Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
AIDS and Behavior
Published in: AIDS and Behavior 5/2013

01-06-2013 | Original Paper

Unprotected Sex Among Heterosexually Active Homeless Men: Results from a Multi-level Dyadic Analysis

Authors: David P. Kennedy, Suzanne L. Wenzel, Ryan Brown, Joan S. Tucker, Daniela Golinelli

Published in: AIDS and Behavior | Issue 5/2013

Login to get access

Abstract

HIV is a serious public health problem for homeless populations. Homeless men who have sex with women have received less attention in the HIV risk literature than other homeless populations. This research uses multi-level modeling to investigate the context of unprotected sex among heterosexually active homeless men in the Skid Row area of Los Angeles. Based on interviews with 305 randomly selected men who discussed 665 of their recent female sexual relationships, this project investigates the correlates of unprotected sex during the past 6 months at the partnership, individual, and social network levels. Several different measures of relationship closeness and lack of communication about HIV/condoms were associated with unprotected sex. Controlling for relationship factors, men’s negative attitudes towards condoms, mental health, and higher number of male sex partners also were associated with having unprotected sex with female partners. We discuss the implications of these findings for health interventions.
Literature
1.
Centers for Disease Control and Prevention. HIV/AIDS surveillance report, 2005. Vol. 17 Rev. ed. Atlanta: US Department of Health and Human Services, CDC; 2007.
2.
UNAIDS. Global report: UNAIDS report on the global AIDS epidemic.2010.
3.
Schackman BR, Gebo KA, Walensky RP, Losina E, Muccio T, Sax PE, et al. The lifetime cost of current human immunodeficiency virus care in the United States. Med Care. 2006;44(11):990–7.PubMedCrossRef
4.
Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL. Selected major risk factors and global and regional burden of disease. The Lancet. 2002;360(9343):1347–60.CrossRef
5.
UNAIDS. Condoms and HIV prevention: Position statement by UNAIDS, UNFPA and WHO. Geneva: UNAIDS; 2009.
6.
Warner L, Gallo MF, Macaluso M. Condom use around the globe: how can we fulfil the prevention potential of male condoms? Sex Health. 2012;9(1):4–9.PubMedCrossRef
7.
Zolopa AR, Hahn JA, Gorter R, Miranda J, Wlodarczyk D, Peterson J, et al. HIV and tuberculosis infection in San Francisco’s homeless adults: prevalence and risk factors in a representative sample. J Am Med Assoc. 1994;272(6):455–61.CrossRef
8.
Robertson MJ, Clark RA, Charlebois ED, Tulsky J, Long HL, Bangsberg DR, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. 2004;94(7):1207–17.PubMedCrossRef
9.
Aidala A, Cross J, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav. 2005;9(3):251–65.PubMedCrossRef
10.
Wenzel SL, Tucker JS, Elliott MN, Hambarsoomians K, Perlman J, Becker K, et al. Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: a comparison of sheltered and low-income housed women in Los Angeles county. Prev Med. 2004;39(3):617–24.PubMedCrossRef
11.
Gorbach PM, Murphy R, Weiss RE, Hucks-Ortiz C, Shoptaw S. Bridging sexual boundaries: men who have sex with men and women in a street-based sample in Los Angeles. J Urban Health-Bull N Y Acad Med. 2009;86:S63–76.CrossRef
12.
Kidder DP, Wolitski RJ, Pals SL, Campsmith ML. Housing status and HIV risk behaviors among homeless and housed persons with HIV. Jaids-J Acquir Immune Defic Syndr. 2008;49(4):451–5.CrossRef
13.
Kipke MD, Weiss G, Wong CF. Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS Behav. 2007;11(6):S56–69.CrossRef
14.
15.
Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al. Estimation of HIV incidence in the United States. JAMA J Am Med Assoc. 2008;300(5):520–9.CrossRef
16.
National Coalition for the Homeless. Who is homeless? Washington, DC. 2009.
17.
Centers for Disease Control and Prevention. HIV among women. Atlanta: US Department of Health and Human Services, CDC; 2011.
18.
Dworkin SL, Fullilove RE, Peacock D. Are HIV/AIDS prevention interventions for heterosexually active men in the United States gender-specific? Am J Public Health. 2009;99(6):981–4.PubMedCrossRef
19.
Wolitski RJ, Kidder DP, Fenton KA. HIV, homelessness, and public health: critical issues and a call for increased action. AIDS Behav. 2007;11(6):S167–71.CrossRef
20.
Higgins JA, Hoffman S, Dworkin SL. Rethinking gender, heterosexual men, and women’s vulnerability to HIV/AIDS. Am J Public Health. 2010;100(3):435–45.PubMedCrossRef
21.
Corbett AM, Dickson-Gomez J, Hilario H, Weeks MR. A little thing called love: condom use in high-risk primary heterosexual relationships. Perspect Sex Reprod Health. 2009;41(4):218–24.PubMedCrossRef
22.
Bryan A, Fisher JD, Fisher WA. Tests of the mediational role of preparatory safer sexual behavior in the context of the theory of planned behavior. Health Psychol. 2002;21(1):71–80.PubMedCrossRef
23.
Logan TK, Cole J, Leukefeld C. Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychol Bull. 2002;128(6):851–85.PubMedCrossRef
24.
Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000;27(5):539–65.PubMedCrossRef
25.
Campbell CA. Male gender-roles and sexuality—implications for womens AIDS risk and prevention. Soc Sci Med. 1995;41(2):197–210.PubMedCrossRef
26.
Kaufman MR, Shefer T, Crawford M, Simbayi LC, Kalichman SC. Gender attitudes, sexual power, HIV risk: a model for understanding HIV risk behavior of South African men. AIDS Care. 2008;20(4):434–41.PubMedCrossRef
27.
Poehlman J. Masculine identity and HIV/AIDS risk behavior among African-American men. Pract Anthr. 2008;30(1):12–7.
28.
Whitehead TL. Urban low-income African American men, HIV/AIDS, and gender identity. Med Anthropol Q. 1997;11(4):411–47.PubMedCrossRef
29.
Aronson RE, Whitehead TL, Baber WL. Challenges to masculine transformation among urban low-income African American males. Am J Public Health. 2003;93(5):732–41.PubMedCrossRef
30.
Pleck JH, Sonenstein FL, Ku LC. Masculinity ideology: its impact on adolescent males’ heterosexual relationships. J Soc Issues. 1993;49(3):11–29.CrossRef
31.
O’Sullivan LF, Hoffman S, Harrison A, Dolezal C. Men, multiple sexual partners, and young adults’ sexual relationships: understanding the role of gender in the study of risk. J Urban Health-Bull N Y Acad Med. 2006;83(4):695–708.CrossRef
32.
Seal DW, Wagner-Raphael LI, Ehrhardt AA. Sex, intimacy, and HIV—an ethnographic study of a Puerto Rican social group in New York City. J Psychol Hum Sex. 2000;11(4):51–92.CrossRef
33.
Harrison A, O’Sullivan LF, Hoffman S, Dolezal C, Morrell R. Gender role and relationship norms among young adults in South Africa: measuring the context of masculinity and HIV risk. J Urban Health-Bull N Y Acad Med. 2006;83(4):709–22.CrossRef
34.
Shearer CL, Hosterman SJ, Gillen MM, Lefkowitz ES. Are traditional gender role attitudes associated with risky sexual behavior and condom-related beliefs? Sex Roles. 2005;52(5–6):311–24.CrossRef
35.
Kennedy DP, Brown R, Golinelli D, Wenzel S, Tucker JS, Wertheimer S. Masculinity and HIV risk among homeless men in Los Angeles. Psychol Men Masculinity. 2012; (in press).
36.
Rayburn R, Corzine J. Your shelter or mine? Romantic relationships among the homeless. Deviant Behav. 2010;31(8):756–74.CrossRef
37.
Sobo EJ. Inner-city women and AIDS—the psychosocial benefits of unsafe sex. Cult Med Psychiatr. 1993;17(4):455–85.CrossRef
38.
Afifi WA. Harming the ones we love: relational attachment and perceived consequences as predictors of safe-sex behavior. J Sex Res. 1999;36(2):198–206.CrossRef
39.
Thomsen S, Stalker M, Toroitich-Ruto C. Fifty ways to leave your rubber: how men in mombasa rationalise unsafe sex. Sex Transm Infect. 2004;80(6):430–4.PubMedCrossRef
40.
Kennedy DP, Wenzel SL, Tucker JS, Green HD, Golinelli D, Ryan G, et al. Unprotected sex of homeless women living in Los Angeles county: an investigation of the multiple levels of risk. AIDS Behav. 2010;14(4):960–73.PubMedCrossRef
41.
Kennedy DP, Tucker JS, Green HD, Golinelli D, Ewing BA. Unprotected sex of homeless youth: results from a multilevel analysis of individual, social network, and relationship factors. AIDS Behav. 2012; 16(7):2015–2032.
42.
Tucker JS, Elliott MN, Wenzel SL, Hambarsoomian K. Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles county. Health Psychol. 2007;26(5):644–9.PubMedCrossRef
43.
Seal DW, Ehrhardt AA. HIV-prevention-related sexual health promotion for heterosexual men in the United States: pitfalls and recommendations. Arch Sex Behav. 2004;33(3):211–22.PubMedCrossRef
44.
Brown RA, Kennedy DP, Tucker JS, Wenzel S, Golinelli D, Wertheimer S, et al. Sex and relationships on the street: how homeless men judge partner risk on Skid Row. AIDS Behav. 2011;16(3):774–84.CrossRef
45.
46.
Stein JA, Nyamathi AM, Zane JI. Situational, psychosocial, and physical health-related correlates of HIV/AIDS risk behaviors in homeless men. Am J Mens Health. 2009;3(1):25–35.PubMedCrossRef
47.
Forney JC, Lombardo S, Toro PA. Diagnostic and other correlates of HIV risk behaviors in a probability sample of homeless adults. Psychiatr Serv. 2007;58(1):92–9.PubMedCrossRef
48.
Wenzel S, Rhoades H, Hsu H-T, Golinelli D, Tucker J, Kennedy D, et al. Behavioral health and social normative influence: Correlates of concurrent sexual partnering among heterosexually-active homeless men. AIDS Behav. 2012; 16(7):2042–2050.
49.
Green HD Jr, Tucker JS, Wenzel SL, Golinelli D, Kennedy DP, Ryan GW, et al. Association of childhood abuse with homeless women’s social networks. Child Abuse Negl. 2012;36(1):21–31.PubMedCrossRef
50.
Rice E, Milburn NG, Rotheram-Borus MJ. Pro-social and problematic social network influences on HIV/AIDS risk behaviours among newly homeless youth in Los Angeles. AIDS Care. 2007;19(5):697–704.PubMedCrossRef
51.
Ennett ST, Bailey SL, Federman EB. Social network characteristics associated with risky behaviors among runaway and homeless youth. J Health Soc Behav. 1999;40(1):63–78.PubMedCrossRef
52.
Tyler KA. Social network characteristics and risky sexual and drug related behaviors among homeless young adults. Soc Sci Res. 2008;37(2):673–85.PubMedCrossRef
53.
Rhoades H, Wenzel SL, Golinelli D, Tucker JS, Kennedy DP, Green HD, et al. The social context of homeless men’s substance use. Drug Alcohol Depend. 2011;118(2–3):320–5.PubMedCrossRef
54.
Hawkins RL, Abrams C. Disappearing acts: the social networks of formerly homeless individuals with co-occurring disorders. Soc Sci Med. 2007;65(10):2031–42.PubMedCrossRef
55.
Irwin J, LaGory M, Ritchey F, Fitzpatrick K. Social assets and mental distress among the homeless: exploring the roles of social support and other forms of social capital on depression. Soc Sci Med. 2008;67(12):1935–43.PubMedCrossRef
56.
Davey-Rothwell MA, Latimore A, Hulbert A, Latkin CA. Sexual networks and housing stability. J Urban Health-Bull N Y Acad Med. 2011;88(4):759–66.CrossRef
57.
Tucker JS, Kennedy D, Ryan G, Wenzel SL, Golinelli D, Zazzali J. Homeless women’s personal networks: implications for understanding risk behavior. Hum Organ. 2009;68(2):129–40.PubMed
58.
Kenny DA, Kashy DA, Cook WL. Dyadic data analysis. New York: The Guilford Press; 2006.
59.
Snijders TAB, Spreen M, Zwaagstra R. The use of multilevel modeling for analysing personal networks: networks of cocaine users in an urban area. J Quant Anthr. 1995;5(2):85–105.
60.
Fisher JD. Possible effects of reference group-based social influence on AIDS risk behavior and AIDS prevention. Am Psychol. 1988;43(11):914–20.PubMedCrossRef
61.
Sallis JE, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health. 2006;27:297–322.PubMedCrossRef
62.
Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K, editors. Heath behavior and health education: theory, research and practice. 4th ed. San Francisco: Josey-Bass; 2008. p. 465–82.
63.
Bronfenbrenner U. The ecology of human development: experiments by nature and design. Cambridge: Harvard University Press; 1979.
64.
Stokols D. Establishing and maintaining healthy environments—toward a social ecology of health promotion. Am Psychol. 1992;47(1):6–22.PubMedCrossRef
65.
Campbell KE, Lee BA. Name generators in surveys of personal networks. Soc Netw. 1991;13(3):203–21.CrossRef
66.
67.
McCarty C, Bernard HR, Killworth PD, Shelley GA, Johnsen EC. Eliciting representative samples of personal networks. Soc Netw. 1997;19(4):303–23.CrossRef
68.
McCarty C, Killworth PD, Rennell J. Impact of methods for reducing respondent burden on personal network structural measures. Soc Netw. 2007;29(2):300–15.CrossRef
69.
StataCorp LP. Stata statistical software. Release 9.2 ed. College Station, TX: StataCorp LP; 2007.
70.
Drigotas SM, Rusbult CE. Should I stay or should I go—a dependence model of breakups. J Pers Soc Psychol. 1992;62(1):62–87.CrossRef
71.
Rusbult CE, Johnson DJ, Morrow GD. Predicting satisfaction and commitment in adult romantic involvements—an assessment of the generalizability of the investment model. Soc Psychol Q. 1986;49(1):81–9.CrossRef
72.
Castañeda D. The close relationship context and HIV/AIDS risk reduction among Mexican Americans. Sex Roles. 2000;42(7–8):551–80.CrossRef
73.
Wasserman S, Faust K. Social network analysis: methods and applications. New York: Cambridge University Press; 1994.CrossRef
74.
Ware JE Jr, Sherbourne CD. The mos 36-item short-form health survey (sf-36): i. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.PubMedCrossRef
75.
Rumpf H-J, Meyer C, Hapke U, John U. Screening for mental health: validity of the mhi-5 using DSM-IV axis I psychiatric disorders as gold standard. Psychiatry Res. 2001;105(3):243–53.PubMedCrossRef
76.
Prins A, Ouimette P, Kimerling R, Cameron RP, Hugelshofer DS, Shaw-Hegwer J, et al. The primary care PTSD screen (pc-PTSD): development and operating characteristics. Prim Care Psychiatry. 2003;9(1):9–14.CrossRef
77.
Calhoun PS, McDonald SD, Guerra VS, Eggleston AM, Beckham JC, Straits-Troster K. Clinical utility of the primary care—PTSD screen among u.S. Veterans who served since September 11, 2001. Psychiatry Res. 2010;178(2):330–5.PubMedCrossRef
78.
Mutchler MG, Bogart LM, Elliott MN, Mckay T, Suttorp MJ, Schuster MA. Psychosocial correlates of unprotected sex without disclosure of HIV-positivity among African-American, Latino, and White men who have sex with men and women. Arch Sex Behav. 2008;37(5):736–47.PubMedCrossRef
79.
Jemmott LS, Jemmott JB. Applying the theory of reasoned action to AIDS risk behavior—condom use among black-women. Nurs Res. 1991;40(4):228–34.PubMedCrossRef
80.
Neff JA. A confirmatory factor analysis of a measure of “machismo” among Anglo, African American, and Mexican American male drinkers. Hisp J Behav Sci. 2001;23(2):171–88.CrossRef
81.
Caron SL, Davis CM, Halteman WA, Stickle M. Predictors of condom-related behaviors among first-year college students. J Sex Res. 1993;30(3):252–9.CrossRef
82.
Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000;42(7–8):637–60.CrossRef
83.
Piggott ME. Double jeopardy: Lesbians and the legacy of multiple stigmatised identities. Unpublished thesis. Melbourne, Australia: Swinburne University of Technology; 2004.
84.
Latkin CA, Forman V, Knowlton A, Sherman S. Norms, social networks, and HIV-related risk behaviors among urban disadvantaged drug users. Soc Sci Med. 2003;56(3):465–76.PubMedCrossRef
85.
Adimora AA, Schoenbach VJ, Doherty IA. Concurrent sexual partnerships among men in the United States. Am J Public Health. 2007;97(12):2230–7.PubMedCrossRef
86.
Shubert V, Bernstine N. Moving from fact to policy: housing is HIV prevention and health care. AIDS Behav. 2007;11(6):S172–81.CrossRef
87.
88.
Sikkema KJ, Heckman TG, Kelly JA, Anderson ES, Winett RA, Solomon LJ, et al. HIV risk behaviors among women living in low-income, inner-city housing developments. Am J Public Health. 1996;86(8):1123–8.PubMedCrossRef
89.
Wenzel SL, Tucker JS, Elliott MN, Hambarsoomians K. Sexual risk among impoverished women: understanding the role of housing status. AIDS Behav. 2007;11(6):S9–20.CrossRef
90.
Reed E, Gupta J, Biradavolu M, Devireddy V, Blankenship KM. The role of housing in determining HIV risk among female sex workers in Andhra Pradesh, India: considering women’s life contexts. Soc Sci Med. 2011;72(5):710–6.PubMedCrossRef
91.
Des Jarlais D, Braine N, Friedmann P. Unstable housing as a factor for increased injection risk behavior at us syringe exchange programs. AIDS Behav. 2007;11(0):78–84.PubMedCrossRef
92.
German D, Davey M, Latkin C. Residential transience and HIV risk behaviors among injection drug users. AIDS Behav. 2007;11:21–30.PubMedCrossRef
93.
Kipke M, Weiss G, Wong C. Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS Behav. 2007;11:56–69.PubMedCrossRef
94.
Friedman MS, Marshal MP, Stall R, Kidder DP, Henny KD, Courtenay-Quirk C, et al. Associations between substance use, sexual risk taking and HIV treatment adherence among homeless people living with HIV. AIDS Care. 2009;21(6):692–700.PubMedCrossRef
95.
Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health. 2007;97(12):2238–45.PubMedCrossRef
96.
Curran PJ, Bauer DJ. The disaggregation of within-person and between-person effects in longitudinal models of change. Annu Rev Psychol. 2011;62(1):583–619.PubMedCrossRef
97.
Metadata
Title
Unprotected Sex Among Heterosexually Active Homeless Men: Results from a Multi-level Dyadic Analysis
Authors
David P. Kennedy
Suzanne L. Wenzel
Ryan Brown
Joan S. Tucker
Daniela Golinelli
Publication date
01-06-2013
Publisher
Springer US
Published in
AIDS and Behavior / Issue 5/2013
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-012-0366-z

Other articles of this Issue 5/2013

AIDS and Behavior 5/2013 Go to the issue

Brief Report

What’s Sex Got to Do with It? The Role of Sexual Affect in the Relationship Between HIV Stigma and Mental Health

Brief Report

Associations Between Partner-Venue Specific Personal Responsibility Beliefs and Transmission Risk Behavior by HIV-Positive Men Who Have Sex with Men (MSM)

Brief Report

Food Insecurity, CD4 Counts, and Incomplete Viral Suppression Among HIV+ Patients from Texas Children’s Hospital: A Pilot Study

Original Paper

Provider-Initiated HIV Testing and Counseling in Low- and Middle-Income Countries: A Systematic Review

Original Paper

Do Safer Sex Self-Efficacy, Attitudes toward Condoms, and HIV Transmission Risk Beliefs Differ among Men who Have Sex with Men, Heterosexual Men, and Women Living with HIV?

Original Paper

Posttraumatic Stress Symptoms Among Adults Caring for Orphaned Children in HIV-Endemic South Africa
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits