Mpox stigma in the UK and implications for future outbreak control: a cross-sectional mixed methods study

Area of Science:

• Public Health
• Social Epidemiology
• Infectious Disease Control

Background:

• Stigma significantly challenged global mpox outbreak control and affected individuals' well-being.
• Addressing mpox-related stigma is vital for enhancing infection prevention and control strategies.
• A robust assessment of mpox stigma was lacking despite its prominence in public and policy discussions.

Purpose of the Study:

• To investigate the causes, manifestations, and impacts of mpox-related stigma within the UK.
• To focus on anticipated stigma among communities directly and indirectly affected by mpox.
• To develop and validate a tool for assessing stigma in new and re-emerging outbreaks.

Main Methods:

• An online, mixed-methods cross-sectional survey was conducted to assess mpox stigma.
• The Stigma Survey and Community-based Assessment for New and Re-emerging outbreaks (Stigma-SCANR) tool was developed and validated.
• Quota sampling targeted populations most affected, including gay, bisexual, and other men who have sex with men (GBMSM) and healthcare workers.

Main Results:

• Pre-existing prejudices, fear, and misinformation were identified as key drivers of mpox stigma.
• Respondents anticipated higher levels of negative judgment and avoidance, particularly from sexual partners and the public.
• A significant proportion of respondents with mpox experienced stigma, and shame was a major barrier to care-seeking.

Conclusions:

• Findings offer insights for international mpox outbreak responses, especially in similarly affected communities.
• Lessons learned may be transferable to managing stigma in other disease outbreaks.
• Recommendations include peer support, accessible information on social/work timelines, and co-designed public communications and contact tracing.