PONE-D-21-18575Deriving and interpreting population size estimates for adolescent and young men who have sex with men and female sex workersPLOS ONE

Dear Dr. Johnston,

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Reviewer 2 had some concerns about reliable sources and censoring. I think that you need to write something about this in your response but I am not sure that you can easily address this in the paper as it seems to me an intractable problem. You just need to do what you can.

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: This is a well written and interesting paper that provies sample size estimates for adolescent sex workers in differnet countries. While the accuracy and precision of these estimates are difficult to pin down (both due to various methods used to estimate population sizes and the reliance on underlying data sources), the paper makes interesting contributions by providing cross-country comparisons which could be informative for international collaborative efforts undertaken by international and national public health agencies focused on adolescent sex workers. Despite the limitations (which the authors recognize), I think this is a nice paper.

Reviewer #2: I think the authors did their best efforts to summarize all available data from different sources.

There is a major problem that of course cannot be fully averted by any means.

Notwithstanding, I would like to propose they should be candid on such major challenges, doing their best to incorporate exogenous (besides endogenous) adjustments.

In case this is not possible, re. countries where information is far from free, one should highlight “information to be double-checked”, as explained in detail below. This is a modicum of transparency we need to do in a context of major armed conflicts, collapse of democracy in several countries, ample dissemination of fake news, as well as censorship, worldwide.

The emergence of extreme right and left governments combined with the effects of deeply-entrenched prejudices tend to make some of national estimates nothing but a piece of fiction or a bad version of a fairy tale.

This can be observed in the recent papers showing that “non-existent” COVID epidemics in some African countries have been, at least partially, secondary to misinformation (available at: https://www.bmj.com/company/newsroom/impact-of-covid-19-in-africa-vastly-underestimated-warn-researchers/).

Local governments did NOT provide any help to fix such errors. But at least in the available papers (e.g. the ones from Zambia), censorship has NOT been imposed on accurate information.

In places where misinformation is disseminated in tandem with censorship, no reliable information can be properly obtained and disseminated.

Worst, misinformation backfires: why should international organizations and donors provide vaccines to contexts where epidemics did not take place? Misinformation is a terrible asset for those who want to disseminate false information about unscientific myths, such as a putative “natural immunity” of a given society or country (e.g. the bizarre information from Belarus: https://news.sky.com/story/coronavirus-belarus-president-who-claimed-vodka-could-ward-off-covid-19-says-he-survived-virus-on-his-feet-12038414).

My team and I have experienced such a situation for years. The findings from our population-based survey on the use of substance in Brazil did not match the expectations of the government and have been censored for years (https://www.fairplanet.org/editors-pick/what-the-censorship-of-a-research-now-released-says-about-brazils-deepening-war-on-drugs/).

Similar actions have affected several areas of science (e.g. https://news.mongabay.com/2021/04/intimidation-of-brazils-enviro-scientists-academics-officials-on-upswing/).

The final report was finally cleared, but incorporating a joint statement reached by an agreement between our institution and the government (the full report is available at: https://www.arca.fiocruz.br/bitstream/icict/34614/2/III%20LNUD_ENGLISH.pdf).

The statement allowing peer-reviewed publications eventuating from the original report (there are several peer-reviewed publications and papers currently “in press” despite the substantial delay) made very clear this was/is a “provisional agreement” (The original text is available in Brazilian Portuguese but can be easily understood using a standard translating device and it´s available as follows:

https://www.arca.fiocruz.br/bitstream/icict/34614/12/Nota%20Conjunta%20%c3%a0%20Imprensa.pdf)

Not to make a worldwide problem a personal issue, I would like to cite here a former initiative of a large team of researchers who did their best analyze HIV/AIDS among gay and men who have sex with other men in a large group of South Asian and Middle-East countries. The answer from their respective governments is that there was not a single case of AIDS among this population cause this population does NOT exist!

Of course, there is no way to adjust or carry out any imputation of data about categories that do not even exist!

There is no magic solution for problems such as the ones described above, but authors can and should define strata/rankings of countries where freedom of speech does or does not exist.

Unfortunately, triangulation does not help. The same countries that do not provide reliable data impose strong censorship on peer-reviewed publications. So, one would be cross-comparing non-available data (or even absent conceptual categories) with non-existent papers or papers published under harsh censorship.

