By Shelby Asrianti, Ronggo Astungkoro, Rr Laeny Sulistyawati

JAKARTA — The number of positive cases of monkeypox or monkeypox (mpox) in Indonesia continues to grow every day. The Ministry of Health (MoH) confirmed there were three additional cases in the last 24 hours. One of the obstacles in preventing its spread is the evasiveness of homosexual groups known to be the largest contributor to cases of monkeypox in the country.

“The number of confirmed cases is 30 cases. One in Bandung, two in Tangerang Regency, two in South Tangerang, and one in Tangerang City. The rest is Jakarta,” said the Head of the Communications and Public Services Bureau of the MoH Siti Nadia Tarmizhi to Republika, Thursday (2/11/2023).

According to her, prevention efforts continue to be carried out by the ministry. However, the process of tracking cases of monkey pox is constrained by the spread occurring in specific communities only. However, the Ministry of Health continues to make educational efforts to high-risk groups and the general public to suppress the spread of cases of the disease. 

The provision of education and information is in the form of encouragement for those who experience symptoms of monkeypox to immediately get treatment and undergo isolation. Then, she said, the Ministry also provides education and information to those affected by symptoms not to have sexual intercourse. 'Immediately getting treatment and isolation and not having sex, 'Nadia said.

Nadia said that certain populations are associated with communities that have risky sex behaviors, namely lesbian, gay, bisexual, and transgender (LGBT). He acknowledged that certain populations were difficult to track because of their closed characteristics.

The Ministry of Health will strengthen surveillance or detection of active cases throughout health facilities in efforts to combat monkeypox. The Ministry works with communities or volunteers to reach out to homosexual and bisexual groups to be able to detect, especially seeking close contacts.

“We look into each case, we immediately carry out an epidemiological investigation and also set up a referral laboratory,” said Maxi Rein Rondonuwu, Director General of Disease Prevention and Control of the Ministry of Health.

He explained that a number of laboratories, such as the Central Hall of Health Laboratory belonging to the Ministry of Health, have the ability to check for monkey pox. That way, it only needs to distribute the associated reagents. The Ministry is also waiting for a whole-genome sequencing examination of a confirmed case of monkeypox to determine the type of virus variant.

In addition, the Ministry of Health also asks patients to conduct isolation and provide therapy. The average patient is isolated in hospital and indeed the treatment is more to supportive. Patients are also given antiviral drugs and antibiotics if symptoms are severe. “All the patients are currently in stable condition, so within one to two weeks the lesions on the skin begin to disappear and if the condition is good, the patient can be discharged,” he said.

In an effort to prevent, the Ministry of Health carries out vaccinations. The vaccine was prepared since the end of last year. The vaccine stock is currently only available at 1,000 doses for a target number of 477 people with two doses administered over a four-week span. Vaccine administration is prioritized in close contact with people with monkeypox and people with HIV.

100 per cent male

Dermatologist Dr. Hanny Nilasari said about 84.3 percent of monkey pox patients were men who had sexual contact with their partner and 6.5 percent identified as bisexual. “They are young, 31-40 years old. Its dissemination is through sexual contact and having risky sexual contact without a condom,” she said in a health webinar on Thursday.

Therefore, she said, health professionals need to inquire about a patient's sexual history if they suspect cases of suspected monkeypox. Symptoms of monkeypox are usually preceded by headache, followed by fever of more than 38 degrees Celsius and sore throat and enlarged lymph nodes, followed by the appearance of a rash after one or three days.

Consultant internist for tropical diseases and infections Robert Sinto said a World Health Organization study last year identified the vulnerable group as men who have sexual intercourse with men, as well as sexual workers. Monkey pox during this time was known to most affect males with an age range between 29-41 years existing in a sexually active period. In Indonesia, Robert said, 100 percent of people with monkeypox are men.

The gay community NGO Indonesia Positive Network (JIP) acknowledges that government socialization of monkeypox is still minimal. As a result, the homosexual community is less well educated regarding the disease. “The constraint of the homosexual community that has not opened the issue of monkeypox is because it has not been educated,” said JIP's advocate for health enumerator, Miko, when contacted by Republika.

He added that there are also parts of the gay community who understand the issue of monkeypox, but they are still afraid of getting stigmatized and discriminated against. Finally, they are reluctant to open up although in fact many members of the gay community already have an open mind.

Miko considers same-sex sexual activity no longer taboo, especially in big cities. However, he admits, monkeypox education to the LSL community has not been much. Finally, not all gay communities know about monkeypox yet. 

He exemplified, the enthusiasm of the educated and open LSL community can be seen when there was a vaccination against monkey pox at the health center in Gambir District, Central Jakarta, some time ago. Miko saw a great many members of the gay community who wanted to get vaccinated against monkeypox.

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