Strategies Adopted by Gay, Bisexual, and Other Men Who Have Sex With Men to Prevent Monkeypox Virus Transmission

United States, August 2022

Kevin P. Delaney, PhD; Travis Sanchez, DVM; Marissa Hannah, MPH; O. Winslow Edwards, MPH; Thomas Carpino, MPH; Christine Agnew-Brune, PhD; Kaytlin Renfro, PhD; Rachel Kachur, MPH; Neal Carnes, PhD; Elizabeth A. DiNenno, PhD; Amy Lansky, PhD; Kathleen Ethier, PhD; Patrick Sullivan, PhD; Stefan Baral, MD; Alexandra M. Oster, MD

Disclosures

Morbidity and Mortality Weekly Report. 2022;71(35):1126-1130. 

In This Article

Abstract and Introduction

Introduction

The first U.S. case of monkeypox during the current outbreak was confirmed on May 17, 2022;[1] on August 4, the U.S. Department of Health and Human Services declared the outbreak to be a public health emergency.* To date, most reported monkeypox cases in the United States and globally have occurred among men who reported sexual or close intimate contact with another man during the 3 weeks before symptom onset.[2] The multipronged response to monkeypox has included expanding access to monkeypox vaccine and developing messaging for gay, bisexual, and other men who have sex with men (MSM) seeking to reduce their chances for acquiring monkeypox. During August 5–15, 2022, a monkeypox-specific follow-up survey was completed by a convenience sample of 824 MSM who responded to the annual American Men's Internet Survey (AMIS).§ Overall, 48% of respondents reported reducing their number of sex partners, 50% reported reducing one-time sexual encounters, and 50% reported reducing sex with partners met on dating apps or at sex venues since learning about the monkeypox outbreak. Nearly one in five respondents reported receiving ≥1 dose of vaccine to prevent monkeypox. Receipt of vaccine was highest among Hispanic or Latino (Hispanic) men (27.1%) and lowest among non-Hispanic Black or African American (Black) men (11.5%); 17.7% of non-Hispanic White (White) men and 24.2% of men of other race or ethnicity received vaccine. Receipt of vaccine was higher in urban (27.8%) and suburban (14.5%) areas than in other areas (5.7%–7.0%). These data suggest that MSM are taking steps to protect themselves and their partners from monkeypox. It is important that federal, state, and local public health programs continue to deliver tailored, respectful harm reduction messages that do not create stigma to diverse communities of MSM. Vaccine programs should prioritize efforts to maximize equitable access to vaccines to prevent monkeypox.

AMIS is an annual, cross-sectional, online behavioral survey of a convenience sample of cisgender men in the United States who report sex with another man during the 12 months preceding the survey.[3] During August 5–15, 2022, AMIS 2021 survey participants who agreed to be recontacted were invited to complete a follow-up survey assessing knowledge of and experiences with monkeypox. After providing research consent, participants answered questions about general knowledge, awareness, and concern about monkeypox; personal behavior changes during the past 3 months because of the monkeypox outbreak; and receipt of vaccine to prevent monkeypox infection. The Emory University Institutional Review Board reviewed and approved procedures for the AMIS survey. This activity was also reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.

Overall, 2,999 AMIS 2021 participants were invited to participate in the monkeypox survey, and 824 (27.5%) responded and completed all questionnaire sections. Among these respondents, 70.5% were White, and 50.9% were aged <45 years. Most men (90.0%) reported sex with a man during the preceding 3 months (i.e., during the current monkeypox outbreak); 238 (28.9%) reported two or more sex partners during the preceding 14 days. Respondents were from all regions of the United States; (47.8%) lived in urban areas.

Respondents reported changing sexual behaviors since they learned about the monkeypox outbreak (Table 1). Overall, 47.8% reported reducing their number of sex partners, 49.8% reported reducing one-time sexual encounters, and 49.6% reported reducing sex with partners met on dating apps or at sex venues. In addition, 50.4% reported reducing group sex participation, and 41.9% reported reducing attendance at sex venues or social events with close contact because of the monkeypox outbreak.

A total of 151 respondents (18.6%) reported receiving ≥1 dose of vaccine to prevent monkeypox (Table 2). Receipt of vaccine was highest among Hispanic men (27.1%) and lowest among Black men (11.5%); 17.7% of White men and 24.2% of men of another race and ethnicity received vaccine. Receipt of vaccine was higher in urban (27.8%) and suburban (14.5%) areas than in medium or small metropolitan (7.0%) or rural (5.7%) areas and was higher in the Northeast (27.8%) and West (21.5%) than in the Midwest (14.9%) or South (13.0%) U.S. Census Regions.

Receipt of vaccine was more common among respondents reporting two or more partners during the preceding 14 days (30.1%) than among those reporting no partners or one partner (13.9%) and among those reporting engaging in group sex with male partners during the preceding 3 months (31.5%) than among those not engaging in group sex during that time (12.8%). Among 662 persons who had not received monkeypox vaccine, 180 (28.5%) indicated that they had tried to get vaccinated.

Frequency of receipt of vaccine was similar for persons who reported having received a diagnosis of HIV infection (22.3%) and those whose most recent HIV test was negative (19.0%). Among those who reported not having HIV, a higher proportion of persons taking HIV preexposure prophylaxis (PrEP) (31.4%) than those not taking HIV PrEP (7.0%) were vaccinated. When limited to 188 men with two or more partners during the preceding 14 days, vaccination was even more prevalent among those taking HIV PrEP: 46 (38.0%) of 121 respondents taking HIV PrEP reported having received vaccine, compared with nine (13.4%) of 67 who were not taking HIV PrEP. Receipt of vaccine was also more prevalent among men who received testing for another sexually transmitted infection during the preceding 3 months.

Three (1.7%) participants reported having received a diagnosis of monkeypox, and 91 (11.4%) of 798 who responded to the question reported knowing someone who had received a diagnosis of monkeypox. Although 53.1% reported they were "somewhat concerned" or "very concerned" about monkeypox, 82.3% reported feeling confident that they could protect themselves from monkeypox.

*https://www.hhs.gov/about/news/2022/08/04/biden-harris-administration-bolsters-monkeypox-response-hhs-secretary-becerra-declares-public-health-emergency.html (Accessed August 25, 2022).
This messaging was first published online June 7, 2022, and was updated as of August 5, 2022. https://www.cdc.gov/poxvirus/monkeypox/sexualhealth/index.html (Accessed August 25, 2022).
§ https://emoryamis.org (Accessed August 25, 2022).
45 C.F.R. part 46.102(l)(2); 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

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