Paralleling the Gay Man's Trauma: Monkeypox Stigma and the Mainstream Media

Abstract

Mainstream media portrayed monkeypox as a sexually transmitted disease through government guidance and increased a sense of hypersexualization and stigma among gay men and men who have sex with men (MSM). The purpose of this study is to understand how the US mainstream media perpetuated stigma toward gay and bisexual men (MSM) in its coverage of monkeypox in 2022. This article, therefore, contributes to the fields of queer studies and health communication. Using discourse analysis, we found three discourses including: Global disparities, LGBTQ Behavior and Stigma, and Racialized Discussion of Health Disparities.

Keywords

sex gay men health communication queer theory news coverage

When gay and bisexual men—also commonly referred to as men who have sex with men or MSM—in the United States became the demographic most affected by the HIV/AIDS epidemic in the 1980s, cracks in the guise of LGBTQ acceptance became more pronounced. HIV/AIDS became known as a “gay disease” that only had an effect on one specific group. This social construction spurred stigma, a sociological framework involving the social stratification of oppressed groups (Goffman, 1963). Stigma is further “learned and internalized through childhood socialization, [shaping] the minority individual's identity” (Meyer & Northridge, 2007). Scholars have concluded that societal discomfort with the sexual behaviors of MSM influences the stigma for both hetero-cis and LGBTQ people, and attitudes like blame for the HIV/AIDS epidemic are an underlying symptom of stigma (Worthen, 2020). In the case of HIV/AIDS, mainstream media was instrumental in popularizing stigma. While recently there has been more focus on dispelling public health myths and breaking down stigma in journalistic reporting, there once was sensationalism that furthered stigmatic ideas.

In 2022, interviewees speculated whether monkeypox was a sexually transmitted disease through government communications and subsequent media coverage, increasing a sense of hypersexualization and blame for MSM, following a pattern set forth by HIV/AIDS. The purpose of this study is to understand how the US mainstream media perpetuated stigma toward MSM in its coverage of monkeypox in 2022. This article, therefore, contributes to the fields of queer studies and health communication. In establishing a connection between monkeypox coverage and that of HIV/AIDS, history can act as a guide for how the legacy media outlets continue to repeat old mistakes or choose to learn from them.

As current US legislative policies attack the rights of LGBTQ individuals, media representations of health are key in dismantling systemic institutions and advocating for social justice. In this study, we propose the following questions: How did mainstream media outlets stigmatize men who have sex with men in their coverage of monkeypox in news coverage? How did communication trends shift or stay the same in later follow-up coverage once there was more nuanced understanding of the disease among official sources of information, quasi-official sources of information, and journalists?

Literature Review

Few studies have discussed the monkeypox phenomenon; most discourse happened on social media. Still, there is scholarship dispelling much of the misinformation perpetuated by outlets and a general documentation of public attitudes—often influenced by media—toward monkeypox. Research confirms scientists do not unilaterally consider monkeypox a sexually transmitted disease, despite initial media reports based on health communication from official organizations that suggested so as objective truth (Khatri et al., 2022; Sah et al., 2022; Ghazvini & Keikha, 2022). Sexual activity and promiscuity thus held public focus.

Officials confirmed the outbreak of monkeypox at hand on May 7, 2022, when a British resident brought it to Europe following a trip to Africa, where the disease has been present since 1958 (Anwar & Waris, 2022). A US case was first identified on May 17, 2022. By August 22, 2022, monkeypox had spread to all 50 states, with California ranking first in the number of cases. Officials began to record deaths on August 30, 2022. In May 2023, the World Health Organization (WHO) declared it no longer a global public health emergency, about 6 months after the Biden administration removed a national emergency status (Nirappil, 2022; World Health Organization Regional Office for the Americas, 2023).

Similar research has been conducted relative to HIV/AIDS, both in the United States and abroad. Myrick (1998) analyzed coverage of the epidemic from The Daily Oklahoman and The Birmingham News, two major daily newspapers in the Deep South. Though Myrick found the papers did not shy away from writing articles about the crisis, it rendered the harsh realities of MSM “completely absent” from public understanding. The media, in other analyses as well, associated HIV/AIDS with MSM and their decisions about monogamy (Biddle et al., 1993; Kinsella, 1989).

