STD Clinics Are an Important Part of the U.S. Healthcare Safety Net

Background:  STD clinics have been an important component of the U.S. healthcare safety net, providing quality care for persons regardless of ability to pay. Recent changes in the U.S. healthcare system offer opportunities to increase health insurance coverage, and expand access to clinical services. To define the role of STD clinics in a changing healthcare environment, it is important to understand healthcare access and utilization patterns of persons who seek health services in STD clinics.

Methods:  We conducted a survey of 4,400 persons who utilized publically funded, categorical STD clinics in 22 U.S. cities with the largest number of reported cases of chlamydia, gonorrhea, and syphilis during 2007-2011. Using a brief self-administered survey, we assessed patient sociodemographic characteristics, reasons for selecting the STD clinic for care, access to other healthcare venues, insurance status, and willingness to use insurance to pay for care at the STD clinic.

Results:  In a preliminary analysis of surveys from 100 women and 100 men, we found a mean age of 32 years (range 16-70 years); that 62% were non-white; and 54% were uninsured.  The most common reasons for visiting the clinic were STD symptoms (32%), STD screening (33%), and HIV testing (12%). Among STD clinic patients, 59% had access to another type of healthcare venue for sick care, and 54% for preventive care.  Among those with health insurance, 60% would be willing to use it to pay for care at the STD clinic. Persons chose the STD clinic because of availability of walk-in/same-day appointments (56%), low-cost care (17%), or expert care (8%).

Conclusions:  STD clinics were utilized for convenient, low-cost, expert care, even by patients with access to other types of healthcare venues. These findings underscore the importance of the STD clinic as part of the U.S. healthcare system to assure the sexual health of men and women.