It’s hard not to think about AIDS when thinking about monkeypox — the media images of otherwise healthy gay men covered in sores, the homophobic anti-sex puritanism from people across the political spectrum, and the widespread culture of blame and shame directed at queer sexual pleasure. And, as always, stigma distracts from the actual cause of the problem, which, in this case, is devastating neglect by the United States government.
Every queer person lives with the ongoing trauma of the AIDS crisis, and this plays out generationally. There is a generation that experienced sexual liberation in the 1970s, and then watched as entire circles of friends died of a mysterious illness while the government did nothing to intervene. There is a generation that grew up in the midst of the AIDS crisis, and internalized the trauma of mass death as part of becoming queer. And there is a generation growing up now, with effective treatment and prevention available, and yet still grappling with the magnitude of the AIDS crisis at the personal, social, intimate and collective levels.
For anyone familiar with the ongoing trauma of the HIV/AIDS crisis, there are brutal parallels in the mishandling of the monkeypox outbreak in the U.S. Unlike the early years of the AIDS crisis, though, when no effective treatments were available until a decade of mass death and public protest forced the government and pharmaceutical industry to action, monkeypox is generally not a deadly disease, and we already have the tools for treatment and prevention: the Jynneos vaccine (a smallpox vaccine that is also effective against monkeypox); tecovirimat (also called Tpoxx), an antiviral medication; and pre-approved tests for rapid diagnosis. The problems are the lack of access and the lack of care.
Three months into the monkeypox outbreak in the U.S., the federal government has finally declared monkeypox a health emergency, and this may direct more resources to helping people in need. But if the government had acted with a sense of urgency right away, and distributed the vaccine immediately to those most at risk, then it’s possible that monkeypox wouldn’t have become such a crisis.
While the spread of monkeypox is a new phenomenon in the United States, the virus has existed in Central and West Africa for decades. In 2017, there was a deadly outbreak. At that time, the U.S. government let 20 million doses of the vaccine in its strategic stockpile expire rather than using those doses to help people suffering from the disease in Nigeria. If those 20 million doses had been sent to Nigeria five years ago, perhaps monkeypox would not have become a global emergency. Even more importantly, the people suffering then would have received the care they so desperately needed. Still, to this day, neither the vaccine nor the medication are available at all in Nigeria, while the outbreak which began in 2017 continues.
Terms like “vaccine apartheid” and “vaccine hoarding” have been popularized during the COVID pandemic, but vaccine hoarding predates the COVID crisis. What is it called when you stockpile 20 million doses of an expiring vaccine instead of offering it to the people who need it? You can’t blame this on governmental ineptitude. It stems from racist arrogance and the continuing legacy of colonialism.
Every article about monkeypox should state that the U.S. government is a cause of this crisis, instead of shifting the blame onto individual acts and policing people’s sex lives while refusing to challenge the structural violence that continues, along with its devastating consequences.
As virologist Joseph Osmundson says, “Gay sex is not driving this epidemic, this epidemic is being driven by a lack of access to resources globally that could prevent spread. People want to get vaccinated, and they can’t get vaccinated.”
Here in the United States, there is an extreme shortage of the Jynneos vaccine, and mass panic among the people most affected by monkeypox in this country — at least 97 percent of the reported cases are among gay and bisexual men, and trans, genderqueer and nonbinary people who are part of their sexual networks. So across the U.S., we see the dystopian spectacle of queer folks desperately waiting in line for hours and hours to get the vaccine — 10 hours outside a bathhouse in Berkeley; five hours in hospital hallways in Seattle and San Francisco; outside in a sweltering New York City heat wave. Sometimes people wait in line for hours, only to be turned away because supplies of the vaccine have run out.
None of this is necessary. It’s been over a year since COVID vaccines were rolled out, when hundreds of people were vaccinated at a time in some locations, thousands of doses a day in many cities, and now most cities don’t even have thousands of doses of the monkeypox vaccine in total. So why couldn’t the same kind of care and attention be directed to administering the monkeypox vaccine quickly and effectively, without adding to risk or vulnerability, while we are still in the midst of the COVID pandemic? This is being done just across the border in Canada, while in the U.S. we’re faced with a top-down model of scarcity and a “while supplies last” mentality of vaccine availability: Get in line, shoppers, the wait is definitely worth it… If you’re still standing.
Meanwhile, people suffering from monkeypox do so in extreme pain, without the financial support necessary for the isolation to prevent the spread of the disease, and most often without the antiviral medication that alleviates the excruciating symptoms, since Tpoxx is only available through a convoluted CDC protocol.
Who has access to this knowledge? Information about where, when, and how to get the vaccine and treatment for monkeypox has been passed on anecdotally through the social and sexual networks of the people most impacted. Again, this echoes the early years of the AIDS crisis. There is a potential in sharing strategies for how to beat the system so the system will actually serve you, but not if you are in unnecessary pain and distress. And, this informal sharing of knowledge prioritizes the people who already have the most access — often wealthy and white — furthering the privatization of a public health system that barely serves the people most in need, including poor people, people of color, and undocumented, disabled and unsheltered people.
The trauma of the AIDS crisis comes to the fore again as queer folks seeking the knowledge, information and access necessary to take care of one another during another health crisis face the brutality of a resurgent sexual moralism, in a country steadily moving backwards. Viruses don’t cause stigma, people do. We already have the tools necessary to treat monkeypox and prevent the spread of the disease, but, as we have seen with the ongoing COVID pandemic, the U.S. government is far more adept at abandoning the people who are most vulnerable than offering care. So, in the midst of the COVID pandemic, and in the shadow of the AIDS crisis, we are faced with yet another unnecessary global health crisis furthered by structural racism and homophobia.