Title: Does asset ownership influence sexual risk-taking behaviors among women engaged in
sex work in Southern Uganda? A mediation analysis.
Version: 2 Date: 23 Oct 2022
Reviewer's report:
Short summary
The study investigates the moderating role of asset ownership in influencing risky sexual
behaviors among WESW in Uganda. Data from an NIH funded parent study are extracted
to focus on sexual-risk taking behaviors as an outcome variable and asset ownership as an
independent variable, depression and access to healthcare as mediator variables. Structural
equation modelling showed that asset ownership was associated with a decrease in depression,
increase in asset ownership was associated with increased access to medical care and an increase
in access to medical care was associated with a decrease in sexual risk-taking behaviors. The
mediation role of asset ownership explained 31% of the relationship. The paper concludes that
economic resources are significant factors in helping to reduce the indulgence in risky behaviors
be WESW.
Major issues
1. The paper could use a bit more literature review to look for studies on the subject in Uganda
and the rest of Sub-Saharan Africa. This is important to identify gaps in past studies as well as
to justify why the current study is novel.
2. As it stands, the problem does not come out clearly owing to lack of identification of a clear
gap in research or literature.
3. Additionally, research on financial capability and asset building should also be considered to
strengthen the authors’ arguments.
4. The theoretical framework also needs literature to clearly map out a picture of how both the
asset and resilience frameworks were used to guide the study.
5. In the methods section, the study setting should also be briefly discussed to give a clear picture
of the whole story. (I understand that this might have been done in the study protocol elsewhere)
6. The discussion should ideally synthesize the sample characteristics and the variables. For
example, which region, marital status, etc is more likely to have access to economic resources
and engage less in risky sexual behaviors? Who are these women, which region are they likely to
come from, what are the characteristics of that region? What is unique about these women?This
is where the culture of the region (for example) and that of Uganda should be clearly articulated
in the context of the literature and also compared to other contexts.
7. The study limitations should have a separate heading. Implications should also be included
in the paper.
Strengths
The study is relevant, considering the at risk population of WESW with limited interventions
and literature. It is also methodologically sound, with variables and models clearly explained
and labelled. Data used for the paper was collected ethically. The paper is well written with little
to no grammatical errors, the authors did a good job in editing and revising it before submission.
The mediation relationship is clearly explained and shown graphically.
Minor issues
Introduction
Line 63- more literature is needed to support that statement
Line 67- consider revising to improve how it reads, eg…  they are at a high risk of engaging
in risky sexual behaviors
Line 71- provide a reference for the Ford Foundation. This is a 2004 reference, which is old,
and a lot has been done on economic empowerment of women since then. Recent peer reviewed
articles would be more ideal to strengthen your argument, for example, on financial capability
and asset building (Sherraden and colleagues have written extensively on the topic), as well as
literature in Africa. Here are a few resources:
Mantsios, A., Shembilu, C., Mbwambo, J., Likindikoki, S., Sherman, S., Kennedy, C., &
Kerrigan, D. (2018). ‘That’s how we help each other’: Community savings groups, economic
empowerment and HIV risk among female sex workers in Iringa, Tanzania. PloS one, 13(7),
e0199583.
Economic empowerment of sex workers
https://www.nswp.org/sites/default/files/Summary%20Regional%20Reports%20Economic
%20Empowerment%2C%20NSWP%20-%20November%202015.pdf
Economic strengthening for sex workers
https://www.fhi360.org/sites/default/files/media/documents/
Economic_Strengthening_for_Female_Sex_Workers.pdf
Line 93: Even though there are no similar studies on the subject in Uganda, what about in the
region, or Sub-Saharan Africa? These could provide a better understanding of the situation with
populations with similar characteristics as the one being studied
Line 100- the sentence sounds more like implications. Perhaps it could fit better in that section:
This study has essential practice, and policy implications as the study findings can inform
programs and policies that could reduce engagement in high-risk sexual behaviors among
WESW and relatedly the acquisition and spread of HIV through this population.
The paper tightly points out risk factors that drive women with limited economic resources into
sex work. Additionally, the challenges that the women engaged in sex work are discussed
It would however be expected that the paper would start off by giving us the statistics of women
engaged in sex work in Uganda, and the unique characteristics that push women into risky sexual
behaviors. This helps to shape the story of the paper.
Theoretical framework
Line 105- More literature about both the resilience and asset theories is needed to justify their
use and suitability, 2 references are not sufficient. Since there are many models of the resilience
framework, picking a few tenets and aligning them to the participants, or showing how they
have shown resilience, what they did to bounce back from risks and adversities would strengthen
the paper
Methods
Perhaps you could elaborate more on the study setting, especially the HIV hotspots.
Discussion
Line 251- explain why women with more assets may be more likely to access medical care and
consequently less likely to engage in risky behaviors in Uganda. Support this also with previous
research in similar contexts.
Line 258- In the introduction you mentioned that there are no studies on this subject except on
adolescents, but here you mention it (Scorgie er at, 33)
- Ideally, the discussion should fuse the results with the situation in Uganda as well as the
literature on the subject.
- I would also have expected to see implications for practice and research clearly stated.