered invisible. The structural determinants of health that resulted in disproportionate HIV rates among Black and other racialized communities across North America were neglected, while the communities themselves provided convenient scapegoats for policymakers.

In many countries, including Canada, non-disclosure of HIV continues to be criminalized, and that criminalization (and accompanying media sensationalism) is disproportionately enacted on Black and brown people. We have already seen how COVID disproportionately impacted Black and other racialized communities due to structural inequities. Now, in Georgia, we see that Black men represent up to 80 per cent of new monkeypox cases, and that global vaccine disparities are replicated locally along racial lines. Rather than recognizing and addressing the structural and political factors that created these conditions, there are concerns that media and policymakers could use these numbers to justify racist and discriminatory policies for increased state surveillance, quarantine and further criminalization.

Clinicians, scientists, journalists and policymakers must convey scientific nuance and complexity to help people hold two truths at once – monkeypox can be easily and more readily transmitted via certain sexual behaviours, but it is still transmissible in other ways. We must target communications and rally resources toward communities most affected, while ensuring that we do not systematically neglect and under-recognize other communities at risk. We must also recognize how our words and even our science may be used in service of anti-queer ideologies, and how stigma and misinformation can be used to uphold and enact unjust policies. We must proactively combat this in our research and our communication. It’s not just about (re)shaping the narrative for its own sake, but because of what those narratives make possible.

And we can’t just stop at tinkering with our messaging. Just as inequities have shaped the course of the HIV epidemic and the COVID pandemic, monkeypox lays bare the ways in which discrimination, homophobia, racism and capitalism continue to shape the material conditions of people’s lives and health. For instance, homelessness, precarious working conditions and inadequate labour protections such as the lack of paid sick days make self-isolation extremely difficult – for some, it can mean not being able to put food on the table or make rent.

Monkeypox lays bare the ways in which discrimination, homophobia, racism and capitalism continue to shape the material conditions of people’s lives and health.

But again, we have been here before. Structurally oppressed communities who have often borne the brunt of the infectious complications of structural violence have also led the way in dreaming up innovative solutions and practicing collective care models.

In the 1970s, trans activists Sylvia Rivera and Marsha P. Johnson with the Street Transvestite Action Revolutionaries (STAR) created a sanctuary for unhoused trans girls. In the 1980s, AIDS activists in the U.S. demanded and won access to life-saving medications and their rightful involvement in setting research and political agendas. In the 2000s, before it was legal to do so, communities affected by the drug poisoning crisis and overdose epidemic organized to get naloxone and train community members on how to use this life-saving intervention, and have re-imagined how people who use drugs and have HIV or hepatitis C engage with health care. Since the beginning of the HIV epidemic, community-based organizations throughout sub-Saharan Africa have led the way in demanding access to care, providing service delivery and holding institutions accountable.

Communities have always resisted authoritarian attempts to control and diminish their lives through practices of collective care; by ensuring no one is left behind. How can we as community members, scientists and health-care workers fight back? How can we participate in these movements from a place of solidarity, not charity?

We can and should participate in collective action to improve the material conditions of people’s lives and oppose unjust laws that uphold structural inequities along the lines of race, gender, sexual orientation and class. These acts of solidarity will look different in Orlando, Toronto, Zurich, Lagos and New Delhi, but the foundational principles remain the same: engaging in collective action rooted in the principles of self-determination and collective liberation.

When we think about monkeypox, it is critical that we place this most recent outbreak in the historical and contemporary context of climate destruction, global medical apartheid and the rise of far-right and fascist ideologies that threaten the very existence of Indigenous, Black and other racialized communities, including those who are part of the 2SLGBTQIA+ community. Making connections between past and present, as well as across geographies, is key to understanding what has made this current moment possible, and how it can be resisted. Only then can we understand how resisting medical apartheid globally requires acting in solidarity with others across borders in order to put an end to the health consequences driven by neoliberal political and economic forces.

HIV, COVID, monkeypox … then, as now, structural injustices have been made clear in the wake of any infectious outbreak. How we respond to this outbreak and dismantle the structural violence that created the conditions that allowed it to happen is up to us.

 

For more information on monkeypox, please see these external links from ScienceUPFirst: 

https://twitter.com/ScienceUpFirst/status/1559905602952122368

https://www.instagram.com/p/ChXN1JxsMW0/

https://www.facebook.com/100063749336847/posts/pfbid027s58iQ3Q1BL6pJ83W7KrskPh16i31jRirschDmEAKw1ucrurzPapzzvbMdezohqul/?d=n

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1 Comment
  • rickk says:

    Be careful for what you wish for.

    “The truth is, we don’t know the efficacy of any of these monkeypox vaccines,” Ira Longini, Ph.D., a biostatistician at the University of Florida who is advising the World Health Organization, told Science.

Authors

Malika Sharma

Contributor

Malika Sharma is a feminist writer, educator, and an infectious disease and HIV physician in Toronto.

Nanky Rai

Contributor

Nanky Rai is an aspiring anti-colonial feminist, a harm reductionist and a primary care physician at Parkdale Queen West Community Health Centre who works closely with people who are queer, trans, unhoused and/or people who use drugs.

 

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