22 Comments
Jun 6, 2023·edited Jun 7, 2023

This phrasing reminds me of the way we used to talk about HIV/AIDS risk in the 1990s. Which meant I spent years in the 2000s in the Global South trying to undo the messaging that only men who have sex with men, drug users, or sex workers have to think about condom usage. I had to drill it into ppl’s minds that if you have sex, you are at risk and should use a condom.

This could’ve been phrased so much differently. You could have said, “Mpox continues to spread through one very tight social network: men who have sex with men. Yes, some straight men got it, as well as women and children, but at relatively low rates. While current spread is through this one social group, because it is spread through close, intimate contact, anyone is at risk, but men who have sex with men should be on higher alert right now.”

Do you see how less stigmatizing that statement is as well as accurate? It really just takes one bi-sexual man to bring it to another population, correct? I mean are we really so obtuse as to think the men who have sex with men population “keeps to themselves” and women and non-binary ppl never have relations with those queer men?

I spent four years explaining that the risk of the virus is associated with the ACT (in this case close, intimate contact), NOT THE GROUP of the person that you have sex with.

Please don’t make health educator’s jobs harder for when we do need to go to the masses and explain to them that it is possible for them to be at risk for a virus. That viruses don’t follow certain groups of people (groups that are often perceived negatively), they just follow people who engage in close intimate contact.

I am annoyed because it just seems like we learn nothing. Like, if this is how we are talking about mpox in 2023, what did we learn about our failures re: risk assessment and messaging from HIV/AIDS? Ughhhhhhhh

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Jun 6, 2023·edited Jun 6, 2023

Anyone who tries to explain the dynamics of mpox in today's world runs the risk of *inadvertently* stigmatizing certain groups of people. My take - and maybe I'm misunderstanding - is that "men who have sex with men" is code for a particular type of sex: anal sex. And that other types of sex are not as risky. Yes, men and women can also engage in this type of sex, yet perhaps the risk is lower because each person is less likely to be infected in the first place.

I appreciate YLE's brave attempt to clarify the dynamics of mpox with straightforward language. The CDC's guidance on safe sex during Pride month last year was so opaque it was confusing: "consider having sex with your clothes on." Today's post is a huge improvement and an important public service message.

From the CDC's website:

Anal sex is the riskiest type of sex for getting or transmitting HIV. Being the receptive partner (bottom) is riskier than being the insertive partner (top). The bottom’s risk is higher because the rectum’s lining is thin and may allow HIV to enter the body during anal sex. The top is also at risk. HIV can enter the body through the opening at the tip of the penis (urethra); the foreskin if the penis isn’t circumcised; or small cuts, scratches, or open sores anywhere on the penis.

Link here:

https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html#:~:text=The%20bottom%27s%20risk%20is%20higher,the%20body%20during%20anal%20sex.

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Jun 6, 2023·edited Jun 6, 2023

While yes anal sex was more a risk factor for HIV/AIDS (which is not excluded to "men who have sex with men" population obviously) that is not the case with mpox. It's prolonged intimate contact.

I spent years teaching ppl that anal sex is the most risky, then vaginal, then oral but they all carry some level of risk and should be treated as such. This was super surprising and important information in a predominately Catholic country where a lot of teen girls would engage in anal sex in order to keep vaginal virginity.

I provided an example of what would have been much more straightforward and clear language about risk assessment at the individual level.

Mpox has nothing to do with anal sex.

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Thanks for clarifying. The CDC recently updated their mpox advice (link below), which supports what you’re saying and is a big improvement over “have sex with your clothes on.”

On a separate point, it seems we now live in a world where no matter how careful we are with our words, we risk being accused of stigmatizing, offending or triggering someone somewhere - no matter how benevolent our intent. The more this goes on, the less likely people with important messages will be to speak up. Messages will become so watered down that they lose meaning and clarity. What does it mean to have “sex with your clothes on”? Abstain? Can zippers be down as long as pants remain on? This is absurd.

Btw, I appreciate your clear language, as well as the work you did educating others to safeguard their health.

Here’s the link:https://www.cdc.gov/poxvirus/mpox/prevention/sexual-health.html

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Jun 6, 2023·edited Jun 6, 2023

This isn't about being "triggered" this is about language that helps people accurately interpret their risk for any disease. This is about public health messaging. My ire is not that it "hurts ppl's feelings" my ire is that that language de-emphasizes the risk of disease spread based on groups vs. acts, which doesn't help non-public health minded ppl accurately assess their risk. And yes, we should be very careful how we craft statements that help people understand their risk for acquiring and spreading disease.

Those who work in the public health field should be the most careful with our words, bc we should theoretically know better.

I don't feel folks need to know how to have sex with clothes on or whatever you're suggesting - simply ask your sexual partners about potential symptoms or vaccination histories before having sex and be a bit more cautious, maybe have less partners for a time being (like the summer), etc. EVERYONE could and should do this, not just one group of ppl. The phrasing of the statement makes it sound like "hetero ppl this is not your problem, gay men be careful, but hetero ppl can keep having orgies, it's fine,". Do you see the difference in risk assessment and what steps I should take as a result info there?

*Everyone* should be encourage to be vigilant about mpox, with increased targeted messages and campaigns directed at the communities most effected. That's effective public health messaging.

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founding

I really appreciate this discussion so much. I want to bring up an issue that I think is allied, which has to do with public health and health care data. David was right, in my first comment on this, I was too flip, and I apologize. It's hard to know how to do this well.

