JMIR Publications

ABSTRACT

Background:

The 2022 multi-country mpox outbreak positioned the condition as a public health emergency of international concern, as declared by the World Health Organization. By January 2023 Brazil ranked second globally in cumulative number of mpox cases and deaths. The higher incidence of mpox among vulnerable groups such as gay, bisexual, and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against LGBTQIA+ communities and might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. However, there are no data available on mpox knowledge in Latin America.

Objective:

We aimed to evaluate mpox knowledge and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis among LGBTQIA+ individuals.

Methods:

This was a cross-sectional, internet-based survey conducted in a convenience sample of adults (>18 years) living in Brazil recruited through advertisements on dating apps (Grindr and Scruff), social media (Facebook and Instagram), referral institutions for infectious diseases websites and social medias (Instituto Nacional de Infectologia Evandro Chagas and Fundação Oswaldo Cruz), and radio, and mass media, from October to November 2022. We compared sociodemographic, behavior and clinical characteristics according to self-reported mpox diagnosis (yes vs. no) using a chi-squared test or Fisher’s exact test for qualitative variables and a Kruskal-Wallis test for quantitative variables.

Results:

We enrolled 6236 participants: 91.2% were cisgender men, 96.7% gay/bi/pansexual, 62.2% White, 78.7% had college education, and 73.0% reported low/middle income. Most participants reported perceiving mpox stigma towards LBGTQIA+ communities (84.4%). Mpox knowledge was 96.9%, and 95.1% were willing to get vaccinated for mpox. Overall, 5.2% reported a mpox diagnosis. Among these, 98.1% reported lesions, 56.0% local pain, and 99.4% sought healthcare. Among participants not reporting a diagnosis, 84.1% knew the condition, 4.9% had a suspicious lesion, but only 54.9% of these had sought healthcare. Compared to participants with no diagnosis, those reporting a mpox diagnosis were younger (34[IQR:30-39.2] vs. 37[IQR:31-44] years, p<0.001), had more sex partners (10[IQR:5-20] vs. 4[IQR:1-10], p<0.001), more frequently reported sex partners with mpox (34.6% vs. 3.5%, p<0.001), HIV testing in the prior 3 months (74.1% vs. 42.1%, p<0.001), current HIV pre-exposure prophylaxis use (47.8% vs. 24.4%, p<0.001), any sexually transmitted infections diagnosis (25.0% vs. 10.6%, p<0.001), changes in sexual behavior after mpox onset (57.4% vs. 48.7%, p=0.002), and higher HIV prevalence (37.7% vs. 22.9%, p<0.001).

Conclusions:

Our results point to a high mpox awareness among LGBTQIA+ communities. Stigma and discrimination associated with a mpox diagnosis adds to the already existing structural barriers, preventing most vulnerable populations from a proper access to diagnosis and care. Expanding access to gender competent care is critical to avoid mpox underdiagnosis and address stigma and discrimination in health services.