Health Insurance and Health Services Use in African-American and Latino Men who have Sex with Men (MSM)

Poor access to health insurance and medical services is a problem for ethnic minorities, particularly Hispanics/Latinos and African-Americans, and for sexual minorities such men who have sex with men (MSM). Access to health care and health insurance have not been adequately studied in individuals who are both racial/ethnic minorities and MSM. We compared health services use and health insurance coverage of Latino and African-American MSM to white MSM using data from the Los Angeles Center of the Multicenter AIDS Cohort Study (MACS). Race/ethnicity, education, clinical symptoms, health insurance, and number of medical visits were ascertained from self-administered questionnaires. CD4, CD8, and CD3 levels were measured by flow cytometry. African-American and Latino MSM were younger and more likely to report annual incomes of less than $20,000 than white MSM. Logistic regression identified age, HIV serostatus, and income, but not race/ethnicity, as predictive of health insurance. A Poisson regression analysis revealed that significant predictors of health services use were non-African American race, HIV-negative serostatus, full-time employment, income, 2+ symptoms reported, having health insurance, higher CD4 & CD8 and lower CD3 leukocyte counts. Race/ethnicity was not a significant predictor of having heath insurance in the multivariate model. We observed comparable health services use among Latino and white MSM, but lower use among African-American MSM. Health care facilities need to be more culturally sensitive and welcoming to sexual minorities, especially to African-American MSM.