Abstract and Introduction
Abstract
Objectives: Our objective was to examine the public response to public health and media messaging during the human monkeypox virus (MPXV) outbreak in the UK, focusing on at-risk communities.
Methods: A co-produced, cross-sectional survey was administered in June and July 2022 using community social media channels and the Grindr dating app. Basic descriptive statistics, logistic regression, and odds ratio p values are presented.
Results: Of 1932 survey respondents, 1750 identified as men, 88 as women, and 64 as gender non-conforming. Sexual identity was described as gay/lesbian/queer (80%), bisexual (12%), heterosexual (4%), and pansexual (2%); 39% were aged <40 years; 71% self-identified as White, 3% as Black, 8% as Asian, 2%as LatinX, and 11% as 'Mixed or Other' heritage groups. In total, 85% were employed and 79% had completed higher education. A total of 7% of respondents identified themselves as living with HIV. Overall, 34% reported limited understanding of public health information, 52% considered themselves at risk, 61% agreed that people with MPXV should isolate for 21 days, 49% reported they would first attend a sexual health clinic if symptomatic, 86% reported they would accept a vaccine, and 59% believed that MPXV originated from animals. The most trusted sources of information were healthcare professionals (37%), official health agencies (29%), and mainstream media (12%).
Conclusions: Vaccine acceptability was very high, yet the understanding and acceptance of public health information varied. Social determinants of health inequalities already shaping the UK landscape risk were compounded in this new emergency. Engagement with structurally disadvantaged members of affected communities and better dissemination of public health messaging by trusted healthcare professionals are essential for the public health response.
Introduction
Mounting an effective response to the human monkeypox virus (MPXV) emergency requires targeted public health programmes that address the needs of the full spectrum of the most affected communities. As we have witnessed in both the HIV and COVID-19 pandemics, the proliferation of misinformation and processes of marginalization posed significant barriers to pandemic control and continue to do so.[1] due to delays in diagnosis, treatment, and vaccine uptake. This has compounded health inequalities in minoritized and structurally marginalized communities, including people living with HIV, who have been disproportionately affected in the global outbreak. A global case series of 528 people with MPXV reported that 41% were people living with HIV and that 57% of those without HIV were receiving pre-exposure prophylaxis (PrEP) for HIV.[2–6] These specific communities have been and continue to be blamed for viral spread.[7]
The US Center for Disease Control and Prevention, the World Health Organization, and the UK Health and Security Agency (UKHSA) all adopted a public health approach that placed the engagement of affected communities of gay, bisexual, and other men who have sex with men (GBMSM) at the heart of the response, demonstrating a clear understanding of the lessons learned from previous pandemics.[8] This approach is well-supported by research on the co-production of knowledge and resources with affected communities to deepen and facilitate engagement with and support the response.[9] Leveraging knowledge gained from communities strengthens 'structural competency', helps counter processes of marginalization, and contributes to strengthening systems of care and service provision.[10–12] Public health leadership has emphasized that creating trust with communities is essential for sustaining interventions in the response to the current MPXV emergency, as it has been proven to be a core component of pandemic response, most notably in the recent case of COVID-19.[13–15]
The UK national government and health authorities are orchestrating the ongoing response. Since the first UK cases of MPXV infection were reported, the national government and national health service (NHS) have published information online (e.g., UK.gov, NHS.gov), covering key facts about transmission, risk factors, self-isolation measures, vaccines, and where to attend for diagnosis. This information specifies that sexually active GBMSM are at highest risk for MPXV. However, evidence about how this public health information has been interpreted, especially by GBMSM as the most affected community, is limited.
A 2022 survey of a nationally representative panel of US adults (n = 1580) found that nearly one in five adults (19%) were worried about MPXV infection, and the majority (60%) had limited knowledge of vaccine availability. It also revealed concerning findings about misinformation and conspiracy theories, including that MPXV was bioengineered in a laboratory, was intentionally released for political reasons, and is caused by exposure to 5G mobile signal.[16] Similarly, a 2022 study on MPXV information on YouTube found that, of the 100 'most viewed' videos relating to MPXV in May 2022, 11.9% contained misleading information in relation to MPXV epidemiology, transmission, symptoms, testing, treatment, and prognosis.[17] A 2022 online survey designed to assess understanding and acceptance of public health information in MSM (who were predominantly users of HIV PrEP) in the Netherlands showed similarities in intention to self-isolate and take up a vaccine among at-risk groups of PrEP and non-PrEP users. The survey identified differences in intention among respondents based on social determinants such as education and migration status.[18] Research on previous MPXV outbreaks in the USA, Congo, and Nigeria since 2000 has shown that working with affected communities and leveraging digital media can support community uptake of public health measures.[19–21] Although evidence on MPXV is only starting to emerge, structural barriers will nonetheless remain a key issue in all outbreak responses. In the USA, disparities in access to and uptake of vaccines as well as clinical outcomes in people of colour who live with HIV have already been reported.[22]
This paper explores public views on media and public health messaging about MPXV in the UK from the first survey on this topic co-produced by community groups and academics.
HIV Medicine. 2023;24(5):544-557. © 2023 Blackwell Publishing
