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


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

In This Article


These findings among a convenience sample of men who reported male sexual contact provide early information about the actions that MSM are taking to reduce their risk for acquiring and transmitting Monkeypox virus. These data highlight the importance of health communication in the context of strong community leadership in response to the U.S. monkeypox outbreak. The adoption of prevention strategies reported here aligns with specific harm reduction strategies developed for monkeypox and with broader sexual health information and recommendations for MSM.** A modeling study that assessed the potential effects of reductions in one-time sexual partnerships found that these changes might substantially slow transmission and ultimately reduce the percentage of MSM who acquire monkeypox.[4] It is important that federal, state, and local public health programs continue to deliver tailored harm reduction messages to diverse communities of MSM. These messages should be designed to reduce the potential for stigma[5] and build strength and resiliency.[6]

These data also suggest racial and ethnic disparities in vaccination, with particularly low reported vaccination among Black men, who are disproportionately affected by monkeypox.[2] In addition, men who were not taking HIV PrEP or who had not received STI testing were less likely to have received vaccine, suggesting opportunities to improve access for persons who are less engaged with routine health care and sexual health services. Equitable vaccine program implementation involves community engagement in program planning and implementation, engaging diverse partners already working with special populations, delivering vaccines through mobile outreach and pop-up events, and diversifying times and locations for vaccine administration.††

These survey data suggest important geographic differences in vaccination, with lower reported vaccination receipt in less urban areas and among men in the South and Midwest. This is particularly concerning because the highest number of cases reported to date have been from southern states.§§ Expanding vaccine availability geographically, including diversifying vaccination locations to include nonurban areas, can help ensure that those who need vaccination have access to it. This will be especially important as vaccine availability increases and vaccine strategies expand beyond postexposure prophylaxis to include preexposure vaccination.

The findings in this report are subject to at least four limitations. First, this survey represents a convenience sample of Internet-using cisgender MSM who chose to participate in a survey about monkeypox. This subset of men is older and less racially diverse than the full AMIS sample,[7] and persons who were more concerned about monkeypox might have been more likely to complete the survey, which could lead to overestimates of behavior modifications and receipt of vaccine. Additional efforts to collect information from populations disproportionately affected by the current monkeypox outbreak are underway. Second, these data are self-reported and might be subject to social desirability bias. Third, the reported number of partners during the preceding two weeks might not reflect sexual behaviors throughout the entire outbreak (and thus eligibility for expanded postexposure prophylaxis with vaccine), particularly if behaviors changed because of the outbreak or receiving vaccine; ongoing monitoring will be needed to understand persistence or changes in these findings over time. Finally, because the survey did not ask whether respondents had seen harm reduction messaging, these changes cannot be ascribed directly to messaging efforts.

Addressing inequities in vaccine availability and coverage is an urgent public health priority. However, vaccination alone will not be sufficient to end the current monkeypox outbreak. These findings suggest that MSM are already taking actions to protect their sexual health and making decisions to reduce risk to themselves and their partners. These changes are important to protect MSM from exposure before access to vaccine is possible and after vaccination.¶¶ CDC will continue to work with state and local partners to develop and provide tailored, respectful harm reduction messaging to diverse communities affected by the monkeypox outbreak and to monitor the impact of messaging and prevention strategies, including vaccination.

** (Accessed August 25, 2022).
†† (Accessed August 25, 2022).
§§ (Accessed August 25, 2022).
¶¶The current vaccine regimen for JYNNEOS vaccine consists of 2 doses, 28 days apart, with maximal immune protection achieved 2 weeks after the second dose: Persons who are vaccinated should continue to take steps to protect themselves from monkeypox as knowledge of vaccine efficacy during the current outbreak continues to evolve: (Accessed August 25, 2022).