title: Assessing the Changing Landscape of Sexual Health Clinical Service After the Implementation of the Affordable Care Act.
abstract: BACKGROUND
  Federal health reform has the potential to impact many public health services, especially sexual health clinics. To assess the impact of such reform within the Denver Sexual Health Clinic (DSHC), we conducted a survey of patients to better understand our client population and their care-seeking behavior.
  
  
  METHODS
  Survey data were collected from patients attending the DSHC at 3 different points in time to ascertain insurance status, reasons for not having insurance, reasons for choosing care at the DSHC, and health care use over the past 12 months.
  
  
  RESULTS
  A total of 1603 surveys were completed. Forty-two percent of participants were enrolled in health insurance at the time of visit. The percentage of patients with Medicaid increased more than 200% across the survey cycles. Cost was the main reason cited for not having insurance. Participants identified confidentiality and convenience among the top reasons for seeking care at the DSHC regardless of sex or insurance. Although there was no difference in health care use for sexual health services, individuals with health insurance were more likely to have used nonsexual health services in the past 12 months than those without insurance.
  
  
  CONCLUSIONS
  Patients continue to visit the DSHC despite having health insurance. Sexual health clinics must work to understand what drives people to seek care so that they can better prepare for the future.
authors.affiliation: From the *Denver Public Health, Denver Health and Hospital Authority, Denver, CO; †Department of Epidemiology, Colorado School of Public Health, Aurora, CO; and ‡Department of Medicine, University of Colorado Denver, Aurora, CO.
authors.forename: Christie
authors.initials: C
authors.lastname: Mettenbrink
authors.forename: Alia
authors.initials: A
authors.lastname: Al-Tayyib
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Eggert
authors.forename: Mark
authors.initials: M
authors.lastname: Thrun
mesh_terms: D000328:Adult; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D058991:Patient Protection and Affordable Care Act; D060728:Reproductive Health / Q000191:economics*; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology