During the 2022 outbreak of monkeypox, 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. 

A new study published in The Journal of Rural Health attempts to clarify the attitudes and behaviors of rural and urban MSM toward monkeypox testing, vaccination, and risk mitigation. In the study, Christopher Owens, PhD, 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 monkeypox testing and vaccination intentions, behaviors, attitudes, media consumption, opinions, and sexual mitigation practices between rural and urban MSM.

STI and Monkeypox Testing

The researchers found that around 76% of the respondents had a primary care physician; however, nearly 20% 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% of the respondents had heard of monkeypox and more than 97% 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 monkeypox 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 monkeypox and saw the disease as being less severe. Rural respondents also saw fewer benefits to the monkeypox vaccine and had less intention to be vaccinated. Rural MSM also reported greater perceived barriers to monkeypox vaccination than urban MSM.

Attitudes Toward Sexual Health Issues

Despite its limitations, this study shows how attitudes and behaviors regarding monkeypox 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 monkeypox 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.