Trends, Challenges, and Socioeconomic Impacts of HIV in Bangladesh: A Data-Driven Analysis (2000–2024)

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Comments

The work is interesting in that it describes a situation of interest to public health in Bangladesh.

Indeed, these cases are underreported, so the statistics present the weaknesses described by the researchers.

Increased or improved detection could increase the number of people living with HIV/AIDS.

The social determinants are cross-cutting, as evidenced by the results and the lack of access (of any kind) to care in rural and low-income areas.

Additionally, the stigmatization of these patients prevents people from seeking care.

That said, the research data demonstrates the situation described above.

Suggestions:

Regarding the correlation map, it would be advisable to outline the theoretical aspects of the relationship or association between the variables (social determinants) and the reduction in the overall HIV burden, which are interpreted as an increase, especially for the variables included in the model. In other words, how can this model be justified? If these variables that are associated, whether positive or negative, are subtracted, they propose a model that could be analyzed using more appropriate statistics that allow for a cause-and-effect relationship. The same applies to scatter plots.

This would be my only observation to clarify the results. The result could also constitute a theoretical model that could be addressed in future studies.

 

Comments for author File: Comments.pdf

Author Response

Reviewer 1:

1. The work is interesting in that it describes a situation of interest to public health in Bangladesh. Indeed, these cases are underreported, so the statistics present the weaknesses described by the researchers. Increased or improved detection could increase the number of people living with HIV/AIDS. The social determinants are cross-cutting, as evidenced by the results and the lack of access (of any kind) to care in rural and low-income areas. Additionally, the stigmatization of these patients prevents people from seeking care. That said, the research data demonstrates the situation described above.

 

Answer: Thank you very much for your interest.

 

2. Regarding the correlation map, it would be advisable to outline the theoretical aspects of the relationship or association between the variables (social determinants) and the reduction in the overall HIV burden, which are interpreted as an increase, especially for the variables included in the model. In other words, how can this model be justified? If these variables that are associated, whether positive or negative, are subtracted, they propose a model that could be analyzed using more appropriate statistics that allow for a cause-and-effect relationship. The same applies to scatter plots. This would be my only observation to clarify the results. The result could also constitute a theoretical model that could be addressed in future studies.

 

Answer: We sincerely thank the reviewer for the constructive feedback regarding the correlation map and scatter plots. In response to your insightful observation, we have expanded the manuscript to better articulate the theoretical underpinnings of the associations observed between socioeconomic determinants and HIV prevalence, as well as clarified the interpretive scope of our statistical approach.

 

We have now added the following clarification to the manuscript (see Section 4.3 and 4.4):

 

From a theoretical standpoint, the socioeconomic determinants included in our analysis—such as GDP per capita, HDI, urban population ratio, and poverty rate—are known to influence health outcomes through several mechanisms, as outlined by the WHO Social Determinants of Health framework. Improved GDP and HDI generally reflect increased access to healthcare services, better education, and awareness—all of which are critical for early HIV diagnosis. Therefore, the observed strong positive correlations between HIV case reporting and variables like GDP per capita and urbanization do not necessarily indicate a higher disease burden, but rather an enhanced diagnostic capability in more developed and urbanized regions. Conversely, the negative correlation with poverty and rural population may reflect healthcare access limitations and underreporting in these areas.

 

We acknowledge that correlation-based analyses, such as those presented in the heatmap and pair plots, do not establish causality. These results are interpreted as associations that highlight important patterns but do not imply direct cause-and-effect relationships. Importantly, the associations revealed through the correlation and scatter plots can serve as the basis for a conceptual model linking socioeconomic progress to HIV-related health outcomes. We now suggest that future studies could build on our findings by developing and testing such theoretical models using more advanced statistical tools suited for causal analysis. This may include integrating time-lag effects, mediating variables (e.g., stigma reduction, testing coverage), and spatial-temporal variations.

Reviewer 2 Report

Comments and Suggestions for Authors

In this study the authors describe the epidemiology of HIV between year 2000 and 2024 in Bangladesh. Risk-populations are described and the progress towards the 95-95-95 targets are presented.

Given the sparce data from Bangladesh it is great that the authors are aiming at describing nationwide data. My main concern is that the authors mix up HIV (the viral infection) and AIDS (the collective name for the condition that occurs when an untreated HIV infection has severely weakened the immune system). I strongly advice not to use “AIDS infection” or “HIV/AIDS”. “HIV/AIDS” should not be used in a text where you are trying to describe the epidemiology of HIV in a country as these two words do not refer to the same thing at all.

See more detailed comments/questions below

Abstract:

Q1. Replace “HIV/AIDS” to “HIV” or “AIDS” depending on what you are referring to.

Q2. I suggest including a few sentences about the methodology and specify that the main outcomes are “number of HIV infections, number of cases of AIDS and AIDS-related mortality”.

Introduction:

Q3. The introduction is very long (more like a master thesis than an article) and would benefit from shortening. Consider skipping the following parts at least:  the part about Kongo (lines 44-50), the part describing the viral mechanism (lines 51-69).