März et al. (2022) postulate focusing too much on risk communication toward MSM does not take into account sociopolitical determinants of health; that is, by focusing messaging on MSM, organizations increase hostile attitudes toward them. By failing to “address the problem of structural LGBTQI + discrimination and health inequality” and misrepresenting the disease as only spread through sexual contact, März et al. (2022) argued stigma increases. Government response aligns with media coverage, too, as official and quasi-official sources of information are cited in mainstream media due to perception of authority. As a result of colonialism, Anzaldúa (2012) argues that Westernized and non-Western populations cannot distinguish between these invisible “borders.” Therefore, individuals become part of both worlds, but must still meet the cultural expectation within those spaces. There are nuances in the specifics of each country and region, but analyses have ultimately concluded the global press—with varying degrees of press freedom—emulated the same stigma-causing rhetoric in regions like England (Beharell, 1993), sub-Saharan Africa (D’Angelo et al., 2013), China (Wu, 2006), Portugal (Traquina, 2007), Canada (Mensah, 2008), and others. Overall, existing literature points to stigma, even within the response from governmental and intergovernmental organizations.

Communication scholars argue visibility in mass media is an important goal of the LGBTQ movement. Some recognizable representational form of homosexuality is necessary for political power and equality of the LGBTQ community—a fundamental part of developing identities (Butler, 1990; Fejes & Petrich, 1993; Gross, 2001; Kielwasser and Wolf, 1992; Morris & Sloop, 2006; Walters, 2001). Queer portrayals in mainstream news are significant because stories and photojournalism play a role in constructing LGBTQ politics in contemporary American civic life (Alwood, 1996; Hariman & Lucaites, 2007).

Ultimately, literature centers around the invisibility of LGBTQ people and the politics produced through representation. It argues homosexuality is overlooked; but when it is portrayed, it takes narrow, homophobic, heterosexist, and heteronormative forms.

Using HIV/AIDS as a Framework

When the HIV/AIDS epidemic emerged as an issue confronting MSM in the 1980s, there was a lack of visibility within mainstream media in the United States and abroad. Coverage that did exist widely popularized patients as “the other,” harping on what would become known as “the gay disease” without proper context for MSM's behavioral risks (Stevens & Hull, 2013). And victims most visible in the media were often white and male. The LGBTQ liberation movement was still young; following the Stonewall Riots in 1969, there were small wins for 21st century fight for gay rights, launching it into the collective American consciousness. HIV/AIDS, which much like monkeypox was a crisis targeting MSM, lodged a wrench in the societal gains of the movement.

At the beginning of what would become a largely ignored public health crisis, there was a feeling among activists that the media—newspapers as well as television and film—left victims behind (Alonzo & Reynolds, 1995). That legacy had disproportionate impacts on public health for decades. Stevens and Hornik (2014) draw a connection between stigma put forth by sensationalized coverage and low HIV/AIDS testing rates of Black Americans when compared to their white counterparts well into the early 2000s. This shows coverage can correlate with direct, measurable, and disproportionately manifested impacts on public health outcomes, especially when it has to do with portrayals of MSM.

The Criminalization of Gay Sex

On December 15, 1950, members of Congress received a report entitled “Employment of Homosexuals and Other Sex Perverts in Government,” a summary of secretive efforts to investigate federal employees’ sexuality toward the beginning of the Cold War. As a panic to oust those associated with communism rose, another to expose LGBTQ people did, too. It stipulated homosexuality was a mental illness; therefore, employees who fit outside of a heteronormative view of society—or engaged “in overt acts of perversion”—were “security risks” who “lack the emotional stability of a normal person” (Public Broadcasting Service, n.d.).

Homosexuality was not legal in the United States until January 1, 1962, when Illinois became the first state to repeal sodomy laws, marking the first effort to decriminalize homosexuality, years before the Stonewall Riots (Public Broadcasting Service, n.d.). Decriminalization came to a head with a sweeping Supreme Court decision. The effort to legalize same-sex marriage was gradual over the course of decades, with some states opting for civil partnerships until the court narrowly declared same-sex marriage legal in Obergefell v. Hodges on June 26, 2015 (Public Broadcasting Service, n.d.).

