Hu Ran, Krüsi Andrea, Shannon Kate, Zhou Haoxuan, Ge Alaina, Chong Grace, Goldenberg Shira M
College of Social Work, The Ohio State University, Columbus, Ohio, USA.
School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada.
BMJ Open. 2025 Mar 18;15(3):e092124. doi: 10.1136/bmjopen-2024-092124.
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.
研究移民经历与女性性工作者使用健康及性工作社区服务之间的交叉关联。
数据取自《性工作者健康服务评估》，这是一个基于社区的性工作者队列研究，时间跨度为2014年9月至2022年2月。采用带有交互项的广义估计方程（GEE）进行双变量和多变量回归，分别对移民经历的交叉方面（公民身份、英语流利程度和亚洲身份）与服务获取结果之间的关联进行建模。
加拿大温哥华市中心不同的基于社区的性工作场所。
652名顺性别和跨性别女性性工作者，其中149名（22.8%）是在加拿大境外出生的移民/流动人口（n = 149）。
（1）在需要时获得健康服务；（2）使用基于社区的性工作服务。
在单独调整的多变量GEE模型中，我们发现，没有加拿大公民身份且英语流利程度有限的女性，以及缺乏加拿大公民身份但英语流利的女性，在需要时获得健康服务的几率显著降低。在没有加拿大公民身份且认同自己为亚洲人的性工作者中，获得健康服务的几率也显著降低。关于使用基于社区的性工作服务，缺乏加拿大公民身份且英语流利程度有限的女性性工作者，以及亚洲人且缺乏加拿大公民身份的女性，使用基于社区的性工作服务的几率较低。
研究结果表明，在缺乏公民身份、英语流利程度有限和亚洲身份的交叉经历与性工作者获得健康服务及基于社区的性工作服务之间的关系中存在梯度差异。建议提供具有文化响应性和语言针对性的服务，关注并解决这些交叉形式的结构性边缘化问题，同时全面将性工作的各个方面合法化，并取消与性工作相关的惩罚性移民政策。
