Community-Led Responses to Mpox Among Gay, Bisexual, and Queer Men in Canada: Mapping the Collaboration of Community-Based Organizations, Public Health, and Clinicians

Since 2022, a global mpox outbreak in non-endemic countries, including Canada, has spread rapidly, mainly affecting gay, bisexual, and queer men (GBQM). With mpox primarily transmitted through sexual and close physical contact, concerns emerged over the replication of early responses to HIV/AIDS, which was initially labeled as a "gay disease," perpetuating ongoing negative stereotypes and discrimination against GBQM. To prevent potential social and health-related stigmatization, institutional actors, including public health authorities, community-based organizations (CBOs), and clinical bodies, collaborated to provide guidance and promote culturally informed responses. We aimed to examine how health institutional collaborations were formed and maintained as challenges emerged during Canada's mpox outbreak response. We conducted 30 online individual interviews and six small focus groups with 48 CBO practitioners, public health personnel, and clinical providers across Canada. Data were analyzed using institutional ethnography and actor-network theory, through indexing, which involves categorizing and consolidating categories. We mapped four interrelated networks of coordination: assembling the network through existing HIV infrastructures; co-developing public health messaging to increase cultural sensitivity to GBQM's lived experiences; negotiating vaccine eligibility criteria to reflect community realities; and mobilizing networks to deliver vaccines in GBQM community-friendly settings. Regional differences in public health infrastructure influenced the development of coordination, messaging, and access to care. Findings highlight how relational infrastructures developed for HIV were reactivated and repurposed during the mpox response. Investing in and maintaining strong community and public health relationships outside of crisis periods can improve future responses to health emergencies affecting GBQM communities and other marginalized populations.