Bon bagay (good stuff): A faith-based outlook on biomedical prevention among Haitians and Haitian Americans

Candice A. Sternberg; Maurice J. Chery; Maika Beauvoir; Pepita Jean; Dominique Guillaume; Joelle-Ann Joseph; Regine Thermy Jean Baptiste; Tyra Montour; Valeria Botero; Anjalie Geffrard; Chantal Napoleon; Terese Gelin; Allan Rodriguez; John F. P. Bridges; Christopher J. Hoffmann; Guerda Nicolas; Sannisha K. Dale; Maria L. Alcaide

doi:10.1371/journal.pone.0330852

Peer Review History

Original SubmissionMay 21, 2025
2 Jul 2025 Decision Letter - Awatif Al-Judaibi, Editor 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 Aug 16 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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Dr. Sternberg has also been supported by the University of Miami’s Center for HIV and Research in Mental Health (CHARM; P30MH116867 (Developmental-AIDS Research Center), P30MH133399 (AIDS Research Center) [National Institute of Mental Health]) the University of Miami CTSI through the National Center for Advancing Translational Sciences, award number KL2TR002737. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. [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? Reviewer #1: Yes Reviewer #2: Partly ******** 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 Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Good afternoon, This article addresses a highly relevant topic with an appropriate methodological approach and presents significant findings that can help improve public health outcomes for Haitian and Haitians and Haitian Americans. With some minor adjustments, the manuscript could be ready for publication. The study is technically sound, and the language is clear, professional, and accessible. It uses a qualitative design (focus groups), which is well-suited to its aim of exploring perceptions, beliefs, and cultural barriers regarding PrEP. However, I believe it would be helpful for the article to more clearly explain how the findings can guide future interventions, clinical practices or public policies targeted at this specific population, although limitations are acknowledged in the discussion these results could serve as a starting point for exploring similar issues in other communities. While the article’s goal is to dismantle stigma and better understand cultural barriers, the emphasis on prevalence rates—if not carefully contextualized—might unintentionally reinforce existing stereotypes about Haitians and HIV. Suggest revising the lines (94,95 and 96) to avoid possible misunderstandings or biased interpretations, what could be misinterpreted by readers unfamiliar with the historical stigma linked to this group. Currently, I have no further suggestions. Thank you very much. Reviewer #2: 1. Abstract The type of study and design must be indicated. 2. Ethics Statement Why wasn't a signed informed consent form used for the whole study? It's striking that the patients gave verbal consent to participate in the research but didn't sign any documents. 3. Methods Recruitment It is not indicated how the sample size was established. Privacy and access to research data It is not indicated how privacy and access to research data were protected. This should be mentioned. Data Analysis The current description of the data analysis process is insufficient for a qualitative study, as it lacks critical details necessary to assess methodological rigor and transparency. Specifically, the manuscript does not indicate the type of qualitative analysis conducted (e.g., thematic analysis, grounded theory), whether an inductive, deductive, or mixed coding approach was used (the summary indicates that it was inductive), or how discrepancies between coders were resolved. The process of codebook development is briefly mentioned, but no information is provided regarding its structure, validation, or use across the dataset. Moreover, the manuscript does not address how data saturation was assessed or what strategies were employed to ensure trustworthiness (e.g., triangulation, reflexivity, audit trail, or member checking). It is recommended that the authors expand this section by clearly outlining the analytic approach, coding procedures, software use, criteria for saturation, and strategies to enhance the credibility of findings. 4. Results Although six major themes or categories of analysis were explored, this section does not indicate whether there were emerging categories, as this information is also relevant as it provides new insights that enrich the study, especially since a semi-structured approach was used for the focus group. 5. Discussion This is a well-done section, but I think it would be improved if the importance of cultural relevance in health interventions were explored in more depth. This allows for better shaping of health strategies to achieve better outcomes for people's health and well-being, as well as helping to narrow the gaps in access to health information and healthcare. ****** 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: Yenifer Lizeth Gañan Rojas Reviewer #2: Yes: Katya Cuadros-Carlesi ******** [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: PONE-D-25-27087 REV.pdf https://doi.org/10.1371/journal.pone.0330852.r001
Revision 1
