Are STD Clinics Still Safety Net Providers in the Aftermath of the Affordable Care Act? Results from an STD Clinic Patient Survey, New York City, 2014

Background: The New York City (NYC) Department of Health and Mental Hygiene operates eight sexually transmitted disease (STD) clinics. In fall 2014 a patient survey was conducted in all STD clinics to understand the role they play as safety net providers and to measure patients’ insurance status. Citywide population-based survey data show that 14% of NYC residents lacked health insurance in 2014 while an STD clinic survey that same year indicated 51% of patients were uninsured. 

Methods: Patients accessing clinic services during November–December 2014 received an anonymous, 11-question, paper-based survey available in English and Spanish.  

Results: Of the 1602 survey respondents, 63% (1002/1602) were male and 46% (735/1597) were less than 27 years old, reflecting overall patient population characteristics. Twenty-nine percent of respondents (411/1408) reported current unemployment and 48% (748/1564) were uninsured. Two-thirds (1060/1585) reported previously visiting a NYC STD clinic. When asked where they would have gone if the STD clinic did not exist, 21%, (317/1503) would have waited to see how they felt. Twenty percent (308/1503) would have visited a private MD; 15% (226/1503), emergency room; 13% (192/1503), community health center; 12% (178/1503), urgent care; and 19% (282/1503), other clinic settings. Females were more likely than males to report a primary care check-up in the last year (67% vs 53%, p<.0001), and to have had a sexual history taken during the last primary care visit (65% vs 51%, p<.0001).

Conclusions: Survey findings confirm that the NYC STD clinics continue to serve vulnerable populations who have much lower insurance coverage compared with NYC residents overall even after passage of ACA. STD clinics serve a vital safety net function, particularly for young adults and men who might otherwise delay or rely on emergent care.  As sexual history taking is suboptimal in primary care settings, STD clinics minimally ensure that these patients are screened appropriately.