Background
Mpox vaccination is recommended for transfeminine individuals with new STI diagnoses, with multiple sex partners, and those reporting sex at commercial venues. In 2025, mpox vaccine uptake remains low, and sexual healthcare including HIV and other STI services represent opportunities to reach underserved communities. We investigated mpox vaccine uptake and associated characteristics among transfeminine persons in the US.
Methods
From February-May 2025 through the Transgender Women’s Internet Survey and Testing (TWIST) study, we recruited transgender women and transfeminine nonbinary persons assigned male at birth (hereafter “tranfems”) in the United States (U.S.) to participate in an online survey about mpox and related health behaviors. We estimated the prevalence of mpox vaccination uptake (any dose) among transfems in the sample with HIV or participating in events with higher transmission risk (rave, sex party, sex club, group sex) in the past 3 months. We described sample characteristics and calculated adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations between vaccine uptake and preventive sexual healthcare engagement (uptake of STI testing, doxyPEP, or HIV PrEP) in the past 3 months. Models adjusted for age, region, employment, and housing stability.
Results
Of 397 transfems, 126 (31.7%) had at least one indication for mpox vaccination. Of these, 30 (24.6%) had received at least one dose of an mpox vaccine and 8 (6.6%) were unsure if they had been vaccinated. Of 84 participants who were eligible but not vaccinated, 70 (83.3%) had seen a healthcare provider in the last 3 months, 42 (50.0%) had engaged in preventive sexual healthcare in the past 3 months, 23 (27.4%) were aged<25, 15 (17.8%) were unemployed, 34 (40.5%) experienced recent food insecurity, and 7 (8.3%) faced housing instability (Figure). Just over one in ten (11.9%) had heard “a lot” about mpox. In adjusted models, recent STI testing (PR 2.32, 95% CI 1.39-3.87) and use of HIV PrEP (PR 2.36, 95% CI 1.31-4.26).
Conclusions
In this study of mpox-related behaviors among U.S. transfems, uptake of mpox vaccination was low, with nearly three-quarters of vaccine-indicated participants remaining unvaccinated. Sexual healthcare engagement was common among transfems who were eligible but unvaccinated, representing a critical and potentially missed opportunity to reach transfems with mpox prevention.
Table or Figure
