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Stigma against gay men could worsen Congo’s largest mpox epidemic, scientists warn

KINSHASA, Congo (AP) — As Congo faces its largest mpox epidemic, scientists warn that discrimination against gay and bisexual men on the continent could make the situation worse.

In November, the World Health Organization reported that mpox, also known as monkeypox, was spreading sexually in Congo for the first time. This is a significant change from previous surges, where the virus mainly sick people in contact with sick animals.

Mpox has been present in parts of central and west Africa for decades, but it was not until 2022 that it was documented. spread via sex; Most of the 91,000 people infected in around 100 countries that year were gay or bisexual men.

In Africa, failure to report symptoms could drive the outbreak underground, said Dimie Ogoina, an infectious disease specialist at Nigeria’s Niger Delta University.

FILE - A family nurse practitioner prepares a syringe with the Mpox vaccine to inoculate a patient at a vaccination site in the Brooklyn borough of New York, Tuesday, Aug. 30, 2022. Gay and bisexual men at high risk of mpox infection should receive vaccinations against the virus even after the current outbreak subsides, government health advisers said Wednesday, Oct. 25, 2023. (AP Photo/Jeenah Moon, File)

“It could be that because homosexuality is against the law in most parts of Africa, many people do not come forward if they think they have been infected with mpox,” Ogoina said.

WHO officials said they identified the first sexually transmitted cases of the most serious type of mpox in Congo last spring, shortly after the arrival in the Congolese capital of Kinshasa of a Belgian resident who ” identified as a man having sex with other men.” . THE United Nations health agency said five other people who had sexual contact with the man were later infected with mpox.

“We have underestimated the potential for sexual transmission of mpox in Africa for years,” said Ogoina, who with colleagues first reported in 2019 that mpox could be spread sexually.

Gaps in surveillance make it difficult to estimate the number of sex-linked mpox cases, he said. Yet most mpox cases in Nigeria involve people with no known contact with animals, he noted.

In Congo, there have been approximately 13,350 suspected cases of mpox, including 607 deaths through the end of November, with only about 10% of cases confirmed by laboratories. But the number of infections transmitted through sex is unclear. The WHO said about 70% of cases were in children under 15 years old.

During a recent trip to Congo to assess the outbreak, WHO officials found that health workers “were not aware” that mpox could be spread sexually, leading to missed cases.

The WHO said health authorities had confirmed sexual transmission of mpox “between male partners and simultaneously through heterosexual transmission” in different parts of the country.

Mpox usually causes symptoms including fever, rash, muscle sores and pain for up to a month. It is spread through close contact and most people recover without needing medical treatment.

During the major international epidemic of 2022, mass vaccination programs were undertaken in some countries, including Canada, Great Britain and the United States, and targeted those most at risk: gay men and bisexual. But experts say this is unlikely to work in Africa for several reasons, including stigma against gay communities.

“I don’t think we’ll see the same demand for vaccines in Africa as we did in the West last year,” said Dr. Boghuma Titanji, assistant professor of infectious disease medicine at Emory University School of Medicine. from Atlanta.

She said gay and bisexual men most at risk of mpox may be afraid to come forward for a large vaccination programme. Countries should work on ways to administer vaccines – if available – in a way that does not stigmatize them, she said.

Dr Jean-Jacques Muyemba, director general of the National Institute of Biomedical Research of Congo, said two provinces in Congo had reported outbreaks of sexually transmitted mpox, a worrying development.

There is no approved vaccine in Congo and it would be difficult to obtain enough vaccines for a large-scale program, Muyemba said. The country is trying to procure a Japanese mpox vaccine, but regulatory issues are complicating the situation, he said.

Globally, only one vaccine has been authorized against mpox, manufactured by the Danish company Bavarian Nordic. Supplies are very limited and even if they were available, they would have to be approved by the African countries using them or by the WHO. To date, the vaccine is only available in Congo thanks to research.

Oyewale Tomori, a Nigerian virus expert who serves on several WHO advisory boards, said African governments probably have too many competing priorities to ask the U.N. health agency or donors for help to get vaccines.

“In Africa, mpox is most likely considered a low-priority nuisance,” Tomori said.

He said stronger surveillance, laboratory networks and better availability of diagnostic supplies would help the continent more than vaccines.

Without more efforts to stop outbreaks in Africa, Ogoina predicted that mpox would continue to infect new populations, warning that the disease could also trigger outbreaks in other countries, like the global emergency declared by the WHO last year.

“When the HIV pandemic started, it affected gay and bisexual men in the North, and Africa thought it was not our problem,” he said. “Before we knew it, it happened in Africa, but we still thought heterosexual populations would be protected. »

Women of childbearing age now account for more than 60% of new HIV infections in Africa.

“I fear the same thing will now happen with mpox,” he said. “If we don’t treat these outbreaks in Africa, this virus will continue to reappear. »

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Cheng reported from Toronto.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Education Media Group. The AP is solely responsible for all content.

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