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

Mpox has particularly adverse effects among people with HIV (PWH). We examined mpox vaccine utilization and hesitancy among men who have sex with men (MSM), and transgender women (TW) in HIV care in a multisite U.S. cohort. We queried MSM/TW reporting past 3-month sexual activity at 7 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites regarding mpox vaccination status, and willingness and hesitancy to vaccinate via questionnaires self-administered at routine HIV care visits between 1/2023 and 4/2024. We measured bivariate cross-sectional associations between vaccination status and demographic characteristics; among those reporting no vaccination, we measured associations between hesitancy and demographic characteristics. Among MSM/TW (n = 1146, mean age 46; 97% cisgender MSM, 3% TW; 46% white, 39% Black, 11% Hispanic), 52% (n = 597) reported not being vaccinated against mpox. Of these, 33% (n = 195) indicated they were not likely to be vaccinated despite provider recommendation. A higher proportion of Black respondents indicated they would not get vaccinated compared with white or Hispanic (42% vs. 23% and 33%, respectively; p ≤ 0.001). Key reasons were health concerns (57%, highest among Black participants, p ≤ 0.001), particularly concerns that 'not enough is known' about the vaccine (47%), side effects (25%), and low perceived acquisition risk (33%). Among sexually active MSM/TW in HIV care, mpox vaccine hesitancy was highest among persons of Black race. Common reasons were concerns about negative health effects, the belief that not enough is known about the vaccine, and low perceived risk. Education efforts should highlight mpox vaccine safety as well as mpox transmission risk.