Exploring commercial sex work among transgender women in Nepal: Contributors and stigma—A mixed-method study

Himani Shree Pokharel; Salau Din Myia; Anisha Chalise; Shishir Paudel

doi:10.1371/journal.pone.0314619

Peer Review History

Original SubmissionMay 14, 2024
24 Sep 2024 Decision Letter - Julia Morgan, Editor PONE-D-24-19414Exploring Commercial Sex Work among Transgender Women in Nepal: Contributors and Stigma - A Mixed-Method StudyPLOS ONE Dear Dr. Paudel, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Thank you for your interesting paper. Please see the reviews from the reviewers below and take on board their suggestions to further consolidate the paper. Please put (IDIs) after In depth interviews in abstract. On page 4 please remove the capital c on confidence interval and check for other capital letter typos. It would be good to highlight the topics of the qualitative interviews. I would also like you to engage in more depth with COREQ for qualitative interviews and also discuss quality and rigor in qualitative interviews. What was the range and mean of interview times for the women. Please also see further reviews below. Please submit your revised manuscript by Nov 07 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Julia Morgan Academic Editor PLOS ONE Journal requirements: 1. When submitting your revision, we need you to address these additional requirements.Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified (1) whether consent was informed and (2) what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information.If you are reporting a retrospective study of medical records or archived samples, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information. 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is mixed research on the factors associated with commercial sex work among transgender women in Nepal, with an emphasis on the stigmas they experience in this context. Its theme is current and relevant to the health field. The material requires critical review in the “Methods” section, due to the low level of compliance with the STROBE and COREQ checklists. Furthermore, in the “Disucssion” section, the results relating to the characterization of the participants were not discussed and the discussion about the domains of stigma is restricted to one sentence, without any dialogue with the findings of other studies. Below is a detailed evaluation of the manuscript, highlighting the points in the text that require revision: Abstract: The wording of the objective (to explore […] of Nepal along with sex work stigma and their lived experience) is not the same as that presented in the introduction (to explore […] of Nepal along with their experience and stigma associated with it.). I suggest adopting the wording presented in the introduction. Methods: Critically review the text considering the recommendations of the STROBE and COREQ checklists. In this sense, I present some notes: The exclusion criteria adopted were missing. Considering the technique adopted to capture participants, it remained to be explained how many participants were the seeds and how many referral chains were formed. If there were losses or refusals in this process. What was the calculation adopted to determine how many participants would be interviewed? Regarding table 1 (Characteristics of participants involved in the in-depth interview (n =17)), I suggest presenting it in the “Results” section. In the item “Data collection”, the quantitative stage of the research was missing. Was the instrument for this stage ESES? If the qualitative part of the research had 152 participants and the qualitative part had 17 participants, wasn't the quantitative stage the first to be carried out? The reader is therefore confused by the way the information is described in this section (“The data were collected through face-to-face interviews. For the quantitative survey, the interviews were executed using a set of questionnaires divided into three sections”) , it seems that the article is restricted to presenting qualitative data. When did the quantitative data collection take place? What about qualitative data? What procedures were adopted to capture the 17 women who were interviewed? Where were the interviews carried out? Who conducted the interviews? Did you have any prior training? Regarding the data collection instrument: the data collected on the sociodemographic characteristics of the participants was missing; the questions adopted in the second section of the instrument were missing; and the Experiences with Sex Work Stigma Scale (ESWS) failed to be described. Was the ESWS self-completed by the participants or administered by one of the authors? What were the study variables? What was the technique used to analyze the qualitative data? I suggest citing the reference used for this purpose. Results: I suggest reorganizing the text of this section so that the quantitative results are presented first and, subsequently, presenting the qualitative data. Discussion: The findings regarding the characterization of the participants (age, relationship status and socialization) were not discussed. And the discussion regarding the domains of stigma is restricted to the phrase “a notable proportion of stigmatization was seen across different domains of the sex work stigma scale”, without any dialogue with the results of other studies. References: I strongly recommend updating most of the references used, since out of a total of 37 references, 23 are publications that are more than 5 years old. Reviewer #2: This is an important piece of research examining an under-researched topic. The background to your research in detailed and your methods and analysis are also very thorough. However, I would like to understand why you chose the particular research methods and what the limitations might be. I wonder if a more intersectional analysis would add strength to your findings rather than homogenising the participants. I would also like to see recommendations for improving the lives of these participants linked to policy. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Sally Bashford-Squires ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0314619.r001
