Sexual health, mpox, wellbeing and being South Asian By Dan Singh I freelance with LGBT HERO as a group facilitator and I've recently been offered the opportunity to develop a sexual health and wellbeing hub for gay, bi and trans men who have sex with men (MSM) of South Asian heritage, with a focus on mpox (preciously called monkeypox), HIV testing and general sexual health and wellbeing. I thought this is also an excellent opportunity to reflect on our collective lived experience as people of South Asian heritage and look into why this is the right time for us to continue to talk about sex, sex and dating, being sex positive, and sexual health & wellbeing. I come from a traditional Punjabi background. There were certainly some tough times to cope with in terms of accepting who I was at first, while trying to be respectful to my culture, religion, and faith – falling way to often in the ‘good-boy trap’. Eventually, the cultural attitudes I lived through did not align with my own authenticity and through talking and listening to others from my queer and ally South Asian community and accessing the right support, I became more confident and inspired way back in the late 90s. In preparation for a forthcoming panel discussion on mpox and sexual health, I started to think about my own sexual health and wellbeing and why I haven't had my two mpox vaccinations. Could it just be vaccine injection fatigue? I live with a lifelong medical condition, Diabetes Type 1, where I have to inject around six times a day to survive. This can be tiring and socially disruptive, especially if I am on a night out. Or have I just become complacent and feel less at risk or even less sex positive? Either way, during conversations with friends and work colleagues, I realised perhaps I have become less sex positive and more anxious due to covid and now mpox. I guess it may be a better idea to have both mpox vaccinations, not only for myself but to protect others, and break through any anxieties I have. I have started to go out again, since my covid anxieties (socialising once a month, whether this be cinema, theatre or indeed the gay scene of my home city, Birmingham). I think it’s also important to be talking about sex, sex and dating, being sex positive and how we socially connect with each other. I feel we need diverse cultural and inter-generational voices to be talking about this, so we get a wider perspective. We should try to perhaps re-look at how we are making friends and take in a deeper focus into how we can reduce social isolation through our existing and new social or virtual spaces. Some of these topics are already being explored in South Asian HangOuts, our twice monthly social and support online group for gay, bi, trans and MSM men. On reflection, I haven’t seen much focused media campaigns on Mpox specifically for gay, bi, trans and MSM men with South Asian Heritage or 'people of colour'. So, I wanted to find out more anecdotally how others from my South Asian tribe felt about this. Is there just too much social media and digital noise happening? Do we simply just need to keep talking and learning from one another with greater empathy? I recently spoke to three South Asian friends and colleagues who identify as either gay, bi, trans or MSM men and asked them for their reasons for having or not having the mpox vaccination. One friend mentioned that he has not had the covid or flu vaccination as he didn’t trust them, after an elderly relative fell ill from side-effects a few weeks after a flu vaccination. He said logically he knows that the covid and flu vaccinations are safe but lacked trust and said he could not even consider the mpox vaccinations for now. (So how do we build trust with public health systems - a question worth asking post Covid.) He said he did not feel comfortable going to get the mpox vaccination as he didn’t identify as gay or bi, but visited gay saunas as part of his freedom of being his authentic self. He said, "I guess part of it is the fear of side-effects and I also don’t want to out myself. I know information is private and confidential, but you never know who you might bump into in a waiting room. The thing is I don’t know enough about what mpox is or where I would go for the jabs, but know I am at a higher risk. I faced a lot of pressure and stigma when I didn’t have my covid and flu jab and that was stressful enough. I’ll probably have the mpox vaccination eventually, as I guess cases could spike again. I don’t want to catch it and pass it on to my partner or to others. Maybe I will have it when I have my next sexual health test.” Another friend explained to me, “When I found out about mpox, it put me off sex and this affected my mental health and wellbeing. I had just developed the confidence to start meeting men for sex after the covid crisis and then mpox happened. It scared me. I eventually decided to have the mpox vaccination and now I feel much more confident sexually and my mental health is better. I think we need to encourage people to have this vaccination as it protects the community as a whole. I know friends who are still not vaccinated and are meeting other men and women, potentially putting themselves and others at risk.” I explained to my friend that there is a smallpox vaccine called Imvanex which is being used as a vaccine for mpox and that it is a similar virus to smallpox. The vaccine reduces the likelihood of symptomatic infection and severe symptoms. I also spoke to someone living with HIV who said, “The problem is a lot of information cannot be trusted these days. You hear a lot of people saying there is so much fake news. But what I have been telling others is that having the mpox vaccinations doesn’t affect your PrEP or HIV medication and U still equals U! - something that people forget." Statistically LGBT HERO’s last survey on mpox (in 2021) was only filled out by 3% of South Asian people. Potentially more awareness is needed? There may be a need to produce more information around mpox and general sexual health and wellbeing for South Asian gay, bi, trans and MSM men. Over the next couple of months LGBT HERO will be reaching out to South Asian GBMSM communities to strengthen the knowledge around mpox, vaccinations and also start conversations around better sex, sexual health and wellbeing, and looking at any barriers preventing us from accessing the support we need and the solutions to resolve this. We are keen hear your voice and amplify any concerns. >> Survey link here << Final thoughts Currently, large numbers of gay, bi and trans men have had their two jabs of the mpox vaccination and the more people that are able to have the vaccination the less chance of any potential local mpox spikes occurring. At the moment, the variant that's spreading is considered 'mild' but can have severe affects for some people. As of August 2022, there have been some reported deaths related to the virus recorded in Europe and South America, many of these cases have been linked to underlining health conditions. So, I guess for South Asian gay, bi, trans and MSM men we all still need to continue raising awareness of all the support that is out there, through talking to one another, giving feedback to spaces that care for us, virtual and in-person social and support groups, through poster and social media campaigns around sexual health and wellbeing and having the sex that you want that is right for you, for now; and to ask questions we are may be afraid or reluctant to ask within our own communities. I am now on the waiting list for my mpox vaccination. Hopefully soon I will have the protection I need for myself and others. Further reading Mpox: what you need to know Mpox vaccines Dan Singh (he/him) is the Group Facilitator for South Asian HangOuts – an online social support group for gay, bi and trans men with South Asian Heritage.