Gay men have been cautious about mpox. Will a second Donald Trump term set them back?

Gay men may be more trusting of medicine than other groups, but the incoming Trump Administration will need more than their willingness to continue combating mpox.

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Because of the persisting legacy of the AIDs crisis, as well as the use of PreP and other preventative drugs in the LGBTQ+ community, gay men are more likely to have an increased trust in medicine than other groups, according to a recent report from researchers at the Medical College of Wisconsin. They are also more enthusiastic about vaccinations, including the mpox, formerly known as monkeypox, and COVID-19 vaccines.

"Gay men and their sexual culture, especially with big cities and people who go out a lot and have a lot of partners, has been totally revolutionized, first by PreP and now by medications for other STIs," Daniel Hughes, lead author of the report and M.D. Candidate tells The Advocate.

The report, which surveyed 30 gay men in Chicago, found that the trend persists across ages, as even younger gay men without first-hand knowledge of the AIDs crisis are now "also very aware" of the importance of medicine in sexual health. The group’s willingness to get vaccinated and take precautions against mpox has been one of the key factors in curtailing the ongoing epidemic.

"I thought it was really interesting when JD Vance talked about the normal gay guy vote, because to some degree, my study is a study of normal gay guys," Hughes adds.

The trend did not span across other minority groups, instead finding a decreased trust in medicine among them sometimes due to past discrimination. For minorities such as Black Americans, Hughes says they may be less trusting because they "can point to cases where they were very clearly not treated in an ethical way."

Distrust in medicine has also been fueled in recent decades by "conspiracy theories" surrounding vaccines, COVID-19, and "fluoride in the water," as Hughes notes, which have been parroted by figures as large as failed presidential candidate Robert F. Kennedy Jr. Hughes says it's concerning how "misinformation has taken root in certain ways so deeply." While he isn't quite sure what the root cause of this misinformation movement is, the future administration will be responsible for dealing with it — or amplifying it.

"A lot of it is pretty ignorant," Hughes says. "The idea that vaccines cause autism — it's hard for me to explain why that has gotten so much currency. I just don't quite even understand it. There's not a clear cause that you can point to, like a historical or unethical injustice."

As the mpox epidemic still requires an active effort to prevent it from further spreading, Hughes raises a few points of concern about how the incoming administration will handle it. One concern Hughes notes is how Trump will influence litigation around "whether healthcare providers have to provide PreP to their patients," like the court case in Texas where conservatives argued that the ACA’s requirement for insurance plans to cover preventive services violated their religious freedom. They specifically objected to covering PrEP, citing their Christian beliefs against homosexuality.

Hughes also voices concerns for how vaccine production and distribution will be handled under Trump. With mpox, the "main challenge was that there just wasn't enough vaccines available right away," and the Biden Administration "figured it out" by rationing and prioritizing distribution. This is especially crucial now, Hughes says, as the Clade I mpox strain spreads in Africa.

The strain emerged earlier this year in the Democratic Republic of the Congo before spreading to neighboring countries. The World Health Organization declared the outbreak as a global health emergency in August. While there have not yet been any cases detected in the United States, the Centers for Disease Control and Prevention, the Department of Health and Human Services, and other groups are monitoring cases globally.

Hughes' recommendation for the future administration is to "stockpile vaccines" and to continue "monitoring what is going on with that current African outbreak, because it has really been a major public health crisis in Congo and a couple of adjoining countries."

"There's no reason to think that [the Congo strain] might not spread or couldn't spread or wouldn't spread," he says. "That's definitely something that has to be planned for in advance, because the last time the mpox epidemic arose very quickly, the United States was definitely back on its heels."

For individuals, Hughes recommends that "all gay men who are sexually active with multiple partners should get mpox vaccinated." He also emphasizes that getting vaccinated does not mean you can't still get infected, or that you shouldn't take other precautionary measures.

"Like a lot of vaccines, like the COVID-19 vaccine, there isn't perfect protection for individuals," he explains. "The takeaway from that is not to not use the vaccine. But it does just say there's limitations."

Hughes also stresses the importance of "being really aware of your partners, talking to them, and asking them" about their health, particularly if you notice symptoms in them. Simply put: "If you don't feel good about a sexual encounter with someone, you shouldn't have it."