Title: Social networks, mobility, and HIV risk among women in the fishing communities of
Lake Victoria
Version: 1 Date: 10 Sep 2022
Reviewer's report:
Thank you for the opportunity to review this manuscript which used qualitative methods
to conduct 72 semi-structured interviews with women living and/or working in fishing
communities around Lake Victoria, 24 interviews with key informants from these communities,
and participant observation to examine how social networks influence mobility. The study
found that women living in fishing communities belong to defined and often overlapping
social networks and those networks help/encourage women to move within and between
fishing communities in search of sex work and other paid work opportunities. The findings
are interesting and add additional evidence regarding the roles of social networks in shaping
mobility patterns. However, concerns about the analytic approach and the absence of data
regarding HIV risk dampened enthusiasm for the study.
The description of the recruitment of communities and participants is incomplete. It would
be helpful to know how many fishing communities met the eligibility criteria and how the 6
communities were ultimately selected. Similarly, we need more specific information on how
participants were recruited (was it all through the key informants?) and details about the key
informants. Why/how were these key informants selected? Did they have particular expertise
about mobility, HIV risk, the fishing culture, etc and what is it that they understood beyond the
direct experiences of the participants?
The conceptualization of ‘mobility’ is unclear. It was difficult to tell if mobility was defined as
movement within different areas of the same fishing community, from non-fishing communities
into fishing communities (and back again), and/or between different fishing communities.
Specifying this in the Methods is necessary. A more fulsome description of the fishing
communities and seasons would be similarly helpful to help understand mobility.
The interviews were not audio recorded, rather interviewers were trained to capture summarized
notes of the interviews (based on the citation provided). Using this approach, it seems unlikely
that the interviewers captured quotes verbatim, but such quotes are included in the results as
evidence for the themes. Given all of the language translations necessary, additional information
about how the summarized note-taking was done, including translations and back translations
of the interviews is necessary.
Please clarify whether the analysis of the interview transcripts done by country and then
reconciled or whether one code book was developed and applied across the entire 3-country
dataset.
The Discussion notes that “triangulation” was used, but the Methods do not describe how this
was done across data from multiple sites, multiple countries, and different types of participants
(key informants and women residing/working in fishing communities).
Suggest updating Table 1 to share the characteristics of the key informants separately from the
participants.
Theme (a) is shared without providing direct evidence of the themes from the data. Several other
themes are described very briefly.  Theme (b) includes a quote that does not speak to the “mode
of communication”. Theme (d) doesn’t speak to “risks” of the networks although that is in the
title. As presented, this theme appears to be more about the protection offered by moving in
groups (rather than as individuals) between different locations, as a specific benefit of belonging
to a social network. The most fulsome theme is theme (c) and I wonder whether findings from
the other themes can be incorporated into theme (c). Theme (c) describes not only the social
networks themselves but how they operate to influence mobility patterns including modes of
communication (theme b), benefits (theme d), and risks (theme e). A theoretical framework
would help structure the themes.
Theme (c) is highly informative and fascinating. One point that is not fully drawn out in the
description of the different networks is that transactional sex is a feature of all of the networks,
not only the formal “sex worker” network.
The connection from social networks to mobility to HIV risks is less fulsomely explored. The
data presented suggests that social networks help vulnerable women move to places where they
are more likely to make money. Some of that money is made through transactional sex. But the
connection between being a mobile vs non-mobile sex worker and HIV risk is not examined in
the data presented. For instance, no data are presented about the women’s HIV status, condom
use practices, access to PrEP, HIV testing services, or other features that would tell us more
about the HIV risk profile. Further, data are not presented about whether women use these social
networks to talk about general health and protection against HIV, but it’s not clear whether these
the interview guide did not probe for these practices or if it’s just not happening.
The Discussion needs to expand on the suggestion that social networks can be used to advance
health interventions. As in, if we know that women belong to multiple and likely overlapping
social networks and that information/pressures shared in these social networks fuel women’s
movements between different fishing communities in search of money (through sex work
activities or other paid work activities), how does knowing this set us up for better health
interventions?  Is the idea that we should circulate HIV prevention information through these
existing social networks?  Or that we should be providing mobile HIV prevention, testing, and
care services that follow the fish harvesting seasons? Or other ideas? Additional specificity here
will be very valuable since we’ve long known about the potential value of social networks to
promote health information and behaviours.
A limitation of the study is noted to be the focus on women in fishing communities. This is not
a limitation but a huge strength of this qualitative research.
Thank you again for the opportunity to review this manuscript.