Journal of the International AIDS Society · 2026
Mpox Vaccination and Diagnosis Among Sexual and Gender Diverse Populations in Brazil: Results From a Large Nationwide Online Survey.
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Silva Mayara Secco Torres, Luz Paula Mendes, Coutinho Carolina, Hoagland Brenda, Jalil Emilia Moreira, Pimenta Cristina, Benedetti Marcos, Cardoso Sandra Wagner, Veloso Valdilea Gonçalves, Grinsztejn Beatriz, Torres Thiago Silva
Аннотация
INTRODUCTION: Since the onset of the 2022 multinational mpox outbreak, Brazil has reported one of the highest case burdens globally, disproportionately affecting sexual and gender diverse populations. Mpox vaccination efforts in Brazil have been limited by delayed procurement, restricted eligibility criteria and structural access barriers. Understanding vaccination use, correlates of uptake and characteristics of individuals previously diagnosed with mpox is essential to guide equitable prevention strategies.
METHODS: We conducted an online cross-sectional survey between August and December 2024 among individuals recruited through social media and dating apps. Eligible participants were aged ≥18 years, identified as a sexual and gender diverse person, and residing in Brazil. Primary outcomes were previous mpox vaccination and mpox diagnosis. Sociodemographic, behavioural, internalized LGBTQIAPN+phobia and HIV/sexually transmitted infections (STIs) variables were collected. Adjusted logistic regression models identified independent factors associated with both outcomes.
RESULTS: Of 9546 respondents, most were cisgender men (91.8%), aged >30 years (81.5%) and residing in capital cities (77.2%). Overall, mpox vaccination coverage was 4.9%; nearly half received only one dose, and one quarter were vaccinated outside Brazil. Previous mpox diagnosis was reported by 2.1% of respondents, with 76.5% seeking healthcare and 7.0% requiring hospitalization. Factors associated with previous mpox vaccination were self-identification as White (aOR = 1.36; 95% CI: 1.10-1.69), more than five sex partners (aOR = 1.29; 95% CI: 1.03-1.62), living with HIV (aOR = 3.40; 95% CI: 2.59-4.47), current/prior HIV pre-exposure prophylaxis (PrEP) use (aOR = 1.88; 95% CI: 1.41-2.53) and internalized LGBTQIAPN+phobia score (aOR = 0.80; 95% CI: 0.71-0.90). Factors associated with previous mpox diagnosis were living in capital cities (aOR = 1.88; 95% CI: 1.17-3.20), more than five sex partners (aOR = 1.93; 95% CI: 1.35-2.79), stimulant drug use (aOR = 1.61; 95% CI: 1.14-2.25), any STI diagnosis (aOR = 2.41; 95% CI: 1.74-3.33), living with HIV (aOR = 3.73; 95% CI: 2.31-6.25) and current/prior PrEP use (aOR = 2.35; 95% CI: 1.43-4.01).
CONCLUSIONS: Mpox vaccination among sexual and gender diverse populations in Brazil remains critically low. Findings highlight structural barriers, including vaccine scarcity, delayed rollout and stigma, that hinder equitable vaccine access. Integrating mpox vaccination into combined HIV/STI prevention services, adopting differentiated care delivery models and partnering with community-led organizations are essential to expanding reach, improving dose completion and reducing health inequities during ongoing and future outbreaks.
METHODS: We conducted an online cross-sectional survey between August and December 2024 among individuals recruited through social media and dating apps. Eligible participants were aged ≥18 years, identified as a sexual and gender diverse person, and residing in Brazil. Primary outcomes were previous mpox vaccination and mpox diagnosis. Sociodemographic, behavioural, internalized LGBTQIAPN+phobia and HIV/sexually transmitted infections (STIs) variables were collected. Adjusted logistic regression models identified independent factors associated with both outcomes.
RESULTS: Of 9546 respondents, most were cisgender men (91.8%), aged >30 years (81.5%) and residing in capital cities (77.2%). Overall, mpox vaccination coverage was 4.9%; nearly half received only one dose, and one quarter were vaccinated outside Brazil. Previous mpox diagnosis was reported by 2.1% of respondents, with 76.5% seeking healthcare and 7.0% requiring hospitalization. Factors associated with previous mpox vaccination were self-identification as White (aOR = 1.36; 95% CI: 1.10-1.69), more than five sex partners (aOR = 1.29; 95% CI: 1.03-1.62), living with HIV (aOR = 3.40; 95% CI: 2.59-4.47), current/prior HIV pre-exposure prophylaxis (PrEP) use (aOR = 1.88; 95% CI: 1.41-2.53) and internalized LGBTQIAPN+phobia score (aOR = 0.80; 95% CI: 0.71-0.90). Factors associated with previous mpox diagnosis were living in capital cities (aOR = 1.88; 95% CI: 1.17-3.20), more than five sex partners (aOR = 1.93; 95% CI: 1.35-2.79), stimulant drug use (aOR = 1.61; 95% CI: 1.14-2.25), any STI diagnosis (aOR = 2.41; 95% CI: 1.74-3.33), living with HIV (aOR = 3.73; 95% CI: 2.31-6.25) and current/prior PrEP use (aOR = 2.35; 95% CI: 1.43-4.01).
CONCLUSIONS: Mpox vaccination among sexual and gender diverse populations in Brazil remains critically low. Findings highlight structural barriers, including vaccine scarcity, delayed rollout and stigma, that hinder equitable vaccine access. Integrating mpox vaccination into combined HIV/STI prevention services, adopting differentiated care delivery models and partnering with community-led organizations are essential to expanding reach, improving dose completion and reducing health inequities during ongoing and future outbreaks.