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Communities at Risk for Mpox and Stigmatizing Policies: A Randomized Survey, Republic of Korea, 2022
Abstract
Objectives. To estimate the impact of communicating to the public that men who have sex with men (MSM) are most at risk for mpox on potential stigmatization and risk perception.
Methods. We conducted a survey experiment randomizing exposure to messages about mpox among a sample of the South Korean public (n = 1500) in July 2022. We randomized respondents to receive an informational message about mpox that was (1) a neutral informational message about mpox that did not highlight its origins or risk groups (control group), (2) a message explaining that the virus originated in Africa, or (3) a message emphasizing that MSM are most at risk.
Results. We found that emphasizing that MSM are most at risk increases support for policies that would restrict lesbian, gay, bisexual, transgender/-sexual, queer or questioning–related events by about 7 percentage points compared with the control condition. However, the message describing African origins did not affect support for restricting travel from Africa. Neither changed risk perceptions or willingness to be vaccinated against mpox.
Conclusions. Messages aimed at educating the public about most at-risk groups may trigger increased stigmatization of those groups in ways that could contribute to unnecessary persecution. (Am J Public Health. 2023;113(10):1120–1127. https://doi.org/10.2105/AJPH.2023.307347 )
... Venereal and skin diseases are also a greater source of stigma than other pathologies. All these factors make MSM particularly susceptible to discrimination due to Mpox (31,(40)(41)(42) The results underscore the pervasive nature of discrimination in various environments, highlighting significant challenges in both public and private spheres that contribute to the marginalization of this community. ...
Background
The recent Monkeypox (Mpox) outbreak has disproportionately affected men who have sex with men (MSM), amplifying stigma and discrimination. While prior research examined media portrayals and public perceptions, little is known about MSM’s direct experiences. To address this gap, we assess discrimination, stigma, and psychosocial impact across social and healthcare settings.
Methods
A cross-sectional observational study was conducted using a structured, pilot-tested survey to assess discrimination against MSM in media, family, socio-occupational, and healthcare environments.
Results
Among 115 MSM surveyed, 81.7% observed discriminatory comments in media, while discrimination was noted in workplaces (41.7%), by family/friends (45.2%), cohabitants (15.7%), and healthcare (34.8%). Stigma significantly impacted healthcare-seeking behavior, with 33% avoiding medical care due to fear of discrimination. Psychologically, 50.4% reported low mood/anxiety, and 72.7% of those frequently fearing Mpox also experienced these symptoms. The outbreak led 71.3% to alter sexual behavior, primarily reducing encounters (60%). Fear of Mpox was strongly associated with behavioral changes (p < 0.001).
Conclusion
The Mpox outbreak has exacerbated stigma toward MSM, highlighting an urgent need for intervention. Authorities, media, and community leaders must disseminate accurate information and implement psychological support programs to mitigate stigma and its detrimental effects on MSM.
... 23 While fear may act as an effective medium to inspire changes in behaviour, excessive or irrational fear may also reinforce stigma and motivate inaction or inappropriate changes in behaviours in an attempt to address the source of fear. [24][25][26] Future studies may wish to consider evaluating if fear is indeed a mediating variable influencing the positive associations between selfperceived mpox/HIV/STI risk, mpox stigma and willingness to modify sexual behaviours in Singapore, to better understand and customise interventions addressing these psychological influences. ...
Objectives
Monkeypox (mpox) was declared as a global health emergency by the WHO, with most reported cases disproportionately involving gay, bisexual and other men who have sex with men (GBMSM). This study explored the willingness of Singaporean GBMSM to receive mpox vaccines and engage in changes to sexual behaviour, and analysed the factors influencing both decisions.
Methods
An online cross-sectional study was disseminated through community groups and Grindr from September to October 2022 among GBMSM in Singapore, where we surveyed respondents’ demographics, stigma associated with mpox, perceived risks of sexually transmitted infections (STIs) and changes to sexual behaviours in response to mpox. Descriptive statistics and multivariable linear and logistics regression analyses, as well as thematic analysis of data, were also conducted.
Results
237 GBMSM community members responded to the survey, with the majority being receptive to vaccine and 67.5% indicating changes to sexual behaviour in view of rising mpox infections. Predictors of vaccine receptivity among GBMSM included self-perceived mpox risk (adjusted OR (aOR)=0.44, 95% CI 0.07, 0.82) and self-perceived STI risk (aOR=0.39, 95% CI 0.03, 0.76). Predictors for changes to sexual behaviour included self-perceived mpox stigma (aOR=1.17, 95% CI 1.08, 1.27), self-perceived mpox risk (aOR=1.22, 95% CI 1.03,1.44), age (aOR=0.96, 95% CI 0.93, 1.00) and race (aOR=0.31, 95% CI 0.10, 0.93). In the thematic analysis, respondents raised concerns about vaccine effectiveness, side effects, cost and privacy.
Conclusions
Our findings suggest that the rise in mpox infections have prompted changes to GBMSM’s sexual practices. In general, GBMSM are willing to receive the mpox vaccine but are concerned about the physical and social consequences of uptake. These concerns should be addressed when vaccines are released.
... This can result in the adoption of high-risk behaviors for this group, such as chemsex (Watkins et al., 2016). Moreover, health policy responses are still being formulated in stigmatizing ways in different parts of the world, as highlighted in a study in Korea (Choi & Fox, 2023). ...
Objective
To understand the factors associated with the practice of chemsex among MSM in Brazil, especially during the Mpox health crisis, and to design effective prevention and intervention strategies specifically for this population.
Design
A cross‐sectional and analytical study using an electronic survey, conducted from September to December 2022, during the peak of the Mpox outbreak in Brazil.
Sample
A total of 1452 MSM aged 18 and older.
Measurements
Data were collected via the REDCap platform through a survey with 46 questions. These addressed demographic data, sexual affiliations, practices, experiences with Mpox, healthcare service usage, and stigma or fear related to Mpox.
Results
The prevalence of chemsex was 19.42% ( n = 282). Multivariate Poisson modeling indicated a high incidence of chemsex among those diagnosed with Mpox and those involved in high‐risk behaviors. The practice of chemsex was six times higher among those diagnosed with Mpox (95% CI: 4.73–9.10). MSM who engage in bugchasing had a prevalence twice that of the main outcome (95% CI: 1.31–3.16).
Conclusion
There is a significant need for targeted interventions for MSM in Brazil, especially given the Mpox outbreak. This study highlights the strong relationships between chemsex, experiences with Mpox, and various sexual behaviors, underscoring the importance of effective public health initiatives.
... This can result in the adoption of high-risk behaviors for this group, such as chemsex (Watkins et al., 2016). Moreover, health policy responses are still being formulated in stigmatizing ways in different parts of the world, as highlighted in a study in Korea (Choi & Fox, 2023). ...
Objective: To evaluate the prevalence of non-testing for HIV among immigrant men who have sex with men (MSM) residing in Brazil and identify associated factors. Design: An analytical web-survey study was conducted across all Brazilian states from January 2020 to May 2021. Sample: The study included 804 MSM immigrants from Portuguese-speaking countries. Measurements:
Odds ratio (OR) and adjusted Odds Ratio (AOR) were utilized to determine the strength of the association between non-HIV testing and associated factors. Results: Among the participants, 63.7% had never undergone HIV testing. Multivariate analysis revealed several factors associated with a higher likelihood of not being tested for HIV: having a steady/monogamus partner (AOR: 1.5; 95%CI: 1.1-2.3) or both casual and steady partners (AOR: 1.8; 95%CI: 1.2-3.4), not engaging in bareback sex (AOR: 1.91; 95%CI: 3-3.5), being an immigrant in the country for less than 12 months (AOR: 3.7; 95%CI: 2.5-9.7), and having a preference for insertive (AOR: 1.5; 95%CI: 1.1-2.5) or receptive (AOR: 2.9; 95%CI: 1.4-5.7) roles. However, practicing chemsex was found to be a protective factor for testing (AOR: 4). Conclusion: To enhance HIV prevention strategies, it is crucial to implement specific measures that ensure accessibility, confidentiality, and a reduction in stigma associated with HIV testing.
Background:
Stigma relating to health can result in a broad range of vulnerabilities and risks for patients and healthcare providers. The media play a role in people's understanding of health, and stigma is socially constructed through many communication channels, including media framing. Recent health issues affected by stigma include monkeypox and COVID-19.
Objectives:
This research aimed to examine how The Washington Post (WP) framed the stigma around monkeypox and COVID-19. Guided by framing theory and stigma theory, online news coverage of monkeypox and COVID-19 was analyzed to understand the construction of social stigma through media frames.
