As a fifth monkeypox case is confirmed in New Zealand, health officials are making progress in preparing for the virus to spread locally. 

But men who have sex with men (MSM) have plenty of questions and remain concerned at the rate their community is being disproportionately affected in the current global outbreak.

“I feel like I have to be celibate for the rest of the year or risk taking a month off class,” Wellington-based university student Lane says. 

Like many MSM, monkeypox has been on the 22-year-old’s mind in recent months. 

Lane says they’re concerned about getting infected, being out of class for weeks while isolating, and being left with permanent scarring.

Lane says not knowing what Te Whatu Ora - Health New Zealand’s overall plan looks like is the “most unsettling thing”.

“Who is getting prioritised? What can we do to protect ourselves? We know it’s transmitted by prolonged skin-to-skin contact but what counts as a risky interaction?”

Anyone can be infected with the virus which can be spread through skin-to-skin contact with lesions as well as through droplets, bodily fluids and saliva. Monkeypox is harder to get infected with compared to Covid-19.

As of Monday, there have been five cases in New Zealand, all people returning from overseas. 

However more cases are expected and officials have long warned they expect monkeypox will eventually spread in the community - likely before a vaccination drive begins.

Te Whatu Ora - Health New Zealand and Pharmac are working together to secure a supply of the smallpox vaccine known as Imvanex or Jynneos, which is effective against monkeypox. 

But no supply has been secured and Pharmac, which has responsibility for contractual negotiations with the supplier, hasn’t responded about whether it is confident to secure vaccines by the end of the year. 

Officials have secured 504 courses of antiviral drug tecovirimat, which is due to be available by the end of the month. 

However, it hasn’t been approved by Medsafe yet (there are provisions around this) and Te Whatu Ora - Health New Zealand is still working on how the drug would be distributed.

Knowing this was “gutting” for Lane, who has been “much more scared to have sex” because “nothing screams prolonged physical contact like sex”. 

But fears about sex aren’t necessarily widespread among MSM.

Auckland-based working professionals Matt and John share some of Lane’s concerns but haven’t changed their sexual or social behaviours because there isn’t monkeypox transmission in New Zealand.

John enjoys being in Auckland’s thriving gay party scene and would “probably” continue to going to events if there was a local outbreak, despite knowing raves are linked to some cases overseas.

“I expect that some events could be cancelled but I expect I would be slightly less risk averse than organisers,” the 25-year-old says. 

Matt, 38, feels like he has to go hunting for information about the virus from health officials. 

“I just don’t think there is enough … Information about monkeypox isn’t ‘advertised’ so to speak,” he says.

Pride and prejudice

Hand-in-hand with the disproportionate monkeypox infection rate among MSM in the current outbreak are homophobic stigmas and prejudice. 

Health officials are aware of the challenge around creating MSM-targeted messaging about the virus while simultaneously trying to ensure it’s not fueling hate directed towards MSM. 

While John admits he’s “slightly concerned” about how non-MSM people could misinterpret targeted responses, there are people like Lane who are quite worried about prejudice towards MSM. 

Lane is “visibly queer” and says they carried a fear of violence towards themself even before the current global outbreak. 

If people with homophobic views “get further emboldened”, the idea of “leaving the house could be daunting”, they say. 

Matt says he has been feeling frustrated and annoyed. 

“If it affected heterosexuals more, rather than predominately MSM, would the information [and] vaccines be easier to obtain?”

One of the country’s leading safe sex advocates worries already-prominent stigmas could prevent people testing for the virus. 

Body Positive executive director Mark Fisher says it’s a “disincentive” to test when you have to isolate while waiting for your results and then for another 21 days if you’re positive - on top of “the judgement that you must be gay and promiscuous”. 

"We don’t quarantine people for other conditions spread in a similar fashion such as syphilis, instead educating people so they can minimise ongoing transmission.”

‘Preparation is well underway’

It’s been a month since Te Whatu Ora - Health New Zealand revealed it did not have a communications plan relating to the virus. 

Things have changed since, including bringing the Burnett Foundation - formerly known as the NZ Aids Foundation - back into the fold after the organisation was one of three signee’s of a letter urging the Government to do more. 

But Body Positive’s Mark Fisher is not totally impressed and says the current strategy “has created a lot of fear”. 

He says Te Whatu Ora - Health New Zealand needs more engagement with the MSM community and organisations. 

He also wants to know what’s happening at New Zealand’s borders - where the virus will arrive before community transmission starts. 

What about people wanting to go overseas and be protected? “These are the people that should be prioritised for the vaccine,” Fisher says. 

A Health New Zealand spokesperson did not explicitly answer questions about what the communications plan entailed other than saying resources have gone out to services nationally.

However, the Burnett Foundation has been funded for targeted communications “to reach those communities at high risk” and the spokesperson said information about the virus on Health New Zealand’s website is “comprehensive”. 

The spokesperson said officials “remain vigilant”, that “preparation is well underway” and highlighted that the World Health Organisation reported a 21% decline in global cases about two weeks ago. 

“If required, future activity will include expanded health promotion and education campaigns.”

Burnett Foundation chief executive Joe Rich says he’s “happy with how things are progressing” but the significant wait for vaccines was “obviously a little disappointing”. 

The foundation was “fully aware this is a global supply issue”, he said. 

Being brought into the official response team showed health officials understood and were taking the concerns of MSM seriously, Rich said. 

Note: Matt and Lane did not want their surnames published, and John spoke anonymously, because of the stigmas MSM are facing in the current global Monkeypox outbreak as well as talking about their sexual activities. 

Top Image: An illustration of a man looking worried. Photo: iStock

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