Primarily drawing upon a Judeo-Christian moral framework, opponents of change employed moral arguments to advance ethical objections. Rhetoric around homosexuality as “sinful,” “morally wrong,” “sick,” “unnatural,” or “deviant” is well established in both psychological and public discourse (Smith, 1994). In the United States, antigay activist Anita Bryant's campaign equating antidiscrimination proposals with “child-molesting,” “boy prostitution” and “gay recruiting” was responsible for the ban on open LGBTQ people teaching in public schools in some states (Diamond, 1995) and for proposed antidiscrimination measures being overturned in others (Adam, 1995).

Queering Health Communication

Social stigma can have an impact on societal power dynamics and self-perception (Goffman, 1963). Theory shows media portrayals are an integral part of legitimizing societal stigma. Saksena (2018) asserts there is a correlation between increased pressure from the press toward a public health crisis and how the public perceives it. The media also can dictate how public health policy is framed and constructed. Other scholarship agrees there is an undeniable tie between how media coverage portrays public health crises and how it is translated into sociocultural contexts (Sherlaw & Raude, 2013; Washer, 2004). Scholars say the media wields power to influence public perception, specifically within a health communication framework.

Queer theory has long been the basis in work about media perceptions of LGBTQ people. Warner (1991) coined the term heteronormativity, the idea that society expects people to be heterosexual by default, and that most institutions are geared for the heterosexual gaze. Mainstream media coverage paints a picture of an othered caste of MSM, many of whom are othered by their identities of race, ability, or gender (Crenshaw, 1989).

Somerville (1994) established an understanding of the homosexual body within a scientific framework, linking institutionalized medical racism to institutionalized medical homophobia. Foundational medical literature considered homosexuality a “deviant sexual object choice,” and Somerville argues that is directly correlated with a lack of standard of care that takes into account social determinants of health, like sexuality. This permeated conventional medical wisdom for centuries—until 1973, the American Psychological Association considered homosexuality a mental illness (Public Broadcasting Service, n.d.).

In recent decades, the field of health communication has been expanded to consider the diverse realities of the LGBTQ community. Scholarship has begun to center queer narratives, especially as discourse around HIV/AIDS has shifted from study of risk to a structural notion of post-HIV/AIDS, where there are preventative drugs and vaccine developments, and most patients have an undetectable viral load. For instance, in a 2016 paper, Spieldenner discusses the pitfalls of the term “PrEP Whores,” which stigmatizes the sex lives of gay men who choose to take PrEP, a preventative drug (Spieldenner, 2016). Recent studies have explored how othered bodies and the health issues associated with them are discussed in mainstream media, social circles, or online can have an impact. Media constructions can either discourage or, instead, empower those who fall in a minority to take charge of their health (Yep et al., 2014; Dutta, 2007; Scambler & Paoli, 2008; Basnyat, 2017). For MSM in particular, the importance of inclusive, literate queer-centric health communication strategies cannot be overstated when measuring how they impact health outcomes (Basu et al., 2022).

Methodology

As the production of stigma is imbued in power struggles, we turn to critical discourse analysis (CDA) to examine the social tensions that shape mainstream coverage. A cultural reimagining of CDA has opened research to include diverse perspectives (Martinez Guillem & Toula, 2018). “Discourse analysis is key in revealing the implicit norms present in different practices,” scholars have found (Martinez Guillem & Toula, 2018, p. 143). At its core, Critical Discourse Studies (CDS) is about diversification of experiences and expands new paradigms. Primarily, CDA allows for a vertical emphasis on systemic inequalities as opposed to horizontal identity differences (Martinez Guillem, 2017, p. 346). The sample included U.S. mainstream coverage from May 2022 when monkeypox cases were first detected until December 19, 2022, when numbers were no longer documented by the CDC. Using the search term “monkeypox,” the sample included 474 mainstream newspaper articles using News Bank. We analyzed the article text in the discourse to see how mainstream media depictions are presented through the lens of stigma. Recent studies have highlighted how CDA concentrates on everyday talk in routine practices such as storytelling to normalizing ideologies (Martinez Guillem et al., 2017; Martinez Guillem, 2013). In our study, we focused on the linguistic markings associated with specific groups, non-Western, racial, and queer individuals in terms of health. Then, we highlighted those connections to constructs of normal or privileged groups by making a chart with identity descriptions of the different groups. Martinez Guillem et al. (2017) noted the mutual dependency on oppositional identities within communications and how they lead to practices of stigma. Building on her work, we follow the “ideological construction” process to emphasize the materiality of systems of oppression (Martinez Guillem et al., 2017, p. 362).

