PONE-D-24-32402Recognising and responding to community needs of gay and bisexual men around mpoxPLOS ONE

Dear Dr. gilmore,

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Ranjan K. Mohapatra, PhD

Academic Editor

PLOS ONE

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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

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

Reviewer #3: N/A

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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: Yes

Reviewer #2: Yes

Reviewer #3: No

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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

Reviewer #2: Yes

Reviewer #3: Yes

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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: Although your article (PONE-D-24-32402) is organised effectively, there are a few places where it could be more focused, succinct, and clear. Based on the overall composition, the following particular suggestions will improve your document: I recommend this manuscript after minor revision.

1. Consistency in Title and Terminology:

• Ensure that the language is consistent. As an illustration, you utilise both "mpox" and "mbpox." Stick to a single term throughout the entire document. Per the most recent WHO standards, the recommended term is "mpox".

2. Context: Explain why the mpox outbreak in 2022 worried gbMSM populations especially. This should include a succinct description of the virus's characteristics, the reasons certain communities were disproportionately afflicted, and any early opinions or responses from the general public.

Relevance: Highlight why the study is specifically focused on Ireland. Is it due to a unique public health response, or were there specific community dynamics in play?

3. Methods

• Detail the Methods: You could provide a little more detail to the description of your mixed-methods approach, like the duration of the survey, the participant recruitment process, and any analysis tools that were employed.

• Reflexive Thematic Analysis: Mention briefly what "reflexive thematic analysis informed by critical realism" entails, especially for readers who may not be familiar with these concepts.

4. Findings

• Contextualize the Numbers: While stating that 163 men participated, it could be useful to provide some context, like how representative this sample is of the wider gbMSM community in Ireland.

• Thematic Overview: You’ve listed the four themes developed from the qualitative data. Consider briefly explaining what each theme entails or its significance rather than just listing them. This gives the reader a better grasp of the findings.

5. Discussion

• Strengthen the Argument: Although you discuss the efficacy of community-led projects, it would be helpful to give specific instances or further describe these activities. This would support your claim about the significance of these kinds of projects.

• Institutional Critique: Any particular instances from the research or literature that highlight the negative effects of institutionalised homophobia on public health outcomes could be added to the conversation about the issue.

• Balance the Discussion: In addition to stressing the difficulties, it could be a good idea to highlight any achievements or compliments received on the public health response, if any. This makes the conversation more fair-minded.

6. Conclusion

• Actionable Recommendations: Your conclusion is strong, but it would benefit from more actionable recommendations. For instance, how can public health strategies are made more inclusive and transparent? What specific steps can be taken to ensure equitable access and address structural inequalities?

7. Language & Tone

• Conciseness: There are some opportunities to tighten the language. For example, "the study underscores the need for inclusive, culturally sensitive, and transparent public health strategies" could be simplified to "the study highlights the need for inclusive and transparent public health strategies."

• Avoid Jargon: Some readers may not be familiar with terms like "critical realism" or "reflexive thematic analysis." While these are important, consider simplifying or explaining them briefly to ensure accessibility.

8. Overall Structure

• Flow & Transitions: Ensure smooth transitions between sections. For example, the findings section should naturally lead into the discussion, where the implications of these findings are explored in more depth.

Incorporating these improvements should make your write-up clearer, more persuasive, and accessible to a broader audience.

Reviewer #2: This paper reports on a community-based survey of gay and bisexual men in Ireland on the 2022 mpox outbreak. The paper employs a mixed methods analysis, which suggests that gay and bisexual men were well informed about mpox, but were critical of the government’s response and highly concerned about stigma. The authors suggest that robust community collaboration and ensuring equitable responses are vital.

This is an excellent paper; the authors have done a fantastic job of presenting in-depth findings from a relatively small community sample, including effectively presenting qualitative findings in a layered and sophisticated way from survey responses that in my experience, can often be done in a way that is quite ‘shallow’. I’ve also seen articles on mpox from much larger sample sizes that really lack the depth and resonance displayed here. There is an excellent alignment between the aims, methods, analysis, and discussion. Fantastic job!

My suggested revisions below are very minor, e.g., typographical, adding a little bit more detail in places, and some small suggestions of other sources for the discussion.

MINOR SUGGESTED REVISIONS:

Abstract

Minor spelling error – ‘mbpox’ should be ‘mpox’?

Introduction

Minor spelling error – as an institution, the spelling is ‘World Health Organization’

Should the authors mention somewhere that the WHO declared this outbreak no longer a PHEIC in 2023? (noting that there’s currently a different outbreak declared a PHEIC).

Methods

Participants – could the authors distinguish which recruitment methods applied to the convenience sampling and purposive sampling, respectively?

I think you could provide a brief descriptive summary of the participants here to complement Table 1. E.g., ‘the majority of participants identified as gay, the average age group, etc.’

Findings

In the first theme (divergence), it appears that the first quote (Gay man, Westmeath, 36-40) is from a person who was diagnosed with mpox from the context of the quote? I think this could be made explicit before you introduce the quote.

The second theme is interesting – from what I saw there were claims about stigma in both directions. E.g., framing mpox as a ‘gay disease’ being stigmatising, but also that saying ‘everyone is at risk’ was inappropriate for risk messaging and resource allocation, which constituted a different form of stigma from the state. It makes me think of this op ed:

Highleyman, L. (2022, July 25). Not Everyone Has to Be Equally Worried About Monkeypox. Slate. https://slate.com/technology/2022/07/monkeypox-spread-sex-men-vaccines-worry.html

Some similar themes in this paper expressed in this chapter and article. E.g., comparisons to AIDS crisis and COVID-19, the framing of risk groups, frustrations with public health response, concerns for embedded community connections:

https://www.taylorfrancis.com/chapters/oa-edit/10.4324/9781003322788-10/thinking-hiv-pandemic-times-kiran-pienaar-dean-murphy

Storer, D., Holt, M., Paparini, S., Haire, B., Cornelisse, V. J., MacGibbon, J., Broady, T. R., Lockwood, T., Delpech, V., McNulty, A., & Smith, A. K. J. (2024). Informed, but uncertain: Managing transmission risk and isolation in the 2022 mpox outbreak among gay and bisexual men in Australia. Culture, Health & Sexuality, 1–16. https://doi.org/10.1080/13691058.2024.2346540

General comment:

I noticed a switch to using MPOX (all capitalised) at one stage, which was inconsistent with earlier points in the article where it was talked about as mpox.

Reviewer #3: Many thanks for the opportunity to review this manuscript. This is an important, topical and timely piece of work that I enjoyed reading It would be helpful if the survey could be included as an appendix. The majority of content in the paper appears to be reporting the free text answers – so it would be good to see what the questions were. The results are really interesting to read – so much seems to be influenced by the post COVID (and HIV) context. During the 2022 Mpox outbreak I was able to observe how communities harnessed the power of social media to connect and support each other (e.g., informing others about vaccine availability etc). It’s great to see that this was something that was actively supported in Ireland. I completely agree with the conclusion that better collaboration between community organizations and government are needed (as well as better, and more funding for sexual

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Reviewer #1: Yes: Dr. Puneet Kumar Singh

Reviewer #2: No

Reviewer #3: No

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Submitted filename: Review report PONE-D-24-32402.docx

Recognising and responding to community needs of gay and bisexual men around mpox

PONE-D-24-32402R1

Dear Dr. gilmore,

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,

Ranjan K. Mohapatra, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #2: Yes

Reviewer #3: N/A

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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: No

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #2: Yes

Reviewer #3: Yes

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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: (No Response)

Reviewer #2: The authors have addressed my feedback, which were minor. Great article!

I'm apparently supposed to write a minimum of 100 characters here, got to love these silly systems.

Reviewer #3: (No Response)

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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

Reviewer #2: No

Reviewer #3: No

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