Reviewer's report
Title:Predictors of HIV prevalence among street-based female sex workers in
Andhra Pradesh state of India: a district-level analysis
Version:1Date:26 February 2014
Reviewer: Brigitte Tenni
Reviewer's report:
Major Compulsory Revisions
1) The aim is posed in the abstract- “We assessed the predictors associated with
HIV prevalence among street-based FSWs.” However it is not explicitly stated in
the background and then it goes straight into the methods- need to state clearly
the aim of the data analysis.
2) Need to use ‘risk’ and ‘vulnerability’ properly. Risk is the behaviour that has a
real chance of acquiring HIV- vulnerability is a set of circumstances or the
environment that can increase the chance of taking up risk behaviour. The last
sentence in the background therefore needs to be changed- ‘particularly
vulnerable to risk working on the street’ does not really make sense- are they
vulnerable? Are they at risk?
3) Methods
FSWs behavioural data- last 2 sentences..
A total of 3,271 FSWs participated in IBBA survey round 1 and 3,225 in round 2
of whom 1,728 (52.8%) and 2,436 (75.5%) were street-based FSWs,
respectively. This difference in proportions is thought to be due to the sampling
approaches in the two rounds.
4) Were the sampling methods for the two rounds of IBBA different? They were
described as being the same- “A probability sampling method was used in all
districts with conventional cluster sampling used to sample the brothel- and
home-based FSWs, and time cluster sampling used to sample street-based
FSWs.”
If there is a difference in sampling between the two surveys what is it? And if not
can you give a reason for the more than 20% increase in the % of street based
FSW over a 3 year period.
5) Discussion paragraph 3
“The HIV positivity was significantly higher in districts where high proportion of
FSWs was registered with TIs. As TI strategy is based on the premise that
prevention of HIV transmission from FSWs to their clients will likely result in lower
rates of HIV transmission, it seems probable that many interventions attempt to
register or target FSWs who are already infected with HIV or are at high risk of
HIV.” I think this needs further discussion- it shouldn’t be difficult to verify whether
this premise is true- does TI target those that are already positive? If not, you
need to explore this issue in more depth- as the findings as they stand could
suggest that TI make FSW more vulnerable to HIV??
6) According to table 1- HIV prevalence increased in street based FSWs in two of
the 8 districts included- Chittoor and Warangal- a big increase in Warangal- this
was not mentioned or explored in the discussion- needs to discuss the
differences between districts- why were some so successful and others very
unsuccessful?
Discretionary Revisions
1) The data methods are appropriate and well described.
2) Only one significant limitation has been stated. There could be more
limitations explored- difficulties in estimating the number of street based sex
workers? interventions other than Avahan that could have changed behaviour
and influenced HIV status? etc.
3) The title and abstract adequately convey what has been found. The writing is
acceptable but awkward in parts- some of this has been pointed out in the ‘minor
essentials’ section however it would be beneficial if it was edited by a native
English speaker.
4) It would benefit from another table that compares round 1 and round 2 for the
variables in table 2.
Minor Essential Revisions
1) Need a reference for number 1- this link does not take you to this information
2) First sentence in the last paragraph of background- need to use HIV not
HIV/AIDS. The UNAIDS terminology advises to use HIV & AIDS and only when
you specifically need to use both- in this instance you should HIV only.
3) Discussion paragraph 3- “The HIV positivity was significantly higher in districts
where high proportion of FSWs was registered with TIs.” Should read “HIV
positivity was significantly higher in districts where a high proportion of FSWs
were registered with TIs.”
4) Reference 12- link does not work
5) Reference 22- this link does not take you to this publication
6) Reference 23- link does not work
7) Reference 25- link does not take you to this publication
There are some edits in the attached article in the form of sticky notes.
Level of interest: An article of importance in its field
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.