Gerard Funes Martin and Sergio Cuho have a lot of things in common. They both like going to the gym and hanging out with friends. They are also part of the gay, bisexual and other men who have sex with men (GBMSM) community, and volunteer for STOP (previously “STOP SIDA”) – a community-based organization in Barcelona, Spain, that works closely with local health authorities.
They are both outspoken and feel strongly about speaking out for lesbian, gay, bisexual, transgender, queer/questioning and intersex (LGBTQI+) rights and against stigma, and revealing their identity whilst doing so. That is why Gerard talks openly about him being a sex worker, and why Sergio has stepped forth to talk about living with HIV.
They have both also had mpox (monkeypox), a disease that in the current outbreak in the WHO European Region has mostly affected the GBMSM community, and has placed people living with HIV at greater risk of severe disease if they catch the monkeypox virus.
When, last July, Gerard started feeling unwell, he went to the hospital. The nurse who attended to him, after Gerard waited for 5 hours, remarked: “Too much partying, isn’t it?”
Gerard wasn’t expecting such a comment, and since he wasn’t feeling well, he let it go.
He felt equally unconformable the day before, when he went to get vaccinated against mpox. As people were lining up, waiting to get vaccinated, some journalists were there too.
“They didn’t say anything. They didn’t ask for permission. They just started filming us,” he recalls.
“My objective is to change perceptions and fight stigma. So that people don’t speak about us without including us in those discussions. This is why I’m here [talking with you]. To humanize us…. I think people often don’t understand what the work entails and the risks we run. Also, many people don’t think of us as people who have a regular life. We are more than just the job we do. We have our lives, friends, aspirations and values.”
“It’s important to have people by your side. People who understand and support you,” he adds.
And this is why he’s supporting others, by volunteering at STOP.
“I’m a bit ‘addicted’ to the work I do at the organization,” he says, smiling. “It’s been taking up a lot of my spare time over the last few years. I’ve been involved in different projects, including taking photos and doing interviews, documenting the political movement of sex workers in Barcelona, and being part of support groups for sex workers, or people involved in chemsex* or suffering from substance abuse.”
As for mpox, the disease hit Gerard hard.
“I had it bad. I was hospitalized. This affected my life, and also my income. I couldn’t work for a month.”
“Having to isolate again, after COVID-19, wasn’t easy,” he says, adding that at first, when coming down with mpox, he didn’t know how to look after the lesions that emerged. He found that the initial health advice he received was focused on how not to pass on the infection to others, and didn’t include information on how to manage his symptoms.
“Judgement creates fear.”
Sergio’s mpox experience was different.
“I had a fever and went to the hospital. They ran tests, and initially did not find anything. Then, I was told that it could be COVID-19. But it wasn’t COVID-19. A week later, I got tested for mpox, and this is when I found out. By then, I didn’t really have any more symptoms. I didn’t have a severe infection,” says Sergio.
Still, once the mpox diagnosis came, Sergio got worried, and went to see his HIV doctor.
“I didn’t have any sexual relations at that time as I was really worried,” he says, going on to explain that he knew people who didn’t have HIV but got hit hard by mpox, and that he also knew people living with HIV who suffered from milder mpox symptoms.
Sergio speaks with ease and his statements are often followed by a smile.
But he is serious when talking about his motivation for speaking about being HIV-positive.
“I haven’t always been open about my HIV status. When initially diagnosed, I was afraid to talk about it. But things have changed. Me and others, we want to put a face to people in this situation.”
“Last summer, there was a lot of stigma surrounding people who had mpox. It was like when one got diagnosed with HIV. People start wondering: Shall I go [to a health centre]? Are they [health workers] going to hear me out? So, lots of people [who had mpox] didn’t say they had it and didn’t go for testing. Judgment creates fear,” he says.
His message to health-care professionals is clear: “Don’t judge us. Listen to us. That’s much more useful.”
That said, he believes that it is important for people to seek support, when unwell, from health-care professionals.
“There are always solutions,” he concludes.
It is out of this need to be part of a solution that Sergio joined STOP in 2020, and continues to volunteer there, including providing support to people living with HIV, and speaking out for their rights.
Jean Sebastian Meyer Guignard, the President of STOP, agrees: “It’s not just about stopping SIDA [AIDS]. What we want to stop is homophobia, discrimination, stigma, and other situations that put people’s health at risk”.
Meyer makes a strong case for fighting stigma and discrimination.
If stigma and discrimination persist in the health system or in the workplace, he argues, it’s difficult for people affected by mpox to access the care they need as well as vaccination.
More so, he adds, for people living in the surrounding areas of Barcelona. Financial considerations aside, they might face judgment when having to inform their employers about the need to go into the city to get vaccinated against mpox, as the vaccine is not available outside of Barcelona.
WHO/Europe’s call to eliminate mpox
Though the number of people with mpox is currently low in the WHO European Region – which was the epicentre of the current global outbreak in its early months – the disease has not gone away, and cases have been on the rise in some countries.
WHO/Europe – through its mpox campaign “Eliminating mpox: placing affected populations at the heart of our response” (May–September 2023), complemented by a risk communication, community engagement and infodemic management toolkit for mpox elimination (May 2023) and its latest mpox policy (April 2023) – has been calling for sustained resources, increased vigilance and lower barriers to testing and vaccination so that mpox can be controlled and eventually eliminated in the Region.
Chief among these is WHO/Europe’s call to: bring testing and vaccination closer to affected communities; reach all underserved and vulnerable groups, including sex workers and people living with HIV; and combat discrimination and stigma.
To support this call, WHO resources, such as the toolkit, include public health advice for sex workers and considerations for health-care providers supporting sex workers. They also contain practical advice on how health authorities can reach and include underserved groups in the mpox response.
WHO/Europe worked closely with some 30 civil society organizations (CSOs) representing affected communities, listening and learning, and incorporating their feedback in the mpox toolkit.
“CSOs have played a crucial role in bringing mpox case numbers down and, along the way, fighting stigma and discrimination. We have come a long way since last summer. But if we stand a chance of eliminating mpox in the Region, more needs to be done to reach all underserved groups, such as sex workers, trans people, migrants and homeless people, who might not be connected to the formal health system. Ensuring easy access to mpox testing and vaccination is also key,” said Dr Richard Pebody, who leads the High-threat Pathogen team at WHO/Europe. “Underpinning this is the need to squarely confront and address stigma and discrimination for once and for all.”
* Chemsex is defined as “sexual activity mostly between men while under the influence of drugs” .