Reviewer ’s report  
 
Title: "Life at the River is a Living Hell:" A Qualitative Study of Trauma, Mental Health, 
Substance Use and HIV Ri sk Behavior among Female Fish Traders from the Kafue Flatlands in 
Zambia  
 
Version: 0 Date: 22 Feb 2016  
 
Reviewer: Colleen Fisher  
 
Reviewer's report:  
 
Thank you for the opportunity to review this manuscript.  It was very well written, very well 
structured and provided real insight into the issue under investigation - namely HIV risk 
behaviours among female fish traders in the Kafue Flatlands in Zambia along with trauma, 
mental health and substance use.  The manuscript was very well written and engaging.  The 
detail provided in terms of the study site and information related to Zambia was at a level that the 
international readership of the journal would need to fully understand its content  and the 
importance of the subject matter.  Similarly, the background and literature review were very well 
written with the latter leading logically to the research aim.  The study design was most 
appropriate to address the aim and a sound justification was provided.  There is a very good 
description of the data collection and analysis processes.  The results are well presented and 'told 
the story' in a logical manner.  The discussion was well written and logical conclusions reached.  
The strengths and limitations of the manuscript are clearly described.  
 
I have some revisions that I consider compulsory:  
1. It is important in the 'Abstract' and the 'C onceptual Model' that past tense is used - the study 
has now been undertaken.  
2. Line 198 it is noted that a 'local male' conducted the interviews.  Although the implications of 
this are noted in the 'Strengths and Limitations' section, having that inform ation where it is 
first mentioned.  I had in my mind whilst reading the manuscript questions about the impact 
this given that the topic is sensitive and gender -based.  
3. Line 725 - it is noted that 'caution' should be taken in generalizing the findings'.  Because the 
purpose of qualitative research is not generalization, but rather, transferability, I would 
suggest this sentence be re -worded to reflect this.  
 
 
Discretionary Revisions  
The use of the word 'hypothesis' (lines 564 and 582) is somewhat anomalou s to qualitative 
research.  Can another term be used?  
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.  
 
Yes 
 
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 the 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.  
 
Not relevant to this manuscript  
 
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 years 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 any 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 recei ved 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.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the websi te along with the authors'  
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CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my name d report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal