PONE-D-21-17959

Discriminatory attitude towards people living with HIV/AIDS and its associated factors among adult population in Sub-Saharan Africa.

PLOS ONE

Dear Dr. Teshale,

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PLOS ONE

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Additional Editor Comments (if provided):

This is an important contribution to raise the awareness of discriminatory attitudes towards people living with HIV/AIDS. The authors used DHS datasets from 15 countries and conducted two analyses. One for the prevalence of discrimination. And to study the factors they used multilevel regression analysis to identify potential determinants. However, a few issues.

I. Major

1. DHS is designed to collect mother and child information. The HIV information is either secondary or additional on these surveys. This may make the woman selected to be likely to have had a recent pregnancy (or married) when compared to another woman in the community. How this was accounted for here? And why not do an additional analysis with males and females separated?

2. Moreover to the previous point, this analysis disregards that the SSA is not one big Africa. Another analysis that looks at least regionally would be appropriate here.

3. Discrimination is a bit hard to measure. The two questions used to assess this may not perform the same way across the countries included. This must be discussed.

4. It is to cause concern that the Southern Africa region is not included in the analysis when there are countries for that region (Malawi, Zimbabwe and Zambia). What classification did the authors use?

5. Statistical analysis. Why use deviance to decide which model to choose? The deviance does not penalize the addition of more variables. BIC or AIC would be better. Anyways, I would keep model 4 by pre-specification (and the analysis has been done).

II. Minor:

Abstract

1. Please add the unweighted numbers to the results.

Background

No comments

Methods

1. Line 97 - please list the countries included together with the name of the region

2. Line 100 - please add the unweighted numbers

3. Lines 120 to 123 are a repetition of what is stated between lines 136 to 146.

4. Lines 145 please cite Stata properly

5. For the prevalence calculation how the confidence intervals were computed

6. Did you incorporate the weights in the multilevel models?

Results

1. Table 1 please add the unweighted counts.

2. Table 2 please do this table per country (or region) and add such a table to the supplements.

3. Table 3 - in the supplements add one table for the females and another for males. As well there should by region.

4. Figure 2 - There is some strange grouping of the regions. Why not the Southern region?

5. Lines 199 - The fixed effects analysis is not documented in the statistical analysis. Can you describe what is done in this model?

Discussion

1. Line 320 - what “author”? Shouldn’t be “authors”?

2. Please expand the discussion of the limitations in light of the issues raised above

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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: No

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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

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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: No

Reviewer #2: 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: Suggest title revision: Discriminatory attitude .... in 15 sub-Saharan African nations (there are a total of some 50)

Add section on limitations, i.e. existing data sets only allows use of variable measured in the existing data set, particularly a potential issue with the dichotomous dependent variable.

Expand implications for HIV work, i.e. targeting identify sub-groups - conclusion is very brief.

Reviewer #2: Thank you for your efforts in writing this manuscript.

Generally, HIV-related discrimination remains high but varies among countries. As of 2019 Guinea had about 80% and South Africa about 16.9% of people with discriminatory attitudes towards people living with HIV/AIDS. Is there a reason why South Africa, with the highest number of people living with HIV/AIDS is not included in your study despite the availability of data on South Africa from the Population-based Survey 2014-2018? What has South Africans done differently to reduce discriminatory attitudes as compared to Guinea and other countries in your study? Data from South Africa is pertinent and needs to be discussed in your manuscript.

Please check the following lines:

87 peoples?

99 (why women in brackets) Why?

299 peoples?

325 (residual confounders is there) Expain what you mean here.

Page 36: Prevalence...by individual countries

It should read country and not 'conutry'

Proofreading is necessary.

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Reviewer #1: Yes: William L Holzemer

Reviewer #2: No

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Discriminatory attitude towards people living with HIV/AIDS and its associated factors among adult population in 15 sub-Saharan African nations.

PONE-D-21-17959R1

Dear Dr. Teshale,

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,

Orvalho Augusto, MD, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

This is the second revision of this manuscript The authors responded fully to the reviewers' comments.

Few more issues:

1. Please correct STATA to Stata. Stata is not an acronym (see the official Stata documentation).

2. I am OK with (or not) the use of weighted multilevel analysis. In my response, the authors said that they did use weighted multilevel analysis. I would ask them to make this clear in the text as well. The use of weights here could be a bit problematic as the weights from each survey could be standardized (or not) and therefore lead to questions like whether these weights are comparable. So, some may see issues. Could you add the unweighted multilevel analysis in the supplementary materials as well? (for the same models in table 3)

3. Please make sure that fractional numbers (in proportions/fractions) have 1 or 2 (choose one) decimal places and stick to this. It is not OK that in the very same paragraph (lines 175 to 181) some have 2 decimals and other (the 41%) none decimal places.

4. Line 177 - better say something like “better of” rather than “richest households”.

5. Table 2 - please state that the frequencies are weighted.

6. How the prevalence for the regions was computed (figure 2)? Would be good to use a meta-synthesis for this rather than simple weighted prevalence.

7. Tables in the supplementary materials have **** or something similar, can you put below the table what those mean?

8. Line 247 the 382838.4 corresponds to model 4 not to model 3.

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 #2: (No Response)

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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 #2: Yes

**********

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

Reviewer #2: Yes

**********

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 #2: 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 #2: Yes

**********

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 #2: Thank you for considering some of my comments in revising your manuscript. However, your manuscript still needs to be proofread. There are some small errors that should be looked at. For example: lines 95-98; lines 99 and more in the text.

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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 #2: No