Perceived concern and risk of getting infected with monkeypox among MSM: Evidence and perspectives from the Netherlands, July 2022


The current monkeypox epidemic is most prevalent among men-who-have-sex-with-men (MSM). PrEP users and MSM with HIV (MSMHIV) are considered having the highest risk for monkeypox infection in the Netherlands and being targeted for monkeypox vaccination. Next to the epidemiological evidence, perceived concern/risk are also important in decision making about health behaviour uptake, e.g., vaccination uptake. It is thus relevant to examine which subpopulations among MSM consider themselves most at risk and most concerned about monkeypox. This study aimed to investigate this to complement and to help determining if the current measures to curb the epidemic are successfully targeted or not in the Netherlands. We conducted an online survey among 394 Dutch MSM. We first calculated the prevalence and standardised prevalence ratio (SPR) of high perceived concern/risk of monkeypox by the PrEP-use and HIV status. We then conducted two multivariable logistic regression analyses to investigate the perceived concern/risk of monkeypox and their potential socio-demographic/behavioural/health/psycho-social determinants. Among the included MSM, 52% showed high perceived concern and 30% showed high perceived risk of monkeypox. PrEP users (SPR=0.83) showed a significantly lower chance of perceived concern; and MSMHIV (SPR=2.09) were found to have a significant higher chance of perceiving high risk of monkeypox. In the multivariable logistic analyses, non-PrEP users (aOR=2.55) were more likely to perceive high concern, while MSM who were retired (aOR=0.23) and who had chemsex recently (aOR=0.63) were less likely to perceive high concern. MSMHIV (aOR=4.29) and MSM who had an unknown/undisclosed HIV status (aOR=6.07), who had attended private sex parties (aOR=2.10), and who knew people who have/had monkeypox (aOR=2.10) were more likely to perceive high risk of monkeypox. We found that a higher perceived risk (aOR=2.97) and a higher concern (aOR=3.13) of monkeypox were correlated with each other, more results see Table 2. In sum, only one-third of Dutch MSM considered themselves at a high risk of a monkeypox infection, and only half of them showed a high concern. We identified a potential discrepancy between the "actual risk" and the perceived risk and concern of monkeypox among MSM in this early stage of the monkeypox epidemic in the Netherlands, especially among PrEP users and MSMHIV. More refined public health communication strategies may be needed to improve the understanding and knowledge of the "actual risk" of monkeypox infections among these MSM sub-populations to encourage and facilitate an improved health behaviour uptake.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

There was no funding source for this study.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.


The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was assessed and approved by the Ethics Review Committee Psychology and Neuroscience of Maastricht University (ref.188_11_02_2018_S32).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.


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Data Availability

Data are available upon request.

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