Public understanding, awareness, and response to monkeypox virus outbreak: A cross-sectional survey of the most affected communities in the United Kingdom during the 2022 public health emergency

Objectives To examine awareness, understanding, and response to the monkeypox (MPXV) outbreak among the most affected communities in the United Kingdom. Methods A cross-sectional survey was administered between June 15 and July 27, 2022, targeting adults using LGBTQI community channels on social media platforms and the dating app, Grindr. Basic descriptive statistics have been created and logistic regression implemented to explore associations. Odds ratio p values have been given for completeness. No formal power calculation was implemented. Results 1932 respondents completed the survey, 1691 (90%) were cis or trans men who have sex with men. 1750/1932 identified as men, 88 as women and 64 as gender non-conforming. 1453 (77%) described their sexual identity as gay/ lesbian, 64 (3%) as queer, 221 as bisexual (12%), 81 (4%) as heterosexual, 37 (2%) as pansexual. 744 (39%) were under the age of 40. 71% (1366) self-identified as being from White, 3% (67) Black, 8% Asian (158), 2% LatinX(36) and 11% (203) ‘Mixed or Other’ heritage groups. 85% were employed and 79% had completed higher education. 137 (7%) identified themselves as living with HIV when asked if they lived with a long-term condition. Overall, 34% reported a limited understanding of public health information, 52% considered themselves at risk, 61% agreed people infected with MPXV should isolate for 21 days, 49% reported they would first attend a sexual health clinic if infected, 86% reported they would accept a vaccine and 59% believed MPXV originated from animals. Reported level of understanding of public health information, agreement to the need to isolate for 21 days, vaccine acceptance, and beliefs about the origins of MPXV varied by income level, education and heritage. Trust in healthcare providers, perception of risk of MPXV, and willingness to be vaccinated differed by gender and sexual identity. The most trusted sources of information were healthcare professionals (37%), official health agencies (29%), and mainstream media (12%). Younger participants were most likely to state they would not engage with clinical services if they had MPXV symptoms. Conclusions In this group of respondents, largely made up of White, male, employed men who have sex with men with university education, vaccine acceptability was very high, yet public health information and advice were neither universally accepted nor correctly understood. Social determinants of health inequalities already shaping the UK public health landscape are at risk of being compounded in this new emergency. Engagement with structurally disadvantaged members of affected communities is essential for the public health response. Further research is needed to establish awareness, risk perception, engagement in care, and vaccine acceptability, especially in more diverse and vulnerable populations. ### Competing Interest Statement None of the authors have competing interests to declare in relation to this research. CO has received honoraria for lectures, advisory boards, travel scholarships from Gilead Sciences, Viiv Healthcare, Janssen and MSD and research grants to institution from Gilead Sciences, Viiv Healthcare, Janssen, Astra Zeneca and MSD. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Queen Mary University Committee of Ethics panel gave ethical approval for this work (QMERC22.239, 6th June 2022). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors