YET CONSEQUENCES EXIST:

 "Even if we found a silver bullet for AIDS tomorrow, something else would come along." I wrote quickly to get distinguished psychiatrist Richard Pillard's exact words down as he spoke at Columbia University's HIV Center in the early 2000s. He ruefully admitted that the human immune system simply wasn't designed to handle the frequent introduction of bodily fluids from multiple sexual partners. Our research, therefore, was the "hope for the future" that would free people to engage in the range of behaviors they desired without the consequences. The body may have limits, but sexual behaviors shouldn't. Enter medical technology.

Fast forward two decades. Monkeypox has now emerged almost exclusively among men who have sex with men (MSM)--according to the largest global data releases to date, 97 percent of cases affect MSM. Wider transmission has occurred in settings where multiple-partner sex takes place, often among strangers, such as sex-themed festivals for gay-identified men. In an effort to avoid stigmatizing the population being affected, early reports on the outbreaks emphasized that monkeypox can be spread by skin-to-skin contact and sought to downplay the sexual-activity aspect of transmission. However, the emerging data are so overwhelmingly consistent that public health advice is now being revised. Less than 1 percent of global cases have occurred through skin-to-skin contact; rather, research indicates that "sex between men is fueling monkeypox."

In addition to containment and treatment, much of the public health discussion has centered around parallels between the HIV/AIDS epidemic, the troubled history of its handling, and its effect on the gay male population. I am reminded both of the AIDS crisis and the prediction that "something else will come along." But today, we've forgotten the harsh lessons about our bodily limits that HIV/AIDS taught us, and instead we embrace a sexual ethic of non-judgmentalism and autonomy. Monkeypox reminds us of our natural limits--and the consequences of ignoring them.

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