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Men who have sex with men should consider limiting the number of sexual partners they have to reduce their risk of contracting monkeypox, the director-general of the World Health Organization said Wednesday.

In an apparent shift in WHO messaging about monkeypox, Tedros Adhanom Ghebreyesus said that the burgeoning outbreak can be stopped, but that people in the community where most transmission is occurring — gay and bisexual men, and other men who have sex with men — should take the risk seriously and take steps to help stop spread.

“For men who have sex with men, this includes, for the moment, reducing your number of sexual partners, reconsidering sex with new partners, and exchanging contact details with any new partners to enable follow-up if needed,” Tedros said during the WHO’s weekly press conference.

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Previously much public health messaging, including the WHO’s, has focused on the importance of not stigmatizing gay men in this outbreak, rather than on the role the community could play in helping to stop the spread. Initially, in fact, much of the public health messaging was so vague about who was most at risk that some advocates in the community stressed the need for communications that made clear to men who have sex with men that they were at risk.

On Saturday, Tedros declared the monkeypox outbreak a public health emergency of international concern, doing so despite the fact that a committee of experts he convened to advise him on the issue could not reach a consensus on whether the outbreak rose to the level of a PHEIC.

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The unprecedented outbreak, which has spread monkeypox effectively around the globe, is primarily being fueled by transmission among men who have sex with men — especially among men who have multiple sex partners or who have anonymous sex.

That has made some of the tools normally used to control an infectious disease — contact tracing and targeted vaccination — potentially less effective in this outbreak. A number of the confirmed cases couldn’t give contact tracers the names of all of their sexual partners, for instance. Unless contacts can be traced, policies that rely on offering vaccine — which is in limited supply globally — to people who have been exposed to the virus will only help a limited number of those at actual risk.

Keletso Makofane, a social network epidemiologist at Harvard’s FXB Center for Health and Human Rights, said the recommendations from the WHO are appropriate at this time, but cautioned that health officials need to be sure their tone or language doesn’t disparage sex if they suggest people limit their activity. Sometimes, when people talk about halting certain sexual behavior, the implication can be that there is something inherently wrong with the behavior itself, he said.

But as a temporary measure, limiting certain sex practices “is one tool, among many tools, people can use to manage risk,” Makofane said. “This is a thing people can do to protect themselves and their communities.”

Makofane is one of the investigators involved with RESPND-MI, an LGBTQ+ community-led survey that’s studying monkeypox cases and providing information about the outbreak and access to treatments and vaccines. The group has also issued guidance for having safer sex during the outbreak, which includes reducing group sex and sex in higher-risk spaces.

“It might be time to hang up the group sex and saunas until we all get shots one and two of the vaccine,” the recommendations say. “This is temporary and out of a love for group sex and those who enjoy it.”

For years, monkeypox virus was considered endemic only in about a dozen countries in West and Central Africa, and for years cases were recorded sporadically in those locations.

But in mid-May, health authorities in the U.K. reported detecting monkeypox in four men who have sex with other men; none had recently traveled to a country where monkeypox is endemic. In the weeks since, the number of cases has ballooned worldwide.

As of Tuesday, the United States has recorded nearly 3,600 cases of monkeypox across 46 states, the District of Columbia, and Puerto Rico. Worldwide, roughly 70 countries have reported a total of over 19,000 cases.

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