PONE-D-21-33143"It's behaviors, not identity": Attitudes and Beliefs Related to HIV Risk and Pre-Exposure Prophylaxis Among Transgender Women in the Southeastern United StatesPLOS ONE

Dear Dr. Olivia T. Van Gerwen,

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PLOS ONE

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Additional Editor Comments:

Well written manuscript addressing gaps in PrEP use among TGW in Southeastern US

1. Background:

• The authors state that PrEP uptake for TGW is low. It would be helpful to present data for PrEP uptake among TGW compared to that of other population types. If there are data available, please indicate estimates of TGW at risk and the proportion of these that are on PrEP.

2. Methods

• May be useful to indicate and cite instances where the health belief model has been used in similar or related work

• Were there disagreements in coding? Please explain how they were resolved.

3. Results

• Lines 216-219 – this statement appears to be an interpretation of results. You may consider moving this to Discussion

4. Discussion:

• Line 283-284 – participants did not feel PrEP was for them because they did not engage in HIV risk behavior. Did the authors explore whether this perception was correct either through the qualitative work or by examining data obtained in the questionnaires e.g., what was the prevalence of STIs, # of sex partners etc.

• The authors have detailed a couple of barriers to PrEP use. It may be useful to discuss whether such barriers can be addressed as way of next steps following on from this work.

Other:

Line 49: is the last ‘through’?

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

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Reviewer #1: Yes

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Reviewer #1: N/A

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: Well written manuscript addressing gaps in PrEP use among TGW in Southeastern US

1. Background:

• The authors state that PrEP uptake for TGW is low. It would be helpful to present data for PrEP uptake among TGW compared to that of other population types. If there are data available, please indicate estimates of TGW at risk and the proportion of these that are on PrEP.

2. Methods

• May be useful to indicate and cite instances where the health belief model has been used in similar or related work

• Were there disagreements in coding? Please explain how they were resolved.

3. Results

• Lines 216-219 – this statement appears to be an interpretation of results. You may consider moving this to Discussion

4. Discussion:

• Line 283-284 – participants did not feel PrEP was for them because they did not engage in HIV risk behavior. Did the authors explore whether this perception was correct either through the qualitative work or by examining data obtained in the questionnaires e.g., what was the prevalence of STIs, # of sex partners etc.

• The authors have detailed a couple of barriers to PrEP use. It may be useful to discuss whether such barriers can be addressed as way of next steps following on from this work.

Other:

Line 49: is the last ‘through’?

**********

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Reviewer #1: No

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"It's behaviors, not identity": Attitudes and Beliefs Related to HIV Risk and Pre-Exposure Prophylaxis Among Transgender Women in the Southeastern United States

PONE-D-21-33143R1

Dear Dr. Van Gerwen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Kimani Makobu

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Just for information, while data comparing PrEP uptake in transgender women and cis gender MSM are limited there is a publication from East Africa that seems to have done this in a small cohort. Please consider citing them.

https://pubmed.ncbi.nlm.nih.gov/33465090

Reviewers' comments: