HIV Is a Story First Wrten on the Bodi of Gay and Bisexual Men - PMC

Contents:

• HIV AND GAY AND BISEXUAL MEN
• HIV AND ALL GAY AND BISEXUAL MEN
• HIV AMONG GAY AND BISEXUAL MEN THE U.S.
• WHAT PERCENTAGE OF GAY MEN HAVE HIV
• HIV IS A STORY FIRST WRTEN ON THE BODI OF GAY AND BISEXUAL MEN
• INTIFYG HIV PREP ATTRIBUT TO INCREASE PREP USE AMONG DIFFERENT GROUPS OF GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN: A LATENT CLASS ANALYSIS OF A DISCRETE CHOICE EXPERIMENT
• DISCRIMATN AND HOMOPHOBIA FUEL THE HIV EPIMIC GAY AND BISEXUAL MEN
• NST T="UNFED"!=TYPEOF HTMLIMAGEELEMENT&&"LOADG" HTMLIMAGEELEMENT.PROTOTYPE;IF(T){NST T=DOCUMENT.QUERYSELECTORALL("IMG[DATA-MA-IMAGE]");FOR(LET E OF T){(E.SETATTRIBUTE("SRC",),E.REMOVEATTRIBUTE("DATA-SRC")),(E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET"));NST T=E.PARENTNO.QUERYSELECTORALL("SOURCE[DATA-SRCSET]");FOR(LET E OF T)E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET");PLETE&&(,E.PARENTNO.PARENTNO.QUERYSELECTOR("[DATA-PLACEHOLR-IMAGE]"))}}HIV BASICSOVERVIEWABOUT HIV & AIDSWHAT ARE HIV AND AIDS?HOW IS HIV TRANSMTED?WHO IS AT RISK FOR HIV?SYMPTOMS OF HIVDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSHISTORYHIV AND AIDS TIMELEMAKG A DIFFERENCESUPPORTG SOMEONE LIVG WH HIVSTANDG UP TO STIGMAGETTG INVOLVEDHIV PREVENTNUSG HIV MEDITN TO RCE RISKHIV TREATMENT AS PREVENTNPRE-EXPOSURE PROPHYLAXIS (PREP)POST-EXPOSURE PROPHYLAXIS (PEP)RCG SEXUAL RISKPREVENTG SEXUAL TRANSMISSN OF HIVRCG RISK OM ALHOL & DG USEALHOL AND HIV RISKSUBSTANCE USE AND HIV RISKRCG RISK OF PERATAL TRANSMISSNPREVENTG PERATAL TRANSMISSN OF HIVPOTENTIAL FUTURE OPTNSHIV VACCLONG-ACTG HIV PREVENTN TOOLSMICROBICISHIV TTGLEARN ABOUT HIV TTGWHO SHOULD GET TTED?HIV TTG LOTNSHIV TTG OVERVIEWUNRSTANDG HIV TT RULTSJT DIAGNOSED: WHAT'S NEXT?LIVG WH HIVTALKG ABOUT YOUR HIV STATSTARTG HIV CAREFD A PROVIRLOTE AN HIV CARE PROVIRTYP OF PROVIRSTAKE CHARGE OF YOUR CAREGETTG READY FOR YOUR FIRST VISWHAT TO EXPECT AT YOUR FIRST HIV CARE VISSTAYG HIV CAREPROVIR VISS AND LAB TTSMAKG CARE WORK FOR YOUSEEG YOUR HEALTH CARE PROVIRHIV LAB TTS AND RULTSRETURNG TO CAREHIV TREATMENTHIV TREATMENT OVERVIEWVIRAL SUPPRSN AND UNTECTABLE VIRAL LOAD TAKG YOUR HIV MEDICE AS PRCRIBEDTIPS ON TAKG YOUR HIV MEDITN EVERY DAYPAYG FOR HIV CARE AND TREATMENTOTHER RELATED HEALTH ISSUOTHER HEALTH ISSU OF SPECIAL CONCERN FOR PEOPLE LIVG WH HIVALHOL AND DG USECORONAVIS (COVID-19) AND PEOPLE WH HIVHEPATIS B & CIMMUNIZATNS AND PEOPLE WH HIVFLU AND PEOPLE WH HIVMENTAL HEALTHMPOX AND PEOPLE WH HIVOPPORTUNISTIC INFECTNSSEXUALLY TRANSMTED INFECTNSSMOKGHIV AND WOMEN'S HEALTH ISSULIVG WELL WH HIVTAKG CARE OF YOURSELFAGG WH HIVEMERGENCI AND DISASTERS AND HIVEMPLOYMENT AND HEALTHEXERCISE AND PHYSIL ACTIVYFOOD SAFETY AND NUTRNHOG AND HEALTHTRAVELG OUTSI THE U.S.YOUR LEGAL RIGHTSCIVIL RIGHTSWORKPLACE RIGHTSLIMS ON CONFINTIALYFERAL RPONSENATNAL HIV/AIDS STRATEGYNATNAL HIV/AIDS STRATEGY (2022-2025)PRR NATNAL HIV/AIDS STRATEGI (2010-2021)IMPLEMENTG THE NATNAL HIV/AIDS STRATEGYENDG THE HIV EPIMICABOUT ENDG THE HIV EPIMIC THE U.S.OVERVIEWKEY STRATEGIPRRY JURISDICTNSHHS AGENCI INVOLVEDFUNDGTIMELELEARN MORE ABOUT EHEREADY, SET, PREPREADY, SET, PREPREADY, SET, PREP PHARMACIREADY, SET, PREP ROURCAHEADAHEAD: AMERI’S HIV EPIMIC ANALYSIS DASHBOARDFERAL ACTIVI & AGENCIHIV PREVENTN ACTIVIHIV TTG ACTIVIHIV CARE AND TREATMENT ACTIVIHIV REARCH ACTIVIACTIVI COMBATG HIV STIGMA AND DISCRIMATNPOLICI & ISSUTHE AFFORDABLE CARE ACT AND HIV/AIDSHIV CARE CONTUUMSYRGE SERVIC PROGRAMSFUNDGBUDGETFERAL FUNDG FOR HIV/AIDSMORY HIV/AIDS FUNDOVERVIEWBACKGROUNDFUND ACTIVITHE FUND ACTNPACHAABOUT PACHACHARTERMEMBERS & STAFFSUBMTEPRR PACHA MEETGS AND REMENDATNSCAMPAIGNSI AM A WORK OF ART CAMPAIGNAWARENS CAMPAIGNSPEPFAR & GLOBAL AIDSGLOBAL HIV/AIDS OVERVIEWPEPFARU.S. GOVERNMENT GLOBAL HIV/AIDS ACTIVIGLOBAL HIV/AIDS ORGANIZATNSEVENTSAWARENS DAYSNATNAL BLACK HIV/AIDS AWARENS DAY FEBARY 7HIV IS NOT A CRIME AWARENS DAY FEBARY 28NATNAL WOMEN AND GIRLS HIV/AIDS AWARENS DAY MARCH 10NATNAL NATIVE HIV/AIDS AWARENS DAY MARCH 20NATNAL YOUTH HIV & AIDS AWARENS DAY APRIL 10HIV VACCE AWARENS DAY MAY 18NATNAL ASIAN & PACIFIC ISLANR HIV/AIDS AWARENS DAY MAY 19HIV LONG-TERM SURVIVORS AWARENS DAY JUNE 5NATNAL HIV TTG DAY JUNE 27ZERO HIV STIGMA JULY 21SOUTHERN HIV/AIDS AWARENS DAY AUGT 20NATNAL FAH HIV/AIDS AWARENS DAY AUGT 29NATNAL HIV/AIDS AND AGG AWARENS DAY SEPTEMPBER 18NATNAL GAY MEN'S HIV/AIDS AWARENS DAY SEPTEMBER 27NATNAL LATX AIDS AWARENS DAY OCTOBER 15WORLD AIDS DAY DECEMBER 1EVENT PLANNG GUI CONFERENCU.S. CONFERENCE ON HIV/AIDS (USCHA) NATNAL RYAN WHE CONFERENCE ON HIV CARE & TREATMENT AIDS 2020 (23RD INTERNATNAL AIDS CONFERENCE VIRTUAL) LEARNG OPPORTUNILEARNG OPPORTUNILEARNG OPPORTUNIWANT TO STAY ABREAST OF CHANG PREVENTN, RE, TREATMENT OR REARCH OR OTHER PUBLIC HEALTH ARENAS THAT AFFECT OUR LLECTIVE RPONSE TO THE HIV EPIMIC? OR ARE YOU NEW TO THIS FIELD? CURAT LEARNG OPPORTUNI FOR YOU, AND THE PEOPLE YOU SERVE AND LLABORATE WH.STAY UP TO DATE WH THE WEBARS, TWTER CHATS, NFERENC AND MORE THIS SECTN.MORE LEARNG OPPORTUNIBLOGGET TTED. FD SERVIC + PREPSEARCHGOESPAñOL ESPAñOL ES GET TTED. FD SERVIC + PREPSEARCHOPEN LOTOR SEARCHHIV SERVICES LOCATORSEARCH⨯CLOSEHOMEHIV BASICSOVERVIEWDATA AND TRENDSU.S. STATISTICSSECTN MENUGET TTED. FIND SERVICES + PREP.DATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSSEARCHDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSU.S. STATISTICS

