In Monkeypox Fight, Healthcare Must Communicate Better, Differently

In national public health emergencies like monkeypox, our sensitivities around not stigmatizing people can keep us from our goals. We don’t deliver helpful information or use language that doesn’t resonate with the intended audience.

The result? We lose valuable time.

And we don’t have time to waste. The U.S. has more monkeypox cases than any other non-endemic country. But it doesn’t have to be that way.

A non-stigmatizing harm-reduction approach is the most effective way to reduce exposure and infection.

We must avoid continuing the misperception that monkeypox is a “gay disease” so our message reaches the most people — particularly, racial and ethnic minority communities including men who have sex with men. While most people exposed in the latest outbreak are MSM, the virus isn’t classified as a sexually transmitted disease nor limited to this group.

Monkeypox in the current epidemic is primarily spread by close skin-to-skin contact. Because people will and do have sex, public health officials and healthcare providers must do everything we can to reduce risk.

We can start by changing how we communicate. Asking someone if they have, in the past 90 days, had anonymous sex or sex with multiple partners is the wrong way to do it. This approach potentially shames people. The stigmatization often makes it harder to come forward because people don’t want to be blamed or judged.

Instead, we can ask people if they have had sex in the past 90 days with someone they recently met or don’t know well. Or if they are sexually active and not in a monogamous relationship. Reframing in this way is less judgmental and invites conversation and an opportunity to support sexual health.

The CDC has effective materials to help sexually active people reduce risk. The agency’s Director of the Division of HIV Prevention, Dr. Demetre Daskalakis, MD, MPH, is one of the people getting messaging right. His official CDC videos, tweets, and interviews are plain-language, sex-positive messaging appeal to MSM and young people with guidance that is easy to understand and relatable.

We also need to provide clearer guidance to partners, close family, and friends.

It’s vital to encourage open communication before sex and other intimate contact. If you’re sexually active, talk to your partner/s about whether they’re feeling sick. Do they have a fever, muscle aches, a sore throat, or an unexplained rash or lesion? Are they experiencing difficulty swallowing, a sore throat, or trouble defecating? When anyone answers yes, refrain from sex and other close skin-to-skin contact — and seek testing from a trusted healthcare provider.

Families also need support managing the virus in their homes. If you live with someone who’s been exposed or has monkeypox, you can lower the risk of the virus transmitting within your household. Don’t kiss, hug, cuddle or have sex with anyone who has monkeypox. Avoid touching their rash or scabs and their clothes, bedding, and towels. And wash your hands frequently, especially before eating.

Nurses play a critical role in operationalizing harm reduction and slowing the spread. We are the boots on the ground and our sheer numbers make us a force multiplier in screening, testing, and vaccinating. This is especially important since the vaccine was approved for intradermal (between layers of the skin) administration, which requires less per shot and increases available doses fivefold.

And, as the most trusted professionals in healthcare, people feel comfortable talking to nurses about their health and disclosing behaviors. Since they see us as reliable sources of accurate, fact-based information, we have a direct impact on their decision-making and actions.

The current approach, in effect, subjects people to shame and blame to get a vaccine that preserves their health and prevents forward transmission. This practice perpetuates health inequities and encourages the spread.

We have a narrow window to make progress on monkeypox. The recent national emergency declaration creates opportunities for rapid escalation of our response, innovation, and partnerships with communities at greatest risk. Let’s capitalize on it.

Let’s make sure we’re reaching the right people with targeted messages. Let’s get shots in arms at an accelerated pace. Let’s share observed data and current evidence in a way that encourages sexual health instead of reinforcing stigma and arbitrary dichotomized positions.

Vincent Guilamo-Ramos is dean of the Duke University School of Nursing, vice chancellor of nursing affairs, and a distinguished professor of nursing at Duke University. A nurse practitioner, he specializes in the prevention of HIV/AIDS, sexually transmitted infections, and improving the lives of sexual minorities and other youth receiving HIV prevention and treatment.

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