Trends in healthcare access and utilization among young men who have sex with men: The P18 Cohort Study

Background: An understanding of overall access to healthcare and healthcare utilization among young men who have sex with men (YMSM) is warranted as the period of emerging adulthood is characterized by both social/structural changes as well as behavioral changes that can impact the health and well-being of this population.

Methods: This study employs 7 waves of data (collected semi-annually over a 3 year period), from n=600 YMSM enrolled in a prospective cohort study to examine factors such as sociodemographic characteristics, current perceived health status, prior HIV/STI diagnoses, income, education, health insurance coverage, and HIV related risk behaviors for their independent associations with healthcare utilization trends over time. 

Results: At baseline, 63% of YMSM accessed health care at a private clinic/doctor, 31% at a public clinic, 2% at a VA clinic, and 4% at an ER.  By the 36-month follow up, use of private doctor/clinic had decreased (59%) while use of ER services increased (7.2%). Health insurance coverage declined from 87% to 76% during follow-up.  Findings suggest a lower odds of healthcare service utilization was associated Black and Hispanic/Latino race/ethnicity, lower SES, maintaining health insurance coverage and prior STI diagnoses.

Conclusions:  The impact of limited health care access among YMSM transitioning into adulthood warrants further attention as reductions in access and utilization of healthcare services can impact not only health behaviors but also access to early screening for HIV/STIs.  The findings from this study can help inform public health interventions designed to improve health care access and use among YMSM.