Reviewer's report
Title:Determinants of Consistent Condom Use among Female Sex Workers in
Savannakhet, Lao PDR
Version:2Date:27 April 2014
Reviewer: Venkatesan Chakrapani
Reviewer's report:
Major Compulsory Revisions
1. Operationalisation of ‘regular partner’:
The operationalisation of the ‘regular partner’ needs to be justified. Why it was
chosen to consider “a paying or non-paying partners that the respondent had sex
with on more than one occasion” as a regular partner?” The authors themselves
have mentioned that often it is the intimacy which prevents people from using
condoms with their regular partners. The information that, in the previous week,
FSWs had a mean number of 1.4 regular partners (range 1 to 5 regular partners)
(page 7) also possibly indicate that many of these partners may not be ‘intimate’
partners. If data are available, is it possible for the authors to describe/explain
how the condom use differs with intimate regular partner (spouse/lover) and with
non-paying regular partners – at least qualitative description based on the
responses from the open-ended questions.
2. Selection of independent variables:
The authors need to briefly summarise the rationale behind the selection of
certain independent variables only as other potential independent variables such
as ease of condom availability and exposure to HIV prevention intervention
would have been more logical, given the several years of HIV intervention in the
study district. If intervention exposure variables (yes or no, intensity of exposure)
are available, they could be tested in the model.
3. FSWs – between 15 to 18 years of age:
About one-fourth (23%) were reported to be between 15 and 18 years of age.
Even though the ethics approval details are provided, the authors can specifically
include a few sentences how they addressed ethical issues in relation to legal
minors in this study. I am not sure whether less than 18 years would be ‘legal
minor’ in Lao PDR. Whether assent of the study participant below the legal minor
age and consent from a guardian (or equivalent) were obtained?
4. Criteria for inclusion of variables in multiple logistic regression:
In Table 5, it is not clear whether other background/sociodemographic variables
were included or not. It is also not clear about the need for including ‘number of
sexual partners last week’ in the multiple logistic regression model when that
variable was not statistically significant in bivariate analysis (crude odds ratio was
not significant), and when the authors had stated that only those variables with
significant p-values in bivariate analysis were included in multiple logistic
regression model.
5. Need to explain the importance of a key finding - Association between years of
experience in sex work and consistency in condom use with regular partners:
One major gap in the Discussion section is lack of any discussion or tentative
explanation for what could be the reason behind the statistically significant
association between the years of experience (less than one year) and consistent
condom use with regular partners: FSWs with more than one year of experience
were found to be less consistent than FSWs with less than one year of
experience. The authors need to speculate on the most likely reasons for this
finding – based on insights from program people or based on findings from
qualitative studies, if available, conducted among FSWs in Lao PDR. Or at least
the authors could suggest that this particular area needs to be explored further in
future studies.
Minor Essential Revisions
1. The first sentence states “Female sex workers (FSWs) have significantly
higher HIV prevalence than other population groups and HIV often spreads
among FSWs prior to spreading into the general population” seems to be an
over-generalisation, as in some countries other at-risk groups have higher HIV
prevalence than FSWs. Thus, the authors need to appropriately qualify the first
sentence.
2. Line 6 (Page 2): “...spouses, regular and non-paying...” – these are not
mutually exclusive. Possible revision: spouses/regular partners and casual
partners...”
3. ‘Condom practices latest sex’ in Table 1 can be changed to ‘condom use
during last sex’.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests