Stigma,Discrimination,and Psychological Distress among the LGBTQ Community in Times of Monkeypox Outbreak—A Wake-up Call

To the editor,

Monkeypox is a zoonotic disease caused by the monkeypox virus, belonging to the genus Orthopoxvirus of the Poxviridae family. The first case of monkeypox in humans was identified in the Democratic Republic of Congo in 1970. Over the last half-century, thousands of cases of monkeypox have been reported. However, most of these cases were from African countries. ¹ In the last few months, there has been a spike in monkeypox cases across the globe. The World Health Organization (WHO) reported that 86% of the lab-confirmed cases in the current outbreak are from the European region. ² In India, the first lab-confirmed case was reported in Kerala on July 14, 2022. Since then, 19 cases of monkeypox have been reported in India. ³ On July 23, 2022, WHO declared the current monkeypox outbreak a “Public Health Emergency of International Concern,” which alarmed professionals, administrators, and researchers, globally. ⁴

Monkeypox is a communicable disease. The onset of symptoms occurs 5–21 days after a person gets exposed. Human-to-human transmission of monkeypox occurs by contact with infected lesions, bodily fluids, contaminated personal belongings, or respiratory droplets. Most cases have been identified in Men having Sex with Men, especially those with a history of recent sex with new or multiple sexual partners. ² For example, in the United Kingdom, it was found that 83% of cases (who were linked to neither a travel-related case nor household clusters) were either gay, bisexual, or other men who have sex with men. ⁵ The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) community is one of society’s most vulnerable groups. Such individuals are frequently denied access to healthcare facilities because of prevalent social stigma and discrimination. Additionally, in India, the perceived stigma also prevents LGBTQ people from being tested or seeking medical attention. ⁶ Furthermore, as most patients are experiencing only mild symptoms in the current outbreak, they are less likely to disclose symptoms or seek care. Inadequate health-seeking behavior might lead to serious adverse health consequences, apart from increased risk of community transmission.

Viral infections cause fear, loss, stigma, and discrimination among those diagnosed with the illness. ⁷ The LGBTQ community, in particular, faces various forms of stigma and discrimination due to viral diseases. Discrimination and rejection by other people of the LGBTQ community, ageism, racial stigma, self-stigma, and discrimination related to health status were reported by gay men living with Human Immunodeficiency Virus (HIV). ⁸ Furthermore, stigma and discrimination are associated with stress and psychological distress in people belonging to the LGBTQ community. ⁹

After witnessing the disruption caused by the COVID-19 pandemic, people are apprehensive regarding this new viral outbreak. ¹⁰ Hence, it is necessary to provide accurate information regarding the illness. Monkeypox is neither as contagious nor as fatal as the COVID-19. However, it still warrants strict measures and precautions, and governments, media, and professional bodies must ensure that misinformation, rumors, and unnecessary panic are not spread among people. At the same time, addressing stigma and discrimination against the LGBTQ community is necessary. These issues are more pertinent in developing countries like India, where there is a high stigma and discrimination against the LGBTQ community, ¹¹ apart from a wide mental health treatment gap ¹² and poor health literacy. Some experts speculate that the infection is being transmitted in India but is being underreported due to the associated stigma. ⁶ A five-level framework has been proposed by Chang et al to mitigate stigma. ¹³ This framework must be adopted at the individual, organizational, community, and public policy levels. As there is very limited original research on stigma and discrimination against the LGBTQ community, in the context of monkeypox outbreak, well-designed studies should be conducted to assess the psychological impact of the current monkeypox outbreak on the LGBTQ community.