Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021)
Background: Sex workers face substantial health inequities related to sexual health and gender-based violence, many of which are amplified for the large proportion of workers who are racialized im/migrants. While criminalization and stigma are known barriers to health care for this population, we kn...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Journal of Migration and Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666623524000576 |
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| author | Shira M. Goldenberg Maggie Hamel-Smith Grassby Alaina Ge Melissa Braschel Charlie Zhou Kate Shannon |
| author_facet | Shira M. Goldenberg Maggie Hamel-Smith Grassby Alaina Ge Melissa Braschel Charlie Zhou Kate Shannon |
| author_sort | Shira M. Goldenberg |
| collection | DOAJ |
| description | Background: Sex workers face substantial health inequities related to sexual health and gender-based violence, many of which are amplified for the large proportion of workers who are racialized im/migrants. While criminalization and stigma are known barriers to health care for this population, we know little about health insurance coverage, and in particular how this relates to im/migration experience and racialization. We examined associations between im/migration status, duration, and racialization on gaps in health insurance coverage in a cohort of women sex workers. Methods: Analyses used data from a prospective, community-based cohort of women sex workers in Vancouver, BC (Sept 2014-August 2021). Interviewer-administered questionnaires were by experiential (current/former sex workers) and community-based staff. We developed multivariable logistic regression confounder models with generalized estimating equations (GEE) to examine associations between migration and racialization exposures of interest and health insurance coverage. Results: Of 644 sex workers, 411 (63.8%) reported lacking health insurance coverage for services needed during the 7-year study. In multivariable GEE analysis, precarious im/migration status (adjusted odds ratio (AOR) 2.37, 95% confidence interval (CI) 1.56 – 3.60), recent (AOR 4.22, 95% CI 2.42 – 7.35) and long-term (AOR 2.13, 95% CI 1.54 – 2.96) migration, and being a racialized Asian im/migrant (AOR 3.06, 95% CI 2.14 – 4.39) were associated with recent lack of health insurance coverage. Conclusion: Policy and program reforms are needed to decouple health insurance access from immigration status, remove mandatory waiting periods for health insurance coverage, and ensure that provincial insurance provides sufficient coverage for marginalized women's healthcare needs. |
| format | Article |
| id | doaj-art-caee247dbd8f42e499cac74f58e4df24 |
| institution | OA Journals |
| issn | 2666-6235 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Migration and Health |
| spelling | doaj-art-caee247dbd8f42e499cac74f58e4df242025-08-20T02:31:13ZengElsevierJournal of Migration and Health2666-62352024-01-011010026810.1016/j.jmh.2024.100268Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021)Shira M. Goldenberg0Maggie Hamel-Smith Grassby1Alaina Ge2Melissa Braschel3Charlie Zhou4Kate Shannon5Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, Hardy Tower Room 119, 5500 Campanile Drive, San Diego, CA 92182-4162, United States; Corresponding author at: School of Public Health, San Diego State University, United States.Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, CanadaDepartment of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, CanadaDepartment of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, CanadaDepartment of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, CanadaDepartment of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, CanadaBackground: Sex workers face substantial health inequities related to sexual health and gender-based violence, many of which are amplified for the large proportion of workers who are racialized im/migrants. While criminalization and stigma are known barriers to health care for this population, we know little about health insurance coverage, and in particular how this relates to im/migration experience and racialization. We examined associations between im/migration status, duration, and racialization on gaps in health insurance coverage in a cohort of women sex workers. Methods: Analyses used data from a prospective, community-based cohort of women sex workers in Vancouver, BC (Sept 2014-August 2021). Interviewer-administered questionnaires were by experiential (current/former sex workers) and community-based staff. We developed multivariable logistic regression confounder models with generalized estimating equations (GEE) to examine associations between migration and racialization exposures of interest and health insurance coverage. Results: Of 644 sex workers, 411 (63.8%) reported lacking health insurance coverage for services needed during the 7-year study. In multivariable GEE analysis, precarious im/migration status (adjusted odds ratio (AOR) 2.37, 95% confidence interval (CI) 1.56 – 3.60), recent (AOR 4.22, 95% CI 2.42 – 7.35) and long-term (AOR 2.13, 95% CI 1.54 – 2.96) migration, and being a racialized Asian im/migrant (AOR 3.06, 95% CI 2.14 – 4.39) were associated with recent lack of health insurance coverage. Conclusion: Policy and program reforms are needed to decouple health insurance access from immigration status, remove mandatory waiting periods for health insurance coverage, and ensure that provincial insurance provides sufficient coverage for marginalized women's healthcare needs.http://www.sciencedirect.com/science/article/pii/S2666623524000576MigrationHealth insuranceHealth equityStructural racismImmigration statusMarginalized women |
| spellingShingle | Shira M. Goldenberg Maggie Hamel-Smith Grassby Alaina Ge Melissa Braschel Charlie Zhou Kate Shannon Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021) Journal of Migration and Health Migration Health insurance Health equity Structural racism Immigration status Marginalized women |
| title | Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021) |
| title_full | Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021) |
| title_fullStr | Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021) |
| title_full_unstemmed | Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021) |
| title_short | Gaps in health coverage for racialized im/migrant sex workers in metro Vancouver: Findings of a community-based cohort study (2014–2021) |
| title_sort | gaps in health coverage for racialized im migrant sex workers in metro vancouver findings of a community based cohort study 2014 2021 |
| topic | Migration Health insurance Health equity Structural racism Immigration status Marginalized women |
| url | http://www.sciencedirect.com/science/article/pii/S2666623524000576 |
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