ArticleEpidemiologia (Basel, Switzerland)2022
Is Monkeypox Being Underdiagnosed in Countries with More Stigmatizing Attitudes towards Men Who Have Sex with Men? A Simple Ecological Analysis.
Article in Epidemiologia (Basel, Switzerland), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 17 citations in OpenAlex.
- Healthcare inequity in mpox testing intention: A socioeconomic status-stratified path analysis of medical discrimination and distrust among men who have sex with men in China.Global health research and policy · 2026Article
- Knowledge, attitudes, and practices (KAP) of the Philippine general public towards human mpox (hMPX): a cross-sectional study.Journal of preventive medicine and hygiene · 2025Article
- Self-reported Infection Status, Knowledge and Associated Factors of Monkeypox Among Men Who Have Sex with Men in Jiaxing, China.BMC public health · 2024Article
- Ethical considerations during Mpox Outbreak: a scoping review.BMC medical ethics · 2024Article
- Quantifying the basic reproduction number and underestimated fraction of Mpox cases worldwide at the onset of the outbreak.Journal of the Royal Society, Interface · 2024Article
- Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities.JMIR public health and surveillance · 2023Article
- Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries.Frontiers in public health · 2023Article
- Knowing the unknown: The underestimation of monkeypox cases. Insights and implications from an integrative review of the literature.Frontiers in microbiology · 2022Review
Corrections and comments
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Authors and funding
1 author at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
It is not known why the recent outbreak of monkeypox (MPX) has been more extensive in certain European countries than others. Previous studies have found that European countries with more stigmatizing attitudes to homosexuality have more undiagnosed HIV infections in men who have sex with men (MSM). We hypothesized that MPX in MSM may be underdiagnosed in European countries with more stigmatizing attitudes to homosexuality and less access to sexually transmitted infection (STI) testing for MSM. To test this hypothesis, we used Spearman’s correlation to assess if the national incidence of MPX in European countries was negatively associated with the intensity of screening for STIs and a composite indicator of Lesbian Gay Bisexual Transgender Intersex (LGBTI) rights (the Rainbow Index). We found that the national cumulative incidence of MPX was positively correlated with the intensity of chlamydia/gonorrhoea screening (rho 0.68, p-value < 0.0001), syphilis screening (rho 0.62, p-value < 0.0001), and the Rainbow Index (rho 0.65, p-value < 0.0001). Our analysis thus suggests caution is required in interpreting the relatively lower incidence of MPX reported from several Eastern European countries. A key limitation of this analysis is that the incidence of MPX was calculated in the whole population and not limited to the MSM population.
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