I think that, unfortunately, with the collapse of several democracies, worldwide (see, for instance: https://www.amazon.com/When-Democracies-Collapse-Non-Democratic-Democratization/dp/0367888572/ref=sr_1_3?crid=2I4J3IPIM6PJ3&keywords=collapse+of+democracy&qid=1652123086&s=books&sprefix=collapse+of+democracy%2Cstripbooks-intl-ship%2C191&sr=1-3

https://www.amazon.com/Twilight-Democracy-Seductive-Lure-Authoritarianism/dp/1984899503/ref=pd_sbs_sccl_2_1/132-4376952-7835144?pd_rd_w=GgMmk&pf_rd_p=3676f086-9496-4fd7-8490-77cf7f43f846&pf_rd_r=QTP5GB6ZCP9CJ5P23XVQ&pd_rd_r=f960d4e3-9841-466f-935b-ca0b04eb0ea7&pd_rd_wg=vIrLN&pd_rd_i=1984899503&psc=10

… the classic idea of pooling data on sensitive items from diverse societies without any further input from external sources does not longer make sense.

I´m by no means a nihilist thinker, nor one who does not believe world data are useful and key.

I think they must be double-checked against the reliability of sources instead of taken at their face value.

There are several ways to do it:

One is to cross-compare data with the degree of freedom of speech and thinking in different societies and political systems.

There are reliable rankings regularly updated by international agencies addressing such issues from different perspectives.

For instance:

https://worldpopulationreview.com/country-rankings/countries-with-freedom-of-speech

Of course, there is no statistical tool to handle data belonging to conceptual categories that do not exist (how one could provide a reliable estimate on unicorns?). Of course, there are no unicorns besides those from creative books (https://www.amazon.com/Natural-History-Unicorns-Chris-Lavers/dp/0060874147/ref=sr_1_1?crid=3J4POZ347FMN0&keywords=the+natural+history+of+unicorns&qid=1652124098&s=books&sprefix=the+natural+history+of+unicorns%2Cstripbooks-intl-ship%2C216&sr=1-1), whereas key populations do exist everywhere.

Key populations are NOT unicorns, but “unicorns” are a valuable “commodity” for a non-democratic society.

There is no way to extract data from governments who say that in the society “S” gay and other men who make sex with men do not exist cause this would an “abomination” or a” violation of sacred laws” (verbatim)… or that people who use substances deserve capital punishment and that they may exist here and there “as a failure of systems aiming to eliminate this ‘scourge’” (verbatim; I´m just using the words made public by different governments).

There are very interesting analyses about the pronounced influence of funding on the reliability and transparence of clinical science.

See, for instance:

https://pubmed.ncbi.nlm.nih.gov/19596837/

https://pubmed.ncbi.nlm.nih.gov/19596838/

https://pubmed.ncbi.nlm.nih.gov/18616022/

https://pubmed.ncbi.nlm.nih.gov/29401492/

https://pubmed.ncbi.nlm.nih.gov/31497290/

From my point of view, agencies and researchers should apply a similar reasoning to country-based information.

There is no doubt industry and partisan lobbyists may bias scientific findings (see, for instance: https://www.amazon.com/Merchants-Doubt-Handful-Scientists-Obscured/dp/1608193942/ref=sr_1_1?crid=1R8LNEJDL7T1A&keywords=merchants+of+doubt&qid=1652124771&s=books&sprefix=merchant%2Cstripbooks-intl-ship%2C233&sr=1-1)

Non-democratic societies should not be spared of critical scrutiny. The Discussion must be candid about it. NOT in the sense of criticizing A or B, but putting sensitive data on brackets.

Transparent information about the absence of free access to data could be easily shared with the potential readers using international rankings (see, for instance, the excellent reports by the UN agencies such as those available at: https://www.ohchr.org/en/instruments-and-mechanisms). The authors do not need to express their own points of view. The simple dissemination of available information would be very helpful.

Of course, is not our duty (or possible action) “to mend the world”, but to be critical about the information we disseminate. Unfortunately, we live in dark times (there is an ongoing war, but it is not called a “war”!).

There are several lessons to get from Hannah Arendt (e.g. https://www.amazon.com/Men-Dark-Times-Hannah-Arendt/dp/0156588900/ref=sr_1_1?crid=ZU0IKCW5ZQBW&keywords=men+in+dark+times&qid=1652275547&s=books&sprefix=men+in+dark+times%2Cstripbooks-intl-ship%2C214&sr=1-1).

They are not pleasant, but they say the truth, the plain truth.

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Reviewer #1: No

Reviewer #2: Yes: Francisco Inacio Bastos

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Deriving and interpreting population size estimates for adolescent and young key populations at higher risk of HIV transmission: men who have sex with men and females who sell sex

PONE-D-21-18575R1

Dear Dr. Johnston,

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