With over 7,500 confirmed monkeypox cases nationwide, some public health experts warn that college students may be at higher risk, and are appealing to school administrators to respond to what the Biden administration declared on Aug. 5 as a public health emergency. While the University has yet to issue any public statements regarding monkeypox, University Health Services (UHS) officials told The Daily Princetonian that preparations for a potential outbreak are currently underway.
Still, the University’s silence on the issue thus far, some at-risk students told the ‘Prince,’ has contributed to growing anxiety ahead of the fall semester — anxiety that, for some, has spurred direct action.
Confirmed cases of monkeypox remain low relative to the region, but are on the rise in New Jersey. As of Aug. 4, Mercer County had five reported cases. Outside of the state, the virus has cropped up on college campus: according to NPR, Georgetown University, the University of Texas at Austin, and West Chester University all recorded at least one confirmed case over this summer. And while many universities remain silent on the issue, some have issued statements or protocols on the disease.
The virus, which causes a rash, fever, chills, and other flu-like symptoms, has predominantly impacted men who have sex with men (MSM), according to the Center for Disease Control (CDC).
For Philip Maruri ’23, who identifies as a gay man, this year’s final weeks of summer have been overshadowed by daily fear and frustration.
“I am both surprised and disappointed that Princeton has yet to comment on the outbreak nor provide details of its plan to combat spread,” Maruri wrote in a July 28 email to University Global and Community Health and the Gender and Sexuality Resource Center (GSRC). “With such a pressing issue, especially to members of the queer community, it is frightening that no such action items have been announced, especially considering the University’s commitment towards equity and inclusion.”
Ninety-five percent of confirmed cases in the latest outbreak are suspected to have spread through sexual contact between men, according to a late July study in the New England Journal of Medicine. Widely publicized statistics like these, coupled with what some have described as homophobic sensationalism have fueled misconceptions about the disease.
“You’ll hear people say it’s an STI spread only through gay sex,” Maruri said in an interview with The Daily Princetonian. In fact, anyone with close contact to an infected individual — sexual or otherwise — is susceptible.
Without proactive and sensitively crafted messaging from the University, Maruri and other students fear that LGBTQ+ students could face undue blame or backlash should the disease spread on campus.
Approaching messaging: avoiding stigma
Assistant Professor of Gender and Sexuality Studies Catherine Clune-Taylor weighed in with concerns of her own. Her research focuses on how socio-political influence can lead to adverse health outcomes in marginalized groups. In her view, the national response to monkeypox, to date, shows “that we have learned very little” from the COVID-19 pandemic and the associated discrimination targeting Asian Americans.
“[T]he association of a virus with an already stigmatized group only exacerbates that stigmatization,” she wrote in an email to the ‘Prince.’ “All of this can serve to negatively shape health outcomes.”
Speaking generally to public health communications about monkeypox, she warned against any messaging that explicitly targets MSM.
“Targeted public health messaging can be quite important and strategically very useful, particularly when certain populations might be at higher risk than others,” she wrote. But deploying more targeted messaging runs the “risk of infection for the rest of the population by cultivating their ignorance regarding the virus,” she continued.
The CDC has stated that communicating risk to MSM while safeguarding against stigma are challenging priorities to reconcile. In the meantime, some students said they feel the University’s silence is sending a message of its own: for now, it’s up to students to protect themselves.
The most impacted: Queer student-led advocacy and education
Informal communication channels used by members of the queer community at Princeton, including a GroupMe affiliated with the Pride Alliance, have served as a forum in recent weeks for exchanging monkeypox-related information and support, several students in those channels told the ‘Prince.’
Max Peel ’25, who identifies as bisexual and non-binary, recalled reading a chat message from Maruri that encouraged people to reach out to University administration and demand action. This prompted others to share resources on monkeypox vaccination schedules and clinic locations across the country.
“From talking to people in the [queer] community, I think the general sentiment is that people are fairly worried,” Peel said. “A response that effectively communicates that it’s up to you to avoid getting sick, is what a lot of us fear.”
Peel mentioned being worried about “how stigma could be perpetuated.”
