PONE-D-25-10308 A Comparative Analysis of HIV Status by Sociodemographic and Sexual Behavior Characteristics among Men in Bexar County, Texas: An Ending the HIV Epidemic (EHE) Targeted County PLOS One

Dear Dr. Delgado,

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The reviewer has raised a number of points that need addressing - their comments are available below. They feel the interpretation and discussion of the study's findings should be reframed, and have questions about the analysis methods and quality of the data.

Could you please carefully revise the manuscript to address all comments raised?

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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

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

Reviewer #1: Yes

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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: 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

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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: This manuscript explores sociodemographic and behavioral correlates of HIV status awareness among men in Bexar County, Texas, an EHE priority jurisdiction. The topic is locally relevant, with implications for targeted HIV testing and prevention strategies. The paper is clearly well-written, and includes a substantial amount of contextual background on the EHE initiative and local epidemiology.

However, there are several areas that require further clarification, methodological refinement, and stronger interpretation to maximize the manuscript’s contribution.

1. Unfortunately the sample disproportionately non-Hispanic White (63%) compared to the actual demographic profile of Bexar County (majority Latino) and calls to question the representativeness of the findings for Bexar County

2. The conclusion that HIV-negative men engage in more high-risk behaviors yet remain HIV-negative due to education/economic stability is speculative. Biological and temporal factors (e.g., window periods, testing access) may also play roles. Greater caution is needed in these interpretations.

3. The study limits the analytic sample to men, but no clear justification is provided for this decision. While men who have sex with men are indeed a key population for HIV prevention, excluding women and gender-diverse individuals without explanation diminishes the broader relevance of the study and risks overlooking disparities in other groups in Bexar County.

4. The description of eligibility is unclear. The manuscript states that participants were eligible if they consented, were ≥18 years old, and “indicated their HIV status.” However, it is not defined what “indicating” HIV status entails

5. As the study relied on an online Qualtrics survey distributed via social media and email, procedures to detect and prevent fraudulent responses (e.g., bots, duplicate entries, ineligible participants) should be clearly described. The manuscript does not indicate whether tools such as CAPTCHA, IP address checks, or survey completion time thresholds were used. This omission raises concerns about data quality and the validity of the analytic sample.

6. The Discussion is lengthy and at times disorganized, with substantial repetition of results. The authors should reduce the regurgitation of descriptive findings and instead focus on the key implications for HIV prevention and public health policy.

7. Many of the associations (education, employment, condom use, income) are already well-established in the HIV literature. The true contributions of this study are: providing county-specific data in an EHE target area, and highlighting the characteristics of individuals with “unknown HIV status.”The manuscript should make this clear, rather than suggesting the findings themselves are novel.

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Reviewer #1: No

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A comparative analysis of HIV status by sociodemographic and sexual behavior characteristics among men in Bexar County, Texas: An Ending the HIV Epidemic priority county

PONE-D-25-10308R1

Dear Dr. Delgado,

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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Kind regards,

Daniel Demant, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

The authors have addressed all comments made by the reviewer adequately. While issues such as sampling bias were not fundamentally addresses, this is appropriate given this would involve the collection of new data. The re-framing is therefore appropriate and sufficient.

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

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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

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

Reviewer #1: Yes

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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

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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

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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: The authors have addressed all of my comments satisfactorily. I have no other comments to add. The authors have addressed all of my comments satisfactorily. I have no other comments to add.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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