1. presenting an opportunity for their improvement through

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1.    Yes, there was a clear statement of the
aims of the research in in the abstract and following the literature review.

abstract explicitly states the goal of the research as a study of how “poverty contextualises
sexual health behaviour”, including condom compliance amongst female sex
workers in an Indian red light district. In the introduction, the aim is
restated and discussed with supporting evidence from the literature.

study emphasises the importance of the research topic through multiple
paradigms. The researcher identifies that current HIV/AIDS intervention models
“repudiate the impact of contextual factors”, further supporting this with evidence of “low
correlation” between sexual knowledge and behaviour. The researcher
suggests this to be a weakness in the current intervention models, therefore presenting
an opportunity for their improvement through research. Moreover, “poverty” is
identified as an important contextual factor in the existing literature, which further
accentuated the need to study the significance of poverty for future
intervention planning.

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2.    Yes, a qualitative methodology is

qualitative methodology is appropriate as the researchers aimed to explore how
structural health barriers could affect sexual health practices through an
“ethnographic study”. Resultantly, the personal perspectives of the behaviours
and dialogues leading to the sexual health choices made by the sex workers could
be observed. The semi-structured interviews with “open-ended questions” and
“observations” of the sex workers in their natural setting allowed for their
uniquely subjective experiences in making sexual health choices and previously
unconsidered issues to freely arise.

3.    The research design appears to be
generally appropriate to address the research’s aims. 

participants were female sex workers associated with the DMSC and working in the
“Sonagachi red light district”, “Calcutta, India”. The author used an “ethnographic”
qualitative research design with “observations” and “semi-structured
interviews” to the collect data. “Pen
and paper recordings” were made. Observations allowed in vivo behaviour and sexual health practices
in their natural setting to be made. Open-ended questions enabled divergence
from rigid questioning for participants to express unrestrictedly, thus
allowing more data to be collected. Analysis of the data involved translation
of the interview transcripts to English. However, a data analysis method hasn’t
been explicitly named e.g. IPA, though the researcher attempts to categorise
barriers such as “poverty” and “punitive measures” from the consensus of the

the researcher justifies their design by stating the ethnographic research’s
ability to reveal otherwise complex insights of the sex workers and allow the “marginalised”
individuals to freely express themselves – a feat that would apparently be
difficult via “conventional techniques of project reporting”. However, they do
not delineate which methods they made comparisons to nor suggest alternative
research methods such as a quantitative methodology.

4.    No, the recruitment strategy was inappropriate
to the research aims.

participants were active sex workers of a Calcutta red light district where the
structural barriers such as poverty was present. However, the author does not
discuss any inclusion or exclusion criteria utilised to recruit the
participants. The DMSC committee conducted the participant selection, therefore
their own interest may have interfered with the selection. The researcher does
recognise this as a “drawback”. Nonetheless, the “lack of non-peer sex workers”
limits the researcher’s findings to peer sex workers. Additionally, the sample
size is not justified in the article with regards to its impact on population
generalisability and comparability to similar studies.

is no explicit mention of why the participants were appropriate for the study. They
recognise that the DMSC-mediated participant selection presents as a “drawback”
to accessing the knowledge sought after by the author. However, it is inferable
through their discussion that the participants’ presence in an area with structural
barriers (poverty) and sexually transmitted diseases (HIV/AIDS) made them a
desirable population to be studied for the study’s aim.

is some discussion around recruitment. The researcher gained “permission” from
the DMSC for the research, however the DMSC selected the participants for the
researcher. It is unclear how the DMSC did so. 37 participants were selected for the interview but the background
of 7 participants was not been discussed. They do mention that “no incentives”
were given and all participants were involved “voluntarily”.

5.      The data was collected in a generally
appropriate manner to address the research issue but has some inherent problems.

The researcher
explicitly mentions their use of “observations” and “semi-structured interviews”
to collect the data. “Open-ended questions” were used for uninhibited expression
of participants’ views on condom compliance. Observations were made in project
sites and DMSC offices. Data collection was conducted between “December 2010 to
January 2011” in the “DMSC offices” and “project sites”.

The researcher
justifies their research method by describing semi-structured interviews and
observations as a way of enabling “marginalised individuals” to freely express
themselves. They used open-ended questions to deviate away from a “limited”
structure, thus enabling the researcher to explore barriers and sexual health
practices beyond rigid questioning. Moreover, they assert an ethnographic
approach to be able to “examine the complexities of intervention
implementations” compared to other “conventional methods”. The sex workers’ location, experienced
poverty and active sexual health practices identified by the researcher adds
ecological validity to the study. However, alternative methods of data
collection are not discussed by the author.

The researcher
stated the use of “semi-structured interviews” with open ended questioning
lasting “20-30 minutes”. They used a topic guide, though allowing deviance from
the standardised questions. However, they do not mention how the observation
data was recorded or analysed besides the interview answers, nor is the number
of participants observed mentioned.

The researcher
has made no remark about the saturation of data. The participants were selected
by the DMSC, thus the researcher could not have determined at which participant
number the interviewed would show data saturation.

