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UBC Theses and Dissertations

Access to health care among women sex workers in Vancouver, Canada : universal health coverage in a criminalized sex work environment Socías, María Eugenia


Background: Universal access to health care is a critical determinant of health. Despite the numerous health inequities faced by women sex workers, research on access to health services among this population remains limited, particularly on the role of social-structural factors. This thesis sought to investigate sex workers experiences along the continuum of health care access in a setting with universal health coverage. Methods: Data was dawn from “An Evaluation of Sex Workers’ Health Access”(AESHA), an open prospective cohort of women sex workers in Vancouver, Canada. Logistic regression analyses were employed to evaluate correlates of institutional barriers to care (using generalized estimating equations for longitudinal data), and to assess baseline engagement in the HCV continuum of care. Extended cox regression analyses, with a confounder model approach, were used to examine the independent effect of depot medroxyprogesterone on HSV-2 acquisition. Results: These analyses demonstrated inequities faced by sex workers all along the continuum of health care access, from trying to reach health services (Chapter 2), to utilizing these services (Chapter 3), to the impacts of inadequate and sub-optimal care on their health outcomes (Chapter 4). Among 723 participants, 70.4% reported institutional barriers to health care, only half (52.9%) of 552 HCV-seronegative participants having a recent HCV test, and less than 1% of the 302 women living with HCV receiving treatment. Further, high incidence rates of HSV-2 were documented, with depot medroxyprogesterone use independently associated with approximately 4-times increased risk. Importantly, barriers to care appeared to be exacerbated among most vulnerable women, including sexual/gender minorities, migrants, women of Aboriginal Ancestry, uninsured and those with previous experiences of violence. Conclusions: Findings from this research revealed systemic and persistent barriers to appropriate and quality care among sex workers, highlighting the crucial role played by structural factors in shaping their health care seeking patterns and outcomes. These results further underscore the need to explore new models of care, as well as broader institutional and legal changes to fulfill women sex workers health and human rights, and fully realize the aims of the Canadian universal health system.

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