Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115459

Barbara Allen¹, Geneva Bell-Sanford², Matthew R. Facer, PhD³, Dennis V. Ferrero, MPH², Barbara Green-Ajufo¹, Jeffrey D. Klausner, MD, MPH⁴, George Lemp, DrPH⁵, Martin Lynch⁶, Willi McFarland, MD, PhD⁷, Fred Molitor⁸, Scott Morrow⁹, Kim Page-Shafer, PhD, MPH¹⁰, Juan Ruiz, MD, MPH³, and Jennifer K. Baham, MPH¹¹. (1) Alameda County, 1000 Broadway, Suite 500, Oakland, CA 94607, (2) San Joaquin County, P.O. Box 2009/1601 E. Hazelton Ave., Stockton, CA 95201, (3) California Department of Health Services, Office of AIDS, 1616 Capitol Avenue, Sacramento, CA 95814, (4) STD Prevention and Control Services, San Francisco Department of Public Health, 1360 Mission Street, Suite 401, San Francisco, CA 94103, (5) University of California Office of the President, Universitywide AIDS Research Program, 300 Lakeside Drive, 6th Floor, Oakland, CA 94612, (6) Contra Costa County, 597 Center Avenue, Suite 200, Martinez, CA 94553, (7) HIV Seroepidemiology Unit, San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA 94102, (8) ETR Associates, 2210 21st Street, Sacramento, CA 95818, (9) San Mateo County, 225 W. 37th Avenue, San Mateo, CA 94403, (10) Department of Medicine, University of California Center for AIDS Prevention Studies, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105, (11) HIV/AIDS Epidemiology Branch, Office of AIDS, California Department of Health Services, MS 7700, P.O. Box 997426, Sacramento, CA 95899-7426, 916-449-5853, JBaham@dhs.ca.gov

Objectives: Assess the relation between having medical insurance and HIV/STD-associated risk behaviors within a population-based sample of young men from low-income neighborhoods.

Methods: Census data were used to identify blocks where the median income fell below the 10th percentile within five northern California counties. Outreach teams recruited men aged 18 to 35 from all residences within randomly-sampled blocks. Interviews conducted from standardized questionnaires obtained information on participants' demographics and risk behaviors within the last six months. Multivariate logistic regressions quantified how medical insurance may relate to specific risk behaviors while correcting for race/ethnicity, age, and if born outside the U.S..

Results: Among 1,293 participants, over 87.4% were non-white, 48.6% were born outside the US, and 57.0% reported not currently having any form of medical insurance (including Medicare/MediCal). Lack of medical insurance was associated with having at least 1 recent IDU sex partner (OR=5.5; 95% CI 2.1-14.4), at least 1 anonymous partner (OR=1.5; 1.1-2.1), and at least 1 casual partner (OR=1.5; 1.1-1.9). It was associated with both receiving money/drugs/other in exchange for sex (OR=3.8; 2.2-6.5) and giving money/drugs/other in exchange for sex (OR=1.6; 1.2-2.2), and strongly associated with recent use of methamphetamine/speed during sex (OR=4.0; 1.9-8.4). Not having medical insurance was associated with unprotected anal sex with a female (OR=1.6; 1.1-2.5) but not unprotected vaginal sex.

Discussion: Lacking medical insurance was associated with certain high-risk behaviors among low-income young men from selected areas of California. Potential health consequences from such behaviors may further strain publicly funded health systems in the future.

Learning Objectives: At the completion of the presentation, the attendee will be able to

• Recognize the importance of knowing whether or not having medical insurance is associated with high-risk behavior, particularly in low-income populations.
• Discuss the relevance of using population-based sampling methods in public health-related studies, particularly within populations containing great demographic diversity.
• Identify several specific risk behaviors known to facilitate HIV/STD transmission to which lacking medical insurance is significantly associated.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.