Analysis

Journalism keeps evolving to meet the digital and technology demands. In terms of public health communication, misinformation has resulted in real-life consequences, especially for marginalized communities. The media influences stereotypes, and power hierarchies maintain oppression and discrimination through language and word choice. We argue monkeypox virus news coverage positioned systemic negative ideologies around LGBTQ behavior. The impact of stigma sensationalized the “otherness” across Westernized ideas of sexuality and health. Further, the language used in stories showed how “privileged speakers routinely engaged in discursive moves that normalized discrimination while at the same time denying individual prejudice” (Martinez Guilliem et al., 2017, p. 360). The broader dynamics of inclusion and exclusion are tied to mainstream culture and ideologies. Based on our analysis, we found the following discourses: Global Health Disparities, LGBTQ Behavior and Stigma, and Racialized Discussion of Health Disparities.

The impact of coverage of monkeypox virus reached international scope; but, despite global awareness, the discourse featured colonial, Westernized undertones. Further, it increased the stigma and misrepresented global health communication without cultural context or perspectives. Even though the virus was infecting everyone, queer communities and non-Western nations were targeted and marginalized. At the beginning of May 2022, US media coverage did not mention a particular group, except that the first cases were a result of traveling to Africa. Media representations of the Global South have been rooted in colonial superiority due to imperialism. Scholars have noted the impact of language in coverage of foreign affairs, in particular medical diseases or viruses. As Durham (2014) deduces, geographical spaces are central to the process of othering. She stated media representations are like maps because they use language, visual imagery, and other symbols to represent the world. Thus, this discourse positions Western media as the source of power of “normalizing ideologies” around international standards of uncivilized, underdeveloped, and impoverished health access. Karim (2003) points out that most media use the Global North as a cultural reference point for geopolitical discussions. A cross-national connection is forged in discourses of power. As the virus spreads globally, reports continually will continue to reference the African origins, despite the fact that the 2022 strain is transmitted differently, adding evidence to this Westernized civility.

As more Westernized countries see an uptick in cases, the media focused on blame on a specific community—in this case, MSM. The sensationalism of queer behavior then became an international concern and issue within European countries. For example, on May 20, 2022, the Philadelphia Daily News was among the first to report United Kingdom cases have predominantly occurred with MSM. The story described that, “Sex is not generally considered to be a route of transmission but is theoretically possible” (Avril, 2022, p. 6). This seemingly began confusing the virus with the African strain that dominated the majority of coverage in May 2022. By the end of the month, reports claim and place blame of the disease on MSM. Here, sex is problematic discourse because the media has placed heteronormative ideals in a global context where being queer is legal. Mohanty (2003) argues the international context of practices of oppression emerge and can be challenged by cartography demarcations. Therefore, division among the west and non-Western nations sensationalized transmission narratives that highlighted deviant sexual behavior at the cause.

The US news coverage shifted to address it as a sexually transmitted disease (STD) despite this never being confirmed. For example, the Centers for Disease Control and Prevention warned that people might first mistake the infection for a STD because “rashes are first appearing around the genitals or anus” (Weintraub, 2022, A2). As a result, the media attempted to show the difference between the virus, but the misinformation of transmission positioned specific identities to be targeted. On June 15, 2022 Arkansas Democrat-Gazette published a story discussing the renaming of monkeypox due to the stigma and discrimination toward underdeveloped countries (Staff, 2022). The media and public health recognized the inaccuracies in the virus’ name and the negative stereotypes connected to non-Western communities. Further, this exemplifies the global research on borderlands and geopolitics (Anzaldúa, 2012). The US media imposed the cultural standards of health communication through stigma and misinformation. Coverage tried to “normalize” language of mainstream identities by targeting and “othering” non-Western and queer individuals (Anzaldúa, 2012).

