Kielhold Kirstin, Shannon Kate, Zhou Charlie, Ramage Kaylee, Pitpitan Eileen, Krüsi Andrea, Pearson Jennie, Goldenberg Shira M
San Diego State and University of California San Diego Joint Doctoral Program in Public Health (Global Health), San Diego, California, United States of America.
School of Public Health, San Diego State University, San Diego, California, United States of America.
PLOS Glob Public Health. 2025 Jun 16;5(6):e0004647. doi: 10.1371/journal.pgph.0004647. eCollection 2025.
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.
我们评估了性工作者中歧视与获得初级医疗、心理健康及物质使用服务之间的关联。利用加拿大温哥华一个以社区为基础的性工作者队列（2015年9月 - 2024年2月）的基线和半年期问卷调查数据，我们使用广义估计方程的双变量和多变量逻辑回归来分析歧视与获得初级医疗、心理健康及物质使用服务之间的关系。在518名参与者（2768次观察）中，歧视得分中位数为19（四分位间距：11 - 25），表明存在严重歧视。在单独的多变量模型中，歧视得分每增加1分，与遇到医疗服务障碍的几率增加相关（调整后的优势比（AOR）：1.03，95%置信区间：1.02 - 1.04）、在需要时无法获得医疗服务（AOR：1.03，95%置信区间：1.01 - 1.04）、心理健康服务需求未得到满足（AOR：1.04，95%置信区间：1.03 - 1.06）、遭受性创伤咨询障碍（AOR：1.04，95%置信区间：1.02 - 1.05）以及物质使用治疗需求未得到满足（AOR：1.07，95%置信区间：1.04 - 1.09）相关。歧视在性工作者中非常普遍，并且与获得初级医疗、心理健康及物质使用服务的机会减少相关。需要开展反歧视工作，包括对医疗服务提供者的培训以及在初级医疗中与性工作者建立伙伴关系，同时进行政策改革。
