Mpox (monkeypox) knowledge, concern, willingness to change behaviour, and seek vaccination: Results of a national cross-sectional survey

Abstract

Objectives: To assess knowledge and concern about monkeypox, acceptability of behavioural changes to reduce transmission risk, and willingness to be vaccinated among gay, bisexual and queer-identifying men and non-binary people. Design: National, online cross-sectional survey with convenience sample, August-September 2022. Participants were recruited through community organisation promotions, online advertising, and direct email invitations. Participants: Eligible participants were gay, bisexual or queer; identified as male (cisgender or transgender) or non-binary; aged 16 years or older; and lived in Australia. The completion rate was 70.76% (2287/3232 of those who started the survey). Main outcome measures: Participant characteristics; knowledge and concern about monkeypox; recognition of monkeypox symptoms and transmission routes; vaccination history; acceptability of behavioural changes to reduce monkeypox risk, and willingness to be vaccinated. Results: Of 2287 participants, most participants were male (2189/2287; 95.71%) and gay (1894/2287; 82.82%), nearly all had heard about monkeypox (2255/2287; 98.60%), and most were concerned about acquiring monkeypox (1461/2287; 64.42%). Most of the 2268 undiagnosed participants identified skin lesions (2087; 92.02%), skin rash (1977; 87.17%), and fever (1647; 72.62%) as potential symptoms, and prolonged and brief skin-to-skin contact as potential ways to acquire monkeypox (2124, 93.65%; and 1860, 82.01% respectively). The most acceptable behavioural changes were reducing or avoiding attendance at sex parties (1494; 65.87%) and sex-on-premises venues (1503; 66.40%), and having fewer sexual partners (1466; 64.64%). Most unvaccinated and undiagnosed participants were willing to be vaccinated (1457/1733; 84.07%). Conclusions: People at risk of monkeypox should be supported to adopt acceptable risk reduction strategies and seek vaccination as supply increases.

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022–2023 UK mpox outbreak

“…It was not deemed ethical to encourage participants into revealing sensitive health information during the workshops as their confidentiality could not be guaranteed, however it is acknowledged that this information could have been gathered using other methods. This could be a limitation, since lived experience of an illness can shape and individuals' perception and experience of stigma [56. We do not know if bisexual participants were represented in the workshops, which is another factor that could shape mpox vaccine willingness [57]. Finally, when assessing the high demand for the mpox vaccine, there may be other factors than those outlined in this paper, such as perceived scarcity, which was shown to increase demand for COVID-19 vaccines in Germany [58].…”

How Australia and Aotearoa New Zealand avoided large‐scale mpox (formerly monkeypox) outbreaks in 2022–2023

“…In addition, the GBMSM community, being well-informed, responded to the mpox outbreak by temporarily changing sexual practices, which is likely to have had a significant impact on transmission rates. 31 This collaborative framework subsequently enabled rapid delivery of mpox vaccines when these became available in Australia, and in NSW, an estimated 65-70% of those at most risk had at least one vaccine, with 77% of those receiving two doses (personal communication, P. Read). This compares favourably with other jurisdictions; for example, data from the United States found that only 33% of surveyed GBMSM received at least one dose.…”

“…33 Active collaboration with the community was also key to engendering trust in public health responses, so that case isolation, contact tracing and surveillance could be implemented most effectively, and to ensure that the initially scarce vaccine supply was delivered to people at highest risk of mpox, while the rest of the GBMSM community waited patiently for larger supplies to become available, despite high levels of mpox-related concern. 31 Another crucial aspect of the mpox response was the rapid and coordinated multilateral sharing of information between various levels of government and the community, clinical and research sectors, by utilising infrastructures developed during the HIV response. These infrastructures included public sexual health clinics, governmentfunded community organisations such as HEM and its member organisations, and government-funded clinical support institutions such as ASHM.…”