When I met D., a man of color in his 20s, it had been more than two weeks since his mysterious symptoms had started. He had a fever and reported feeling “shards of glass” when he swallowed. Just before he came into the emergency department of the hospital where I work, about 100 miles outside Toronto, a pea-sized lump had appeared on his palm. By the time I met D., a rash had erupted all over his body, and his rectum was searing with pain. We administered antibiotics, and at the insistence of our team of infectious diseases specialists, D. agreed to have a test for the monkeypox virus.
To date, more than 31,000 people have been infected with the monkeypox virus across 88 countries. Last month, the World Health Organization (WHO) declared the outbreak a global health emergency.
The first human known to have contracted the monkeypox virus was a 9-month-old child at Basankusu Hospital, in the Democratic Republic of Congo, in 1970. For decades since, the disease was confined to regions of Central and West Africa, where it circulated among men and women who handled bushmeat, sustained animal bites, or had contact with contaminated objects. Then, in 2018, the virus charted a new course. In the individuals it had infected, the virus acquired mutations that, scientists believe, have changed the severity of the illness and the response to treatment and, perhaps most important, have enabled the virus to pass from one person to another.
Beyond marshaling vaccines and antiviral medications and coordinating an international response to curb the spread of infections, many more physicians — like me, in a hospital where resources for emerging contagions are often not immediately available — are learning how to talk about it. And the way we talk about illness and disease matters. In the case of monkeypox, misconceptions about what the virus is and isn’t, where it comes from, and who it affects lend themselves to stigma, which makes the task of reaching and helping the infected all the more difficult.
The virus we know as monkeypox was discovered in Copenhagen in 1958, in a colony of primates under the study of Danish scientists. It belongs to a group of orthopoxviruses, of which smallpox is one. Despite the name, the reservoir for the virus — where it lives and multiplies — remains unknown. Rodents are a likely source. A 2003 outbreak in the United States was traced to an infected prairie dog.
Nevertheless, what endures is the erroneous association between the virus and primates and the African continent. The WHO is reviewing pleas to rename it but has not reached consensus. Meanwhile, images of dark-skinned people in media reporting of the outbreak promote the falsehood that the virus afflicts mainly people of color.
Kaitlin Sibbald, a PhD candidate at Dalhousie University, in Nova Scotia, studies the effect of metaphors on ethical decision making. Sibbald has written that the language around monkeypox has been especially unhelpful. “Suspected” cases “move undetected” and “pop up on our doorstep” — such language, Sibbald argues, describes the virus in a way that criminalizes it in the subconscious minds of a wary public. Add to this the fact that more than 98 percent of reported infections are among men who have sex with men (MSM) and we have another root of the virus’s stigma: echoes of the HIV epidemic in the 1980s that devastated the gay community.
Spreading primarily through sexual contact, monkeypox manifests mainly as pustules that take several weeks to heal. For the MSM community, tightly interconnected sexual networks are thought to be propagating the virus, as once happened with HIV. And because speaking frankly about sexual behaviors is difficult, certainly for men who have long struggled to live in their bodies without apology, this is where our communication becomes deeply fraught.
A few days after I met D., his test came back positive for the monkeypox virus. It was the result he’d feared and, he told us, the reason he’d delayed seeking treatment sooner and hadn’t been vaccinated for the virus when he’d had the opportunity.
Stigma swirls around this diagnosis. It doesn’t have to. Changing that starts with what we call this virus.
Dr. Arjun V.K. Sharma is a writer and resident physician at Western University, in Ontario. Follow him on Twitter @ArjunVKSharmaMD.