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UBC Theses and Dissertations

Investigating the role of structural determinants in shaping sex workers' reproductive health access and outcomes Duff, Katherine Putu


Background and objectives: While sex workers are disproportionately impacted by reproductive health inequities, a significant knowledge gap regarding the contextual drivers of sex workers’ broader reproductive health access and outcomes remains. This dissertation therefore sought to disentangle the role of multiple, and intersecting structural factors on sex workers’ ability to exercise their reproductive rights. Specifically, this dissertation’s objectives were to: explore the structural correlates of sex workers’ pregnancy intentions; investigate the influences of community organization and venue-based features on indoor sex workers’ ability to negotiate and use contraceptives; and examine the structural correlates of accessing cervical screening. Methods: This dissertation drew on data collected from AESHA (An Evaluation of Sex Workers’ Health Access), an open prospective cohort of street- and off-street sex workers across Metro Vancouver, Canada. Bivariable and multivariable regression methods, using generalized estimating equations for longitudinal data, were employed to examine the associations between intersecting structural, community organization, venue-based, interpersonal and individual-level factors and various reproductive health access and outcomes. Spatial analysis using geographical information systems (GIS) were used to examine geographical correlates of reproductive health services access. Results: This dissertation found that sex workers exhibited pregnancy desires similar to that of the general population, with access to off-street venues, inconsistent condom use by clients and intimate partner violence among the important factors shaping these desires. The availability of supportive indoor work features and increased social cohesion increased sex workers’ ability to negotiate for and use condoms. Finally, this dissertation documented suboptimal cervical cancer screening access among HIV seropositive and sero-negative sex workers. While barriers to health care services in general reduced odds of cervical cancer screening, access to screening via outreach models increased odds of screening. Conclusion: Structural factors play a pivotal role in shaping access to reproductive health services and sex workers’ negotiation of their sexual and reproductive health. Given the Canadian government is in the process of revising its sex work legislation, this study offers critical insights into how structural interventions including safer workplace models, sex worker-led integrated HIV/sexual and reproductive health services within a decriminalized legal framework can promote positive sexual and reproductive health.

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Attribution-NonCommercial-NoDerivs 2.5 Canada