LAUSR

Correspondence to Dr Yves Saint James Aquino; yaquino@ uow. edu. au © Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. In a press briefing held last 28 July 2022, the WHO’s Director General Tedros Adhanom Ghebreyesus urged men who have sex with men to reduce sexual partners/activities to help control the monkeypox outbreak. The statement was considered a major shift from initial WHO advisory, which included suggestions for ‘gay, bisexual and other men who have sex with men’ in a flyer published in 18 July 2022 that did not include explicit advisory on frequency of sexual activity or number of sexual partners. Current evidence shows monkeypox cases being identified in communities of gay, bisexual and other men who have sex with men who have had recent sexual contact with a new partner or partners (although the risk is not limited to these groups). However, critics have argued that public health messaging that specifically targets a marginalised group can undermine public health responses by hampering case detection, delaying symptom disclosure, discouraging healthseeking behaviour among targeted and currently marginalised groups. Some have proposed nonstigmatising approaches to public health messaging. 6 In the news, opinions are divided with some arguing that such targeted public messaging are homophobic, while others arguing the opposite. In this piece, we argue that the current public health advisories that target marginalised groups rely on conceptual ambiguities that undermine public health responses to the monkeypox outbreak. In addition, the pitfalls arising from such ambiguities are compounded by the historical and continuing prejudice against the lesbian, gay, bisexual, transexual, intersex, queer/questioning, and asexual (LGBTIQA+) community. In discussing the problem of targeted campaigns, we echo Oxman et al’s distinction between two interrelated functions of health communications during public health emergencies: to inform and/or to persuade. The informative function aims to communicate details about risks, areas of outbreaks and updates on treatment or prevention, among others. The persuasive function is action orientated and generally tends to extend the informative function to produce advisories, guidance or policies. Persuasive communications can range from implied recommendations (eg, encouraging washing hands) to explicit policies (eg, travel ban during pandemic). In the context of targeted campaigns, both informative and persuasive functions raise ethical issues, although in varying degrees. Public health statements from the WHO are considered normsetting advisories to governments around the world, and targeted campaigns, especially those that fulfil persuasive functions, must be carefully assessed as they may do more harm than good to marginalised sectors particularly with regards to issues of social justice and health equity. Summary box