Latest UKHSA monkeypox technical report: recent reduction in daily case growth. "There is no robust evidence of sustained transmission outside some sexual networks of GBMSM". Small increase in # of female cases bears watching, but "there is insufficient evidence to support a change in the transmission dynamics".

Cases with known gender are 96.5% male; just 13/2014 female;
Positivity rate in adult men 53.8%, in women it's now ticked up to 2.24%. Children 0.58%.

Projected growth rate in the UK has been dropping: "The nowcasting suggests that the growth in confirmed daily cases is around zero, but with very high uncertainty (Figure 10), with growth rates estimated between a 23-day doubling time and a 24-day halving time."

Gosh I wish the CDC were as on top of things as the UKHSA.

Anecdotally, I've seen a bunch of my own friends opt to reduce their risk by forgoing hookups, avoiding circuit parties, and opting for more-clothed, less-body-contact venues instead. Optimistic that between testing, short-term behavioral changes, and vaccination, we can beat this thing. :-)

@aphyr I've been wondering about this. Behavioral changes were such an important early response to the AIDS epidemic. But monkeypox may be much more spreadable. Doesn't seem likely condoms alone will make a big difference for instance, although no one's sure yet?

@nelson yeah, we dunno how much protection condoms offer yet--could be spread via proximal contact, and folks are rarely using them for oral anyway. I don't think the conclusion it's "much more spreadable" is consistent with the near-zero estimated growth rate though.

@nelson entirely reasonable advice IMO, and it's what a bunch of us are doing already. Maybe make it a 3-load weekend instead of a 30-load? Risk reduction helps!

@nelson I worry some about the impact on bathhouses, clubs, dances and bars, but given the UK epi curve I can see a US future where the outbreak starts to trend down in a few months. Unlike HIV it's not lifetime transmissible, we have a vaccine, and vaccination is effective for at least a few years. I also suspect that we can get a large reduction in r_t by vaccinating a relatively small number of sexually-active people.

@nelson (pardon, was eliding for space constraints: HIV *was* lifetime transmissible during the initial years, prior to HAART; U=U today, you know the drill. :-))

@aphyr Thanks for the thoughts! I've been wondering why health experts haven't said "maybe limit your contacts?" more.
I'm hopeful this is just an unusual outbreak and not a new endemic and regular threat to our lives. Part of what was so awful about AIDS in the 80s and 90s was the feeling that crisis was going to be for our whole lives. Which it has been (and continues to be) but is at least a whole lot more manageable now.

@nelson I think you can charitably read Weiner and the WHO as aligned here: suggesting a reduction in partners and lecturing people not to have sex are somewhat different in valence. And telling people "reducing sex/contact/etc is an effective way to reduce risk" is exactly the kind of education that we should be issuing right now. The key, I think, is to do that in a way that remains generally sex positive and non-stigmatizing--like the SFAF page you linked earlier.

@nelson I think you and I are both very well aware of the shadow of shame & fear that abstinence-focused HIV education cast in the lives of gay men--and how critically important it is to mitigate stigma in public health messaging. There's also a whole complicated conversation about condoms--how incredible and indeed sex-positive it was to have easy access to protection in gay spaces, but also the condom-fatigue... and perhaps consequent bareback backlash in the PrEP era?

@aphyr thank you again, I appreciate how thoughtful you are and what an informed perspective you have. (Also grateful for Mastodon; would not want to have this conversation in a more public space.)

@nelson agreed! Something here too about the assignation of "just desserts": assumptions that one "earned" a disease by engaging in high-risk behavior are flawed. One can (as a segment of the internet is very focused on reminding us!) do "everything right" and still contract disease. But that doesn't erase quantitative risk! It's tough, I think, for folks to grapple with behavior that is both risky *and* worthy of celebration--that our raucous, free-spirited sex is still worth having.

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