HIV AND GAY AND BISEXUAL MEN

†Unr 50%Only 27% of Black/Ain Amerin, 31% of Hispanic/Lato, and 42% of Whe gay and bisexual men who uld have benefted om medice to prevent HIV (PrEP) ed 50%Only 27% of Black/Ain Amerin, 31% of Hispanic/Lato, and 42% of Whe gay and bisexual men who uld have benefted om medice to prevent HIV (PrEP) ed 2017. 2 3Only about 2 3 Black/Ain Amerin (62%) or Hispanic/Lato (67%) gay and bisexual men wh HIV were virally supprsed 2019, ‡ pared wh about 3 4 (74%) Whe gay and bisexual men.

From 2010 to 2019, new HIV fectns cled among Whe gay and bisexual men but remaed higher and relatively stable among Black/Ain Amerin and Hispanic/Lato gay and bisexual men. Social and stctural barriers such as systemic racism, stigma, discrimatn, homophobia, poverty, and homelsns n make difficult to accs HIV ttg, re, and preventn servic.

HIV AND ALL GAY AND BISEXUAL MEN

There have been signifint advanc HIV preventn and treatment but missed ttg opportuni healthre settgs are preventg some gay and bisexual men om knowg their HIV stat and beneftg om the advanc.

HIV AMONG GAY AND BISEXUAL MEN THE U.S.

Gay and bisexual men who learn they have HIV n start and stay on HIV treatment, get the vis down to an untectable level (bee virally supprsed), live long and healthy liv, and prevent sexual transmissn to others. This goal n only be achieved by dramatilly rcg new HIV fectns among the most affected groups, cludg Black/Ain Amerin and Hispanic/Lato gay and bisexual men, and expandg and stag vtments HIV servic. High levels of HIV stigma—negative attus and beliefs about people wh HIV—make gay and bisexual men ls likely to get tted, e preventn servic like PrEP, receive re, and be virally supprsed.

Innovative and culturally rponsive strategi that addrs gay and bisexual men’s needs n rce barriers that keep men om knowg their HIV stat and receivg HIV preventn and treatment servic. Addrsg HIV service equi by race, sexual orientatn, and socenomic stat and tailorg strategi to meet the needs of lol muni and reach the most affected groups, pecially Black/Ain Amerin and Hispanic/Lato gay and bisexual men, n help end the HIV epimic. Factors that fluence health out—cludg HIV-related stigma, homophobia, racism, discrimatn, poverty, limed accs to high-qualy health re, and other longstandg barriers—have ntributed to the unequal reach of HIV preventn and treatment; higher levels of HIV some muni; and ntued equi.

WHAT PERCENTAGE OF GAY MEN HAVE HIV

Wh effective preventn and treatment tools at our disposal, the natn has a s--the-makg opportuny to end the domtic HIV epimic and elimate dispari HIV preventn and re among gay and bisexual men and other populatns disproportnately affected by HIV.

Addnally, lower e levels and higher rat of unemployment and rceratn may make harr for some gay and bisexual men to seek and receive high-qualy health re, cludg HIV ttg, treatment, and other preventn servic.

HIV IS A STORY FIRST WRTEN ON THE BODI OF GAY AND BISEXUAL MEN

"We n see the impact of preventn strategi like creasg HIV ttg, treatment as preventn, and pre-exposure prophylaxis particularly among gay and bisexual men, for whom new diagnos have been droppg signifintly sce 2014. Atralia has achieved a remarkable 57% rctn new HIV diagnos among gay and bisexual men sce 2013, showsg the succs of prehensive approach to HIV preventn wh this populatn.

Sce reports of the human immunoficiency vis began to emerge the Uned Stat the 1980s, the HIV epimic has equently been lked to gay, bisexual, and other men who have sex wh men by epimlogists and medil profsnals. The first official report on the vis was published by the Center for Disease Control on June 5, 1981 and tailed the s of five young gay men who were hospalized wh ser fectns.

INTIFYG HIV PREP ATTRIBUT TO INCREASE PREP USE AMONG DIFFERENT GROUPS OF GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN: A LATENT CLASS ANALYSIS OF A DISCRETE CHOICE EXPERIMENT

Bisexual people have a number of measurably worse mental health out than their straight and gay unterpartseach of which n lead to creased HIV risk and poorer health while livg wh HIV.

In the 20th century, the gay muny saw such watershed moments as the targetg of gay people by the psychiatric enterprise and the McCarthy era wch-hunts, the birth of gay liberatn, lbian femism, and queer culture, homosexualys and medilisatn, the legalisatn of gay marriage, and the overturng of bans on gay people servg the ary.

DISCRIMATN AND HOMOPHOBIA FUEL THE HIV EPIMIC GAY AND BISEXUAL MEN

For gay men and women born before 1930, whom I terviewed 1995 and who me of age an era of polil, medil, and scientific opprsn, the emergence of gay liberatn was the most signifint event shapg their experience of gay life.

Acrdg to the Centers for Disease Control and Preventn, 2019, adult and adolcent gay and bisexual men acunted for 69% of the new HIV diagnos the Uned Stat and pennt areas. Gay and Bisexual Men face multiple HIV preventn challeng, such as racism, discrimatn, homophobia, and stigma, that put them at higher risk for HIV and prevent them om accsg qualy health re that allows them to be aware of their stat and take steps to improve their health. From 2008 to 2019, Black Gay and Bisexual Men and Hispanic/Lato Gay and Bisexual Men experienced a 2% crease and 18% crease rpectively new HIV diagnos, pared to a 34% crease among whe Gay and Bisexual Men.