Revision 1
8 Oct 2024 Author Response Editor comment Thank you for your interesting paper. Please see the reviews from the reviewers below and take on board their suggestions to further consolidate the paper. � We would like to thank you for your valuable time and suggestions. We have revised the manuscript as per the provided comments. Please put (IDIs) after In-depth interviews in the abstract. On page 4 please remove the capital c on confidence interval and check for other capital letter typos. It would be good to highlight the topics of the qualitative interviews. � Thank you for the suggestion, we have revised it accordingly. I would also like you to engage in more depth with COREQ for qualitative interviews and also discuss quality and rigor in qualitative interviews. What was the range and mean of interview times for the women. � Thank you for your comment, we have refilled the COREQ checklist, and have provided the details on the qualifications of the interviewers there as well as briefly described the quality of researchers involved in the qualitative interviews in the manuscript under the ‘Data collection’ and ‘Data management and analysis’ sections. Journal requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. � Thank you for the comment, we would like to apologize for missing some formatting. We have revised the manuscript accordingly. Please let us know if we have missed anything else. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified (1) whether consent was informed and (2) what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. If you are reporting a retrospective study of medical records or archived samples, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information � Thank you for your comments. In the manuscript we have mentioned these ethical concerns in different portions. � In regards to informed consent, in ‘Data collection’ section we had mentioned that all the interviews were conducted after acquiring written informed consent from the participants. In regards to inclusion of minors, in Sampling procedure section we had mentioned that All the transgender women aged 18 and above, residing inside Kathmandu Valley during the time of data collection were eligible, which directly excludes the minors. This was not a retrospective study or any part of medical records. � We have included the information on informed consent and consent for recording the audio in the Ethical approval section to make it more clear. 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. � Thank you, we have only included ethical statements in the ‘Method’ section in the revised manuscript. Reviewers comments Reviewer #1: This is mixed research on the factors associated with commercial sex work among transgender women in Nepal, with an emphasis on the stigmas they experience in this context. Its theme is current and relevant to the health field. The material requires critical review in the “Methods” section, due to the low level of compliance with the STROBE and COREQ checklists. Furthermore, in the “Discussion” section, the results relating to the characterization of the participants were not discussed and the discussion about the domains of stigma is restricted to one sentence, without any dialogue with the findings of other studies. � Thank you for your valuable time and suggestions. We have revised the STROBE and COREQ checklist. We have revised the manuscript based on your feedback on each section of the manuscript. Abstract: The wording of the objective (to explore […] of Nepal along with sex work stigma and their lived experience) is not the same as that presented in the introduction (to explore […] of Nepal along with their experience and stigma associated with it.). I suggest adopting the wording presented in the introduction. � Thank you for highlighting this inconsistency, we have revised the abstract section. Methods: Critically review the text considering the recommendations of the STROBE and COREQ checklists. In this sense, I present some notes: The exclusion criteria adopted were missing. Considering the technique adopted to capture participants, it remained to be explained how many participants were the seeds and how many referral chains were formed. If there were losses or refusals in this process. • Thank you for suggesting this missing and unclear information in our manuscript. We had mentioned that “transgender women aged 18 and above, residing inside Kathmandu Valley during the time of data collection were eligible”, however, we feel that this might not bring a clear picture of inclusion and exclusion criteria so we have added additional information for clarity. � The study employed a snowball sampling technique, starting with 5 initial seeds who were transgender women engaged in social or activist networks. These seeds were asked to refer other transgender women they knew who fit the eligibility criteria. Through this process, a total of 4 referral chains were formed. The Blue Diamond Society supported the data collection and the snowball sampling process. We have included this in the revised manuscript. What was the calculation adopted to determine how many participants would be interviewed? Regarding table 1 (Characteristics of participants involved in the in-depth interview (n =17)), I suggest presenting it in the “Results” section. � Thank you for your comment. The number of qualitative interview participants was determined based on the principle of data saturation. We have moved the ‘Characteristics of participants involved in the in-depth interview (n =17)’ into the result section as suggested. In the item “Data collection”, the quantitative stage of the research was