‘No Blame, No Judgment’: Elevating Monkeypox Messaging

In this video, Vincent Guilamo-Ramos, PhD, MPH, RN, dean of the Duke University School of Nursing in Durham, North Carolina, discusses what the U.S. has done right on monkeypox messaging — and where improvements can be made to reach communities most affected by the outbreak. Guilamo-Ramos is also the vice chancellor for Nursing Affairs, and the founding director of the Center for Latino Adolescent and Family Health, at Duke University.

The following is a transcript of his remarks:

I think there’s been actually quite a bit that has gone well in terms of messaging in the U.S. regarding monkeypox.

Probably one of the most exciting and important and significant from a public health point of view is the U.S. declaration of monkeypox as a national crisis. I think this presents an opportunity to really enhance our efforts, to really think about innovative approaches to ways that we can respond to the monkeypox epidemic in the country.

It also allows for there to be more prioritization, and more prioritization means more messaging and really signaling to folks that this is something we should be paying attention to, that it is a national priority.

What can be improved in terms of messaging is [using] plain language that’s fact-based, medically accurate, and empathic. No blame, no judgment. Language does matter.

I think really building on partnerships, and realizing that in order for us to effectively combat monkeypox and other infectious diseases, that we need, as healthcare providers and as public health institutions, long-term relationships with communities that are vulnerable and at risk. We need to build on those relationships and those strong ties during periods when there is increased risk, or there’s a new challenge that we’re facing.

I think we also need — and this is something that I feel pretty strongly about — we need guidance that is really practical. You know, too often there’s this sort of dichotomy; it might go something like this: ‘Either have sex or don’t have sex.’ For some folks, the ‘not having sex’ becomes really associated with the idea that the only way you can prevent risk is by not having sex. Well, the truth is that for many people that’s just not going to be a realistic option.

So how do we then provide guidance for the vast majority of folks who are sexually active and who need support in reducing their risk? I think that kind of messaging and language is often sort of absent from a lot of the resources that are available. I do want to point out that the CDC has put [out] a fantastic resource on safer sex from the context of monkeypox. Boy, is that really helpful for people who might be thinking about a harm-reduction approach to how to reduce their risk during this monkeypox epidemic.

I think it also means that we need to offer really, really practical guidance, like, now’s a great time to talk to your sex partners, ‘Do you have a fever? Do you have a sore throat? Are you having problems defecating? Do you have a rash? Do you have any swollen lymph nodes? Are you feeling fatigued?’ Now would be a good time to open that communication up and start trying to see whether or not, through our dialogue, we can support our sexual health.

It would also be a good time — if you see a rash, or you’re concerned that you didn’t notice that blister or that pimple; you’ve got some itching or pain — it’s a great time to seek out your healthcare provider. Even if you think you know what it is, even if you think that it could be something else.

I also think that it’s an important time to think about monkeypox from a health equity lens. This is also part of the messaging. How do we think about individuals in households or families in communities where there may be a greater burden of the disease, where we need to understand why that is.

How do we fully embrace that monkeypox is a virus; it doesn’t select people based on their race, ethnicity, or sexual orientation. It’s the economic and social environmental drivers that account for the disparity. So how do we then think about building a response in our messaging, and our public health efforts, that really puts at the center of that response how we can reach the people who are most vulnerable.

That means thinking about moving the locus of care to where they are. We shouldn’t be building our response in our usual brick-and-mortar structures. That might work for a lot of folks, but it may not work for the people who we are trying to reach.

We, again, need to think about having care that is whole-person-centered. That is really about thinking about this within the context of a whole person — the psychological, the social, the physical. We need to be empathic and culturally appropriate. That means thinking about ways that we can message in the appropriate language, use the right words, really honor and respect the preferences of the communities that we’re trying to reach.

Health equity considerations are what really fuel the epidemic, and they add a lot to the stigma. Imagine, if we fast forward, a country where the messaging is that this is a disease of only gay men, and in particular gay men of color, black MSM [men who have sex with men], or let’s imagine that it impacted also other MSM of color. That’s a very challenging message to roll out, and in many ways could be avoided if we think about it from a health equity lens.

I think that something that’s also important to me… That’s why I am a nurse, I’m a nurse practitioner, and I happen to be the dean of one of the top schools of nursing in the United States: the Duke University School of Nursing.

Nurses are by far the largest segment of the healthcare workforce. We are more than 4 million in the United States. When we think about boots on the ground in terms of education, in terms of vaccine rollout and vaccines in arms, when we think about testing and swabbing lesions, when we think about helping a family or an individual to cope with monkeypox, or ways that within a household we can mitigate forward transmission between people that you live with, we’re talking about really the work of the nursing workforce.

Nurses have been identified as the most trustworthy and the most empathic of all professionals. Not just healthcare professionals — of all professionals. To be honest, that’s another important piece of our public health response that often is not visible. We understand ways that we can really help mitigate infectious diseases like monkeypox.