Reviewer ’s report  
 
Title: Role of HIV in the desire of procreation and motherhood in women living with HIV in 
Spain: a qualitative approach  
 
Version: 0 Date: 28 Dec 2016  
 
Reviewer: Cynthia Fair  
 
Reviewer's report:  
 
Role of HIV in the d esire of procreation and motherhood in women living with HIV in Spain: a 
qualitative approach  
Thank you for the opportunity to review your manuscript on this vital subject.  Understanding 
the ways that HIV influences women's views of motherhood is an imp ortant topic. However, I 
am uncertain that this article, as it currently stands, makes significant contributions to the 
literature.  It may be possible to more clearly articulate the gap that is being addressed by the 
authors.  It may be better suited for a regional or more narrowly focused venue.   
 
Abstract:  
More information about the methods in the abstract would be helpful.  Were interviews recorded 
and transcribed?  It does not appear that the authors used grounded theory as they applied an a 
priori theoretical framework.  Grounded theory is based upon the premise that meaning emerges 
from the data.  Data are plural.  
 
Introduction:  
The topic of HIV and motherhood has been studied extensively.  Can the authors include some 
of the literature that notes the positive aspects of motherhood for women living with H IV? As it 
stands the introduction is entirely focused on barriers and fears.   
Also, please more clearly articulate your gap or question.  Is there little research on women in 
Spain?  Is the approach you're taking unique?   
 
Methods:  
Below are some questi ons designed to further strengthen the methods section.  
 It would be helpful to know how many were approached?  How many agreed to participate?   
 Much more detail is needed on the kinds of questions asked as I found the theoretical 
framework somewhat c onfusing.  Were participants asked about their changes in speech pre -
post HIV?  How did aspirational elements shape the questions? I doubt that women 
frequently think about their "social identity." What is the etiology of this framework?  Please 
cite. 
 Please provide more detail about data analysis.  Grounded theory is mentioned in the abstract 
and not addressed in the methods section.  Did researchers come to consensus about codes?  
 
Results:  
 It would be helpful to know mean years since diagnosis.   
 Results are typically written in past tense. I found this section rich with information, but 
difficult to follow at times.  
 Please consider starting each section with a paragraph that frames the primary findings.   
 The application of the "maternity ideal"  is intriguing.  Was this a finding that emerged from 
the results or was this part of the original framework?  Did women actually talk about their 
aspirational ideals of motherhood?   
 The third dimension "decision on motherhood" assumes that women make a n intentional and 
conscious decision about procreating.  It's been well documented that women living with 
HIV have high rates of unintentional pregnancies and relatively low rates of contraceptive 
use.  In that context, decisions on motherhood would occur after pregnancy and not before.  
 Page 8 lines 25 -29 note that the idea of motherhood is "more related to a notion specific to 
the society in which these women life….so no changes happen after HIV diagnosis."  I find 
this somewhat confusing since it would appear ideal concepts of motherhood were brought 
into sharper focus following their diagnosis.   
 Page 9 line 4: "Women found it complex to verbalize….arguments in favor of procreations 
were initially unclear."  Unclear to whom?  Or was it the women had d ifficulty articulating 
reasons in support for procreation.   
 Consider organizing the barriers section more tightly.  Again, an introductory paragraph 
framing the findings would help.  
 Page 10 line 31: "HIV is not consciously considered an obstacle to mo therhood…"  How 
would the researchers know this?  And this seems to be contradicted by earlier sections 
focused on barriers.   
 Page 10 line 55:  "Some foreign women demonstrate their religious belief.."  Was this only 
true for non -Spanish women?  
 Consid er using the term "intentional" motherhood, rather than "conscious motherhood."  The 
findings related to the use of assisted reproductive technology was quite fascinating.  In fact, 
this is the strongest set of findings and the most unique as much of the p revious results have 
been found in other studies.  Their struggles with conception might be the most significant 
findings.  
 
Discussion  
Please either indent paragraphs or use a space between paragraphs.  It appears to be a 2.5 page 
single paragraph.  
The discussion makes linkages between study findings and existing literature.  It would be 
helpful to have a more explicit implications for women with HIV in Spain as that appears to be 
the most significant aspect of the authors' gap or question.  
 
Best of luck with your work!  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please sp ecify which controls are required in your comments to the authors.  
 
No 
 
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 w ould 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:  
 
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 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.  
 
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