“Princeton is on the whole a very welcoming and tolerant environment, but there’s always the fear that this will be painted as a queer disease, when it’s not,” Peel said.
Beyond concerns about stigma, some students said they feel a general pessimism about the University’s approach to monkeypox. They voiced concern that the administration would replicate its approach to COVID-19, which left some students feeling isolated, under-supported, and burdened by a sense of personal responsibility for their infection.
“What people are most concerned about is that the University is going to have a similar response it did with COVID-19, where it’s up to individuals to reduce the spread and avoid getting sick,” Peel added.
In contrast to COVID-19’s five-to-ten day isolation period, monkeypox is contagious until a patient’s rash heals in full, generally a two-to-four week recovery period.
“The isolation period is significant,” said Maruri. “If you’re having symptoms, it’s possible you won’t be able to sleep or use the restroom. This can impact you socially, academically, and professionally.”
Griffin Maxwell Brooks ’23, who identifies as non-binary, expressed similar concerns.
“Getting sick could functionally ruin a semester,” Brooks said. “Imagine if you have a thesis that requires you to be in a lab. For some students there’s no way to get around that.”
Brooks and Peel among others acknowledged that many of the issues surrounding the monkeypox virus are beyond the University’s control. National vaccine shortages and the duration of infection, for example, will not be solved by either UHS or Environmental Health and Safety (EHS).
Still, Peel argued, while certain solutions may be out of reach, there are still important steps the University could take to support the student body.
“Publicly acknowledging monkeypox would signal that the University is aware of the issue, at a bare minimum,” Peel said. “I think an announcement or statement would alleviate a lot of fears.”
Maruri said he did hear back from the University within a day of his July 28 email. While he expressed appreciation for their prompt response, Maruri said his communications with the GSRC and Global and Community Health left him with the impression that discussions of a University response to monkeypox had been limited, if any were going on at all.
Yet to be seen: A quietly crafted response
Behind the scenes, however, University officials said plans are in the works. Robin Izzo, Assistant Vice President of EHS, told the ‘Prince’ that the University Emergency Management Group’s public health response team is “updating its planning” for a potential outbreak.
According to Dr. Irini Daskalaki, an infectious disease physician at University Health Services who led the University’s response to COVID-19, new protocols are being put in place to collect and process samples from symptomatic students.
UHS staff are also developing educational materials on the virus, which will be available to advise students on potential symptoms, exposure risk, or acquiring the vaccine, officials said in a statement.
There are currently five active vaccination sites in New Jersey, with Cooper University Hospital in Camden being the closest to Princeton’s campus and North Jersey Community Research Initiative in Newark possibly the most accessible via public transit.
The GSRC has provided support to both UHS and EHS in these ongoing efforts, offering counsel on how to avoid further stigmatization of LGBTQ+ students in an outbreak response.
“While [MSM] and trans women communities have experienced a greater likelihood of exposure to the monkeypox virus, it is indiscriminate,” GSRC Director Kristopher Oliviera told the ‘Prince’ in an email.
As health authorities predict that college campuses could become hotspots for viral transmission this fall, it remains to be seen whether the disproportionate infection rate among MSM will replicate in the university environment.
When it comes to a virus that spreads through close contact, a college student’s lifestyle is hardly conducive to best mitigative practices, as some health experts have noted. Active sexual networks, shared living spaces, and crowded nightlife venues put college campuses at heightened risk of outbreak. Dr. Jay Varma, an epidemiologist at Weill Cornell Medical College, told NPR that close-contact areas like locker rooms, gyms, or even theater groups will be important to watch on campuses.
The return to campus itself has the potential to be an exacerbating event. With move-in just weeks away, many Princeton students will travel from major U.S. cities, including national epicenters of the virus.
New York, California and Illinois were the first three states to declare a state of emergency due to monkeypox outbreaks, ahead of the federal government’s declaration on Aug. 5, and continue to lead in reported case counts, according to the CDC.
Tess Weinreich is an Assistant News Editor and features contributor for the ‘Prince.’ She can be reached at firstname.lastname@example.org.