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Walcott MM, Tieu HV, Tipre M, Nandi V, Davis A, Wu E, Wheatle M, Frye V, Figueroa JP. Factors associated with discussing HIV pre-exposure prophylaxis (PrEP) among Jamaican medical providers. Int J STD AIDS 2024; 35:188-196. [PMID: 37966358 DOI: 10.1177/09564624231201187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND The Ministry of Health and Wellness of Jamaica has endorsed the use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy; however, PrEP was not included in the national HIV prevention program in 2021. METHODS A cross-sectional online study involving physicians in Jamaica was conducted in 2021 to describe PrEP awareness, beliefs, attitudes, and practices. The study also assessed individual and social factors associated with discussing PrEP with patients and willingness to prescribe PrEP. FINDINGS The mean age and standard deviation (SD) of the 69 physicians who completed the survey were 45.5 ± 13.6 years. Most of the participants (80%) reported that they were somewhat familiar with PrEP. PrEP attitude and perceived comfort in prescribing PrEP were moderate among participating physicians, with a mean and SD of 3.9 ± 0.8 and 3.6 ± 0.9 respectively. Six percent of physicians reported that they had prescribed PrEP and 17% had discussed PrEP with their patients in the past year. However, most (90%) reported that they were willing to prescribe PrEP after being informed about it. In the unadjusted model, identifying as Christian (compared to non-Christian) and reporting stronger homophobic beliefs were associated with reduced odds of discussing PrEP with patients. In the multivariable model, only homophobia remained statistically significant (OR, 0.24; 95% CI: 0.07-0.63). CONCLUSION The findings suggest that physicians in Jamacia may be willing to prescribe PrEP; however, homophobia is a barrier to discussions, underscoring the need for the Ministry of Health and Wellness to recognize the role that homophobia plays in the national HIV program to further reduce HIV incidence in Jamaica.
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Affiliation(s)
- Melonie M Walcott
- School of Public Health, University at Albany, Rensselaer, New York, USA
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Meghan Tipre
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vijay Nandi
- Laboratory of Data Analytics, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Alissa Davis
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | - Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | | | - Victoria Frye
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
- Community Health and Social Medicine (CSOM), City University of New York, New York, NY, USA
| | - J Peter Figueroa
- Department of Columbia, University School of Social Work, New York, NY, USA
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Smoyer AB, Ferris S, Earnshaw VA. Incarcerated People Living with HIV: A Qualitative Exploration of Stigma. HEALTH & SOCIAL WORK 2022; 47:274-283. [PMID: 36053259 DOI: 10.1093/hsw/hlac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 06/15/2023]
Abstract
Thousands of people living with HIV are incarcerated in the United States. Research about this vulnerable community has focused on access and adherence to medical care, including the impact of stigma on these treatment outcomes. This study presents qualitative data collected from 18 incarcerated and formerly incarcerated men and women living with HIV to expand knowledge about how HIV stigma shapes the lived experience of incarceration. The HIV Stigma Framework, including theory about enacted, anticipated, and internalized stigma, was used to analyze participants' narratives. Findings demonstrate an ongoing struggle with all three of these stigma mechanisms. Most participants deliberately concealed their HIV status and, therefore, experienced little enacted stigma. However, their narratives do describe anticipated stigma and, to a lesser extent, internalized stigma. There were gender differences in HIV disclosure and symbolic stigma and intersectionality are used to understand this variation. These findings illustrate the persistence of HIV stigma in correctional institutions and underscore the importance of fighting HIV stigma and homophobia within social work practice.
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Affiliation(s)
- Amy B Smoyer
- Amy B. Smoyer, PhD, is associate professor, Department of Social Work, Southern Connecticut State University, 501 Crescent Street, New Haven, CT 06515, USA
| | - Shannon Ferris
- Shannon Ferris, MSW, is a social worker, Boston, MA, USA. During the time that she was working on this article, she was an undergraduate research assistant at Southern Connecticut State University
| | - Valerie A Earnshaw
- Valerie A. Earnshaw, PhD, is associate professor, Department of Human Development & Family Sciences, University of Delaware, Newark, DE, USA
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Addiss DG, Amon JJ. Apology and Unintended Harm in Global Health. Health Hum Rights 2019; 21:19-32. [PMID: 31239611 PMCID: PMC6586980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the past few decades, investments in global health programs have contributed to massive advances in health for human populations. As with clinical medicine, however, global health interventions sometimes result in unintended harm, economic adversity, or social disruption. In clinical medicine, when medical error occurs, it is increasingly common for health care workers to offer apology, which involves acknowledging the error, taking responsibility for it, and expressing genuine remorse. In addition, hospitals are beginning to offer affected patients and their families reparation or compensation in an attempt to restore patients' health and repair relationships, as well as take steps to prevent similar harm in the future. By contrast, little is known about apology and reparation for unintentional harm in global health practice. Several factors, including the scale of global health programs, diffusion of responsibility across international networks of state and non-state actors, and concern that acknowledging harm could threaten otherwise successful health programs, render apology and reparation in global health more difficult than in clinical medicine. This article examines how and when individuals and global health organizations address inadvertent harm, illustrated by four case studies. It also describes ethical, legal, and human rights principles that could inform a more systematic approach. Addressing unintended harm in global health requires further attention at the individual, organizational, and global levels.
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Affiliation(s)
- David G. Addiss
- Director of the Focus Area for Compassion and Ethics at the Task Force for Global Health, Decatur, USA
| | - Joseph J. Amon
- Director of global health and clinical professor at Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Culbert GJ, Bazazi AR, Waluyo A, Murni A, Muchransyah AP, Iriyanti M, Finnahari, Polonsky M, Levy J, Altice FL. The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons. AIDS Behav 2016; 20:1026-38. [PMID: 26400080 PMCID: PMC4805506 DOI: 10.1007/s10461-015-1198-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03-1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00-1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.
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Affiliation(s)
- Gabriel J Culbert
- Department of Health Systems Science, University of Illinois at Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL, 60612, USA.
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia.
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
| | - Alexander R Bazazi
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Agung Waluyo
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Astia Murni
- Directorate General of Corrections, Indonesian Ministry of Law and Human Rights, Jakarta, Indonesia
| | | | - Mariska Iriyanti
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Finnahari
- Directorate General of Corrections, Indonesian Ministry of Law and Human Rights, Jakarta, Indonesia
| | - Maxim Polonsky
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Judith Levy
- Department of Health Policy & Administration, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Muessig KE, Rosen DL, Farel CE, White BL, Filene EJ, Wohl DA. "Inside These Fences Is Our Own Little World": Prison-Based HIV Testing and HIV-Related Stigma Among Incarcerated Men and Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:103-116. [PMID: 27459162 PMCID: PMC4965171 DOI: 10.1521/aeap.2016.28.2.103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Correctional facilities offer opportunities to provide comprehensive HIV services including education, testing, treatment, and coordination of post- release care. However, these services may be undermined by unaddressed HIV stigma. As part of a prison-based HIV testing study, we interviewed 76 incarcerated men and women from the North Carolina State prison system. The sample was 72% men, median age 31.5 years (range: 19 to 60). Thematic analysis revealed high levels of HIV-related fear and stigma, homophobia, incomplete HIV transmission knowledge, beliefs that HIV is highly contagious within prisons ("HIV miasma"), and the View of HIV testing as protective. Interviewees described social distancing behaviors and coping mechanisms they perceived to be protective, including knowing their HIV status and avoiding contact with others and shared objects. Interviewees endorsed universal testing, public HIV status disclosure, and segregation of HIV-positive inmates. Intensified education and counseling efforts are needed to ameliorate entrenched HIV-transmission fears and stigmatizing beliefs.
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Affiliation(s)
| | | | | | | | | | - David A Wohl
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Culbert GJ, Earnshaw VA, Wulanyani NMS, Wegman MP, Waluyo A, Altice FL. Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis. J Assoc Nurses AIDS Care 2015; 26:743-57. [PMID: 26304049 DOI: 10.1016/j.jana.2015.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed-method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n = 102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found four groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals.
