The epidemics of mpox during 2022-2024 have been extensively studied, covering various aspects such as clinical features, diagnostic aspects, therapies, and vaccines. However, the factors influencing the reporting of Mpox cases and deaths have received limited attention. Notably, no studies have yet explored the intriguing relationship between LGBT+ rights and the morbidity and mortality from Mpox.

An ecological study was conducted across 106 countries, utilising the LGBT+ rights index (LGBT-RI) per country. This index was obtained from a comprehensive range of reputable sources, including the State-Sponsored Homophobia Reports produced by ILGA, LexisNexis, Factiva, Amnesty International, Human Rights Watch, the U.S. State Department, and Velasco report (2020), from Our World in Data. The study also incorporated data on cases, incidence rates, and mortality rates from the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO). The annual variation of the variables was meticulously assessed, and non-linear regression models (exponential) were conducted at Stata/MP® v.14.0.

The non-linear regression models yielded significant findings, underscoring the importance of this study. The analysis revealed a positive relationship between LGBT-RI and reported Mpox cases (r2 = 0.1006; p = 0.0040), indicating that countries with higher LGBT-RI had higher Mpox cases. Similarly, higher LGBT-RI values were significantly associated with higher Mpox incidence rates (cases/100,000 pop) (r2 = 0.5062; p < 0.0001). The number of deaths notified and the Mpox mortality rate were also associated with the LGBT-RI (r2 = 0.0636; p = 0.0328 and r2 = 0.1390; p = 0.0005, respectively). Notably, the %CFR was not associated with LGBT-RI (r2 = 0.0216; p = 0.3287), as expected. Discussion: These findings underscore the significant influence of stigma and discrimination that may be associated with Mpox. In particular, LGBT+ rights allow trust in the health system, diagnosis and management. At the same, the proper notification of a Mpox case and its associated outcomes. Even in 2024, 88 countries or territories, especially in Africa, the Middle East, and Asia, have not yet reported even a single case of Mpox. Even in Latin America and the Caribbean, ten countries are included in that list. Despite the epidemics of 2022-2024, Mpox remains a neglected condition worldwide, with a resurgence in countries like the Democratic Republic of Congo in 2023-2024.

Mpox, Epidemics, LGBTI, Global, Surveillance.

There was no conflicts of interest.

No financial support.