title: Continued Importance of Sexually Transmitted Disease Clinics in the Era of the Affordable Care Act.
abstract: Following the 2014 expansions of Medicaid and private health insurance through the Affordable Care Act, municipal sexually transmitted disease (STD) clinics-which have historically served predominantly uninsured patients-have been threatened with budget cuts nationwide. This study was conducted to evaluate the impact of the insurance expansions on the demand for STD clinic services.
  
  
  
  The proportion of total incident sexually transmitted infections in Baltimore City that were diagnosed at STD clinics was compared between 2013 and 2014, and a multivariate analysis was conducted to determine factors associated with diagnosis at an STD clinic. Analyses were conducted in July 2015.
  
  
  
  There was no change in the overall proportion of sexually transmitted infection diagnoses made at STD clinics from 2013 to 2014 (relative rate, 1.03; 95% CI=0.95, 1.11). Hispanic ethnicity, black race, male sex, and age >24 years were associated with an increased likelihood of STD clinic utilization (p<0.0001).
  
  
  
  Despite the Affordable Care Act's insurance expansion measures, the demand for STD clinics remained stable. These safety net clinics serve patients likely to face barriers to accessing traditional health care and their preservation should remain a priority.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: nicky.mehtani@jhmi.edu.
authors.forename: Nicky J
authors.initials: NJ
authors.lastname: Mehtani
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Schumacher
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Luke E
authors.initials: LE
authors.lastname: Johnsen
authors.affiliation: Baltimore City Health Department, Baltimore, Maryland.
authors.forename: Joneigh S
authors.initials: JS
authors.lastname: Khaldun
authors.affiliation: Baltimore City Health Department, Baltimore, Maryland.
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Chaulk
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Khalil G
authors.initials: KG
authors.lastname: Ghanem
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jacky M
authors.initials: JM
authors.lastname: Jennings
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Page
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008396:Maryland; D017057:Medically Uninsured; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000208:ethnology; D014481:United States; D055815:Young Adult