The comparison to Africa continued throughout the study and it noted the cultural differences around queer individuals. Coverage in August noted the illegality of same-sex relations in Africa when stories could not report how many of the continent's monkeypox cases are MSM. For example, an Associated Press article stated “‘that indicator is not relevant in the African context,’… Many of Africa's 54 countries criminalize consensual same-sex relations to some extent” (Cara, 2022). Thus, this erasure of LGBTQ identities does not factor into the lack of spreading in the continent. Also, we see how international media can address cultural identities based on different cultural contexts in order to navigate misinformation.

In the study, a shift in coverage occurred when the WHO declared monkeypox an international health outbreak on July 23, 2022. The International Business Times quoted the WHO Director-General “declaring a public health emergency of international concern…that is concentrated among men who have sex with men, especially those with multiple sexual partners” (Grover et al., 2022). The global discourse presented differing viewpoints among US health officials. An US story highlighted how US experts have “speculated whether monkeypox might be on the verge of becoming an entrenched sexually transmitted disease in the country” (Cheng, 2022). This story depicted the marginalization of LGBTQ people within the United States. The intrinsic dynamics of inclusion and exclusion are related to ideological constructs of citizenship, nationality, or culture. Scholars noted the discursive moves in media outlets that define citizenship in opposition to undesirable bodies (Erjavec, 2009). Here, the media positions nationality as intertwined with queer individuals as they are ideologically defined as unwanted “disease-spreaders.” These narratives illustrate the pervasiveness of prejudice and negative stereotypes about LGBTQ individuals.

Within this discourse, more international comparisons sought to perpetuate stigma around African and non-Western countries as being less civilized and underdeveloped medically. Also, misinformation within Europe and the United States sensationalized certain sexual behaviors as problematic. Through these exchanges, we see a cultural duality that scholars argue exists within geopolitical spaces and identities. Coverage highlighted the different strains of the virus internationally, but we still saw it target gay men and MSM as the prime issue.

LGBTQ Behavior and Stigma

Sex was mentioned as a means of monkeypox transmission and the discourse targeted gay men and MSM as the problem. We saw how the media coverage shifted from June to August 2022 as cases began to rise. A fundamental site of reproduction of heteronormative ideologies is based in the interplay of cultural and political aspects of identity processes (Martinez Guillem, 2017). The discursive identity processes illustrated in coverage had to do with a perceived threat or fear of queer individuals, as an attack to physically, healthy “acceptable” bodies and the political, US national body. This discourse highlighted the stigma in connecting to deviant, undesirable behaviors (Spieldenner, 2016).

Cities like San Francisco with higher LGBTQ populations featured awareness stories warning MSM “to look out for symptoms of monkeypox ahead of upcoming Pride festivities” (Allday, 2022, C001). By June 2022, the stigma increased as more cases emerged. Here, we see the limits of public health knowledge and nuance about queerness (Spieldenner, 2016). A Georgia newspaper misinformed the public and presented queer spaces as disease-ridden by criminalizing “a venue where there was known to be monkeypox or in an area where monkeypox is spreading” (Oliviero, 2022). As Spieldenner (2016) argued, “slut shaming” tends to silent discussions about sex among gay men. In our findings, heteronormative stereotypes around queer individuals confined “queer” spaces as transmission sites rather than having discussions about sex. Therefore, the media discussions centered LGBTQ sexual behavior rather than societal health concerns. This reflects the sexualized stigma of queer bodies. “[Gay sex] conversations have been particularly important in developing community norms around sex, and communicating sex practices in a heteronormative world where young queer people are not taught the intricacies of same-sex” (Spieldenner, 2016, p. 1691). San Mateo Daily Journal published an article promoting the usage of condoms as prevention (Bay City News Foundation, 2022). Groups and local organizations urged health departments to renew programs that promote condoms in a push to prevent monkeypox. Later, when the vaccine became available, coverage positioned sexual behaviors and queer lifestyles at the center. The Daily News in Galveston, Texas, reported cases from the “‘gay-friendly’ sauna in Spain or to the four-day Darklands Festival in Belgium, which celebrates sexual fetishes” (Berman & Rupp, 2022). The narrative reinforces the moral debates around homosexuality as unhealthy (Smith, 1994). We also see clean/dirty binaries that are contingent on social values that mark some identities as desirable (Spieldenner, 2016). This kind of labeling has produced problematic constructions within the queer community. Sexual object choice, sexual histories, and sexual fantasies become markers of one's queer identity. Political commentary furthered queer alienation. The Daily Beast reported in August 2022 how “far-right figures tie the virus to baseless panic about LGBT people ‘grooming’ children” (Bixby, 2022). Again, we see child-molesting, predatory myths emerge within coverage as it furthers the clean/dirty binary discussion (Smith, 1994; Spieldenner, 2016). As a result of this stigma, we noticed an increase of violent hate crimes in coverage. For example, on August 9, stations reported “a suspected hate crime after two men were punched by assailants who hurled a gay slur at them while referencing monkeypox, according to a police report.” Stories stated before being attacked the suspect said “monkeypox f—–s” (Deliso & Peterson, 2022).

In July, vaccination availability became the main discourse of the coverage. It still focused on LGBTQ individuals, but we saw more news on public health efforts, instead of stigma. Queer individuals began to actively try to reverse the negative misconceptions. Similar to other studies, various institutions attempt to assert values among gay, bisexual, trans, and other queer men about health options (Spieldenner, 2016). Institutional and social values are revealed even as individuals deploy strategies to resist, reclaim, or reify the discourse. Within a public health focus, outlets highlighted the stigma of AIDS/HIV as a cautionary tale of negative misinformation. For example, the East Bay Times highlighted queer politicians in its July 13 story. California assembly member Evan Lowe explained how his community has a history with public health and recalled the fight for AIDS/HIV. This type of coverage positioned the queer voices in an advocacy role and redefined false narrative. It also allowed for public health to be a solution rather than a stigma because local officials and leaders were taking an active role in providing support to the queer community. Many articles revealed the frustration of negativity toward queer individuals. For example, the Associated Press’ lede wrote, “Members of the LGBTQ community have been furious with slow response from government at all levels” (Thompson & Harr, 2022).

Despite negative coverage, several stories highlighted LGBTQ community empowerment. Instead of living in fear of being discovered or seen, many narratives and sources openly discussed their identity as queer so they could diminish the negative social aspects of it and sexual behaviors. Therefore, these stories reclaimed the stigma and opened discussions around sex. The Sacramento Bee covered a vaccination event on July 21, 2022 where the story addressed the power of social media in spreading awareness. The story began with, “One of the strongest tools in the fight against monkeypox in Sacramento County might be gay friendships.” This positive perspective differed from other outlets. The discourse here showed ways to support queer individuals instead of negatively focusing on sexual behaviors. Further, the social stigma associated with monkeypox shows multiple perspectives to “healthy” relationships (Yep et al., 2014). Gay men were depicted as having relationships not centered around sexual activity. Therefore, coverage diminished the heteronormative focus on relationships.

This discourse illustrated how myths around sex affected the LGBTQ community in news articles. The media coverage sensationalized queerness negatively and resulted in misinformation about the virus. In the later months of the study, we noticed that more positive representations emerged to highlight the community.

Racialized Discussion of Health Disparities

By September, we saw more media discourse focusing on the long history of health disparities within marginalized communities. This discourse included more intersectional identities and the impact of multileveled stigma (Crenshaw, 1989). Thus, the identity of race became vital in understanding how stigma is associated with certain deviant sexual behaviors because of racialized myths of hypersexuality. Scrambler and Paoli (2008) have noted how stigma and deviance may be “enacted” or “felt” or both. “Whereas, enacted stigma and deviance denote discrimination by others, felt stigma and deviance denote (1) an internalized sense of shame and blame, respectively, and (2) a frequently disruptive and sometimes disabling fear of being discriminated against” (Scrambler & Paoli, 2008, p. 1850). This difference is important to note because the majority of coverage featured white individuals as sources or personal narratives. So, this discourse positioned non-White stigma due to monkeypox as different due to racial oppression. The coverage mentioned the lack of access across racial and economic lines. Therefore, as stigma decreased and public health efforts increased, the media crafted stories that featured and targeted more inclusion and advocacy.

By mentioning the US Black history of access and the lack of trust in healthcare, reporters shifted from victim-blaming and shaming to reporting on institutional issues. The norms of stigma and the labeling processes with which they are bound up never exist in a structural vacuum, but always arise within a structural nexus that varies by context or figuration (Scrambler & Paoli, 2008; Basnyat, 2017). The Associated Press described how the United States had seen a drop in new cases, except in communities of color. “While cases in white men have dropped in recent weeks, Black people are making up a growing percentage of infections—nearly 38% during the final week of August, according to the latest data available. In the early weeks of the monkeypox outbreak, Black people made up less than a quarter of reported cases” (Seitz, 2022, p. 1). The story addressed how public health messaging and vaccines were not effectively reaching those communities and introduced the need for a recalibration for interventions. Socially structured discussions about health convey the promotion of “acceptable and proper” health practices while leaving out structural context, which marginalizes certain populations (Basnyat, 2017). As a result, more stories featured local and statewide efforts as well as activist's narratives addressing these health disparities.

When more local news discussed health advocacy, articles positioned surveillance and concerns for safety as important. For example, MinnPost.com focused on the discourse of sexual health being hidden and erased. The story quoted an activist, stating “‘In general, when it comes to sexual health, there historically has been kind of an era of shame and stigma that some patients have had to deal with. So we really want to position ourselves to be kind of a refuge from that” (Kian, 2022, para. 7–10). The mass media offered an understanding of how oppression and discrimination can limit a person's wellbeing. Here, enacted stigma can result in social isolation, and a discredited place in society, disqualifying individuals from full social acceptance (Scrambler & Paoli, 2008; Basnyat, 2017). Enacted stigma becomes a performed form of structural violence. This discourse highlighted the need for safe spaces and alternative options with healthcare to address structural violence. It noted the mistrust and lack of safety as being a factor in public health and the need for outlets to be allies and safe spaces for others by using “technology tools to identify what zip codes, populations and communities the clinic may not be meeting.” By mentioning the cumulative effect of structural violence on an individual, the story highlighted how “poorer health and a shorter life where poverty and hunger are part of everyday violence” (Basnyat, 2017, p. 193).Therefore, this discourse focused on being solution-oriented rather than sensationalized.

Stories noted the institutional barriers to vaccinations as well. This reflected how certain individuals remain discriminated against by multiple identities, especially race. With the prominence of postracial ideas, racism, and race-based oppression tend to be minimized or considered not relevant in current US society. Critical race theorists have noted that race is still a present problem (Ladson-Billings, 2013). Further, stories featured more discussions of intersectionality being at the center of health disparities. For example, when the vaccine became available to women, the Houston Chronicle documented a Black lesbian woman's journey to being vaccinated. The story began like this:

“Kimberly Thomas had to lie to receive the monkeypox vaccine—and she is not the only one…When Thomas called to schedule an appointment, she was turned away. Then, her friends told her how to answer the screening questions. ‘I had to tell them that I was a sex worker,’ she said. ‘I had to tell them that I just had sex with someone who's an MSM. I'm a lesbian woman, and I had to tell them that I was bisexual.” (Gill, 2022, p. 1)

As the story focused on one Black woman's struggle for proper healthcare, it presented how stereotypical norms about Black deviance must be present in order to be treated. In analyzing the language and identities within the story, the highly tarnished social labels given to sex workers result in discrimination (Basnyat, 2017). This is stigmatizing to Black women who have historically been represented as hypersexual and it is Thomas’ “hypersexual” persona that allows her access to the monkeypox vaccine (Davis, 1981). This illustrated the discrimination marginalized people seek in order to receive resources. This was a result of her race, gender, and sexuality (Crenshaw, 1989).

