Beyond messaging, the testing, treatment, and vaccination infrastructure must also be equitable and robust, especially as an outbreak continues to grow. Oni Blackstock, MD, founder and executive director of anti-racist health equity consulting organization Health Justice, worries the U.S.’s health care infrastructure is unprepared for monkeypox: “Many of the same issues that we saw with COVID—lack of access to testing, vaccines, and treatment—are also being seen with [monkeypox],” she tells SELF. “Black and Latino [gay men and their sexual networks are] disproportionately affected,” she adds. “We know these groups have less access to care and are more likely to be uninsured.”
Other experts are also concerned that public health outreach efforts may not reach those in rural areas. “Many people in the U.S. do not have access to sexual health clinics, which are a critical safety-net resource for providing high-quality, LGBTQ-friendly health services at low or no-cost,” Jay Varma, MD, professor of population health services at Weill Cornell Medical College, tells SELF.
The infrastructure underlying the state-by-state vaccine rollout—including online portals for appointment scheduling and the locations and hours of vaccination sites—can also be inaccessible to disabled people, those without reliable internet access, and people who work in the evenings.
In an urgent open letter to the Biden administration, a group of 16 health care and equity experts and queer community members laid out policy solutions that they believe are key to ensuring the monkeypox response reaches marginalized and underserved communities. The letter details the need for free testing and vaccination at community venues, supporting rapid research for testing, and increasing staff resources for front-line agencies such as sexual health clinics, among other proposals.
So, should we consider monkeypox an STI?
It’s possible you’ve seen news stories referring to monkeypox as a sexually transmitted infection—and then other news stories (or social media discourse) contesting that characterization. There are a couple of reasons for both the characterizations and the pushback.
First, it is true that a majority of monkeypox cases reported in the U.S. right now are being driven by sexual contact. But, to be clear, monkeypox can spread via any type of close, skin-to-skin contact with someone who has monkeypox, the CDC says. This can happen during intimate contact like any kind of sex, kissing, hugging, massage, prolonged face-to-face contact, or touching fabrics and objects that were used by someone who has an active infection.
Advocates like Farrow worry—for good reason—that referring to monkeypox as an STI will result in the stigmatization of those most at risk. As Gothamist reported, other experts worry calling it an STI “could also downplay the threat posed to the general public, leading some people to not take precautions when they should.”
Of course, whether something is contracted sexually should not impact the quality of your care, or your access to disease education, vaccination, and treatment. There’s nothing inherently shameful about sexually transmitted infections. It’s when bad-faith actors use the STI label as a way to denigrate communities at risk that the label becomes dangerous.