Methods:
This research used qualitative content analysis to compare news framings in The Washington Post's online news coverage of monkeypox and COVID-19.
Results:
Using endemic, reassurance, and sexual-transmission frames, The Washington Post predominantly defined Africa as the source of monkeypox outbreaks, indirectly labeled gays as a specific group more likely to be infected with monkeypox, and emphasized that there was no need to worry about the spread of the monkeypox virus. In its COVID-19 coverage, The Washington Post adopted endemic and panic frames to describe China as the source of the coronavirus and to construct an image of panic regarding the spread of the virus.
Conclusions:
These stigma discourses are essentially manifestations of racism, xenophobia, and sexism in public health issues. This research confirms that the media reinforces the stigma phenomenon in relation to health through framing and provides suggestions for the media to mitigate this issue from a framing perspective.
Background
The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Despite the availability of vaccines, the high prevalence of vaccine hesitancy represents a significant challenge to public health, and raising vaccine acceptance among the public is critical. Although media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public’s vaccine hesitancy warrants exploration.
Objective
This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors.
MethodsA month before COVID-19 vaccination was initiated in South Korea, we conducted a cross-sectional web-based survey over 6 days (January 20-25, 2021). This study included 1016 participants, and a logit model for regression analyzed associations between sociodemographic factors, health-related factors, psychological factors, and media use toward one’s COVID-19 vaccine hesitancy. Additionally, we conducted a path analysis to examine the indirect effects of media use on vaccine hesitancy by using psychological factors (ie, perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination).
ResultsAmong the participants (N=1016), 53.3% (541/1016) hesitated to take the COVID-19 vaccine, while 46.7% (475/1016) agreed to accept the vaccine. Of the sociodemographic factors, female gender (odds ratio [OR] 1.967, 95% CI 1.36-2.86; P
Background
The public must routinely practice precautionary behaviors to control the spread of COVID-19, as no vaccines and antiviral treatments are currently available. This paper examines the public’s knowledge, attitudes, and practices (KAP) related to COVID-19 and their relationships and identified the pandemic’s vulnerable populations to provide recommendations for behavioral interventions and policies.
Methods
Data collection took place over 3 days (June 26–29) via an online survey 5 months after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first COVID case in South Korea; 970 subjects were included in the statistical data analysis.
Results
Knowledge directly affected both attitudes (e.g., perceived risk and efficacy belief) and practices (e.g., personal hygiene practices and social distancing). Among the influencing factors of COVID-19 preventive behaviors, efficacy belief was the most influential and significant practice factor. It mediated the relationship between knowledge and all three preventive behaviors (wearing facial masks, practicing hand hygiene, and avoiding crowded places). The level of knowledge varied by sociodemographic characteristics. Females ( β = 0.06, p < 0.05) and individuals with higher levels of education ( β = 0.06, p < 0.05) demonstrated higher levels of knowledge.
Conclusion
To increase precautionary behaviors among the public, health officials and policymakers must promote knowledge and efficacy belief. Future interventions and policies should also be developed in a ‘person-centered’ approach, targeting vulnerable subgroups, embracing them, and closing the gap of KAP toward COVID-19.
Stigma and discrimination are among the greatest challenges that people living with human immunodeficiency virus (HIV) face, and both are known to negatively affect quality of life as well as treatment outcomes. We analyzed the growing research and current understanding of HIV-related stigma and contextual factors in HIV/AIDS (human Immunodeficiency virus/ acquired immunodeficiency syndrome) bibliography. A total of 5984 publications published from 1991 to 2017 were retrieved from the Web of Science database. The number of papers and their impacts have been considerably grown in recent years. Research landscapes related to stigma and discrimination include clinical, physical and mental health outcomes, risk behaviors of most-at-risk populations, and HIV-related services. We found a lack of empirical studies not only on social, cultural and economic contexts, but also on specific interventions for particular settings and sub-populations. This study highlights certain gaps and provides a basis for future studies and interventions on this critical issue given the changing drivers of HIV epidemics.