I would appreciate, though, thoughtful responses about how sex and gender discourse might be affecting data collection for medical and public health purposes. Here's an example, and let me make clear I make absolutely no judgment one way or the other on most of it. The one concern I had is the phrase: "along with eliminating sex from our conceptual framework of bodies and disease" in this sentence:

This analytic essay, authored by queer and transgender academic clinicians, researchers, nonacademic community members, and allies, proposes a systems-based approach to degendering oncology, which we define as the conscious and explicit disentangling of gender, anatomy, hormonal milieu, karyotype and other biological factors in oncologic diagnoses, epidemiological analysis, and knowledge production along with eliminating sex from our conceptual framework of bodies and disease. We provide examples of the implementation of degendering oncology, including steps that can be taken immediately by clinicians, researchers, and administrators.

https://ascopubs.org/doi/10.1200/JCO.22.02037

I know this is a really hard thing to discuss these days without sparks flying, but I am hopeful we can, because, as someone who worked in the health care field for a long time myself, it seems to me important.

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Agreed that it’s important to use language so that people can accurately understand and assess risk. You are wonderful at this.

The have “sex with clothes on” was actual advice last year from CDC re mpox. I asked friends what they thought it meant, and the answers were all over the place. Keeping things PG-13, I’ll refrain from saying more.

Given where we are in mpox’s evolution, should we all be equally freaked out and taking the same precautions? Or is it better to target a clear message to those most at risk in the hopes of containment?

If we should all be equally freaked out - what should I be the most freaked out about right now? Covid, mpox or bird flu? There’s only so much panic a brain can absorb before we all throw in the towel and give up trying.

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I really don't know what the CDC says, don't much trust them. I was very specifically talking about the one sentence of the author, not the larger concepts (triggered, what the CDC says, gender, etc.). I don't mean to be spicy, I just really thought we'd gotten better at public health messaging by now regarding making viruses seem tied to a certain population and am tired.

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founding

Great point, and it’s good to see the CDC writing frankly about this. We are in some ways still a nation of puritans and have a hard time speaking directly about sex and sexual behaviors, even where it matters most, as in this case.

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I couldn't agree more. That seemed wildly inappropriate. The big driver of transmission seems to be hookup culture, which is prominent in some (not all) gay communities but by no means restricted to them. Anyone who has sex with multiple people, has a partner who has sex with multiple people, or is immunocompromised should take this seriously. People who have close contact with many people professionally, such as massage therapists and physical therapists, should probably also consider vaccination.

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founding

Very well stated. Makes so much sense to focus on the ACT, not the GROUP, and your alternative way of phrasing this is excellent.

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founding

Much appreciated, as always. In these times, it doesn’t seem we can safely assume this, so I ask re your statement whether “men” and “women” as used here refer to biology, gender identification, or both: “Mpox continues to spread through one very tight social network: men who have sex with men. Yes, some straight men got it, as well as women and children, but at relatively low rates. (Of all the cases worldwide, 1% were children and 3% were women, and they were mainly household close contacts.)”

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It's about a certain broad group of people having sex and/or close contact with each other. Parsing details of sex and gender is totally irrelevant. If you or someone you have sex with like to "hook up" with strangers, go to sex parties, etc., then you're at risk and you need the vaccine. Otherwise, you should try to get the vaccine anyway, because vaccines rock and who wouldn't want to be protected from mpox, smallpox, and other orthopox viruses?

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founding

Agree, David: and also I like very much how Lauren has discussed this. (My comment was actually a bit tongue in cheek, addressing the current vagaries of what should be settled definitions.)

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I have no idea what *you* think the settled definitions should be, but your comment came off as extremely disrespectful of trans and nonbinary people.

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founding

Oh, I didn’t intend that, sorry. I was more concerned about applicability of the terms in data, not about how people identify themselves, which is of course up to them. The data issues, though, I do think are serious and deserve attention.

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What data issues? How people identify is all that matters in most contexts. In the cases where it's not, the situation is almost always more complex than the answer you'll get from assigned gender at birth or karyotyping. Categorizing people in ways that are both useful and valid for medical research purposes is *really hard*.

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First, let me thank you for your newsletter which I've been following since nearly the beginning. This might sound a bit pedantic, but I wish people wouldn't describe asymmetric epidemic curves as "bell-shaped." In general, they aren't bell-shaped and this particular curve isn't close to a bell-shape. Describing it that way props up the fallacy that an epidemic will have nearly symmetric rise and fall and that the peak and fall can be predicted from the early shape of the epidemic curve, regardless of interventions. This is sometimes called "Farr's Law," but it's a fallacy, not a law. People brought it up (and variations) early in the COVID-19 pandemic (and also AIDS) to argue that interventions wouldn't have any effect, or attempted to use variations on it resulting in disastrous pandemic modeling (IHME, for example). Even a simple SIR model is not a symmetric bell curve, and when there are also behavioral changes, vaccinations, and multiple subpopulations (with geographic, demographic, social, and other differences), you end up with a curve that is often even less bell-shaped.

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Thank you for all the work you do. I'm wondering what you may know about the cancer drug shortages. I have a friend who cannot get her much needed Uterine Cancer Chemo as the drug is not available, the alternative is not great and costs her $1000 for each treatment. Thank you

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founding

IIRC, if one integrates that “bell” curve, one obtains a logistic curve. The logistic function has more readily obtained information and, IMAO, is more beautiful. Re: sensitivity, triggers, etc. Reminds me of the people who rail against teaching CRT. Unfortunately, words may lead to offensive behavior, so telling ppl to thicken their skins is inappropriate.

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Super data summary & super fact checker. Retired Bruin,

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With the flow of airborne particles from Canada wildfires, should people who are over 65, immunocompromised etc wear masks outdoors until this passes? If so which ones?will Covid style masks be sufficient?

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