The monkeypox outbreak did not have to happen. At the end of May, when there were fewer than fifteen cases in the United States, queer activist James Krellenstein, molecular microbiologist Joseph Osmundson, and epidemiologist Keletso Makofane argued in the New York Times that it wasn’t too late to prevent an outbreak. The trio urged the government to quickly ease access to testing, deploy vaccines and antivirals held in the Strategic National Stockpile, and consult infectious disease and HIV experts to craft public health messages for queer men. This wasn’t wishful thinking. As epidemiologist, MacArthur “genius” recipient, and ACT UP veteran Gregg Gonsalves recently told PBS NewsHour: “We could have contained this outbreak. We could have stopped it in its tracks.” Instead, the outbreak was allowed to occur. As of this writing, there have now been more than 25,000 cases in the United States.

The government’s missteps point to an irrefutable structural neglect of queer men’s health.

The role of the federal government’s hubris cannot be overstated. A week before the New York Times essay, Ashish Jha, the White House COVID-19 response coordinator, told ABC’s The Week that he was confident the United States could “keep our arms around” monkeypox, and that the government had vaccines and treatments to prevent an outbreak. But by June the government chose to adopt what the New York Times called a “wait and see” approach to vaccination, only ordering 72,000 of the available 372,000 doses of Jynneos—the two-dose vaccine for monkeypox—from its Danish manufacturer, Bavarian Nordic. By the time the government received an additional 800,000 doses that were tied up in bureaucratic red tape, the opportunity to contain the outbreak was far past. In early August, the Biden administration changed how the vaccine would be administered—intradermally, or just under the skin, instead of the approved subcutaneous route—because it would allow the available doses to go five times farther, despite the greater risk of localized reactions (see: the large red bumps vaccine recipients are experiencing). Thankfully, the new dosing regimen appears to be just as effective, but its need highlights the government’s failure to have doses ready for a long-anticipated emergency, a particularly embarrassing oversight for a drug the United States spent nearly $2 billion creating.

Nor did deployment go smoothly. Public health infrastructures already taxed by COVID-19 were unable to meet the immediate vaccine demand. In major cities across the United States, appointments posted online were booked within minutes. In New York City, the scheduling website crashed. For those who contracted the virus, receiving a diagnosis and treatment was its own battle. On social media, queer men shared stories of going to urgent care with symptoms, only to be told by providers that they had the flu, or a different STI. Testing was bottlenecked; only about seventy labs in the country could process diagnostic tests, and physicians had to jump through hoops to get their patients’ samples to them. TPOXX, an antiviral treatment effective against smallpox and related orthopoxviruses (including monkeypox), was nearly impossible to get because doses were held in the Strategic National Stockpile. Though effective against monkeypox, the FDA had never approved TPOXX for use to treat the virus, and each case required prescribing physicians to fill out hours of paperwork to obtain special medical clearance. And once diagnosed, those with monkeypox had to quarantine for up to a month in their homes.

These government missteps pointed to an irrefutable structural neglect of queer men’s health. Not surprisingly, then, early activist responses to monkeypox were deeply shaped by the perceived parallels between the outbreak and the HIV/AIDS epidemic. For example, many queer people analogized the government’s response to monkeypox to the early 1980s, when few politicians cared about HIV/AIDS as long as it primarily affected queer people. Of course, it’s true that the scale of government neglect in the AIDS epidemic and the monkeypox outbreak are not the same. Ronald Reagan didn’t publicly say the word AIDS until the fourth year of the crisis, in 1986—by which point nearly 5,000 people had died in the United States—and it would be a full decade before the first effective multidrug therapy would be available. In contrast, we can already prevent and treat monkeypox and, despite the intense pain associated with its lesions, the virus is, in nearly all cases in the United States, nonlethal.

But if the crime of the 1980s was the government’s refusal to acknowledge AIDS because it “only” impacted queer people, it feels no less cruel that, in 2022, the government knew monkeypox was overwhelmingly affecting queer people, had the vaccine doses and resources to contain the outbreak, and chose not to.

The failure to halt the entirely preventable outbreak immediately generated public confusion and distrust.

The government’s failure to halt the entirely preventable monkeypox outbreak immediately generated public confusion and distrust. Many voiced fears that monkeypox would be labeled a “gay disease,” a concept that dates to the initial year of the AIDS epidemic, before HIV was identified as the cause for AIDS, and before AIDS was even named. At the time, the plague affecting queer men was known as GRID, or Gay-Related Immune Deficiency, a sociological name that quickly became a tautology: one would get GRID if they were gay, and if one had GRID, it was because they were gay. What followed was the homophobic conflation of AIDS with queerness, and the violent belief that queer people deserved to contract HIV, develop AIDS, and die.

