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This study aims to describe the clinical and subclinical characteristics of patients with castration-resistant prostate cancer (CRPC). The retrospective study was conducted on 46 patients with CRPC in Huu Nghi Hospital. The results indicated that the main clinical symptoms were bone pain (63.0%), hematuria (34.0%), and lower urinary tract symptoms (32.6%). The highest and lowest PSA concentrations were 611.3 ng/mL and 0.01 ng/mL, respectively. The most common sites of metastasis were bone (82.6%), lymph node (50.0%), and lung (19.6%). These patients were all at the late stage, so most of them had symptoms of metastasis and high PSA. Keywords: Prostate cancer, castration-resistant, clinical characteristics, subclinical characteristics.

Present diploma thesis deals with pronunciation specifics in Czech of adult speakers whose mother tongue is Vietnamese. It is based on the assumption of the influence of Vietnamese as a mother tongue on the pronunciation of Czech as a second/foreign language. In the theoretical part there is a description of the phonetic aspect of both languages, especially with regard to their differences. On the basis of the given comparison and derivation of differences on the phonetic level, the author determines the expected pronunciation deviations, i.e. potential interference features in Czech. The practical part of the work is the analysis of audio recordings of Czech by adult Vietnamese speakers (4 people), which will be taken for the purposes of the thesis. The recording consists of a short interview and a read text. Part of the experiment will be the creation of a perception test from speech samples of Vietnamese speakers, which will be assessed by native Czech speakers in terms of intelligibility and the level of effort expended to understand the speech.

The bacteria capable of fixing atmospheric nitrogen were isolated from cassava cultivated soils of Vietnam. The potential isolates were identified by analyzing the 16S rRNA gene and by morphological, biochemical, cultural characteristics. The selected isolates were assigned to the species Bacillus sp. DQT2 M17, Bacillus subtilis DTAN6 M17, and Bacillus megaterium DSHB I8. The effect of culture conditions on the nitrogen-fixing activity of three selected isolates were studied and the obtained results showed that the highest amount of accumulated ammonia was detected after 6 days of incubation at 35 oC, pH 7.0 with sucrose as a carbon source. The selected strains could be exploited as inoculants for microbial fertilizer production.

Although the Vietnam’s Criminal Code 2015 (amended in 2017) (“Criminal Code 2015) has come into force since January 1, 2018; the number of criminal cases against commercial legal persons is very limited. The major cause of this limitation originates from the absence of guidance on interpretation of these regulations as they are newly introduced in criminal law of Vietnam. Based on popular doctrines regarding criminal responsibility of legal persons and regulations of other states, the Author of this paper presents her own perspectives on how conditions for a commercial legal person to be criminally charged under Article 75 of the Criminal Code 2015 should be interpreted.

Introduction: Proteases are enzymes that catalyze the hydrolysis of peptide bonds and play an important role in almost all biological processes. However, excessive protein proteolysis can be implicated in several diseases, such as cancer, as well as cardiovascular, inflammatory, neurodegenerative, bacterial, viral and parasitic diseases. In these cases, protease inhibitors can be used as one of versatile tools for regulating proteolytic activity of target proteases as well as therapeutic applications. In this study, we expressed and characterized a new serine protease inhibitory protein (PI-QT) from the metagenome of sponge-associated microorganisms in Escherichia coli. Methods: The gene PI-QT encoding for a new serine protease inhibitory protein was expressed in E. coli BL21(DE3). In addition, the expressed protein was purified and characterized. Results: Optimization of expression of the recombinant protein PI-QT in E. coli showed that suitable conditions for expression of the protein were pre-induction cell density (OD600) of 0.6 - 0.7, IPTG concentration of 1 mM and temperature of 25oC. The protease inhibitory protein was also purified and identified by mass spectrometry LC-MS/MS. The recombinant protein showed inhibitory activity against trypsin anda-chymotrypsin with activity values of 97526 U/mg and 41714 U/mg, respectively. Maximum activity of the protease inhibitory protein was obtained at pH 7 and temperature 20-35oC. The inhibitor was stable over pH 4-9 and up to temperature 50oC. Addition of Zn2+, Mg2+ and Ca2+ enhanced inhibitory activity, whereas other metal ions, surfactants and oxidants reduced inhibitory activity of the protease inhibitor. Conclusion: The recombinant protein PI-QT is a potential protease inhibitor for therapeutic applications.

The current study aimed to examine the health-related quality of life (HRQoL) and to identify its related factors amongst adult patients with type 2 diabetes mellitus (T2DM). This cross-sectional study recruited randomly 519 patients diagnosed with T2DM for at least 6 months in the Family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam. The Short Form 36 (SF-36) health survey was used to measure their HRQoL. The female patients had lower physical and mental scores than the male patients. Patients with older age, comorbidity, and insulin treatment were more likely to have lower HRQoL. Meanwhile, educational attainment and having frequent exercise were positively associated with HRQoL.

Marine sponge is known as a “gold mine” of natural products from marine environment. Many novel bioactive compounds have been isolated from marine sponges and sponge-associated microorganisms such as antibiotics, anti-cancer compounds, protease inhibitors, etc. In this study, we selected a gene encoding protease inhibitor from metagenome of a sponge collected in Da Nang to express in Escherichia coli BL21(DE3). The gene PI-DN9 encoding protease inhibitor (1.3 kb) was cut off cloning vector pUC57/PI-DN9 containing gene PI-DN9 and inserted into expression vector pET32a(+), the recombinant vector pET32a(+)/PI-DN9 then was transformed and expressed in the E. coli strain BL21(DE3). Results showed that recombinant protein (50 kDa) was expressed successfully at 25°C, 1 mM of IPTG in 5 hours. The recombinant protein was purified using Ni-NTA affinity chromatography column. Western blot assay and bioactive assay showed good activity of the purified protein.

The bacteria capable producing IAA were isolated from roots of cassava growing in Tay Ninh region (Southern of Vietnam). The isolate producing highest amount of IAA was chosen for identification and optimization of culture conditions for IAA production. By analyzing 16S rRNA sequence, the selected isolate was identified as Bacillus sp. DTAN-M5. The influence of different parameters on IAA production of this strains was evaluated by “one factor at a time” method and the obtained results showed that the best conditions for IAA production of DTAN-M5 were medium with following components: 1% peptone; 0.5% sucrose , 0.6% yeast extract, 0.5% NaCl, pH 7.1, supplemented with 2mg/L L-tryptophan, incubation in a shaker 150 rpm at 30o C for 84 hours. The maximum amount of IAA was 84,13 µg/mL

Background Stroke is a leading cause of death in Asia; however, many estimates of stroke mortality are based on epidemiological models rather than empirical data. Since 2005, initiatives have been undertaken in a number of Asian countries to strengthen and analyse vital registration data. This has increased the availability of empirical data on stroke mortality. Aims The aim of this paper is to present estimates of stroke mortality for Indonesia, Myanmar, Viet Nam, Thailand, and Malaysia, which have been derived using these empirical data. Methods Age-specific stroke mortality rates were calculated in each of the five countries, and adjusted for data completeness or misclassification where feasible. All data were age-standardized and the resulting rates were compared with World Health Organization estimates, which are largely based on epidemiological models. Results Using empirical data, stroke ranked as the leading cause of death in all countries except Malaysia, where it ranked as the second leading cause. Age-standardized rates for males ranged from 94 per 100 000 in Thailand, to over 300 per 100 000 in Indonesia. In all countries, rates were higher for males than for females, and those compiled from empirical data were generally higher than modelled estimates published by World Health Organization. Conclusions This study highlights the extent of stroke mortality in selected Asian countries, and provides important baseline information to investigate the aetiology of stroke in Asia and design appropriate public health strategies to address the rapidly growing burden from stroke.

One fundamental element needed for tuberculosis control programmes to succeed is that health staff should adequately manage persons with both suspected and confirmed tuberculosis. This study assesses the level of knowledge and reported practices regarding tuberculosis among health staff at basic health care facilities in a rural district in Vietnam. A questionnaire consisting of 17 multiple-choice questions, 6 open questions, and five case-studies was completed by 253 health staff. Nearly half of the respondents (47%) answered at least 17 out of 23 questions correctly. The mean knowledge score was 15.59 +/- 3.78 (range 5-23). The mean practice score was 2.03 +/- 1.28 (range 0-5). Health staff knowledge of theoretical aspects was better than knowledge related to patient management. Even staff members who had attended TB training courses had inadequate TB knowledge, particularly in the area of TB control. District hospital staff reported surprisingly lower knowledge scores than community health care staff. Practice competency related to the management of tuberculosis patients during treatment course was low. The importance of targeted education using multiple educational methods needs to be emphasized within the National Tuberculosis Programme.

Objective The aim was to estimate the gender-specific prevalence of tuberculosis (TB) through screening. A further aim was to calculate case detection within the Vietnamese National TB program. Study design and setting A population-based survey of 35,832 adults was performed within an existing sociodemographic longitudinal study in Bavi district, northern Vietnam. Cases were identified by a screening question about prolonged cough and further diagnosed with sputum examination and a chest X-ray. Results The estimated prevalence of pulmonary TB among men was 90/100,000 (95% CI 45–135/100,000) and among women 110/100,000 (95% CI 63–157/100,000). Case detection in the district was estimated to 39% (95% CI 20–76%) among men and 12% (95% CI 6–26%) among women. Conclusion TB prevalence was similar among men and women. Case detection among men and women was significantly lower than the reported national case detection of 80%, and there was a significant underdetection of female cases. These findings warrant actions, and emphasize the need to perform similar studies in different contexts.

BACKGROUND: The irrational overuse of antibiotics should be minimized as it drives the development of antibiotic resistance, but changing these practices is challenging. A better understanding is needed of practices and economic incentives for antibiotic dispensing in order to design effective interventions to reduce inappropriate antibiotic use. Here we report on both quantitative and qualitative aspects of antibiotic sales in private pharmacies in northern Vietnam. METHOD: A cross-sectional study was conducted in which all drug sales were observed and recorded for three consecutive days at thirty private pharmacies, 15 urban and 15 rural, in the Hanoi region in 2010. The proportion of antibiotics to total drug sales was assessed and the revenue was calculated for rural and urban settings. Pharmacists and drug sellers were interviewed by a semi-structured questionnaire and in-depth interviews to understand the incentive structure of antibiotic dispensing. RESULTS: In total 2953 drug sale transactions (2083 urban and 870 rural) were observed. Antibiotics contributed 24% and 18% to the total revenue of pharmacies in urban and rural, respectively. Most antibiotics were sold without a prescription: 88% in urban and 91% in rural pharmacies. The most frequent reported reason for buying antibiotics was cough in the urban setting (32%) and fever in the rural area (22%). Consumers commonly requested antibiotics without having a prescription: 50% in urban and 28% in rural area. The qualitative data revealed that drug sellers and customer's knowledge of antibiotics and antibiotic resistance were low, particularly in rural area. CONCLUSION: Over the counter sales of antibiotic without a prescription remains a major problem in Vietnam. Suggested areas of improvement are enforcement of regulations and pricing policies and educational programs to increase the knowledge of drug sellers as well as to increase community awareness to reduce demand-side pressure for drug sellers to dispense antibiotics inappropriately.

Introduction Chronic diseases account for most of the disease burden in low- and middle-income countries, particularly those in Asia. We reviewed literature on chronic disease risk factors in Viet Nam to identify patterns and data gaps. Methods All population-based studies published from 2000 to 2012 that reported chronic disease risk factors were considered. We used standard chronic disease terminology to search PubMed and assessed titles, abstracts, and articles for eligibility for inclusion. We summarized relevant study information in tables listing available studies, risk factors measured, and the prevalence of these risk factors. Results We identified 23 studies conducted before 2010. The most common age range studied was 25 to 64 years. Sample sizes varied, and sample frames were national in 5 studies. A combination of behavioral, physical, and biological risk factors was studied. Being overweight or obese was the most common risk factor studied (n = 14), followed by high blood pressure (n = 11) and tobacco use (n = 10). Tobacco and alcohol use were high among men, and tobacco use may be increasing among Vietnamese women. High blood pressure is common; however, people’s knowledge that they have high blood pressure may be low. A high proportion of diets do not meet international criteria for fruit and vegetable consumption. Prevalence of overweight and obesity is increasing. None of the studies evaluated measured dietary patterns or total caloric intake, and only 1 study measured dietary salt intake. Conclusion Risk factors for chronic diseases are common in Viet Nam; however, more recent and context-specific information is required for planning and monitoring interventions to reduce risk factors and chronic disease in this country.

Foot and mouth disease virus (FMDV) causing infectious disease affects broadly cloven-hoofed animals. It has 7 different serotypes. However O is the most prevalent type in 3 founded types (O, A, Asia1) recurrence in Vietnam fields. The current vaccine for FMDV is inactivated or attenuated forms. Vaccines were able to raise strong immune responses but still caused the safety concerns. Virus-like particles could be a new vaccine generation that fulfills the present questions. On the one hand, it can tackle the safety issues, on the other hand, it can reserve FMDV intrinsic form which will provoke high immunogenicity. The important initial step to make virus-like particles is expression the capsid proteins of FMDV in appropriate system. So this study we describe how to design, express and purify of all capsid proteins: VP0, VP1 and VP3 of O type FMDV isolated in Vietnam field using SUMO fusion expression system.

Background: Information on the leading causes of mortality will continue to rely on verbal autopsy (VA) in developing countries. The accuracy of VA methods in correctly ascertaining the cause for each individual death is crucial in order to have confidence in the data collected through the procedure. Accuracy of the VA procedure is generally established by carrying out validation studies involving a comparison of the underlying cause of death derived from the VA with a reference underlying cause from medical records. Such validation is only possible in cases for which clinical records are available, and this is clearly not the case for most deaths in developing countries. We attempt to verify the accuracy of VA evidence by reviewing the responses to specific symptom questions and other information recorded in verbal autopsy questionnaires that were assigned cerebrovascular conditions (stroke) as causes of death upon physician review in Vietnam. Materials and Methods: A national sample mortality surveillance activity identified deaths and causes of death that had occurred during 2008 in selected communes in 16 provinces distributed across Vietnam. All cases from the northern provinces of Hanoi, Hai Duong, Quang Ninh and Thanh Hoa with ICD codes pertaining to cerebrovascular diseases were identified. A total of 326 VA questionnaires for deaths from cerebrovascular diseases were reviewed and analysed in detail for the presence of symptoms pertaining to stroke. The respondents’ narration of the chronological disease history and the hospital diagnosis was also examined with an aim to explore supporting signs for diagnosis and to verify the quality of VA interview. Differences between responses among cases with and without hospital admission were examined using Chi-squared test of statistical significance. Results: Ninty percent of the cases diagnosed as stroke were found to have positive response to the key symptoms; viz., paralysis (in structured question or free text) and history of stroke. For the remaining 10% of cases, stroke was assigned as a cause-of-death based on other suggestive cardiac signs and symptoms such as hypertension, unconsciousness, or headache, etc. Community had different perspectives of “paralysis” and “stroke” which might have affected the diagnosis of stroke in some aspects. Respondents of cases with hospital admission or visit were found to have a better recall of disease symptoms than those without hospital admission. Conclusion: The results of this study suggest the possible utility of VA content analysis method to back up the low coverage of conventional validation studies in developing countries owing to nonavailability of medical records. The understanding of the VA content would also form the basis for improvement in the quality of interviews and collection of data to achieve better quality information in future.

Background Road traffic injuries (RTIs) are among the leading causes of mortality in Vietnam. However, mortality data collection systems in Vietnam in general and for RTIs in particular, remain inconsistent and incomplete. Underlying distributions of external causes and body injuries are not available from routine data collection systems or from studies till date. This paper presents characteristics, user type pattern, seasonal distribution, and causes of 1,061 deaths attributable to road crashes ascertained from a national sample mortality surveillance system in Vietnam over a two-year period (2008 and 2009). Methods A sample mortality surveillance system was designed for Vietnam, comprising 192 communes in 16 provinces, accounting for approximately 3% of the Vietnamese population. Deaths were identified from commune level data sources, and followed up by verbal autopsy (VA) based ascertainment of cause of death. Age-standardised mortality rates from RTIs were computed. VA questionnaires were analysed in depth to derive descriptive characteristics of RTI deaths in the sample. Results The age-standardized mortality rates from RTIs were 33.5 and 8.5 per 100,000 for males and females respectively. Majority of deaths were males (79%). Seventy three percent of all deaths were aged from 15 to 49 years and 58% were motorcycle users. As high as 80% of deaths occurred on the day of injury, 42% occurred prior to arrival at hospital, and a further 29% occurred on-site. Direct causes of death were identified for 446 deaths (42%) with head injuries being the most common cause attributable to road traffic injuries overall (79%) and to motorcycle crashes in particular (78%). Conclusion The VA method can provide a useful data source to analyse RTI mortality. The observed considerable mortality from head injuries among motorcycle users highlights the need to evaluate current practice and effectiveness of motorcycle helmet use in Vietnam. The high number of deaths occurring on-site or prior to hospital admission indicates a need for effective pre-hospital first aid services and timely access to emergency facilities. In the absence of standardised death certification, sustained efforts are needed to strengthen mortality surveillance sites supplemented by VA to support evidence based monitoring and control of RTI mortality.

