ArticleBMJ open2025
Intersectional associations between citizenship, English fluency and racialisation on access to health and sex work community services: findings from a prospective cohort of sex workers in Canada (2014-2022).
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo examine the intersectional associations between migration experiences and use of health and sex work community-based services among women sex workers.
designData were drawn from An Evaluation of Sex Workers Health Access, a community-based cohort of sex workers from September 2014 to February 2022. Bivariate and multivariable regression with generalised estimating equations (GEEs) using interaction terms was used to separately model associations between intersectional aspects of the migration experience (citizenship, English fluency and Asian identity) and service access outcomes.
settingDiverse community-based sex work venues in Metro Vancouver, Canada.
participants652 cis and trans women sex workers, with 149 (22.8%) being immigrants/migrants born outside of Canada (n=149). PRIMARY OUTCOME MEASURES: (1) Accessing health services when needed and (2) utilisation of sex work community-based services.
resultsIn separate adjusted multivariable GEE models, we found significantly reduced odds of accessing health services when needed for women without Canadian citizenship and with limited English fluency, as well as those lacking Canadian citizenship but speaking fluently. Significantly reduced odds of accessing health services were also found among sex workers without Canadian citizenship and who identified as Asian. Regarding using sex work community-based services, women sex workers lacking Canadian citizenship and with limited English fluency, and those who were Asian and lacked Canadian citizenship, had low odds of using sex work community-based services.
conclusionsFindings show a gradient in the relationship between intersectional experiences of lack of citizenship, limited English fluency and Asian identity on sex workers' access to health services and sex work community-based services. Culturally responsive and language-tailored services that attend to and address these intersecting forms of structural marginalisation, along with the full decriminalisation of all aspects of sex work, and the removal of punitive sex work-related immigration policies, are recommended.
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