NST T="UNFED"!=TYPEOF HTMLIMAGEELEMENT&&"LOADG" HTMLIMAGEELEMENT.PROTOTYPE;IF(T){NST T=DOCUMENT.QUERYSELECTORALL("IMG[DATA-MA-IMAGE]");FOR(LET E OF T){(E.SETATTRIBUTE("SRC",),E.REMOVEATTRIBUTE("DATA-SRC")),(E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET"));NST T=E.PARENTNO.QUERYSELECTORALL("SOURCE[DATA-SRCSET]");FOR(LET E OF T)E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET");PLETE&&(,E.PARENTNO.PARENTNO.QUERYSELECTOR("[DATA-PLACEHOLR-IMAGE]"))}}HIV BASICSOVERVIEWABOUT HIV & AIDSWHAT ARE HIV AND AIDS?HOW IS HIV TRANSMTED?WHO IS AT RISK FOR HIV?SYMPTOMS OF HIVDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSHISTORYHIV AND AIDS TIMELEMAKG A DIFFERENCESUPPORTG SOMEONE LIVG WH HIVSTANDG UP TO STIGMAGETTG INVOLVEDHIV PREVENTNUSG HIV MEDITN TO RCE RISKHIV TREATMENT AS PREVENTNPRE-EXPOSURE PROPHYLAXIS (PREP)POST-EXPOSURE PROPHYLAXIS (PEP)RCG SEXUAL RISKPREVENTG SEXUAL TRANSMISSN OF HIVRCG RISK OM ALHOL & DG USEALHOL AND HIV RISKSUBSTANCE USE AND HIV RISKRCG RISK OF PERATAL TRANSMISSNPREVENTG PERATAL TRANSMISSN OF HIVPOTENTIAL FUTURE OPTNSHIV VACCLONG-ACTG HIV PREVENTN TOOLSMICROBICISHIV TTGLEARN ABOUT HIV TTGWHO SHOULD GET TTED?HIV TTG LOTNSHIV TTG OVERVIEWUNRSTANDG HIV TT RULTSJT DIAGNOSED: WHAT'S NEXT?LIVG WH HIVTALKG ABOUT YOUR HIV STATSTARTG HIV CAREFD A PROVIRLOTE AN HIV CARE PROVIRTYP OF PROVIRSTAKE CHARGE OF YOUR CAREGETTG READY FOR YOUR FIRST VISWHAT TO EXPECT AT YOUR FIRST HIV CARE VISSTAYG HIV CAREPROVIR VISS AND LAB TTSMAKG CARE WORK FOR YOUSEEG YOUR HEALTH CARE PROVIRHIV LAB TTS AND RULTSRETURNG TO CAREHIV TREATMENTHIV TREATMENT OVERVIEWVIRAL SUPPRSN AND UNTECTABLE VIRAL LOAD TAKG YOUR HIV MEDICE AS PRCRIBEDTIPS ON TAKG YOUR HIV MEDITN EVERY DAYPAYG FOR HIV CARE AND TREATMENTOTHER RELATED HEALTH ISSUOTHER HEALTH ISSU OF SPECIAL CONCERN FOR PEOPLE LIVG WH HIVALHOL AND DG USECORONAVIS (COVID-19) AND PEOPLE WH HIVHEPATIS B & CIMMUNIZATNS AND PEOPLE WH HIVFLU AND PEOPLE WH HIVMENTAL HEALTHMPOX AND PEOPLE WH HIVOPPORTUNISTIC INFECTNSSEXUALLY TRANSMTED INFECTNSSMOKGHIV AND WOMEN'S HEALTH ISSULIVG WELL WH HIVTAKG CARE OF YOURSELFAGG WH HIVEMERGENCI AND DISASTERS AND HIVEMPLOYMENT AND HEALTHEXERCISE AND PHYSIL ACTIVYFOOD SAFETY AND NUTRNHOG AND HEALTHTRAVELG OUTSI THE U.S.YOUR LEGAL RIGHTSCIVIL RIGHTSWORKPLACE RIGHTSLIMS ON CONFINTIALYFERAL RPONSENATNAL HIV/AIDS STRATEGYNATNAL HIV/AIDS STRATEGY (2022-2025)PRR NATNAL HIV/AIDS STRATEGI (2010-2021)IMPLEMENTG THE NATNAL HIV/AIDS STRATEGYENDG THE HIV EPIMICABOUT ENDG THE HIV EPIMIC THE U.S.OVERVIEWKEY STRATEGIPRRY JURISDICTNSHHS AGENCI INVOLVEDFUNDGTIMELELEARN MORE ABOUT EHEREADY, SET, PREPREADY, SET, PREPREADY, SET, PREP PHARMACIREADY, SET, PREP ROURCAHEADAHEAD: AMERI’S HIV EPIMIC ANALYSIS DASHBOARDFERAL ACTIVI & AGENCIHIV PREVENTN ACTIVIHIV TTG ACTIVIHIV CARE AND TREATMENT ACTIVIHIV REARCH ACTIVIACTIVI COMBATG HIV STIGMA AND DISCRIMATNPOLICI & ISSUTHE AFFORDABLE CARE ACT AND HIV/AIDSHIV CARE CONTUUMSYRGE SERVIC PROGRAMSFUNDGBUDGETFERAL FUNDG FOR HIV/AIDSMORY HIV/AIDS FUNDOVERVIEWBACKGROUNDFUND ACTIVITHE FUND ACTNPACHAABOUT PACHACHARTERMEMBERS & STAFFSUBMTEPRR PACHA MEETGS AND REMENDATNSCAMPAIGNSI AM A WORK OF ART CAMPAIGNAWARENS CAMPAIGNSPEPFAR & GLOBAL AIDSGLOBAL HIV/AIDS OVERVIEWPEPFARU.S. GOVERNMENT GLOBAL HIV/AIDS ACTIVIGLOBAL HIV/AIDS ORGANIZATNSEVENTSAWARENS DAYSNATNAL BLACK HIV/AIDS AWARENS DAY FEBARY 7HIV IS NOT A CRIME AWARENS DAY FEBARY 28NATNAL WOMEN AND GIRLS HIV/AIDS AWARENS DAY MARCH 10NATNAL NATIVE HIV/AIDS AWARENS DAY MARCH 20NATNAL YOUTH HIV & AIDS AWARENS DAY APRIL 10HIV VACCE AWARENS DAY MAY 18NATNAL ASIAN & PACIFIC ISLANR HIV/AIDS AWARENS DAY MAY 19HIV LONG-TERM SURVIVORS AWARENS DAY JUNE 5NATNAL HIV TTG DAY JUNE 27ZERO HIV STIGMA JULY 21SOUTHERN HIV/AIDS AWARENS DAY AUGT 20NATNAL FAH HIV/AIDS AWARENS DAY AUGT 29NATNAL HIV/AIDS AND AGG AWARENS DAY SEPTEMPBER 18NATNAL GAY MEN'S HIV/AIDS AWARENS DAY SEPTEMBER 27NATNAL LATX AIDS AWARENS DAY OCTOBER 15WORLD AIDS DAY DECEMBER 1EVENT PLANNG GUI CONFERENCU.S. CONFERENCE ON HIV/AIDS (USCHA) NATNAL RYAN WHE CONFERENCE ON HIV CARE & TREATMENT AIDS 2020 (23RD INTERNATNAL AIDS CONFERENCE VIRTUAL) LEARNG OPPORTUNILEARNG OPPORTUNILEARNG OPPORTUNIWANT TO STAY ABREAST OF CHANG PREVENTN, RE, TREATMENT OR REARCH OR OTHER PUBLIC HEALTH ARENAS THAT AFFECT OUR LLECTIVE RPONSE TO THE HIV EPIMIC? OR ARE YOU NEW TO THIS FIELD? CURAT LEARNG OPPORTUNI FOR YOU, AND THE PEOPLE YOU SERVE AND LLABORATE WH.STAY UP TO DATE WH THE WEBARS, TWTER CHATS, NFERENC AND MORE THIS SECTN.MORE LEARNG OPPORTUNIBLOGGET TTED. FD SERVIC + PREPSEARCHGOESPAñOL ESPAñOL ES GET TTED. FD SERVIC + PREPSEARCHOPEN LOTOR SEARCHHIV SERVICES LOCATORSEARCH⨯CLOSEHOMEHIV BASICSOVERVIEWDATA AND TRENDSU.S. STATISTICSSECTN MENUGET TTED. FIND SERVICES + PREP.DATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSSEARCHDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSU.S. STATISTICS

In 2019, Black Gay and Bisexual Men and Hispanic Gay and Bisexual Men livg wh HIV had lower rat of viral supprsn, 62% and 67% rpectively, pared to whe Gay and Bisexual Men livg wh HIV.

In addn to racial dispari, many Gay and Bisexual Men experience challeng achievg and matag viral supprsn due to disproportnate levels of homelsns, stigma, and a lack of mental health and culturally petent re that may prevent them om accsg treatment and necsary meditns. 2 A year later, the Centers for Disease Control and Preventn’s (CDC’s) Morbidy and Mortaly Weekly Report scribed five s of Pnmocystis pnmonia among young “homosexual” men livg Los Angel, California.