Rural–Urban Disparities in Monkeypox-Related Behaviors and Attitudes Among Men Who Have Sex with Men

Authors

• Patcharaporn Krainara, Department of Research and Medical Innovation, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, ThailandFollow
• Benjamas Klahan, Chonburi Provincial Public Health Office, Chonburi, Thailand
• Rungrot Jaiyong, Nakhon Nayok Provincial Public Health Office, Nakhon Nayok, Thailand
• Jitti Hanprasertpong, Department of Research and Medical Innovation, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand

Abstract

Background: Monkeypox (Mpox) is a global health threat, particularly among men who have sex with men (MSM). Despite the predominance of urban cases in Thailand, rural–urban disparities in Mpox-related attitudes and behaviors remain underinvestigated. This study aimed to compare Mpox-related attitudes and preventive behaviors among urban (Chonburi) and rural (Nakhon Nayok) MSM and identify their influencing factors.

Method: This cross-sectional study was conducted between March and April 2025. A total of  842 MSM (421 urban; 421 rural) were recruited via convenience sampling. Data were collected using paper-based, self-administered Health Belief Model (HBM) questionnaires and analyzed using descriptive statistics and multivariable logistic regression.

Results: Rural MSM demonstrated more positive attitudes (p < 0.001), whereas urban MSM demonstrated superior preventive behaviors (p = 0.016). Rural residency(odds ratio [OR] = 1.83), income ≥20,000 THB (OR = 1.81), prior information (aOR = 2.22), high perceived severity (aOR = 2.21), and low perceived barriers (aOR = 1.76) were independently associated with positive attitudes. A lower number of sexual partners was associated with increased preventive practices (1-2 partners: aOR = 0.39, ≥3 partners: aOR = 0.14).In addition, high perceived severity (aOR = 3.62), urban residency (aOR = 1.97), and low perceived benefits (aOR = 1.89) were drivers of positive preventive behaviors.

Conclusion: Residential area was associated with preventive behaviors. Although rural MSM reported more positive attitudes, urban MSM demonstrated higher engagement in preventive practices. These findings emphasize the importance of contextual factors and health beliefs in influencing Mpox preventive behaviors.

 Keywords: Men Who Have Sex with Men, Monkeypox, Rural–Urban Disparities

Recommended Citation

Krainara P, Klahan B, Jaiyong R, Hanprasertpong J. Rural–Urban Disparities in Monkeypox-Related Behaviors and Attitudes Among Men Who Have Sex with Men. J Health Res. 2026; 40(1):-. DOI: https://doi.org/10.56808/2586-940X.1200

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