Abstract
OBJECTIVES: This paper examines unmet health care needs in one of Canada’s most hard-to-reach populations, adult sex workers, and investigates whether their reasons for not accessing health care are different from those of other Canadians.
METHODS: Data gathered in 2012–2013 from sex workers aged 19 and over (n = 209) in five Canadian census metropolitan areas (CMAs) were analyzed to estimate the perceived health, health care access and level of unmet health care needs of sex workers, and their principal reasons for not accessing health care. These data were collected using questions identical to those of the Canadian Community Health Survey (CCHS) Cycle 2.1, 2003. The results were compared with those of residents aged 19 and over in the same CMAs who had participated in the CCHS.
RESULTS: Sex workers reported notably worse perceived mental health, poorer social determinants of health (with the exception of income) and nearly triple the prevalence of unmet health care needs (40.4% vs. 14.9%). Those with the greatest unmet health care needs in both groups were younger, unmarried or single and in poorer health, and reported lower income and a weaker sense of community belonging. Even without these within-group risk factors, sex workers were more likely to report unmet health care needs compared with CCHS respondents. Sex workers were also more likely to identify “didn’t get around to it”, “too busy”, “cost”, “transportation problems” and “dislike doctors/afraid” as reasons for eschewing care.
CONCLUSION: Equity policies that reduce cost and transportation barriers may go some way in helping sex workers access needed health care. Qualitative research is needed to better understand the realities of sex workers’ personal and work lives, including the degree of freedom they have in accessing health care when they need it, but also their experiences when they do manage to engage with the health care system.
Key Words: Social determinants of health, access to health care, sex workers, unmet health care needs, barriers
Résumé
OBJECTIFS : Examiner les besoins de soins de santé insatisfaits dans l’une des populations les plus difficiles à atteindre du Canada, les travailleuses et travailleurs du sexe d’âge adulte, et déterminer si les raisons pour lesquelles ces personnes ne se prévalent pas des soins de santé sont différentes de celles d’autres Canadiens.
MÉTHODE : Nous avons analysé des données recueillies en 2012–2013 auprès de travailleuses et de travailleurs du sexe de 19 ans et plus (n = 209) dans cinq régions métropolitaines de recensement (RMR) canadiennes afin d’estimer leur santé perçue, leur accès aux soins de santé et le niveau de leurs besoins de soins de santé insatisfaits, ainsi que leurs principales raisons de ne pas accéder aux soins de santé. Les données ont été recueillies à l’aide de questions identiques à celles du cycle 2.1 de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) de 2003. Nous avons comparé leurs réponses à celles de résidents de 19 ans et plus vivant dans les mêmes RMR et ayant participé à l’ESCC.
RÉSULTATS : Les travailleuses et travailleurs du sexe ont fait état d’une santé mentale perçue remarquablement moins bonne, de moins bons déterminants sociaux de la santé (à l’exception du revenu) et de près de trois fois la prévalence de besoins de soins de santé insatisfaits (40,4 % c. 14,9 %). Les répondants des deux groupes ayant le plus de besoins de soins de santé insatisfaits étaient plus jeunes, non mariés ou célibataires et en moins bonne santé, et ont fait état d’un revenu inférieur et d’un moindre sentiment d’appartenance communautaire. Même sans ces facteurs de risque à l’intérieur des groupes, les travailleuses et travailleurs du sexe étaient plus susceptibles de dire avoir des besoins de soins de santé insatisfaits que les répondants de l’ESCC. Les travailleuses et travailleurs du sexe étaient aussi plus susceptibles d’indiquer les réponses « N’a pas eu l’occasion de s’en occuper », « Trop occupé-e », « Coût », « Problème de transport » et « Aversion pour les médecins/peur » pour expliquer leur évitement des soins.
CONCLUSION : Les politiques d’équité qui réduisent les obstacles du coût et du transport peuvent en partie aider les travailleuses et travailleurs du sexe à accéder aux soins de santé dont ils ont besoin. Il faudrait faire de la recherche qualitative pour mieux comprendre les réalités de la vie personnelle et professionnelle de ces personnes, notamment leur degré de liberté lorsqu’il s’agit d’obtenir des soins de santé lorsque c’est nécessaire, mais aussi leurs expériences quand elles réussissent à interagir avec le système de soins de santé.
Mots Clés: déterminants sociaux de la santé, accès aux soins médicaux, travailleuses et travailleurs du sexe, besoins de soins de santé insatisfaits, obstacles
Footnotes
Acknowledgements: This research was funded by the Institute of Gender & Health, part of the Canadian Institutes of Health Research. We thank those who participated in the interviews; without their input, this work would not have been possible.
Conflict of Interest: None to declare.
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