In March 1983, Larry Kramer published a piece in the New York Native called “1,112 and Counting”—a call to arms about a new virus circulating among gay men in the United States. One thousand one hundred and twelve was the number of cases at the time of this new disease, Acquired Immunodeficiency Syndrome (AIDS). Larry’s piece is a classic of what would be his over-the-top style throughout the AIDS epidemic, right up until a few months before his death in the midst of another plague, Covid-19. He takes aim with unsparing ire at everyone and anyone who might be implicated in the spread of this new disease, from the Centers for Disease Control to New York’s City Hall to the National Institutes of Health, Congress, and the White House—and then gay men themselves for sitting on their hands, ignoring the burgeoning crisis, underplaying the risk of what was unfolding in real time.
Larry was a friend, mentor, and tormentor (who once said he’d like to flush my head down a toilet), and I disagreed with him again and again over the many years I knew him. But I cannot help reflecting back on Larry’s early cries in the wilderness on AIDS as we see a new outbreak of infectious disease show up among gay men. This time we are dealing not with a novel virus but of one ignored because it has existed, flared up, and burned itself out again and again in several countries in Central and West Africa over decades.
The current monkeypox outbreak includes 550 confirmed cases in 30 countries, and is occurring outside of those regions where the virus in endemic. The vast majority of these initial cases are among gay men, tied to a large social gathering in the Canary Islands, a sauna in Spain, and a festival in Antwerp. Thus far, there are 18 cases among gay men in nine US states. Yes, to state the obvious: Monkeypox is not a gay disease—it is simply spread by close physical contact and anyone can get it, but it has arrived in the LGBT community nonetheless.
Unlike 50 years ago, CDC and other health organizations around the globe are already on the alert and responding to this new outbreak. While there are, of course, things to criticize about the national response by federal agencies, the first step in containing this outbreak is to seek out as many cases as possible as fast as possible to get those infected into care (this time there are treatments!) and those potentially exposed vaccinated (there are vaccines, too!), while ensuring that the larger community at risk knows what is happening.
Here, I have to take a page from the Kramer playbook and turn to our nation’s LGBTQ and HIV/AIDS organizations and ask: What are you waiting for? Our LGBTQ and AIDS organizations have been built for this moment: They have 50 years of history in dealing with HIV and other infectious disease outbreaks among gay men—from syphilis and gonorrhea to drug-resistant staph infections to meningitis (with an outbreak of meningococcal disease happening right now among gay men in Florida). They have decades of experience in education and outreach with gay men, have shaped policy responses to protect our rights in the context of a pandemic, and fought and won many victories for us. Yet now they are strangely silent.
June is LGBTQ Pride month across the US and these celebrations are attended by hundreds of thousands of people. With the summer here, there will be parties galore, large and small, in public venues, private residences. After more than two years of Covid-19, which is not done with us yet—we are in the midst of a surge right now—many are looking to make up for lost time, looking forward to seeing friends, socializing, and, yes, having sex. But monkeypox is transmitted through close physical contact, and this summer brings a perfect opportunity for it to spread in these settings.
Unlike Larry Kramer, who was often censorious and puritanical about gay men’s sex lives, I am not suggesting everyone stay at home and remain celibate for the summer of 2022. What I am suggesting is that all of our LGBTQ and HIV/AIDS organizations mount an educational and informational campaign right now—not later this summer—to inform our community about the disease: how it is transmitted, its symptoms, how to seek testing and care should they suspect they’ve been exposed to the virus, and how to minimize risk of exposure to themselves and others, for instance, by forgoing social events if they have a fever or have a rash (which should signal them to seek care).
And yes, minimizing close physical contact is one key way to reduce risk, and we know from the AIDS epidemic that the gay community can effectively respond to infectious disease threats when they know the stakes. In fact, HIV incidence rates in major US cities dropped well before HIV prevention programs ramped up in the mid-1980s. We were already organizing, sharing information, and educating one another before the professionals got involved. We can do it again now.
Shutting down Gay Pride events and the summer’s social activities isn’t likely to be effective and will only drive people underground just as we need to build trust and confidence so people will come forward with symptoms or potential exposure. But those who run these events—and others who make millions off the LGBTQ community—need to step up as well. The advertising muscle of these big corporations can be used to get the word out about monkeypox—if you can sponsor a float in NYC’s Gay Pride parade, you can afford to give back to the community in its moment of need. Local businesses can also help by sharing information with their customers. We have to be all in to stop this outbreak.
This isn’t 1983. Monkeypox is not AIDS. It is treatable, and we have vaccines to prevent it; crucially, unlike HIV infection in the 1980s, infection does not lead to death in most cases. But it is a serious crisis for the LGBTQ community in the US and worldwide. And as we mobilize against the virus, we also have to realize that, as with HIV, monkeypox affects many people outside of our own circles. As we urge our national leaders to step up their response, that response has to be equitable and global. If monkeypox secures a foothold in the US, those with the least access to resources will suffer most—as is the case with almost any infection or condition that afflicts us. Globally, we need to invest in the response to the disease in West and Central Africa, where it is endemic. Five hundred fifty and counting—just in the United States, Europe, South America, and Australia. But there are many, many more cases in endemic countries where treatments and vaccines are unavailable. This time, we have a chance to get things right and do right for ourselves and others. I hope we rise to the challenge. There is no time to lose.