Evaluating the Association of Parental Insurance Coverage on Critical Steps to HIV Pre-exposure Prophylaxis Uptake in Young Men Who Have Sex With Men Pubblico
Adrian, Haley (Spring 2020)
Abstract
Background: Parental insurance is associated with decreased uptake of sexual health services in adolescents and young adults. There are no reported studies examining this impact on pre-exposure prophylaxis (PrEP) uptake in young men who have sex with men (YMSM).
Methods: The American Men’s Internet Survey (AMIS) is an annual online survey conducted in the United States among MSM aged ≥15 years. Multivariable logistic regression was used to assess parental insurance coverage associations with the prevalence of current PrEP willingness, PrEP conversation with a healthcare provider, and PrEP uptake in the past 12 months among HIV-negative, insured YMSM. Models adjusted for age, race/ethnicity, residential population density, living with parent(s), being out about their sexuality to family member(s) or a healthcare provider, and having a regular healthcare provider.
Findings: Most of 3,360 study-eligible participants were non-Hispanic white, 19-22 years old, from small/medium metropolitan or urban areas, and had a regular healthcare provider. Parental insurance coverage was reported by 71.1% (n=2,390). Parental insurance was not significantly associated with PrEP willingness (84% on parental insurance versus 79.4% on other insurance; adjusted prevalence ratio [aPR]= 1.03; 95% confidence interval [CI]= 0.99, 1.08), but was significantly associated with lower PrEP use (9.0% versus 15.3%; aPR= 0.80; CI= 0.66, 0.97). For YMSM who were not out to a family member(s), parental insurance was associated with a lower prevalence of having a PrEP conversation with a healthcare provider (6.4% versus 11.2%; aPR=0.70; CI=0.52, 0.95). Of YMSM on parental insurance who were unwilling to take PrEP, 41.1% agreed they did not want to take PrEP, because they were worried about privacy on their parent’s insurance.
Interpretation: Our study shows that parental insurance and its potential confidentiality concerns may be reducing PrEP uptake among YMSM. Insurance coverage is a critical factor in gaining access to PrEP; however, parental insurance and not being out reduces the likelihood of having a PrEP conversation with a healthcare provider, and being on parental insurance reduces the likelihood of PrEP use. Implementing and communicating improved insurance confidentiality processes for dependents and creating safer spaces to feel comfort to come out to providers may improve PrEP uptake for YMSM.
Table of Contents
Introduction 1
Methods 5
Results 10
Discussion 13
Tables
Table 1. Characteristics of Young HIV-negative MSM Participants
with Insurance Coverage in the American Men’s Internet Survey, 2019 20
Table 2. Willingness to Use PrEP by Parental Insurance Coverage Among
Young MSM Participants in the American Men’s Internet Survey, 2019 21
Table 3. EP Conversation with a Healthcare Provider in Past 12 Months
by Parental Insurance Coverage Among Young MSM Participants in the
American Men’s Internet Survey, 2019 22
Table 4. PrEP Use in the Past 12 Months by Parental Insurance Coverage
Among Young MSM Participants in the American Men’s Internet
Survey, 2019 22
Table 5. Participants on Parental Insurance and Unwilling to Take Prep,
Level of Agreement with, “I don't want to take PrEP, because I'm
worried about my privacy on my parent's insurance." Among Young
MSM Participants in the American Men’s Internet Survey, 2019 23
References 24
Appendices
Appendix I: Table 2.1. Willingness to Use PrEP by Parental Insurance
Coverage Among Young MSM Participants in the American Men’s
Internet Survey, 2019 30
Appendix II: Table 3.1. EP Conversation with a Healthcare Provider
in Past 12 Months by Parental Insurance Coverage Among Young
MSM Participants in the American Men’s Internet Survey, 2019 31
Appendix II: Table 4.1. PrEP Use in the Past 12 Months by Parental
Insurance Coverage Among Young MSM Participants in the American
Men’s Internet Survey, 2019 32
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