Debate Over Monkeypox Messaging Divides N.Y.C. Health Department

The spread of monkeypox has ignited a debate within the New York City Department of Health over whether the agency should encourage gay men to reduce their number of sex partners during this summer’s outbreak.

Inside the department, officials are grappling with public messaging as the number of monkeypox cases has nearly tripled in the past week, almost all of them among men who have had sex with men. Some epidemiologists say the city should encourage gay men to temporarily change their sexual behavior, while other officials argue the approach would stigmatize gay men and be counterproductive.

Internal divisions peaked when the Department of Health last week issued an advisory saying sex could be safe if people were infected with a monkey if they avoided kissing and covered their wounds. According to a review of several epidemiologists and internal emails within the department, many agency officials were outraged, saying the agency was giving misleading and dangerous health advice.

The advice on safe sex was not medically correct, said Dr. Don Weiss, surveillance director for the department’s communicable diseases bureau, in an interview. He believes the department should be advising people at risk of monkeypox to temporarily reduce their number of partners, adding that “we’re not telling people what they need to do to stay safe.”

His concerns are shared by some of his colleagues, emails and interviews show, which reflect the growing dismay and pessimism within the ranks of the Department of Health as the window to controlling New York City’s monkeypox epidemic. The outbreak—the largest of its kind in the United States—stops quickly.

Monkeypox has been spreading globally since early May. In New York City, where nearly all monkeypox patients are gay or bisexual men, the city had 618 documented cases of monkeypox as of Monday, although Dr. Weiss said the true number of infections was much higher, as testing is limited. ,

The strategy endorsed by Dr. Weiss, who has long played a leading role in the department’s response to disease outbreaks, has gained little traction within the department.

In fact, the agency argued against such an approach in a statement on Monday. “For decades, the LGBTQ+ community has dissected, determined and restricted their sex lives in myriad ways, mostly by heterosexuals and cis people,” the statement said.

The city’s response to monkeypox is based on the science and history of “how poorly restraint-only guidance has performed historically,” the statement said, “taking into account this shameful legacy.”

The field of public health has long struggled with how best and even to what extent public health officials should ask people to change their sexual behavior in times of outbreaks.

The debate is influenced by the early years of HIV/AIDS, when panic and stigma was rampant. The stakes are very low with monkeypox, given that no one has yet died of the disease in the United States, treatments and vaccines exist, and for many people the disease passes relatively quickly.

Still, some epidemiologists say an aggressive response now – while transmission is mainly limited to gay and bisexual men – could prevent the virus from becoming endemic in New York or reaching wider swathes of the population.

Some public health experts say that many gay men are likely to reject advice that could be seen as discouraging or stigmatizing gay sex. These experts say such advice lays the blame for the outbreak on gay men and could lead them to view public health officials with distrust.

Charles King, a longtime AIDS activist who is Housing’s chief executive, said, “Telling people that they don’t have sex or have multiple sex partners or have anonymous sex, and it doesn’t work.” will do.” Works, which provides housing and social services to the homeless and people affected by HIV

“People are still going to have sex, and they’re going to have it, even if it comes with a lot of risk,” he said.

But there may be a middle ground, some experts said, noting that urging people to temporarily reduce their number of sex partners or avoid sex parties, where they may have multiple partners, could lead to abstinence or Does not equate to a message of monotony.

“Name the risk factors and behaviors and give people choices,” said Dr Dustin Duncan, an epidemiologist in infectious diseases among sexual and gender minority groups at Columbia University.

He offered an example: Telling people that they could reduce their risk of getting monkeypox by “having a frequent casual partner unlike many people” seemed an appropriate message at the time, he said.

Dr. Weiss said that asking people to change their sexual behavior – even if for just a month – was the most powerful weapon to reduce monkeypox transmission. Vaccine supplies are limited and were initially given out through hard-to-find appointments during daylight hours at some clinics, although large-scale vaccination sites have opened up in recent days.

He has suggested several times that the department should promote short-term abstinence, a relatively minor position. At other times he has suggested that the department should warn gay men to refrain from anonymous sex.

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

“If we had a bowling outbreak, wouldn’t we have warned people to stop bowling?” He has written.

So far, the health department’s reluctance to publicly encourage people to change their sexual behavior, unless they are actively infected with monkeypox, reflects a widespread message about the outbreak by the federal government. .

The department’s advice, posted on its website, notes that “having sexual or other intimate contact with multiple or anonymous people (such as those met through social media, dating apps or parties) puts you at risk of may increase.”

In an online “town hall” event about monkeypox last week, city health commissioner Dr Ashwin Vasan said the department aims to be “sex positive”.

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

Other health experts, such as Dr. Weiss, have publicly called for a temporary change in sexual behavior. In an online briefing last week by the Infectious Diseases Society of America, Dr. Lillian Abbo, associate chief medical officer for infectious diseases at Jackson Health System in Miami, urged people to use condoms and said that unprotected sex with multiple partners It is “really”. The spread is increasing rapidly. ,

“We can all take part in stopping the continued spread, and it’s important that everyone takes a little bit of ownership and understands that you may be putting others at risk,” she said.

Dr. Weiss, who has done the same job for 22 years investigating and responding to new outbreaks for the Bureau of Communicable Diseases, said he felt obliged to speak publicly because he felt That the department’s public statements were at times irresponsible. He pointed to a news release issued Friday that includes several prevention tips for “those who choose to have sex when sick.”

It added that covering monkey wounds with cloth or bandages during sex may “help reduce – but not eliminate” the risk of transmission. The release also states that “for those who choose to have sex when they are sick, it is best to avoid kissing and other face-to-face contact.”

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

The Department of Health’s guidance to the public has often highlighted non-sexual routes of potential transmission, such as hugging or bedding contact. While those are certainly possible routes of transmission, the consequences – Dr. Weiss said – making people overly concerned about casual physical contact and not aware enough that most monkeypox infections in New York appear to be transmitted through sex.

Dr. Weiss said he supervised a team of epidemiologists who reviewed several monkeypox cases in the city. Most of the patients have had sores on the penis, anus or rectum, he said, adding that the disease is mainly spread through sexual contact.

He also said that reports of asymptomatic spread and the presence of virus DNA in semen should have resulted in the department reworking its public advisory.

“I know I sound like a Bible-thumping preacher,” Dr. Weiss wrote in a recent Department of Health email series to a group of epidemiologists.

But, he has argued, “if we don’t act soon, this could be the point of no return.”

Sharon Otterman Contributed to reporting.