Guess which three? California, Illinois, and New York. This is a disease spread almost entirely by sexual contact. It is largely men having sex with men (MSM, the new less judgmental form of the word "homosexual"). This has been known for some time. There are advantages to changing sexual partners less often than you change your socks. The spread of an STD increases with the square of the frequency of different partners per time period. Four different partners a month increases the incidence by 16x. Four a day is a bit worse.
I know that there are gay men who do not spend hours each day at "glory holes," but there are enough that AIDS, syphilis, and now monkeypox are very disproportionately MSM problems. It is really sad, but sexual fidelity (or at least keeping the number per week down) has some real advantages.
