Social-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021)
Abstract Background Due to social-structural marginalization, sex workers experience health inequities including a high prevalence of sexually transmitted and blood-borne infections, mental health disorders, trauma, and substance use, alongside a multitude of barriers to HIV and substance use servic...
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| Language: | English |
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BMC
2025-01-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-12275-x |
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| author | Miriam T. H. Harris Kate Shannon Andrea Krüsi Haoxuan Zhou Shira M. Goldenberg |
| author_facet | Miriam T. H. Harris Kate Shannon Andrea Krüsi Haoxuan Zhou Shira M. Goldenberg |
| author_sort | Miriam T. H. Harris |
| collection | DOAJ |
| description | Abstract Background Due to social-structural marginalization, sex workers experience health inequities including a high prevalence of sexually transmitted and blood-borne infections, mental health disorders, trauma, and substance use, alongside a multitude of barriers to HIV and substance use services. Given limited evidence on sex workers’ broader primary healthcare access, we aimed to examine social-structural factors associated with primary care use among sex workers over 7 years. Methods Data were derived from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women (cis and trans) sex workers in Metro Vancouver, from 2014 to 2021. Descriptive statistics were used to summarize the proportion of primary care use in the past six months and to assess primary care trends over time from 2014–2021. We used multivariate logistic regression with generalized estimating equations (GEE) to identify social-structural factors associated with primary care access (seeing a family doctor in the last six months), after adjusting for confounders. Results Amongst the 646 participants, most (87.4%) accessed primary care at some point during the study period, and primary care use in the last 6 months was relatively stable (ranging from 60–78%) across each follow-up period. At first available observation, participants faced a high burden of sexually transmitted and blood-borne infections (STBBIs) (48.0%, 11.5%, and 10.4% were HCV, HIV, or STI seropositive, respectively), 56.8% were diagnosed with a mental health disorder, 8.1% had recently overdosed, and 14.7% were recently hospitalized. In multivariable GEE analysis, exposure to intimate partner violence was associated with reduced primary care use (Adjusted odds ratios (AOR) 0.63, 95% Confidence interval (CI): 0.49—0.82), and limited English fluency was marginally associated (AOR 0.76 CI: 0.51—1.14). Conclusions This study characterized primary care use and its social-structural determinants among sex workers over 7 years. Participants faced a high burden of STBBIs and other health disparities, and a proportion faced gaps in primary care utilization. Scale-up of trauma-informed, culturally and linguistically tailored, sex worker-friendly primary care models are needed, alongside structural interventions to decriminalize and destigmatize sex work and substance use. |
| format | Article |
| id | doaj-art-8d8c1f9613a0440e8a4d993714408909 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-8d8c1f9613a0440e8a4d9937144089092025-01-26T12:22:08ZengBMCBMC Health Services Research1472-69632025-01-0125111010.1186/s12913-025-12275-xSocial-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021)Miriam T. H. Harris0Kate Shannon1Andrea Krüsi2Haoxuan Zhou3Shira M. Goldenberg4Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center PlaceCentre for Gender and Sexual Health Equity, Faculty of MedicineDivision of Social Medicine, Department of Medicine, University of British ColumbiaCentre for Gender and Sexual Health Equity, Faculty of MedicineCentre for Gender and Sexual Health Equity, Faculty of MedicineAbstract Background Due to social-structural marginalization, sex workers experience health inequities including a high prevalence of sexually transmitted and blood-borne infections, mental health disorders, trauma, and substance use, alongside a multitude of barriers to HIV and substance use services. Given limited evidence on sex workers’ broader primary healthcare access, we aimed to examine social-structural factors associated with primary care use among sex workers over 7 years. Methods Data were derived from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women (cis and trans) sex workers in Metro Vancouver, from 2014 to 2021. Descriptive statistics were used to summarize the proportion of primary care use in the past six months and to assess primary care trends over time from 2014–2021. We used multivariate logistic regression with generalized estimating equations (GEE) to identify social-structural factors associated with primary care access (seeing a family doctor in the last six months), after adjusting for confounders. Results Amongst the 646 participants, most (87.4%) accessed primary care at some point during the study period, and primary care use in the last 6 months was relatively stable (ranging from 60–78%) across each follow-up period. At first available observation, participants faced a high burden of sexually transmitted and blood-borne infections (STBBIs) (48.0%, 11.5%, and 10.4% were HCV, HIV, or STI seropositive, respectively), 56.8% were diagnosed with a mental health disorder, 8.1% had recently overdosed, and 14.7% were recently hospitalized. In multivariable GEE analysis, exposure to intimate partner violence was associated with reduced primary care use (Adjusted odds ratios (AOR) 0.63, 95% Confidence interval (CI): 0.49—0.82), and limited English fluency was marginally associated (AOR 0.76 CI: 0.51—1.14). Conclusions This study characterized primary care use and its social-structural determinants among sex workers over 7 years. Participants faced a high burden of STBBIs and other health disparities, and a proportion faced gaps in primary care utilization. Scale-up of trauma-informed, culturally and linguistically tailored, sex worker-friendly primary care models are needed, alongside structural interventions to decriminalize and destigmatize sex work and substance use.https://doi.org/10.1186/s12913-025-12275-xWomenSex workPrimary careViolenceIm/migrationBarriers |
| spellingShingle | Miriam T. H. Harris Kate Shannon Andrea Krüsi Haoxuan Zhou Shira M. Goldenberg Social-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021) BMC Health Services Research Women Sex work Primary care Violence Im/migration Barriers |
| title | Social-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021) |
| title_full | Social-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021) |
| title_fullStr | Social-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021) |
| title_full_unstemmed | Social-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021) |
| title_short | Social-structural barriers to primary care among sex workers: findings from a community-based cohort in Vancouver, Canada (2014–2021) |
| title_sort | social structural barriers to primary care among sex workers findings from a community based cohort in vancouver canada 2014 2021 |
| topic | Women Sex work Primary care Violence Im/migration Barriers |
| url | https://doi.org/10.1186/s12913-025-12275-x |
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