Mpox Equity and Anti-Stigma Toolkit

Who should use this information? Health departments, public health partners, and groups working with populations most affected by mpox.

What is this page about? This page provides background, strategies, actions, and resources to increase the number and effectiveness of prevention strategies that advance health equity among populations most affected by mpox, including vaccination efforts.

Health and Vaccine Equity

CDC is committed to health equity, which means everyone has fair and just opportunity to their highest level of health. For mpox, this includes reliable access to accurate information and prevention education, as well as vaccine access. It is important that communities most affected by mpox have access to timely, clear, and appropriate information, and a safe and effective mpox vaccine to prevent future outbreaks. In the 2022 mpox outbreak, gay, bisexual, and other men who have sex with men (MSM) make up most of the cases.  Within this population, mpox cases are disproportionately higher among Black and Hispanic or Latino MSM and, in smaller numbers, Black and Hispanic or Latina women. Gender minorities, including transgender women and non-binary people, have also been disproportionately affected by mpox.

Many social, geographic, political, economic, and environmental factors create challenges to health equity and vaccination access. Some of these factors include:

  • Literacy, education, income, and wealth gaps
  • Job access and working conditions
  • Racism, homophobia, transphobia, and other forms of misinformation and discrimination
  • Gaps in healthcare access
  • Transportation and neighborhood conditions
  • Lack of trust because of past medical racism and experimentation
  • Perceived or actual stigma when accessing medical care

Equity-focused outreach and vaccine projects present an opportunity to reach populations who are most affected by mpox but are less likely to be vaccinated. These projects may reach populations who face barriers to vaccination such as language differences, inability to access vaccination sites, lack of transportation, lack of paid time off, low vaccine confidence, mistrust of government, lack of access to online scheduling technology, and fear of stigma.

The U.S. government is working with state, tribal, local, and territorial public health departments and other community partners to distribute vaccines where they are needed most.

Reducing Stigma in Mpox Communication and Community Engagement

Effective health communication about mpox can help people make well-informed decisions to protect their health and the health of their communities, including getting recommended vaccines and practicing preventive behaviors. Prevention messages are most successful when they are agile as information changes. These messages are best delivered by partners and trusted messengers  using specific channels and relatable language nuances to directly reach populations at increased risk for mpox across racial, ethnic, sexual, socioeconomic, and geographic backgrounds.

Health disparities caused by a number of factors, including discrimination, against specific populations and behaviors can reduce or impede the effectiveness of prevention efforts.

People can get mpox through specific behaviors, regardless of an individual’s race/ethnicity, sex, gender identity, sexual orientation, or other characteristics. It is important to reach a wider audience about symptoms and the behaviors that can lead to the spread of mpox, and the importance of prevention. It’s also important to engage trusted community-based organizations, leaders and providers to participate in the design of information dissemination strategies and activities,

Visit the CDC Health Equity Guiding Principles for Inclusive Communication for additional considerations for health communication.

How Partner Organizations Can Disseminate Messages for Events

CDC encourages partners to reach out to local event organizers to provide information about mpox and offer information and messages to share. The following are some tips:

  • Conduct an environmental scan of upcoming, large-scale events in your community. Consider festivals where there may be spin-off or side events like dances and gatherings where people may have close, skin-to-skin contact with others.
  • Develop partnerships with sex-on-premises/commercial sex venues (sex clubs, bath houses, or businesses with back rooms) to disseminate clear messages to staff and patrons in spaces where communities meet for social and sexual engagement.
  • Engage trusted community-based organizations, community leaders, and community healthcare providers to connect with event organizers and impacted communities.
  • Have a clear call to action. This can include raising awareness by sharing information, asking people to seek health care if they experience a rash, or directing community members to local healthcare providers who can coordinate testing or vaccination.
  • Provide event organizers with culturally and linguistically appropriate information and materials such as:
    • Messages that can be used on websites and social media sites
    • Talking points that event organizers can use when talking with their customers or attendees
    • An event organizer letter template (available as Word [32 KB, 2 pages] or PDF [1 MB, 2 pages] files), which organizers can download, adapt, and send to their attendees/customers
    • Printed materials that can be passed out at events and posted in venues
    • A point of contact, if they have more questions or need information

Stigma Reduction Communication Strategies

The following table has been adapted from Hood & Friedman (2010), Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections. Sexual Health (7):1-12.

Describe mpox as a legitimate public health issue that is relevant to all people
Educate about mpox
Emphasize that in the current outbreak:
  • Mpox virus is primarily spread through direct contact with an infectious rash, scabs, or body fluids. The virus may also be spread through:
    1. respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex
    2. touching objects, fabrics (such as clothing or linens) that previously touched the rash or body fluids of someone with mpox
    3. being scratched or bitten by an infected animal
  • People can get mpox through specific behaviors, regardless of an individual’s race/ethnicity, sex, gender identity, sexual orientation, or other characteristics
  • Mpox causes a rash that may be located on hands, feet, chest, face, mouth, or near the genitals
    • During the current outbreak, the most common way mpox has spread is between people through direct contact with the rash, sores, scabs, or body fluids, mostly through sexual contact
    • A person with mpox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed. As of February 2023, new data show that some people can spread mpox to others from one to four days before their symptoms appear. It’s not clear how many people this has affected during the current outbreak. There is currently no evidence showing that people who never develop symptoms have spread the virus to someone else. CDC will continue to monitor the latest information about how mpox spreads.
    • Mpox vaccines are an important tool in preventing the spread of mpox. It protects people from infection, including infection from people who have mpox but do not have symptoms yet. People who are eligible for mpox vaccination should get two doses for the best protection. The second dose should be given four weeks after the first dose.
The framework for mpox messaging
  • Use inclusive language, such as ‘us’ and ‘we’ pronouns
  • Use non-sensationalistic language and images
  • Use language that resonates with the audience
  • Present concepts that the audience will be receptive to hearing or reading
  • Use positive, diverse, and credible images
  • Emphasize prevention strategies, symptom recognition, and the treatable nature of mpox to minimize fear, promote action and a sense of personal agency