Monday briefing: Gay and bisexual men are most at risk from monkeypox. Why aren’t we saying so clearly?

Good morning. Over the weekend, the World Health Organization declared monkeypox to be a global health emergency, and said the outbreak “is concentrated among men who have sex with men, especially those with multiple sexual partners”. In the UK, the Terrence Higgins Trust called for an urgent injection of cash to scale up vaccinations, which are being targeted at men in high-risk groups. And outside Guy’s Hospital in London yesterday, a three-hour queue snaked around the building to get a jab – with those waiting for their turn almost all gay and bisexual men.

This makes sense: all the evidence suggests that the outbreak is highly concentrated among men who have sex with men, and the virus is overwhelmingly transmitted through sexual contact. But even as that has become abundantly clear, there has still been a curious reticence in much of the public health messaging about saying so.

Today’s newsletter, with sexual health activist and researcher Dr Will Nutland and Guardian columnist Owen Jones, is about why that is, what the consequences are, and what a better way to talk about the problem might be. That’s right after the headlines.

Five big stories

  1. Health | The NHS is facing “the greatest workforce crisis” in its history which is putting patients at serious risk of harm, an influential group of MPs warns today. Estimates provided to the health and social care select committee suggest that there may be as many as 50,000 vacancies for nurses and 12,000 for doctors.

  2. Travel | UK holidaymakers hoping to travel to France endured another day of disruption as traffic chaos turned the Eurotunnel into a “hotspot of holiday hell”. British and French officials have blamed each other for the problems.

  3. Conservative leadership | Rishi Sunak is to unveil plans to curb China’s soft power by closing its 30 Confucius Institutes, which promote Chinese language and culture, in the UK. In a veiled attack on his leadership rival, foreign secretary Liz Truss, he will say the UK has “turned a blind eye to China’s nefarious activity and ambitions”.

  4. Ukraine | Russia’s foreign minister, Sergei Lavrov, sought to reassure Egypt over Russian grain supplies at the start of a four-country tour of Africa, amid uncertainty over the future of a deal to resume Ukrainian exports via the Black Sea.

  5. Myanmar | The country’s junta has executed four democracy activists, including a former lawmaker from Aung San Suu Kyi’s party, state media said on Monday, in the first use of capital punishment in decades. The junta has sentenced dozens of activists to death since seizing power last year.

In depth: ‘Who actually gets the right information is random’

People queue for monkeypox vaccinations at Guy’s Hospital in London on Sunday.
People queue for monkeypox vaccinations at Guy’s Hospital in London on Sunday. Photograph: Hollie Adams/Getty Images

Monkeypox is serious: symptoms include fever, an intense headache, a rash and lesions that can be extremely painful. It can lead to hospitalisation and dangerous complications. But most cases are mild. While it can be fatal, there have been no recorded deaths linked to the current outbreak in the UK, and, the WHO said on Saturday, only five deaths among more than 16,000 reported cases worldwide.

While most people are very unlikely to catch monkeypox at the moment, for the communities where it is spreading, it’s suddenly a huge subject. There are fears that if it is not stopped, it could become an entrenched STD (although it is not usually transmitted through bodily fluids, but through prolonged skin-to-skin contact).

“I knew almost nothing about monkeypox about three months ago,” said Dr Will Nutland, co-founder of two organisations devoted to gay and bisexual men’s health, PrEPster and the Love Tank. “Now it’s like another job on top of my job. I’m a bit monkeypoxed out.”

Despite that concentration, as Guardian columnist Owen Jones has warned, efforts to talk about it clearly have sometimes been characterised as evidence of bigotry. “The madness” of that position, he tweeted yesterday, “is that the logic of [the] argument is the vaccine shouldn’t be prioritised for men who have sex with men.”

Here’s what we know about how monkeypox is spreading, and how it should be addressed:


Almost all cases of monkeypox are among gay and bisexual men

The evidence is clear: an article in the New England Journal of Medicine last week, which looked at infections across 16 countries between April and June, found that 98% of cases were in gay or bisexual men. In 95% of cases, the infection occurred through sexual activity. The R number, of coronavirus fame, is 1.6 for men who have sex with men in the UK, but below 1 for everyone else. In the UK, more than 70% of cases were in London as of 6 July.

