Congo faces its biggest outbreak of mpox
KINSHASA, Congo — As Congo copes with its biggest outbreak of mpox, scientists warn discrimination against gay and bisexual men on the continent could make it worse.
Sexual transmission of mpox
In November, the World Health Organization reported that mpox, also known as monkeypox, was being spread via sex in Congo for the first time. This is a significant departure from previous flare-ups, where the virus mainly sickened people in contact with diseased animals.
Mpox has been in parts of central and west Africa for decades, but it was not until 2022 that it was documented to spread via sex. Most of the 91,000 people infected in approximately 100 countries that year were gay or bisexual men.
Discrimination and underreporting
In Africa, discrimination and the illegality of homosexuality in most parts of the continent may lead to underreporting of mpox cases. Dimie Ogoina, an infectious diseases specialist, explains that “many people do not come forward if they think they have been infected with mpox.”
Sexual transmission cases identified
WHO officials had identified the first sexually transmitted cases of the more severe type of mpox in Congo last spring. This came shortly after a Belgian resident, who identified as a man who has sexual relations with other men, arrived in Kinshasa, the Congolese capital. Five other people who had sexual contact with the man later became infected with mpox.
Challenges in monitoring
Gaps in monitoring make it challenging to estimate how many mpox cases are linked to sex. However, most cases in Nigeria involve people with no known contact with animals. In Congo, there have been about 13,350 suspected cases of mpox, including 607 deaths through the end of November. Only about 10% of cases have been confirmed by laboratories. WHO found during a recent trip to Congo that there was “no awareness” among health workers that mpox could be spread sexually, resulting in missed cases.
Vaccination challenges
During the major international outbreak in 2022, mass vaccination programs targeted at-risk groups, including gay and bisexual men. However, experts believe that replicating this approach in Africa is unlikely to succeed due to the stigma against gay communities. Dr. Boghuma Titanji, an assistant professor of medicine in infectious diseases, highlights the fear and potential reluctance of at-risk individuals to come forward for immunization.
Dr. Jean-Jacques Muyemba, general director of Congo’s National Institute of Biomedical Research, reports that two provinces in Congo have reported clusters of mpox spread through sex, further raising concerns.
Priority and solutions
African governments may not prioritize mpox due to competing priorities, according to Oyewale Tomori, a Nigerian virus expert. He suggests that stronger monitoring, laboratory networks, and better availability of diagnostic supplies would be more helpful to the continent than vaccines.
The risk of mpox in Africa
Without greater efforts to stop the outbreaks in Africa, mpox is predicted to continue infecting new populations. Scientists warn that if not addressed, mpox could spark outbreaks in other countries, similar to the global emergency declared by WHO last year. The worry is that, as with HIV, the virus will spread to heterosexual populations in Africa, leading to a larger epidemic.
