P3.144 STD Clinics Serve an Economically Disadvantaged Subset of the Wider Population of Men Who Have Sex with Men (MSM) with Bacterial Sexually Transmitted Infections (STI)

Abstract

Background: U.S. STD clinics are closing. MSM are a priority population for STD treatment. We evaluated differences between MSM diagnosed with STI in an STD clinic and MSM diagnosed in other venues. Method(s): We randomly sampled and interviewed MSM reported with gonorrhoea, chlamydial infection, or early syphilis in King County, Washington, 2007-2012. We weighted for interview non-response based on race, ethnicity, STI diagnosis, STD clinic diagnosis (vs. elsewhere), and year. Result(s): A total of 2,865 (38%) of 7,568 MSM cases were randomly selected, of whom 2107 (73.5%) were interviewed; 1275 (61%) interviewed men were STD clinic patients. STD clinic patients were less likely to have stable housing (91% vs. 95%, p = 0.003) or a college degree (34% vs. 44%, p < 0.0001), and more likely to be unemployed (28% vs. 23%, p = 0.01). Both groups were similar in terms of age, race, ethnicity, and HIV status. STD clinic patients were more likely to be diagnosed with gonorrhoea (57% vs. 47%, p < 0001), to report a prior diagnosis of bacterial STI (68% vs. 55% p < 0.0001), and to have sought care because of symptoms (45% vs. 39%) or a partner with an STD (27% vs. 8%, p < 0.0001), and less likely to be diagnosed with chlamydia (55% vs. 61%, p = 0.007). STD clinic patients reported having more partners (mean 16.3 vs. 11.7, p = 0.0008) in the prior year, and more methamphetamine (18% vs. 11%, p < 0.0001), Viagra (18% vs. 13%, p = 0.006) and popper use (26% vs. 19%, p = 0.0004). HIV-uninfected STD clinic patients were more often HIV-tested (84% vs. 78%, p = 0.001) at the time of STI diagnosis. HIV-infected MSM diagnosed in the STD clinic were less likely to have a primary HIV care provider than other MSM (80% vs. 96%, p < 0.0001). Conclusion(s): STD clinics serve an economically disadvantaged, high risk and disproportionately symptomatic subset of the larger population of MSM with bacterial STI.