Objective To report methods and results from a national sample mortality surveillance programme implemented in Viet Nam in 2009. Conclusion Viet Nam is undergoing the epidemiological transition. Although data are relatively complete, they could be further improved through strengthened local collaboration. Medical certification for deaths in hospitals, and shorter recall periods for verbal autopsy interviews would improve cause of death ascertainment. Findings A total of 9921 deaths were identified in the sample population. Completeness of death records was estimated to be 81%. Adjusted life expectancies at birth were 70.4 and 78.7 years for males and females, respectively. Stroke was the leading cause of death in both sexes. Other prominent causes were road traffic accidents, cancers and HIV infection in males, and cardiovascular conditions, pneumonia and diabetes in females. Methods A national sample of 192 communes located in 16 provinces and covering a population of approximately 2.6 million was selected using multi-stage cluster sampling. Deaths for 2009 were identified from several local data sources. Record reconciliation and capture-recapture methods were used to compile data and assess completeness of the records. Life tables were computed using reported and adjusted age-specific death rates. Each death was followed up by verbal autopsy to ascertain the probable cause(s) of death. Underlying causes were certified and coded according to international guidelines. Refereed/Peer-reviewed

There is a lack of knowledge on mortality and causes of death among human immunodeficiency virus (HIV)-infected patients after initiation of antiretroviral therapy (ART) in Vietnam. We investigated the mortality rate, risk factors, causes of death, and impact of enhanced adherence support on survival among 640 Vietnamese treatment-naïve HIV-infected patients receiving ART in a cluster randomized controlled trial.Patients in the intervention group received enhanced adherence from peer-supporters. Data were collected through medical records and a verbal autopsy questionnaire. We used Kaplan-Meier analysis to describe the survival trends and the Cox proportional hazard model to identify predictors of acquired immune deficiency syndrome (AIDS)-related deaths.After a median follow-up of 15.2 months, there were 60 deaths, 73% of which occurred within 6 months. The mortality rate was 7.4/100 person-y and survival probability was 91% after 1 y. There was no significant difference in mortality rate between the intervention and the control groups. At baseline, the predictive factors for AIDS-related death were age35 y, clinical stage 3 or 4, body mass index (BMI)18 kg/m(2), CD4 count100/μl, haemoglobin level100 g/l, and plasma viral load100,000 copies/ml. Tuberculosis (TB) was the most common cause of death (40%).Early deaths occurred after ART, and delay of ART caused a significant decrease in CD4 count and a high mortality. Adherence support had no impact on survival at the early stage of ART. Early ART initiation and intensive follow-up of patients during the first 6 months of ART are therefore necessary to reduce AIDS-related mortality.

BACKGROUND: To improve HIV prevention and care programs, it is important to understand the uptake of HIV testing and to identify population segments in need of increased HIV testing. This is particularly crucial in countries with concentrated HIV epidemics, where HIV prevalence continues to rise in the general population. This study analyzes determinants of HIV testing in a rural Vietnamese population in order to identify potential access barriers and areas for promoting HIV testing services. METHODS: A population-based cross-sectional survey of 1874 randomly sampled adults was linked to pregnancy, migration and economic cohort data from a demographic surveillance site (DSS). Multivariate logistic regression analysis was used to determine which factors were associated with having tested for HIV. RESULTS: The age-adjusted prevalence of ever-testing for HIV was 7.6%; however 79% of those who reported feeling at-risk of contracting HIV had never tested. In multivariate analysis, younger age (aOR 1.85, 95% CI 1.14-3.01), higher economic status (aOR 3.4, 95% CI 2.21-5.22), and semi-urban residence (aOR 2.37, 95% CI 1.53-3.66) were associated with having been tested for HIV. HIV testing rates did not differ between women of reproductive age who had recently been pregnant and those who had not. CONCLUSIONS: We found low testing uptake (6%) among pregnant women despite an existing prevention of mother-to-child HIV testing policy, and lower-than-expected testing among persons who felt that they were at-risk of HIV. Poverty and residence in a more geographically remote location were associated with less HIV testing. In addition to current HIV testing strategies focusing on high-risk groups, we recommend targeting HIV testing in concentrated HIV epidemic settings to focus on a scaled-up provision of antenatal testing. Additional recommendations include removing financial and geographic access barriers to client-initiated testing, and encouraging provider-initiated testing of those who believe that they are at-risk of HIV.

Aims: Good general lay knowledge of tuberculosis (TB), its cause and treatment is considered important for both prompt healthcare seeking and adherence to treatment. The main aim of this study was to describe the knowledge of TB among men and women with a cough for more than three weeks and to see how their health seeking related to TB knowledge. Methods: A population-based survey was carried out within a demographic surveillance site in Vietnam. The study population included 35,832 adults aged 15 years or over. Cough cases were identified at household level and structured interviews were carried out with all cases of cough in person. Results: A total of 559 people (1.6%) reported coughing with a duration of three weeks or longer (259 men and 300 women). A large proportion of individuals with a cough for more than three weeks had limited knowledge of the causes, transmission modes, symptoms, and curability of TB. Men had a significantly higher knowledge score than women (3.04 vs 2.55). Better knowledge was significantly related to seeking healthcare and seeking hospital care. More men than women did not take any health care action at all. Discussion: Health education for TB thus seems to be useful, but efforts must be made to ensure that both men and women in different socioeconomic contexts can access the information.

This paper describes a diagnosis system for tuberculosis called TUBERDIAG which is able to combine positive and negative knowledge. The knowledge base of the system consists of a set of IF-THEN rules for diagnosis of tuberculosis where each rule assigns its weight in [0,1]. The inference machine will produce the final diagnosis as a total degree of confirmation and exclusion of tuberculosis diagnosis. This paper focuses on a description of the structure of TUBERDIAG. The system is developed in cooperation with doctors at the National Institute of Tuberculosis and Lung Disease, Hanoi. The system is written in Borland Delphi 2.0 programming language for Windows 95 and can run on PCs.

Background The negative effects of stigma on persons living with HIV (PLHIV) have been documented in many settings and it is thought that stigma against PLHIV leads to more difficulties for those who need to access HIV testing, treatment and care, as well as to limited community uptake of HIV prevention and testing messages. In order to understand and prevent stigma towards PLHIV, it is important to be able to measure stigma within communities and to understand which factors are associated with higher stigma. Methods To analyze patterns of community stigma and determinants to stigma toward PLHIV, we performed an exploratory population-based survey with 1874 randomly sampled adults within a demographic surveillance site (DSS) in rural Vietnam. Participants were interviewed regarding knowledge of HIV and attitudes towards persons living with HIV. Data were linked to socioeconomic and migration data from the DSS and latent class analysis and multinomial logistic regression were conducted to examine stigma group sub-types and factors associated with stigma group membership. Results We found unexpectedly high and complex patterns of stigma against PLHIV in this rural setting. Women had the greatest odds of belong to the highest stigma group (OR 1.84, 95% CI 1.42-2.37), while those with more education had lower odds of highest stigma group membership (OR 0.45, 95% CI 0.32-0.62 for secondary education; OR 0.19, 95% CI 0.10-0.35 for tertiary education). Long-term migration out of the district (OR 0.61, 95% CI 0.4-0.91), feeling at-risk for HIV (OR 0.42, 95% CI 0.27-0.66), having heard of HIV from more sources (OR 0.44, 95% CI 0.3-0.66), and knowing someone with HIV (OR 0.76, 95% CI 0.58-0.99) were all associated with lower odds of highest stigma group membership. Nearly 20% of the population was highly unsure of their attitudes towards PLHIV and persons in this group had significantly lower odds of feeling at-risk for HIV (OR 0.54, 95% CI 0.33-0.90) or of knowing someone with HIV (OR 0.32, 95% CI 0.22-0.46). Conclusions Stigma towards PLHIV is high generally, and very high in some sub-groups, in this community setting. Future stigma prevention efforts could be enhanced by analyzing community stigma sub-groups and tailoring intervention messages to community patterns of stigma.