Congo is currently facing its largest outbreak of mpox, a virus previously known as monkeypox, amidst warnings from scientists about the potential exacerbation due to discrimination against gay and bisexual men. The World Health Organization (WHO) confirmed a significant shift in the virus’s transmission in Congo, marking the first instance of its spread through sexual contact, diverging from the usual animal-to-human transmission pattern.
The Concern of Sexual Transmission
This development in Congo is particularly alarming, considering mpox has been endemic to parts of central and west Africa for decades, but sexual transmission was only documented recently. In 2022, the outbreak affected approximately 91,000 people across about 100 countries, predominantly gay or bisexual men. The unwillingness to report symptoms, especially in regions where homosexuality is legally prohibited, poses a serious risk of driving the outbreak underground, as noted by Dimie Ogoina, an infectious diseases specialist at Niger Delta University in Nigeria.
Underestimating the Sexual Spread
The WHO officials linked the first cases of sexually transmitted mpox in Congo to a Belgium resident who arrived in Kinshasa and identified as a man having sexual relations with other men. This discovery followed by infections in five individuals linked to him, spotlighted the previously underestimated potential of sexual transmission in Africa. Ogoina, who speculated about sexual transmission as early as 2019, emphasizes the challenge in estimating the extent of sexually linked cases due to gaps in monitoring.
The Response Challenge
Congo recorded around 13,350 suspected mpox cases, including 607 deaths, by the end of November, with just about 10% confirmed in laboratories. The WHO’s findings during their assessment trip to Congo revealed a lack of awareness among health workers about the possibility of sexual transmission, leading to missed cases. Despite mpox typically causing symptoms like fever, rash, and muscle soreness, the response in Africa faces unique challenges, including stigma against the gay community, which hinders mass vaccination efforts seen in other parts of the world.
A Global Health Concern
The situation in Congo raises global health concerns, mirroring past experiences with diseases like HIV, which initially were prominent among certain groups but eventually spread more broadly. Experts like Ogoina warn that without addressing these outbreaks effectively in Africa, diseases like mpox could continue to impact new populations and potentially spark international crises.