In short, said Nutland: “The vast, vast majority of cases are in gay and bisexual men, and pretending that that’s not the case doesn’t help any of us.”


The public health messaging hasn’t always matched that reality

A mantra of public health communication on the subject in the UK and US is that anyone can can catch monkeypox. “Well yeah, anyone could get monkeypox, but not anyone is getting monkeypox,” said Nutland.

Lurking in the background of that approach is “the HIV/AIDS pandemic, which led to huge stigmatisation”, said Owen. In other words, part of what’s underpinning this may be a well-intentioned desire to avoid creating a sense of shame. “But if we’re not clear about where the risk is, it’s completely self-defeating, because that’s who we have to prioritise talking to and protecting.”

That focus has started to change – and Nutland acknowledged that “it’s always hard in the early stages [of an outbreak] to understand where transmission is happening and what might happen next”.

But the data has been clear for a while now. Nutland was keen to praise “some exceptional people” at the UK Health Security Agency, but he also said: “I really wish more attention had been paid to gay and bisexual men.” He points to a poster campaign, “Spot it, stop it”, saying: “The vast majority of that campaign has not targeted who it should have.”

This PDF shows a bafflingly generic example. A middle-aged straight couple in West Wittering might see it and conclude they’d better have separate beds for a while. A better approach, Nutland said, is the one being adopted by PrEPster and the Love Tank, which have distributed 5,000 information packs through saunas, sex shops and other venues whose clients are most likely to be at risk.


Abstinence-based messaging (still) doesn’t work

“I work alongside some people who want us just to call for gay and bisexual men to stop having sex for a month to get on top of this,” says Nutland. “But we know from Covid, from teenage pregnancy, from so much research on HIV, that when you tell people just not to do something, and particularly not to have sex, it doesn’t work.”

And, after all, somebody likely to be receptive to an abstinence message is already likely to abstain once they’ve been told about the symptoms of monkeypox and how it’s transmitted. “For the others, it stops them seeking help if they’re unwell, and they’re more likely to end up hospitalised.”

Owen also sees a kind of self-censorship at play among some gay and bisexual commentators (a frustration that led him to start tweeting about it about it last week). “People worry about washing the dirty linen in public – it’s almost like, ‘Don’t say it in front of the straights!’ So the discussions are huge for some people on WhatsApp and Instagram, but who is actually getting the right information becomes random. Younger gay and bisexual men, for example, might not have those networks.”


Until vaccines are more easily available, there’s only so much communications can do

It took Owen 20 phone calls to finally get an appointment for a vaccine. “You go right around the block,” he said. “Sexual health clinics are being overwhelmed, which also means their other services are massively under stress. I rang one place 10 times. They were inundated.”

Meanwhile, “supervax” events like the one at Guy’s over the weekend are vital – but, Nutland points out, other strategies are needed to reach those who may not be comfortable being visible in the queue, who are more likely to be from minority groups.

The UK has ordered 100,000 additional doses of vaccine, and the NHS is stepping up vaccination in London (and now advising eligible people to wait to be contacted). It is a good start, says Nutland, but not enough. “Our best estimate if we’re going to double dose is we need at least another 150,000 doses” – and with only one manufacturer globally, that may take some time.

Even so, he says: “It isn’t vaccine supply that is the key broken link – it’s our public health system, and our sexual health system in particular. Local authority budgets have been slashed over the last 12 years. And when councils have to make a decision between sexual health services or some other public health service, sexual health is still the poor relation.”

What else we’ve been reading

  • Six months since the war in Ukraine began, Peter Beaumont’s dispatch from the eastern Donbas region is a portrait of adaptation to the unbearable. “I sleep in my clothes so I can get out quickly if there is an airstrike,” says Tamara, 85, a former nurse. “I hate it! I hate it! I just want this war to end.” Archie

  • Leah McLaren looks back at her unconventional relationship with her mother, unpacking the ways the ‘benign neglect’ she experienced as a teenager has affected her own parenting skills now. Nimo

  • After a week in which the immediacy of the climate crisis was underlined in the UK, John Harris sees disruptive protest as the only way forward. “The people now lying in roads and charging into airports and refineries have conveyed the urgency of climate breakdown more successfully than anyone in a suit,” he writes. Archie

  • Once chic and cool, Airbnb and the individually planned holiday have been falling out of favour with various demographics. Amelia Tait explores the resurgence of the all-inclusive holiday, arguing that we should all embrace it. Nimo

  • In Saturday magazine, Brian Cox (the actor) and Brian Cox (the scientist) met (over Zoom) for the first time. Which is fun for obvious reasons, but also led to a fascinating conversation ranging from Shakespeare to black holes. Archie

Sport

Cycling | Jonas Vingegaard of Denmark celebrated his first Tour de France title after Belgium’s Jasper Philipsen brought the curtain down on the 109th edition with a sprint victory in Paris.

Formula One | Max Verstappen won the French Grand Prix, extending his lead over Charles Leclerc to 63 points after his title rival crashed out. Mercedes’ Lewis Hamilton and George Russell finished second and third.

Cricket | The third one-day international at Headingley was abandoned because of rain, meaning the three-match series between England and South Africa was drawn 1-1. South Africa reached 159-2 before bad weather prevented further play after just two hours.

The front pages

Guardian front page, 25 July 2022
Guardian front page, 25 July 2022 Photograph: Guardian

The Guardian’s print splash this morning: “‘Greatest staffing crisis’ in NHS history leaves patients at risk”. The Mirror also leads with the scathing cross-party report: “Worst NHS staff crisis ever” while the Metro has “NHS is on its knees”. Chaos at the ports makes top story in the Times: “Channel tourists face long queues all summer”. “Why did my baby die?” – the Sun’s lead is about TV personality Lauren Goodger, who lost newborn Lorena minutes after giving birth. “Tory race to be next PM turns toxic” – that’s the i – and the variously aligned titles are well and truly dug in at the front. The Mail says mockingly “Tough on China Mr Sunak? Pull the other one”. It comes after, as the Telegraph explains, “Sunak takes aim at Truss over China’s influence in universities” – the former chancellor says his rival as education minister was “blind to threat from Beijing”. The Express seeks to bolster its favourite with “Truss: my tax breaks will boost Britain”. The lead story in the Financial Times is “China plans corporate disclosure tiers in bid to avoid US delistings”.

Today in Focus

Mojave Desert, CA July 06: Aletha Johnston, 68, holds one of her baby Guinea pig outside of her home in the Mojave Desert, on the northern edge of Los Angeles county, miles from the nearest store. While unhoused people make up nearly 1.3% of the Lancaster population, they accounted for 48% of all police stops for minor municipal code violations in 2020, according to the ACLU, which analyzed public arrest records and obtained citation documents from the LA sheriff’s department (LASD).
Photograph: Barbara Davidson/The Guardian

Homeless in California: the Americans forced to camp in the desert

In the richest state of the richest country in the world, unhoused people are camping in the Mojave desert. Sam Levin reports

Cartoon of the day | Ben Jennings

Ben Jennings’ cartoon.
Ben Jennings’ cartoon. Illustration: Ben Jennings

The Upside

A bit of good news to remind you that the world’s not all bad

James Baird, the farmer behind the Weald to Waves project.
James Baird, the farmer behind the Weald to Waves project. Photograph: Martin Godwin/The Guardian

After seeing the destruction of forests for palm oil in Borneo, James Baird, a farmer and landowner in Sussex, realised that the relationship between agricultural practices and nature was “broken”. He decided he had to do something to better protect the environment, so he helped set up the Weald to Waves project – an ambitious plan that seeks to restore and conserve biodiversity in the area. The goal of the project is to create at least 10,000 hectares of nature-friendly corridors to boost biodiversity on land and in the sea. “The era when nature has been disregarded and degraded is coming to an end,” Baird says. “Farmers who are unwilling to change are going to find it very difficult to continue as they were.”

Sign up here for a weekly roundup of The Upside, sent to you every Sunday

Bored at work?

And finally, the Guardian’s crosswords to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow.


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