The conservative campaign against LGBTQ+ rights has found a new fixation for its hatred: monkeypox. On TV, rightwing commentators openly mock monkeypox victims – the vast majority of whom are men who have sex with men – and blame them for getting the disease. On social media, rightwing users trade memes about how the “cure” to monkeypox is straight marriage while casting doubt on monkeypox vaccines’ efficacy.

This aggressive stigmatization of monkeypox – reminiscent of the homophobic response to HIV/Aids in the 1980s – poses a serious challenge to public health advocates and community leaders trying to have honest conversations about the disease with the gay and bisexual men who are most at risk during the current outbreak. Should public messaging highlight the fact that monkeypox is primarily affecting men who have sex with men? And should public health bodies urge gay men to change their sexual practices?

The simultaneous threats of homophobia and monkeypox require making a difficult choice about which to tackle first, says the writer and veteran Aids activist Mark S King, a 61-year-old gay man.

“I’m about killing the alligator closest to the boat. And right now that means getting information to men who have sex with men about how to avoid this.”

Early in the outbreak, the Centers for Disease Control and Prevention (CDC) struck a cautious note in its communications about monkeypox, which causes painful lesions, fever, and other symptoms. On 18 May, the agency said that “cases include individuals who self-identify as men who have sex with men” while stressing “anyone, regardless of sexual orientation” could spread the disease. But an international study published on 21 July found 98% of recent Monkeypox cases outside of Africa were found in gay or bisexual men, with transmission suspected to have occurred through sexual activity in 95% of those cases.

That’s why King is aligned with an increasing number of US public health officials and advocates who believe the messaging around monkeypox needs to be brutally honest in communicating the risks to the population most affected – even if homophobes are going to pounce on it.

Last week, the CDC appointed Dr Demetre Dasklakis, a gay man and renowned Aids activist, as the deputy coordinator of its national monkeypox response. Days later, the agency published guidance for preventing monkeypox through safer sex that includes an illustration of two men in a bed. The article recommended people limit their number of sex partners, avoid anonymous hookups, and “wash your hands, fetish gear, sex toys” after having sex. It also suggested socially distanced or video masturbation as alternatives to sex.

Sex-positive public health messages like these have drawn scorn from conservative commentators.

“Chastity. Celibacy. Modesty. Disciplined. Not being gross. Keeping your legs closed. All viable options, people,” tweeted the Republican commentator Kathy Barnette in response to the CDC’s guidance.

“Still waiting for gay men who are having random sex with strangers during the Monkeypox outbreak to get lectured and scolded by public health authorities the way that the rest of us did for going to grocery stores and restaurants during Covid,” tweeted the Daily Caller’s Matt Walsh.

And in late July, Fox News’s Tucker Carlson tweeted a poll declaring that the disease should be renamed “schlong Covid”, tagging the CDC.

But King says these rightwing attacks are just a distraction. “We have to ignore that if we are to deliver an effective public message to the community that we care about.”

King contracted HIV in 1985 and remembers feeling frustrated over the lack of official acknowledgment of the toll on gay men. “How many years was it until our president said how many people died of Aids, before there was detailed, explicit language on how the virus was transmitted?” he says. “Fast forward to 2022, where we are at least getting all of this great, explicit information out about monkeypox so that gay men can protect themselves. I consider that progress.”

But not everyone in the queer community agrees on how to talk about the new outbreak. The prominent rights group Glaad has notably cautioned against framing monkeypox as a disease that primarily affects men who have sex with men in guidance issued to the media.

Framing monkeypox as a disease within the gay community will discourage other people from educating themselves on prevention, says DaShawn Usher, the director of communities of color and media at Glaad.

“If history has shown us anything, it would show us that a communicable disease like this doesn’t stay within one community,” he said. “Stigma drives fear, and fear then becomes resistance to public health and stopping the spread of the disease.”

Usher says the belief that monkeypox only affects some people might also discourage employers from offering accommodations for monkeypox, or prevent workers from disclosing that they have monkeypox for fear of being labeled or outed as queer.

There is also disagreement within the queer community about whether and how to discuss changing sexual behavior during the outbreak. Some health authorities’ suggestions that affected communities scale back their sexual activity while the US grapples with vaccine delays can sound uncomfortably similar to conservative attacks on gay culture.

Usher says that just telling people to abstain from sex would send the wrong message. “You could still contract monkeypox if you were to kiss someone that had an active case of monkeypox, or if you cuddled with someone without clothes on. I would just encourage people to understand all of the ways that it could be spread.”

King says he has received pushback within his community for telling others to consider dialing back their hookups. “I’m getting attacked by people who think that I’m contributing to the stigmatization of gay sex. My response to that is: you’re welcome to go back to whatever kind of sexuality suits you in a few weeks. The vaccines are on the truck. Give it a minute.”

The activist believes the best way to offer frank public health advice about sex is to remove any moral judgment. “We’ve learned through the last 40 years of HIV that moral judgments only help HIV,” he says. “Moral judgments shame the people who are most at risk, which leads to people going underground, not admitting what their behaviors are, and not wanting to talk about the risks.”

That’s not to say there isn’t room to discuss why gay men make the choices they do, King says. “But right now it is a completely worthless conversation when it comes to stopping the spread of monkeypox.”

King says it’s a mistake to think that avoiding the realities of monkeypox will reduce homophobic aggression – which has been increasing for many years. The number of anti-LGBTQ+ hate crimes reported have risen substantially over the last decade, federal hate crime statistics show. During that period, US state legislatures have passed an unprecedented number of anti-LGBTQ+ measures, with 2021 deemed the “worst year” ever by the Human Rights Campaign. Many US schools have banned LGBTQ+ books, and attacks on queer spaces are on the rise. In recent months, rightwing activists have stoked fears by promoting conspiracy myths that queer-friendly people are “grooming” children for sexual abuse.

“Those people tracking down queer men to bash, they have a pocket full of hatred on any number of issues that will lead them to pick up that beer bottle,” King says. “They might have new language to use while they’re bashing us over the head, but they would still be bashing us over the head.”