“The disease carries different weight”: Gendered pathways of mpox burden during Sierra Leone's 2025 clade IIb outbreak
- 1National Public Health Agency, Freetown, Sierra Leone; Corresponding author. 42A Main Motor Road, Wilberforce, Western Area, Freetown, Sierra Leone.
- 2Foothills Community-Based Interventions, Monticello, Kentucky, United States of America
- 3National Public Health Agency, Freetown, Sierra Leone
Abstract
Epidemics become socially consequential through the institutions that interpret illness and organise how people respond. This article examines how gendered social relations shaped mpox burden during Sierra Leone's 2025 clade IIb outbreak. We conducted a secondary gender-focused analysis of qualitative data from 140 participants across four districts. Participants included mpox survivors (n = 42), healthcare workers (n = 38), community members (n = 36), and contact tracers (n = 24). Data came from 94 semi-structured interviews and 12 focus group discussions. Analysis used the Framework Method, scene-based charting, cross-case matrices, and negative- and boundary-case review. The source dataset recorded sex as female or male and did not separately collect gender identity. We therefore analyse gender as a social process that shapes the roles, relations, expectations, and institutions through which mpox acquired meaning. Among participants recorded as female, diagnosis was often interpreted through sexual reputation and household judgement. Household conduct frequently communicated that judgement without a spoken accusation. Among those recorded as male, burden centred more often on work, provision, and occupational standing. Healthcare-worker burden extended from facilities into households, neighbourhoods, and children's schools. Recovery continued beyond clinical discharge through intimacy, mutual aid, bodily visibility, and social re-entry. Gender-responsive outbreak responses should address the institutions that organise stigma, workforce burden, and social recovery. Sex-disaggregated case counts alone will not locate them.
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BibTeX
@article{ikoona2026disease,
title = {{“The disease carries different weight”: Gendered pathways of mpox burden during Sierra Leone's 2025 clade IIb outbreak}},
author = {Eric Nzirakaindi Ikoona and Lucy Namulemo and Mary Magdalene Sinnah and Mohamed Alex Vandi and Foday Sahr},
journal = {SSM: Qualitative Research in Health},
year = {2026},
month = oct,
doi = {10.1016/j.ssmqr.2026.100882},
url = {https://doi.org/10.1016/j.ssmqr.2026.100882},
note = {CC BY},
}
RIS
TY - JOUR
TI - “The disease carries different weight”: Gendered pathways of mpox burden during Sierra Leone's 2025 clade IIb outbreak
AU - Eric Nzirakaindi Ikoona
AU - Lucy Namulemo
AU - Mary Magdalene Sinnah
AU - Mohamed Alex Vandi
AU - Foday Sahr
PY - 2026
DA - 2026/10/30
JO - SSM: Qualitative Research in Health
DO - 10.1016/j.ssmqr.2026.100882
UR - https://doi.org/10.1016/j.ssmqr.2026.100882
AB - Epidemics become socially consequential through the institutions that interpret illness and organise how people respond. This article examines how gendered social relations shaped mpox burden during Sierra Leone's 2025 clade IIb outbreak. We conducted a secondary gender-focused analysis of qualitative data from 140 participants across four districts. Participants included mpox survivors (n = 42), healthcare workers (n = 38), community members (n = 36), and contact tracers (n = 24). Data came from 94 semi-structured interviews and 12 focus group discussions. Analysis used the Framework Method, scene-based charting, cross-case matrices, and negative- and boundary-case review. The source dataset recorded sex as female or male and did not separately collect gender identity. We therefore analyse gender as a social process that shapes the roles, relations, expectations, and institutions through which mpox acquired meaning. Among participants recorded as female, diagnosis was often interpreted through sexual reputation and household judgement. Household conduct frequently communicated that judgement without a spoken accusation. Among those recorded as male, burden centred more often on work, provision, and occupational standing. Healthcare-worker burden extended from facilities into households, neighbourhoods, and children's schools. Recovery continued beyond clinical discharge through intimacy, mutual aid, bodily visibility, and social re-entry. Gender-responsive outbreak responses should address the institutions that organise stigma, workforce burden, and social recovery. Sex-disaggregated case counts alone will not locate them.
SN - 2667-3215
ER -