Differences in Sexual Health Clinic Services by Age and Gender in Metropolitan Boston

This study aimed to analyze differences in sexual health clinic service utilization by age and gender.

We analyzed data from 7949 visits by 4004 individuals at a Boston metropolitan sexual health clinic from January 2019 to June 2021. We stratified visits, sexually transmitted infections, HIV preexposure prophylaxis (PrEP) use, and health insurance by age and gender. We assessed predictors of PrEP prescription using multivariable Poisson regression. We defined our key analytic factor, PrEP indication, using US Centers for Disease Control and Prevention guidelines.

At the visit level, attendees were 78% male, 50% White, and 13% uninsured; ≥1 sexually transmitted infection was recorded (using symptom, exposure, laboratory diagnosis, and treatment data) at 23% of visits. At the visit level, the youngest patients were significantly more likely to be uninsured (15-22 years: 15%, >22-26 years: 12%, >26-45 years: 14%, >45 years: 11%; P < 0.0001) and have no prior knowledge of PrEP (7%, 6%, 6%, 4%; P < 0.0001). Among visits at which a PrEP indication was identified (38%), PrEP was prescribed at 84% and 61% of visits attended by males and females, respectively. Women 26 years or younger versus women older than 26 years were 46% less likely to be prescribed PrEP.

Young people presenting for sexual health services in a Boston metropolitan area were more likely to be unaware of PrEP, and among those with indications, younger females were less likely to be prescribed PrEP.