Healthcare inequity in mpox testing intention: A socioeconomic status-stratified path analysis of medical discrimination and distrust among men who have sex with men in China

Abstract

Background: Global mpox outbreaks have exposed healthcare inequities in testing accessibility. Socioeconomic disparities and medical discrimination and distrust influence testing service utilization among vulnerable populations. We examined how medical discrimination and distrust affect testing intention across socioeconomic strata among men who have sex with men (MSM) in China.
Methods: We conducted a nationwide cross-sectional study across six regions of China (November 2023 to March 2024). MSM aged ≥ 18 years who reported male sexual partners within previous six months were recruited through local Centers for Disease Control and Prevention and community-based organizations. Participants completed anonymous questionnaires measuring medical discrimination and distrust (DS), structural determinants, behavioral factors, psychosocial factors, and mpox testing intention. Path analysis was used to examine the effects of medical discrimination and distrust on testing intention, stratified by socioeconomic status (SES).
Results: 50.7% of 2403 participants reported high testing intention. Path analysis revealed that medical discrimination and distrust were associated with testing intention through distinct mechanisms across SES groups. For high-SES participants, positive indirect associations were found between medical discrimination and distrust and testing intention ( β = 0.061, P < 0.001) mediated by voluntary HIV counseling and testing services, social support and depression. For low-SES participants, medical discrimination and distrust demonstrated a negative direct effect ( β = −0.218, P < 0.001) and indirect effects through social support, depression, and mpox prevention-related self-efficacy ( β = −0.028, P < 0.001). Social support emerged as a crucial mediator among low-SES groups, while depression served as the crucial mediator among high-SES groups.
Conclusions: Healthcare inequities manifest through socioeconomically patterned pathways affecting mpox testing intention. Our findings suggest differentiated intervention strategies: integrating services with existing healthcare infrastructure for high-SES populations while strengthening community-based support for low-SES groups. These insights inform efforts to address healthcare disparities in infectious disease responses, particularly in resource-limited settings.

Keywords

healthcare inequity / mpox testing / medical discrimination / socioeconomic status / men who have sex with men (MSM)

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