Health system navigation for STI testing among migrant women sex workers in Metro Vancouver, Canada: a mixed methods...

Migrant sex workers in Canada experience substantial barriers to sexual health. This mixed-methods study examined their sexually transmitted infection (STI) testing experiences in Metro Vancouver, British Columbia. Quantitative data from 167 migrant women sex workers, a subsample of a longitudinal community cohort study, were analyzed. Multivariable generalized estimating equation analyses examined associations of healthcare barriers, insurance coverage, sex work outreach services, language, and stigma with recent STI testing. Qualitative thematic analysis of 22 interviews with indoor migrant women sex workers provided contextual understanding of barriers experienced. Experiencing healthcare barriers and limited English fluency were each associated with reduced recent STI testing; qualitative findings revealed institutional inadequacies in providing multilingual care. Sex work outreach service use was associated with increased recent testing, a finding also confirmed qualitatively. Although healthcare coverage showed no significant association, qualitative narratives revealed concerns about privacy and mandatory reporting, and hesitancy about testing with primary care providers due to stigma and limited multilingual providers. Sex work stigma was associated with increased recent STI testing, a seemingly counterintuitive result that was qualitatively elaborated through participants' strategic disclosure practices. The study suggests an urgent need for culturally responsive STI testing options that prioritize confidentiality, peer support, health system navigation resources, and stigma reduction.