Monkeypox is a zoonotic disease and leads to a smallpox-like disease in humans. The current epidemic in European countries requires informed responses. We investigated the ability to self-diagnose a potential infection, and determinants of vaccination and self-isolation intention after diagnosis among 394 MSM in the Netherlands. We found that about half were able to self-diagnose monkeypox, that 70% had a high intention to get vaccinated and 44% to self-isolate after monkeypox diagnosis. Determinants went beyond mere risk behaviour criteria.

The current monkeypox epidemic is most prevalent among men-who-have-sex-with-men (MSM). Vaccination programs are being rolled-out to curb the epidemic. Behavioural measures have been called for as well, e.g., by the WHO to reduce the number of sexual partners and sexual activity. We investigated intentions and determinants among Dutch MSM to follow such measures. Early July 2022, 394 MSM answered an online questionnaire. The overall intentions to reduce number of partners and sexual activity was high, but only a minority had developed definite intentions. Determinant analysis revealed that dating/open relationship status was a positive predictor, vaccination intentions did not predict sexual behaviour change; those not on PrEP were more likely to change their sexual behaviour. Monkeypox infection concern was negatively related to weaker intentions and only predicted definite intentions. Our results show that additional public health measures are necessary to reach and convince MSM to engage in sexual behaviour change.

The current monkeypox epidemic is most prevalent among men who have sex with men (MSM). PrEP users and MSM with HIV (MSMHIV) are considered at highest risk of monkeypox infection in the Netherlands, and are being targeted for monkeypox vaccination. Together with the epidemiological evidence, perceived concern and risk are also relevant for decision making about health behaviour, e.g., vaccination uptake. It is thus timely to examine which subpopulations among MSM consider themselves to be most at risk and are most concerned about monkeypox. This study aimed to help determine if the current measures to curb the epidemic are successfully targeted or not in the Netherlands. We conducted an online survey among 394 MSM living in the Netherlands. We first calculated the prevalence and standardised prevalence ratio (SPR) of high perceived monkeypox concern/risk by PrEP-use and HIV status. We then conducted two multivariable logistic regression analyses to investigate perceived monkeypox concern/risk and their potential socio-demographic/behavioural/health/psycho-social determinants. Among the included MSM, 52% showed high perceived concern about and 30% showed high perceived risk of monkeypox infection. PrEP users (SPR = 0.83) showed a significantly lower chance of perceived concern; in addition, MSMHIV (SPR = 2.09) were found to have a significantly higher chance of perceiving high risk of monkeypox infection. In the multivariable logistic analyses, non-PrEP users (aOR = 2.55) were more likely to perceive higher concern, while MSM who were retired (aOR = 0.23) and who had had chemsex recently (aOR = 0.63) were less likely to perceive higher concern. MSMHIV (aOR = 4.29) and MSM who had an unknown/undisclosed HIV status (aOR = 6.07), who had attended private sex parties (aOR = 2.10), and who knew people who have/had monkeypox (aOR = 2.10) were more likely to perceive a higher risk for monkeypox infection. We found that high perceived risk (aOR = 2.97) and high perceived concern (aOR = 3.13) were correlated with each other. In sum, only one-third of MSM living in the Netherlands considered themselves at high risk of monkeypox infection, and only half of them reported high concern. We identified a potential discrepancy between “actual risk” and perceived risk of and concern about monkeypox among MSM in this early stage of the monkeypox epidemic in the Netherlands, especially among PrEP users and MSMHIV. More refined public health communication strategies may be needed to improve the understanding and knowledge of the “actual risk” of monkeypox infections among MSM sub-populations, to facilitate health behaviour uptake.

Monkeypox is a zoonotic disease and leads to a smallpox-like disease in humans. The current epidemic in European countries requires informed responses. We investigated the ability to self-diagnose a potential monkeypox infection, and determinants of vaccination intention and self-isolation intention after exposure among MSM in the Netherlands. We found that about half were able to self-diagnose monkeypox, that 70% had a high intention to get vaccinated and 44% to self-isolate after monkeypox exposure. Determinants went beyond mere risk behaviour criteria.

The current monkeypox epidemic is most prevalent among men-who-have-sex-with-men (MSM). PrEP users and MSM with HIV (MSMHIV) are considered having the highest risk for monkeypox infection in the Netherlands and being targeted for monkeypox vaccination. Next to the epidemiological evidence, perceived concern/risk are also important in decision making about health behaviour uptake, e.g., vaccination uptake. It is thus relevant to examine which subpopulations among MSM consider themselves most at risk and most concerned about monkeypox. This study aimed to investigate this to complement and to help determining if the current measures to curb the epidemic are successfully targeted or not in the Netherlands. We conducted an online survey among 394 Dutch MSM. We first calculated the prevalence and standardised prevalence ratio (SPR) of high perceived concern/risk of monkeypox by the PrEP-use and HIV status. We then conducted two multivariable logistic regression analyses to investigate the perceived concern/risk of monkeypox and their potential socio-demographic/behavioural/health/psycho-social determinants. Among the included MSM, 52% showed high perceived concern and 30% showed high perceived risk of monkeypox. PrEP users (SPR=0.83) showed a significantly lower chance of perceived concern; and MSMHIV (SPR=2.09) were found to have a significant higher chance of perceiving high risk of monkeypox. In the multivariable logistic analyses, non-PrEP users (aOR=2.55) were more likely to perceive high concern, while MSM who were retired (aOR=0.23) and who had chemsex recently (aOR=0.63) were less likely to perceive high concern. MSMHIV (aOR=4.29) and MSM who had an unknown/undisclosed HIV status (aOR=6.07), who had attended private sex parties (aOR=2.10), and who knew people who have/had monkeypox (aOR=2.10) were more likely to perceive high risk of monkeypox. We found that a higher perceived risk (aOR=2.97) and a higher concern (aOR=3.13) of monkeypox were correlated with each other, more results see Table 2. In sum, only one-third of Dutch MSM considered themselves at a high risk of a monkeypox infection, and only half of them showed a high concern. We identified a potential discrepancy between the "actual risk" and the perceived risk and concern of monkeypox among MSM in this early stage of the monkeypox epidemic in the Netherlands, especially among PrEP users and MSMHIV. More refined public health communication strategies may be needed to improve the understanding and knowledge of the "actual risk" of monkeypox infections among these MSM sub-populations to encourage and facilitate an improved health behaviour uptake.