Survey of pain and stigma experiences in people diagnosed with mpox in Baltimore, Maryland during 2022 global outbreak

The role of RCCE-IM in the mpox response: A qualitative reflection process with experts and civil society in three European countries

BACKGROUND

Risk communication, Community Engagement and Infodemic Management (RCCE-IM) is a central pillar of emergency management. This study explored the experiences of experts and key stakeholders on RCCE-IM in the 2022-23 mpox response in their countries.

METHODS

We used an exploratory qualitative research design and conducted semi-structured interviews with people actively involved in the mpox response in their country. Content analysis was used to analyze the interviews and identify themes, patterns, and underlying concepts.

RESULTS

A total of 19 participants from Poland, Serbia and Spain were included in the study. RCCE-IM activities were broad-based, involving civil society organizations (CSOs) and affected communities in the co-creation and co-delivery of health information and advice, and ensuring that non-discriminatory language was used. Attitudes towards affected lesbian, gay, bisexual, transgender, queer or questioning, and intersex (LGBTQI+) communities played an important role in the response. Participants reported that stigma was present in all three countries and that it was often influenced by challenging social and political dynamics. These attitudes were often reinforced by the media. RCCE-IM activities were influenced by the ease or difficulty of obtaining financial support and the availability and accessibility of countermeasures, including vaccines. Participants identified groups that were vulnerable and difficult to reach and emphasized the intersectional character of vulnerabilities. CSOs played an important role in advocating for the protection of people in vulnerable situations and linking them to health services.

CONCLUSION

We have been able to demonstrate good practices and challenges of RCCE-IM in the mpox response in three selected European countries. A pre-existing network of CSOs and experts who belong to, serve and have an understanding of the affected communities form the basis of a successful public health emergency response.

Mpox-related stigma and healthcare-seeking behavior among men who have sex with men

The 2022 global mpox outbreak highlighted significant public health challenges, with men who have sex with men (MSM) accounting for 86.7% of confirmed cases. As a high-risk group, MSM faced not only the direct health impacts of mpox but also an additional burden of stigma and discrimination, which severely hindered their willingness to seek care and access timely medical services. This article explores mpox-related stigma and discrimination and their profound impact on healthcare-seeking behaviors among MSM, drawing on evidence from global studies. We examine how stigma affects individual decision-making and has broader public health implications by exacerbating healthcare delays during the outbreak. In response, we propose actionable strategies to mitigate stigma, including providing accurate and responsible communication, strengthening community and social support network, building capacity for frontline workers, and engaging affected individuals for effective intervention. By integrating stigma-reduction measures into pandemic preparedness and response, public health systems can better support vulnerable populations, improve healthcare access, and ensure a more effective response to future outbreaks.

"I Know They're Going to Weaponize This:" Black and Latino Sexual Minority Men's Mpox-Related Sexual Behaviors, Stigma Concerns, and Vaccination Barriers and Facilitators

BACKGROUND

The Mpox epidemic disproportionately impacted Black and Latino sexual minority men (BLSMM) in the United States, with them having the highest prevalence of disease and the lowest rates of vaccination. Despite this disparity, BLSMM perspectives on the disease, Mpox-related stigma, and inequitable rollout of and distrust in the Mpox vaccine are absent from the literature. The present study aims to describe experiences with Mpox-related sexual behaviors, stigma, and vaccine barriers and facilitators among a sample of BLSMM living in both California and New York.

METHODS

In this qualitative interpretive phenomenological study, we utilized semi-structured individual interviews as the primary source for data collection. Data was collected between August 2021 and December 2022 from 41 adult participants in California and New York. Interviews were recorded, transcribed verbatim, and analyzed using thematic content analysis.

RESULTS

Participants ranged in age from 19 to 65 years, with the majority identifying as Black (73%) and male gender (93%). Overall, participants' narratives revealed that initial messaging around Mpox produced stigma parallel to the HIV/AIDS pandemic with many participants curtailing their sexual behaviors as a harm reduction strategy. Mpox-related stigma negatively impacted sexual minority communities both internally and externally. Participants' narratives also revealed general vaccine skepticism due to existing medical distrust, negative vaccine experiences by other BLSMM, and lack of prioritization of outreach and distribution efforts in communities of color.

