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).

Abstract

To examine the intersectional associations between migration experiences and use of health and sex work community-based services among women sex workers. Data 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. Diverse community-based sex work venues in Metro Vancouver, Canada. 652 cis and trans women sex workers, with 149 (22.8%) being immigrants/migrants born outside of Canada (n=149). (1) Accessing health services when needed and (2) utilisation of sex work community-based services. In 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. Findings 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.