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Insurance Status and Access to Sexual Health Services Among At-Risk Men: A Qualitative Study
Genoviva Sowemimo-Coker1, Alice J Lee, Madeline C Montgomery
1Genoviva Sowemimo-Coker, MPH, is a Senior Research Assistant, Department of Medicine, Brown University, Providence, Rhode Island, USA. Alice J. Lee, BA, is a Medical Student, Department of Medicine, Brown University, Providence, Rhode Island, USA. Madeline C. Montgomery, MPH, is a Project Director, Department of Medicine, Brown University, Providence, Rhode Island, USA. Amy S. Nunn, ScD, is an Associate Professor, Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA. Jacob J. van den Berg, PhD, is an Assistant Professor, Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, USA. Philip A. Chan, MD, is an Associate Professor, Department of Medicine, Brown University, Providence, Rhode Island, USA.
Abstract:
Our objective was to evaluate the impact of insurance coverage on access to sexual health services among at-risk men. Data were collected from Hispanic/Latino and non-Hispanic White male patients at a publicly funded sexually transmitted disease clinic in a Medicaid expansion state from February to July 2017, using in-depth, semistructured interviews. A coding scheme was applied to interview transcripts with iterative revisions until a final coding scheme was achieved. Data were analyzed using Nvivo 10 software. Three key themes emerged from qualitative analysis: Most participants reported (a) financial barriers, (b) fluctuations in insurance status and challenges with insurance re-enrollment, and (c) lack of access to a provider and discomfort discussing sexual health as barriers to accessing HIV/sexually transmitted disease care in primary care settings. Hispanic/Latino men more frequently cited these barriers compared with non-Hispanic White men. Insurance status and out-of-pocket costs are barriers to sexual health care for at-risk men.
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