Assessing mpox knowledge and sexual behaviours within high-risk populations in the Democratic Republic of the Congo

Authors: LEMAILLE, CANDICE - University Of Manitoba; HALBROOK, MEGAN - University Of California (UCLA); MERRITT, SYDNEY - University Of California (UCLA); ANTA, YVON - Institute National Research Biomedical; LUNYANGA, LYGIE - Institute National Research Biomedical; MUKADI, PATRICK - Institute National Research Biomedical; VAKANIAKI, EMMANUEL - Institute National Research Biomedical; KALONJI, THIERRY - Ministry Of Public Health; KENYE, MICHEL - Institute National Research Biomedical; Hensley, Lisa; LINSUKE, SYLVIE - Institute National Research Biomedical; BOGOCH, ISAAC - University Of Toronto; CEVIK, MUGE - University Of St Andrews; GONSALVES, GREGG - Yale University; HUNTER, MIKAYLA - University Of Manitoba; LIESENBORGHS, LAURENS - Institute Of Tropical Medicine; SHAW, SOURADET - University Of Manitoba; HOFF, NICOLE - University Of California (UCLA); RIMOIN, ANNE - University Of California (UCLA); MBALA-KINGEBENI, PLACIDE - Institute National Research Biomedical; KINDRACHUK, JASON - University Of Manitoba; KACITA, CRIS - Ministry Of Public Health

Submitted to: British Medical Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/5/2026
Publication Date: 5/18/2026
Citation: Lemaille, C., Halbrook, M., Merritt, S., Anta, Y., Lunyanga, L., Mukadi, P.K., Vakaniaki, E.H., Kalonji, T., Kenye, M., Hensley, L.E., Linsuke, S., Bogoch, I.I., Cevik, M., Gonsalves, G.S., Hunter, M., Liesenborghs, L., Shaw, S.Y., Hoff, N.A., Rimoin, A.W., Mbala-Kingebeni, P., Kindrachuk, J., Kacita, C. 2026. Assessing mpox knowledge and sexual behaviours within high-risk populations in the Democratic Republic of the Congo. British Medical Journal. 11. Article e019865. https://doi.org/10.1136/bmjgh-2025-019865.
DOI: https://doi.org/10.1136/bmjgh-2025-019865

Interpretive Summary: Mpox (formerly known as monkeypox) continues to pose a serious public health concern in the Democratic Republic of the Congo (DRC), with over 70,000 probable cases reported between January 2024 and February 2025. Despite this burden, there has been little community engagement and education about mpox in the urban areas most affected. To better understand this gap, our research team surveyed 2,794 participants in three provinces of the DRC (Kinshasa, Kwango, and North Kivu), focusing on men who have sex with men, sex workers, and other individuals at higher risk of mpox infection. We found that very few people (about 6%) had any prior awareness of mpox. Among this small group, most associated the disease primarily with animal contact rather than human-to-human transmission. We also found that certain groups, particularly sex workers, frequently engaged in behaviors that could increase mpox transmission risk, such as having multiple sexual partners or anonymous sexual encounters. However, both sex workers and men who have sex with men demonstrated higher rates of seeking healthcare when they suspected they might have a sexually transmitted infection. By revealing the low level of mpox knowledge and identifying who is most willing to seek medical help, our findings show where public health officials and community groups can focus their efforts. This includes creating clear, accessible information about how mpox spreads and encouraging timely health care visits. Engaging with high-risk populations through education and support will be an important step toward controlling mpox and reducing its impact in the DRC.

Technical Abstract: Historically, the Democratic Republic of the Congo (DRC) has faced the greatest public health burden from mpox, including more than 70,000 probable cases from 01 January 2024 to 02 February 2025. However, there has been a relative paucity of mpox community engagement historically in DRC, including assessments of disease knowledge and risk perception. Given the ongoing Clade I mpox public health emergency of international concern, and the linkage between sustained human-to-human transmission and dense sexual networks, we sought to investigate mpox knowledge and sexual behaviors among key populations. We recruited 2794 participants distributed across Kinshasa, Kwango and North Kivu provinces, with a focus in urban centers where mpox risk was considered high. Most participants were considered other at-risk populations (1035; 37.0%), followed by men who have sex with men (835; 29.9%) and sex workers (810; 29.0%). Mpox knowledge, including transmission routes, as well as sexual and health-seeking behaviors, were evaluated through questionnaires led by peer educators. Overall, only 6.1% of all participants reported prior mpox knowledge. Among this participant subset, zoonosis (“direct contact with infected animals”) and “people living in high-risk areas” were the most frequently selected options in regard to mpox transmission and populations at risk, respectively. When considering at-risk behaviors for mpox, those that identified as sex workers frequently reported high risk sexual activities including multiple sexual partners (90.3% of sex work participants), engaging in transactional sex (96.0%), and anonymous sex (91.6%). However, both sex workers (49.2%) and MSM (59.8%) reported the highest health seeking behaviors when a sexually transmitted infection was suspected among the study cohorts. Our results highlight that community engagement that incorporates both mpox knowledge and risk perception activities, as well as those that are inclusive of at-risk populations are needed for ongoing mpox containment and mitigation efforts.