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Adeyemi-Adelanwa O, Barton-Gooden A, Dawkins P, Lindo JLM. Attitudes of patients towards being cared for by male nurses in a Jamaican hospital. Appl Nurs Res 2015; 29:140-3. [PMID: 26856505 DOI: 10.1016/j.apnr.2015.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 02/14/2015] [Accepted: 06/26/2015] [Indexed: 11/25/2022]
Abstract
AIM To determine the attitudes of patients towards male nurses in a Jamaican hospital. BACKGROUND More males in nursing will help to address the nursing shortage and provide diversity in the profession. Patient attitudes towards male nurses will influence recruitment and retention. METHODS A cross-sectional study was used. Data were collected using a self-administered questionnaire and an attitudinal measuring scale. RESULTS Seventy-three patients responded (response rate 91%). Male nurses were perceived negatively by 51% of respondents. However, only 10% had a negative perception of the care they received from male nurses. More males (80%) than females (54%) had a negative attitude towards receiving an enema from a male nurse. CONCLUSIONS Patients generally had a negative attitude towards male nurses but had a positive view if they were cared for by a male nurse. These traits can be used as the basis of changing the gender balance of nurses in Jamaica.
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Affiliation(s)
- O Adeyemi-Adelanwa
- The UWI School of Nursing, Mona, University of the West Indies, Mona, Kingston 7, Jamaica
| | | | - Pauline Dawkins
- The UWI School of Nursing, Mona, University of the West Indies, Mona, Kingston 7, Jamaica.
| | - Jascinth L M Lindo
- The UWI School of Nursing, Mona, University of the West Indies, Mona, Kingston 7, Jamaica.
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Kelly-Hanku A, Kawage T, Vallely A, Mek A, Mathers B. Sex, violence and HIV on the inside: cultures of violence, denial, gender inequality and homophobia negatively influence the health outcomes of those in closed settings. CULTURE, HEALTH & SEXUALITY 2015; 17:990-1003. [PMID: 25853184 DOI: 10.1080/13691058.2015.1020877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To map the context of HIV in closed settings in Papua New Guinea (PNG), semi-structured interviews were undertaken with 56 prisoners and detainees and 60 key stakeholders. The nature of HIV-related risk differs for detained women and men, and reflects important gender-based issues present in PNG society more broadly. Women in detention are vulnerable to sexual violence and exploitation and at greatest risk of HIV while detained in police holding cells, where they are typically supervised by male officers, in contrast to prisons, where they have little contact with male staff. HIV risk for men in prison is associated with consensual and non-consensual sex; this risk is perpetuated by a pervasive culture of denial and institutionalised homophobia. The illegal nature of sodomy and male-to-male sex provides Correctional Services the legal grounds by which to refuse access to condoms for prisoners. Addressing HIV risk among detained men and women in PNG requires the reform of legislation, police and prison practices and an understanding of broader structural problems of gender-based violence and stigma and discrimination.
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Affiliation(s)
- Angela Kelly-Hanku
- a School of Public Health and Community Medicine, UNSW Australia , Sydney , Australia
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9
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Figueroa JP. Review of HIV in the Caribbean: significant progress and outstanding challenges. Curr HIV/AIDS Rep 2015; 11:158-67. [PMID: 24623473 DOI: 10.1007/s11904-014-0199-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews the recent literature on HIV in the Caribbean and discusses the challenges faced. HIV incidence in the Caribbean has declined by 49 % in the past decade, coverage of persons living with HIV among those eligible for antiretroviral treatment as per national guidelines was 70 % in 2012, and some countries are meeting the target of virtual elimination of mother-to-child transmission. HIV prevalence in the Caribbean is 1 % with features of both a generalized and concentrated HIV epidemic. HIV prevalence among female sex workers has declined but remains unacceptably high among men who have sex with men. Social and cultural factors, gender norms, and strong stigma associated with HIV and homosexuality contribute to the continued spread of HIV. Caribbean countries and their partners have invested significant resources, creative effort and impressive research in strengthening the HIV response nationally and regionally. However, in order to control the HIV epidemic, leaders at all levels, and the people, must address fundamental structural barriers in society that deny marginalized persons their rights, undermine public health goals, and impede universal access to HIV prevention, treatment, and care.
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Affiliation(s)
- J Peter Figueroa
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston 7, Jamaica,
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10
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Walcott MM, Funkhouser E, Aung M, Kempf MC, Ehiri J, Zhang K, Bakhoya M, Hickman D, Jolly PE. Gender norms and sexual behaviours among men in western Jamaica. Sex Health 2014; 11:42-51. [PMID: 24618497 DOI: 10.1071/sh13099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 01/22/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Objectives Gender norms, especially among men, can reduce the effectiveness of HIV prevention programs. We sought to assess the association between attitudes towards gender norms and risky sexual behaviours, and identify sociodemographic factors that predict gender-inequitable and masculinity norms among men in western Jamaica. METHODS A cross-sectional, survey of 549 men aged 19-54 years was conducted. Attitudes towards gender norms were measured using the Gender Equitable Men and Macho scales. Logistic regression and general linear models were used to assess associations between gender norms and multiple sexual partners, and to identify the associated sociodemographic factors. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) are presented. RESULTS Fifty-four percent of the participants (mean age=32.4 years) reported multiple sex partners and 22% reported unprotected sex with non-regular partner in the past 12 months. Men with moderate (AOR=2.2; 95% CI=1.4-3.3) and high (AOR=4.2; 95% CI=2.0-8.5) support for inequitable gender norms, and moderate (AOR=1.7; 95% CI=1.1-2.7) and high (AOR=2.5; 95% CI=1.5-4.3) support for masculinity norms were more likely to report multiple sex partners. Similarly, men with moderate (AOR=2.4; 95% CI=1.3-4.3) and high (AOR=2.5; 95% CI=1.2-5.2) support for inequitable gender norms were more likely to report unprotected sex with a nonregular partner. CONCLUSION A high proportion of Jamaican men engage in risky sexual behaviours. These results highlight the need for behaviour change interventions addressing gender norms targeting Jamaican men.
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Affiliation(s)
- Melonie M Walcott
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Maung Aung
- Western Regional Health Authority, Cornwall Regional Hospital, Montego Bay, PO Box 9000, St James, Jamaica
| | - Mirjam C Kempf
- Department of Family/Child Health and Caregiving and Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - John Ehiri
- Division of Health Promotion Sciences, University of Arizona, Tucson, AZ 85724, USA
| | - Kui Zhang
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Marion Bakhoya
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Deborah Hickman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Pauline E Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Monteiro SS, Villela WV, Soares PS. The interaction between axes of inequality in studies on discrimination, stigma and HIV/AIDS: Contributions to the recent international literature. Glob Public Health 2013; 8:519-33. [DOI: 10.1080/17441692.2013.779738] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Foster ML, Arnold E, Rebchook G, Kegeles SM. 'It's my inner strength': spirituality, religion and HIV in the lives of young African American men who have sex with men. CULTURE, HEALTH & SEXUALITY 2011; 13:1103-17. [PMID: 21824017 PMCID: PMC4475678 DOI: 10.1080/13691058.2011.600460] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Young black men who have sex with men account for 48% of 13-29-year-old HIV-positive men who have sex with men in the USA. It is important to develop an effective HIV prevention approach that is grounded in the context of young men's lives. Towards this goal, we conducted 31 interviews with 18-30-year-old men who have sex with men in the San Francisco-Oakland Bay Area. This paper examines the roles of religion and spirituality in men who have sex with men's lives, which is central in the lives of many African Americans. Six prominent themes emerged: (1) childhood participation in formal religious institutions, (2) the continued importance of spirituality among men who have sex with men, (3) homophobia and stigmatisation in traditional black churches, (4) tension between being a man who has sex with men and being a Christian, (5) religion and spirituality's impact on men's sense of personal empowerment and coping abilities and (6) treatment of others and building compassion. Findings suggest that integrating spiritual practice into HIV prevention may help programmes be more culturally grounded, thereby attracting more men and resonating with their experiences and values. In addition, faith-based HIV/AIDS ministries that support HIV-positive men who have sex with men may be particularly helpful. Finally, targeting pastors and other church leaders through anti-stigma curricula is crucial.
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Affiliation(s)
- Michael L. Foster
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, USA
| | - Emily Arnold
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, USA
| | - Gregory Rebchook
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, USA
| | - Susan M. Kegeles
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, USA
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