Sexual Identity-Related Shame as a Barrier to Mpox Prevention Among Gay and Bisexual Men.

This study explores emotional mechanisms that help explain the relationships between gay and bisexual men's sexual identity, perceptions of mpox risk, and their intentions to take protective action against mpox. An online survey of cisgender gay and bisexual men (N = 393; 44.8% gay) showed that identity salience was positively associated with fear and perceptions of mpox risk, but risk perceptions were not significantly associated with behavioral intentions. Additionally, identity salience was positively associated with shame, which in turn was associated with reduced intentions to take protective action. Our findings underscore the complexity of the relationships between identity salience, fear, shame, and behavior in the context of a stigmatized health condition and among a stigmatized group. They also extend theory on the role of shame in identity-based health and risk communication by showing that while identity-based messaging may heighten risk perceptions, it can also elicit shame, unintentionally hindering preventive behaviors. Future research should examine the causal pathways linking shame to health-related cognition and behavior and identify message features and characteristics that are most likely to elicit shame.