A debate about how best to warn New Yorkers about monkey pox is raging in the New York City Department of Health.
At the heart of the dispute is a fundamental disagreement over public messages, with some health officials saying the city should encourage gay men to reduce their number of sexual partners as monkeypox spreads, while others argue the message would backfire.
The internal turmoil reached a head when the health department issued an advisory last week suggesting that having sex while infected with monkey pox could be made safer if people avoid kissing and cover their sores. Several agency officials were outraged, saying the agency was giving misleading and even dangerous health advice, according to several epidemiologists within the agency and a review of internal emails.
The advice on safer sex was not medically justified, said Dr. Don Weiss, the division’s director of surveillance for Communicable Diseases, in an interview. He believes the department should advise those at risk for monkey pox to temporarily reduce their number of partners, saying, “We don’t tell people what to do to be safe.”
His concerns are shared by some of his colleagues, emails and interviews show, pointing to growing frustration and pessimism within the ranks of the health department as the window opens to New York City’s monkeypox epidemic — the largest such outbreak in the United States. – quickly get under control closes.
Monkeypox has been spreading worldwide since early May. Cases in New York City, where nearly all monkeypox patients are gay men, have nearly tripled in the past week: Monday, there were 618 documented cases of monkeypox in the city, although Dr. Weiss said the actual number of infections is much higher because testing is limited.
The strategy favored by Dr. Weiss, who has long been at the forefront of the department’s response to disease outbreaks, has gained little traction within the department.
“For decades, the sex life of the LGBTQ+ community has been dissected, prescribed and banned in myriad ways, primarily by heterosexual and cis people,” the health department said in a statement.
The city’s response to monkeypox is based on the science and history of “how poorly abstinence-only counseling has performed in the past,” the statement said, “with this shameful legacy in mind.”
The spread of monkeypox has rekindled an ongoing public health debate about how or even to what extent public health officials should tell people to change their sexual behavior during times of outbreak.
What you need to know about the Monkeypox virus?
What is monkey pox? Monkeypox is a virus endemic to parts of Central and West Africa. It is similar to smallpox, but less serious. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.
It’s a well-known debate from the early days of HIV/AIDS, when terror and stigma ran high. There is much less at stake in monkeypox, as no one in the United States has yet died from the disease, treatments and vaccines exist, and the disease seems to pass relatively quickly. Still, some epidemiologists say an aggressive response now — while transmission is primarily limited to gay and bisexual men — could prevent the virus from becoming endemic in New York or reaching a wider segment of the population.
Some public health experts say many gay men are likely to resist any advice that could be seen as discouraging or stigmatizing gay sex. They say such advice blames them for the outbreak and could lead the targeted public to view public health authorities with suspicion.
“Telling people not to have sex, not to have multiple sex partners, or not to have anonymous sex is just a no-go, and it’s not going to work,” said longtime AIDS activist, Charles King, who is director of Housing Works. , which provides housing and social services to the homeless and people living with HIV
“People will still have sex and they will have it, even if it comes with great risks,” he said.
But there may be a middle ground, some experts said, noting that urging people to temporarily reduce their number of sexual partners or avoid sex parties where they can have multiple partners is not the same as a message of abstinence or monogamy.
“Name the risk factors and the behavior and give people options,” says Dr. Dustin Duncan, an epidemiologist of infectious diseases among sexual and gender minority groups at Columbia University.
He gave an example: Telling people that they can reduce their risk of getting monkey pox by “having one regular casual partner instead of several people” seemed like a reasonable message at this point, he said.
dr. Weiss said asking people to change their sexual behavior — if only for a month or so — was the most powerful weapon health officials currently had to reduce cases of monkey pox. Vaccine supplies are limited and were initially distributed through hard-to-reach daytime appointments in a few clinics, although mass vaccination sites have opened in recent days.
But dr. Weiss said his recommendations were largely ignored by the department’s senior leadership, who “seem paralyzed by fear of stigmatizing this disease,” he wrote in an email to colleagues in June.
“If we had an outbreak related to bowling, wouldn’t we warn people to stop bowling?” He wrote.
Until now, the health department has been reluctant to publicly encourage people to change their sexual behavior unless they are actively infected with monkeypox. That reflects wider coverage of the outbreak by the federal government.
The department’s advice, posted on its website, does note that “having sex or other intimate contact with multiple or anonymous people (such as people who have met through social media, dating apps, or at parties) increases the risk of may increase exposure.”
At an online “town hall” event last week about monkey pox, the city’s health commissioner, Dr. Ashwin Vasan, that the department’s goal is 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 situations.”
dr. Weiss, who has held the same position for 22 years and researches and responds to new outbreaks for the Bureau of Communicable Diseases, said he felt compelled to speak out publicly because he felt the department’s public statements were sometimes irresponsible. . He pointed to the press release issued Friday that contained several prevention tips for “those who choose to have sex while sick”.
It stated that covering monkeypox sores with clothing or bandages during sex “may help reduce — but not eliminate — the risk of transmission.” The release also said, “For those who choose to have sex while sick, it’s best to avoid kissing and other face-to-face contact.”
dr. Weiss said it was “ridiculous” to suggest that these steps would significantly reduce the risk.
Department of Health guidelines to the public have often pointed to non-sexual routes of possible transmission, such as cuddling or contact with bedding. While these are certainly possible routes of transmission, the result – said Dr. Weiss – that people became overly concerned about casual physical contact and were not sufficiently aware that most monkeypox infections in New York appeared to be transmitted through sex.
dr. Weiss said he has overseen a team of epidemiologists who have assessed many of the monkeypox cases in the city. In most patients, patients had lesions on the penis, anus or in the rectum, suggesting, he said, that the disease spreads primarily through sexual contact.
He also said reports of asymptomatic spread and the presence of the virus in semen should have led to a recast of the department’s public advice.
“I know I sound like a Biblical preacher,” wrote Dr. Weiss recently told a group of epidemiologists in a Department of Health email chain.
But, he has argued, “If we don’t act quickly, there may be no turning back.”
Sharon Ottermanreporting contributed.