Reviewer ’s report  
 
Title: Factors related to fertility desire among female sex workers living with HIV in the 
Dominican Republic  
 
Version: 3 Date: 19 Mar 2018  
 
Reviewer: Susan Cohn  
 
Reviewer's report:  
 
The authors have addressed the previous concerns and have thus written a clearer, more 
understandable paper.   
Here are some additional thoughts, primarily on the first half of the manuscript.  
Version 3  
 
Abstract  
First line of abstract not relevant. Would focus on FSW living with HIV and their being at risk 
for multiple health outcomes and stigma (HIV, against pregnancy/childbearing, other health 
outcomes)  
Would keep it at 1 decimal point so "28.34%" would be 28.3% for clarity. Here and throughout 
the manuscript  
Consider adding something here like "have higher [levels of] HIV -related internalized  
Stigma" or "have higher HIV -related internalized stigma [scor es]" 
Consider changing "have less children" to "having fewer children"  
Does "have a negative perception of partner's feeling about pregnancy" mean "have a perception 
that their partner has negative feelings about pregnancy"?   
What is the direction of t his association "Individual and interpersonal barriers to reproductive 
health care were found to be associated with fertility desire in this study."?  As written, implies 
that these barriers and positive associated with fertility desire.  If that is note t he case, perhaps it 
should be written as "Individual and interpersonal barriers to reproductive health care were found 
to be negatively associated with fertility desire in this study. "  
 
 
Background  
Line 29 "and is some regions" should be "and in some regi ons.."  
Line 29 -30 Would remove number to read "this desire is similar to women in the general 
population without HIV."  
Line 39 Considering adding societal before "judgement and criticism from others."  
Line 42 Who is "they"?  Do you mean …"many times wome n find themselves…."  
Consider this revision from" They have reported experiencing humiliation, been demeaned by 
health workers [18] and were more likely to feel socially isolated, been refused medical care or 
feared seeking health services than female sex  workers without HIV." to  
"They were more likely to have reported experiencing humiliation, being demeaned by health 
workers [18], having felt socially isolated, being refused medical care or feared seeking health 
services compared with female sex workers  without HIV."  
Line 68 add "in" before situations  
Line 69 First word Would replace when with where  
Line 71 Not clear who is being counted the maternal mortality ratio?  Does it refer to FSW living 
with HIV? What regional is it being referred to?  
Line 73,  is this referring to DR? If so, would clarify. "…for the general population of DR.   
Line 75  adjust to "…in order to ensure access to education and health services for themselves as 
well as for their partners and their children."  (if that is what you mean)  
Line 77 remove  "for" after contraception services and "that were" after Integral Care Units  
Line 82 Not sure what this sentence means? "..about 36% said they made special emphasis on 
sterilization and discrimination against WLHA was observed for a number of providers"  
Perhaps the authors could say what they mean.  Do they mean that pr oviders emphasized 
sterilization over reversible contraceptive measures and discriminated against WLHA urging 
them not to have children?  
 
Methods  
Line 155 Do women ever give their babies up for adoption?  Some of the pregnancies could 
result in few child ren at home if someone else were to raise the child, rather than "pregnancy 
loss".  
Much clearer presentation of their methods  
 
Results  
Clearer overall  
Line 205 -207  Would only use one decimal point to be consistent throughout so 64.08% would 
be 64.1% et c  Same thing with Table 1 and Table 2.  Should be consistent throughout either 1 
decimal point or 2  
Line 221 If 91 reported a pregnancy, why aren't they all included in the pregnancy loss figure 
(32/90)?  
Line 271  Consider keeping all variables in the s ame direction so "perception that partner would 
be upset by pregnancy" might become "perception that partner would not be upset by pregnancy" 
with a reversed AOR.  
 
Discussion/Conclusion clearer.  Would emphasis the high rates of fertility desires in women with 
permanent fertilization, with the need for assuring women are appropriately counseled prior to 
performing sterilizing procedures in the future.  Women in the US in the early era of HIV were 
encouraged to undergo sterilizing procedures, especially afte r giving birth but those procedures 
have been less common in the era of potent ART.  
Are the methods appropriate and well described?  
If not, please specify what is req uired 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, pleas e 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.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
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 publi cation 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 curr ently 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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