Risk Perception, Risk Practices and Vaccine Hesitancy Regarding Mpox: Exploring Men Having Sex with Men, The High Risk Stratum in Pakistan
DOI:
https://doi.org/10.66344/jpad.v36i2.3447Keywords:
Mpox, Monkeypox, Men’s sex with men, Perceptions, Practices, Condom use, Public healthAbstract
Background The 2022 and 2024 Public Health Emergencies of International Concern declared by the World Health Organization for Mpox have underscored men who have sex with men (MSM) as a stratum at disproportionate risk of Mpox infection. The lack of locally generated data on Mpox-related perceptions and preventive practices among Pakistani MSM limits effective preparedness and response planning.
Objective To assess perception and practices regarding Mpox among men who have sex with men (MSM).
Methods A cross sectional survey was carried out in a period of 2 months to identify 109 men who reported having sex with at least one male partner in the past 12 months. A pretested structured questionnaire was administered to assess demographic characteristics, awareness of Mpox, sexual behavior, perceptions, and condom use.
Results The predominant age group was 30-39 years (56.8%). Multiple sexual partners were reported by 81.7% and bisexual concurrency by 67.8%. Although 65.7% had heard of Mpox, only 44.9% recognized it as a skin disease, 33.0% identified physical contact as a transmission route, and only 19.3% were aware of sexual transmission between men. Always condom use was documented by only 26.6%, while 43.1% had never used condoms. Consistent condom use was significantly associated with urban residence (P=.023), higher educational attainment (P=.0031), and reporting multiple sexual partners (P=.001).
Conclusion Pakistani MSM demonstrate limited practical knowledge of its transmission and prevention, alongside prevalent high-risk sexual behaviors and inconsistent protective practices, highlighting the need for culturally appropriate, peer-led interventions integrated into existing HIV/STI services and for larger representative studies to inform evidence-based strategies.
References
1. Lum FM, Torres-Ruesta A, Tay MZ, Lin RTP, Lye DC, Renia L, et al. Monkeypox: disease epidemiology, host immunity and clinical interventions. Nat Rev Immunol. 2022;22(10):597-613.
2. Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox: a potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141.
3. Mitja O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, et al. Monkeypox. Lancet. 2023;401(10370):60-74.
4. Vivancos R, Anderson C, Blomquist P, Balasegaram S, Bell A, Bishop L, et al. Community transmission of monkeypox in the United Kingdom, April to May 2022. Euro Surveill. 2022;27(22):2200422.
5. World Health Organization. Multi country outbreak of mpox: external situation report. Geneva: WHO; 2023.
6. Inigo Martinez J, Gil Montalban E, Jimenez Bueno S, Martin Martinez F, Nieto Julia A, Sanchez Diaz J, et al. Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022. Euro Surveill. 2022;27(27):2200471.
7. Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. Monkeypox virus infection in humans across 16 countries, April to June 2022. N Engl J Med. 2022;387(8):679-91.
8. Tarin Vicente EJ, Alemany A, Agud Dios M, Ubals M, Suner C, Anton A, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet. 2022;400(10353):661-9.
9. Curran KG, Eberly K, Russell OO, Snyder RE, Phillips EK, Tang EC, et al. HIV and sexually transmitted infections among persons with monkeypox, eight US jurisdictions, May 17 to July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(36):1141-7.
10. Endo A, Murayama H, Abbott S, Ratnayake R, Pearson CAB, Edmunds WJ, et al. Heavy tailed sexual contact networks and monkeypox epidemiology in the global outbreak, 2022. Science. 2022;378(6615):90-4.
11. Delaney KP, Sanchez T, Hannah M, Edwards OW, Carpino T, Agnew Brune C, et al. Strategies adopted by gay, bisexual and other men who have sex with men to prevent monkeypox virus transmission, United States, August 2022. MMWR Morb Mortal Wkly Rep. 2022;71(35):1126-30.
12. Mancuso G, De Gaetano S, Midiri A, Zummo S, Biondo C. The 2022 monkeypox outbreak: an epidemiological update. Pathogens. 2024;13(3):213.
13. Vakaniaki EH, Kacita C, Kinganda Lusamaki E, OToole A, Wawina Bokalanga T, Mukadi Bamuleka D, et al. Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo. Nat Med. 2024;30(10):2791-5.
14. World Health Organization. WHO declares mpox outbreak a public health emergency of international concern. Geneva: WHO; 14 August 2024.
15. Laurenson Schafer H, Sklenovska N, Hoxha A, Kerr SM, Ndumbi P, Fitzner J, et al. Description of the first global outbreak of mpox: an analysis of global surveillance data. Lancet Glob Health. 2023;11(7):e1012-23.
16. Saeed U, Uppal SR, Piracha ZZ, Uppal R. Looming threat of mpox in Pakistan: time to take urgent measures. J Infect. 2024;89(4):106261.
17. Khan FMA, Hasan MM, Kazmi Z, Dos Santos Costa AC, Ahmad S, Essar MY. Highlighting the increasing threat of monkeypox in Pakistan as a pressing public health concern. Discov Public Health. 2025;22:14.
18. Salman M, Ali S, Mustafa ZU, Khan TM, Hussain K, Khan YH, et al. Epidemiological features of travel related mpox cases detected at airports in Pakistan: insights from screening surveillance. Int J Infect Dis. 2024;144:107243.
19. Hawkes S, Collumbien M, Platt L, Lalji N, Rizvi N, Andreasen A, et al. HIV and other sexually transmitted infections among men, transgenders and women selling sex in two cities in Pakistan: a cross sectional prevalence survey. Sex Transm Infect. 2009;85 Suppl 2:ii8-16.
20. Rajabali A, Khan S, Warraich HJ, Khanani MR, Ali SH. HIV and homosexuality in Pakistan. Lancet Infect Dis. 2008;8(8):511-5.
21. Mumtaz G, Hilmi N, McFarland W, Kaplan RL, Akala FA, Semini I, et al. Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa? A systematic review and data synthesis. PLoS Med. 2010;8(8):e1000444.
22. Mowbray F, Woodland L, Smith LE, Webster RK, Amlot R, Rubin GJ. Did mpox knowledge, attitudes and beliefs affect intended behaviour in the general population and men who are gay, bisexual and who have sex with men? An online cross sectional survey in the UK. BMJ Open. 2023;13(10):e070306.
23. MacGibbon J, Cornelisse VJ, Smith AKJ, Broady TR, Hammoud MA, Bavinton BR, et al. Mpox knowledge, behaviours and barriers to public health measures among gay, bisexual and other men who have sex with men in Australia: a qualitative analysis. BMC Public Health. 2024;24(1):767.
24. Chow EPF, Samra RS, Bradshaw CS, Chen MY, Williamson DA, Towns JM, et al. Mpox knowledge, vaccination and intention to reduce sexual risk practices among men who have sex with men and transgender people in response to the 2022 mpox outbreak: a cross sectional study in Victoria, Australia. Sex Transm Infect. 2024;100(2):86-92.
25. Patel A, Bilinska J, Tam JCH, Da Silva Fontoura D, Mason CY, Daunt A, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022;378:e072410.
26. Wang H, dEspiney Amaro C, Kapfhammer S, Ulrich SR, Lemmer A, Jensen BO, et al. Awareness of and attitudes towards monkeypox among gay and other men who have sex with men: results from cross sectional online survey. Sex Transm Infect. 2023;99(7):491-3.
27. Owens C, Hubach RD, Williams D, Voorheis E, Lester J, Reece M, et al. Mpox vaccination among a sample of gay, bisexual, and other men who have sex with men in the United States. AIDS Behav. 2024;28(2):507-15.
28. Mitchell KM, Hoornenborg E, Pickles M, Boyd A, Coyer L, McManus H, et al. Effects of behaviour change and vaccination on mpox transmission in MSM in three settings. Lancet Public Health. 2024;9(6):e398-407.
29. Tan RKJ, Wang YN, Wong CS, Choong BCH, Park K, Liu L, et al. Awareness of mpox and willingness to receive mpox vaccination among gay, bisexual, and other men who have sex with men in Singapore: a cross sectional survey. Vaccine. 2023;41(48):7197-203.
30. Riad A, Drobov A, Rozmarinová J, Drapáčová P, Klugarová J, Dušek L, et al. Monkeypox (mpox)-related knowledge and vaccine hesitancy among Czech healthcare professionals. Vaccines (Basel). 2022;10(12):1-22.
31. Jiao K, Xu Y, Huang S, Zhang Y, Zhou J, Li Y, et al. Mpox risk perception and associated factors among Chinese young men who have sex with men: results from a large cross-sectional survey. J Med Virol. 2023;95(8):e29057.
32. Mitja O, Alemany A, Marks M, Lezama Mora JI, Rodriguez Aldama JC, Torres Silva MS, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023;401(10380):939-49.
33. Yang S, Guo X, Hu D, Yang X, Cui M, Zhao C, et al. The impact of human immunodeficiency virus coinfection on mpox patients during the 2022 global outbreak: a systematic review and meta analysis. Front Microbiol. 2024;15:1369353.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Journal of Pakistan Association of Dermatologists
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
