Health Care Coverage and Preexposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men Living in 22 US Cities With vs Without Medicaid Expansion, 2017

Abstract

Objectives. To compare health care coverage and utilization between men who have sex with men (MSM) in Medicaid expansion versus nonexpansion states.Methods. We used cross-sectional weighted data from the National HIV Behavioral Surveillance system, which used venue-based methods to interview and test MSM in 22 US cities from June through December, 2017 (n = 8857). We compared MSM in Medicaid expansion versus nonexpansion states by using the Rao-Scott χ² test stratified by HIV status. We used multivariable logistic regression to model the relationship between Medicaid expansion, coverage, and preexposure prophylaxis (PrEP) use.Results. MSM in expansion states were more likely to have insurance (87.9% vs 71.6%), have Medicaid (21.3% vs 3.8%), discuss PrEP with a provider (58.8% vs 44.3%), or use PrEP (31.1% vs 17.5%).Conclusions. Medicaid expansion is associated with higher coverage and care, including PrEP.Public Health Implications. States may consider expanding Medicaid to help end the HIV epidemic.

FIGURE 1—

Differences in Preexposure Prophylaxis (PrEP) Discussion and Use Between HIV-Negative Men Who Have Sex With Men (MSM) Living in Medicaid Expansion Versus Nonexpansion States: United States, National HIV Behavioral Surveillance, 2017 Note. CI = confidence interval. MSM live in a state that implemented Medicaid expansion before June 1, 2017