Town and country: Urban and rural differences in Mpox vaccination and testing

During the 2022 outbreak of monkeypox, now referred to as Mpox, the Centers for Disease Control and Prevention (CDC) urged men who have sex with men (MSM) to get tested and vaccinated and engage in mitigation behaviors to prevent further spread of the virus. Prior research has shown differences in urban and rural MSM attitudes toward and behaviors in sexual preventive health measures. For example, studies have found lower rates of vaccination for HPV and hepatitis and testing for HIV and other sexually transmitted infections among rural MSM than their urban counterparts. However, it has been unclear whether the same trends would hold regarding Mpox.

A new study published in The Journal of Rural Health attempts to clarify the attitudes and behaviors of rural and urban MSM toward Mpox testing, vaccination and risk mitigation. In the study, Christopher Owens, Ph.D., assistant professor at the Texas A&M University School of Public Health, together with a researcher from Purdue University, surveyed MSM in the United States to compare Mpox testing and vaccination intentions, behaviors, attitudes, media consumption, opinions, and sexual mitigation practices between rural and urban MSM.

The researchers found that around 76 percent of the respondents had a primary care physician; however, nearly 20 percent reported being uncomfortable discussing their sexual behaviors with them. More rural participants reported being uncomfortable discussing sexual behaviors with a primary care physician than urban participants. Most participants had taken an STI or HIV test in the prior six months, but more urban MSM reported being tested than their rural counterparts.

Around 95 percent of the respondents had heard of Mpox and more than 97 percent had not been tested. Less than one-quarter of participants reported being vaccinated, and vaccination rates were lower in rural MSM. Similarly, urban respondents were more likely to consume media reports on Mpox and change their sexual behaviors in response to the outbreak.

Further analysis of health beliefs in unvaccinated respondents found that rural MSM perceived themselves as being less susceptible to Mpox and saw the disease as being less severe. Rural respondents also saw fewer benefits to the Mpox vaccine and had less intention to be vaccinated. Rural MSM also reported greater perceived barriers to Mpox vaccination than urban MSM.

Despite its limitations, this study shows how attitudes and behaviors regarding Mpox parallel those toward other sexual health issues among urban and rural MSM. Testing, vaccination and behavior changes have been somewhat successful at slowing the 2022 Mpox outbreak. However, as in other public health issues, there are differences between rural and urban populations.

A better understanding of the differences between rural and urban populations will be valuable for continuing to control this outbreak, prepare for future ones, and help make infectious disease prevention, testing and vaccination efforts equitable among rural and urban populations.