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KINSHASA, Congo (AP) — Scientists warn that discrimination against gay and bisexual men in Africa could exacerbate the ongoing mpox outbreak in the region. The World Health Organization (WHO) reported in November that mpox, also known as monkeypox, is being transmitted through sexual activity in Congo for the first time. This marks a significant shift from previous cases where the virus primarily affected individuals in contact with infected animals. Although mpox has been present in parts of central and west Africa for decades, it wasn't until 2022 that sexual transmission was documented. In that year, the majority of the approximately 91,000 infected individuals in over 100 countries were gay or bisexual men. Dr

Dimie Ogoina, an infectious diseases specialist at Niger Delta University in Nigeria, points out that the reluctance to report symptoms in Africa may drive the outbreak underground. He suggests that the criminalization of homosexuality in many parts of the continent discourages infected individuals from seeking help. The first sexually transmitted cases of a more severe strain of mpox in Congo were identified by the WHO shortly after a Belgian resident, identifying as a man who has sex with men, arrived in Kinshasa. These cases prompted further investigation into sexual transmission. Dr. Ogoina and his colleagues initially reported in 2019 that mpox might be transmitted through sexual activity

However, significant gaps in monitoring make it challenging to estimate the number of mpox cases linked to sex. In Nigeria, the majority of mpox cases involve individuals with no known contact with animals. Congo has identified around 13,350 suspected cases of mpox, including 607 deaths as of the end of November. WHO reports that only about 10% of cases have been confirmed by laboratories. It remains unclear how many infections were spread through sexual contact

The majority of cases in Congo (about 70%) affect children under the age of 15. During a recent assessment of the outbreak in Congo, WHO officials found a lack of awareness among health workers about the possibility of sexual transmission of mpox, resulting in missed cases. The WHO has confirmed sexual transmission "between male partners and simultaneously through heterosexual transmission" in various parts of the country. Common symptoms of mpox include fever, skin rash, lesions, and muscle soreness, which can last up to a month. The virus is primarily spread through close contact, and most people recover without requiring medical treatment. Mass vaccination programs were implemented in some countries, such as Canada, Britain, and the U.S., during the major outbreak in 2022. These programs targeted individuals at the highest risk, including gay and bisexual men

However, experts believe that similar efforts in Africa may not be as successful due to the stigma surrounding gay communities. Dr. Boghuma Titanji, an assistant professor of medicine in infectious diseases at Emory University School of Medicine, suggests that gay and bisexual men at risk of mpox may be hesitant to participate in broad immunization programs. She calls for countries to find ways to administer the shots without stigmatizing these communities. In Congo, two provinces have reported clusters of mpox spread through sexual activity, which is a concerning development. However, there is currently no licensed vaccine in the country, and obtaining enough shots for a large-scale program is challenging

Congo is attempting to secure a Japanese mpox vaccine, but regulatory issues complicate the situation. Globally, only one vaccine against mpox has been authorized, produced by Denmark's Bavarian Nordic. However, supplies are limited, and approval from African countries or the WHO would be necessary for their use. Currently, the vaccine is only available in Congo for research purposes. African governments likely have competing priorities and may not request assistance from the WHO or donors in procuring vaccines. Nigerian virus expert Oyewale Tomori suggests that focusing on stronger monitoring, laboratory networks, and improved diagnostic supplies would be more beneficial to the continent than vaccines. Without greater efforts to control the outbreak in Africa, Dr

Ogoina predicts that mpox will continue to spread to new populations and potentially trigger outbreaks in other countries, similar to the global emergency declared by the WHO last year. He highlights the importance of addressing the outbreaks in Africa to prevent the virus from recurring. Note: The article mentions that the AP Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group, but it is responsible for all content.