Monkeypox spread among men who have sex with men: how do people explain this relationship? A quali-quantitative study of beliefs among heterosexual and non-heterosexual Italian individuals

The majority of monkeypox (Mpox) cases in the 2022 outbreak have been traced back to mass gathering events in May, primarily among men who have sex with men (MSM). While some quantitative studies exist in the literature, focusing mainly on the link between Mpox knowledge, conspiracy theories, and vaccination hesitancy, there is a dearth of qualitative or mixed-method research that examines the beliefs surrounding this phenomenon, particularly including LGBTQIA+ groups. This study's primary objective is to delve into the beliefs associated with the media's portrayal of a connection between Mpox and MSM during the initial outbreak period. A total of 333 participants, including 212 cisgender women, 110 cisgender men, and 11 individuals identifying with other genders, took part in an online quali-quantitative survey conducted in June 2022 in Italy. This survey aimed to explore participants' perceptions of Mpox, their knowledge about it, and their attitudes towards LGBTQIA+ individuals and sexuality. The final thematic structure revealed a hierarchical arrangement of themes, encompassing: (1) The linkage between Mpox and MSM, elucidated through risky sexual behaviours or contextual factors; (2)The absence of any connection, explained through causal effects and a general mistrust of society. Individuals identified as male at birth and cisgender men tended to attribute the primary reason behind Mpox contagion to sexual promiscuity. Conversely, non-heterosexual participants were more inclined to consider both sexual promiscuity and the presence of stigma. The results demonstrated a diverse range of opinions concerning Mpox, spanning from objective behavioural risks to the stigmatising notion that MSM constitute a socially hazardous group. It is incumbent upon researchers and scientific organisations to disseminate lucid, non-alarmist, and destigmatizing information aimed at curbing risky behaviours. The opinions of both LGBTQIA+ and non-LGBTQIA+ people regarding Mpox during the 2022 outbreak were diverse, often expressing scientific misconceptions and stigmatising beliefs.To address misconceptions and fake news surrounding Mpox infection, it is the responsibility of researchers and scientific organisations to promote clear, non-alarmist information aimed at preventing risky behaviours and protecting against stigma.Health messages related to Mpox prevention should employ sensitive and affirmative language, providing useful information about prevention and care.