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Background: Many new HIV diagnoses are made in STD clinics. Partner services have been an STD program priority for many years, but other HIV-related client services might be influenced by health care system changes. We examined HIV service delivery to black and Hispanic/Latino populations seen in STD clinics, comparing Medicaid expansion states (MES) to non-Medicaid expansion states (NMES).
Methods: For 2014, 61 health department jurisdictions submitted data on CDC-funded HIV testing, HIV positivity, linkage to care, partner services, and HIV risk-reduction services. We selected data for black and Hispanic/Latino clinic patients. We stratified data by Medicaid expansion status as of January 2014 and used chi-square analyses for comparisons.
Results: Among blacks, 25 MES conducted 72,667 CDC-funded HIV testing events in STD clinics; 26 NMES conducted 212,144. Linkage within 90 days differed for blacks by Medicaid expansion status 59.9% (MES) versus 51.5% (NMES), p<.01, but interviews for partner services did not differ by expansion status (72.2% vs. 74.1%, p=.40). Additionally, MES conducted 45,555 CDC-funded HIV testing events in STD clinics among Hispanics/Latinos; NMES conducted 49,900. Linkage within 90 days did not differ by Medicaid expansion status, 72.4% versus 73.1%, p=.82, nor did the proportion interviewed for partner services, 78.3% versus 79.1%, p=.76. Finally, in MES, referral rates among blacks for HIV risk-reduction services was 56.5% versus 75.5% in NMES, p<.001. The association was reversed for Hispanics/Latinos, 83.9% versus 77.4%, p<.02.
Conclusions: Partner services interviews, a long-standing staple of STD clinics, did not differ by Medicaid expansion status in 2014 for racial/ethnic minority patients. Other services differed, but the direction of the associations by population were not always as expected.