While the monkeypox outbreak has so far been highly prevalent among those who identify as LGBTQ, public health officials have taken pains to stress that the disease is not exclusive to that demographic, nor is it exclusively sexually transmitted. 

The situation has placed queer-centric healthcare provider FOLX Health in the difficult position of trying to provide needed care to LGBTQ patients while making sure not to contribute to the perception that monkeypox is a "gay disease" — as HIV/AIDS was initially treated in the 1980s.  

Threading that needle, the company last week launched a virtual service targeting the disease that includes education, counseling, and referrals for monkeypox treatment. The announcement came three weeks after the Biden administration declared the outbreak a public health emergency, and public discussion on how to respond has escalated. 

"There's been a lot of misinformation out there," Liana Douillet Guzmán, CEO of FOLX Health, told Cheddar. "I think there's a history of gatekeeping and scapegoating and judgment when it comes to seeking care for our community. We certainly saw that with the HIV crisis, and we're starting to see pieces of it with the monkeypox break out."

The goal of the monkeypox offering, Guzmán said, is for patients to get the care they need without experiencing judgment or discrimination. She added that the reason FOLX formed in the first place was because many LGBTQ people experience discrimination in health care settings, and that there is a lack of queer-specific medical training for doctors. 

"Even if you're able to find a clinician that isn't discriminatory, they lack the expertise around our differentiated medical needs through no fault of their own," she said. "Most clinicians graduate with five hours of LGBTQI-specific training." 

How does FOLX's approach differ from what other providers are saying? Guzmán said many are wrongly treating monkeypox as a sexually transmitted disease.  

"There's sort of this misalignment around it being a sexually transmitted disease that's specific to members of our community, and that's just simply not the case," she said. "Really what we're aiming to do is provide a source of truth for our community, so they can access information that they know is clinically accurate and free of judgment."

The debate over monkeypox transmission remains unsettled, however. The Centers for Disease Control and Prevention (CDC) currently defines monkeypox as "sexually transmissible," though it says other modes of transmission are also possible. The National Coalition of STD Directors, similarly, refers to the disease as "sexually associated." 

While some medical experts call this a semantic argument, the emphasis on monkeypox's sexually transmitted nature could shape the public health response, and how the wider public perceives it. 

Jeffrey D. Klausner, clinical professor of medicine, infectious disease, population, and public health sciences at the University of Southern California and a former medical officer for the CDC, recently argued in a Medium post that "the transmission dynamics of human monkeypox, at least across the United States and Europe, appears to be highly consistent with a sexually transmitted infection." As a result, he argued, the public health response should focus on that dimension of the virus, even if it's transmissible in other ways such as close contact or even from surfaces or clothes. He also said that at the same time, "we must destigmatize both the disease and its route of transmission."

Guzmán, for her part, said the biggest public health mistake made around monkeypox is how the federal government let 20 million vaccine doses expire. 

"I would have loved for us to have been able to see the lessons we learned over the course of COVID applied to monkeypox," she said. "It really shines a light on the lack of queer-centric care out there."