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Changing behaviors to mitigate the spread of monkeypox

Study shows more people are focused on changing sexual behavior than other modes of transmission
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The prevalence of monkeypox has increased throughout the world and the United States. In early August the United States Department of Health and Human Services declared the outbreak a public health emergency, and by the end of August there were more than 17,000 reported cases of the disease. Additionally, more than 47,000 cases have been reported globally.

Most reported cases in the United States have been among those assigned male at birth and among that group, 99 percent reported male-to-male sexual contact. Men who have sex with men and transgender women are disproportionately affected by monkeypox.

Despite the rapid evolution of the disease in the United States, few studies have investigated behavioral changes to mitigate monkeypox exposure among males who have sex with men and transgender women.

A new study led by Christopher Owens, PhD, assistant professor in the Department of Health Behavior at the Texas A&M University School of Public Health, examined whether men who have sex with men and transgender women are changing their sexual behaviors in the wake of the monkeypox outbreak.

The study, was recently published in the journal, Archives of Sexual Behavior.

“About half of respondents changed their behaviors,” Owens said. “The other half are not, and those who are changing their behaviors seem to be focusing more on sexual transmission rather than other modes of transmission such as direct skin-to-skin contact, fomite transmission or prolonged exposure to respiratory droplets that often happens when you’re in close contact and during sexual contact.”

The transmission of monkeypox occurs mostly through direct skin-to-skin contact with lesions or bodily fluids. Additionally, however, it can be spread by respiratory secretions through prolonged face-to-face contact, and transmission through fomites, which are objects and materials such as bed sheets or clothes that can carry infection.

The Center for Disease Control recently concluded and released a study on transmission of monkeypox, but the focus was on how to mitigate the spread of the disease through skin-to-skin contact.

This study conducted by Owens and his co-author Randolph D. Hubach, PhD, director of the Sexual Health Research Lab and associate professor of Public Health at Purdue University, is more comprehensive because it also asked the participants about modifying their behavior regarding fomite transmission, respiratory droplets and other avenues of transmission as well as skin-to-skin contact.

“I think our study is more comprehensive because we ask about behaviors regarding fomite transmission as well as respiratory droplets,” Owens said. We ask things such as, ‘Are you wearing a mask or washing beddings and other fabric after having sex?’

“Again, I think people are changing their sexual behaviors, but they are not changing other behaviors outside of or before or after their sexual encounter.”

According to Owens and Hubach the results of this study can advise the tailoring of monkeypox prevention messaging campaigns and interventions for men who have sex with men and transgender women in the United States.

“We need to continue doing testing, we need to continue doing vaccinations and we need to have a holistic harm reduction approach to monkeypox prevention,” Owens said. “We can learn a lot from the early HIV/AIDS and COVID-19 epidemics, but we need to act now.”

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