PATIENTS ATTENDING STD CLINICS IN AN EVOLVING HEALTH-CARE ENVIRONMENT- DEMOGRAPHICS, INSURANCE-COVERAGE, PREFERENCES FOR STD SERVICES, ANDSTD MORBIDITY

Objectives: To characterize client demographics, sexually transmitted diseases (STD) morbidity, insurance status, reasons for attending publ ic STD clinics, and future preferences for source of STD services. Des ign: Cross-sectional study of 2,490 clients attending five urban STD c linics for new problems with interviewer-administered 23-item question naire and chart review to obtain clinical and laboratory STD diagnoses . Results: Participants were young (51% <25 years of age), minority (6 4% nonwhite), poor (43% less than or equal to$10,000/year), and largel y uninsured (59% uninsured, 27% private insurance, and 14% Medicaid). Half had previously visited the STD clinic, and 81% had used other pro viders for non-STD services in the prior 3 years. STD symptoms were ci ted as the reason for the visit by 63%. The most common factors associ ated with seeking care at these STD clinics were walk-in services, cos ts, and confidentiality concerns. STD morbidity was high; 66% of clien ts were diagnosed with one or more STD. Most (68%) clients preferred t o be treated at the STD clinic in the future if they could go anywhere for STD services. Conclusions: STD clinics see young, minority, poor, and uninsured clients with high STD rates. Even with unlimited future choice, two thirds of the clients surveyed would still prefer to be t reated at STD clinics. This study indicates the continuing need for pu blicly funded, categorical STD clinics in urban areas with high STD mo rbidity and the importance of easily accessible, confidential, expert STD services from the private sector and managed care organizations.