550… 和計數中

但隨著超過 1,000 人死亡——且計數還不斷增加中——它已經來到了我們的社區，幾十年來處理HIV的經驗給了我們機會和專業知識，讓我們這次能把事情做好。

資料來源：格雷格·貢薩爾維斯 / 2022 年 6 月 2 日 / The Nation / 財團法人台灣紅絲帶基金會編譯

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1983 年 3 月，拉里·克萊默 (Larry Kramer) 在《紐約在地人》(New York Native) 上發表了一篇名為“1,112 and Counting”的文章——呼籲人們對一種在美國男同性戀中流行的新病毒進行武裝。 

1,112 是這種新疾病——後天免疫缺乏症候群 (AIDS) 發生時的病例數。拉里的作品是他在整個愛滋病流行期間誇張風格的經典之作，直到他在另一場瘟疫 Covid-19 當中去世之前幾個月。他都毫不留情地瞄準了每一個人和任何可能與這種新疾病傳播有關的人，從疾病控制中心到紐約市政廳，再到美國國家衛生研究院、國會和白宮——然後是男同性戀自己束手坐視迅速發展的危機，低估了當時正發生之事情的風險。

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拉里是一個朋友、導師和折磨者（他曾經說過他想把我的頭衝進馬桶），在我認識他的這麼多年裡，我一次又一次地不同意他的觀點。但當我們看到新的傳染病之爆發在男同性戀者中出現時，我不禁回想起拉里早期在荒野中對愛滋病的呼喊。這一次，我們處理的不是一種新型病毒，而是一種被忽視的病毒，因為幾十年來它在中非和西非的幾個國家已經存在、爆發和一次又一次地燃燒起來。

當前的猴痘疫情包括 30 個國家的 550 例確診病例，並且發生在病毒流行地區之外。這些最初的病例中絕大多數是男同性戀者，與西班牙加那利群島的一個大型社交聚會的桑拿浴室和比利時安特衛普的一個節慶有關。到目前為止，美國九個州的男同性戀者中有 18 例。是的，很明顯：猴痘不是一種同性戀疾病——它只是透過密切的身體接觸傳播，任何人都可以得到它，但它仍然傳播到了 LGBT 社區。

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與 50 年前不同，疾病預防控制中心和全球其他衛生組織已經處於警戒狀態並應對這種新的疫情。當然，對於聯邦機構的國家應對措施，仍有一些值得批評的地方，但遏制這次疫情的第一步是盡快地尋找出盡可能多的病例，讓感染者得到治療（這次有治療方法！）和那些可能的接觸者去接種疫苗（這次也有疫苗！），同時並確保更大具風險的社區知道正在發生的事情。

在這裡，我必須從克萊默的劇本中翻閱一頁，然後轉向我們國家的 LGBTQ 和 HIV/AIDS 組織並問道：你們還在等什麼？我們的 LGBTQ 和 AIDS 組織就是為這一刻而建立的：他們在處理男同性戀者中的 HIV 和其他傳染病爆發方面擁有 50 年的歷史——從梅毒和淋病到抗藥性葡萄球菌感染以及到腦膜炎（腦膜炎球菌疾病暴發，註1）現在發生在佛羅里達州的男同性戀者中）。他們在男同性戀教育和外展方面擁有數十年的經驗，制定了在大流行背景下保護我們權利的政策反應，並為我們爭取並贏得了許多勝利，然而現在他們卻出奇地沉默了。

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六月是橫跨全美的 LGBTQ 驕傲月，成千上萬的人會參加這些慶祝活動。隨著夏天的到來，在公共場所、私人住宅中都會舉辦大大小小的狂歡派對。經過兩年多的 Covid-19，我們並還沒有結束——我們現在正處於激增之中——許多人正在尋找彌補失去的時間，期待見到朋友，進行社交，是的，做愛。但猴痘是透過密切的身體接觸傳播的，今年夏天正為它在這些環境中之傳播提供了絕佳的機會。

與拉里·克萊默 (Larry Kramer) 不同，他經常對男同性戀的性生活持清教徒式和批評的態度，我並不是建議每個人都呆在家裡，並在 2022 年夏天保持獨身。我的建議是，我們所有的 LGBTQ 和 HIV/AIDS 組織都必須立即採取行動（而不是今年夏天晚些時候），開展教育和信息宣傳活動，向我們的社區通報這種疾病：它是如何傳播的、它的症狀、如果他們懷疑自己已經接觸過病毒，如何尋求檢測和照護，以及如何最大限度地減少自己和他人暴露於風險中，例如，如果他們發燒或出現皮疹（這應即是警示他們該尋求治療），就放棄社交活動。

是的，盡量減少密切的身體接觸是降低風險的關鍵方法之一，我們從愛滋病流行中知道，同性戀社區在知道利害關係時可以有效地應對傳染病威脅。事實上，美國主要城市的愛滋病毒發生率早在 1980 年代中期愛滋病毒預防計畫逐漸興起之前就下降了。在專業人士參與之前，我們已經在組織、共享信息和相互教育。我們現在可以再做一次。

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關閉 Gay Pride 活動和夏季的社交活動不太可能有效，只會將人們推向地下，就像我們需要建立信任和信心一樣，如此這樣人們才會在有症狀或潛在的暴露時站出來。但那些舉辦這些活動的人——以及其他從 LGBTQ 社區賺取數百萬美元的人——也需要站出來。這些大公司的廣告力量可以用來宣傳猴痘——如果你能贊助紐約市同性戀驕傲遊行的花車，你就有能力在社區需要的時候回饋社區。本地企業也可以透過與客戶共享信息來提供幫助。我們必須全力以赴阻止這場疫情。

