Social science & medicine (1982) · 2025
Mpox among people reporting being unhoused or engaging in transactional sex within a multijurisdictional case-control study of sexually and gender minoritized individuals- United States, August 2022-March 2024.
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Sherman Jessica P, Morris Adeline L, Niccolai Linda M, Ruff Anna, Schneider Dakota, Sutton Melissa, Hawkins Sam, Pathela Preeti, Betancourt Gabriela S, Rothrock Gretchen, Nadle Joelle, Rowlands Jemma V, Felsen Christina B, Britton Amber, Farley Monica M, Duval Lauren M, Kamis Kevin F, Still William L, Morrow Allison S, Waddell Caroline J
Аннотация
BACKGROUND: Since May 2022, a clade II multinational mpox outbreak has disproportionately affected certain sexually and gender minoritized individuals (SGM). Beyond infectious disease risks, SGM populations face social and structural inequities that may increase their likelihood of experiencing homelessness or engaging in transactional sex (TS). Research on the impact of homelessness and TS on risk of mpox is limited, especially among SGM. This study examined the risk of mpox among people who reported homelessness and/or TS from a survey of SGM participants.
METHODS: We conducted a secondary analysis of data from a vaccine effectiveness case-control study among SGM conducted between August 2022-March 2024 across 12 U.S. jurisdictions. Case-patients had a confirmed or probable mpox virus or orthopoxvirus diagnosis and control patients visited a sexual health clinic but never received an mpox diagnosis. Our analysis included 1295 participants who self-reported their housing status and engagement in TS. We used multilevel logistic regression models to determine whether housing status and TS were associated with increased odds of mpox. Models included a random intercept for jurisdiction and time, adjusting for race/ethnicity. We included a product term between housing status and TS to determine if there was an interaction effect.
RESULTS: Among participants, 63 (4.9 %) were unhoused, 61 (4.7 %) engaged in transactional sex, and 20 (1.5 %) reported both. Experiencing homelessness (aOR: 2.4, 95 % CI: 1.35-4.36) and engaging in TS (aOR: 2.4, 95 % CI: 1.35-4.31) were both associated with higher odds of mpox. The product term between housing status and TS was not statistically significant (aOR: 0.8, 95 % CI: 0.21-3.32).
DISCUSSION: People who experienced homelessness and engaged in TS had increased odds of mpox, within a sample of SGM individuals; these populations should be considered for tailored interventions, such as vaccine outreach, housing support, and low barrier access to care.
METHODS: We conducted a secondary analysis of data from a vaccine effectiveness case-control study among SGM conducted between August 2022-March 2024 across 12 U.S. jurisdictions. Case-patients had a confirmed or probable mpox virus or orthopoxvirus diagnosis and control patients visited a sexual health clinic but never received an mpox diagnosis. Our analysis included 1295 participants who self-reported their housing status and engagement in TS. We used multilevel logistic regression models to determine whether housing status and TS were associated with increased odds of mpox. Models included a random intercept for jurisdiction and time, adjusting for race/ethnicity. We included a product term between housing status and TS to determine if there was an interaction effect.
RESULTS: Among participants, 63 (4.9 %) were unhoused, 61 (4.7 %) engaged in transactional sex, and 20 (1.5 %) reported both. Experiencing homelessness (aOR: 2.4, 95 % CI: 1.35-4.36) and engaging in TS (aOR: 2.4, 95 % CI: 1.35-4.31) were both associated with higher odds of mpox. The product term between housing status and TS was not statistically significant (aOR: 0.8, 95 % CI: 0.21-3.32).
DISCUSSION: People who experienced homelessness and engaged in TS had increased odds of mpox, within a sample of SGM individuals; these populations should be considered for tailored interventions, such as vaccine outreach, housing support, and low barrier access to care.