Navigating the Mpox Outbreak: Insights on Vaccination Decisions and Psychosocial Impacts Among Gay, Bisexual, and Other Men Who Have Sex with Men in Los Angeles.

The 2022 mpox outbreak significantly impacted gay, bisexual, and other men who have sex with men (MSM) in the U.S., with Los Angeles representing nearly 40% of California cases. Limited data exist on how MSM living with and without HIV navigated the outbreak and their decision-making regarding vaccination. Between November 2023 and March 2024, we conducted a mixed-methods study with 21 cisgender MSM in Los Angeles who completed a semi-structured interview and quantitative survey. Recruitment prioritized diversity in mpox vaccination history, HIV status, race, and ethnicity. Interviews were recorded, transcribed, and analyzed using thematic content analysis; surveys were analyzed using descriptive statistics. Participants had a mean age of 40 years; 33% were living with HIV; 48% identified as Black/African American or mixed-race, 38% White; nearly half identified as Hispanic/Latinx (48%); 57% reported receiving at least one mpox vaccine dose, and 38% reported two doses for maximum protection. Knowledge about mpox transmission, prevention, treatment, and outcomes varied. Participants self-reported hearing that mpox could be transmitted by skin-skin contact (76%), kissing (67%), engaging in oral sex (67%), and contact with semen (33%); 62% had heard there was a treatment for mpox, 14% thought that mpox was not curable, and 48% believed that mpox was likely to cause death. Psychosocial impacts were prominent at both individual and community levels, including fear and distress. Mpox vaccination was motivated by fear and a desire for protection, facilitated by accessible venues and peer influence. Barriers included initially poor availability of vaccine and the specific eligibility criteria requirements for vaccination early on in the epidemic. Logistical challenges, such as long wait times (> 2 h), work hours, lack of transportation, mistrust in research, and confusing initial rollout also presented unique barriers. LGBTQ+ community-based organizations and peer networks were the primary trusted source of mpox-related information. Most initially adopted risk reduction behaviors but generally viewed the mpox response more favorably than COVID-19 due to time differences in vaccine availability. Post-vaccination, many resumed pre-outbreak activities, feeling more prepared for future outbreaks despite some lingering concerns. Findings underscore varied mpox knowledge and significant psychosocial impacts, reminiscent of the early HIV epidemic. Key facilitators and barriers to vaccination highlight the critical reliance on LGBTQ+ community-based organizations and peer networks for sources of trustworthy information. Providing referrals to mental health counseling and other forms of support during vaccination is recommended.