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In 2013 approximately 37,000 people were living with HIV in Ecuador (prevalence 0.4%), representing a generalized epidemic where most new infections arise from sexual interactions in the general population. Studies that examine attitudes towards people living with HIV (PLWH), individual risk perception of acquiring HIV amongst Ecuadorians, and the ways in which levels of risk perception may affect risk behaviors are lacking. This qualitative study aimed to fill this gap in the literature by investigating these issues in the rural, coastal community of Manglaralto, Ecuador, which has among the highest incidence of HIV in Ecuador. We conducted interviews with 15 patients at Manglaralto Hospital. Analysis of interview transcripts revealed widespread negative attitudes towards PLWH, prevalent risk behaviors such as multiple sex partners and lack of condom use, and low individual risk-perception of contracting HIV. These findings underscore the need for increased efforts to prevent further growth of the HIV epidemic in Ecuador.
Overall, I found this to be a well written study but it wasn't clear why you sampled exclusively from a hospital outpatient list if you wanted to explore general population attitudes to HIV. It is also unclear how you sought out 'negative' instances- was this on the basis of the previously conducted questionnaire?
Finally, I would rephrase lines 349-350 in the discussion, as a qualitative study can only provide one with insights into perceptions of prevalence of risk behaviours and not prevalence estimates per se (even if these are broad descriptors like 'high' prevalence).
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