1
|
Hawangchu D, Rene Lamy F, Stephan Felix M, Phukao D. Transition from nonmedical prescribed opioids to non-injection heroin use among young integrated Thai male users in Bangkok. J Ethn Subst Abuse 2022:1-27. [PMID: 36190323 DOI: 10.1080/15332640.2022.2126421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Opioid use and misuse are understudied in Thailand despite evidence suggesting that a portion of young Thai male integrated drug users are initiating use of non-medical prescribed opioids with some transitioning to heroin. This study aims to capture and analyze the individual and social factors influencing these transitions. Twenty in-depth semi-structured interviews were conducted between December 2019 and January 2020 in the Bangkok metropolitan area with young male opioid users who transitioned to heroin. Sixteen respondents initiated opioid through a Tramadol cocktail named "YaPro" and tended to transition to heroin use within 21 months. The interaction of specific social and individual factors such as joining recreational activities, curiosity or experimentation gradually modified the opioid-related meanings, attitude and practices of Thai users, who ultimately transition to heroin use. These results indicate that drug prevention programs in Thailand should encompass young opioid users in their intervention and further research need to focus on nonmedical use of prescription opioids in Thailand.
Collapse
Affiliation(s)
- Donlachai Hawangchu
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Francois Rene Lamy
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Mark Stephan Felix
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| | - Darunee Phukao
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Thailand
| |
Collapse
|
2
|
Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs. BMC Public Health 2020; 20:1450. [PMID: 32972359 PMCID: PMC7517806 DOI: 10.1186/s12889-020-09549-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background People who inject drugs (PWID) are the most exposed to hepatitis C virus (HCV). In Thailand, drug use is highly criminalized, and harm reduction services are scarce. This study estimates risky injection practices and assesses the proportion of HCV awareness and screening in the PWID population in Northern Thailand. Methods We used respondent-driven sampling (RDS) to recruit PWID in Chiang Mai Province. Social and behavioural data were collected through face-to-face interviews at an addiction treatment facility. Weighted population estimates were calculated to limit biases related to the non-random sampling method. Univariate and multivariate analyses were performed to study factors associated with HCV awareness and screening. Results One hundred seventy-one PWID were recruited between April 2016 and January 2017. Median age was 33 (Interquartile range: 26–40) years, 12.2% were women, and 49.4% belonged to a minority ethnic group. Among participants, 76.8% injected heroin, 20.7% methadone, and 20.7% methamphetamine. We estimate that 22.1% [95% CI: 15.7–28.6] of the population had shared needles in the last 6 months and that 32.0% [95% CI: 23.6–40.4] had shared injection material. Only 26.6% [95% CI: 17.6–35.6] had heard of HCV. Factors independently associated with knowledge of HCV included belonging to a harm reduction organization (adjusted odds ratio (aOR) = 5.5 [95% CI: 2.0–15.3]) and voluntary participation in a drug rehabilitation programme (aOR = 4.3 [95% CI: 1.3–13.9]), while Lahu ethnicity was negatively associated (aOR = 0.3 [95% CI: 0.1–0.9]). We estimate that 5% of the PWID population were screened for HCV; the only factor independently associated with being screened was membership of a harm reduction organization (aOR = 5.7 [95% CI: 1.6–19.9]). Conclusion Our study reveals that the PWID population is poorly informed and rarely screened for HCV, despite widespread risky injection practices. A public health approach aimed at reducing the incidence of HCV should target the PWID population and combine harm reduction measures with information and destigmatization campaigns. Civil society organizations working with PWID are a major asset for the success of such an approach, based on their current positive interventions promoting awareness of and screening for HCV.
Collapse
|
3
|
Cepeda JA, Vickerman P, Bruneau J, Zang G, Borquez A, Farrell M, Degenhardt L, Martin NK. Estimating the contribution of stimulant injection to HIV and HCV epidemics among people who inject drugs and implications for harm reduction: A modeling analysis. Drug Alcohol Depend 2020; 213:108135. [PMID: 32603976 PMCID: PMC7829087 DOI: 10.1016/j.drugalcdep.2020.108135] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Stimulants, such as amphetamines and cocaine, are widely injected among people who inject drugs (PWID). Systematic reviews indicate stimulant injection is associated with HIV and HCV among PWID. Using these associations, we estimated the contribution of stimulant injection to HIV and HCV transmission among PWID. METHODS We modeled HIV and HCV transmission among PWID, incorporating excess injecting and sexual risk among PWID who inject stimulants. We simulated three illustrative settings with different stimulants injected, prevalence of stimulant injecting, and HIV/HCV epidemiology. We estimated one-year population attributable fractions of stimulant injection on new HIV and HCV infections, and impact of scaling up needle-syringe programs (NSP). RESULTS In low prevalence settings of stimulant injection (St. Petersburg-like, where 13 % inject amphetamine), 9% (2.5-97.5 % interval [95 %I]: 6-15 %) and 7% (95 %I 4-11 %) of incident HIV and HCV cases, respectively, could be associated with stimulant injection in the next year. With moderate stimulant injection (Montreal-like, where 34 % inject cocaine), 29 % (95 %I: 19-37 %) and 19 % (95 %I: 16-21 %) of incident HIV and HCV cases, respectively, could be associated with stimulant injection. In high-burden settings like Bangkok where 65 % inject methamphetamine, 23 % (95%I:10-34%) and 20 % (95%I: 9-27%) of incident HIV and HCV cases could be due to stimulant injection. High-coverage NSP (60 %) among PWID who inject stimulants could reduce HIV (by 22-65 %) and HCV incidence (by 7-11 %) in a decade. DISCUSSION Stimulant injection contributes substantially to HIV and HCV among PWID. NSP scale-up and development of novel interventions among PWID who inject stimulants are warranted.
Collapse
Affiliation(s)
- Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA.
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Julie Bruneau
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada
| | - Geng Zang
- Department of Family Medicine, Université de Montréal, Montréal, QC, Canada
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, USA; Population Health Sciences, Bristol Medical School, University of Bristol, UK
| |
Collapse
|
4
|
The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:172-184. [DOI: 10.1016/j.drugpo.2019.07.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
|
5
|
Martin M, Vanichseni S, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Pitisuttithum P, Kaewkungwal J, van Griensven F, McNicholl JM, Tappero JW, Mastro TD, Kittimunkong S, Choopanya K. HIV Incidence and Risk Behaviours of People Who Inject Drugs in Bangkok, 1995-2012. EClinicalMedicine 2019; 9:44-51. [PMID: 31143881 PMCID: PMC6510716 DOI: 10.1016/j.eclinm.2019.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Three consecutive prospective studies were conducted among people who inject drugs (PWID) from May 1995 through June 2012 in Bangkok, Thailand. We examined data from these studies to evaluate HIV incidence and explore trends in risk behaviours. METHODS We used data from a 1995-1998 cohort study, a 1999-2004 HIV vaccine trial, and a 2005-2012 HIV pre-exposure prophylaxis (PrEP) study to examine per-quarter trends in HIV incidence, using a restricted cubic spline function for time in a Poisson regression. We also examined temporal trends in HIV-associated risk behaviours. FINDINGS HIV incidence declined from 5.7 per 100 person-years during the cohort study, to 2.7 per 100 person-years in the vaccine trial, to 0.7 per 100 person-years among PrEP study placebo recipients. Incidence peaked at 12.1 per 100 person-years in 1996 and declined to < 1 per 100 person-years during 2005-2012. Reports of injecting drugs and sharing needles also declined from the cohort study to the PrEP study (p < 0.0001). Heroin was the most common drug injected during the cohort study and the vaccine trial, but stimulants (e.g., methamphetamine) and sedatives (e.g., midazolam) were injected more often during the PrEP study. INTERPRETATION HIV incidence among PWID declined during 2005-2012. Several factors likely contributed to the decline, including decreases in the frequency of injecting and sharing, improved access to HIV testing and antiretroviral therapy, and the use of PrEP. Expanding access to effective HIV prevention tools can hasten control of the HIV epidemic among PWID. FUNDING The Bangkok Metropolitan Administration and U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention.
