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Background: Minority stress from racism and heterosexism may uniquely interact to impact the mental health of racialized sexual minorities. We examined variations in anxiety and depressive symptoms by reported by ethno-racial identity among gay, bisexual, and other men who have sex with men (gbMSM) in Vancouver, Canada. Methods: We recruited gbMSM aged ≥ 16 years from February 2012 to February 2015 using respondent-driven sampling (RDS). Participants completed computer assisted self-interviews (CASI) at enrollment and every 6 months until February 2017. We examined factors associated with moderate/severe anxiety and depression scores (> 10) on the Hospital Anxiety and Depression Scale (HADS) and differences in key explanatory variables including sociodemographic, psychosocial, and substance use factors. We used multivariable mixed effects models to assess whether moderate/severe scores were associated with ethno-racial identity across all visits. Results: After RDS-adjustment, of 774 participants, 79.9% of participants identified as gay. 68.6% identified as white, 9.2% as Asian, 9.8% as Indigenous, 7.3% as Latin American, and 5.1% as other ethno-racial identities. Participants contributed a median of 6 follow-up visits (Q1-Q3: 4–7). In the multivariable analysis, Asian participants had decreased odds of moderate/severe anxiety scores compared to white participants (aOR = 0.39; 95% CI: 0.18–0.86), and Latin American participants had decreased odds of moderate/severe depression scores compared to both white (aOR = 0.17; 95% CI: 0.08–0.36) and Asian (aOR = 0.07; 95% CI: 0.02–0.20) participants. Conclusion: Asian and Latino gbMSM reported decreased mental health symptoms compared to white participants. Asian and Latino gbMSM in Vancouver appear to manage multiple minority stressors without adversely affecting their mental health. Key messages: - What is already known on this topic: ◦ Sexual minority groups, including gay, bisexual, and other men who have sex with men (gbMSM), experience higher rates of mental health disorders than their heterosexual counterparts. ◦ Evidence is mixed on how stigma from intersecting minority identities among gbMSM, such as racism experienced by non-white ethno-racial identities, further affects mental health outcomes. - What this study adds: ◦ Among a sample of urban-residing gbMSM in Vancouver, Canada, ethno-racial minority status was not associated with increased odds of reporting moderate/severe depression or anxiety symptoms. ◦ Asian gbMSM had reduced odds of reported anxiety symptoms and Latino men had reduced odds of depression symptoms compared with white men. - How this study might affect research, practice, or policy: ◦ More research is needed with ethno-racialized gbMSM to understand mental health risks and vulnerabilities and to qualify survival and resilience narratives surrounding mental health. ◦ Healthcare providers should recognize nuance in how racism and homophobia may uniquely interact to affect the mental health of individual gbMSM. [ABSTRACT FROM AUTHOR]

• We studied vaccine uptake in STI clinic clients 5–7 weeks after vaccine program start. • 65.7% of eligible transgender/men who have sex with men (T/GBM) had been vaccinated. • Among unvaccinated, acceptability was high (85.3%) yet vaccine barriers were common. • Mpox vaccine uptake was patterned along sociodemographic gradients. • Early, intentional efforts to reach diverse groups of T/GBM are needed to maximize uptake. As the primary public health strategy for controlling the 2022 Mpox outbreak, it is critical to evaluate the impact of Mpox vaccination campaigns for transgender people and gay, bisexual and other men who have sex with men (T/GBM). We measured vaccine uptake and associated factors among T/GBM clients of an urban STI clinic in British Columbia (BC). We conducted a cross-sectional online survey between August 8–22, 2022 of clients who had attended the STI clinic, 5–7 weeks following the first-dose Mpox vaccination campaign in BC. We drew on a systematic review of factors associated with vaccine uptake to develop survey questions, and measured vaccine uptake among vaccine-eligible T/GBM. Overall, 51% of T/GBM had received the first dose of the vaccine. The sample (331 participants) was majority White and university educated, identified as a man and gay, 10% had trans experience, and 68% met eligibility criteria for vaccination. Among vaccine-eligible participants identifying as T/GBM, 66% had been vaccinated; being unvaccinated was more common among participants identifying as bisexual or heteroflexible/mostly straight, and who spent less time with other T/GBM. Eligible yet unvaccinated participants had lower perceived susceptibility, and reported fewer cues to action (e.g., fewer saw information promoting the vaccine), and increased constraints to vaccine access; vaccine barriers related to accessing clinics and privacy were common. The majority (85%) of those eligible and unvaccinated at time of survey were willing to receive the vaccine. In this sample of STI clinic clients, vaccine uptake among eligible T/GBM was high in the initial weeks following a Mpox vaccination campaign. However, uptake was patterned on social gradients with lower uptake among T/GBM who may be less effectively engaged by available promotion channels. We recommend early, intentional and diverse engagement of T/GBM populations in Mpox and other targeted vaccination programs. [ABSTRACT FROM AUTHOR]