PROJECT SUMMARY/ABSTRACT Specific Aims: The overarching goal of this proposed study is to assess the factors associated with monkeypox (MPOX) vaccination, testing, and stigma amongst men who have sex with men (MSM) in the United States (US). Specially, we aim to 1. Evaluate determinants and disparities of MPOX vaccination amongst MSM; 2. Characterize differences in MPOX testing uptake amongst MSM with MPOX-like symptoms; 3. Develop MPOX-specific stigma measures to evaluate the impacts of MPOX-related stigma amongst MSM. Significance: Since May 2022, MPOX has been declared a public health emergency of international concern with over 86,700 cases of MPOX in 110 countries/territories. Due to its widespread and rapid incidence, its threat of endemicity or re-emerging outbreaks is significant. There is a growing but scarce body of literature related to MPOX, with many unanswered questions related to disparities and determinants of vaccination, testing, and stigma and how this will change in the coming years. Gay men have historically faced adverse health effects compared to other reproductive aged adults, as witnessed in the global HIV/AIDS epidemic. Furthermore, the emergence of COVID-19 has influenced accessibility of sexual health services and public perception of infectious diseases, which could be leveraged to inform public health responses for MPOX and future threats. Approach: We will leverage data from approximately 10,000 MSM in the United States between 2022-2023 who participated in the American Men’s Internet Survey (AMIS). This proposed study is a rapid response to the MPOX Epidemic using an innovative approach to understand trends and address unsolved questions in the public health response. These data allow for assessment of higher level, contextual effects through developing consistent metrics, to perform exploratory factor analysis and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Training Information: Mr. Carpino’s training will consist of advanced infectious disease epidemiological methodologies and social and behavioral factors. He will also incorporate contextual and structural level factors and incorporate large data sources to apply analysis methods of observational data.

PROJECT NARRATIVE The US Monkeypox (MPOX) Epidemic is a public health emergency of international concern which has disproportionately affected gay and other men who have sex with men (MSM) in the United States (US). Testing and pre-exposure prophylaxis for MPOX prevention (e.g., vaccination) promise to be efficacious opportunities to abate the epidemic, but little data exists in the US to describe disparities and barriers to uptake, such as stigma. Using a large cross sectional annual study of approximately 10,000 MSM in the US, the American Men’s Internet Survey, we aim to 1) Evaluate determinants and disparities of MPOX vaccination amongst MSM, 2) Characterize differences in MPOX testing uptake amongst MSM experiencing MPOX-like symptoms, and 3) Develop MPOX-specific stigma measures to evaluate the impacts of MPOX-related stigma amongst MSM.