Dear Dr. Sternberg,

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 Apr 25 2025 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.

• 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'.
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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Zypher Jude G. Regencia, Ph.D.

Academic Editor

PLOS ONE

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Please update your Data Availability statement in the submission form accordingly.

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“Dr. Sternberg is funded by the National Center for Advancing Translational Sciences, award number KL2TR002737.”

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Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

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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?

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

Reviewer #1: Thank you for the opportunity to review this important research. Kindly address the following comments to ensure your paper meets PLOS One’s criteria for scientific suitability and publication:

_____________________________________________________________________________________________________

General comments:

• The authors’ account for the unavailability of the data appears limited. While they mention that the data are available upon request, they do not provide sufficient details about the specific restrictions or exceptional circumstances that prevent public sharing.

• (Page 6, Line 119) “Materials and Methods:” All level 1-3 headings must be written in sentence case with only first word in capital letters.

_____________________________________________________________________________________________________

Abstract:

• (Page 2, Line 30) The phrase “third greatest” should be written in words rather than using numerals (“3rd”) for formality.

• (Page 2, line 30-33) The background section of an abstract must incorporate aim to clarify specific purpose and direction of the study.

• (Page 2, line 34-37) Under Material and methods section, authors should briefly outline the approach, design, sampling method, and tool used for analyses, despite the word limit of the abstract section.

• (Page 2 Line 39) Change “For all respondents” since this is not a general statement but it a comparing from a group of participants, thus the use “Out of all respondents” would best fit this context.

• (Page 2 Line 40) Provide statistics from empirical data for this statement “Over half of all respondents were foreign born”.

• (Page 2, line 42) Authors must ensure consistent formatting by placing all percentages within parentheses.

• (Page 2, Line 44 & line 46-47) If these were results emanated from Chi-square analysis, author should include chi-square statistic value i.e., χ²(2, N = 173) = ….. p = .012.

_____________________________________________________________________________________________________

Introduction:

• (Page 3, Line 59-60) clarify where “Deep South” is

• (Page 3, line 62) Write “3rd” in words such “Third” and include statistics that are indicative of a high prevalence of new HIV infections in this context.

• (Page 3, line 67) Define briefly and in simple terms “pre-exposure prophylaxis (PrEP)” and “post-exposure prophylaxis (PEP)”

• (Page 3, line 77-79) This sentence warrants citation “Many of these misconceptions can be traced back to the spread of misinformation during the AIDS epidemic in the 1980s, when little was known about the virus or its transmission.”

• (Page 4, line 79-83) Authors need to clarify the logic connected to how the misconceptions about HIV transmission could have the implications for community screening, care and ART adherence. For instance, how using public toilets, or mosquito bites could significantly discourage one from seeking community screening, pursing HIV care, and ART adherence. Does this mean, when people fear that casual contact could expose them to HIV, they may avoid testing and treatment? This may not always be the case, as some individuals might view these misconceptions as a health threat and still actively seek testing and treatment, motivated by the desire to safeguard their well-being despite their fears and false beliefs.

• (Page 4, Line 84-90) These sentences must be cited.

• (Page 4, Line 92-93) Authors might need to clarify the exact nature of the relationship since it is not clear whether this relationship is positive (both types of stigma lead to increased care and adherence) or negative (high levels of stigma lead to decreased care and adherence to ART). “Studies show that increased perceived and personal stigma are directly correlated with later care utilization and ART usage among PLWH. [19,20].

• (Page 5, line 99) Revise this phrase to best fit the context “These and other studies”.

• (Page 5-6, Line 115-118) The aim is very bread and vague “This cross-sectional study aims to gather information about HIV education and perception in South Florida to improve community outreach efforts, and better understand how HIV knowledge and perception may differ by race, primary language, and country of origin. Suggested revision: “This cross-sectional study aims to assess HIV education and perceptions among diverse populations in South Florida to enhance public health community outreach efforts. Specifically, it will investigate how HIV knowledge and perceptions vary based on race, primary language, and country of origin.”

_____________________________________________________________________________________________________

Material and methods:

• (Page 6, line 120) Rephrase the following sentence for clarity “A 23-question survey was developed using questions adapted from previous validated surveys analyzing HIV knowledge and stigma among the public (S1 Appendix).” See suggested revision: “A survey instrument was developed consisting of 23 questions adapted from previously validated scales that measured HIV knowledge and stigma among the general public”.

• (Page 6, line 131-132) Back translation was performed to ensure the accuracy and cultural appropriateness of the translated materials? If yes, Authors should further elucidate this process and the No answer should be accompanied by explanation of how conceptual equivalence and content validity was ascertained on data collection instruments.

• (Page 6-7, line 120 -162) Authors should reorganize the manuscript under “Materials and methods” using level two subheadings for clarity and organization. Specifically, the following subheadings should be included:

1. Research Approach and Design: (Clearly define whether the study employed a quantitative approach using a cross-sectional design.)

2. Population, Sample Size, and Sampling: (Define the target population, explain how the sample size was determined using a specific formula with clear parameters, and state the sampling method used to select participants, justifying the choice of sampling method.)

3. Measures: (Describe and outline the items adapted from previously validated scales, report the internal consistency (Cronbach’s alpha coefficient) demonstrated by previous studies adopted the same scales, and include the internal consistency established by the current study.)

4. Analysis: (Detail the statistical methods used to analyze the data, including any software utilized, the specific tests conducted, and the criteria for significance.)

_____________________________________________________________________________________________________

Results:

• (Page 8, line 164) Rephrase “Among 173 total respondents” to “Out of 173 respondents,…” and change “ and” to “while” in the following sentence for proper context “149 received HIV testing and 24 declined HIV testing.”

• (Page 8, line 166-171) all percentage values should be consistently placed within the parentheses for uniformity.

• (Page 8, line 165) Rephrase this part of the sentence for clarity “ranged in age from 18 to older than 75..” and change it to “…ranged between the age of 18 to over 75 years old,…”.

• (Page 8, line 176), In accordance with PLOS One guidelines, figures should be referenced in the text as (Fig. 1, Fig. 2, Fig. 3, etc.) instead of using the term “figure.”

• (Page 8-9, line 181-185) I strongly recommend authors to either discard this part or insert figure 1 as outlined and same comment applies to (Page 11, line 197 – 200) and (Page 12, line 213-215).

• (Page 11, line 201 – 202) Incorporate all values from the chi-square test for statistical difference /independence among these categorical variables. Further, this comment applies to all reported results without chi-square statistic.

• (Page 10, line 186) As a general guideline, the title for tables should be placed above the table.

• (Page 12, line 217) Rewrite “2-folds” as “two-folds” and this applies to (Page 14, Line 268)

• (Page 12, line 224) Rephrase “modified” to “influenced” throughout the manuscript.

_____________________________________________________________________________________________________

Discussion:

• (Page 12, line 226-227) This study’s aim indicates a significant discrepancy between what is outlined in the last sentence of the introduction and the actual aim (to gather information while also now is to identify knowledge gaps). Authors should consider incorporating a consistent aim throughout to remind readers of the clear research direction and scope. Use the suggested statement of the aim.

• (Page 12, line 227-229) Revise this sentence in accordance with the revision made above.

• (Page 12, line 230) Authors should not introduce new concepts in the discussion for consistency, I thought initially it was “HIV transmission” not “HIV risk”.

• (Page 12-13, line 230-235) The discussion of the results should incorporate findings and outcomes from previous studies for comparison to provide context and highlight the value of the current research within the existing literature.

• (Page 13, line 237) Write “about three thirds” instead of “Close to 100%” since this is a discussion section.

• (Page 13, line 249) Rephrase this part of the sentence for clarity “usage of PEP and PrEP have shown” to “the use of PEP and PrEP has proven to be significantly effective in reducing risks of HIV transmission” and cite the source (s).

