People with diverse sexual orientation, gender identity and/or gender expression (SOGIE) are a hard-to-reach population. This is because of restrictive legal frameworks, social exclusion, stigma and discrimination in service delivery. Because people with diverse SOGIE often avoid seeking healthcare at government health centres, mpox-related health services might not reach them. Contact tracing can be stymied by laws that criminalise same-sex behaviour. In contexts where sodomy laws are enforced and arrests are being made, listing same-sex partners can be akin to admitting to criminal behaviour, and providing contact details of sexual partners poses grave risks to them.
Laws that criminalise same-sex behaviour do not criminalise providing services for people with diverse SOGIE, but they justify marginalisation and can encourage discriminatory service provision. Healthcare providers and humanitarian workers supporting the mpox response need to know the framing and the impact of such restrictive laws to help them reach people with diverse SOGIE effectively without putting themselves or their patients at risk.
This brief provides a socio-behavioural analysis of the vulnerabilities, risks and resultant operational key considerations for working with people with diverse SOGIE in the mpox response. The World Health Organization (WHO) declared the second mpox Public Health Emergency of International Concern (PHEIC) in August 2024. The brief’s considerations are especially pertinent given that in the countries most affected by mpox, people with diverse SOGIE are at best stigmatised and at worst criminalised, necessitating a careful approach to ensure that they are reached adequately without creating further harms. This brief provides contextual information and practical recommendations to humanitarian aid workers and healthcare providers responding to mpox outbreaks in contexts that restrict rights related to SOGIE, with a specific focus on African settings. The brief provides an overview of the epidemiology of mpox as it relates to gay, bisexual and other men who have sex with men (GBMSM) and explains the specific medical and social vulnerabilities of this group. The brief then provides an overview of the relevant legal frameworks in the Democratic Republic of the Congo (DRC), Uganda, Nigeria and Burundi. These countries have reported high numbers of mpox cases during the most recent PHEIC, and the brief explains the consequences of each country’s legal framework for both healthcare and humanitarian aid provision.
The brief is available in English and French.
