Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional study

Phoenix K. H. Mo; Meiqi Xin; Zixin Wang; Joseph T. F. Lau; Xinchen Ye; Kam Hei Hui; Fuk Yuen Yu; Ho Hin Lee

doi:10.1371/journal.pone.0300988

Peer Review History

Original SubmissionSeptember 20, 2023
14 Nov 2023 Decision Letter - Nelsensius Klau Fauk, Editor PONE-D-23-30000Patterns of sex behaviors and factors associated with condomless sex during the COVID-19 pandemic among men who have sex with men in Hong KongPLOS ONE Dear Dr. Mo, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Dec 29 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Nelsensius Klau Fauk, S.Fil., M., MHID, MSc, PhD Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Kindly find the attached comments on the “Patterns of sex behaviors and factors associated with condomless sex during the COVID-19 pandemic among men who have sex with men in Hong Kong”. Abstract - “The present study examined the patterns of sex behaviors before and during COVID-19, and identified the factors associated with condomless sex during COVID-19 from individual, interpersonal, and contextual level among men who have sex with men (MSM) in Hong Kong”. Here the authors stated that the participants were MSM. But later in the abstract they mentioned “However, a higher level of condomless sex with all types of sex partners during the COVID-19 period was also observed”. So, who were the study participants? Introduction - The introduction is too long. Be concise. Methods - The study design should be recognized from the title and abstract. But even after read the methods, I could not find the study design utilized by the authors. - There is no information about the population and sampling, sampling techniques, and the calculation of the sample size. - I calculated that at least 47 questions aside from the socio-demographic variables raised by the interviewers. They applied telephone surveys for the data collection. How the authors will explain the decision to use this approach instead of other methods of data collection? - How did the authors explain the online methods they used to reach the participants? This approach was applied by a trained and experienced fieldworker and peer referral. How did a single person reach more than 600 participants? The authors should explain step-by-step process they used so that at the end they came up with 463 participants. - In the introduction, the very first sentence is related to HIV. I highlighted and understand that “….COVID-19 can still be detected in semen and feces and persists even after the virus is no longer detected”. In the “Factors at the individual lever” and all other items, no more question about HIV. So the condomless sex is only focus on the COVID-19? Elaborate this. Results - In the inclusion criteria, the authors mentioned “self-reported having had sex with a male” or in other parts stated as MSM. But in the Table 1, they included homosexual, heterosexual, and bisexual. I am not specifically in this area, but I think the inclusion criteria need to be detailed. - The data collection was conducted with telephone surveys. I am interested to know how did the authors/interviewers asked the monthly income? So that only 4 participants who “prefer not to say”. - In the methods, the authors mentioned the measures they used: (1) Same-sex behaviors before and during the COVID-19 period, (2) Factors at the individual level, (3) Factors at the interpersonal level, and (4) Factors at the contextual level. Later, the authors divided the results into (1) Socio-demographic characteristics of the participants, (2) Pattern and changes of sexual behavior during the COVID-19 period, (3) Descriptive statistics of potential factors of CAI during the COVID-19 period, (4) Socio-ecological factors on CAI with any sex partners during the COVID-19 period. How did the authors retrieve the data in the results with the measurement they planned in the methods? I think the headings/sub-headings of the results should align with the domains they mentioned in the methods section. - Under Table 3 (Descriptive statistics of potential….) the authors explain a, b, and c. What for are these in the analysis? They did not mention anything about the threshold scores in the methods. - In the methods, the authors explained the “factors at the individual level: (1) Perceived risk of COVID-19 infection in general, (2) Perceived risk of COVID 19 infection during sexual intercourse, (3) Perceived severity of COVID-19, (4) COVID-19 risk reduction behaviors in general, and (5) COVID-19 risk reduction behaviors during sex. How did the authors get the data of “COVID-19 related worry” in the results? (line 273). No data about it in the Table 4. Discussion - Better to re-state the purpose of the study to start the discussion. - The authors may analyze/discuss the differences between “perceived severity of COVID-19” with “perceived severity of HIV AIDS”. Find the article “Perceptions of determinants of condom use behaviors among male clients of female sex workers in Indonesia: A qualitative inquiry” Overall: - Do check the abbreviation policy of the journal. Is CAI a common abbreviation? I read many use UAI, CAS, CLAI, and many more for the similar matter. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0300988.r001
Revision 1
28 Dec 2023 Author Response Comments from the editor: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: Thank you for your comment. We've revised the manuscript to align with PLOS ONE's style requirements, including proper file naming. 2. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. Response: Thank you for your comment. We have incorporated the full ethics statement into the 'Methods' section of the manuscript. Additionally, we obtained verbal informed consent, and we've included this information in the statement. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: Thank you for your comment. We further cited an article as suggested by the reviewer to enrich the introduction section and the discussion section. Fauk NK, Kustanti CY, Liana DS, Indriyawati N, Crutzen R, Mwanri L. Perceptions of Determinants of Condom Use Behaviors Among Male Clients of Female Sex Workers in Indonesia: A Qualitative Inquiry. Am J Mens Health. 2018 Jul;12(4):666-675. doi: 10.1177/1557988318756132. Epub 2018 Feb 22. PMID: 29468942; PMCID: PMC6131453. Comments from the reviewer: Abstract - “The present study examined the patterns of sex behaviors before and during COVID-19, and identified the factors associated with condomless sex during COVID-19 from individual, interpersonal, and contextual level among men who have sex with men (MSM) in Hong Kong”. Here the authors stated that the participants were MSM. But later in the abstract they mentioned “However, a higher level of condomless sex with all types of sex partners during the COVID-19 period was also observed”. So, who were the study participants? Response: Thank you for your comment. The participants of this study are MSM in Hong Kong. Types of sex partners mentioned in this study included regular sex partners, non-regular sex partners, and casual sex partners. We have clarified this in the manuscript. Introduction - The introduction is too long. Be concise. Response: Thank you for your comment. We have revised the introduction section to make it be concise and to the point. Methods - The study design should be recognized from the title and abstract. But even after read the methods, I could not find the study design utilized by the authors. Response: Thank you for your comment. This study is a cross-sectional study. We have revised the title, abstract and methods section to clarify this. - There is no information about the population and sampling, sampling techniques, and the calculation of the sample size. Response: Thank you for your comment. We have revised the methods section to acknowledge that “this study included a convenient sample”. We also included information about sample size calculation in the manuscript. - I calculated that at least 47 questions aside from the socio-demographic variables raised by the interviewers. They applied telephone surveys for the data collection. How the authors will explain the decision to use this approach instead of other methods of data collection? Response: Thank you for your comment. We have reviewed the methods section to justify the choice of telephone surveys. - How did the authors explain the online methods they used to reach the participants? This approach was applied by a trained and experienced fieldworker and peer referral. How did a single person reach more than 600 participants? The authors should explain step-by-step process they used so that at the end they came up with 463 participants. Response: Thank you for your comment. We have revised the methods section to provide further details regarding the recruitment procedure. - In the introduction, the very first sentence is related to HIV. I highlighted and understand that “….COVID-19 can still be detected in semen and feces and persists even after the virus is no longer detected”. In the “Factors at the individual lever” and all other items, no more question about HIV. So the condomless sex is only focus on the COVID-19? Elaborate this. Response: Thank you for your comment. Since this study focused more on the influence of COVID-19 pandemic on sex behaviors, we focused on factors related to COVID-19. HIV-related factors were not investigated. We have revised the introduction section to clarify this. Results - In the inclusion criteria, the authors mentioned “self-reported having had sex with a male” or in other parts stated as MSM. But in the Table 1, they included homosexual, heterosexual, and bisexual. I am not specifically in this area, but I think the inclusion criteria need to be detailed. Response: Thank you for your comment. Since the target population of this study is MSM, self-reported having had sex with a male, which was more behaviorally defined, was one of the inclusion criteria. We acknowledged that men who choose to have sex with men are not necessarily homosexual. Therefore, we also measured sexual orientation, i.e. homosexual, heterosexual, and bisexual, as one of characteristics of participants. - The data collection was conducted with telephone surveys. I am interested to know how did the authors/interviewers asked the monthly income? So that only 4 participants who “prefer not to say”. Response: Thank you for your comment. The participants were not requested to provide an accurate number of the monthly income. They were just requested to indicate a level, i.e. 10000 or below, 10000 to 19999, 20000 to 29999, and 40000 or above. We have revised the methods section to clarify this. - In the methods, the authors mentioned the measures they used: (1) Same-sex behaviors before and during the COVID-19 period, (2) Factors at the individual level, (3) Factors at the interpersonal level, and (4) Factors at the contextual level. Later, the authors divided the results into (1) Socio-demographic characteristics of the participants, (2) Pattern and changes of sexual behavior during the COVID-19 period, (3) Descriptive statistics of potential factors of CAI during the COVID-19 period, (4) Socio-ecological factors on CAI with any sex partners during the COVID-19 period. How did the authors retrieve the data in the results with the measurement they planned in the methods? I think the headings/sub-headings of the results should align with the domains they mentioned in the methods section. Response: Thank you for your comment. We have revised the headings to make sure that there is a match between the results section and the methods section. - Under Table 3 (Descriptive statistics of potential….) the authors explain a, b, and c. What for are these in the analysis? They did not mention anything about the threshold scores in the methods. Response: Since factors of condomless anal intercourse were rated on Likert Scale, we set thresholds to help us better describe characteristics of participants’ answers. We have revised the methods section to clarify the thresholds we used. - In the methods, the authors explained the “factors at the individual level: (1) Perceived risk of COVID-19 infection in general, (2) Perceived risk of COVID 19 infection during sexual intercourse, (3) Perceived severity of COVID-19, (4) COVID-19 risk reduction behaviors in general, and (5) COVID-19 risk reduction behaviors during sex. How did the authors get the data of “COVID-19 related worry” in the results? (line 273). No data about it in the Table 4. Response: Thank you for your comment. We did not include this information in our analysis. We have deleted it from the manuscript. Discussion - Better to re-state the purpose of the study to start the discussion. Response: Thank you for your comment. We have revised the discussion section to re-state the purpose of the study prior to the commencement of the discussion. - The authors may analyze/discuss the differences between “perceived severity of COVID-19” with “perceived severity of HIV AIDS”. Find the article “Perceptions of determinants of condom use behaviors among male clients of female sex workers in Indonesia: A qualitative inquiry” Response: Thank you for your comment. We have revised the discussion section to compare our findings with studies investigating risk perceptions regarding HIV. Overall: - Do check the abbreviation policy of the journal. Is CAI a common abbreviation? I read many use UAI, CAS, CLAI, and many more for the similar matter. Response: Thank you for your comment. We have revised the manuscript to replace CAI with condomless anal intercourse. We would like to take this opportunity to thank the reviewer and the editor who have provided very constructive comments on our paper. Your comments have helped us strengthen our arguments and enhance the quality of our manuscript. We greatly appreciate your review of our resubmission and look forward to your reply in due course. Should you have any enquiries, feel free to contact us. Thank you very much for your consideration. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0300988.r002
1 Feb 2024 Decision Letter - Nelsensius Klau Fauk, Editor PONE-D-23-30000R1Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional studyPLOS ONE Dear Dr. Mo, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 17 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Nelsensius Klau Fauk, S.Fil., M., MHID, MSc, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Thanks to the authors for submitting the revised version which much improvement. Please address a minor comment raised by the reviewer about the inconsistency of the numbers used in text and table in the results section. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for delivering the response from the authors. I have read the new version and the response letter. I attached the comments on the revised version of the paper. Title - It is clear now that the study is a cross-sectional study. Abstract - The new version provides a better understanding of the terminologies and the research methods. Methods - The new version has more detailed information on the procedure. - Sample size calculation: need a reference/references Results - Need to be consistent with numbers after coma. i.e “Table 2. Participants reported an average of 1.2 regular partners (SD = 1.34), 2.09 non-regular 288 partners (SD = 4.58), and 0.08 casual partners (SD = 0.80) during the COVID-19 period”. In the table, they used 1.24; in the description, it is 1.2. Meanwhile, for numbers, they used two numbers after the coma. I have no more comments. Generally, the new version is more explicit as various parts I was concerned about before have been detailed. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0300988.r003
Revision 2
4 Mar 2024 Author Response Comments from the editor: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: Thank you for your comment. We have reviewed the reference list. We slightly changed the information regarding reference No.1, No.5, and No.19 in the bibliography to make information provided correct. In addition, we deleted the reference No.9. Thanks to the authors for submitting the revised version which much improvement. Please address a minor comment raised by the reviewer about the inconsistency of the numbers used in text and table in the results section. Response: Thank you for your comment. We have revised the manuscript according to the comment raised by the reviewer. Comments from the reviewer: Title - It is clear now that the study is a cross-sectional study. Response: Thank you for your comment in the previous round. Abstract - The new version provides a better understanding of the terminologies and the research methods. Response: Thank you for your comment in the previous round. Methods - The new version has more detailed information on the procedure. Response: Thank you for your comment in the previous round. - Sample size calculation: need a reference/references Response: Thank you for your comment. We have revised the manuscript to provide references for information regarding sample size calculation. Results - Need to be consistent with numbers after coma. i.e “Table 2. Participants reported an average of 1.2 regular partners (SD = 1.34), 2.09 non-regular 288 partners (SD = 4.58), and 0.08 casual partners (SD = 0.80) during the COVID-19 period”. In the table, they used 1.24; in the description, it is 1.2. Meanwhile, for numbers, they used two numbers after the coma. Response: Thank you for your comment. We have revised the manuscript to make sure that numbers of the present study are rounded to 2 decimal places and percentages of the present study are rounded to 1 decimal place. We would like to take this opportunity to thank the reviewer and the editor who have provided very constructive comments on our paper. Your comments have helped us strengthen our arguments and enhance the quality of our manuscript. We greatly appreciate your review of our resubmission and look forward to your reply in due course. Should you have any enquiries, feel free to contact us. Thank you very much for your consideration. Attachments Attachment Submitted filename: Response to Reviewers_240304.docx https://doi.org/10.1371/journal.pone.0300988.r004
7 Mar 2024 Decision Letter - Nelsensius Klau Fauk, Editor Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional study PONE-D-23-30000R2 Dear Dr. Mo, 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. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at http://www.editorialmanager.com/pone/ and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Nelsensius Klau Fauk, S.Fil., M., MHID, MSc, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0300988.r005
Formally Accepted
26 Mar 2024 Acceptance Letter - Nelsensius Klau Fauk, Editor PONE-D-23-30000R2 PLOS ONE Dear Dr. Mo, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Nelsensius Klau Fauk Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0300988.r006

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