• (Page 14, line 256-259) Authors should clarify the connection between knowledge and language, as the study suggests that the lack of PEP and PrEP knowledge is somewhat influenced by language barriers. If the issue lies with language, it implies that the knowledge exists and is accessible but is hindered by challenges in decoding and interpreting it. Therefore, previous evidence should be cited to corroborate this assertion.

• (Page 14, line 261-263) This assertion should be supported by citations of scientific studies that have documented the connection between language and culture in the adoption of these preventive measures (PEP &PrEP) against HIV transmission.

• (Page 14, line 275) Authors should be careful not to use the term “screened positive” due to that stigma is typically measured using a validated scale rather than a screening tool. Various scales have been developed to assess different types of stigmas, such as HIV-related stigma, these scales include items that quantify the level of stigma an individual experiences or perceives, which makes it possible to measure the correlation between stigma and other variables. Thus, using a well-established stigma scale is not a limitation for measuring the correlation between stigma and other variables, as long as the scale is reliable and valid for the population being studied.

• Under limitations, authors should address the following aspects:

1. Design Used - The cross-sectional design adopted by the study

2. Self-Report measures - The use of self-report measures may introduce bias due to social desirability.

3. Sample size - The sample size may limit the generalizability of the findings, particularly if it is small.

_____________________________________________________________________________________________________

Conclusion:

• (Page 15, line 286-287) “Stigma” is singular, so “was” should be used instead of “were.”

• (Page 15, line 287) “combat transmission” authors should specify that it “HIV transmission” for consistency.

____________________________________________________________________________________________________

References:

• (Page 17, reference 10) Authors should provide page number.

• (Page 17, reference 12) Authors should provide an issue number for this source.

• (Page 18, reference 21) Authors should provide an issue and page number for this source.

• (Page 19, reference 28) Authors should provide a page number for this source.

_____________________________________________________________________________________________________

On the highest note: Additional recommendation:

Authors should provide a table that presents the results from the Chi-Square test of difference, clearly outlining the variables compared, the chi-square statistic (χ²), degrees of freedom (df), sample sizes, and p-values to highlight significant and non-significant differences.

Thank you.

Reviewer #2: There is no clear sample size calculation provided. Was the sample size of 173 participants determined based on power analysis? Since participants were recruited from health fairs, they may already be more health-conscious than the general population. A brief discussion on potential selection bias would strengthen the methodology section. The study considers race, language, and country of origin, but educational attainment could also significantly impact HIV knowledge. Were potential confounders controlled for? The study suggests that interventions should target Hispanic communities, but the data primarily focus on White Hispanic participants. Can these findings be generalized to all Hispanic groups, or are they specific to this subgroup?

Reviewer #3: Please provide the inclusion and exclusion criteria you used in recruiting survey respondents.

Among the respondents who consented to HIV screening, how many percent tested reactive, non-reactive? Perhaps it would be significant to assess their test results against their HIV transmission knowledge.

In Table 1, please include the key population in which the respondents qualify as (MSM, PWID, TGW etc).

**********

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.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes:  Adrian Jonathan D. Velasco

**********

[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.

Attachments

Attachment

Submitted filename: HIV Knowledge.docx

Dear Dr. Sternberg,

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 Jul 20 2025 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.

• 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,

Zypher Jude G. Regencia, Ph.D.

Academic Editor

PLOS ONE

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

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Partly

Reviewer #2: Yes

**********

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

Reviewer #1: No

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: Yes

**********

Reviewer #1: Comments to the Authors:

Thanks for addressing majority of the previous-round’s review comments. This second-round feedback focuses on issues not previously addressed.

Additional major concerns:

Line 44–49, Page 3:

- “Transmission knowledge was significantly influenced by race” and “Familiarity with PrEP and/or PEP was also influenced by race…”.

- The use of “influenced” implies a causal relationship, which is not supported by a cross-sectional design and Chi-square test employed.

