Targeting mpox messages to at-risk groups could result in stigma, study finds

Emphasizing that men who have sex with men (MSM) are most at risk for the virus mpox has the negative effect of increasing support for restricting LGBTQ+ events, according to a new study by UAlbany Associate Professor Ashley Fox and Yongjin Choi of the London School of Hygiene and Tropical Medicine.

The study, published in the American Journal of Public Health, is based on a survey done in South Korea in July of last year. The survey group received one of three randomized messages about mpox—a neutral informational message, one explaining that the virus originated in Africa, or one that emphasized that MSM are most at risk.

Results showed that emphasizing the risk for MSM had the effect of increasing support—by about 7 percentage points compared to the control group—for policies that would limit or cancel LGBTQ+ events. The message that mentioned the origins of mpox did not increase support for travel restrictions from Africa, the study found.

Neither message affected willingness to be vaccinated against mpox.

"It's a double-edged sword," said Fox, an associate professor in the Department of Public Administration and Policy at UAlbany's Rockefeller College. "On the one hand, identifying most at-risk groups can heighten risk perceptions in affected groups and ensure that resources are being appropriately targeted. However, identifying groups most at risk also carries with it the possibility of stigmatizing those same groups in ways that can be counterproductive to public health responses."

Fox's research partner and co-author Choi also is her former Ph.D. student at Rockefeller.

The paper notes that stigma and scapegoating is not a new response to infectious disease. "Disease names, such as the 'Spanish flu' and 'gay-related immune deficiency,' may convey connotations of accusation or xenophobia and can contribute to acts of violent aggression against persecuted groups," the article says. "Commentators have attributed the increase in anti-Asian hate crimes in the United States during the COVID-19 pandemic to the hateful populist rhetoric reinforcing its East Asian origins (e.g., calling COVID-19 the 'China virus' or 'Kung Flu')."

The survey was conducted during a period of heightened attention to mpox and LGBTQ+ rights in the Republic of Korea: just after the first case of mpox had been confirmed in Korea and just before a gay pride festival was scheduled to be held in the capital city, Seoul, Fox explained. At the time, there was an active discussion about whether to cancel these events due to mpox. News coverage of mpox in Korea at this time was similar to news coverage in the United States in terms of noting how cases were rising in non-endemic countries.

This discussion reemerged recently in preparation for the 2023 gay pride events in South Korea.

Homosexuality remains a contentious issue in Korea. According to a 2020 Pew Center Poll, only 44% of Koreans say that homosexuality should be accepted by society compared with 72% in the United States.

While the majority of respondents did not support canceling LGBTQ+ related events, about 35% of respondents did.

The article concludes that messages aimed at the general public that emphasize the most at-risk groups might trigger increased stigmatization and persecution of those groups.