Public Health Reticence To Call Monkeypox A Sexually-Transmitted Disease Meets New Evidence

 One of the most baffling things about the recent monkeypox outbreak is the nearly unanimous refusal of public health agencies to declare it a sexually transmitted disease. On the one hand, monkeypox is above the break at the CDC's sexually transmitted disease page — along with COVID-19:

On the other, it doesn't make the big list at the bottom. Moreover, the CDC continues to insist that "anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has monkeypox is at risk." The WHO website is even worse on the subject of transmission, saying, "While close physical contact is a well-known risk factor for transmission, it is unclear at this time if monkeypox can be transmitted specifically through sexual transmission routes."

Careful researchers will always need to make sure they aren't fooling themselves, it's true, but a CNBC news story today highlights exactly how illusory is the politically-motivated desire of public health officials to omit gay male sexual behavior as the primary mode of transmission:

In recent weeks, a growing body of scientific evidence — including a trio of studies published in peer-reviewed journals, as well as reports from national, regional and global health authorities — has suggested that experts may have framed monkeypox’s typical transmission route precisely backward. 
…

“A growing body of evidence supports that sexual transmission, particularly through seminal fluids, is occurring with the current MPX outbreak,” said Dr. Aniruddha Hazra, medical director of the University of Chicago Sexual Wellness Clinic, referring to monkeypox and to recent studies that found the virus in semen.

Consequently, scientists told NBC News that the Centers for Disease Control and Prevention and other public health authorities should update their monkeypox communication strategies to more strongly emphasize the centrality of intercourse among gay and bisexual men, who comprise nearly all U.S. cases, to the virus’ spread.

It will likely take a while for this to pervade the CDC et al., because their cosmology does not admit that gay male promiscuity never entirely went away, even after after the AIDS crisis, and is loathe to criticize LGBT+ individuals for any reason. While it may be true that a comparative minority of gay men are promiscuous in this way, young gay men especially are more likely to have multiple partners than either older gay men or straight people of either sex. The lessons of AIDS have been frequently forgotten by the current generation.

Bush (And Reagan!) Versus AIDS Patients: The Blamethrowing

With the death of George Herbert Walker Bush, we now go back in time to the late 80s and early 90s, when AIDS activists blamed Reagan and Bush for AIDS deaths. Particularly, this HuffPo piece dropping the blame "nearly 10 years into the epidemic, 150,000 cases of people with HIV had been reported in the U.S., and 100,000 people had died due to AIDS."

This was largely the political view of American gay advocates at the time, who blamed AIDS deaths on Bush and his predecessor, never mind a considerable list of achievements under Reagan (a number of which that were booed as he delivered them at a 1987 speech). But as Elizabeth Whelan wrote in 1988 in Reason, there was precious little the government could do about those deaths:

Can anyone who knows the facts deny that AIDS, as it appears in the homosexual and drug-using population, is a self-inflicted disease? A promiscuous homosexual lifestyle carries inherent health risks, and gays knew this by the mid-1970s when rates of sexually transmitted diseases soared. Just because AIDS or any other fatal disease was not specified on the "morbidity menu" prior to 1982, how can they look to anyone but themselves for an explanation why these infections occurred? This is not to say that gays deserve AIDS, any more than cigarette smokers deserve lung cancer. It comes with the territory.

Was the government blasé about the AIDS epidemic in the years between 1981 and 1984? Yes and no. "Yes" in the sense that 20/20 hindsight now shows AIDS to be a more insidious and formidable opponent than was first thought. But "no" in that federal research dollars were forthcoming, progress was made, and Shilts seems to have forgotten that America had and continues to have other health concerns demanding our attention. While in mid-1983 there were some 1,279 cases of AIDS on record, in that year nearly 450,000 people died from the effects of cigarette-related disease (also the consequence of a chosen behavior).

Gay sexual behavior was always going to be hard to police and needle-sharing as well. In 2000, the CDC released a report on high-risk AIDS behaviors (PDF); its findings included

• 30% of IV drug users had used needles they suspected or were used by others (Table 10, p. 17)
• 49% of those surveyed at gay bars had four or more sexual partners in the prior year (Table 12, p. 19)
• 37% used condoms sometimes or never when having receptive anal intercourse (Table 13, p. 20)

The problems involved are those of addiction, and male evolved sexual preferences, which revolve around partner novelty. Both are hard to solve. Blaming that on Reagan or Bush fails to consider the choices gay men (and drug users) were still making nearly a decade after the latter was out of office.