Addressing Stigma in Public Health: Mpox and the MSM Experience
During the global mpox outbreak of 2022, men who have sex with men (MSM) bore a disproportionate share of the disease burden, accounting for nearly 87% of confirmed cases. While the clinical response focused on containment and treatment, a quieter, yet critical, challenge emerged: stigma. For many MSM, the fear of judgment, discrimination, or mistreatment served as a powerful deterrent to seeking timely medical care.
A recent commentary published in Global Health Research and Policy by Liu and colleagues explores how stigma surrounding mpox significantly influenced healthcare-seeking behavior among MSM. The authors emphasize that, much like during the early HIV/AIDS crisis, misinformation and societal prejudice compounded the risks faced by this already vulnerable group.
Official guidance during the outbreak urged those with symptoms to seek care and isolate to reduce transmission. Yet stigma played a major role in delaying medical attention. In a survey conducted in the UK during the peak of the outbreak, fewer than one in three respondents from highly affected communities—mainly MSM—indicated they would seek medical attention if symptomatic. These delays, particularly early in the outbreak, contributed to case underreporting, which in turn complicated resource distribution and outbreak control.
The commentary highlights how stigma stems from a mix of societal attitudes, misinformation, and intersecting forms of discrimination. MSM living with HIV, for example, may hesitate to seek care due to concerns about dual stigma related to both HIV and mpox. Racial and ethnic minority MSM may also face additional barriers rooted in systemic healthcare inequities.
To address these challenges, the authors call for a multi-pronged response that includes:
Accurate, Inclusive Public Communication: Public health authorities should prioritize timely, evidence-based information about mpox transmission and prevention, delivered across both digital and traditional platforms. Clear, nonjudgmental messaging can help counter harmful stereotypes and misconceptions.
Community-Based Support Networks: Lessons from HIV care, such as peer-support or “treatment buddy” models, can be adapted to support MSM affected by mpox. Tailored community programs can help mitigate isolation and promote access to healthcare, especially for those facing multiple forms of marginalization.
Training for Frontline Healthcare Workers: Ensuring healthcare providers receive training in cultural competence, privacy ethics, and stigma awareness is essential. The commentary cites examples from Rwanda, where discriminatory behavior by providers discouraged MSM from accessing services—underscoring the need for ongoing training and support resources.
Involvement of Affected Individuals: Designing stigma-reduction initiatives should involve the input of those directly affected. Their experiences provide valuable insight into real-world barriers and can inform more effective, context-specific interventions.
The authors argue that addressing stigma must be considered a core element of pandemic preparedness and response planning. Health systems that fail to anticipate the social dimensions of disease risk overlooking critical gaps in care access and compliance. Reducing stigma, they suggest, is not just a matter of equity—it’s a strategic imperative for controlling outbreaks and protecting public health.
As the world prepares for future health crises, the mpox experience offers a crucial reminder: effective response requires more than vaccines and case counts. It demands communication, compassion, and cross-sector collaboration that places vulnerable populations at the center of the conversation.
Source
Liu, Yujie, Jiechen Zhang, and Yong Cai. "Mpox-Related Stigma and Healthcare-Seeking Behavior Among Men Who Have Sex with Men." Global Health Research and Policy 10, no. 16 (2025). https://doi.org/10.1186/s41256-025-00418-w.