Sexual Exposure to HIV Infection during the COVID-19 Pandemic in Men Who Have Sex with Men (MSM): A Multicentric Study
, Shirley Verônica Melo Almeida Lima 3, João Victor Rocha 4, Herica Emilia Félix de Carvalho 5, Artur Acelino Francisco Luz Nunes Queiroz 5, Guilherme Schneider 5, Layze Braz de Oliveira 5, Emerson Lucas Silva Camargo 5, Adélia Dalva da Silva Oliveira 1, Isabel Amélia Costa Mendes 5 and Inês Fronteira 2
Carmen Figueroa
Round 1
Reviewer 1 Report
The risk factors for engaging in risky behavior for HIV transmission by MSM in Portugal and Brazil from April and May 2020 are examined in this manuscript. A conclusion is drawn that CoVID-19 preventative measures may favor an increase of risky behavior for HIV transmission. While there are some issues with this conclusion documented below, the manuscript makes several poignant and fascinating arguments about considering the implications of CoVID-19 social preventative measures on risky behaviors withing the LGBTQIA+ community.
There appears to be a logical disconnect in that this study claims to provide evidence that CoVID-19 preventative measures can favor the growth of risky behavior for HIV transmission. However, one of the greatest risks factors is self-reported risky behavior for HIV transmission which predates the CoVID-19 preventative measures. The discussion on lines 290-298 partially addresses this concern but does not provide sufficient evidence that CoVID-19 preventative measures are causing an increase in risky behavior for HIV transmission.
This highlights a major weakness of this study: the survey instrument was only used to conduct sampling during CoVID-19 preventative measures, yet comparisons are made to surveys using other instruments which predate the CoVID-19 pandemic and may have been conducted with different research methods. Discussion of this as a limitation of the study would improve the manuscript. Additionally, a more credible argument that CoVID-19 preventative measures are exacerbating risky behavior for HIV transmission could be made by rephrasing some of the findings stemming from this such that it is apparent a concerning trend has been identified, but more research on the phenomena is required.
Minor comments:
Line 239: A specific incidence of comparison to previous studies citing references #27, #30, and #31. Citation 31 is a duplication of citation 30 with only the DOI included. Please carefully check all citations for accuracy. Additionally, all these references contain authors in common with this article. This argument would be improved by a comparison to meta-data from multiple studies including those conducted by external groups.
A definition for chemsex is missing from the manuscript.
Line 82: Please include a citation or link to this project to comply with the data availability policy of this journal.
Line 93: Please provide a citation for the snowball sampling technique.
Author Response
Dear reviewer. Thank you very much for your comments on our manuscript!
Next, we respond point-to-point to the suggestions made by the reviewers.
- There appears to be a logical disconnect in that this study claims to provide evidence that CoVID-19 preventative measures can favor the growth of risky behavior for HIV transmission. However, one of the greatest risks factors is self-reported risky behavior for HIV transmission which predates the CoVID-19 preventative measures. The discussion on lines 290-298 partially addresses this concern but does not provide sufficient evidence that CoVID-19 preventative measures are causing an increase in risky behavior for HIV transmission.
-We understand that our main conclusion may be much broader than our data are able to support and for this reason, we modified our conclusions to fit what our method allows. However, although we have not followed the same subjects before and during the pandemic, as the reviewer himself puts it, it is possible to suppose that the behaviors were exacerbated due to social isolation. As stated in our study, several references point to this growth in behaviors that existed before the pandemic.
- This highlights a major weakness of this study: the survey instrument was only used to conduct sampling during CoVID-19 preventative measures, yet comparisons are made to surveys using other instruments which predate the CoVID-19 pandemic and may have been conducted with different research methods. Discussion of this as a limitation of the study would improve the manuscript. Additionally, a more credible argument that CoVID-19 preventative measures are exacerbating risky behavior for HIV transmission could be made by rephrasing some of the findings stemming from this such that it is apparent a concerning trend has been identified, but more research on the phenomena is required.
- We completely agree with the reviewer, for this reason we have placed these considerations where we feel it is necessary and all these limitations have been added to the text.
