On 23 July 2022, the WHO Director-General (DG) determined that the multi-country outbreak of Mpox (monkeypox) constituted a Public Health Emergency of International Concern (PHEIC). Subsequently, the DG issued temporary recommendations to States Parties (SP) accordingly.
Taking those recommendations into account, the Health Emergency Programme of the WHO’s Regional Office for South-East Asia (SEARO) held a Mpox (monkeypox) clinical management webinar titled “Diagnostic and clinical approach to Mpox (monkeypox): perspectives of a human immunodeficiency virus (HIV) physician” on 16 November 2022.
The speaker was Dr. Monica Gandhi (MD, MPH). Dr. Gandhi is an Infectious Disease physician, a professor of Medicine and the associate chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco (UCSF). She is also the director of the University of California San Francisco (UCSF) Center for AIDS Research (CFAR) and the medical director of the HIV Clinic at San Francisco General Hospital. Dr Gandhi has a research background focusing on HIV and women and adherence measurements in HIV treatment and prevention and most recently, on how to mitigate the effects of the COVID-19 pandemic. Since the Mpox (monkeypox) outbreak, she has engaged in Mpox (monkeypox) treatment at her hospital.
The U.S, where Dr Gandhi comes from, had reported 29,199 cases of Mpox (monkeypox) \ at the time of the webinar. Of this number, more than 5500 cases were from California. It was apparent that in most cases, the Mpox (monkeypox) viral transmission was caused primarily by sexual contact. Hence, most of the cases were being concentrated in HIV hospitals.
Firstly, it was stressed that with symptomatic therapy, such as conservative treatment of rash lesions and discomfort/pain control, most of the normally healthy people tended to recover within weeks of the disease.
Secondly, the deep concern was for high-risk populations. In United States, 61% of the people with Mpox (monkeypox) had either HIV or sexually transmissive infections (STI)[i]. The risk of immunosuppressed person being infected with Mpox (monkeypox) was also high. Similarly highlighted was the fact that at the time of the webinar, the current Mpox (monkeypox) outbreak was mostly prevalent among men who had sex with men (MSM). Further they were predominately identified amongst men seeking care in primary care and sexual health clinics due to symptoms like other sexually transmitted infections (STIs)[ii]”, Hence the speaker believed it was reasonable to identify Mpox (monkeypox) as a STI.
The audience highlighted their concern for discrimination against and resultant stigma for the patients. The speaker shared her experience highlighting the need for effective risk communication, more resource allocation for infodemics management and promoting resilience and empowerment of the targeted community as relevant interventions.
[i] Curran KG, Eberly K, Russell OO, et al. HIV and Sexually Transmitted Infections Among Persons with MPX — Eight U.S. Jurisdictions, May 17–July 22, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1141–1147. DOI: http://dx.doi.org/10.15585/mmwr.mm7136a1