Ebola emerged on U.S. soil during the 2014 midterm election campaign, and the threat of infectious disease became prominent in political rhetoric. African immigrant communities experienced stigma and suspicion during the outbreak. This study investigates the implications of this epidemic on immigration attitudes. We fielded a survey experiment during the Ebola crisis with a sample of 3881 adults in the United States to examine the conditions under which global health threats affect domestic attitudes on immigration. Contrary to expectations, we find that the mere mention of Ebola has no effect on immigration attitudes, even when the identity of the Ebola carrier is described as an African traveler into the United States. Our results show, however, that politicizing the crisis can lead to more exclusionary attitudes toward immigrants. This finding is driven by partisanship: views of immigration were significantly more negative when Republican participants read a statement by a Republican politician critical of President Obama's Ebola response. The study has implications for future epidemics, including the important role political entrepreneurs can play in shaping public perceptions during a disease outbreak. The results raise concerns about how political rhetoric surrounding disease can have both short-term and longer term consequences for vulnerable populations.
Introduction: Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV.
Methods: From 2013 to 2015, a survey using total population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed (n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address.
Results: Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070).
Conclusions: These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV-related health problems to psychological distress and internalized HIV stigma. This highlights the potential for interventions that do not explicitly target adolescents living with HIV but are sensitive to their needs.
Purpose:
An outbreak of the monkeypox virus has been documented in the United States with most cases occurring among gay, bisexual, and other men who have sex with men (MSM). As monkeypox cases increase among relatively rural states, current public health messaging may not resonate with rural at-risk populations. Given this, there is a need to assess potential rural-urban differences in monkeypox behaviors and attitudes among MSM.
Methods:
A total of 582 eligible MSM completed an online cross-sectional survey between August 6 and 15, 2022. Participants answered questions about their demographics, sexual behaviors, monkeypox testing and vaccination behaviors, monkeypox media consumption and attitudes, and their intention and attitudes found in the Health Belief Model of getting the monkeypox vaccine. Rural-urban differences in behaviors and attitudes were assessed with a chi-square test of independence. Differences in intention to get vaccinated and Health Belief Model factors were assessed with a Mann-Whitney U test.
Findings:
Rural MSM, in comparison to their urban counterparts, were found to be less likely to report modifying their behaviors to decrease monkeypox exposure, being susceptible to monkeypox, or perceiving severe consequences acquiring monkeypox. Similarly, rural MSM had a lower intention to get vaccinated for monkeypox.
Conclusions:
As vaccination uptake among rural populations for vaccine-preventable diseases remains suboptimal, results from this novel study can inform the development of monkeypox prevention, testing, and vaccination messaging campaigns geared toward rural MSM and other at-risk populations. It will be important to ensure that monkeypox prevention, testing, and vaccination interventions are available and accessible in rural areas.
This Viewpoint updates information about the current monkeypox outbreak, including confirmed cases, primary modes of transmission, clinical characteristics, diagnosis, treatment, and prevention.
This Viewpoint examines the ongoing monkeypox outbreak and the recent decision by the director-general of the World Health Organization to declare a Public Health Emergency of International Concern.
The once slow spreading virus may have found a new niche in tightly connected sexual networks
Weight stigma is an important issue colliding with obesity-related policies; both have population health and social impacts. Our aim was to conduct a systematic review of the peer-reviewed literature that combined the concepts of stigma, obesity, and policy. We searched PsycINFO, Medline, Scopus, and Google Scholar for peer-reviewed articles amalgamating terms relevant to stigma, obesity, and policy. Of 3219 records identified, 47 were included in the narrative synthesis. Two key types of studies emerged: studies investigating factors associated with support for obesity-related policies and those exploring policy implementation and evaluation. We found that support for nonstigmatizing obesity-related policies was higher when obesity was attributed as an environmental rather than individual problem. An undercurrent theme suggested that views that blame individuals for their obesity were associated with support for punitive policies for people living in larger bodies. Real-world policies often implicitly condoned stigma through poor language choice and conflicting discourse. Our findings inform recommendations for policy makers that broader socioecological stigma-reduction approaches are needed to fully address the issue of weight stigma in obesity-related policies. Efforts are needed in the research and policy sectors to understand how to improve the design and support of nonstigmatizing obesity-related policies.
Objectives. To examine the extent to which the phrases, “COVID-19” and “Chinese virus” were associated with anti-Asian sentiments.
Methods. Data were collected from Twitter’s Application Programming Interface, which included the hashtags “#covid19” or “#chinesevirus.” We analyzed tweets from March 9 to 23, 2020, corresponding to the week before and the week after President Donald J. Trump’s tweet with the phrase, “Chinese Virus.” Our analysis focused on 1 273 141 hashtags.
Results. One fifth (19.7%) of the 495 289 hashtags with #covid19 showed anti-Asian sentiment, compared with half (50.4%) of the 777 852 hashtags with #chinesevirus. When comparing the week before March 16, 2020, to the week after, there was a significantly greater increase in anti-Asian hashtags associated with #chinesevirus compared with #covid19 (P < .001).
Conclusions. Our data provide new empirical evidence supporting recommendations to use the less-stigmatizing term “COVID-19,” instead of “Chinese virus.” (Am J Public Health. Published online ahead of print March 18, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306154 )
The arrival of Kent Brantly and Thomas Duncan in the United States in late summer 2014 marked a shift in American news media's coverage of the 2014 Ebola outbreak. The media triggered Americans' fear and conceptualization of Ebola as “other” and “African,” sparking a discourse of panic and propelling the otherization of Africa and Africans. The othering process led to the stigmatization of Africans living in the United States and those returning from West Africa. This article examines this discourse in American mainstream news and social media from late July to December 2014. It shows how otherization reproduced and perpetuated the Ebola-is-African, Ebola-is-all-over-Africa, and Africa-is-a-country narratives.
Emotions matter in politics — enthusiastic supporters return politicians to office, angry citizens march in the streets, a fearful public demands protection from the government. Anxious Politics explores the emotional life of politics, with particular emphasis on how political anxieties affect public life. When the world is scary, when politics is passionate, when the citizenry is anxious, does this politics resemble politics under more serene conditions? If politicians use threatening appeals to persuade citizens, how does the public respond? Anxious Politics argues that political anxiety triggers engagement in politics in ways that are potentially both promising and damaging for democracy. Using four substantive policy areas (public health, immigration, terrorism, and climate change), the book seeks to demonstrate that anxiety affects how we consume political news, who we trust, and what politics we support. Anxiety about politics triggers coping strategies in the political world, where these strategies are often shaped by partisan agendas.
Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health. (Am J Public Health. Published online ahead of print March 14, 2013: e1-e9. doi:10.2105/AJPH.2012.301069).
Two disease entities are used for the analysis of stigmatization processes within the health care system. It is shown how overall cultural norms, specific professional role interpretations and certain characteristics of the disease are contributory factors. Cultural norms of devaluating persons with disabilities are considered. The relative power of the medical profession within the health care system is assessed in order to evaluate their potentially stigmatizing impact. Previously formulated theoretical concepts and findings of empirical studies provide the overall framework for the discussion. The conclusions include implications which might lead to the improvement of treatment and rehabilitation of currently stigmatizing diseases.
Health and human rights are complementary approaches for defining and advancing human well-being. This article presents a three-part provisional framework for exploring potential collaboration in health and human rights. The first relationship involves the impact (positive and negative) of health policies, programs and practices on human rights; the goal is to negotiate an optimal balance between public health goals and human rights norms. The second relationship posits that violations of rights have important health effects, thusfar generally unrecognized, that must be described and assessed. The third and most fundamental relationship proposes that promotion and protection of health are inextricably linked to promotion and protection of human rights and dignity.The interdependence of health and human rights has substantial conceptual and practical implications. Research, teaching, field experience and advocacy are required to explore this intersection.This work can help revitalize the health field, contribute to enriching human rights thinking and practice, and offer new avenues for understanding and advancing human wellbeing in the modern world.
In the closing decades of the 20th century, a broadly shared view took hold that the stigmatization of those who were already vulnerable provided the context within which diseases spread, exacerbating morbidity and mortality by erecting barriers between caregivers and those who were sick and by imposing obstacles upon those who would intervene to contain the spread of illness. In this view, it was the responsibility of public health officials to counteract stigma if they were to fulfill their mission to protect the communal health. Furthermore, because stigma imposed unfair burdens on those who were already at social disadvantage, the process of stigmatization implicated the human right to dignity. Hence, to the instrumental reason for seeking to extirpate stigma, was added a moral concern. But is it true that stigmatization always represents a threat to public health? Are there occasions when the mobilization of stigma may effectively reduce the prevalence of behaviors linked to disease and death? And if so, how ought we to think about the human rights issues that are involved?