- Line 239: A specific incidence of comparison to previous studies citing references #27, #30, and #31. Citation 31 is a duplication of citation 30 with only the DOI included. Please carefully check all citations for accuracy. Additionally, all these references contain authors in common with this article. This argument would be improved by a comparison to meta-data from multiple studies including those conducted by external groups.
- Thank you very much for that comment. As highlighted by the reviewer, because we have to make comparisons with studies that did not use the same instrument as ours, we tried to reduce the differences using studies with similar methodology and that investigated the incidence of HIV in a similar way. In this case, it was easier to use previous texts developed by these members of this group of authors.
However, after an even more detailed review, we exchanged one of the references which the reviewer indicates for a study carried out in Brazil by another group of researchers but which used a methodology similar to ours.
About citation 31, it was a typo already corrected.
- A definition for chemsex is missing from the manuscript.
-Thank you very much for that suggestion. A definition was added;
- Line 82: Please include a citation or link to this project to comply with the data availability policy of this journal.
-Unfortunately, we don't have any online repository where the project is located so that we can add this link, there are only private university sites. For these reasons we were unable to supply this suggestion.
- Line 93: Please provide a citation for the snowball sampling technique.
We add a citation as per the reviewer's suggestion.
Reviewer 2 Report
Dear authors
I've carefully revised your manuscript "Sexual Exposure to HIV Infection during the COVID-19 Pan-demic in Men who have Sex with Men in Brazil and Portugal"
Here my comments to improve your work:
Major
- Please revise your methods and your conclusion, some statements do not correlate: "The findings indicate that the public health measures adopted to contain the advancement of the COVID-19 pandemic can favor the growth of new infections by the HIV virus."
- Please revise the statement "advice as avoiding sex/abstinence" as none of the countries directly advise against sexual intercourse.
- Please be careful with your conclusions, your study is not comparing sexual behavior before the restrictions, and we do not yet know how those restrictions impacted sexual behavior, to imply that those measures lead to increase at-risk sexual behavior.
- Please make sure to include the strengths of your study.
- Please revise your discussion for effectiveness.
- Please revise the length of your manuscript,
- Also please make sure to discuss what are the implications of your research in actual program implementation and
Minor
- Please revise your manuscript and the references for errors.
- Suggest you to revise the readability of your title and to consider the characteristics for a strong title.
Author Response
Dear reviewer. Thank you very much for your comments on our manuscript!
Next, we respond point-to-point to the suggestions made by the reviewers.
1. Please revise your methods and your conclusion, some statements do not correlate: "The findings indicate that the public health measures adopted to contain the advancement of the COVID-19 pandemic can favor the growth of new infections by the HIV virus."
--We understand that our main conclusion may be much broader than our data are able to support and for this reason, we modified our conclusions to fit what our method allows. However, although we have not followed the same subjects before and during the pandemic, as the reviewer himself puts it, it is possible to suppose that the behaviors were exacerbated due to social isolation. As stated in our study, several references point to this growth in behaviors that existed before the pandemic.
2. Please revise the statement "advice as avoiding sex/abstinence" as none of the countries directly advise against sexual intercourse.
-Thank you very much for this comment. We removed this excerpt from the manuscript
3. Please be careful with your conclusions, your study is not comparing sexual behavior before the restrictions, and we do not yet know how those restrictions impacted sexual behavior, to imply that those measures lead to increase at-risk sexual behavior.
- Thank you very much for that suggestion. We add this weighting to every possible section of the text and we also discuss this as an important limitation;
4.Please make sure to include the strengths of your study.
- The strengths of the manuscript were highlighted in the discussion and conclusion.
5.Please revise the length of your manuscript,
- The size of the manuscript is in accordance with the amount of data we have. This is a considerable sample size; many variables and two multivariate analyzes for different countries. It's impossible to cover all of this in a smaller paper. We ask the reviewer to consider this;
6. Also please make sure to discuss what are the implications of your research in actual program implementation;
- This discussion is based on our text. We reinforce as suggested by the reviewer. Thanks.
7. Please revise your manuscript and the references for errors.
-We review all references and citations.
8. Suggest you to revise the readability of your title and to consider the characteristics for a strong title.
-We also changed the title to make it more streamlined and at the same time give an idea of the scope of the text (Two large countries).