22 Jul 2025 Author Response Reviewer #1 Yenifer Lizeth Gañan Rojas Comments to Author: This article addresses a highly relevant topic with an appropriate methodological approach and presents significant findings that can help improve public health outcomes for Haitian and Haitians and Haitian Americans. With some minor adjustments, the manuscript could be ready for publication. The study is technically sound, and the language is clear, professional, and accessible. It uses a qualitative design (focus groups), which is well-suited to its aim of exploring perceptions, beliefs, and cultural barriers regarding PrEP. 1) However, I believe it would be helpful for the article to more clearly explain how the findings can guide future interventions, clinical practices or public policies targeted at this specific population, although limitations are acknowledged in the discussion these results could serve as a starting point for exploring similar issues in other communities. a) Thank you for your comment, in lines 472-482 we have added further discussions on how the findings can guide future interventions, clinical practices or public policies targeted at this specific population. “These findings reinforce the importance of integrating cultural relevance into public health interventions and research. For communities like the Haitian diaspora, where language, spirituality, and historical experience deeply shape health perceptions, culturally aligned strategies are essential for building trust and achieving behavior change (Allen et al., 2013; Pardo et al., 2021). This includes developing interventions in Haitian Creole, collaborating with respected faith leaders, and acknowledging the community’s unique experiences with stigma and marginalization. Culturally relevant approaches not only improve the accessibility and acceptability of health information but also help narrow persistent gaps in care and outcomes (Cipita et al., 2024). By aligning prevention efforts like PrEP education with the values and lived realities of the Haitian community, public health programs can be more effective in reducing disparities and advancing health equity.” 2) While the article’s goal is to dismantle stigma and better understand cultural barriers, the emphasis on prevalence rates—if not carefully contextualized—might unintentionally reinforce existing stereotypes about Haitians and HIV. Suggest revising the lines (94,95 and 96) to avoid possible misunderstandings or biased interpretations, what could be misinterpreted by readers unfamiliar with the historical stigma linked to this group. a) Thank you for bringing this to our attention. We believe this is a very important point. In lines 95-98, we revised the sentences to “Moreover, Black, or African American individuals remain disproportionately affected by HIV largely due to structural factors and marginalization (CDC, 2021; Saunt et al., 2025). In 2021, the Center for Disease Control (CDC) data reports showed that Black or African American individuals, made up 40% of new HIV diagnoses in the U.S. (CDC, 2021).” Reviewer #2 Katya Cuadros-Carlesi Comments to Author: 1) Abstract- The type of study and design must be indicated. a) Thank you for your comment. We’ve updated the abstract to include “In this qualitative study, focus groups were conducted with Haitian church leaders using snowball sampling.” This change can be found in line 45. 2) Ethics Statement- Why wasn't a signed informed consent form used for the whole study? It's striking that the patients gave verbal consent to participate in the research but didn't sign any documents. a) Thank you for your inquiry, given the sensitive nature of HIV- related discussions regarding Haitians with church leaders, this was a confidential minimal risk study. The University of Miami IRB waived the requirements to obtain sign consent. We added this in lines 210-213. 3) Methods Recruitment- It is not indicated how the sample size was established. Privacy and access to research data It is not indicated how privacy and access to research data were protected. This should be mentioned. a) Thank you for your comment, we used standard focus group methods to establish our sample size. Typically focus groups are recommended to have 6 to 10 individuals, but some guidelines and research reports note that groups as small as 4 and as large as 12 can be productive. We added to the manuscript in lines 207-209 “The sample size was established using published scientific research protocols in which the recommended number of participants are between 4-12 individuals per focus group (Teufel-Shone et al., 2010).” In lines 191-195 we describe how privacy and access to research data were protected by stating “To protect research data and ensure privacy, all participant data was stored in a secured, password protected University of Miami approved cloud platform (Box) and data collection program (RedCap®- Research Electronic Data Capture). All study staff received training regarding participant privacy. A link between ID number and participant’s name were kept in a separate file and password protected.” Data analysis- The current description of the data analysis process is insufficient for a qualitative study, as it lacks critical details necessary to assess methodological rigor and transparency. Specifically, the manuscript does not indicate the type of qualitative analysis conducted (e.g., thematic analysis, grounded theory), whether an inductive, deductive, or mixed coding approach was used (the summary indicates that it was inductive), or how discrepancies between coders were resolved. The process of codebook development is briefly mentioned, but no information is provided regarding its structure, validation, or use across the dataset. Moreover, the manuscript does not address how data saturation was assessed or what strategies were employed to ensure trustworthiness (e.g., triangulation, reflexivity, audit trail, or member checking). It is