Reviewer's report
Title:Determinants of Consistent Condom Use among Female Sex Workers in
Savannakhet, Lao PDR
Version:2Date:11 August 2014
Reviewer: Thanh Bui
Reviewer's report:
Manuscript ID:
Title: Determinants of Consistent Condom Use among Female Sex Workers in
Savannakhet, Lao PDR
This paper mainly aims to provide descriptive statistics of consistent condom use
with non-regular and regular sexual partners, and reasons for condom
use/non-use among female sex workers (FSWs) in Lao PDR. There are not
many publications about condom use among FSWs in Lao PDR; thus this paper
would potentially contribute to the literature related to condom practices in this
population. The study methods were appropriate and are well-described.
Nevertheless, further revision is needed so that the manuscript is ready for
publication.
Major Compulsory Revisions
1. In ‘Results’\‘Condom practices with non-regular and regular partners’, and in
Table 1, the authors provided descriptive statistics of condom initiation and
condom use with non-regular versus regular partners. Please test if these
differences are statistically significant and provide p-values for these differences.
If these differences are not statistically significant, the authors cannot make such
conclusions as ‘Consistent condom use decreased the closer the relationship
was between the FSWs and their partners”.
2. In ‘Data Analysis’, given the descriptive aim of this study, why did the authors
need to perform multiple regression? Even if the authors chose to do so, which
variable were selected into the multiple regression models, based on which
criteria, and using which methods? The authors said that ‘Number of sexual
partners last week was included in the multiple logistic regression as a
confounding variable.’ If number of sexual partners last week was considered a
potential confounder, then it was confounding an association between the
outcome (consistent condom use) and which main independent variable? Why
was it so? This section needs to be carefully rewritten.
3. The ‘Results’ and ‘Discussion’ needs more work with regards to
(non)associations between some demographic characteristics and consistent
condom use. For example, in the ‘Results’, why did not the authors examine the
association between education level and consistent condom use? How many
percent of participants were street-based versus establishment-based, and was
this characteristic associated with consistent condom use? In the ‘Discussion’,
the authors should discuss these found associations or non-associations. For
example, why was a longer time (>1 year) in sex work associated with less
consistent condom use, which seems to be different from other FSW studies in
other countries?
4. The ‘Conclusions and recommendations’ should be more carefully
stated/re-stated. Conclusions and recommendations should not go too far
beyond what the data/results suggested. For example, the authors wrote that
‘Drop-in centres should be provided with an adequate supply of condoms and
should be extended to all districts in Lao PDR.’ This study did not aim to provide
cost-effectiveness analysis/information of the program, and also showed that
91.5% can afford condoms. Moreover, we don’t know several other things, such
as whether all districts in Lao PDR have FSWs, or whether the high rate of
consistent condom use found in this study was attributable to effective behavioral
interventions (e.g. counseling, health education) or to condom availability. Thus,
this conclusion is not compelling.
Minor Essential Revisions
5. In ‘Introduction’, paragraphs 2 & 3 should be merged into 1 paragraph.
6. In ‘Introduction’, paragraphs 2, the authors write that ‘…the prevalence in
FSWs is high, between one and four percent’. Please clarify this prevalence is
high compared to what (e.g. general Laotian women, FSWs in another country)?
This prevalence seems to be still low in comparison to FSWs in neighboring
countries.
7. In ‘Measure’, ‘Consistent condom use was defined as always using condoms
with all sexual partners in the previous month from the time of the interview’ # Did
the authors mean ‘all sexual partners’ or ‘all sex episodes’? For regular partners,
whom participants had sex with for multiple times, using condoms with all regular
partners did not actually reflect consistent condom use if participants did not use
condoms all the times.
8. In ‘Measure’, ‘…a regular partner was a paying or non-paying partner that the
respondent had sex with on more than one occasion’ # what was the time frame
for this definition (e.g. past week, past month)? It would be inappropriate if a
partner was considered ‘regular’ when the participant had sex with him twice in
her lifetime.
9. In ‘Results’\ ‘Reasons for inconsistent condom use’, what were the reasons for
not using condoms with non-regular partners (although the frequency of this was
low)?
10. In the fourth paragraph of ‘Discussion’ (limitations), why did the authors
mention that ‘Cross-sectional studies cannot account for causality’? Given the
descriptive aim of this manuscript, what was the causal association(s) which this
sentence implies? All sections in the manuscript should follow the aim(s); thus, I
suggest the authors to remove this and the following sentences.
11. The paper needs to be edited and proofread for English language. For
example, in ‘Results’\ ‘Reasons for inconsistent condom use’, the authors wrote
that ‘With the regular partners reasons for not wanting to use condom being:
reduced sexual pleasure, difficulties with sustaining erection and ejaculating
small condom size, allergic reactions to condoms and not wanting to use condom
when drunk.’ An appropriate verb is needed; and what the authors meant by
saying ‘difficulties with sustaining erection and ejaculating small condom size’?
12. In ‘Table 3’, the ‘n=82’ in ‘Preferred sources’ should be corrected to ‘n=257’.
Discretionary Revisions
None.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.