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

BACKGROUND: To analyze differences in sexual health clinic service utilization by age and gender. METHODS: We analyzed data from 7,949 visits by 4,004 individuals at a Boston metropolitan sexual health clinic from January 2019 to June 2021. We stratified visits, sexually transmitted infections (STI), HIV pre-exposure 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 CDC guidelines. RESULTS: At the visit-level, attendees were 78% males, 50% white, and 13% uninsured; ≥1 STI 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 (15-22y: 15%; >22-26y: 12%; >26-45y: 14%; >45y: 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. Females ≤26y vs. >26y were 46% less likely to be prescribed PrEP. CONCLUSIONS: 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.