Group Sex and Behavior Change Associated With the 2022 Mpox Outbreak Among Men Who Have Sex With Men in Southern California.

BACKGROUND

The monkeypox (mpox) outbreak disproportionately affected sexually active gay, bisexual, and other men who have sex with men. To understand community-level changes in sexual behavior, we surveyed individuals in a semi-urban area in Southern California.

METHODS

Participants were recruited between October 2022 and April 2023, using palm cards and geolocation-focused online advertisements on social media and dating apps. Eligible participants were male; 18 years or older; those who reported having sex with men; residents of San Bernardino or Riverside counties, California; human immunodeficiency virus (HIV) negative; and currently not taking preexposure prophylaxis. Descriptive analyses were performed. χ2 , Fisher exact, and Student t tests examined the association between group sex behaviors and demographics.

RESULTS

We enrolled 91 gay, bisexual, and other men who have sex with men with a median age of 35 years (range, 18-70 years). Nearly half reported having participated in group sex in the past year. Overall, 48.9% of group sex participants reported changing their sexual behaviors to prevent mpox transmission, with limiting the number of sex partners being the most reported prevention strategy (47.6%). To prevent mpox infection, participants who engage in group sex reported limiting the number of sex partners (34.4%), using condoms for anal sex (16.7%), avoiding crowded social venues (14.3%), and asking partners about mpox symptoms before sex (9.5%).

CONCLUSIONS

Survey participants reported modest sexual behavior changes in response to the mpox outbreak. Group sex may increase the risk for mpox, human immunodeficiency virus, and other sexually transmitted infections; therefore, public health messages should include specific discussion of safer group sex practices in sexual health promotion.