missing. Was the instrument for this stage ESES? If the qualitative part of the research had 152 participants and the qualitative part had 17 participants, wasn't the quantitative stage the first to be carried out? The reader is therefore confused by the way the information is described in this section (“The data were collected through face-to-face interviews. For the quantitative survey, the interviews were executed using a set of questionnaires divided into three sections”) , it seems that the article is restricted to presenting qualitative data. � Thank you for helping us bring clarity in our manuscript. We have revised the ‘Data Collection’ section to clarify the following: “Both the quantitative and qualitative phases of data collection were conducted through face-to-face interviews. For the quantitative phase, a structured questionnaire with close-ended questions was used, while for the qualitative phase, an open-ended interview guide was employed. This study followed a concurrent mixed-methods design, meaning that both the quantitative and qualitative data were collected simultaneously. Participants for the qualitative interviews were recruited during the quantitative phase. Experiences with Sex Work Stigma Scale (ESWS) was used in the quantitative phase.” We hope this clarifies the structure of the study and addresses the confusion. When did the quantitative data collection take place? What about qualitative data? What procedures were adopted to capture the 17 women who were interviewed? Where were the interviews carried out? Who conducted the interviews? Did you have any prior training? � Thank you for suggesting the missing information in our manuscript, we have revised the section to make both phases clear and added the missing information that has been suggested. All interviews were conducted in private settings at the residences of the TGWs by HSP, a public health professional with prior training. Regarding the data collection instrument: the data collected on the sociodemographic characteristics of the participants was missing; the questions adopted in the second section of the instrument were missing; and the Experiences with Sex Work Stigma Scale (ESWS) failed to be described. Was the ESWS self-completed by the participants or administered by one of the authors? What were the study variables? What was the technique used to analyze the qualitative data? I suggest citing the reference used for this purpose. � Thank you for your comment. All the data, including ESWS, were collected through face-to-face interviews. We have revised the manuscript to make it clear. We are unclear on your comment regarding “the data collected on the sociodemographic characteristics of the participants was missing; the questions adopted in the second section of the instrument were missing; and the Experiences with Sex Work Stigma Scale (ESWS) failed to be described”, as we have mentioned the various sections of the quantitative tool in the ‘Data collection’ section and the collected variables are presented in the first table of the result section. We have also mentioned what the second section of the data collection tool covered. We have described ESWS along with its citation. We are more than happy to attach the questionnaire used in the study as a supplemental file if needed. The technique and process used in qualitative data analysis has been described under the ‘Data management and analysis’ section. Results: I suggest reorganizing the text of this section so that the quantitative results are presented first and, subsequently, presenting the qualitative data. � Thank you for your suggestion, we have revised the manuscript accordingly. Discussion: The findings regarding the characterization of the participants (age, relationship status and socialization) were not discussed. And the discussion regarding the domains of stigma is restricted to the phrase “a notable proportion of stigmatization was seen across different domains of the sex work stigma scale”, without any dialogue with the results of other studies. � The characterization of the participants has been explained in the results section of our study. We are a bit unclear regarding your comment concerning not including discussion about characterization of the participants (age, relationship status and socialization). We would be happy to revise our discussion as per your suggestion if you could guide us on what you meant. Currently our discussion is more focused on the factors found to be associated with CSW, based on our study objectives. � As there are limited studies that have assessed Commercial sex work stigma and during the literature review, we were unable to find any studies that have focused on Transgender women and their stigma related to CSW. Most of the literatures on CSW stigma are connected with HIV, which is not a focus of our study. So, we feel that it will not be relevant and not compatible to make a discussion on CSW stigma based on Female or male gender and make its reflection to TWGs considering their unique challenges and context. Furthermore, in our result section we have explored the CSW stigma among TWGs in detail so we felt that repeating the findings from the results in discussion might be redundant. References: I strongly recommend updating most of the references used, since out of a total of 37 references, 23 are publications that are more than 5 years old. � Thank you for your suggestion. We acknowledge that there are studies that are older than 5 years. Some of the older studies are references to legal documents and most of the studies have focused on transgender women, sex work, and sex work among transgender women which do not have many recent studies and the literatures used in our manuscript cannot be replaced as the reflections are drawn from these literatures. As there are limited studies on this topic we have included literature that we found relevant to our study. We feel that the original