6.    The relationship
between the researcher and participant has been partly considered.

researcher spent a period of time with sex workers in “2009”, therefore
realising the importance of rapport building to encourage free conversation and
eliminate participant behaviour biases due to unfamiliarity with the
researcher. However, the DMSC’s selection of the participants rendered this
somewhat trivial. The researcher does recognise this as a “drawback”, as it is
out of their control. The researcher does not show reflexivity; they singly
translated and analysed the interview transcripts, thus potentiating translation
errors and restricted subjective interpretations to arise. Consideration for an
independent translator was not given. “No video or audio-tapings” were
performed preventing cross-checking by other researchers, thus reducing
inter-researcher reliability.

7.    Some ethical considerations have been
made, but incompletely.

is no clear explanation of how the study details, such as the aim and the inherent
risks and benefits, were explained to the participants. This hinders a thorough
assessment of whether ethical standards were maintained. Individual-level participant
consenting cannot be acknowledged from the article.

are some discussions about the issues raised by the study. The researcher states
the “voluntary” decision of participants to partake in the study. Moreover, the
researcher protected participant confidentiality via the exclusion of “personal
information”. Nonetheless, neither individual-level consent or a withdrawal
option were offered to the participants. Whether the conduction of the
interviews in the “DMSC offices” and “project sites” provided sufficient privacy
hasn’t been addressed by the researcher, therefore highlighting confidentiality
as a potential limitation of the study. Furthermore, the researcher does not
discuss if any support were needed for the participants following the sensitive
dialogue regarding their intimate sexual practices.

the researcher states the approval given by the “Temple University’s” ethical
committee before their research began.

8.    The data analysis was somewhat rigorous, but
with inherent problems.

The researcher
does not use a named method to analyse the interview transcripts. They attempt
to categorise the transcripts into structural barriers such as “income loss” and
present the consensus of the sex workers with supporting quotations. However, validations
were not performed via repeated transcript checks nor via an independent analyst.

analysis was not used. The researcher does attempt to categorise the structural
factors with supporting quotations, though this is implicitly presented. For
example, “loss of earnings” and “punitive measures” were some of the
consensuses established to explain condom non-compliance.  It is unclear how many participants
contributed to these different categories.

the article length and participant numbers, a variety of quotes are used to
support each of the identified structural factors. The quotes are sufficiently
elaborate for interpretation by an independent researcher. However, the
potential existence of bias in DMSC’s selection may have limited the range of

researcher did not critically examine their own role, potential biases and
influence. The author does not recognise the risk of errors when singly translating
the interview transcripts, and the importance of “audiotaping or videotaping”
the interviews for content validation
by another analyst.

9.    Yes, there is a clear statement of

findings are predominantly explicit. With poverty being the umbrella focus, the
researcher presents associated factors in subcategories – income loss, procurer
violence and health status of the sex workers. However, these needed an inference;
clear subheadings are not used to distinguish these factors in the findings.

The researcher
discusses key findings as such as income loss and procurer violence experienced
by sex workers as aetiological in sexual health practices. Although, comparisons to
determine which factor played a greater role in condom non-compliance has not
been discussed. They also offer alternative findings supporting poverty as an
“impetus” for condom compliance, therefore suggesting their impartial approach
to the study aim. They explore and explain this discrepancy as due to the “income
loss” and “life-threat” associated with HIV/AIDS. Quotations are used to
support all findings. The evidence generally appears to have been analysed in
detail, although as the sole analyst this is questionable. Alternative interpretations such as the
fear of procurer violence forcing sex workers to refrain from condom use can
occur irrespective of poverty, but have not been discussed.

The researcher
has not explicitly discussed the credibility of their findings. As the sole
analyst, they have not recognised their limited scope in interpretation of
their findings. Moreover, the potential use of peer debriefing has not been
considered. Respondent validation has not been used to check for any alterations
that the participants wanted to make to their interview transcripts or suggest
any inputs to the analysis of the findings. 
However, a form of method triangulation is incorporated by the author;
by observing and interviewing the participants, the structural barriers could
be validated through different means. The potential use of the direct
quotations for transferability of the findings has not been recognised by the

The researcher
consistently relates their findings to the existing literature and research aim
within the results and conclusion. They further this by challenging existing
literature with their contrary findings of poverty as an “impetus for healthy
sex behaviour”, therefore showing thorough engagement with main stream evidence
and their research aim. Findings are also evaluated to be useful for future HIV

10.  The
research is valuable in showing the importance of considering structural
factors in planning HIV interventions and understanding the mechanisms affecting
condom compliance.

The researcher
discusses the contribution of their findings for the reassessment of current approaches
in “HIV/AIDS intervention research”. Resultantly, interventions based on structural
barriers can be targeted at sex worker populations at risk of HIV/AIDS. The researcher
also challenges the pre-existing notion held in literature of poverty “exacerbating
unsafe sex practices” by showing its rather protective effect in a community. This
alternative finding adds to the existing literature.

The researcher
does not identify new research areas.

The researcher
discusses the implication of their findings on current approaches in HIV/AIDS
intervention research that are predominantly deviant from studying structural
barriers. This addresses the significant public health concern related to
HIV/AIDS and protection of commercial sex workers who are particularly susceptible
to the disease. They recommend the efficacy of transferring the Sonagachi model
to other red light districts in the developing parts of the world to unify and
protect sex workers against structural barriers and HIV/AIDS.






Categories: Strategy


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