Designing responses at different stages of the mpox outbreak; how MPOWER in Ireland is working with partners and engaging communities to eliminate the disease (2023)

The MPOWER Programme at HIV Ireland works with members of the gay, bisexual, and men who have sex with men (MSM) community to design and implement activities to help reduce HIV and other sexually transmitted infections, while also helping to improvethe sexual health and well-being of those in its community.

Adam Shanley is Programme Manager of MPOWER and remembers the swift reaction to mpox (monkeypox) in Ireland, well before the first cases were detected in the country.

“When the first cases were notified in the UK and in Portugal, a national crisis management team was convened in Ireland, which included stakeholders from across the health service, including epidemiologists, national and regional public healthteams, clinical leads for sexual health and the National Immunization Office. MPOWER was included from the get-go because of its close links to the affected communities, our ability to develop meaningful engagement, and for being able to steerthe response from a community perspective.”

Adam believes that trust and collaboration have been major factors in the success of Ireland’s response to mpox, and is proud of the way that authorities view MPOWER as a vital partner in national health responses.

“As a community organization, MPOWER is trusted not only by those most at risk from mpox (men who have sex with men with multiple partners), but our history of successful collaborative working in response to previous disease outbreaks meantthat the government and health authorities already had trust and respect for our expertise when it came to shaping the national response to mpox – also providing the necessary funding to allow us to mount effective responses at key momentsin the disease outbreak. Our messaging has also been well tailored, thanks to working closely with another community-led organization, Man2Man, together with the national Health Service Executive.”

Alerting the community to mpox

The first priority of MPOWER at the start of the outbreak was to alert the community to the new disease threat. Calling upon its pool of 50 volunteers, they organized a full-day training course on what was known about mpox, and how to communicateabout the risks and ways to prevent it. This formed the basis of their subsequent outreach work.

Everyday throughout May and June 2022 and once a week since then, the volunteers have also helped distribute mpox flyers to every bar, club and sex-on-premises venue they could think of, while gay dating apps, such as Grindr, were also brought onboard to carry the organization’s messages on the new health threat.

As Adam explained to us, engaging with sex-on-premises venues was particularly important, as these are often visited by MSM who do not necessarily identify as gay or bisexual, and by a large rural community that travels in to the capital to visitthem.

Preparing for Pride Month

With June being Pride Month in Dublin, MPOWER ramped up its efforts and interactions still further, liaising with event organizers and venues throughout the city.

“Here in Ireland, we’re a small, but very well connected community, ” Adam tells us. “During Dublin Pride, bars and clubs in the city were more than happy to help us and to offer their spaces. We also had great access to allthe Pride events, including the massive 3-day Block Party, being able to make use of the big screens they put up during this event and the Pride March to display our mpox messaging.”

Crucially, MPOWER was given access to the email addresses of all those who attended the ticketed events, which then allowed them to follow up with more tailored mpox information.

Promoting informed choices around mpox

Following Pride, the next stage in MPOWER’s communication campaigning focused not only on ensuring that MSM had all the information they needed on mpox, but also on encouraging them to make the right choices, as “agents of their own sexlives”, as Adam explains:

“We wanted to say at this stage in the outbreak ‘look, this [mpox] isn’t going anywhere for now, so here are the symptoms to look out for and here is where you can get tested’. We’ve learned from decades of messagingto our community that telling someone not to do something simply isn’t the right approach. Instead, we needed to promote informed choices around questions, such as ‘what does safer sex look like during the mpox outbreak?’, ‘howcan you assess your level of risk?’, ‘what is it that you feel comfortable doing right now?’, ‘could you reduce your sexual partners or perhaps create a ‘sex bubble’?’’

This was reflected in a campaign that was rolled out through posters and leaflets, as well as online, and as Adam is proud to relate seemed to have a real impact on the MSM community, given the positive feedback they received.

Encouraging vaccination

As mpox vaccines became widely available to the MSM community in Ireland, MPOWER adjusted its campaigning to reflect this change in the situation:

“We put out a call to the community that highlighted the criteria for those eligible for vaccination, to allow people to identify themselves as in need of the vaccine – so those with multiple sexual partners, that go to sex-on-premisesvenues, for instance – to make sure they were first in line to get it.”

Adam explained to us how the aim of the campaign was to get community buy-in for vaccination, while promoting the fact that only those at most risk should come forward for it, given that supplies were limited. This was particularly important giventhat MPOWER had been working with health authorities to ensure there was a “no questions asked” policy when people arrived at vaccination centres, to avoid feelings of stigma and so as not to deter people from coming forward to gettheir vaccine.

Next steps in the mpox response

Following intense demand before Christmas, there has been a marked drop in those wanting to get vaccinated, possibly as a result of a sharp decline in mpox cases both in Ireland and across the WHO European Region. MPOWER is now working with epidemiologistsand the operations teams in the health service to analyse how the current situation has led to changes in perceptions of mpox and how people behave, to shape the next stage in their campaigning.

“We have bombarded our community with a lot of messaging – also following on from a global COVID-19 pandemic that affected everyone – and many people have had enough. In this next phase we need to be more innovative and that’swhere looking at more data-led approaches to vaccination or engagement will be really important,” Adam told us.

Despite there having been no new mpox cases in Ireland for several weeks, Adam believes that now is not the time to be complacent and that there are still groups of MSM out there who remain vulnerable to mpox infection.

“In Ireland, we have a large, vibrant Latin American population, and although MPOWER has 2 Spanish and Portuguese speaking outreach workers, and we have produced communications around mpox in both languages, fewer people from that communityare coming forward for vaccination than we had expected. We need to investigate why that is and deal with those barriers. The fact that the online booking system is only available in English or Irish may be one of these, for instance.”

As mpox continues to constitute a Public Health Emergency of International Concern, Adam is keen to conclude our interview with a word of caution:

“From a community perspective, it's really, really important that we don't leave anybody behind in our mpox response, particularly as a resurgence of the disease isn't something beyond the realms of possibility. We also need to be thinking aboutyounger people under the age of 18, and using different channels of communication from those traditionally used for public health messaging.”


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