Similarly, in the Casa Grande Dispatch, the story compared the medical access for queer people of color. “The white gay community has a lot of resources—they have nonprofit organizations, they have clinics and private doctors that are culturally attuned to our queer community,’ said Richard Zaldivar, an LGBTQ advocate in Los Angeles. ‘But when you look at people of color communities, we do not have that capacity’” (Drumgoole, 2022, para. 6). Here, coverage mentions privilege and access by highlighting racial issues. Stories within this discourse pointed out social determinants of health (Somerville, 1994). Thus, stories pointed out how hegemonic narratives place blame on individuals’ health rather than pointing to conditions of the environments where people are born, live and learn affect health and quality of life expectations (Somerville, 1994).

As cases started to decline, news coverage reflected on the work done by advocacy groups and activists to aid public health and resources (Rowan, 2022, A1). More stories featured partnerships between public health and advocacy organizations, which explained the impact of diverse communities to take action over their neighborhoods and identities. At the same time, in November 2022, medical officials discussed the decline as a result of certain sexual behavior changes. A story in Orlando had a source mention how “The community that largely was affected was very responsible…If that had not been the case, we would have definitely seen a lot of spread well beyond the men who have sex with men population and into other populations” (Catherman, 2022, A1). Later, the same source mentions the “access-to-care issue” and how “it's not a trivial thing for many people” (Catherman, 2022, A1).

Overall, this shift in reporting health inequities illustrated the US power hierarchies across different identities and experiences. By inserting race and economic gaps into coverage, an expanded range of personal narratives allowed for non-White communities, most-affected by monkeypox, to be visible within their own understanding of their existence. Further, these stories emphasized the legacy of racism and the social determinants of health by negating that all LGBTQ individuals are a monolith.

Conclusion

We have found that mainstream media was integral in disseminating information about monkeypox, which came with its own set of biases and framing choices as the US grappled with a new public health crisis. News reporting in our period of analysis placed emphasis on identity, specifically that of MSM. Given the history of the HIV/AIDS crisis and how it had a direct, measurable impact on MSM's standard of care, coverage did not always root itself in intersectional understandings of sexuality, race, and gender. Rather, it generally presented a public health crisis again as a disease predominantly affecting white, gay men. This can be particularly harmful for MSM of color, who were not usually targeted by messaging of health risk (Mgbako, 2022). Therefore, false messaging affects health prevention and treatment.

Overall, there was a lack of a comprehensive effort to provide unbiased information about monkeypox to at-risk populations. Informal networks of LGBTQ people both physical and online became dire in disseminating critical information about vaccinations and disease spread, which, in turn, squashed the curve of the disease (Mgbako, 2022; Nirappil, 2022; Cooper et al. 2023). In establishing a record of media coverage from this period, we contribute to the burgeoning and rapidly shifting areas of health communication, queer studies, and critical discourse studies. These fields are widening their understanding of varied parts of the LGBTQ community and are exploring how deeply connected they are with studies of media coverage. The results also illustrate a significant relationship between historical narratives of queer individuals and the systemic power structures that harm communities.

This study has limitations including using US print news stories available on News Bank. We also did not analyze news images or video. This study was also limited to mainstream news coverage and not alternative media, public health communication campaigns and social media posts occurring during this period. Thus, diverse, non-mainstream perspectives or voices were limited to journalists’ selection of news sources. Future studies should explore visual communication in news and social media platforms, like Instagram or TikTok. Also, studies should interview queer individuals about public health campaigns and combating stereotypes.

Because so much importance was placed on a singular social determinant of health—sexuality—there was a heightened sense of visibility and subsequent stigma that came with getting a vaccine. To be LGBTQ is sometimes to lead an invisible life. In most cases, vaccines were only offered to MSM or sex workers, sometimes in queer spaces (Girgis Staff Writer, 2022; Taylor, 2022; Von Buol, 2022), meaning patients were effectively required to out themselves in order to receive life-saving treatment. Ultimately, we found media practitioners fanned the flames of stigma, thus leading to poorer public health outcomes for MSM.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Rachel Grant

Author Biographies

Rachel Grant is an assistant professor in the College of Journalism and Communications at the University of Florida. Her research focuses on media activism and historical and contemporary social movements.

Alan Halaly is an undergraduate student in the College of Journalism and Communications at the University of Florida.

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