Collapse
Affiliation(s)
- Michael Martin
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand
- Corresponding author at: 4 Igor Sikorsky Street, Kyiv 04112, Ukraine.
| | | | | | - Philip A. Mock
- Thailand MOPH – U.S. CDC Collaboration, Nonthaburi, Thailand
| | | | | | | | | | - Frits van Griensven
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Janet M. McNicholl
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Jordan W. Tappero
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Timothy D. Mastro
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
- FHI 360, Durham, NC, USA
| | | | | |
Collapse
|
6
|
Handanagic S, Sevic S, Barbaric J, Dominkovic Z, Dakovic Rode O, Begovac J, Bozicevic I. Correlates of anti-hepatitis C positivity and use of harm reduction services among people who inject drugs in two cities in Croatia. Drug Alcohol Depend 2017; 171:132-139. [PMID: 28088084 DOI: 10.1016/j.drugalcdep.2016.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND We assessed correlates of anti-hepatitis C (anti-HCV) positivity and utilization of needle and syringe exchange programs (NSEP) and opioid agonist treatment (OAT) among people who inject drugs (PWID) in two Croatian cities. METHODS We conducted a cross-sectional study using respondent-driven (RDS) sampling among PWID in Rijeka (N=255) and Split (N=399). We used RDS-weighted population estimates and multivariable logistic regression to explore correlates of anti-HCV positivity and NSEP and OAT utilization. RESULTS Seventy-eight percent (78.0%) of PWID in Rijeka and 61.5% in Split had been tested previously for HCV, while 21.5% and 7.0%, respectively, were tested for HCV in the past 12 months. Among PWID who report being infected with HCV, 24.9% in Rijeka and 11.3% in Split received anti-HCV treatment. In Rijeka, PWID who utilized NSEP and, in Split, those who were ever imprisoned, had higher odds of anti-HCV positivity. In Rijeka, PWID on OAT were more likely to use non-sterile injecting equipment and to inject for longer than 10 years. PWID enrolled in NSEP were more likely to inject opioid agonist medication (OAM) and less likely to use non-sterile injecting equipment. More than half of PWID reported misuse of OAM in the past month, while out of PWID enrolled in OAT, 65.4% in Rijeka and 88.7% in Split injected OAM in the month prior to the survey. CONCLUSIONS Key findings of the paper point to the need to scale up HCV testing and treatment, improve access to NSEP and the quality of OAT provisions in order to prevent its misuse among PWID.
Collapse
Affiliation(s)
- Senad Handanagic
- WHO Collaborating Centre for HIV Strategic Information, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova ulica 4, 10000 Zagreb, Croatia.
| | - Sandra Sevic
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lucica 3, 10000 Zagreb, Croatia.
| | - Jelena Barbaric
- WHO Collaborating Centre for HIV Strategic Information, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova ulica 4, 10000 Zagreb, Croatia.
| | - Zoran Dominkovic
- Non-governmental Organization for Sexual and Gender Minorities Iskorak, Petrinjska ulica 27, 10000 Zagreb, Croatia.
| | - Oktavija Dakovic Rode
- University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska cesta 8, 10000 Zagreb, Croatia.
| | - Josip Begovac
- University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska cesta 8, 10000 Zagreb, Croatia.
| | - Ivana Bozicevic
- WHO Collaborating Centre for HIV Strategic Information, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova ulica 4, 10000 Zagreb, Croatia.
