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. 2016 May 16;11(5):e0155828.
doi: 10.1371/journal.pone.0155828. eCollection 2016.

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

M Eugenia Socías  1   2 , Jean Shoveller  3 , Chili Bean  4 , Paul Nguyen  1 , Julio Montaner  1   2 , Kate Shannon  1   2
Affiliations

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

M Eugenia Socías et al. PLoS One. .

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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Conflict of interest statement

Competing Interests: JM has received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Frequency of institutional-level barriers to health care among sex workers in Vancouver, Canada, 2010–2013.
See this image and copyright information in PMC

References

    1. Solar O, Irwin A. A conceptual framework for action on the social determinants of health Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: WHO, 2010.
    1. Global health and foreign policy, (2012).
    1. Transforming our world: the 2030 Agenda for Sustainable Development New York: United Nations, 2015.
    1. Andersen RM, Davidson PL. Improving access to care in America: Individual and contextual indicators Changing the US health care system: Key issues in health services, policy and management. San Francisco, CA: Jossey-Bass; 2001. p. 3–30.
    1. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International journal for equity in health. 2013;12:18 10.1186/1475-9276-12-18 - DOI - PMC - PubMed

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