recommended that the authors expand this section by clearly outlining the analytic approach, coding procedures, software use, criteria for saturation, and strategies to enhance the credibility of findings. a) In line 239-240we added “Thematic analysis was conducted to analyze data utilizing an inductive approach (Thomas et.al, 2008).” We also added how discrepancies between coders were resolved in lines 242-244 “The coders met two times to discuss their codes, emergent themes, and resolve discrepancies through collective consensus. Once consensus was reached, the final coding structure was reviewed by the PI.” To elaborate on how we ensured trustworthiness in lines 248-251 we added “Study team members conducted member checking by presenting results to the churches to ensure interpretations accurately reflect the participants' perspectives (Mckim, 2023). Church leaders provided feedback on the results and shared their thoughts on the project.” 4) Although six major themes or categories of analysis were explored, this section does not indicate whether there were emerging categories, as this information is also relevant as it provides new insights that enrich the study, especially since a semi-structured approach was used for the focus group. a) Thank you for your comment. In line 239, we added” Thematic analysis was conducted to analyze data utilizing an inductive approach.” Given the inductive approach, all themes were emerging. 5) Discussion- This is a well-done section, but I think it would be improved if the importance of cultural relevance in health interventions were explored in more depth. This allows for better shaping of health strategies to achieve better outcomes for people's health and well-being, as well as helping to narrow the gaps in access to health information and healthcare. a) Thank you for your insightful comment. In response, we have added a new paragraph in the discussion section (lines 472–482) that expands on the importance of cultural relevance in health interventions, emphasizing its role in improving health outcomes and reducing disparities in access to information and care. “These findings reinforce the importance of integrating cultural relevance into public health interventions and research. For communities like the Haitian diaspora, where language, spirituality, and historical experience deeply shape health perceptions, culturally aligned strategies are essential for building trust and achieving behavior change (Allen et al., 2013); Pardo et al., 2021). This includes developing interventions in Haitian Creole, collaborating with respected faith leaders, and acknowledging the community’s unique experiences with stigma and marginalization. Culturally relevant approaches not only improve the accessibility and acceptability of health information but also help narrow persistent gaps in care and outcomes (Cipita et al., 2024). By aligning prevention efforts like PrEP education with the values and lived realities of the Haitian community, public health programs can be more effective in reducing disparities and advancing health equity.” Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0330852.r002
7 Aug 2025 Decision Letter - Awatif Al-Judaibi, Editor Bon bagay (good stuff): A faith-based outlook on biomedical prevention among Haitians and Haitian Americans PONE-D-25-27087R1 Dear Dr. Candice Aurelus 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. 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. For questions related to billing, please contact billing support . 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, Awatif Abid Al-Judaibi, PhD Academic Editor PLOS ONE Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: N/A ****** 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: Yes Reviewer #2: Yes ****** Reviewer #1: This article addresses a highly relevant topic from a culturally grounded perspective: HIV prevention through PrEP in Haitian communities in South Florida, with Christian churches serving as a central point of engagement. It is a well-designed qualitative study, with strong methodological execution, rigorous analysis, and a well-developed discussion, offering concrete contributions to public health and the development of culturally responsive interventions. The manuscript represents a valuable and original contribution at the intersection of public health, religion, and migration. It explores a historically stigmatized population from a respectful and empowering perspective, integrating key cultural elements essential to the effectiveness of PrEP interventions. I recommend approval with minor revisions. The article is conceptually sound, well written, and presents relevant and actionable findings. The suggested improvements do not compromise the core structure of the study and can be readily addressed in a revised version of the manuscript. Reviewer #2: After the proofreading process, the manuscript is well-structured and error-free. I hope the authors continue to deepen their knowledge on the topic, thereby developing better strategies to reduce HIV infection among the Haitian population. ****** 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: Katya Cuadros-Carlesi ******** https://doi.org/10.1371/journal.pone.0330852.r003
Formally Accepted
Acceptance Letter - Awatif Al-Judaibi, Editor PONE-D-25-27087R1 PLOS ONE Dear Dr. Sternberg, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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 Professor Awatif Abid Al-Judaibi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0330852.r004

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