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Mpox Vaccine Hesitancy Among Sexually Active People with HIV in Care at Risk for mpox

R J Fredericksen1, L S Mixson2, R M Nance2

  • 1Department of Medicine, University of Washington, Seattle, WA, USA. rfrederi@uw.edu.

AIDS and Behavior
|June 30, 2026
PubMed

Insights

Mpox vaccine hesitancy is high among men who have sex with men and transgender women in HIV care, especially Black individuals. Concerns include vaccine safety and perceived low risk of mpox infection.

Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Vaccinology

Background:

  • Mpox (formerly monkeypox) poses significant health risks, particularly to people with HIV (PWH).
  • Understanding mpox vaccine uptake and hesitancy is crucial for targeted public health interventions.
  • Men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by mpox.

Purpose of the Study:

  • To examine mpox vaccine utilization and hesitancy among MSM and TW receiving HIV care.
  • To identify demographic factors associated with mpox vaccine hesitancy in this population.
  • To understand the primary reasons for mpox vaccine hesitancy.

Main Methods:

  • A cross-sectional study was conducted among sexually active MSM and TW in HIV care across 7 U.S. Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites.
  • Data were collected via self-administered questionnaires on mpox vaccination status, willingness, and hesitancy between January 2023 and April 2024.
  • Bivariate analyses assessed associations between vaccination status, hesitancy, and demographic characteristics.

Main Results:

  • Over half (52%) of the 1146 participants reported not being vaccinated against mpox.
  • Among unvaccinated individuals, 33% expressed unwillingness to vaccinate, with higher rates among Black respondents (42%) compared to white (23%) or Hispanic (33%) individuals.
  • Key reasons for hesitancy included health concerns (57%), insufficient knowledge about the vaccine (47%), side effects (25%), and low perceived risk of mpox acquisition (33%).

Conclusions:

  • Mpox vaccine hesitancy is substantial among sexually active MSM and TW in HIV care, particularly within the Black community.
  • Addressing concerns about vaccine safety, knowledge gaps, and perceived risk is essential for improving mpox vaccination coverage.
  • Public health education should emphasize both the safety of mpox vaccines and the risks associated with mpox transmission.
Keywords:
Men who have sex with menMpoxPeople with HIVSexually transmitted infectionsTransgender womenVaccine hesitancy

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