1
|
Ye L, Wei S, Zou Y, Yang X, Abdullah AS, Zhong X, Ruan Y, Lin X, Li M, Wu D, Jiang J, Xie P, Huang J, Liang B, Zhou B, Su J, Liang H, Huang A. HIV pre-exposure prophylaxis interest among female sex workers in Guangxi, China. PLoS One 2014; 9:e86200. [PMID: 24465956 PMCID: PMC3899205 DOI: 10.1371/journal.pone.0086200] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 12/08/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Acceptability of pre-exposure prophylaxis (PrEP) and willingness to participate in a clinical trial for both safety and efficacy of PrEP were investigated among female sex workers (FSWs) in Guangxi, China. METHODS A cross-sectional study was performed in three cities in Guangxi. Structured, self-administered questionnaires were used to assess the acceptability of PrEP and the willingness to participate in a clinical trial. Multivariable logistic regression models were fitted to identify predictors. RESULTS Among 405 participants, 15.1% had heard of PrEP. If PrEP was deemed to be effective, safe and provided for free, 85.9% reported that they would accept it, and 54.3% of those who accepted PrEP said that they would participate in a clinical trial. The increased acceptability of PrEP was associated with working in male dominated venues, higher income, a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, not being forced to use condoms by the gatekeepers, consistent use of condoms, and use of drugs to prevent STD infection. The increased willingness to participate in a clinical trial was associated with a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, a willingness to adhere to daily PreP use, and not being concerned about discrimination by others. The main reason for rejecting PrEP or participating in a clinical trial was the concern about the side effects of PrEP. CONCLUSIONS Acceptability of PrEP among Guangxi FSWs is relatively high, indicating that PrEP intervention programs may be feasible for Chinese FSWs. Given the fact that most of the participants had never heard of PrEP before, and that family, gatekeepers, and social discrimination could significantly affect its acceptability, a comprehensive mix of multiple interventions is necessary for the successful implementation of a PrEP program among this population in Guangxi.
Collapse
Affiliation(s)
- Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Suosu Wei
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yunfeng Zou
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaobo Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Abu S. Abdullah
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United Staes of America
| | - Xiaoni Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinqin Lin
- Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Mingqiang Li
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Deren Wu
- Beihai Center for Disease Control and Prevention, Beihai, Guangxi, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Peiyan Xie
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bo Zhou
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinming Su
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Ailong Huang
- School of Public Health, Chongqing Medical University, Chongqing, China
| |
Collapse
|
2
|
Hood JE, Hogben M, Chartier M, Bolan G, Bauer H. Dual contraceptive use among adolescents and young adults: correlates and implications for condom use and sexually transmitted infection outcomes. ACTA ACUST UNITED AC 2013; 40:200-7. [PMID: 24293508 DOI: 10.1136/jfprhc-2012-100295] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Simultaneous condom and hormonal contraception usage ('dual method use') maximises protection against pregnancy and sexually transmitted infection (STI), although there is concern that promotion of this strategy could result in diminished condom use and inadvertently increase STI risk. In this study, we (1) assessed how the use of dual methods, versus condoms alone, related to STI and consistency of condom use and (2) described the correlates of dual use. METHODS A sample of 1450 young people aged 12-25 years were surveyed and screened for chlamydia and gonorrhoea at non-clinical sites in two high morbidity Californian counties in 2002-2003. Differences in STI prevalence and reported consistency of condom use were assessed for 'condom only' and 'dual method' users. Correlates of dual use were analysed via multivariate polytomous logistic regression. RESULTS Condom only and dual method users did not significantly differ in terms of STI prevalence or reported consistency of condom use. Sex, age, race and relationship tenure were significant correlates of dual use. DISCUSSION In these observational data, dual method use did not detrimentally affect STI risk. If interpreted alongside each subgroups' risk patterns for STI and unplanned pregnancy, the correlates of dual use can inform STI and pregnancy prevention interventions.
Collapse
Affiliation(s)
- Julia E Hood
- Epidemiologist II, Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Matthew Hogben
- Chief, Social & Behavioral Research & Evaluation Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maggie Chartier
- National Public Health Clinical Psychologist, Department of Veteran Affairs, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Gail Bolan
- Division Director, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heidi Bauer
- Chief, STD Control Branch, California Department of Public Health, Richmond, CA, USA
| |
Collapse
|
3
|
Li B, Zaveri T, Ziegler GR, Hayes JE. User preferences in a carrageenan-based vaginal drug delivery system. PLoS One 2013; 8:e54975. [PMID: 23358688 PMCID: PMC3554666 DOI: 10.1371/journal.pone.0054975] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022] Open
Abstract
Topical microbicides are a promising solution to address the global threat of HIV and other sexually transmitted infections. To be successful, a microbicide not only needs to be biologically functional but also highly acceptable to users. User acceptability of microbicides can be incorporated early in the product formulation and design process. Previous qualitative research revealed women had strong preferences regarding product shape, while preferences related to size and firmness were less clear. Here, we explored the effect of size and firmness on the acceptability of semisolid ovoid microbicide prototypes intended for vaginal use. Sexually active women (n = 74) were randomized to one of two conditions: with and without applicator. Nine different prototypes were evaluated; they were formulated to low, medium and high firmness using mixtures of kappa and iota carrageenan and potassium chloride. Three sizes were produced at each firmness level. Women manipulated all nine prototypes, rating them for perceived effectiveness, imagined ease-of-insertion and willingness-to-try on visual analog scales. The influence of size and firmness on these three outcome measures were assessed using ANOVA and response surface models. Results indicated size and firmness both influenced the outcome measures, but firmess was more influential than size. Also, the specific effects of size and firmness depended strongly on presence or absence of an applicator. Generally, women in the without applicator condition wanted a larger, firmer product. Collectively, these data suggest efforts to rationally design of microbicides for enhanced user acceptability must consider factors like size and firmness. Also, the decision to include or forego an applicator should be addressed early in the design process, as it strongly influences other design decisions.
Collapse
Affiliation(s)
- Bangde Li
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Toral Zaveri
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Gregory R. Ziegler
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - John E. Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
4
|
Guest G, Shattuck D, Johnson L, Akumatey B, Clarke EEK, Chen PL, Macqueen KM. Acceptability of PrEP for HIV prevention among women at high risk for HIV. J Womens Health (Larchmt) 2012; 19:791-8. [PMID: 20210540 DOI: 10.1089/jwh.2009.1576] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the acceptability of a daily pill for prevention of HIV acquisition among 400 Ghanaian women in the oral tenofovir disoproxil fumarate (TDF) clinical trial. METHODS Structured questionnaires were conducted with women enrolled in the trial at enrollment and at each of the 12 monthly follow-up visits. Growth curve analysis was used to examine adherence patterns over time. Qualitative interviews were carried out with a subsample of the clinical trial population, and thematic analysis was applied to these data. RESULTS Overall, acceptability of the pill was good. Adherence remained > 82% throughout the 12-month trial. Consistent access to the pill and study assignment were both associated with adherence. Most reported problems diminished over time as women became accustomed to the pill and developed strategies to incorporate pill taking into their daily routines. CONCLUSIONS If daily preexposure prophylaxis (PrEP) for HIV is found to be efficacious and has as few physical side effects as TDF, acceptability of this method among women in the study population may not be problematic. However, future studies must develop better acceptability measures, in order to more fully address the relationship among adherence, safety, and effectiveness.
Collapse
Affiliation(s)
- Greg Guest
- Family Health International, Research Triangle Park, North Carolina 27709, USA.
| | | | | | | | | | | | | |
Collapse
|
5
|
Abraham T, Macauda M, Erickson P, Singer M. "And let me see them damn papers!" The role of STI/AIDS screening among urban African American and Puerto Rican youth in the transition to sex without a condom. AIDS Behav 2011; 15:1359-71. [PMID: 20844945 DOI: 10.1007/s10461-010-9811-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Common strategies employed in preventing STI/AIDS transmission among young adults in America include abstinence, monogamy and safer sex. These strategies require a high level of vigilance and responsibility and, according to inner city participants in Project PHRESH.comm, neither option is always desirable, available, or rational in the context of their lived experiences. This article reports findings from Project PHRESH.comm, a mixed-method, ethnographic study incorporating data from focus group discussions, semi-structured interviews, coital diaries, systematic cultural assessments and a structured survey designed to explore concepts of risk and decision making about condom use among at risk African American and Puerto Rican young adults aged 18-25 years in Hartford, CT. We found that many young adults from our study population rely on a strategy of using clinic-sponsored STI/AIDS screening when wanting to discontinue condom use with a partner. While our data suggest that screening is a common strategy used by many couples to transition to having sex without a condom, the data also show that most youth do not maintain monogamy even in long-term, serious relationships. Thus, sharing test results may provide a false sense of security in the sexual culture of inner city, minority youth.
Collapse
|
6
|
|
7
|
Holmes WR, Maher L, Rosenthal SL. Attitudes of men in an Australian male tolerance study towards microbicide use. Sex Health 2008; 5:273-8. [PMID: 18771643 PMCID: PMC3777800 DOI: 10.1071/sh07093] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Accepted: 05/15/2008] [Indexed: 04/14/2024]
Abstract
BACKGROUND Vaginal microbicides are in development to provide new options for the prevention of sexually transmissible infections. Although promoted as a female-initiated product, men may influence the decision to use a microbicide and the way that it is used, so it is important to explore their views. METHODS Men (n = 36) enrolled in a 7-day, phase 1 clinical safety trial of SPL7013 Gel were interviewed pre- and post-use of the gel. The trial did not include use of the gel during sex. Interviews were digitally-recorded and transcribed verbatim, and analysed using a framework approach. RESULTS The men (mean age 37 years) were interested in the idea of vaginal microbicides, had little knowledge about them, and varied beliefs about how they work. They tended to assess microbicide use in relation to condoms and lubricants. Many would want a microbicide to be as effective as condoms. Participants did not anticipate difficulties discussing use with their partners. Many thought that a microbicide would be less intrusive than condoms; some anticipated that the lubricating properties might enhance sexual pleasure. Some anticipated using a microbicide with a condom or with a lubricant, and a few raised questions about the timing of use and use during different types of sexual activity. CONCLUSIONS No major barriers to microbicide use were found in this sample of Australian men, who anticipated being willing to use them if they are shown to be safe and effective. Our findings should help to inform the design of further studies as well as future information materials and anticipatory guidance.
Collapse
Affiliation(s)
- Wendy R Holmes
- Centre for International Health, Macfarlane Burnet Institute for Medical Research and Public Health, 23?87 Commercial Road, Melbourne, Vic. 3004, Australia.
| | | | | |
Collapse
|
8
|
Koo HP, Woodsong C, Dalberth BT, Viswanathan M, Simons-Rudolph A. Context of Acceptability of Topical Microbicides: Sexual Relationships. THE JOURNAL OF SOCIAL ISSUES 2005; 61:67-93. [PMID: 21822334 PMCID: PMC3150999 DOI: 10.1111/j.0022-4537.2005.00394.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Domains central to the effects of sexual relationships on the acceptability of a vaginal protection method were explored in 14 focus groups and 38 in-depth interviews with women and men recruited from a health department's sexually transmitted infections (STI) and family planning clinics. Findings indicate that acceptability depended on a couple's relationship type, classified as serious, casual, or "new." Potential barriers to communication about product use may be overcome through direct or indirect covert use, depending on relationship type. More men than women thought women should always tell their partners if they use microbicides, regardless of relationship type. Results indicate the importance of the relationship context in understanding the likely acceptability of using microbicides, and perhaps any method of STI/HIV protection.
Collapse
|
9
|
Severy LJ, Tolley E, Woodsong C, Guest G. A framework for examining the sustained acceptability of microbicides. AIDS Behav 2005; 9:121-31. [PMID: 15812619 DOI: 10.1007/s10461-005-1687-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Revised: 06/09/2004] [Accepted: 07/26/2004] [Indexed: 10/25/2022]
Abstract
The concept of acceptability involves a complex set of individual, couple and socio-cultural factors. Within a specific focus on microbicides, this article sets forth the relevant behavioral issues demanding attention as scientists and product developers strive to identify microbicides that will be used in a sustained, long-term fashion to prevent HIV/AIDS. The paper re-conceptualizes long-term acceptability within the ARRM framework, reviews the basic issues and research related to microbicide acceptability, discusses couple relationships (especially the nature of intimate relationships), and identifies related gender and power factors. The importance of the cultural context within various international settings pervades all of these issues. Finally, a set of challenges is discussed for those contemplating such research.
Collapse
Affiliation(s)
- Lawrence J Severy
- Behavioral and Social Sciences, Family Health International, Research Triangle Park, North Carolina 27709, USA.
| | | | | | | |
Collapse
|
10
|
Wilson TE, Koenig LJ, Walter E, Fernandez I, Ethier K. Dual contraceptive method use for pregnancy and disease prevention among HIV-infected and HIV-uninfected women: the importance of an event-level focus for promoting safer sexual behaviors. Sex Transm Dis 2004; 30:809-12. [PMID: 14603086 DOI: 10.1097/01.olq.0000086617.41012.14] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Many women who report condom use also use other methods of birth control such as oral contraceptive pills. The use of 2 or more contraceptive methods often results in less consistent condom use. GOAL This study sought to document the prevalence and patterns of such dual contraceptive use among HIV-seropositive and HIV-seronegative women, and to assess factors associated with condom-only versus dual contraceptive use. STUDY DESIGN At 6 months postpartum, 361 sexually active women were interviewed regarding sexual behavior, male condom and other contraceptive use, and psychosocial factors. RESULTS Dual contraceptive method use was reported by 39% of sexually active women; 30% reported using condoms only. Almost two thirds of dual method users (64%) reported always using these methods together (ie, simultaneously) during vaginal sex. Among dual users, those who used methods simultaneously were more likely to be HIV-seropositive (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.5), to believe that a pregnancy would be very upsetting should it occur in the next 6 months (OR, 2.4; 95% CI, 1.1-5.4), and to report no alcohol use (OR, 3.7; 95% CI, 1.5-9.2). CONCLUSION Dual contraceptive users should be encouraged to use methods together at every episode of vaginal sex. Interventions promoting simultaneous use should include pregnancy attitudes and the role of alcohol use, as well as a consideration of HIV serostatus as it impacts on dual use.
Collapse
Affiliation(s)
- Tracey E Wilson
- Department of Preventive Medicine and Community Health, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA.
| | | | | | | | | |
Collapse
|
11
|
Exploring the Context of Women's Relationship Perceptions, Sexual Behavior, and Contraceptive Strategies. ACTA ACUST UNITED AC 2002. [DOI: 10.1300/j056v13n02_01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
12
|
Abstract
In a sample of college women at two private universities, this study examined dual use of self-protective measures, i.e., simultaneous use of condoms for disease prevention and birth control pills for contraception. Those who were dual users of condoms and birth control pills were in newer relationships, were less committed to their current relationships, and perceived their partners as more likely to have HIV or other STDs, as compared to college women using condoms only, birth control pills only, or no method. Dual use was unrelated to personality or health and risk behavior. Rather, dual use reflected a pattern of sexual self-protection based on risk management associated with concerns about consequences of sexual activity, that is STDs and conception, and not with more distal factors.
Collapse
Affiliation(s)
- P J Poppen
- Department of Psychology, George Washington University, Washington, DC 20052, USA
| | | |
Collapse
|
13
|
Abstract
In the US, continued high rates of unintended pregnancy, combined with increases in heterosexual transmission of HIV to women, have sharply magnified concern about the factors leading to or barring the use of contraceptive methods to protect concurrently against both risks. This paper reports on results of focus group research among African-American women participating in a longitudinal study and African-American men who are either partners of the women or are of similar socio-economic status as their partners. We found a high level of agreement between men and women on the issues and problems that both sexes face. People felt that regardless of a woman's use of other contraceptive methods, a condom should always be used for protection. This belief, however, differed markedly from actual practice. Although we attempted to discern the relative salience of concern about pregnancy versus STIs, we conclude that people may not separate these two concerns in their resolve to use two methods. Furthermore, they recognized the need for dual protection, but expected conflict with their partners from using condoms as a second method because of high levels of distrust regarding sexual fidelity. Thus people are caught in a bind: distrust further increases the sense of a need for dual methods, but using condoms exacerbates the problems people have with achieving trust in relationships.
Collapse
Affiliation(s)
- C Woodsong
- Center for International Development, Research Triangle Institute, Research Triangle Park, NC 27709-2194, USA.
| | | |
Collapse
|
14
|
Abstract
PURPOSE To explore associations of self-reported condom use with sexual risk knowledge and behaviors, perceptions of peer condom use, and communication with sexual partners about condom use among adolescent girls with sexually transmitted diseases (STDs). METHODS Adolescent girls with cervicitis or pelvic inflammatory disease (PID) completed a 62-item self-administered questionnaire on sexual risk knowledge and behaviors, condom use, perceptions of peer condom use, and condom use negotiation with partners. Associations with frequency of condom use and condom use at last sexual intercourse were analyzed. RESULTS A total of 24 girls were enrolled: 13 with cervicitis and 11 with PID; 22 had complete data for analysis. Compared with girls who reported low frequency of condom use, girls who reported condom use all or most of the time were younger (16.7 vs. 19.5 years; p = .008), were less likely to have a prior history of STD (67% vs. 0%; p = .03), and were more likely to think that all or most of their friends use condoms (72% vs. 0%; p = .02). Compared with girls who had not used a condom with last sexual intercourse, girls who had used a condom were younger (16.2 vs. 17.9 years; p = .04), had fewer lifetime partners (2.7 vs. 8.4; p = .03) and had higher mean scores in condom use negotiation (29.1 vs. 24.4; p = .02), and were more likely to think that all or most of their friends used condoms (100% vs. 31%; p = .001). Knowledge about condoms and STD prevention was high (mean 14.3 +/- 2.3 of 16) but was not associated with condom use. CONCLUSIONS STD interventions for partner condom use among high-risk adolescent girls must recognize the decrease in condom use with increasing age and focus on maintaining safer sex behaviors, building condom use negotiation skills, and promoting the perception of condom use by friends.
Collapse
Affiliation(s)
- L A Shrier
- Division of Adolescent/Young Adult Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | | | | |
Collapse
|