Congo is currently grappling with its most significant outbreak of monkeypox (mpox), and experts are warning that discrimination against gay and bisexual men in Africa may exacerbate the situation.
In November, the World Health Organization (WHO) reported a noteworthy shift in the transmission pattern of mpox in Congo, as it was identified to be spreading through sexual contact for the first time. This is a departure from previous outbreaks, where the virus primarily affected individuals in contact with infected animals, writes the AP.
Mpox has been present in parts of central and west Africa for decades, but it was only in 2022 that sexual transmission was documented, with the majority of the approximately 91,000 infected individuals worldwide that year being gay or bisexual men.
According to Dimie Ogoina, an infectious diseases specialist at the Niger Delta University in Nigeria, the reluctance to report symptoms in Africa could drive the outbreak underground due to the legal prohibition of homosexuality in many parts of the continent.
The first sexually transmitted cases were identified by WHO in Congo after a Belgian resident, who identified as a man engaging in sexual relations with other men, arrived in Kinshasa, the Congolese capital.
Ogoina and his colleagues had already reported in 2019 that mpox might be spreading through sexual contact, suggesting that the potential for sexual transmission had been underestimated for years.
The lack of comprehensive monitoring makes it challenging to estimate the number of mpox cases linked to sexual transmission, but Ogoina noted that most cases in Nigeria involve individuals with no known contact with animals.
As of the end of November, Congo has reported about 13,350 suspected cases of mpox, with 607 deaths, but only around 10% of cases have been confirmed by laboratories.
During a recent assessment trip to Congo, WHO officials discovered a lack of awareness among health workers regarding the potential sexual transmission of mpox, leading to missed cases.
Health authorities in Congo have confirmed sexual transmission of mpox “between male partners and simultaneously through heterosexual transmission” in various parts of the country.
Symptoms of mpox typically include fever, skin rash, lesions, and muscle soreness, lasting up to one month. The virus is primarily spread through close contact, and most individuals recover without the need for medical treatment.
During the major international outbreak in 2022, mass vaccination programs were implemented in some countries, including Canada, Britain, and the U.S., targeting those at the highest risk, such as gay and bisexual men. However, experts express skepticism about the feasibility of such programs in Africa due to stigma against gay communities.
Dr. Boghuma Titanji, an assistant professor of medicine in infectious diseases at Emory University School of Medicine in Atlanta, highlights the potential reluctance of at-risk individuals to participate in broad immunization programs and suggests finding ways to administer shots without stigmatizing them.
Dr. Jean-Jacques Muyemba, the general director of Congo’s National Institute of Biomedical Research, expressed concern over the emergence of clusters of mpox spread through sex in two provinces of Congo. The absence of a licensed vaccine in Congo and regulatory issues hindering the acquisition of a Japanese mpox vaccine pose additional challenges.
Globally, only one vaccine against mpox, manufactured by Denmark’s Bavarian Nordic, has been authorized. However, supplies are limited, and approval by African countries or the WHO is required for distribution. Currently, the vaccine has only been available in Congo through research.
Oyewale Tomori, a Nigerian virus expert affiliated with WHO advisory boards, suggests that African governments may prioritize other issues over seeking help for vaccines.
Tomori emphasizes the importance of strengthening monitoring, laboratory networks, and diagnostic supplies as more helpful measures for the continent than vaccines.
Without increased efforts to control the outbreaks in Africa, Ogoina warns that mpox could continue to infect new populations, potentially leading to outbreaks in other countries, similar to the global emergency declared by WHO last year.
Drawing parallels with the HIV pandemic, Ogoina expresses concern that unless these outbreaks in Africa are addressed, mpox may follow a similar trajectory to HIV, which initially affected gay and bisexual men in the global north before spreading widely in Africa.
