Impact of the LGBT+ rights on reporting cases and deaths of Mpox globally: Relationships with the LGBT+ rights index during 2022-2024 epidemics

Introduction

Multiple aspects of the epidemics of mpox during 2022-2024 have been explored, including clinical features, diagnostic aspects, therapies and vaccines. However, factors associated with reporting of cases and death of Mpox have been poorly assessed. No studies regarding the relationships between the LGBT+ rights and the morbidity and mortality from Mpox have been published yet.

Methods

An ecological study for 106 countries was done using the LGBT+ rights index (LGBT-RI) per country that were obtained from the State Sponsored Homophobia Reports produced by ILGA, LexisNexis, Factiva, Amnesty International, Human Rights Watch, the U.S. State Department, and Velasco report (2020), from Our World in Data, and the cases, calculating the incidence rates (cases per 100,000 pop.), from the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO). Also, mortality rates (cases per 100,000 pop.) and case fatality rates (deaths per 100 cases, %CFR) were calculated. The annual variation of the variables was assessed, and non-linear regression models (exponential) were done at Stata/MP® v.14.0.

Results

The non-linear regression models revealed significant findings. The relationship between epidemiological factors and LGBT-RI was found to be significant. During this epidemic, there was a positive relationship between LGBT-RI and reported of Mpox cases (r2=0.1006; p=0.0040), countries with higher LGBT-RI had higher Mpox cases. Similarly, higher LGBT-RI values were also significantly associated with higher Mpox incidence rates (cases/100,000 pop) (r2=0.5062; p<0.0001). Number of deaths notified were also associated with the LGBT-RI (r2=0.0636; p=0.0328). Consistently, the Mpox mortality rate was also associated with the LGBT-RI (r2=0.1390; p=0.0005). Finally, the %CFR, as expected, this variable was not associated with LGBT-RI (r2=0.0216; p=0.3287).

Discussion

These findings underscore the significant influence of stigma and discrimination that may be associated with Mpox. In particular, the LGBT+ rights allow trust in the health system, diagnostic and management. At the same, the proper notification of a Mpox case and its associated outcomes. Even in 2024, there are 88 countries or territories, specially in Africa, Middle East, and Asia, that have not reported yet, even a single case of Mpox. Even in Latin American and the Caribbean, ten countries are included in that list. Despite the epidemics of 2022-2024, Mpox remains a neglected condition worldwide, with a resurgence in countries like the Democratic Republic of Congo in 2023-2024. The need for further studies on multiple epidemiological factors of Mpox is therefore paramount.

Conclusion

Sexual rights still influence not just HIV and other sexually transmitted infections epidemiology, but also of the reemerging/emerging Mpox globally.