Discrimination against homosexuals in Africa could exacerbate mpox epidemic in Kinshasa, Congo

KINSHASA, Congo (AP) - As Congo faces its worst-ever measles outbreak, scientists are warning that discrimination against gay and bisexual men on the continent could exacerbate the outbreak. in November, the World Health Organization reported that mpox, also known as monkeypox, has been transmitted sexually for the first time in Congo, a departure from the past when it was spread primarily through contact with sick animals. In November, the World Health Organization reported that mpox, also known as monkeypox, had been transmitted sexually for the first time in the DRC, a far cry from the past when the disease was spread primarily through contact with sick animals.

Mpox has long been prevalent in parts of Central and West Africa, but it wasn't until 2022 that sexual transmission of the virus was first documented; in that year, 91,000 infections were reported in about 100 countries around the world, most of them among gay or bisexual men.

Dimie Ogoina, an infectious disease expert at Nigeria's Niger Delta University, said that in Africa, many people may be reluctant to report symptoms of infection because of legal bans on homosexuality, which could drive the epidemic underground. "Many people will not come forward if they think they are infected with MPOX," he said.

The first, more serious case of sexually transmitted MPOX was discovered in Congo last spring by WHO officials after a Belgian man arrived in the capital, Kinshasa, after claiming to have had sex with other men. The U.N. health agency said five other people who had sexual contact with the man later became infected with MPOX.

For years, we have underestimated the possibility of MPOX transmission through sexual intercourse in Africa, Ogoina said. He and colleagues first reported in 2019 that MPOX may be transmitted through sexual intercourse. He noted that surveillance gaps make it a challenge to estimate how many MPOX cases are sexually related.

As of the end of November, there have been about 13,350 suspected cases of MPOX in the DRC, of which 607 have died, and only about 101 TP3T cases have been confirmed by laboratories. However, it is not clear how many of the infections are sexually transmitted. About 70% of the cases were in children under 15 years of age, the WHO said.

During major international outbreaks in 2022, a number of countries, including Canada, the United Kingdom and the United States, have embarked on mass vaccination programs that target the populations most at risk - gay and bisexual men. But experts say this is unlikely to work in Africa for a number of reasons, including stigmatization of the gay community.

"I don't think we're going to see the same strong demand for vaccines in Africa that we saw in the West last year," said Dr. Bogumar Tetangi, assistant professor of infectious disease medicine at Emory University School of Medicine in Atlanta. She believes that gay and bisexual men, who are most at risk for measles, may be afraid to participate in widespread immunization programs.

Dr. Jean-Jacques Muyemba, director of the National Institute of Biomedical Research in the DRC, said the reports of sexually transmitted cluster pox in two provinces of the DRC were worrying. Mouyemba said there was no licensed vaccine in the DRC, making it difficult to get enough vaccine for any large-scale program.

Globally, only one vaccine against MPOX has been approved, produced by Bavarian Nordic in Denmark. Supplies are very limited, and when they are available, they must be approved by the African countries where they are used or by the WHO. To date, the vaccine has only been available in the DRC through research.

Nigerian virus expert Oyewale Tomori says African governments may have too many competing priorities to ask the U.N. health agency or donors to help obtain the vaccine. "In Africa, MPOX is probably considered a low-priority public health hazard," Tomori said.

He said the continent would benefit more from stronger surveillance, a network of laboratories and better diagnostic supplies than from a vaccine. If efforts are not stepped up to stop the outbreak in Africa, Ogoina predicted that mpox will continue to infect new populations and warned that the disease could also cause outbreaks in other countries, similar to the global state of emergency declared by the World Health Organization last year.

"When the HIV pandemic started, it was prevalent among gay and bisexual men in the northern hemisphere, and Africa didn't think it was our problem," he said. "Before we knew it, it had come to Africa, but we still thought the heterosexual population would be protected." Currently, women of childbearing age account for more than 60% of new HIV infections in Africa.

"I'm worried that the same thing is going to happen now with mpox," he said. "Unless we address these outbreaks in Africa, this virus is going to keep coming back."

Cheng reported from Toronto.

The Associated Press Health & Science Division is supported by the Science & Education Media Group of the Howard Hughes Medical Institute. The Associated Press is solely responsible for all content.