To hunt for additional monkeypox cases, health authorities have deployed the wide-net contact tracing methods used to track people exposed to COVID-19. Twenty individuals, including family, friends, household domestic staff and people the deceased patient had played soccer with, were identified as being “high-risk primary contacts”. Another 165 who travelled on the same plane were told to watch for symptoms.

In the context of monkeypox, where infections are currently occurring mostly via sexual networks, identifying contacts is a sensitive issue, especially if it forces people to disclose their sexual orientation, Gilada said. “They’re contact tracing every ‘Tom, Dick and Harry’ they have come in touch with,” he said. “You are identifying people indirectly.”

Genetic sequencing of virus specimens from other patients in Kerala indicated that monkeypox might have been circulating in the state for some time before it was reported.

In Africa, the only continent where the virus has been endemic for decades, infections are mostly a result of household transmission, not sex between men. Women account for about 40 per cent of cases there, because they’re typically the ones who care for the sick, said Patrick Otim, the health emergency officer for the WHO’s Africa region.

In India and other countries where men who have sex with men, or “MSM”, face discrimination, sensitive and non-judgmental public health campaigns are needed to help persuade people to come forward for testing, said Sanjay Pujari, director and chief consultant at the Institute of Infectious Diseases in the west Indian city of Pune.

Cases will be reluctant to provide information about their contacts unless a “trusted relationship” has been established, he said. “Community involvement, including MSM organisations, need to be included in the planning and implementation of the entire public-health response to monkeypox.”

Many nations haven’t yet factored this into their testing strategies or public awareness campaigns, even though the outbreak is almost certain to spread, according to Nikolay Lunchenkov, health coordinator at the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity, which works on access to health treatment for gay men, other men who have sex with men and transgender people.

“Stigma is only likely to make things worse and stop us from ending this outbreak as fast as we can,” he said.

What’s more, the mislabelling of monkeypox as a “gay disease” is tragically reminiscent of the demonisation gay men were subjected to when HIV emerged more than 40 years, Milka Sokolovic, director general of the European Public Health Alliance, wrote last month.

“This leads to an instant branding of us versus them, allowing stigmatisation and discrimination to raise their ugly heads yet again,” she said. “We must not forget how labelling HIV infection a homosexual disease during the HIV/AIDS pandemic in the 1980s led to indescribable suffering in gay communities.”

Bloomberg