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Background: Whether healthcare reform will change care-seeking patterns among municipal STD clinic MSM clients is unknown; surveillance might be helpful to monitor the impact on utilization and delivery of sexual health services. The US National HIV Behavioral Surveillance (NHBS) system surveys a venue-based sample of MSM (men who have ever had a male sexual partner) every three years. We used NHBS to describe differences between insured and uninsured MSM in San Francisco surveyed in 2011.
Methods: We explored self-reported demographics, risk behaviors, and care-seeking behaviors, collected 07/21-12/19/2011, stratified by insurance status, using chi-square tests.
Results: Of 510 participants, 76% were insured, primarily by private insurance/HMO (65%). The insured were more likely than the uninsured (p <0.05) to identify as homosexual /gay (93% vs 83%), have visited a healthcare provider in the past year (92% vs 71%), have a physician/HMO for usual care (74% vs 14%) as opposed to a clinic/health center (17% vs 44%), and be HIV-infected (24% vs 14%). In the past year, the uninsured were more likely to have lacked needed healthcare due to cost (28% vs 9%) and used methamphetamine (19% vs 10%) or crack (9% vs 2%). There were no differences between insured and uninsured MSM in self-reported chlamydia, gonorrhea, or syphilis positivity, HIV testing, or use of PEP or PrEP in the past year. Insured and uninsured MSM were equally likely to have received STD testing at the municipal STD clinic in the past year (11% among insured vs 15% among uninsured).
Conclusions: Despite having superior access to primary health care, MSM with insurance in San Francisco were equally likely to receive services at the municipal STD clinic as uninsured MSM, the reasons for which should be explored. Ensuring access to expert STD care and services for MSM will be essential as healthcare reform is implemented.