Title: "Even if I’m undetectable, I just feel like I would die": A qualitative study to understand
the psychological and socioeconomic impacts of the COVID-19 pandemic on women living
with HIV (WLWH) in Chicago, IL
Version: 1 Date: 24 Apr 2022
Reviewer's report:
Thank you for the invitation to review this manuscript. I have included the following comments
for the authors to address:
1. In the abstract section, the authors should carefully use numbers/percentages in the results as
this is a qualitative study.
2. Can the authors support the first statement in the background section with a systematic review
of HIV and the COVID-19 pandemic since the authors are referring to a worldwide perspective?
"The COVID-19 pandemic has uniquely impacted both women and people living with HIV
(PLWH) worldwide" - For instance, the authors may want to consider the following reference:
Tamuzi, J. L., Ayele, B. T., Shumba, C. S., Adetokunboh, O. O., Uwimana-Nicol, J., Haile, Z.
T., ... & Nyasulu, P. S. (2020). Implications of COVID-19 in high burden countries for HIV/TB:
A systematic review of evidence. BMC infectious diseases, 20(1), 1-18. https://doi.org/10.1186/
s12879-020-05450-4
3. As your study focused on WLWH and mental health (including anxiety and depression),  the
last sentence in the first paragraph in your background section will benefit from supporting it
with the following reference:
Ogueji, I. A. (2021). Experiences and predictors of psychological distress in pregnant women
living with HIV. British Journal of Health Psychology, 26(3), 882-901. https://doi.org/10.1111/
bjhp.12510
And the second sentence in your background section will benefit from supporting it with the
following reference:
Ogueji, A. I. & Okoloba, M. M. (2020). Compassion-focused therapy (CFT) as an intervention
against suicidal ideation in newly diagnosed people living with HIV/AIDS (PLWHA)
attending a Nigerian maternity teaching hospital. Global Psychiatry, 3(1), 104-112. https://
doi.org/10.2478/gp-2020-0012
4. In the third sentence in the background section, as you are referring to qualitative studies,
the authors should include a recent FGD study  that revealed the vulnerability of PLWH to the
impact of the COVID-19 pandemic:
Ogueji, I. A. (2021). People newly diagnosed with HIV during the COVID-19 pandemic: A
focus group study on the associated early biopsychosocial reactions. Journal of HIV/AIDS &
Social Services, 20(3), 209-227. https://doi.org/10.1080/15381501.2021.1955800
5. In the background section of the abstract, the authors claimed that few studies have examined
the impact of the pandemic on WLWH; while in the last paragraph in the background section
of the main body of the manuscript, the authors claimed that their study is the first to examine
the effects of the pandemic in WLWH. This is logically inconsistent. I understand that the time
taken for the authors to write their paper from the time they completed their data analysis might
have contributed to this. The authors should thus find a more logical /appropriate way to present
their argument about their study being the first to examine the pandemic's effects on WLWH.
6. In the methods section, the authors should briefly explain why their data collection lasted
long (June 2020 to April 2021). The authors should also have a separate section titled "design"
where they elaborate on their research design as the current form of the manuscript is unclear
regarding what qualitative design the study employed.
7. How did the authors confirm potential participants on the eligibility criteria? Particularly birth
sex and current gender identity of female.
8. The authors wrote that the codebook was applied by the primary coder but failed to tell us
who the primary coder was or what was the experience of the coder with qualitative research.
9. Who among the authors conducted the data analysis and what was their experience with
qualitative research?
10. I suggest the authors have a section in their methods titled "trustworthiness and rigor"
11. Was member checking conducted?
12. What benefit was offered to participants who were distressed by the pandemic?
13. It remains unclear what sampling technique was used to recruit participants.
14. Were only 25 participants initially contacted to participate in the study? Or did only 25
consent to participate out of a total number who were initially contacted?
15. I suggest the authors do away with the usage of percentages as it seems they are trying to
achieve generalization which is not the aim of qualitative research.
16. The first time ART appears in the manuscript should be written out.
17. The suggested reference in the fourth comment also applies to your first paragraph in the
discussion section.
18. In the discussion section, the authors wrote - "Additionally, participants were recruited from
hospital/clinic sites (UCM, HBH), so our results may not generalize to WLWH who are not
engaged in care" - Do qualitative investigations seek to achieve generalization? In fact, I have
read the usage of "generalize" in several parts of the manuscript. I suggest the authors replace the
word "generalize" with "transfer" as qualitative investigations pay attention to the transferability
of findings.
19. The authors focused on the negative impacts of the pandemic on WLWH. Did your prompts
and data analysis reveal any positive impact of the pandemic on WLWH? What opportunities
did the pandemic offer to WLWH?
20. In the limitations of the study, the authors wrote that their study could not establish gender
disparities but they emphasized so much on gender inequalities in various parts of the manuscript
(for instance but not limited to the conclusion section). The authors should present their argument
on this clearly to avoid confusing the readers.
21. It is unclear what the novel contribution of this study is to knowledge as I believe that the
authors are aware that several papers have been published on the various impacts of the pandemic
on WLWH. For instance, see references below:
Closson, K., Lee, M., Gibbs, A., & Kaida, A. (2020). When home is not a safe place: impacts of
social distancing directives on women living with HIV. AIDS and Behavior, 24(11), 3017-3019.
https://doi.org/10.1007/s10461-020-02941-y
Joska, J. A., Andersen, L., Rabie, S., Marais, A., Ndwandwa, E. S., Wilson, P., ... & Sikkema,
K. J. (2020). COVID-19: increased risk to the mental health and safety of women living
with HIV in South Africa. AIDS and Behavior, 24(10), 2751-2753.https://doi.org/10.1007/
s10461-020-02897-z
Nyashanu, M., Chireshe, R., Mushawa, F., & Ekpenyong, M. S. (2021). Exploring the challenges
of women taking antiretroviral treatment during the COVID#19 pandemic lockdown in peri#
urban Harare, Zimbabwe. International Journal of Gynecology & Obstetrics, 154(2), 220-226.
https://doi.org/10.1002/ijgo.13771