The Caribbean has the highest HIV rates outside of sub-Saharan Africa. In recent decades, tourism has become the most important Caribbean industry. Studies suggest that tourism areas are epicenters of demographic and social changes linked to HIV risk, such as transactional sex, elevated alcohol and substance use, and internal migration. Despite this, no formative HIVprevention studies have examined tourism areas as ecologies that heighten HIV vulnerability. HIV/AIDS research needs to place emphasis on the ecological context of sexual vulnerability in tourism areas and develop multilevel interventions that are sensitive to this context. From our review and integration of a broad literature across the social and health sciences, we argue for an ecological approach to sexual health in Caribbean tourism areas, point to gaps in knowledge, and provide direction for future research.Currently, the Caribbean region has the highest prevalence rates of HIV infection outside of sub-Saharan Africa. 1 As of 2007, 1% of Caribbean adults are estimated to be HIV positive, with nearly three fourths of the region's AIDS cases occurring in 2 countries, the Dominican Republic and Haiti, which comprise the island of Hispaniola. 1 The primary mode of HIV transmission in the Caribbean is classified as heterosexual, 2 despite persistently high prevalence rates among men who have sex with men (MSM). 3,4 Although the recent plateau in adult HIV prevalence in some Caribbean nations, such as the Dominican Republic,

Some quantitative behavioral studies in the USA have concluded that bisexually behaving Latino men are less likely than White men to disclose to their female partners that they have engaged in same-sex risk behavior and/or are HIV-positive, presumably exposing female partners to elevated risk for HIV infection. Nevertheless, very little theoretical or empirical research has been conducted to understand the social factors that promote or inhibit sexual risk disclosure among Latino men who have sex with men (MSM), and much of the existing literature has neglected to contextualize disclosure patterns within broader experiences of stigma and social inequality. This paper examines decisions about disclosure of sex work, same-sex behavior, and sexual risk for HIV among male sex workers in two cities in the Dominican Republic. Data derive from long-term ethnography and qualitative in-depth interviews with 72 male sex workers were used to analyze the relationships among experiences of stigma, social inequality, and patterns of sexual risk disclosure. Thematic analysis of interviews and ethnographic evidence revealed a wide range of stigma management techniques utilized by sex workers to minimize the effects of marginality due to their engagement in homosexuality and sex work. These techniques imposed severe constraints on men's sexual risk disclosure, and potentially elevated their own and their female partners' vulnerability to HIV infection. Based on the study's findings, we conclude that future studies of sexual risk disclosure among ethnic minority MSM should avoid analyzing disclosure as a decontextualized variable, and should seek to examine sexual risk communication as a dynamic social process constrained by hierarchical systems of power and inequality.

This project increased awareness about issues of violence to youth, their communities, and policy makers through the technique of photovoice and its translation into photo exhibitions and other community events. Youth participants learned photography skills, engaged in critical communal discussions about important issues affecting their health, wrote reflective stories about their photos, and engaged in policy change efforts. Their photos depict the need to address economic devastation and built environment degradation to prevent violence in their communities. Youth presented policy makers and community leaders with an "insider's perspective" of the issues facing their communities, with the hope of promoting policy change.

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