Infectious Diseases and Stigma

By Kimberly Shriner, MD, FACP

Medical Director, Infection Prevention and Control, Huntington Health

As if our past two and a half years of dealing with COVID was not enough, the director of W.H.O. has declared monkeypox a global health emergency.  In the last few weeks, this viral disease has spread around the world and is yet another example of the smallness of our planet and our vulnerability as a species. Monkeypox, which, like so many infectious diseases, is a zoonotic infection, harbored mostly in rodents (the name comes from a large outbreak in laboratory monkeys years ago) and in the same family as smallpox (variola). It has been endemic (and largely ignored by the rest of the world) in central and western Africa for many years. The familiar effects of globalization, international travel, environmental destruction, and climate change causing migration of wild animals to more hospitable ecosystems have contributed to the spread. 

Throughout history, infectious diseases create pandemics and prejudice.  When syphilis first emerged in Europe during the 15^th century it was called “the French disease” by England, Germany and Italy.  The French called it the “Neapolitan disease,” the Russians named it the “Polish disease,” the Polish, “the German Disease” and everyone else in the world blamed the “Europeans”.¹  In the end, like all infectious diseases, syphilis is a microbial pathogen that doesn’t care about the culture, gender, ethnicity, socioeconomic status, race, or sexual orientation of its host. It just wants to infect a nonimmune organism.

Unfortunately, like so many infectious diseases, monkeypox may also create stigma and isolation. As an infectious disease specialist whose career began in the late 1980’s, I have witnessed the consequences of ignorance, judgment, politicization and just plain meanness during the early days of the HIV pandemic. Infectious pathogens pose ongoing dangers to all of us, but it is not uncommon for them to be particularly damaging in marginalized and underserved communities.  This has nothing to do with the host and everything to do with limited access to care, cultural barriers, stigma, fear, and ignorance. If it were not for the grit, courage, and determination of “HIV activist groups” such as ACTUP and Shanti, the US government and the pharmaceutical industries may never have undertaken the research and policy development that has led to the virtual control, but not cure of AIDS around the world.  Tolerance and truth are not just important for societal growth, but they help control the spread of disease. Stigmatization and isolation can drive populations underground, not seek diagnosis and treatment and lead to further spread of the pathogen.

Although it can’t be said for all healthcare workers during those early and dark days of HIV, I never once saw hesitation among the Huntington Hospital staff to provide excellent and compassionate care for my patients. We all carry are own perceptions and opinions about the world around us.  So, let’s get this right from the beginning and going forward for all the future pandemics we face. We must stand up and show the importance of truth, equity, science, tolerance, and compassion in the face of emerging infectious diseases.

1. Tampa M et al. Brief History of Syphilis. J Med Life 2014 . March 15 . 7(1):4-10.

About Dr. Kimberly Shriner

Born and raised in Pasadena, Kimberly Shriner, MD, FACP, has been working to care for her community as an infectious disease specialist at ground zero in this pandemic. Dr. Shriner is also a tropical medicine specialist as well as the medical director if infection prevention and control at Huntington Health. She is Huntington’s leading physician regarding COVID-19 and has been an actively educating and informing the community throughout the pandemic.

Dr. Shriner efforts extend throughout the world. She was a pioneering specialist during the HIV/AIDs epidemic, and is the founder and director of Huntington’s Phil Simon Clinic providing complete HIV and infectious disease care for the underserved in the San Gabriel Valley. In 2001, she founded The Phil Simon Clinic Tanzania Project, a nonprofit, global outreach program in East Africa. The Project continues to be a platform for scholarship, post graduate training for Huntington’s staff and an amazing philanthropic experience for professionals in healthcare and supportive services.