Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024).
We evaluated the association between discrimination and access to primary, mental health, and substance use services among sex workers. Using baseline and semi-annual questionnaire data from a community-based cohort of sex workers in Vancouver, Canada (09/2015-02/2024), we used bivariate and multiva...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2025-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0004647 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849222393716801536 |
|---|---|
| author | Kirstin Kielhold Kate Shannon Charlie Zhou Kaylee Ramage Eileen Pitpitan Andrea Krüsi Jennie Pearson Shira M Goldenberg |
| author_facet | Kirstin Kielhold Kate Shannon Charlie Zhou Kaylee Ramage Eileen Pitpitan Andrea Krüsi Jennie Pearson Shira M Goldenberg |
| author_sort | Kirstin Kielhold |
| collection | DOAJ |
| description | We evaluated the association between discrimination and access to primary, mental health, and substance use services among sex workers. Using baseline and semi-annual questionnaire data from a community-based cohort of sex workers in Vancouver, Canada (09/2015-02/2024), we used bivariate and multivariable logistic regression with generalized estimating equations to analyze the relationship between discrimination and access to primary care, mental health, and substance use services. Among 518 participants (2768 observations), the median discrimination score was 19 (IQR:11-25), indicating substantial discrimination. In separate multivariate models, every one-point increase in discrimination was associated with increased odds of experiencing barriers to health services (adjusted odds ratio (AOR):1.03, 95%CI:1.02-1.04), unable to access health services when needed (AOR:1.03, 95%CI:1.01-1.04), unmet need for mental health services (AOR:1.04, 95%CI:1.03-1.06), experiencing barriers to counseling for sexual trauma (AOR:1.04, 95%CI:1.02-1.05), and unmet need for substance use treatment (AOR:1.07, 95%CI:1.04-1.09). Discrimination is highly prevalent and associated with reduced access to primary, mental health, and substance use services among sex workers. There is a need for anti-discrimination efforts, including provider training and sex worker partnerships in primary care, alongside policy reforms. |
| format | Article |
| id | doaj-art-59d467b289fe472fb3f26c741aedd2da |
| institution | Kabale University |
| issn | 2767-3375 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj-art-59d467b289fe472fb3f26c741aedd2da2025-08-26T05:46:50ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752025-01-0156e000464710.1371/journal.pgph.0004647Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024).Kirstin KielholdKate ShannonCharlie ZhouKaylee RamageEileen PitpitanAndrea KrüsiJennie PearsonShira M GoldenbergWe evaluated the association between discrimination and access to primary, mental health, and substance use services among sex workers. Using baseline and semi-annual questionnaire data from a community-based cohort of sex workers in Vancouver, Canada (09/2015-02/2024), we used bivariate and multivariable logistic regression with generalized estimating equations to analyze the relationship between discrimination and access to primary care, mental health, and substance use services. Among 518 participants (2768 observations), the median discrimination score was 19 (IQR:11-25), indicating substantial discrimination. In separate multivariate models, every one-point increase in discrimination was associated with increased odds of experiencing barriers to health services (adjusted odds ratio (AOR):1.03, 95%CI:1.02-1.04), unable to access health services when needed (AOR:1.03, 95%CI:1.01-1.04), unmet need for mental health services (AOR:1.04, 95%CI:1.03-1.06), experiencing barriers to counseling for sexual trauma (AOR:1.04, 95%CI:1.02-1.05), and unmet need for substance use treatment (AOR:1.07, 95%CI:1.04-1.09). Discrimination is highly prevalent and associated with reduced access to primary, mental health, and substance use services among sex workers. There is a need for anti-discrimination efforts, including provider training and sex worker partnerships in primary care, alongside policy reforms.https://doi.org/10.1371/journal.pgph.0004647 |
| spellingShingle | Kirstin Kielhold Kate Shannon Charlie Zhou Kaylee Ramage Eileen Pitpitan Andrea Krüsi Jennie Pearson Shira M Goldenberg Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024). PLOS Global Public Health |
| title | Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024). |
| title_full | Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024). |
| title_fullStr | Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024). |
| title_full_unstemmed | Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024). |
| title_short | Everyday discrimination and barriers to primary care, mental health, and substance use services: Findings from a community-based cohort of sex workers in Vancouver, Canada (2015-2024). |
| title_sort | everyday discrimination and barriers to primary care mental health and substance use services findings from a community based cohort of sex workers in vancouver canada 2015 2024 |
| url | https://doi.org/10.1371/journal.pgph.0004647 |
| work_keys_str_mv | AT kirstinkielhold everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 AT kateshannon everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 AT charliezhou everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 AT kayleeramage everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 AT eileenpitpitan everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 AT andreakrusi everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 AT jenniepearson everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 AT shiramgoldenberg everydaydiscriminationandbarrierstoprimarycarementalhealthandsubstanceuseservicesfindingsfromacommunitybasedcohortofsexworkersinvancouvercanada20152024 |