Threading the Needle on Monkeypox Communication

This is going to be HIV in the 1980s all over again, isn’t it?

René F. Najera, MPH, DrPH

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If there is “a tradition like no other” in public health, it must be the fumbling of communications on an emergency situation. If there is “a tradition like no other” in American public discourse, it must be the tradition of blaming ‘the other’ for the problems of the nation. When HIV arrived in the United States in the late 1970s and 1980s, the entire country blamed gay men for the epidemic. Why? Because of fumbled communications.

The Story of HIV, Abridged

In June 1981, the Centers for Disease Control and Prevention (CDC) published a report of a rare fungal infection in five patients. The report describes the five patients as “5 young men, all active homosexuals,” in the first sentence. Why was it necessary to point out that they were homosexuals? I’ll get to that in a minute.

A group of people dressed in colorful outfits hold a banner for the “Association of Nurses in AIDS Care: Chesapeake Chapter”

That report was the first hint that something was affecting people to the point where they decimated their immune system when they were otherwise healthy. Soon thereafter, more reports started pouring into CDC, some of which were retrospectively done on people from the 1970s. (It is believed that HIV probably crossed over from a reservoir animal to humans earlier in the 1900s.)

Throughout the 1980s, what became known as Acquired Immune Deficiency Syndrome (AIDS) — which was due to HIV infection — was reported primarily in men who have sex with men (MSM), with outbreaks among the gay community in pockets of the United States. That was not the whole story, however. We now know that plenty of heterosexual people were infected as well. The large counts among MSM and other “non-straight” people were primarily due to surveillance bias. That is, CDC and other public health agencies declared the epidemic primarily in homosexual men, so healthcare providers tested primarily homosexual men.

If you did not identify as homosexual and went to the doctor with symptoms similar to an HIV infection or developing AIDS situation, you probably were not tested. No test means no reporting, and no reporting means no counting. That all tilted the numbers, and HIV/AIDS became a “gay epidemic.” (For a while, AIDS was called “GRID” for Gay-Related…

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René F. Najera, MPH, DrPH

DrPH in Epidemiology. Associate/JHBSPH. Adjunct/GMU. Epidemiologist. Father. Husband. (He/Him/His/El)