Q4. Write out these abbreviations; GDP, GNI, HDI, the first time they are mentioned (line 135).

Q5. Rewrite the introduction so it is clearer when you are referring to HIV or AIDS. Eg lines 145-146 “The aim of this research is to study the outbreak trends of AIDS in Bangladesh from 2000 to 2024 by analyzing infection and death data, with the ultimate objective of understanding how the virus’s impact on the population has evolved over time”. You should not talk about outbreak trends of AIDS, outbreaks are infections ie HIV the virus.

Methods

Q6. Describe more clearly how HIV infections, AIDS cases and AIDS-related mortality is reported and documented in Bangladesh ie from where do you get the data?

Q7. It is unclear to me if you are reporting HIV cases, AIDS cases or what you call HIV/AIDS. In the first line (203) under Data analysis you write “AIDS infection” which does not exist. I suggest removing the word “HIV/AIDS” throughout the manuscript and replace with either “HIV” or “AIDS” depending on what you are referring to in that particular sentence.

Q8. Again, in line 219, “AIDS infection” should be replaced with “HIV infections, AIDS cases and AIDS mortality” if this is the case.

Findings and Discussions

Q9. This section is very long. More like a master thesis than a manuscript. Consider shortening.

Q10. The different axes of Figure 1 need to be better explained, what do they show?  And suggest a different title to make it clearer what the map shows. Does it show the geographic distribution of all people with HIV in Bangladesh?

Q11. Again, the sentence  “The geographic distribution of HIV/AIDS in Bangladesh from 1989 to 2023, as depicted in the map in Fig. 1” in lines 264-265 needs correction. Is Figure 1 showing the number of people living with HIV or the number of AIDS cases?

Q12. The first 95% goal is always a challenge to calculate. How was the number “77% aware of their status” calculated ie how was the number of undiagnosed cases estimated? If this was not done by you but rather by others this should be clearly stated.

Q13. Line 317. Suggest rounding up. As a person can only be infected once it does not really make clinical  sense to present means with a decimal. Same goes for deaths.

Q14. What is the data regarding number of new HIV infections based on? Are positive tests mandatory to be reported to health authorities?

Q15. The pair plot and heat map indicate similar things. Perhaps the pair plot can be moved to supplementary material.

 

Author Response

Reviewer 2:

1. In this study the authors describe the epidemiology of HIV between year 2000 and 2024 in Bangladesh. Risk-populations are described and the progress towards the 95-95-95 targets are presented. Given the sparce data from Bangladesh it is great that the authors are aiming at describing nationwide data. My main concern is that the authors mix up HIV (the viral infection) and AIDS (the collective name for the condition that occurs when an untreated HIV infection has severely weakened the immune system). I strongly advice not to use “AIDS infection” or “HIV/AIDS”. “HIV/AIDS” should not be used in a text where you are trying to describe the epidemiology of HIV in a country as these two words do not refer to the same thing at all.

Answer: Thank you. We now understand the difference between HIV and AIDS. We made update to the manuscript.

Abstract:

2. Replace “HIV/AIDS” to “HIV” or “AIDS” depending on what you are referring to.

Answer: We made update to the manuscript. Thank you very much.

3. I suggest including a few sentences about the methodology and specify that the main outcomes are “number of HIV infections, number of cases of AIDS and AIDS-related mortality”.

Answer: updated with the following sentence in the last paragraph of introduction

The two main outcomes examined in this study are the number of individuals infected with HIV and the number of HIV-related deaths, aggregated by year and division.

Introduction:

4. The introduction is very long (more like a master thesis than an article) and would benefit from shortening. Consider skipping the following parts at least: the part about Kongo (lines 44-50), the part describing the viral mechanism (lines 51-69).

Answer: We removed the part describing the viral mechanism. Thanks

5. Write out these abbreviations; GDP, GNI, HDI, the first time they are mentioned (line 135).

Answer: We made the update. Thanks

6. Rewrite the introduction so it is clearer when you are referring to HIV or AIDS. e.g. lines 145-146 “The aim of this research is to study the outbreak trends of AIDS in Bangladesh from 2000 to 2024 by analyzing infection and death data, with the ultimate objective of understanding how the virus’s impact on the population has evolved over time”. You should not talk about outbreak trends of AIDS, outbreaks are infections i.e. HIV the virus.

Answer: We made the update. Thanks

The aim of this research is to study the outbreak trends of HIV in Bangladesh from 2000 to 2024 by analyzing infection and death data, with the ultimate objective of understanding how the virus’s impact on the population has evolved over time. Since the first documentation of HIV in Bangladesh back in 1989, the country has experienced annual outbreaks, with steady infection and death rates, case fatality ratios, and regional spread. This study seeks to uncover the key factors that have influenced the transmission dynamics and severity of HIV outbreaks, as well as the effectiveness of public health interventions. This study is of critical importance as it addresses the dual challenges of underreporting and underdiagnosis, which have historically skewed perceptions of the epidemic in Bangladesh. By leveraging improved diagnostic capabilities and enhanced datasets, it provides a clearer picture of the epidemic’s trajectory. Furthermore, the study’s findings can guide policymakers in designing targeted interventions to achieve the 95-95-95 goals, ensuring that resources are efficiently allocated to high-risk groups and underserved regions. In doing so, this research not only contributes to the academic understanding of HIV in Bangladesh but also serves as a practical tool for public health planning and intervention design.

Methods

7. Describe more clearly how HIV infections, AIDS cases and AIDS-related mortality is reported and documented in Bangladesh i.e. from where do you get the data?

Answer: All the details are provided here and all data are freely and publicly available: Please see the following:

The data for this study was gathered from various publicly available sources, including the National AIDS/STD Control (https://asp.portal.gov.bd/), which falls under the Institute of Epidemiology, Disease Control, and Research (IEDCR, https://www.iedcr.org/), the World Health Organization (WHO) (https://www.who.int/), and others. The dataset covers the period from 2000 to 2024 and includes key variables such as the number of infected cases, deaths, and social factors like GDP/GNI (https://www.worldbank.org/en/country/bangladesh, https://www.imf.org/external/datamapper/profile/BGD), HDI (https://data.undp.org/countries-and-territories/BGD) and Poverty rate (https://www.adb.org/where-we-work/bangladesh/poverty). The dataset also includes population dynamics such as urbanization and population density, sourced from the Bangladesh Bureau of Statistics (https://bbs.gov.bd/) and Worldometer, Bangladesh (https://www.worldometers.info/world-population/bangladesh-population/).

8. It is unclear to me if you are reporting HIV cases, AIDS cases or what you call HIV/AIDS. In the first line (203) under Data analysis you write “AIDS infection” which does not exist. I suggest removing the word “HIV/AIDS” throughout the manuscript and replace with either “HIV” or “AIDS” depending on what you are referring to in that particular sentence.

Answer: We actually talked about HIV throughout the manuscript. We updated all the concern and now we clearly mentioned about HIV, not AIDS. Thanks for your insightful comments.

9. Again, in line 219, “AIDS infection” should be replaced with “HIV infections, AIDS cases and AIDS mortality” if this is the case.

Answer: Updated as suggested. Thanks

Findings and Discussions

10. This section is very long. More like a master thesis than a manuscript. Consider shortening.

Answer: Thank you for your comment. The Findings and Discussion section was intentionally detailed to capture the full scope of issues related to HIV in Bangladesh. We aimed to present a comprehensive picture by incorporating all relevant information, which we believe is essential for readers to fully understand the complexities of the topic. While we acknowledge that the section is extensive, we consider this depth necessary to ensure clarity and completeness.

11. The different axes of Figure 1 need to be better explained, what do they show? And suggest a different title to make it clearer what the map shows. Does it show the geographic distribution of all people with HIV in Bangladesh?

Answer: The X and Y axes in Figure 1 represent geographic coordinates (longitude and latitude) of Bangladesh. The map is a geospatial visualization based on administrative boundaries (ADM1 level) of the eight divisions. It does not represent a Cartesian plot, but rather spatial placement of regions on a map of Bangladesh.

12. Again, the sentence “The geographic distribution of HIV/AIDS in Bangladesh from 1989 to 2023, as depicted in the map in Fig. 1” in lines 264-265 needs correction. Is Figure 1 showing the number of people living with HIV or the number of AIDS cases?

Answer: Updated as suggested, thanks.

13. The first 95% goal is always a challenge to calculate. How was the number “77% aware of their status” calculated i.e. how was the number of undiagnosed cases estimated? If this was not done by you but rather by others this should be clearly stated.

Answer: It was done by Bangladesh government and data is taken from National AIDS/STD Control (https://asp.portal.gov.bd/). Thanks

14. Line 317. Suggest rounding up. As a person can only be infected once it does not really make clinical sense to present means with a decimal. Same goes for deaths.

Answer: Updated as suggested. Thanks

15. What is the data regarding number of new HIV infections based on? Are positive tests mandatory to be reported to health authorities?

Answer: Yes, according to Bangladesh health officials, positive test is mandatory. Thanks

16. The pair plot and heat map indicate similar things. Perhaps the pair plot can be moved to supplementary material.

Answer: Thank you for this valuable observation. We agree that the pair plot and the correlation heatmap present similar trends; however, we believe that each visualization provides distinct analytical value. While the heatmap offers a compact summary of linear relationships through correlation coefficients, the pair plot complements it by visualizing the distributions and potential nonlinear trends, clusters, or outliers in the data.

Moreover, the scatterplots in the pair plot help reveal patterns (e.g., skewness, variability) that are not evident in the heatmap alone. For instance, the diagonal histograms offer insight into data distribution, and the bivariate scatterplots help us observe possible interactions beyond simple correlation.

Given these advantages, we have opted to retain the pair plot in the main manuscript to support a more comprehensive understanding of the relationships among variables. Thanks

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I am happy with the response from the authors and have no further questions