Understanding sociocultural influences in sexual health promotion and HIV protection among Latinx sexually minoritized men: A qualitative study

Lisvel A. Matos; Sarah E. Janek; Jasmine Salas; Caroline Munoz; Michael V. Relf; Rosa Gonzalez-Guarda

doi:10.1371/journal.pone.0318096

Peer Review History

Original SubmissionSeptember 30, 2024
30 Sep 2024 Author Response https://doi.org/10.1371/journal.pone.0318096.r001
19 Nov 2024 Decision Letter - Jonathan Garcia, Editor PONE-D-24-42433Understanding Sociocultural Influences in Sexual Health Promotion and HIV Protection among Latinx Sexually Minoritized Men: A Qualitative StudyPLOS ONE Dear Dr. Matos, 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. In regards to reviewer observations about clarity in terms of defining the population, please consider using the suggested definition of "only Spanish-speaking sub-population of Latinx" with an acknowledgement of the diversity of cultures and languages spoken in the Latine community. Please submit your revised manuscript by Jan 03 2025 11:59PM. 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Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. [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 Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 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 Reviewer #2: Yes ****** 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 ****** 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: Thank you for the opportunity to review this manuscript. The paper is well-written, and the authors provide incredibly rich data and a very thoughtful analysis. The findings offer important insights into what shapes sexual health behavior among Latinx SMM, which is highly useful for informing future research and intervention efforts. With some minor revisions (comments below), it will make a valuable contribution to PLOS ONE and the public health field. Abstract: - Lines 17-18: Suggest adding 1-2 examples of self-protective behaviors in parentheses - Lines 19-20: Recruitment strategy should be (briefly) indicated here (e.g., an online convenience sample of...) - Lines 21-22: It looks like this sentence is meant to justify the age of the data, which doesn't seem necessary given it's relatively recent; it is also redundant with the material above, so it could be removed (unless required by the journal) - Suggest adding a sentence about implications of your findings (e.g., how it might inform future research or intervention) Introduction: - Lines 52-65: The authors nicely summarize the literature on barriers to sexual health access among Latinx SMM, including sociocultural factors. However, it is not entirely clear how this study addresses pertinent gaps (the authors state this in lines 65-67, more but specificity is needed). Please revise to say more about the types of gap(s) that this study addresses (e.g., methodological gap; focus on certain HIV self-protective behaviors or barriers/facilitators that have received less attention...) Methods: - Suggest moving the Data Collection section up, after Setting and before Study Materials - Data Collection section: It is stated that the interview was semi-structured, but it would be helpful to have more information on the types of interview questions/domains (e.g., broadly asked about sexual health promotion vs. specific HIV/STI prevention behaviors). This could include a few sample questions (structured or open-ended) and/or follow-up probes. - Lines 100-101: This sentence is a little unclear in describing the number of participants; suggest rephrasing to "Of those, 15 individuals enrolled in the study, including..." - Line 144: It is unclear what is meant by "...in batches balancing recruitment, data collection, and analyses". Please rephrase. - Lines 144-146: The authors note that new codes emerged in analyzing the latter 10 interviews; please state whether these codes were applied/back-coded to the first 5 cases that were coded Results: - Pg. 13, 1st paragraph: Did discussions of HIV include the type/source of testing (e.g., testing in a clinic or HIV self-testing). If so, please indicate. - Pgs. 12-15: This theme is very rich and there is a lot of information in this section; suggest adding sub-headers to help organize (e.g., HIV testing, condom use, PrEP, other) - The authors describe similarities regarding minimal sex education received by participants who grew up in the US vs. Latin America. Did any other similarities/differences emerge between participants who immigrated to the US vs. born in the US? Discussion: - Throughout the manuscript but particularly in the discussion, there are some run-on sentences and minor grammar errors. Suggest further proofreading and using more concise language when possible. Reviewer #2: Thank you for the opportunity to review this article titled, "Understanding Sociocultural Influences in Sexual Health Promotion and HIV Protection among Latinx Sexually Minoritized Men: A Qualitative Study". The authors conducted qualitative interviews with the intention of gaining insights into the barriers to PrEp uptake among sexual minoritized Latinx men. This article is well written and the data contributes meaningfully to the literature. However, I do have major concerns regarding how the study population is defined which impacts how the data is interpreted and how it can be generalized. Authors appear to use the terms “Hispanic” and “Latinx” interchangeably, they are NOT interchangeable terms. This centers Spanish as “the” language of the Latine which is not only inaccurate, it is harmful. There is already a term available to refer to Spanish-speaking peoples, co-opting “Latinx” for this same purpose is an act of oppression against those Latine whose ancestry is not linked to the Spanish language. Some of the statistics cited are in reference to “Hispanic” people, yet the authors nevertheless report that they refer to “Latinx” communities in there narrative - again, these two populations are not defined in the same way, these terms cannot be used interchangeably. It is an act of erasure of non-Spanish speaking Latine communities to superimpose the term “Latinx” on data that refers only to Spanish-speaking peoples. The authors define their study population as Latinx however they sampled only individuals who speak Spanish or English, from a longitudinal study of young adult Hispanic immigrants in the U.S, and on the internet. All study participants report ancestry from Spanish-speaking countries in the Americas/Caribbean. By definition, the Latinx population also includes individuals from countries in the Americas/Caribbean where Portuguese and French are spoken. It would be more accurate to refer to the study population as “Spanish-speaking” or “Hispanic” or to otherwise specify “only Spanish-speaking sub-population of Latinx", as these findings cannot reasonably be generalized to portions of the Latine population in the U.S. that were systematically excluded from participation in this study. The authors did not report the exclusion criteria. ****** 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: Yes: Ashley Schuyler Reviewer #2: 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.0318096.r002
Revision 1
3 Jan 2025 Author Response We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere. This manuscript was included in my dissertation and submitted to PROQuest. The dissertation has been embargoed until July 2026 and is therefore not publically available. Please clarify whether this conference proceeding or publication was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript. Explanation provided in cover letter. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. A minimal anonymized data set has been uploaded to QDR.org. This explanation has been provided in the cover letter and the Data Availability Statement has been updated to reflect this change. Reviewer #1: Thank you for the opportunity to review this manuscript. The paper is well-written, and the authors provide incredibly rich data and a very thoughtful analysis. The findings offer important insights into what shapes sexual health behavior among Latinx SMM, which is highly useful for informing future research and intervention efforts. With some minor revisions (comments below), it will make a valuable contribution to PLOS ONE and the public health field. Abstract: - Lines 17-18: Suggest adding 1-2 examples of self-protective behaviors in parentheses Thank you for this suggestion. We have addressed this by adding examples of self-protective behaviors in the abstract on lines 18-19. - Lines 19-20: Recruitment strategy should be (briefly) indicated here (e.g., an online convenience sample of...) We have addressed this comment by including a brief description of the recruitment strategy in the abstract on lines 21-22. - Lines 21-22: It looks like this sentence is meant to justify the age of the data, which doesn't seem necessary given it's relatively recent; it is also redundant with the material above, so it could be removed (unless required by the journal) Thank you for your feedback. We agree that this sentence is not necessary and have removed it from the abstract as suggested. - Suggest adding a sentence about implications of your findings (e.g., how it might inform future research or intervention) We have addressed this by adding a sentence about the implications of our findings in the abstract on lines 27-29. Introduction: - Lines 52-65: The authors nicely summarize the literature on barriers to sexual health access among Latinx SMM, including sociocultural factors. However, it is not entirely clear how this study addresses pertinent gaps (the authors state this in lines 65-67, more but specificity is needed). Please revise to say more about the types of gap(s) that this study addresses (e.g., methodological gap; focus on certain HIV self-protective behaviors or barriers/facilitators that have received less attention...) We appreciate this suggestion. We have revised the manuscript on lines 70-74 to provide greater specificity about the types of gaps this study addresses, including the focus on less-explored HIV self-protective behaviors and barriers/facilitators unique to Latinx SMM. Methods: - Suggest moving the Data Collection section up, after Setting and before Study Materials We have made this change and moved the Data Collection section to follow the Setting section on lines 124-137. - Data Collection section: It is stated that the interview was semi-structured, but it would be helpful to have more information on the types of interview questions/domains (e.g., broadly asked about sexual health promotion vs. specific HIV/STI prevention behaviors). This could include a few sample questions (structured or open-ended) and/or follow-up probes. We appreciate this suggestion. We have expanded the Data Collection section to include examples of the interview questions and follow-up probes used to guide discussions on lines 129-132, as requested. - Lines 100-101: This sentence is a little unclear in describing the number of participants; suggest rephrasing to "Of those, 15 individuals enrolled in the study, including..." We have corrected this sentence for clarity as recommended on lines 114-119. - Line 144: It is unclear what is meant by "...in batches balancing recruitment, data collection, and analyses". Please rephrase. We agree that it was confusing and have rephrased this sentence for clarity on lines 164-165. - Lines 144-146: The authors note that new codes emerged in analyzing the latter 10 interviews; please state whether these codes were applied/back-coded to the first 5 cases that were coded Thank you for this important feedback. Yes, the new codes that emerged during the analysis of the latter 10 interviews were applied and back-coded to the initial five cases. We have clarified this point in the manuscript on lines 166-168. Results: - Pg. 13, 1st paragraph: Did discussions of HIV include the type/source of testing (e.g., testing in a clinic or HIV self-testing). If so, please indicate. Thank you for this question. We did not specifically ask participants about HIV self-testing during the interviews. However, in their responses, participants often referred to going to a clinic or seeing a healthcare provider for HIV testing. We have clarified this point in the manuscript on lines 248-249. - Pgs. 12-15: This theme is very rich and there is a lot of information in this section; suggest adding sub-headers to help organize (e.g., HIV testing, condom use, PrEP, other) Thank you for your suggestion. We have added sub-headers (e.g., HIV testing, condom use, PrEP, other) to this section to help organize the content, as recommended, on pages 13-16. - The authors describe similarities regarding minimal sex education received by participants who grew up in the US vs. Latin America. Did any other similarities/differences emerge between participants who immigrated to the US vs. born in the US? The other theme where similarities between participants who immigrated to the US and those born in the US emerged was in the cultural and religious norms theme. With both groups highlighting that cultural expectations and religious beliefs significantly influenced their sexual health behaviors and attitudes. We have added a sentence to the manuscript on lines 390-392 to highlight this similarity. Discussion: - Throughout the manuscript but particularly in the discussion, there are some run-on sentences and minor grammar errors. Suggest further proofreading and using more concise language when possible. Thank you for noting these issues. We have thoroughly proofread the manuscript and revised the discussion section, as well as the rest of the text, to eliminate run-on sentences and improve conciseness. Reviewer #2: Reviewer #2: Thank you for the opportunity to review this article titled, "Understanding Sociocultural Influences in Sexual Health Promotion and HIV Protection among Latinx Sexually Minoritized Men: A Qualitative Study". The authors conducted qualitative interviews with the intention of gaining insights into the barriers to PrEp uptake among sexual minoritized Latinx men. This article is well written and the data contributes meaningfully to the literature. However, I do have major concerns regarding how the study population is defined which impacts how the data is interpreted and how it can be generalized. Authors appear to use the terms “Hispanic” and “Latinx” interchangeably, they are NOT interchangeable terms. This centers Spanish as “the” language of the Latine which is not only inaccurate, it is harmful. There is already a term available to refer to Spanish-speaking peoples, co-opting “Latinx” for this same purpose is an act of oppression against those Latine whose ancestry is not linked to the Spanish language. Thank you for bringing this important issue to our attention. We have revised the manuscript to use the term "Latinx" consistently throughout when referring to the populations discussed. Additionally, we have clarified that our study focuses on a Spanish-speaking sub-population of Latinx individuals and explicitly acknowledge that this does not encompass the full linguistic and cultural diversity of the Latinx community. These changes can be found on lines 32-35, 87-88, and 97-99. Some of the statistics cited are in reference to “Hispanic” people, yet the authors nevertheless report that they refer to “Latinx” communities in there narrative - again, these two populations are not defined in the same way, these terms cannot be used interchangeably. It is an act of erasure of non-Spanish speaking Latine communities to superimpose the term “Latinx” on data that refers only to Spanish-speaking peoples. Thank you for raising this important point. We acknowledge the distinction between the terms "Hispanic" and "Latinx" and recognize that they are not interchangeable. In our manuscript, we have chosen to use the term "Latinx" consistently to refer to the populations discussed, as it is a gender-neutral term intended to encompass individuals of Latin American ancestry. We provide this definition on lines 32-35. While some of the statistics cited in our work use the term "Hispanic," we use "Latinx" in our narrative to align with our study’s focus on inclusivity and to reflect the terminology commonly used in current research and discourse. We revised the manuscript to specify that our use of Latinx throughout the manuscript refers to Spanish- and English speakers on lines 87-89. We have also expanded the limitations of our study’s inclusion criteria and cited research on lines 668-678. The authors define their study population as Latinx however they sampled only individuals who speak Spanish or English, from a longitudinal study of young adult Hispanic immigrants in the U.S, and on the internet. All study participants report ancestry from Spanish-speaking countries in the Americas/Caribbean. By definition, the Latinx population also includes individuals from countries in the Americas/Caribbean where Portuguese and French are spoken. It would be more accurate to refer to the study population as “Spanish-speaking” or “Hispanic” or to otherwise specify “only Spanish-speaking sub-population of Latinx", as these findings cannot reasonably be generalized to portions of the Latine population in the U.S. that were systematically excluded from participation in this study. We acknowledge that our study sampled only Spanish- and English-speaking individuals with ancestry from Spanish-speaking countries in the Americas and Caribbean. To address this, we have revised the manuscript to more accurately describe our study population as a Spanish- and English speaking sub-population of Latinx. Additionally, we have clarified in the limitations section that our sampling approach excluded individuals from non-Spanish-speaking communities within the Latinx population on lines 673-676. The authors did not report the exclusion criteria. Thank you for pointing this out. We have added the exclusion on lines 102-103. Attachments Attachment Submitted filename: Response to reviewers PLOS One.docx https://doi.org/10.1371/journal.pone.0318096.r003
10 Jan 2025 Decision Letter - Jonathan Garcia, Editor Understanding Sociocultural Influences in Sexual Health Promotion and HIV Protection among Latinx Sexually Minoritized Men: A Qualitative Study PONE-D-24-42433R1 Dear Dr. Matos, 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 Editorial Manager® 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, Jonathan Garcia Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0318096.r004
Formally Accepted
Acceptance Letter - Jonathan Garcia, Editor PONE-D-24-42433R1 PLOS ONE Dear Dr. Matos, 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. Jonathan Garcia Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0318096.r005

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