studies should be acknowledged. Reviewer #2: This is an important piece of research examining an under-researched topic. The background to your research in detailed and your methods and analysis are also very thorough. However, I would like to understand why you chose the particular research methods and what the limitations might be. I wonder if a more intersectional analysis would add strength to your findings rather than homogenising the participants. I would also like to see recommendations for improving the lives of these participants linked to policy. � We chose a quantitative component to understand the magnitude of the problem (i.e. commercial sex work among TWG) and a qualitative component to explore their lived experience including their sex work stigma. Thank you for your comment regarding intersectional analysis, however, considering the small sample size we think we are unable to go for intersectional analysis at this stage. We acknowledge the value of this approach and have included it as a suggestion for future research, where a larger and more diverse sample could enable a robust intersectional analysis. � Thank you for notifying this missing component, we have added some recommendations for improving the lives of these participants linked to policy in our discussion section. Attachments Attachment Submitted filename: Reviewer comments.docx https://doi.org/10.1371/journal.pone.0314619.r002
8 Nov 2024 Decision Letter - Julia Morgan, Editor PONE-D-24-19414R1Exploring Commercial Sex Work among Transgender Women in Nepal: Contributors and Stigma - A Mixed-Method StudyPLOS ONE Dear Dr. Paudel, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please consider the reviewers comments below and make changes. In addition please consider the following: 1) Please be consistent with the use of TGW and CSW throughout sometimes it is written as Transgender women and other times TGW, the same with commercial sex work2) Please use the term commercial sex work rather than prostitution3) In the Introduction take out reference to trans-sexual - use transgender only4) In the introduction you write 'in comparison to female sex workers' maybe consider using the term 'cis-gendered women' rather than female. Please submit your revised manuscript by Dec 23 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Julia Morgan Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors met the recommendations and suggestions from the last round of evaluation, except: Although the text presents the steps of the analytical process of qualitative data, the authors did not clarify which analysis technique was used or include a reference. References published more than 5 years ago predominate. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0314619.r003
Revision 2
10 Nov 2024 Author Response Dear Editor, We sincerely thank you and the reviewers for your valuable feedback and time dedicated to improving our manuscript. We have carefully considered each comment and have made revisions to address these suggestions. Below is a detailed response to each point raised: Editor comment and author response 1) Please be consistent with the use of TGW and CSW throughout sometimes it is written as Transgender women and other times TGW, the same with commercial sex work � We have ensured consistent use of terminology throughout the manuscript. Specifically, we have spelled out “Transgender women” and “commercial sex work/commercial sex workers” throughout the document to enhance clarity for readers and avoid any potential confusion. We have refrained from using the abbreviations TGW and CSW. 2) Please use the term commercial sex work rather than prostitution � We have replaced the term "prostitution" with "commercial sex work" throughout the manuscript. 3) In the Introduction take out reference to trans-sexual - use transgender only � In the introduction, we have removed the term "trans-sexual" and used "transgender" exclusively, as suggested. 4) In the introduction you write 'in comparison to female sex workers' maybe consider using the term 'cis-gendered women' rather than female. � Thank you, We have replaced “female sex workers” with “cis-gendered women” to align with more accurate and inclusive terminology. Reviewers comment and author response Although the text presents the steps of the analytical process of qualitative data, the authors did not clarify which analysis technique was used or include a reference. � We appreciate the time and effort that has been dedicated to strengthening our work. Thank you for notifying the missing information, we have now clarified that thematic analysis was used, along with an appropriate citation detailing the specific steps followed. References published more than 5 years ago predominate. � We acknowledge the feedback regarding the use of references predominantly older than five years. Due to the specificity of our research topic, recent studies are limited, and many current publications refer back to foundational sources. To ensure accuracy, we chose to cite original sources where relevant rather than secondary citations in more recent publications. We hope this approach is understandable given the context of our study. Thank you once again for the opportunity to improve our manuscript. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0314619.r004
14 Nov 2024 Decision Letter - Julia Morgan, Editor Exploring Commercial Sex Work among Transgender Women in Nepal: Contributors and Stigma - A Mixed-Method Study PONE-D-24-19414R2 Dear Dr. Paudel, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Julia Morgan Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0314619.r005
Formally Accepted
18 Nov 2024 Acceptance Letter - Julia Morgan, Editor PONE-D-24-19414R2 PLOS ONE Dear Dr. Paudel, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Julia Morgan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0314619.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .