D Binson

University of California, San Francisco, San Francisco, CA, United States

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Publications (22)80.81 Total impact

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    ABSTRACT: Many HIV prevention interventions have been launched in gay bathhouses and sex clubs since the onset of the AIDS epidemic, such as condom distribution and HIV testing. Perhaps none of these are as intrusive to the venue's environment as what is called "monitoring," which involves staff, during every shift, repeatedly walking throughout the public areas of a bathhouse to check on patrons' sexual behavior. Yet, monitoring has received little evaluation. Between 2002 and 2004, we conducted qualitative interviews with venue managers, staff and patrons in New York City, Los Angeles, and the San Francisco Bay Area. An analysis found that monitoring was influenced by the kinds of space available for sex, suggesting three approaches to monitoring: 1) monitoring all sex in clubs that only had public areas where men had sex ; 2) monitoring some sex in clubs with private rooms for sex; and 3) no monitoring of sex, regardless of the kinds of space for sex. This paper explores each approach as described by club managers, staff, and patrons to understand the potential effectiveness of monitoring as an HIV prevention intervention.
    Sexuality Research and Social Policy Journal of NSRC 06/2013; 10(2):77-86.
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    ABSTRACT: Implementing HIV voluntary counselling and testing (VCT) in bathhouses is a proven public health strategy for reaching high-risk men who have sex with men (MSM) and efficiently identifying new HIV cases. However, some bathhouse managers are concerned that VCT programmes could adversely affect business. This study examined whether offering VCT on the premises of a bathhouse changed patterns of patron visits. A collaborating bathhouse provided electronic anonymized patron data from their entire population of attendees. VCT was offered on premises with varying frequencies over the course of three years. Club entrances and exits were modelled as a function of intensity of VCT programming. Club entrances did not differ as a function of how many days per week testing was being offered in a given month. Additionally, club entrances did not decrease, nor did club exits increase, during specific half-hour time periods when testing was offered. Implementing bathhouse-based VCT did not have any demonstrable impact on patronage. Public health officials can leverage these results to help alleviate club managers' concerns about patron reactions to providing testing on site, and to support expanding sexual health programmes for MSM in these venues.
    International Journal of STD & AIDS 03/2012; 23(3):182-4. · 1.00 Impact Factor
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    ABSTRACT: HIV prevalence estimates from bathhouse testing programmes differ widely, ranging from 3% to 11%. The observed difference may be a consequence of whether the programme was part of a research project or a community-based programme. A research-funded testing programme was offered at a bathhouse between May 2001 and December 2002. A local community-based organization began a testing programme in July 2006 at the same bathhouse; the data for this analysis cover the period July 2006 through December 2007. County-wide HIV prevalence estimates were available across the two time periods (i.e. 2001-2002 and 2006-2007). The research-funded testing programme recruited fewer men but identified more positive individuals (10.7% of those testing in the research programme) than were identified among men who tested in the area clinics (3.8% of those men who have sex with men [MSM] testing throughout the county in the same time period). However, the community-based testing programme identified about the same proportion of positive MSM (2.6%) as county clinics (2.7%) in the same time period. In conclusion, results confirmed that even in the same venue, a community-based HIV testing programme identified a similar proportion of positive MSM as the area clinics; however, the research-funded programme identified appreciably more. Incentives may contribute to the difference.
    International Journal of STD & AIDS 01/2010; 21(1):19-22. · 1.00 Impact Factor
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    ABSTRACT: Substance use, sexual behavior, and reincarceration among 89 men from 5 state prisons across the USA, aged 18-29 years, were examined in relation to individual patterns of coping with community reintegration after their release from prison. Analyses of a series of qualitative interviews conducted over a 6-month period post-release revealed three global reintegration coping patterns: moving toward successful reintegration, resuming behavioral patterns that preceded incarceration, and reintegrating through withdrawal or isolation. Four key contextual factors that differentiated these three coping patterns were the consistency and extensiveness of social relationships, the nature of social support, and the degree of structural stability (e.g., stable employment and housing). Participants were assigned a Likert scale score (1 for poor rating to 3 for better rating) for their pattern of global reintegration and for their rating on each of the four contextual factors across the longitudinal qualitative interviews. Collectively, these five factors differentiated the prevalence and frequency of substance use, patterns of sexual behavior, and incidence of reincarceration as assessed by a quantitative survey administered 6 months post-release. Poorer ratings on all five contextual indices were related to the use of substances other than marijuana and alcohol. Men with less consistent social relationships reported more sexual partners. However, vaginal or anal sex without a condom was associated with greater social consistency and greater structural stability, possibly due to the presence of a steady main partner. Reincarceration was significantly associated with poorer global reintegration ratings, more negative social support, and less structural stability. These findings highlight the need to consider the role of social and structural support systems in HIV and sexually transmitted infection risk reduction interventions for men after their release from prison.
