The Backstory: Is reporting about the monkeypox virus stigmatizing the LGBTQ community?

Luis Cruz: Welcome to “San Diego News Fix — The Backstory.” Every week on this podcast we tackle important questions about journalism ethics and give you a behind-the-scenes look at our industry and what’s happening in our newsroom. This week we wrote about a monkeypox vaccination program coordinated by the county ahead of San Diego Pride weekend. The story was criticized by some LGBTQ leaders. Joining me today to talk about that is our health care reporter, Paul Sisson; topic editor Tarcy Connors; managing editor Lora Cicalo; we also have Max Disposti, executive director of the North County LGBTQ Resource Center; and we begin with publisher and editor Jeff Light.

Jeff Light: The work that we do as journalists turns out to be both consequential and pretty complex at times, and I think this is an example of how the positioning of the news, the prominence of news, the context or lack of context, the words that are used, the headline, how those things can turn a public service story into what could potentially be a stigmatizing story, or, depending on your perspective, feed into the history of hate and stigmatization, in this case, in the LGBTQ community. So there’s a lot of layers to this and I think some lessons to be learned. Let’s just start with the basics so that readers or listeners can follow along. Paul, if you could just share the basic facts of the story. What is it that is going on?

Paul Sisson: Thank you so much for the opportunity to chat about this a little more. I think it’s really important that we have these kinds of conversations and in sensitive areas like this where we want to do a good job and we need to be self-critical, of course.

In this case, the county put out a press release at roughly 5 p.m. Tuesday and posted on their website as well, letting the entire community know that they were asking for an increased level of what they said was abstinence during the Pride Week festivities that are coming up this weekend, and also letting the community know that they were running a special vaccination event a couple of days before Pride weekend – this Wednesday and Thursday.

I was able to get a hold of the epidemiology director, Dr. Seema Shah, shortly before that press release came out and talked to her about what some of the motivations were. She told me in our interview that they were directly concerned about this disease spreading and they cited, specifically, the increase in cases and increased demand for vaccine in other cities that had previously had Pride events – Los Angeles and San Francisco they cited specifically. But as I understand it, this has been kind of a recurring theme in Spain, Germany, several different places where Pride events have occurred. They have subsequently seen an increase in monkeypox infections in, specifically, the men who have sex with men population, and that was what it said — in the county’s press release and also in some information that I saw on Twitter from the Pride Foundation, as well about the vaccine event in promoting it.

So that took a little time — to look around and see what the numbers look like in other cities. And it did seem like that in San Francisco, for example, before their Pride event, they had something like four cases. And when I checked it on Tuesday, it was up to 60. Since then, I looked again this morning, I think they’re up to 68. Los Angeles is now up to 82 cases. I saw a Los Angeles Times story that just last week, (the numbers) were in the 40s. So it does seem like the infections have been spreading.

So, it just seemed like a public health situation where we have our local public health department reaching out, not just to a specific community, but to the entire community to try to encourage vaccination, and I guess my thinking was, they said they only had 600 doses. And so it seemed like we wanted to let people know as directly as we could, “Hey, there’s a limited number of vaccines, and here’s where you can get one. Here’s a number that you can call to get vaccinated.” It does seem like this is an actual public health concern where we have demonstrated growth in cases following these specific events that our government – the public health department – is citing in a public release to the entire community posted on their website.

Jeff Light: That part of it sounds pretty straightforward. So, we published this story. And I just wanted to share a little bit of the feedback we received. Here’s a tweet from Fernando López, who is the head of San Diego Pride and does a pretty terrific job in that position: “Fuck the media, sensationalizing monkeypox as a gay disease. Period.” And then some other feedback I got that was maybe a little more nuanced. And I’ll just read from an email I got from an acquaintance of mine: “I simply don’t understand why the U-T would cover a story as though this is a gay disease when there are literally six, maybe seven, cases. Who does this article serve at this point? The reporter took something that is peer-to-peer advocacy and put it on a community and events. That is simply not OK.” That’s a very different perspective on the story that we published, and I think there are some important issues in those comments.

Let me turn to you, Max. See if you can walk me through why this story would be such a touchstone for those emotions that we just heard about and help me understand.

Max Disposti: Thank you, Jeff. Thanks everyone for the opportunity, and obviously I speak for what I see in the community. The LGBTQ Center is an agency that provides services and resources to LGBTQ people, including clinical services and testing. We’ve done a lot of vaccinations around COVID and so forth, just to give context for the people who are listening about why I’m even here.

The issue is definitely the context. It’s not about a particular word in the article, it is the context. We have to be extremely careful because, you know, the AIDS time — I’m not trying to compare this epidemic to what happened, but the price our community has paid throughout the past 40 years about the stigmatization of an infection. We know more around the LGBTQ community because a lot of our folks get tested a lot because we do a lot of public health information within the LGBTQ community. So, we have data that comes from Pride and from LGBTQ experiences. We can say, “Hey, we have five infections; now we have 40 infections.” There is nothing wrong with sharing public data; they actually are useful to the population. But the context is more what we don’t say than what we said.

I’ll give you an example: We just came out (of a series) — I’m just talking about San Diego County — of Fourth of July parties, community events, Comic-Con is coming up next week. So there are major events and major public gatherings, and there was never, ever a mention about the risk of monkeypox. We need to go back to the basics. This is an infection – it can obviously be transmitted through sexual contact, but not only through sexual contact, right? It looks like, at least in the last report I saw, skin-to-skin, so it could be really anything else beyond even sexual contact. But those are not the only experiences, the only places where people exchange interactions. The Padres games — and not to point out the Padres — but the games are, statistically, a breeding ground for trafficking, sexual experiences (legal or not). There is a lot going on around any public event. So to me, being silent about the dynamics on infection is worrisome. I’m glad that we have the first 600 vaccines, and at our agency we are doing our best to talk to our people, of course. But to pick Pride as the only event where we should be worried about (infection) just because we have these cases from San Francisco . . .

Again, this has to do with the relationship our community has established with public health because we had to take charge and ownership of our own health, so we are usually very ahead of the curve about telling our folks, “Do take care of yourself. This is how you do it.” We have conversations around affirming sex practices, for instance, and harm-reduction approaches that help the community. But this . . . conveys an idea that this is just something that only LGBTQ people need to be worried about. Now, I know that Pride is the biggest event in San Diego, so I know there was not an intention . . . I’m not blaming anyone that they had an intention to do that, but the stigmatization is already happening.

The county, perhaps, has a responsibility for having released that (with) bad timing because, again, we had this news in the past few weeks. It hasn’t come out as a public health issue and now it comes out a few days prior to Pride. Again, the intent of the county was to inform, prevent and support people. I know there was not ill intent. But at the same time, you see how the perfect storm here has caused an idea where our people are terrified, besides the terrifications of LGBTQ Pride events having been targeted by right-wing supremacists throughout the United States, so we have issues of people that are telling us “I cannot go. I’m afraid.” We have that level of fear and isolation, and now we have this. So, the context is really important. Again, we haven’t spoken about monkeypox (regarding) any of these public events that just occurred a week ago and now we’re all creating a health crisis around it.

I think I’m concerned about monkeypox; I’m glad that we have vaccines already. I would maybe focus on why only 600 (vaccines). Why – since we know so much – why can’t we provide 60,000 or whatever the number is? Maybe we can have a conversation around that. Instead, the focus has been sending out the release, Pride is happening . . . And people — the people that are not LGBTQ people — automatically are associating monkeypox with the LGBTQ community, and you can’t take away that association unless you do education. So, it sets us back in the conversation because now we have to explain, “Hey, by the way, this is not a gay infection.” And that’s the concern that the community is experiencing right now in relation to that sharing.

Jeff Light: And I do think, Max, the context of the kind of threat that the LGBTQ community is under, generally, right now is also very important. Lora Cicalo, let me let me turn to you for a moment because I thought one of the interesting points made in that email that I was reading was we, as a media organization, took a peer-to-peer effort and then we transformed it into a public issue. Talk to me a little bit about how we handle in-group speech versus out-group speech and the concept that the same facts mean different things to different people and how we handle that as journalists.

Lora Cicalo: Well, that’s exactly what I was going to say – that the same set of facts could have very different meanings and implications to various groups and to various people. And, as Max was just saying, the context of this information – these set of facts – is critical, as it always is. We deal with issues of in-group and out-group communication and speech all of the time, in various ways, in the reporting we do, and I think it’s really critical that we keep that in mind and that we reflect on – as we’re doing our work – what is (at least at its root) in-group conversations and communication versus out-group. I don’t want to speak for Paul or his editor, Tarcy, but I think perhaps part of the complication around this story was that what may have – on one level – been in-group speech also became a public notification around the vaccines being made available, and I think that was a conscious effort on the part of the county so that information was distributed as widely as possible. So, yes, there is in-group conversation going on about this. I think the awareness on Paul’s part was because the county was making it a very public notification and that is different. And I think on our part, we have to recognize both levels of communication there – that there was an in-group element to this that maybe we weren’t as aware of or sensitive to or cognizant of initially.

Jeff Light: And just to put a plainer face on that, I guess what we’re talking about there is the work that in this case, Pride and county public health people might have been doing together – “Hey, let’s work together because we’re good stewards of the public health, both of us” – is a different context than, “Hey, community, there’s this vaccination program around Pride,” which then touches on these toxic fault lines in a traumatized community about how they will be perceived in the general community. So that’s what I meant by those same facts, but very different meaning of those two contexts.

Lora Cicalo: Right. And one thing that Max mentioned that I also think is important is yes, the incidents of this are rare in San Diego County – there are six known cases – but I was also conscious of the fact that there’s been discussion in other cities – especially around vaccines – that characterizing this as rare also has some risk. Again, same set of facts, but those could be interpreted very differently and is it stigmatizing or marginalizing to treat this as such a rare thing and potentially miss a larger story?

Jeff Light: And certainly all sorts of risk around “Oh, things that we’re afraid to talk about” in the public health realm that also has very bad consequences.

I wanted to get back to Tarcy and Paul. So, Tarcy, after we started getting feedback on the story, we had some conversations about “Ah, we may have missed some layers of context that are pretty important in this story.” I just thought maybe you could address how we tried to improve the story or what other reporting went into it or your thoughts generally on this difficult topic?

Tarcy Connors: Our approach was we got a release from the county regarding what they said was a public health matter. That was our initial approach going in. The county talked about collaborating with Pride and other organizations, and I think that’s where we sort of tripped up to a degree – was the county saying, “We’ve been having conversations,” so that there was this implication that they had buy-in from the LGBTQ community.

Jeff Light: Buy-in on the programming or buy-in on publicity?

Tarcy Connors: Publicity, yes. And Fernando spoke to that. But again, I didn’t go beyond that. I looked at it as purely a public health issue, as opposed to looking at the larger ramifications of reporting on that. I mean, I think our reporting was correct. I think I can certainly understand how others would have perceived it as being very narrow and not attempting to understand the community. I’m keenly aware of the stigma that accompanied the AIDS epidemic that does, indeed, persist today. And that actually was in the back of my mind as we were doing this story. And Paul and I genuinely were trying to avoid doing just that. Unfortunately, we didn’t succeed. We tried to get more voices to weigh in on that. We went back to the county to try to get them to explain their reasoning about how they went about it. Did they make any effort at all to avoid stigmatizing the community? So we did go back and try to gain a greater understanding of how we could have done better. Were we really hearing all of the voices that needed to be heard and to give it all of the context that Max has raised?

Jeff Light: Paul, you were trying to jump in earlier.

Paul Sisson: I would note that you cited one voice that was critical of this story. You know, another organization – The Center – when I asked them to comment on it they said, “Hey, great story. We really liked it.” So, characterizing this as the entire community is homogenously feeling like this approach was stigmatizing, I don’t know if that’s entirely accurate. And here’s another point that I wanted to make: You know, before I wrote this story, I cashed it out. I did what I could. I mean, we got this interview with the county at 4, the press release came out at 5, so there just wasn’t a lot of time between then and deadline to write this story. And I wanted to make sure that I tracked down somebody from the LGBTQ community to comment in this story. And that takes a little time; you’re frantically calling as many people as you can think of to get somebody to comment on deadline.

I did see this story that was published last week by the LA Times that talked about this very stigmatization issue. I also listened to some of the first updates that the CDC did – the calls where reporters can call in – and as far back as May they were indicating that the epidemiological data was indicating that these monkeypox infections, in fact, are occurring mostly in the MSM community, that there is data to suggest that these infections are, to a large extent, occurring in this population and associated with these specific events. And here’s something that the LA Times said, they quoted a gentleman who was an activist named Weinstein: “I understand the concern about stigmatizing gay men. But if our concern about not stigmatizing these groups trumps actually informing them, that’s a major problem.”

Jeff Light: I think that goes right to the very dilemma at the heart of the story. Of course, I think the question really might be more “Informed how and by whom?” So, in this case, Pride has an entire campaign running to inform attendees of these public health concerns. That might be different than using the Union-Tribune or how the Union-Tribune may have handled the material. I think both things could be true.

Max, I’m going to give you the last word on this. It looked like you had something to say as well.

Max Disposti: I appreciate the conversation because I know there is a lot of work that goes on behind this, and I don’t mean to disregard or discard the work and the thought process behind it, so I’m not here to accuse anyone of intentionally doing anything, but we do need to take the responsibility of two facts: One, the country has chosen the wrong time. And again, this is not about not informing the public or not making a big deal about a risk. I remind you that we are public service providers; we are educating the community even when nobody else is talking about it. So, it’s definitely always been our responsibility in the past 40 years. Paul, I don’t mean to disregard what you say about the communication you had with the San Diego LGBTQ Center; I don’t know who you spoke to, but I know this conversation has been had over and over and over in any crisis and our leaderships are really strong together, so usually we’re connected with the community and we know when we speak up that it is quite representative of the people that are doing this work in the community. Of course, every gay person can have a different perspective.

This is not about “Don’t tell the news story because I don’t want to be stigmatized.” It has nothing to do with that, and to me, asserting that runs another risk that tells us “Oh, let’s put it under a rack because we don’t want to compromise this event or that event.” This is absolutely not (the case). Because we are the ones bringing these concerns in the frontline, even when actually the straight community is highly affected by HIV infection, yet they are not doing their own job to educate people and we take the responsibility and the stigma to carry on – as a world disease, which, as you know, affects (more) heterosexual people versus LGBTQ people in the rest of the world. So that’s one thing. The second, we have a meningitis crisis, for instance. Meningitis, which is airborne and so can be spread really easily in any context, is actually very deadly. Yet we had situations even in LA between the LGBT community; we took over in charge of that epidemic like two years ago, just prior to COVID. We did our job to inform everyone. The way we did it was not stigmatizing. It was not perpetuating the stigma that this is just happening to us. We know that it’s happening to everyone, but we’re taking care of the community.

So, I’m a little bit concerned about the narrative of trying to justify something that the county did wrong, in my opinion. Again, it was the wrong time. Why didn’t the county come out with a public announcement two weeks ago, with all the Fourth of July celebrations? Why hasn’t the county come out (with an announcement) with all the games that we have in San Diego? It was the wrong time. To me, again, the intention was not to harm. I totally agree. I understand. But the timing was wrong. And if the press doesn’t understand the context — it’s not about not repeating or sharing the information, it’s understanding and doing a little bit more work and saying, “Hey, this is one of the biggest celebrations coming up, but this is not just about Pride. What are we doing in the schools . . . for preventing this when colleges are going to open in August, for instance?

The conversation was very dry, very direct, and once again, restigmatizing, even though the intent was absolutely not done in that direction. I’m a little bit concerned that we are still giving for granted that this is just happening in the LGBTQ community, even though the data shows that. The MSM community, by the way, is men having sex with men, which also includes straight people by the way, and that’s why there is a designation MSM, because there are a lot of people who don’t identify as LGBTQ that have sex with people of the same sex. So, that’s a huge community that doesn’t even go to Pride, right? And so we are using that terminology with no understanding of what it means, when in reality it has to do with a population that is usually in the closet, that maybe is married — in a heterosexual marriage — and so forth. There’s a lot to say around that, and you see how trying to simplify the message causes the problem that we witnessed in the past few days. Thank you for the opportunity, and I’m sorry if I took too much time on that.

Jeff Light: No, not at all. I thought it was very well said, Max, and I think you really got at the essence of the issue at hand here, which is as journalists, we do simplify. The virtue or the value of journalism is out of complexity, clarity. That’s the goal. But I think the other challenge in simplifying is — the other essential part of journalism is — understanding events from many different perspectives, genuinely presenting, exploring and understanding what things mean to different people from different points of view. And that’s something that we’re constantly learning, and I think there are lessons learned in this story.

I really want to thank all of you for taking the time to talk about it.