September 11, 2025

Mpox Awareness and Vaccine Acceptability among Transgender Women and Men who have Sex with Men in India: Predictors and Implications for Outbreak Preparedness.

VCVenkatesan ChakrapaniNational Institute of Advanced Studies ASAleena SebastianNational Institute of Advanced Studies JJJulian Lamborlem Roy JyrwaNational Institute of Advanced Studies

Key Points

Overall awareness of mpox was only 59% among participants, revealing significant gaps in knowledge about the virus.
Vaccine acceptability was much lower among transgender women at 19.9% compared to 53.6% for men who have sex with men.
The study utilized hybrid-mode surveys with robust Poisson regression to identify critical predictors of vaccine acceptability.
Addressing stigma through tailored educational interventions is essential for enhancing vaccine uptake among these vulnerable populations.

Abstract

Men who have sex with men (MSM) and transgender women (TGW) are at elevated mpox risk; vaccination can greatly reduce that risk. We assessed mpox awareness and vaccine acceptability among MSM and TGW. In 2022, hybrid-mode (offline/online) surveys were administered among 250 MSM and 251 TGW in Chennai, India. Robust Poisson regression models were used to identify predictors of mpox awareness and vaccine acceptability. Participants' mean age was 29.1; mean monthly income USD 192. Over half (54.5%) had a college/diploma degree; 29% of MSM and 90% of TGW reported engaging in sex work in the past month; and 49% of MSM and 86% of TGW reported inconsistent condom use with male partners. Overall, 59% had heard of mpox; 37% knew of its high burden among MSM/TGW. Vaccine acceptability was 36.7% (MSM: 53.6%; TGW: 19.9%). Mpox awareness was predicted by higher education (Prevalence-Rate-Ratio/PRR = 1.18, p = 0.04), online recruitment (PRR = 1.28, p = 0.01), PrEP awareness (PRR = 1.30, p < 0.001), and more non-regular male sexual partners (PRR = 1.03 per 10-partner increment, p = 0.01). Mpox vaccine acceptability was positively associated with awareness about high mpox burden among MSM/TGW (PRR = 1.31, p = 0.04) and online recruitment mode (PRR = 1.52, p = 0.001), but negatively with depression (PRR = 0.68, p = 0.02) and inconsistent condom use (PRR = 0.68, p = 0.002). TGW were less willing than MSM (PRR = 0.43, p < 0.001). Suboptimal mpox awareness and vaccine acceptability among MSM and TGW highlight key vulnerabilities. Tailored, non-stigmatizing educational interventions delivered via community-based organisations, online platforms, and HIV services are needed to address informational and psychosocial barriers. For preparedness, enhancing equitable vaccine access and clinical vigilance may help strengthening India's mpox response.

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