In the early weeks of the outbreak, the fear of monkeypox being labeled a “gay disease” dominated conversations about how to craft public health messaging about the virus. Some argued that tailoring public health campaigns to queer men would encourage monkeypox’s status as a “gay disease,” instead of a virus that could affect anyone. For example, outlets like NPR encouraged its readers not to “overemphasize” sex when talking about monkeypox, despite nearly every indication that the virus was moving through sexual networks.

However well intentioned, what these arguments misunderstood was that public health campaigns for queer men are not only not homophobic, but are in fact one of the greatest achievements of the AIDS epidemic. AIDS activists, who fought incessantly for government action and pharmaceutical resources, understood the fundamental difference between homophobic attention that stigmatizes queer sex and dismisses HIV and AIDS as a “gay disease,” and the specific messaging necessary for queer men to safeguard themselves from contracting the virus.

For example, public health posters during the 1980s and ’90s not only eroticized condom use and safe sex for gay men, but, as historian Jennifer Brier details in her book Infectious Ideas (2009), Black, Latinx, and other gay activists of color worked tirelessly to create safe sex campaigns that addressed their community’s specific needs. Nor did HIV education for queer men end with the introduction of antiretrovirals in 1996. For example, in the recent “Swallow This” advertisement for the prevention regime PrEP, a close-up photograph of a Black man’s open mouth shows a PrEP pill on his outstretched tongue, and is accompanied by the words “Swallow This” in bold type. The ad builds on the success of earlier campaigns targeted to queer people of color, for example ACT UP action group Gran Fury’s 1989 “Kissing Doesn’t Kill” NYC bus campaign, which showed people of color kissing to raise awareness about how the disease is (and isn’t) spread. Such messaging, directed to queer and trans people of color, is crucial to any serious public health education aimed at ending the epidemic.

The brave leadership of such campaigns, which playfully embrace sexuality, can be contrasted with present-day squeamishness over whether to even call monkeypox an STI. Initially the suggestion that monkeypox is an STI was met with incredulity and claims of homophobia. When the Associated Press tweeted an article with the headline “Monkeypox virus could become entrenched as a new STD in the US,” the tweet was ratioed by accounts claiming they had reported the AP’s account for spreading misinformation. As with the concern of monkeypox as a “gay disease,” the pushback to labeling monkeypox an STI was undoubtedly a well-intentioned attempt to prevent the stigmatization of queer sex.

However, HIV is actually a wonderful example of why we should call monkeypox an STI. As journalism scholar Steven Thrasher recently argued in Scientific American, there are many viruses that we call STIs that can be transmitted in nonsexual ways, HIV, herpes, and hepatitis chief among them. “STI” is not a strictly scientific classification. Rather, it is a useful framing for the purposes of prevention, treatment, and education—all things that queer men needed and continue to need with monkeypox. Arguments that calling monkeypox an STI will stigmatize gay sex are themselves a product of erotophobia, accept the underlying assumption that STIs are stigmatizing entities, and ignore the fact that many gay men talk about STIs and prevention on a daily basis. Most gay hookup apps now offer users the option to list HIV status, prevention techniques, and the date they were last tested, and manufacturers of HIV and PrEP drugs routinely advertise there. While Grindr’s release of users’ HIV status reveals the need for greater privacy protections around how such information can be used, gay men’s willingness to share their status and harm-reduction practices points to the success of HIV/AIDS activism in removing stigma around STIs. Monkeypox continues to move through the queer community via sex and calling it an STI enables already existing public health efforts to incorporate it into their sexual health messaging.

Public health campaigns for queer men are not only not homophobic, but are in fact one of the greatest achievements of the AIDS epidemic.

Some who wished to not identify it as an STI did so in part because they worried that other mechanisms of transmission, and in other populations, were being ignored. This was, again, a concern with a legitimate basis in the history of HIV/AIDS: for the first decade of the AIDS epidemic, the diagnostic criteria for AIDS excluded cisgender women, which denied important health care to women living with HIV while maintaining the tautology of it as a “gay disease.” At this point, though, we can rule out the possibility of monkeypox only being diagnosed in queer men because of a testing bias. Data from the World Health Organization (WHO) indicates that a large testing bias in the monkeypox outbreak is incredibly unlikely. WHO data from the end of September showed that 95.3 percent of monkeypox cases were in men, 2.6 percent in women, and 68.9 percent of respondents identified as men who have sex with men. These numbers have remained consistent over the course of the outbreak. This doesn’t mean there hasn’t been issues with getting non-queer men tested and vaccinated, but as a general rule, there isn’t a large population of individuals presenting with symptoms of monkeypox who are being categorically dismissed.