    Social Science [?] Medicine 01/2008; 65(11):2394-406. · 2.73 Impact Factor
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    ABSTRACT: The aim of this study was to examine the meaning of significantly higher proportions of positive test results through outreach HIV/sexually transmitted infection testing programmes at gay bathhouses compared with clinic programmes among high-risk men who have sex with men. We conducted a random digit dial survey of men who have sex with men in New York, Los Angeles, Chicago, and San Francisco. Half of the men in the sample did not test in the past year. Among those who did not test, a sizeable minority (17%) reported engaging in high-risk sexual behaviour with a casual or secondary partner. Over half of these non-testing, high-risk men went to bathhouses. These findings strongly support the potential value of locating outreach-testing programmes in bathhouses. Although further studies are necessary, such programmes have the potential to increase testing among the high-risk segment of the population. This is particularly noteworthy given that many men among those who do not test regularly engage in high-risk behaviours.
    International Journal of STD & AIDS 10/2005; 16(9):600-4. · 1.00 Impact Factor
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    ABSTRACT: Men entering prisons have high rates of sexually transmitted disease (STD), hepatitis, and HIV. This study sought to determine the acceptability and feasibility of screening for STD and hepatitis in young men released from prison. Participants were interviewed six months after release and offered free screening. Of 42 (56%) eligible men who participated in the qualitative interview, 33 (79%) provided at least a blood or urine specimen. Eight of 33 (24%) men tested had chlamydia, trichomoniasis, hepatitis B or C virus (HBV or HCV). Three of 32 (9%) had chlamydia, three of 32 (9%) had trichomoniasis, two of 28 (7%) had prior syphilis, and two of 28 (7%) had HCV. Of 28 tested for HBV, six (21%) were immune, two (7%) had chronic infection, and 20 (71%) were susceptible. Barriers to screening included lack of forewarning, inconvenience, and insufficient incentive. In conclusion, screening for STD and hepatitis among former inmates can be acceptable and feasible. Forewarning, reducing the time burden, and providing monetary incentives may increase screening rates.
    International Journal of STD & AIDS 03/2005; 16(2):117-22. · 1.00 Impact Factor
  • 12/2001: pages 133-162;
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    ABSTRACT: To measure the prevalence and independent associations of heavy and problematic use of alcohol and recreational drugs among a household-based sample of urban MSM (men who have sex with men). Cross-sectional survey. Men who identified as being gay or bisexual or who reported sex with another man in the prior 5 years were included in this analysis (n = 2172). A probability telephone sample of MSM was taken within Zip Codes of four large American cities (Chicago, Los Angeles, New York and San Francisco) estimated to have total concentrations of at least 4% of all households with one resident MSM. Standard measures of alcohol use, problems associated with alcohol use, and recreational drug use were administered by trained telephone interviewers. Both recreational drug (52%) and alcohol use (85%) were highly prevalent among urban MSM, while current levels of multiple drug use (18%), three or more alcohol-related problems (12%), frequent drug use (19%) and heavy-frequent alcohol use (8%) were not uncommon. The associations of heavy and/or problematic substance use are complex, with independent multivariate associations found at the levels of demographics, adverse early life circumstances, current mental health status, social and sexual practices and connection to gay male culture. The complex pattern of associations with heavy and/or problematic substance use among urban MSM suggests that heavy and/or problematic substance use is grounded in multiple levels: the individual, the interpersonal and the socio-cultural.
    Addiction 12/2001; 96(11):1589-601. · 4.58 Impact Factor
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    ABSTRACT: This report investigates differences in risk behaviors among men who have sex with men (MSM) who went to gay bathhouses, public cruising areas, or both. We used a probability sample of MSM residing in 4 US cities (n = 2,881). Men who used party drugs and had unprotected anal intercourse with nonprimary partners were more likely to go to sex venues than men who did not. Among attendees, MSM who went to public cruising areas only were least likely, and those who went to both public cruising areas and bathhouses were most likely to report risky sex in public settings. Distinguishing between sex venues previously treated as a single construct revealed a significant association between pattern of venue use and sexual risk. Targeting HIV prevention in the bathhouses would reach the segment of men at greatest risk for HIV transmission.
    American Journal of Public Health 10/2001; 91(9):1482-6. · 3.93 Impact Factor
