Data obtained between January and February were analyzed. Participants are followed up on a semi-annual basis. Multivariable logistic regression using generalized estimating equations was used to identify correlates of service uptake. Of FSWs included in the present analysis, Service use was independently associated with age adjusted odds ratio [AOR] 1. A sex-work-specific drop-in space for marginalized FSWs had high uptake.
Women-centered and low-threshold drop-in services can effectively link marginalized women with SRH services. In many international settings, female sex workers FSWs of reproductive age experience high reproductive and sexual health morbidity e. Access and utilization of broader SRH services among FSWsβincluding positive sexual health resources, contraceptive access, family planning, and pregnancy and prenatal supportβhave been largely neglected. Alongside a high burden of HIV and STIs among FSWs relative to the general population of women [ 2 , 4 , 6 , 7 ], studies show large SRH disparities, including poor access to pregnancy and parenting services, low rates of cervical cancer screening, a high burden of unwanted pregnancies, and low contraception use [ 5 , 8 ].
However, FSWs face increased risks for reproductive and sexual morbidity because they have multiple sexual partners and encounter gender and economic barriers to male condom use and contraceptive access and use [ 6 , 9 ]. FSWs face significant barriers to SRH access across low-, middle-, and high-income settings [ 6 , 8 ]. These barriers include the criminalization of sex work and HIV status non-disclosure, occupational stigma, discrimination by healthcare providers, limited knowledge of services available, reluctance to seek help from healthcare professionals because of mistrust, and social and health inequities e.
In Vancouver, Canada, FSWs have also been found to face significant challenges while pregnant or caring for a child, including lack of financial support, fear of partner violence, avoidance of services as a result of fear of child apprehension, and stigma [ 11 ].
The substantial health disparities and barriers to care experienced by FSWs highlights the need for appropriate, nonjudgmental services and outreach programs, which can promote better SRH access. Other effective strategies have been implemented in low- and middle-income countries LMICs , such as India [ 15 ], Brazil [ 16 ], and Mozambique [ 17 ]. Although these programs have been shown to successfully link FSWs with health and support services [ 6 ], data from high-income settings such as Canada remain scarce.
