Generational Considerations for Health Service Utilization Among Gay Men

Background: Sexual minority men including gay men report unique health disparities compared to their heterosexual peers including a lack of healthcare participation leading to chronic health and mental health conditions. Limited research has been conducted analyzing inter-group differences among gay men such as the influence of one’s generational group may have on disparities. Research suggests older sexual minority adults avoid sexual identity disclosure in health settings reducing participation, while younger sexual minority individuals report a need for more comprehensive care highlighting issues other than sexual health to engage this group. The purpose of this study was to examine the impact generational influences have on health service utilization.

 Method: A sample of 383 self-identified gay/homosexual men was conducted in 2014 by the San Francisco Department of Public Health for the purpose of tracking HIV at-risk individuals. Healthcare utilization was operationalized using the questions: “In the past 12 months have you seen a medication provider?” and “Do you have a usual source of medical care?”. Separate logistic regressions were completed to analyze these questions based on three age cohorts (Older: 55+; Middle: 35-54; Younger: 18-34).

 Results: The sample consists of younger men (45%), middle-aged men (32%) and older men (23%). The majority of the sample was white (80%) followed by African-American (11%). Most of the men were employed full-time (62%) and a majority earned more than $60,000/year (42%). Most men had accessed health services in the past twelve months (89%) as well as had a usual source of care (86%). The majority of men had disclosed their sexual identity to their medical provider (93%), were HIV negative (76%) and most had health insurance (90%). Older men were less likely to have visited a medical provider in the past 12 months compared to middle-aged men (OR= 0.10; CI= 2.47, 39.87) as well as compared to younger men (OR=0.35; CI=1.28, 10.42). Older men were more likely to have a usual source of medical care compared to younger men (OR= 4.0; CI= .05, .84).

 Discussion: The implications of this study for social work practice include a consideration for generational differences existing within the gay population. This finding is evidence for the need for interventions and service delivery tactics that are not marketed as blanket fixes for the entire gay male population but consider age related issues as well. This study highlights additional areas needing further exploration including the impact HIV and socio-economic status have on health seeking behavior and health service utilization. In general, these results give rise to additional questions surrounding health seeking behaviors of gay men. Based on the results of this study, research is needed on the health service utilization of older gay men, in particular, to gain an understanding of why this generation appears at a greater risk of service avoidance.