CONCLUSION

Alterations to vaccine administration protocols and outreach efforts for reasons identified in this study are critical to addressing disparities in vaccine uptake among BLSMM. Public health practitioners must consider equitable frameworks, existing stigmas, and medical distrust when engaging BLSMM.

Psychosocial impact and stigma on men who have sex with men due to monkeypox

Background

The recent Monkeypox (Mpox) outbreak has disproportionately affected men who have sex with men (MSM), amplifying stigma and discrimination. While prior research examined media portrayals and public perceptions, little is known about MSM's direct experiences. To address this gap, we assess discrimination, stigma, and psychosocial impact across social and healthcare settings.

Methods

A cross-sectional observational study was conducted using a structured, pilot-tested survey to assess discrimination against MSM in media, family, socio-occupational, and healthcare environments.

Results

Among 115 MSM surveyed, 81.7% observed discriminatory comments in media, while discrimination was noted in workplaces (41.7%), by family/friends (45.2%), cohabitants (15.7%), and healthcare (34.8%). Stigma significantly impacted healthcare-seeking behavior, with 33% avoiding medical care due to fear of discrimination. Psychologically, 50.4% reported low mood/anxiety, and 72.7% of those frequently fearing Mpox also experienced these symptoms. The outbreak led 71.3% to alter sexual behavior, primarily reducing encounters (60%). Fear of Mpox was strongly associated with behavioral changes (p < 0.001).

Conclusion

The Mpox outbreak has exacerbated stigma toward MSM, highlighting an urgent need for intervention. Authorities, media, and community leaders must disseminate accurate information and implement psychological support programs to mitigate stigma and its detrimental effects on MSM.

Development and validation of the mpox stigma scale (MSS) and mpox knowledge scale (MKS)

BACKGROUND

Few validated brief scales are available to measure constructs that may hinder mpox-related prevention and care engagement, such as knowledge and stigma. Both are highly salient barriers to infectious disease care and disease understanding, precursors to evaluating one's risk and need to, for example, accept vaccination. To address this gap, we developed and validated the Mpox Stigma Scale (MSS) and Mpox Knowledge Scale (MKS).

METHODS

As part of a full-scale clinical trial, we offered an optional mpox survey to participants who self-identified as African American or Black, were 18-29 years old, and lived in Alabama, Georgia, or North Carolina (2023, N = 330). We calculated psychometric properties through confirmatory factor analyses (CFA) and applied Comparative Fit Index (CFI), Goodness of Fit Index (GFI), and Tucker-Lewis Index (TLI) values equal to or exceeding 0.90 and Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) values less than 0.08 to determine adequate model fit. We computed internal reliability using Cronbach's alpha and calculated Pearson or Spearman correlation coefficients between the MSS and MKS and related variables.

RESULTS

For the MSS, CFA results showed that the one-factor model fit the data well (χ2(df = 5, N = 330) = 34.962, CFI = 0.97, GFI = 0.99, TLI = 0.94, RMSEA = 0.13, SRMR = 0.03). For the MKS, the one-factor model provided a good fit to the data (χ2(df = 6, N = 330) = 8.44, CFI = 0.99, GFI = 0.99, TLI = 0.95, RMSEA = 0.15, SRMR = 0.02). Cronbach's alphas were MSS = 0.91 and MKS = 0.83, suggesting good to excellent reliability. The MSS was correlated with the MKS (r = .55, p < .001), stigmatizing attitudes (r = .24, p < .001), attitudes towards mpox vaccination (r=-.12, p = .030), and worry about contracting mpox (r = .44, p < .001). The MKS was correlated with worry about contracting mpox (r = .30, p < .001) and mpox disclosure (r=-.16, p = .003).

CONCLUSIONS

The MSS and MKS are reliable and valid tools for public health practice, treatment and prevention research, and behavioral science. Further validation is warranted across populations and geographic locations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05490329.