| |
Collapse
|
7
|
Visavakum P, Punsuwan N, Manopaiboon C, Pattanasin S, Thiengtham P, Tanpradech S, Sukwicha W, Wolfe M, Prybylski D. HIV prevalence and risk behaviors among people who inject drugs in Songkhla, Thailand: A respondent-driven sampling survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 31:163-7. [PMID: 26916088 DOI: 10.1016/j.drugpo.2016.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/12/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Prin Visavakum
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand.
| | - Niramon Punsuwan
- Bureau of Epidemiology, Disease Control Department, Ministry of Public Health, Nonthaburi 11000, Thailand
| | | | | | - Panupit Thiengtham
- Bureau of Epidemiology, Disease Control Department, Ministry of Public Health, Nonthaburi 11000, Thailand
| | | | - Wichuda Sukwicha
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand
| | - Mitchell Wolfe
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand; Division of Global HIV/AIDS, Center for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Dimitri Prybylski
- Thailand MOPH - U.S. CDC Collaboration, Nonthaburi 11000, Thailand; Division of Global HIV/AIDS, Center for Disease Control and Prevention, Atlanta, GA 30333, USA
| |
Collapse
|
8
|
Phanuphak N, Lo YR, Shao Y, Solomon SS, O'Connell RJ, Tovanabutra S, Chang D, Kim JH, Excler JL. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials. AIDS Res Hum Retroviruses 2015; 31:1060-76. [PMID: 26107771 DOI: 10.1089/aid.2015.0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.
Collapse
Affiliation(s)
| | - Ying-Ru Lo
- HIV, Hepatitis, and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sunil Suhas Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Robert J. O'Connell
- Department of Retrovirology, U.S. Army Medical Component, Armed Forces Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jean Louis Excler
- U.S. Military HIV Research Program, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| |
Collapse
|
9
|
Mattocks KM, Sullivan JC, Bertrand C, Kinney RL, Sherman MD, Gustason C. Perceived Stigma, Discrimination, and Disclosure of Sexual Orientation Among a Sample of Lesbian Veterans Receiving Care in the Department of Veterans Affairs. LGBT Health 2015; 2:147-53. [PMID: 26790121 DOI: 10.1089/lgbt.2014.0131] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Many lesbian women experience stigma and discrimination from their healthcare providers as a result of their sexual orientation. Additionally, others avoid disclosure of their sexual orientation to their providers for fear of mistreatment. With the increasing number of lesbian, gay, bisexual, and transgender (LGBT) veterans seeking care from the Veterans Health Administration (VHA), it is important to understand lesbian veterans' experiences with stigma, discrimination, and disclosure of sexual orientation. This article examines lesbian veterans' experiences with perceived stigma and discrimination in VHA healthcare, their perspectives on disclosure of sexual orientation to VHA providers, and their recommendations for improvements in VHA healthcare to create a welcoming environment for lesbian veterans. METHODS This is a mixed methods study of twenty lesbian veterans at four VHA facilities. The women veterans participated in a one-hour interview and then completed an anonymous survey. RESULTS Ten percent of lesbian veterans had experienced mistreatment from VHA staff or providers, but nearly 50% feared that their Veterans Affairs (VA) providers would mistreat them if they knew about their sexual orientation. A majority of lesbian veterans (70%) believed that VHA providers should never ask about sexual orientation or should only ask if the veteran wanted to discuss it. A majority (80%) believed the VHA had taken steps to create a welcoming environment for LBGT veterans. CONCLUSION Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.
Collapse
Affiliation(s)
- Kristin M Mattocks
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - J Cherry Sullivan
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Christina Bertrand
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Rebecca L Kinney
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Michelle D Sherman
- 3 Department of Psychology, University of Minnesota , St. Paul, Minnesota
| | - Carolyn Gustason
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 4 Department of Nursing, University of Massachusetts , Amherst, Massachusetts
| |
Collapse
|