HIV risk profile and prevention needs of individuals seeking monkeypox (mpox) vaccination in an urban clinic in the U.S.: a brief report – BMC Infectious Diseases | CPT PPP Coverage

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Monkeypox, now renamed mpox, a zoonosis endemic to Central and West Africa since the 1970’s, and has since become a global pandemic beginning in May 2022 [1]. The monkeypox virus that is spread primarily by close contact with and bodily fluids from infected humans or animals [2], has caused over 82,500 mpox cases globally, likely an underestimate due to under-detection and under-reporting. Unique to this pandemic is an avidity for sexual transmission, occurring disproportionately among gay and bisexual men and close contacts [3, 4].

As monkeypox virus is a close relative of smallpox virus (another orthopoxvirus with which it shares similar virologic characteristics [1]), antiviral treatments and vaccines, which were relatively dormant, have been deployed to address the emerging threat [5, 6].

In addition to promoting uptake of biomedical interventions for mpox, public health measures have focused on education, promoting safe sexual practices, and reducing behaviors that would place individuals at increased risk for HIV (e.g., increased number of sexual partners, condomless anal sex, etc.). This current epidemic is occurring in the context of ongoing recent epidemics like SARS CoV-2 infection/COVID-19 and long-term epidemics such as HIV. In some cases, ongoing epidemics share similar modes of transmission and affect similar populations, a phenomenon occasionally referred to as syndemics [7]. This provides opportunity and occasion to cross-utilize relevant prevention approaches to concurrent epidemics.

As gay and bisexual men were at increased risk for mpox, they were priority groups for mpox vaccination (using the mpox expanded post-exposure prophylaxis PEP++ vaccination strategy). Those eligible for mpox vaccination under PEP++ vaccination strategy included the following: (1) Known contacts to someone with mpox, (2) People aware that a recent sex partner was diagnosed with mpox (within past 14 days), (3) Gay, bisexual, and other men who have sex with men (MSM); and transgender, nonbinary, and gender-diverse people; who have experienced at least of the following (within past 14 days): sex with multiple partners; at a commercial sex venue; or in association with an event, venue, or area where mpox transmission is occurring. As approximately 25% of those at risk of acquiring HIV are utilizing HIV pre-exposure prophylaxis (PrEP) in the U.S. [8], one way to increase reach is to utilize opportunities and venues where individuals source other health services to assess needs and provide additional sexual and reproductive health services as indicated [9].

According to the Connecticut Department of Public Health, in 2019, in New Haven County, there were 3,380 people living with HIV and the rate of people living with HIV was 395 per 100,000. There were greater than 25 new cases of HIV diagnosed in New Haven, Connecticut in 2019. In 2021 in Connecticut, the number of HIV PrEP users was 3234. The rate of PrEP users per 100,000 population in the same year was 106 [10]. PrEP is covered by private and state insurance in Connecticut. Options include oral agents and injectables. To provide contextualization, in a longitudinal study performed of MSM on HIV PrEP in the New Haven, CT and Providence, Rhode Island setting (2015–2017), demonstrated that the median number of sexual partners in the past 3 months was 3, reported illicit drug use was 57%, and 20% had had sex with a known partner with HIV in the past 3 months [11]. With regards to mpox, at the time our study was conducted, there were 144 cases of monkeypox reported in Connecticut.

Thus, our study aimed to assess HIV risk behaviors, knowledge, uptake, and preferences of prevention services among individuals seeking mpox vaccination at an urban, outpatient academic center infectious diseases clinic.