What question did this study set out to answer?

This study aims to identify behavioral factors influencing mpox vaccination uptake among men who have sex with men.

July 9, 2026Open Access

Who got vaccinated for mpox? A cross-sectional survey on behavioral correlates of vaccine uptake among men who have sex with men attending an STI/HIV reference center in Rome, Italy

MDMaria Gabriella DonàSan Gallicano Hospital MZMauro ZaccarelliBritish HIV Association EGEugenia GiulianiSan Gallicano Hospital

Key Points

This study aims to identify behavioral factors influencing mpox vaccination uptake among men who have sex with men.
Cross-sectional survey conducted from October 2023 to October 2025 among MSM at an STI/HIV center in Rome, Italy.
Anonymous online questionnaire assessed demographics, sexual behaviors, STI history, and drug use.
Logistic regression models analyzed associations with mpox vaccination uptake.
25.7% of 331 MSM reported receiving mpox vaccination.
Multivariable analysis showed significant associations of vaccination with HIV PrEP (aOR: 3.32, 95% CI: 1.62-6.81, p<0.001) and chemsex (aOR: 2.44, 95% CI: 1.22-4.90, p=0.012).
Uptake remains low, highlighting the need for improved vaccination coverage among at-risk populations.

Abstract

BACKGROUND: Following the 2022 outbreak, vaccination against mpox became available in many European countries using a third-generation non-replicating smallpox vaccine (MVA-BN). It is primarily recommended for individuals at higher risk of exposure, including men who have sex with men (MSM), especially those reporting multiple partners, group sex, chemsex, or recent sexually transmitted infections (STIs). METHODS: A cross-sectional survey about mpox vaccination uptake was conducted between October 2023 and October 2025 among MSM attendees of an STI/HIV center (Rome, Italy). An anonymous questionnaire, self-administered online, investigated demographic data, sexual behaviors, STI history, and drug use for sex. Univariable and multivariable logistic regression models were used to identify factors associated with self-reported mpox vaccination. RESULTS: Of the 331 MSM who completed the questionnaire, 85 (25.7%) reported having received mpox vaccination, whereas 17 had already been vaccinated against smallpox (5.1%). Four participants reported having acquired mpox infection (1.2%). In univariable analyses, mpox vaccination was associated with history of STI, higher number of sexual partners, group sex, use of dating apps, HIV PrEP, use of erectile dysfunction agents (EDA), sexualised drug use (SDU), and chemsex. In multivariable analysis, uptake of mpox vaccination remained independently and positively associated with EDA (aOR: 1.88, 95% CI: 1.02-3.48, p=0.044), HIV PrEP (aOR: 3.32, 95% CI: 1.62-6.81, p<0.001) and chemsex (aOR: 2.44, 95% CI: 1.22-4.90, p=0.012), whereas it showed an inverse association with reporting female partners in the previous year (aOR: 0.25, 95% CI: 0.07-0.89, p=0.033). CONCLUSIONS: Among MSM participants in our survey, mpox vaccination uptake was reported by only about one quarter of the individuals. Uptake was independently and positively associated with both chemsex and HIV-PrEP use, with HIV-PrEP showing the strongest association. Overall uptake remains suboptimal, highlighting persistent gaps in mpox vaccination coverage among individuals at higher risk. This underscores the need to reinforce integrated combination-prevention pathways in HIV/STI services, also in the context of HIV PrEP continuum.

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