Monkeypox and transgender women: The need for a global initiative

Silva, Mayara Secco Torres; Jalil, Emilia Moreira; Torres, Thiago Silva; Coutinho, Carolina; Jalil, Cristina Moreira; Cardoso, Sandra Wagner; Veloso, Valdiléa G.; Grinsztejn, Beatriz

doi:10.1016/j.tmaid.2022.102479

Cited by 11 publications

(7 citation statements)

References 7 publications

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“…This indicates that our survey may have reached populations most affected by mpox by the current outbreak [ 2 , 5 , 6 ]. There were no reported cases among transgender women, which highlights the low mpox burden in this group, in agreement with Brazilian official data available, disaggregated by gender [ 8 , 27 ]. Our findings point to a high awareness of mpox among SGM, with the internet and television as the most frequent information sources.…”

Section: Discussionsupporting

confidence: 86%

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Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities

Torres¹,

Silva²,

Coutinho³

et al. 2023

JMIR Public Health Surveill

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Background The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America. Objective We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis. Methods A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants’ characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables. Results We enrolled 6236 participants: 5685 (91.2%) were cisgender men; 6032 (96.7%) were gay, bisexual, or pansexual; 3877 (62.2%) were White; 4902 (78.7%) had tertiary education; and 4070 (65.2%) reported low or middle income. Most participants (n=5258, 84.4%) agreed or strongly agreed that “LGBTQIA+ individuals are being discriminated and stigmatized due to mpox.” Mpox awareness was 96.9% (n=6044), and 5008 (95.1%) were willing to get vaccinated for mpox. Overall, 324 (5.2%) reported an mpox diagnosis. Among these, 318 (98.1%) reported lesions, 178 (56%) local pain, and 316 (99.4%) sought health care. Among participants not reporting a diagnosis, 288 (4.9%) had a suspicious lesion, but only 158 (54.9%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001). Conclusions Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis.

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Section: Discussionsupporting

confidence: 86%

“…Brazil ranked second globally in the cumulative number of mpox cases and deaths, with 10,941 confirmed diagnoses and 16 deaths as of May 23, 2023 [ 4 ]. Confirmed mpox cases in Brazil mostly occurred among cisgender MSM, with a potential role of sexual contact in the transmission dynamics [ 6 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities

Torres¹,

Silva²,

Coutinho³

et al. 2023

JMIR Public Health Surveill

Self Cite

View full text Add to dashboard Cite

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“…Trans women have higher rates of HIV and STIs than cis women and non-binary individuals, which might influence the acquisition and clinical course of monkeypox virus infection, and also face barriers to accessing health care and social support. 24 , 25 Our data showed that a higher proportion of trans women engaged in sex work (55%) compared with the proportion of cis women and non-binary people (3%), suggesting higher levels of precarity and vulnerability, which might include factors like homelessness, injection drug use, and migrant status.…”

Section: Discussionmentioning

confidence: 70%

Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series

Thornhill¹,

Palich²,

Ghosn³

et al. 2022

The Lancet

108

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“…It should be noticed that transgender women were not included in the study cohort if they chose to update their current gender in CHS registries. While data is still limited, transgender women might also be at a high risk for mpox ( 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%