You know, I think that the risk that rumors will start is high in this situation and rumors and false information are connected to stigma. Volberding: It's been interesting to see some of the infectious disease people who've become front and center with the COVID pandemic being turned to now to comment on monkeypox and that is a good thing they're very good communicators (and educators) about infectious diseases. Medscape: What are some of the key learnings from HIV that might be useful to primary care clinicians who are going to be on the front lines as monkeypox unfolds? So, the reaction to one epidemic clearly affects another one and I think that the same risk is there within monkeypox. But as a result of COVID, people stopped going to regular healthcare, prescriptions for preexposure prophylaxis dropped off, HIV testing decreased - the things that are so much part of the prevention strategy for the HIV epidemic. With the COVID pandemic, there was a lot of concern at first that people who are HIV infected would be at incredible risk and that's proved not to be the case. But the more cases that we hear about, the more attention will be drawn to this, and the gay community is going to be smack in the middle of it. Volberding: It depends on how real this outbreak proves to be if the numbers remain very small as they are in this country, I would hope that monkeypox will go away pretty quickly. Do you have any thoughts about the confluence of these factors and possible clinical ramifications? And at the same time, the new CDC HIV Surveillance Report details a 17% decline in new HIV diagnoses. It's ironic that this is playing out just as folks are starting to let down their guards over COVID, almost like a perfect storm of events. Medscape: One of the things that the ECDC monkeypox surveillance report highlights is that we're moving into the summer months, a time for increasing numbers of social and mass gatherings. I think in contrast to all the progress that we've made in terms of developing treatments for HIV, we still haven't made much of an impact on the stigma. To this day, in this country and definitely globally, the fact that many - either with HIV infection or at risk for it - haven't been tested or even if they have, haven't looked for treatment, all of this is the result of stigma. And as treatment and testing became available, this stigma resulted in many not being tested, not doing what they could have been doing in terms of prevention, which furthered transmission.
That did help increase transmission in the numbers of people affected early on. In the situation of gay men with HIV - especially in the early days - many were quite closeted families were unware, people were engaging in often anonymous sexual activities. Volberding: There are so many ways in which stigma affects how the public perceives transmissible diseases like HIV, and also how people themselves facing the infections experience these kinds of epidemics. Medscape: Using the HIV/AIDS epidemic as a framework, would you say that stigma - both initially and throughout the decades - is significantly intertwined with outcomes? I think that there's a horrible possibility that it will continue it's raising all of the same issues. There's a tendency for many groups in our country and globally to start pointing fingers, and in this case pointing fingers at the gay community again. It shows our reflexes of blaming and targeting and stigmatizing continue. Just today, I've seen news reports from Africans saying that you're targeting us in the same way.