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    ABSTRACT: This study examined preferences for specific types of HIV tests as well as for test attributes such as cost, counseling, and privacy. A survey was administered to 354 clients of public testing services. Nonparametric tests and logistic regression were used to compare test preferences and attribute ratings, and to assess differences by demographic and risk groups. Nearly two thirds of respondents chose a public clinic test as their first choice, whereas 24% chose a home self-test, 12% chose a test at a doctor's office, and 1% chose a home specimen-collection test. Three attributes (accuracy/timeliness, privacy of test disclosure, and linking of test results) were rated equally-and most-important. In-person counseling was endorsed as the fourth most important attribute. Availability of in-person counseling was the strongest predictor of "loyalty" to public clinic tests-a consistent preference for that type of test even when the other tests were offered as additional no-cost options. There was also substantial interest in home self-tests. The results suggest specific attributes of testing that may be particularly important to individuals from diverse demographic and risk backgrounds.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 08/2001; 27(3):292-300. · 4.65 Impact Factor
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    ABSTRACT: Based on national level surveys, we examined data relevant to the United States' overall effort to prevent the spread of HIV among heterosexual adults. We examined changes in condom use among at-risk heterosexuals over the past decade. The observed increases over time in condom use across all heterosexual at-risk population segments are consistent with the observed (declines) trends in HIV and syphilis in the 1990s. These results and findings from prior studies suggest that U.S. efforts to facilitate condom use and contain HIV and related sexually transmitted disease (STD)-cofactors among adult at risk heterosexuals was succeeding over most of the 1990s. The absence of national level behavioral trend data after 1996, and the ambiguities of HIV spread suggest some caution in projecting trends into this century. National and local efforts need to be directed at sustaining behavioral change and conducting more rigorous studies on population trends in HIV/STD-related behaviors/pathogens.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 07/2001; 27(2):176-82. · 4.65 Impact Factor
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    ABSTRACT: This study investigated the limitations of probability samples of men who have sex with men (MSM), limited to single cities and to the areas of highest concentrations of MSM ("gay ghettos"). A probability sample of 2881 MSM in 4 American cities completed interviews by telephone. MSM who resided in ghettos differed from other MSM, although in different ways in each city. Non-ghetto-dwelling MSM were less involved in the gay and lesbian community. They were also less likely to have only male sexual partners, to identify as gay, and to have been tested for HIV. These differences between MSM who live in gay ghettos and those who live elsewhere have clear implications for HIV prevention efforts and health care planning.
    American Journal of Public Health 07/2001; 91(6):980-3. · 3.93 Impact Factor
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    ABSTRACT: This study characterized the AIDS epidemic among urban men who have sex with men (MSM). A probability sample of MSM was obtained in 1997 (n = 2881; 18 years and older) from New York, Los Angeles, Chicago, and San Francisco, and HIV status was determined through self-report and biological measures. HIV prevalence was 17% (95% confidence interval = 15%, 19%) overall, with extremely high levels in African Americans (29%), MSM who used injection drugs (40%), "ultraheavy" noninjection drug users (32%), and less educated men (< high school, 37%). City-level HIV differences were non-significant once these other factors were controlled for. In comparing the present findings with historical data based on public records and modeling, HIV prevalence appears to have declined as a result of high mortality (69%) and stable, but high, incidence rates (1%-2%). Although the findings suggest that HIV prevalence has declined significantly from the mid-1980s, current levels among urban MSM in the United States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progress, the AIDS epidemic continues unabated among subsegments of the MSM community.
    American Journal of Public Health 06/2001; 91(6):907-14. · 3.93 Impact Factor
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    ABSTRACT: This study sought to determine the prevalence and determinants of use of recommended antiretroviral regimens among urban seropositive men who have sex with men (MSM). A probability telephone sample of MSM was taken within regions of Chicago, Los Angeles, New York, and San Francisco. Analysis focused on use of antiretroviral therapies. Although the majority of seropositive MSM with CD4 counts below 500 per microliter were using recommended antiretroviral regimens, 26% of seropositive MSM were not receiving such care. Men who were younger, who reported a sexual orientation other than homosexual, who had a more recent interview date, who were at middle levels of affiliation with the gay community, and who reported higher levels of perceived exclusivity on the part of the gay community were less likely to be using recommended antiretroviral regimens. Although current efforts to make antiretroviral therapies available to HIV-seropositive MSM are reasonably effective, additional efforts are needed for MSM characterized by relative youth and lower social support.
    American Journal of Public Health 06/2001; 91(5):767-73. · 3.93 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate a programme of human immunodeficiency virus (HIV) antibody testing at gay sex clubs. Conducting secondary analyses with 2 datasets, we evaluated HIV-testing preferences of patrons at 2 sex clubs and compared their risks to testers at a standard testing clinic. Sex club testers had significantly more partners and were significantly older than their clinic peers. Sixteen per cent of sex club testers reported that they would not test if testing were not available at the sex club. Gay sex clubs offer an opportunity to reach men at high risk for HIV, some who otherwise may not test.
    International Journal of STD & AIDS 04/2000; 11(3):173-5. · 1.00 Impact Factor
  • JAMA The Journal of the American Medical Association 05/1999; 281(15):1378; author reply 1379-80. · 29.98 Impact Factor
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    ABSTRACT: Most heterosexual women with AIDS have been infected by male sex partners who acquired HIV via injecting drug use or sex with men. The contribution of bisexuality to heterosexual HIV however, has been poorly quantified. In this paper, we estimate the number of HIV infections that spread from the homosexual community to women who have sex with bisexual men. We developed an HIV transmission model and assigned values to the model's parameters using data from a probability survey of US cities with a high risk of HIV. We estimated that these are about 400 HIV infections transmitted annually from HIV-infected bisexual men in high-risk cities to their female sex partners; two-thirds of these infections are transmitted to main female partners and one-third to casual partners. Uncertainties in the value of model parameters lead to variation in expected HIV infections mostly within the range 200 to 600, and for one parameter up to nearly 800. We conclude that transmission via bisexuality is a relatively minor component of the estimated 40,000 annual HIV infections in the USA.
    AIDS 08/1997; 11(8):1031-7. · 6.41 Impact Factor
  • D Binson, L Pollack, J A Catania
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    ABSTRACT: Women in midlife and older represent over 25% of all women with AIDS and 4% of all reported AIDS cases in the United States. We present prevalence estimates and demographic correlates of AIDS-related risk behavior and safer sex practices among women in midlife and older from the National AIDS Behavioral Surveys (NABS). Data are of women aged 40 to 75 in the (a) NABS 1 national sample (n = 887), (b) NABS 1 urban sample (n = 2,111), and (c) NABS 2 national sample (n = 624). Data from the baseline survey (NABS 1) revealed that approximately 8% or 4.5 million women aged 40 to 75 engaged in behaviors that might expose them to HIV. Data from the follow-up survey (NABS 2) indicated that the proportion of women who reported a risk factor remained at about 8%. Overall safer sex practices among older women who reported sexual risk behaviors were minimal. Between 90% and 100% had not used condoms in the previous 6 months. Moreover, almost 90% of the women who reported a risk behavior did not perceive themselves to be at risk.
    Health Care For Women International 01/1997; 18(4):343-54. · 0.63 Impact Factor
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    ABSTRACT: The National AIDS Behavioral Survey (1990-1992) of heterosexual adults (18-49 years) measured human immunodeficiency virus (HIV) risk factors, condom use, and HIV antibody testing, with a focus on major "high-risk" cities. A longitudinal survey was conducted. There was little reduction in the overall prevalence of HIV risk factors in the national or high-risk cities cohorts over time. Despite this picture of stability, approximately 39% of the population at risk for HIV because of multiple sexual partners turns over annually. There was little change in HIV test-seeking or in consistent condom use with primary sexual partners. Although the majority of at-risk respondents used condoms sporadically or not at all (65%), a significant increase in condom use was found among those reporting multiple sexual partners in both waves, particularly among Black heterosexuals. Data from other surveys and condom sales nationally support the findings. There is a need for a series of surveys in this area to assess the reliability of the present findings and to monitor the general US population's response to prevention programs.
    American Journal of Public Health 12/1995; 85(11):1492-9. · 3.93 Impact Factor
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    ABSTRACT: We examined risk factors for HIV and changes in condom use among heterosexual adults (N = 987) over three waves of data from the AIDS in Multi‐Ethnic Neighborhoods (AMEN) cohort survey (1988–89, 1989–90, 1991–92). We found that respondents had maintained increases in condom use reported at Wave 2, but the overall picture is one of condom use having plateaued (and possibly decreased; see sales data). The self‐report condom use data parallel national data on condom sales for 1990 to 1992. Changes in condom use between Waves 2 and 3 were unrelated to social class, race / ethnicity, and age. Men and people without primary sexual partners were the most likely to report gains in condom use from Wave 2 to 3. At‐risk people did not show changes in condom use with primary sexual partners. People with multiple sexual partners at Waves 2 and 3 also did not change in condom use. However, people who acquired risk by Wave 3 showed significant increases in occasional condom use. The results call for renewed efforts to facilitate condom use (and HIV testing) among the chronically at risk and those at‐risk individuals who enter “monogamous” relationships.
    The Journal of Sex Research 01/1995; 32(3):193-200. · 2.53 Impact Factor

Publication Stats

872 Citations
80.81 Total Impact Points

Institutions

  • 1997–2013
    • University of California, San Francisco
      • • Center for AIDS Prevention Studies
      • • Division of Hospital Medicine
      San Francisco, CA, United States
  • 2001
    • Centers for Disease Control and Prevention
      • Division of HIV/AIDS Prevention, Intervention and Support
      Druid Hills, GA, United States