While there are still some unknowns with monkeypox, it is crucial to remember that we are not starting from scratch as scientists, doctors, and public health officials were in the AIDS epidemic. It took several years for HIV to be determined as the cause of AIDS, and lifesaving treatment wasn’t available until fifteen years into the epidemic, at which point over 300,000 people had died in the United States. But this isn’t the case with monkeypox; we’ve known about the virus for nearly fifty years and developed vaccines and antivirals before the outbreak began. While well intended, many analogies between the early responses of HIV/AIDS and monkeypox have inadvertently ignored what occurred afterward, and the many things we did learn from the AIDS epidemic. The dangers of exclusionary diagnostic criteria, the need for non-stigmatizing but culturally specific safe sex campaigns, and even safe sex itself—these are all products of the activist work during the AIDS epidemic. It is critical that in our attempts to diagnose problems with the monkeypox response, we don’t ignore the legacies that can help us.

Unfortunately, instead of a careful consideration of monkeypox and HIV’s differences and similarities, an additional, unhelpful invocation of AIDS history has emerged in the form of sexually conservative gay men arguing that it is the responsibility of other gay men to end the outbreak.

During the AIDS epidemic, Larry Kramer, one of the founders of Gay Men’s Health Crisis and ACT UP, was especially known for this position. In his most pointed formulation, he wrote in 1983: “I am sick of guys who moan that giving up careless sex until this blows over is worse than death. . . . How can they value life so little and cocks and asses so much?” During the monkeypox outbreak, Kramer’s politics have been revived in opinion pieces that draw on his legacy for authority. In a Washington Post op-ed, “Gay men can fight monkeypox ourselves—by changing how we have sex,” prominent gay journalist Benjamin Ryan opens by quoting Kramer to argue that gay men should alter their sexual behavior to prevent the transmission of monkeypox, even suggesting abstinence as one way to do so. Likewise, in an Atlantic essay called “Asking Gay Men to Be Careful Isn’t Homophobia,” queer historian Jim Downs overleaps commonsense measures to suggest that gay men should limit their sexual activity—and not only during the health crisis. To bolster his argument, Downs approvingly cites Kramer’s 1978 pre-AIDS novel Faggots, with its self-righteous criticism of “orgies, urban bathhouses, and sex-filled summers on Fire Island, which, he [Kramer] believed, prevented gay men from having intimate, monogamous relationships.”

Kramer’s castigation of gay men is difficult to read outside of the context of the darkest days of the crisis; Ryan’s and Downs’s invocation of it is cynical and out of step with the legacy of AIDS activism. Simply put, monkeypox should never have been an occasion to relitigate Kramer. We know that sex shaming cannot be the basis for public health strategy, end of story. As scholar and ACT UP activist Douglas Crimp argues in his 1987 essay “How to Have Promiscuity in an Epidemic,” it was queer male sexual experimentation and ingenuity, not abstinence, that led to the creation of life-saving safe sex techniques. We can see this legacy today in’s “Six Ways We Can Have Safer Sex in the Time of Monkeypox,” which recommends queer men avoid sex clubs, use condoms, and wear long-sleeve shirts at bars—even while having sex. Instead of opting for demonization, these suggestions honor the realities of queer sexual needs while offering achievable harm-reduction ideas.

Rather than empowering gay men, Ryan’s and Downs’s pieces produces the same effect that Kramer’s did forty years ago: by putting the onus on gay men to solve the monkeypox outbreak, it not only blames the outbreak on the queer community, but paves the way for the individualization of monkeypox, in which those who contract it are seen as “irresponsible.” The enduring lesson from AIDS activists wasn’t to individualize the epidemic, but to draw structural critiques and put pressure on those who could affect change: the pharmaceutical industry, politicians, and the federal government. Ryan and Downs—and any gay man with similar politics—would be wise to remember that.

As a response to monkeypox, anti-sex invocations of Larry Kramer are cynical and out of step with the legacy of AIDS activism. We know that sex shaming cannot be the basis for public health strategy, end of story.

