Awareness of the risk of monkeypox among men having sex with men: a cross-sectional survey in Chongqing, China.

Abstract

Background: Monkeypox (Mpox) was declared a public health emergency by World Health Organization (WHO) in 2024. This study aimed to identify subpopulations of men who have sex with men (MSM) in Chongqing, China, who may perceive themselves to be at risk of Mpox infection.

Methods: In September 2023, a cross-sectional online survey was conducted with the support of non-governmental organizations (NGOs). A total of 760 MSM were recruited to assess their socio-demographic characteristics, Mpox-related knowledge and awareness, risk perceptions, behavioral risk factors, and willingness to receive Mpox vaccination.

Results: Among the participants, 219 (28.8%) were HIV-positive. Significant heterogeneity was observed across HIV statuses in terms of geographic origin, household registration, education level, income, sexual role, and other factors. After adjusting for age, a multivariable linear regression model revealed that Mpox risk perception was positively associated with higher levels of Mpox knowledge (β = -0.64, 95% confidence intervals (CI): -1.01 to -0.27, P < 0.001), experiences of stigma or discrimination (β = -0.20, 95% CI: -0.31 to -0.08, P < 0.001), and willingness to be vaccinated (β = 0.76, 95% CI: 0.64 to 0.88, P < 0.001). It was negatively associated with lower educational attainment and fewer high-risk sexual behaviors (β = 0.30, 95% CI: 0.12-0.48, P = 0.001).

Conclusions: HIV-positive MSM, particularly those of lower socioeconomic status and educational attainment, tend to perceive themselves at lower risk of Mpox infection. Future interventions targeting MSM should focus on enhancing disease knowledge, fostering inclusive attitudes, and offering psychological support. Broader societal efforts to promote tolerance and reduce stigma are also essential.