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Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada

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  • M Eugenia Socías
  • Jean Shoveller
  • Chili Bean
  • Paul Nguyen
  • Julio Montaner
  • Kate Shannon

Abstract

Background: Access to health care is a crucial determinant of health. Yet, even within settings that purport to provide universal health coverage (UHC), sex workers’ experiences reveal systematic, institutionally ingrained barriers to appropriate quality health care. The aim of this study was to assess prevalence and correlates of institutional barriers to care among sex workers in a setting with UHC. Methods: Data was drawn from an ongoing community-based, prospective cohort of women sex workers in Vancouver, Canada (An Evaluation of Sex Workers’ Health Access). Multivariable logistic regression analyses, using generalized estimating equations (GEE), were employed to longitudinally investigate correlates of institutional barriers to care over a 44-month follow-up period (January 2010-August 2013). Results: In total, 723 sex workers were included, contributing to 2506 observations. Over the study period, 509 (70.4%) women reported one or more institutional barriers to care. The most commonly reported institutional barriers to care were long wait times (54.6%), limited hours of operation (36.5%), and perceived disrespect by health care providers (26.1%). In multivariable GEE analyses, recent partner- (adjusted odds ratio [AOR] = 1.46, % 95% Confidence Interval [CI] 1.10–1.94), workplace- (AOR = 1.31, 95% CI 1.05–1.63), and community-level violence (AOR = 1.41, 95% CI 1.04–1.92), as well as other markers of vulnerability, such as self-identification as a gender/sexual minority (AOR = 1.32, 95% CI 1.03–1.69), a mental illness diagnosis (AOR = 1.66, 95% CI 1.34–2.06), and lack of provincial health insurance card (AOR = 3.47, 95% CI 1.59–7.57) emerged as independent correlates of institutional barriers to health services. Discussion: Despite Canada’s UHC, women sex workers in Vancouver face high prevalence of institutional barriers to care, with highest burden among most marginalized women. These findings underscore the need to explore new models of care, alongside broader policy changes to fulfill sex workers’ health and human rights.

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  • M Eugenia Socías & Jean Shoveller & Chili Bean & Paul Nguyen & Julio Montaner & Kate Shannon, 2016. "Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-15, May.
  • Handle: RePEc:plo:pone00:0155828
    DOI: 10.1371/journal.pone.0155828
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    References listed on IDEAS

    as
    1. Deering, K.N. & Amin, A. & Shoveller, J. & Nesbitt, A. & Garcia-Moreno, C. & Duff, P. & Argento, E. & Shannon, K., 2014. "A systematic review of the correlates of violence against sex workers," American Journal of Public Health, American Public Health Association, vol. 104(5), pages 42-54.
    2. Wei Pan, 2001. "Akaike's Information Criterion in Generalized Estimating Equations," Biometrics, The International Biometric Society, vol. 57(1), pages 120-125, March.
    3. Dilley, J.A. & Simmons, K.W. & Boysun, M.J. & Pizacani, B.A. & Stark, M.J., 2010. "Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest," American Journal of Public Health, American Public Health Association, vol. 100(3), pages 460-467.
    4. Cruz, Taylor M., 2014. "Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination," Social Science & Medicine, Elsevier, vol. 110(C), pages 65-73.
    5. Hwang, S.W. & Ueng, J.J.M. & Chiu, S. & Kiss, A. & Tolomiczenko, G. & Cowan, L. & Levinson, W. & Redeimeier, D.A., 2010. "Universal health insurance and health care access for homeless persons," American Journal of Public Health, American Public Health Association, vol. 100(8), pages 1454-1461.
    6. Stueve, A. & O'Donnell, L.N. & Duran, R. & San Doval, A. & Blome, J., 2001. "Time-space sampling in minority communities: Results with young Latino men who have sex with men," American Journal of Public Health, American Public Health Association, vol. 91(6), pages 922-926.
    7. Buchmueller, T. & Carpenter, C.S., 2010. "Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007," American Journal of Public Health, American Public Health Association, vol. 100(3), pages 489-495.
    8. Stroumsa, D., 2014. "The state of transgender health care: Policy, law, and medical frameworks," American Journal of Public Health, American Public Health Association, vol. 104(3), pages 31-38.
    9. Colin D Mathers & Dejan Loncar, 2006. "Projections of Global Mortality and Burden of Disease from 2002 to 2030," PLOS Medicine, Public Library of Science, vol. 3(11), pages 1-20, November.
    10. Mayer, K.H. & Bradford, J.B. & Makadon, H.J. & Stall, R. & Goldhammer, H. & Landers, S., 2008. "Sexual and gender minority health: What we know and what needs to be done," American Journal of Public Health, American Public Health Association, vol. 98(6), pages 989-995.
    11. Bryant, Toba & Leaver, Chad & Dunn, James, 2009. "Unmet healthcare need, gender, and health inequalities in Canada," Health Policy, Elsevier, vol. 91(1), pages 24-32, June.
    12. Elena Argento & Katherine A Muldoon & Putu Duff & Annick Simo & Kathleen N Deering & Kate Shannon, 2014. "High Prevalence and Partner Correlates of Physical and Sexual Violence by Intimate Partners among Street and Off-Street Sex Workers," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-7, July.
    13. Swendeman, Dallas & Basu, Ishika & Das, Sankari & Jana, Smarajit & Rotheram-Borus, Mary Jane, 2009. "Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases," Social Science & Medicine, Elsevier, vol. 69(8), pages 1157-1166, October.
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    2. Gerardo Santoyo-Sánchez & César Merino-Soto & Sergio Flores-Hernández & Blanca Estela Pelcastre-Villafuerte & Hortensia Reyes-Morales, 2022. "Content Validity of a Scale Designed to Measure the Access of Older Adults to Outpatient Health Services," IJERPH, MDPI, vol. 19(16), pages 1-16, August.
    3. Jennie Pearson & Sylvia Machat & Jennifer McDermid & Shira M. Goldenberg & Andrea Krüsi, 2023. "An Evaluation of Indoor Sex Workers’ Sexual Health Access in Metro Vancouver: Applying an Occupational Health & Safety Lens in the Context of Criminalization," IJERPH, MDPI, vol. 20(3), pages 1-15, January.

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