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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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    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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