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Abstract

This thesis investigates barriers and facilitators to preventative mpox vaccination among underrepresented gay, bisexual, transgender people, and other men who have sex with men in and around Vancouver, British Columbia, as part of a larger inter-provincial mixed-methods study funded by the Canadian Institutes of Health Research. Using Interpretive Description and Reflexive Thematic Analysis, this qualitative strand foregrounds the lived experiences of participants (n=14) who are racialised, transgender, sex working, or living with HIV. Findings show that vaccine engagement was shaped by the interplay of stigma and trust, where stigma eroded confidence in health systems, yet affirming care, trust, and resilience enabled uptake. Community networks and grassroots-oriented outreach functioned as stabilising forces that countered inequitable conditions. However, mpox-related communications inadvertently reinforced stigma and exclusion. Despite these barriers, participants reframed vaccination as a form of solidarity, turning vulnerability into strength through collective action and peer support. The subsequent application of the Health Stigma and Discrimination Framework highlighted multi-level drivers, manifestations, and outcomes of stigma, while the heuristic use of the kite metaphor offered ways of visualising the complex dynamics of agency and constraint in public health engagement across socio-ecological levels. This study advances health equity scholarship by amplifying underrepresented perspectives and demonstrating that vaccine uptake reflects both systemic inequities and community strength. It calls for stigma-sensitive communication, affirming care, and sustained investment in community-led initiatives as structural imperatives for public health.