It is undeniable that since the initial outbreak, we have made progress. The White House has brought in trusted queer public health expert Demetre Daskalakis, director of the CDC Division of HIV Prevention, to help coordinate the national monkeypox response. The FDA and CDC have implemented strategies to make tests and TPOXX more accessible, and queer men have, like those before them in the AIDS epidemic, altered their sexual behavior as a prevention method. Cases have fallen by 65 percent since the beginning of August, and over 803,000 doses of the vaccine have been administered. While the monkeypox outbreak has certainly been defined by public health and government failure, these improvements point to the successes of HIV/AIDS history on present-day thinking: tailored public health messaging, culturally appropriate prevention methods, and vaccine deployment—“getting drugs into bodies,” in ACT UP parlance—have worked.

And yet, the latest data reveals a deepening racial disparity in monkeypox cases. Black men now account for 51 percent of cases, while Latinx men account for 17 percent. Worse yet, Black men have received fewer than 9 percent of administered vaccine doses.

Throughout the current outbreak, racism has been largely absent from discussions of parallels with the HIV/AIDS crisis. But innumerable scholars have shown that HIV/AIDS is experienced very differently by communities of color. Historians Darius Bost, Kevin Mumford, and Cathy Cohen, for example, have detailed the racism and homophobia that Black gay men faced from mainstream society, white gay men, and their own communities during the AIDS epidemic of the 1980s and ’90s. Crucially, for Black and Latinx communities, the HIV/AIDS epidemic is ongoing in a way it is not for white gay men; according to a 2016 CDC report, if current rates of infection continue, 50 percent of Black queer men and 20 percent of Latinx queer men will test HIV-positive in their lifetime. These are not the narratives that have been used to compare HIV/AIDS to monkeypox, and they point to the terrifying likelihood that monkeypox will divide into two pandemics—over, for white men; ongoing, for Black and Latinx communities—unless queer communities of color are supported with every available resource.

To prevent this from happening, we can draw inspiration from HIV/AIDS activists who saw the virus as the nexus for a wide set of interlocking social issues, like access to housing and prison abolition. These activists understood that health care doesn’t exist in a vacuum, but is instead tied to, and distributed unevenly along, axes of gender, race, class, sexual orientation, and nationality. In his recent book The Viral Underclass (2022), Steven Thrasher uses these insights to investigate how the AIDS epidemic and COVID-19 have created a “viral underclass”: a group of individuals who are made structurally vulnerable to contracting a virus, and then blamed for that virus when they do.

As I said began by saying, this outbreak did not have to happen. And not just this outbreak, but a world in which there are monkeypox outbreaks, period. The virus has been endemic in Africa for decades, but due to colonial medical apartheid, African nations don’t have access to either vaccines or antiviral treatments. Lest it go without saying, the same is true for HIV: 25.7 million people in Africa have HIV, but in some parts of the continent, fewer than 11 percent of those living with it are able to access treatment. As Ngofeen Mputubwele and Joseph Osmundson recently argued in a paper on the colonial histories of HIV and monkeypox, “the current [monkeypox] outbreak and the ongoing HIV pandemic proceed from the same flawed premise, in which we can separate the health of Black African individuals in the Democratic Republic of the Congo or Nigeria from the health of the communities we consider closer to home.” Viruses have no fidelity to borders, and the creation of a viral underclass in one place will ultimately lead to the creation of another elsewhere.

Current figures point to the terrifying likelihood that monkeypox will divide into two pandemics—over, for white men; ongoing, for Black and Latinx communities—unless queer communities of color are supported with every available resource.

In the United States, the CDC recently launched the Monkeypox Vaccine Equity Pilot Program, which has earmarked 50,000 doses of the vaccine for communities with barriers to vaccination. This is a start, though that quantity is a pittance. Moving forward, federal and state support nationwide will be necessary, and public health departments from the CDC to the local level should draw on the expertise of Black and Latinx community leaders and public health experts to create meaningful vaccine messaging and education. This not only means creating campaigns specifically for Black and Latinx queer men, but also meeting them where they are: at community events, sex parties, and gatherings designated for queer men of color. If we continue creating strategies that imply all queer men are the same, white queer men will continue to benefit, and Black and Latinx queer men will continue to be ignored.

The monkeypox outbreak is still ongoing, which means that we need to be vigilant about the stories we tell to describe it. Using HIV/AIDS history to incorrectly describe monkeypox, stigmatize sexually active queer men, or ignore racial inequalities will only make it worse for those who are already structurally vulnerable to health disparities. As AIDS activists have taught us, the stories we tell matter, and they can be the difference between someone getting the care they need or remaining sick. If there is an enduring lesson to be learned from all AIDS histories, let it be this.