- Gold standard way of reporting, which reflects what Chi-square actually tests “Familiarity with PrEP and/or PEP was significantly associated with race…”

Line 217, Page 12 and throughout results section:

- Some chi-square statistics use more than two decimal places including for p-values.

- I strongly suggest consistency in rounding to two for chi-square statistic and three decimals for p-values throughout the manuscript.

Line 151-179, Page 8-9, Measures:

- The measures section should use consistent tense and structured subheadings

- Present each construct separately and clearly with the name and description of the instrument employed to measure the construct. For example:

HIV Transmission Knowledge and HIV stigma are the main constructs measured using previously validated instruments.

- Describe the origin of items, psychometric properties, scoring, and interpretation.

- Clearly state how variables were operationalized and analysed.

- There is no mention of Cronbach’s alpha coefficient for the adapted versions in current study. Given that the instruments were translated and adapted, I recommend that the authors either include a table summarizing the internal consistency (e.g., Cronbach’s alpha) for each scale or report these values directly under the Measures section to ensure transparency on the reliability of the instruments.

Line 167–169, Page 8-9:

- Defining adequate HIV transmission knowledge as missing ≤1 question is an arbitrary without statistical rationale.

- Provide justification from prior literature or explain how pilot data support this threshold as valid (acknowledge this as a limitation).

Line 237–240, Page 13:

- Authors claim that “there was no significant difference in rates of college educated individuals broken down by race or language” yet no statistical test or supporting data.

- Provide chi-square results that support this claim

- The authors mention race and language when exploring potential confounders, yet none of the central variables (HIV knowledge, stigma, PrEP/PEP awareness) were included in this analysis, making the confounder exploration to be methodologically unsound.

Figure 3 and Lines 231–233, Page 13:

- Some subgroup analyses, such as bilingual or Creole speakers, include very small sample sizes (n=9–11).

- Concern is that these small groups may produce unstable estimates and wide margins of error, which may invalidate statistical inferences.

- Acknowledge this limitation explicitly in the Discussion and temper your conclusion based on these groups.

Line 251-252, Page 14:

- Authors mentioned that “Otherwise, perceived stigma was not significantly influenced by race, country of origin, or primary language.” Yet without chi-square statistics.

Absence of adjusted analysis:

- All findings rely solely on bivariate chi-square analyses.

- Bivariate associations do not account for confounding exploration mentioned in the manuscript.

- Consider conducting a multivariate logistic regression for key outcomes or justify the decision not to do so in the limitations.

Minor concerns:

- Recommendation for language editing.

- Line 183 -184, page 9 – “All data underwent chi-square analysis…” avoid using passive voice in stead of active voice. “All data were analysed using chi-square…”

- Use of “unfamiliarity” consider using “lack of familiarity”

Line 345 and 351, Page 19:

- Reference 4 (Duplicate of Ref. 1):

- “Statistics Overview | Statistics Center | HIV/AIDS | CDC. Accessed April 15, 2024.https://www.cdc.gov/hiv/statistics/overview/index.html”

Reviewer #2: The manuscript addresses a critical and timely public health issue—persistent misconceptions and stigma surrounding HIV transmission and prevention.The study sample includes a demographically diverse group, with analyses disaggregated by race, language, and country of origin. This allows for the identification of disparities in knowledge and stigma across subgroups, particularly highlighting gaps among Black and White Hispanic participants and Spanish-speaking individuals. The revised manuscript clearly incorporates detailed responses to reviewer comments, including a comprehensive power analysis, clear inclusion/exclusion criteria, and improved internal consistency reporting. The restructuring of the Methods section using standardized subheadings enhances clarity and reproducibility.

**********

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

Reviewer #2: Yes:  BIEN ELI NILLOS

**********

[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.

HIV Knowledge and Reported Stigma Among South Florida Health Fair Participants

PONE-D-24-36376R2

Dear Dr. Sternberg,

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.

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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,

Zypher Jude G. Regencia, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: