Author Response
We wholeheartedly agree with Drs. Mungmunpuntipantip and Wiwanitkit that MPX occurs among people who do not identify as MSM and PLWH. We did not intend to minimize the risk experienced by other groups. However, we cannot ignore that the 2022 MPX virus outbreak has disproportionately affected MSM and PLWH. In the United States and elsewhere, PLWH and MSM experience high levels of stigma that negatively affects their physical, mental, and emotional wellness. It is this history of stigma and discrimination that prompted our concern and response.
In our discussion, we specifically mention the rash associated with MPX because it is an outward sign of illness that may invoke fear, stereotypes, and stigma. Unlike other clinical symptoms like fever, chills, and other atypical signs, rashes can be visual indicators of MPX, leading to status disclosure.
As the authors adeptly point out, MPX circulating in endemic regions is not associated with stigma in the literature. In West African regions, MPX is not closely tied to one specific minority group. Unlike Clade I and Clade IIa, this particular outbreak is associated with the historical marginalization and dismissal of PLWH and MSM, which may intensify and prolong the stigma of infectiousness. We would also note that the HIV epidemic and other long-standing infectious diseases, such as Hansen's disease, carry enormous amounts of stigma despite widespread public education campaigns.
Minority status and stigma may play a role in subsequent public health responses, vaccine, and treatment access, as well as prevention and treatment uptake. In the United States, we already see inadequate access to vaccines, testing, and treatment for MSM and people of color. Whether disparities in access are significantly mediated by interpersonal stigma, structural inequities, or other social factors has not been established. We can only apply lessons learned from other areas of research and infer that stigma will have negative consequences for those who perceive, internalize, and experience it.
Author Contributions
A. Bergman conceptualized and drafted the response. K. McGee, K. McNabb, J. Farley, J. Kwong, and J. Voss edited and approved the final response.