Gregg Gonsalves推特，Gregg Gonsalves 是The Nation 之公共衛生記者及全球衛生正義夥伴關係的聯合主任，也是耶魯大學公共衛生學院流行病學副教授。

註1：美國疾病控制和預防中心(CDC) 於二個月前，已就佛羅里達州爆發由奈瑟氏雙球菌所引起的流行性腦脊髓膜炎發布了健康警告，該機構表示，該病主要影響男同性戀和雙性戀男性，包括愛滋病毒感染者。CDC 敦促同性戀、雙性戀和其他男男性行為者如果他們住在佛羅里達州，則建議接種MenACWY 疫苗；它還建議那些計畫訪問佛羅里達州的人與他們的醫療保健提供者討論接種疫苗的問題。

550… and Counting

But with well over 1000 deaths—and counting—it has arrived in our community, where decades of experience dealing with HIV give us the chance, and the expertise, to get things right this time.

By Gregg GonsalvesTwitter / JUNE 2, 2022

In March 1983, Larry Kramer published a piece in the New York Native called “1,112 and Counting”—a call to arms about a new virus circulating among gay men in the United States. 

One thousand one hundred and twelve was the number of cases at the time of this new disease, Acquired Immunodeficiency Syndrome (AIDS). Larry’s piece is a classic of what would be his over-the-top style throughout the AIDS epidemic, right up until a few months before his death in the midst of another plague, Covid-19. He takes aim with unsparing ire at everyone and anyone who might be implicated in the spread of this new disease, from the Centers for Disease Control to New York’s City Hall to the National Institutes of Health, Congress, and the White House—and then gay men themselves for sitting on their hands, ignoring the burgeoning crisis, underplaying the risk of what was unfolding in real time.

Larry was a friend, mentor, and tormentor (who once said he’d like to flush my head down a toilet), and I disagreed with him again and again over the many years I knew him. But I cannot help reflecting back on Larry’s early cries in the wilderness on AIDS as we see a new outbreak of infectious disease show up among gay men. This time we are dealing not with a novel virus but of one ignored because it has existed, flared up, and burned itself out again and again in several countries in Central and West Africa over decades.

The current monkeypox outbreak includes 550 confirmed cases in 30 countries, and is occurring outside of those regions where the virus in endemic. The vast majority of these initial cases are among gay men, tied to a large social gathering in the Canary Islands, a sauna in Spain, and a festival in Antwerp. Thus far, there are 18 cases among gay men in nine US states. Yes, to state the obvious: Monkeypox is not a gay disease—it is simply spread by close physical contact and anyone can get it, but it has arrived in the LGBT community nonetheless.

Unlike 50 years ago, CDC and other health organizations around the globe are already on the alert and responding to this new outbreak. While there are, of course, things to criticize about the national response by federal agencies, the first step in containing this outbreak is to seek out as many cases as possible as fast as possible to get those infected into care (this time there are treatments!) and those potentially exposed vaccinated (there are vaccines, too!), while ensuring that the larger community at risk knows what is happening.

Here, I have to take a page from the Kramer playbook and turn to our nation’s LGBTQ and HIV/AIDS organizations and ask: What are you waiting for? Our LGBTQ and AIDS organizations have been built for this moment: They have 50 years of history in dealing with HIV and other infectious disease outbreaks among gay men—from syphilis and gonorrhea to drug-resistant staph infections to meningitis (with an outbreak of meningococcal disease happening right now among gay men in Florida). They have decades of experience in education and outreach with gay men, have shaped policy responses to protect our rights in the context of a pandemic, and fought and won many victories for us. Yet now they are strangely silent.

June is LGBTQ Pride month across the US and these celebrations are attended by hundreds of thousands of people. With the summer here, there will be parties galore, large and small, in public venues, private residences. After more than two years of Covid-19, which is not done with us yet—we are in the midst of a surge right now—many are looking to make up for lost time, looking forward to seeing friends, socializing, and, yes, having sex. But monkeypox is transmitted through close physical contact, and this summer brings a perfect opportunity for it to spread in these settings.

Unlike Larry Kramer, who was often censorious and puritanical about gay men’s sex lives, I am not suggesting everyone stay at home and remain celibate for the summer of 2022. What I am suggesting is that all of our LGBTQ and HIV/AIDS organizations mount an educational and informational campaign right now—not later this summer—to inform our community about the disease: how it is transmitted, its symptoms, how to seek testing and care should they suspect they’ve been exposed to the virus, and how to minimize risk of exposure to themselves and others, for instance, by forgoing social events if they have a fever or have a rash (which should signal them to seek care).

And yes, minimizing close physical contact is one key way to reduce risk, and we know from the AIDS epidemic that the gay community can effectively respond to infectious disease threats when they know the stakes. In fact, HIV incidence rates in major US cities dropped well before HIV prevention programs ramped up in the mid-1980s. We were already organizing, sharing information, and educating one another before the professionals got involved. We can do it again now.

Shutting down Gay Pride events and the summer’s social activities isn’t likely to be effective and will only drive people underground just as we need to build trust and confidence so people will come forward with symptoms or potential exposure. But those who run these events—and others who make millions off the LGBTQ community—need to step up as well. The advertising muscle of these big corporations can be used to get the word out about monkeypox—if you can sponsor a float in NYC’s Gay Pride parade, you can afford to give back to the community in its moment of need. Local businesses can also help by sharing information with their customers. We have to be all in to stop this outbreak.

Gregg GonsalvesTWITTERNation public health correspondent Gregg Gonsalves is the codirector of the Global Health Justice Partnership and an associate professor of epidemiology at the Yale School of Public Health.