Navigating Stigma in Disease Prevention: The Association between PrEP Use and Mpox Vaccination Among Sexual Minority Men

Objectives: Mpox, formerly known as Monkeypox, poses a significant public health challenge, predominantly affecting men who have sex with men (e.g., sexual minority men, SMM). Despite the decreased urgency of the initial public health emergency, epidemiological data indicate ongoing clusters of outbreaks, mainly impacting queer men. Although vaccination is a primary preventative measure, vaccine hesitancy and stigma may have hindered its uptake. The Mpox vaccine shares similarities with ongoing HIV prevention efforts, such as pre-exposure prophylaxis (PrEP). Given that tools to measure Mpox stigma are limited, we seek to determine if there is a potential association between being on PrEP, PrEP-related stigma, and Mpox vaccination uptake.

Method: We surveyed SMM using social media and geosocial-networking applications. The sample was limited to participants who indicated they were not living with HIV (n=731). We used logistic regression to estimate the association between PrEP stigmatization and receiving the Mpox vaccine. We controlled for age, race, ethnicity, medical comorbidities, relationship status, education, biological sex, sexual orientation, health insurance status, and PrEP usage.

Results: Of the 731 participants, 427 indicated they were on PrEP and 375 reported having the Mpox vaccine. Being on PrEP was associated with higher odds of receiving the Mpox vaccination (OR = 3.307, 95% CI 2.362 – 4.630, p < .001). Higher levels of PrEP stigmatization were associated with lower odds of receiving the Mpox vaccination (OR = 0.966, 95% CI 0.936 – 0.997, p = 0.032).

Discussion: Being on PrEP was associated with an increased likelihood of receiving the Mpox vaccination, highlighting the interconnected nature of preventative measures against multiple sexually transmitted diseases within the SMM community. However, the observed lower odds of Mpox vaccination amid higher levels of PrEP stigmatization underscore the urgent need for de-stigmatization in reaching those most at risk. This suggests that integrating tailored health communication strategies that not only highlight the benefits of vaccination but also actively counteract stigma could significantly improve vaccination and PrEP usage rates. Healthcare providers play a crucial role in this effort and should engage in open dialogues with queer male patients about the prevention of diseases like Mpox and HIV, framing these conversations within the broader context of destigmatizing primary prevention. Leveraging the trust and rapport present in SMM communities to disseminate accurate and stigma-countering information about disease prevention may further enhance vaccine uptake and mitigate the detrimental effects of stigma.