Reviewer ’s report  
 
Title: "Life at the River is a Living Hell:" A Qualitative Study of Trauma, Mental Health, 
Substance Use and HIV Risk Behavior among Female Fish Traders from the Kaf ue Flatlands in 
Zambia  
 
Version: 0 Date: 26 Aug 2016  
 
Reviewer: Theresa Li -Yun Chang  
 
Reviewer's report:  
 
In this manuscript, Michalopoulos et al examined several mental, social and behavior parameters 
and their link with the risk of HIV acquisition in a unique population, female fish traders in 
Zambia. The manuscript is well written but descriptive. Although the sample size is small, 
authors addressed the important issue in the women whose mental issues and risks to HIV have 
been ignored.  There is no control group in the study although it would be challenging to define 
such groups. Sever al concerns are listed in the following.  
1. The age range of the focus group in Table 1 was incorrect. Based on the supplementary data. 
The age range is 37 -63 instead of 18 -55.  Please define M and give IQR.  
2. It seems that the majority of subjects are middle to older women instead of adolescents and 
young women who have much higher risks for HIV acquisition. Although the  HIV risk in 
older women cannot be ignored, authors should clarify this issue.  
3. It would be informative to know the ages of childre n during the interview if available. 
Younger women with younger children may be more prone to have PTSD.  
4. It's not clear why the status of sexually transmitted infections is not considered if subjects' 
husbands have multiple sex partners.  
5. Was PTSD di agnosis assessed by the health professional who has expertise in this area?  
6. Although I appreciate authors' transparency for pointing out that the data were acquired by 
one male interviewer, it would be important to justify why the male interviewer was c hosen 
to conduct the study. What is the male interviewer's credentials?  
7. In line 265, authors should eliminate the sentence.  
8. Authors should mention tables, figures and supplementary tables in the text.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please  specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in th e manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five year s received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in a ny way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding , or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you  can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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