SARS-CoV-2 testing and COVID-19-related primary care use among people with citizenship, permanent residency, and temporary immigration status: an analysis of population-based administrative data in British Columbia.

OBJECTIVES: Having temporary immigration status affords limited rights, workplace protections, and access to services. There is not yet research data on impacts of the COVID-19 pandemic for people with temporary immigration status in Canada. METHODS: We use linked administrative data to describe SARS-CoV-2 testing, positive tests, and COVID-19 primary care service use in British Columbia from January 1, 2020 to July 31, 2021, stratified by immigration status (citizen, permanent resident, temporary resident). We plot the rates of people tested and confirmed positive for COVID-19 by week from April 19, 2020 to July 31, 2021 across immigration groups. We use logistic regression to estimate adjusted odds ratios of a positive SARS-CoV-2 test, access to testing, and primary care among people with temporary status or permanent residency, compared with people who hold citizenship. RESULTS: A total of 4,146,593 people with citizenship, 914,089 people with permanent residency, and 212,215 people with temporary status were included. Among people with temporary status, 52.1% had "male" administrative sex and 74.4% were ages 20-39, compared with 50.1% and 24.4% respectively among those with citizenship. Of people with temporary status, 4.9% tested positive for SARS-CoV-2 over this period, compared with 4.0% among people with permanent residency and 2.1% among people with citizenship. Adjusted odds of a positive SARS-CoV-2 test among people with temporary status were almost 50% higher (aOR 1.42, 95% CI 1.39, 1.45), despite having half the odds of access to testing (aOR 0.53, 95% CI 0.53, 0.54) and primary care (aOR 0.50, 95% CI 0.49, 0.52). CONCLUSION: Interwoven immigration, health, and occupational policies place people with temporary status in circumstances of precarity and higher health risk. Reducing precarity accompanying temporary status, including regularization pathways, and decoupling access to health care from immigration status can address health inequities.

RéSUMé: OBJECTIFS: Le statut d'immigration temporaire confère des droits, des mesures de protection au travail et un accès aux services limités. Il n'y a pas encore de données de recherche sur les impacts de la pandémie de COVID-19 chez les personnes ayant un statut d'immigration temporaire au Canada. MéTHODE: Nous utilisons des données administratives maillées pour décrire le dépistage du SRAS-CoV-2, les tests positifs et l'utilisation des services de soins de première ligne liés à la COVID-19 en Colombie-Britannique entre le 1er janvier 2020 et le 31 juillet 2021, stratifiées selon le statut d'immigration (citoyenneté, résidence permanente, résidence temporaire). Nous reportons sur des graphiques les taux hebdomadaires de personnes testées et confirmées positives pour la COVID-19 entre le 19 avril 2020 et le 31 juillet 2021 dans les groupes d'immigration. Nous utilisons la régression logistique pour estimer les rapports de cotes ajustés d'un test positif pour le SRAS-CoV-2, de l'accès au dépistage et de l'accès aux soins primaires chez les personnes ayant le statut de résidents temporaires ou permanents comparativement aux personnes ayant la citoyenneté canadienne. RéSULTATS: En tout, 4 146 593 citoyens, 914 089 résidents permanents et 212 215 résidents temporaires ont été inclus. Chez les personnes ayant le statut de résidents temporaires, 52,1 % étaient de sexe administratif « masculin ¼ et 74,4 % avaient entre 20 et 39 ans, contre 50,1 % et 24,4 % respectivement chez les personnes ayant la citoyenneté. Chez les résidents temporaires, 4,9 % avaient obtenu un test positif pour le SRAS-CoV-2 au cours de la période de l'étude, contre 4 % chez les résidents permanents et 2,1 % chez les citoyens. La probabilité ajustée d'un test positif pour le SRAS-CoV-2 chez les personnes ayant le statut de résidents temporaires était près de 50 % plus élevée (RCa 1,42, IC de 95 % 1,39, 1,45), même si leurs probabilités d'accès au dépistage (RCa 0,53, IC de 95 % 0,53, 0,54) et aux soins primaires (RCa 0,50, IC de 95 % 0,49, 0,52) étaient moitié moindres. CONCLUSION: La conjugaison des politiques d'immigration, de santé et de main-d'œuvre met les personnes ayant le statut de résidents temporaires en situation de précarité et de risques accrus pour la santé. La réduction de la précarité qui accompagne le statut temporaire, dont les voies de régularisation, et le découplage entre l'accès aux soins de santé et le statut d'immigration pourraient répondre aux iniquités en santé.

Association between interrupted access to sex work community services during the COVID-19 pandemic and changes in sex workers' occupational conditions: findings from a community-based cohort study in Vancouver, Canada.

OBJECTIVES: Globally, criminalisation has shaped sex workers' structural exclusion from occupational protections, and this exclusion has been exacerbated during the COVID-19 pandemic. While community organisations aim to bridge this gap through providing health and safety resources for sex workers, many were forced to scale back services when Canadian provinces declared a state of emergency at the pandemic onset. As little empirical research has examined the impacts of sex work community services interruptions amid COVID-19, our objectives were to (1) examine the correlates of interrupted access to community services and (2) model the independent association between interrupted access to community services and changes in working conditions (ie, self-reported increases in workplace violence or fear of violence), among sex workers during the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: As part of an ongoing community-based cohort of sex workers in Vancouver, Canada (An Evaluation of Sex Workers Health Access, 2010-present), 183 participants completed COVID-19 questionnaires between April 2020 and April 2021. ANALYSIS: Cross-sectional analysis used bivariate and multivariable logistic regression with explanatory and confounder modelling approaches. RESULTS: 18.6% of participants (n=34) reported interrupted access to community services (closure/reduction in drop-in hours, reduced access to spaces offering sex worker supports and/or reduced access/contact with outreach services). In multivariable analysis, sex workers who had difficulty maintaining social supports during COVID-19 (adjusted OR, AOR 2.29, 95% CI 0.95 to 5.56) and who experienced recent non-fatal overdose (AOR 2.71, 95% CI 0.82 to 8.98) faced marginally increased odds of service interruptions. In multivariable confounder analysis, interrupted access to community services during COVID-19 was independently associated with changes in working conditions (ie, self-reported increases in workplace violence or fear of violence; AOR 4.00, 95% CI 1.01 to 15.90). CONCLUSIONS: Findings highlight concerning implications of community service interruptions for sex workers' labour conditions. Sustainable funding to community organisations is urgently needed to uphold sex workers' occupational safety amid COVID-19 and beyond.

Barriers to Governmental Income Supports for Sex Workers during COVID-19: Results of a Community-Based Cohort in Metro Vancouver

The COVID-19 pandemic has brought into stark focus the economic inequities faced by precarious, criminalized and racialized workers. Sex workers have been historically excluded from structural supports due to criminalization and occupational stigma. Given emerging concerns regarding sex workers' inequitable access to COVID-19 income supports in Canada and elsewhere, our objective was to identify prevalence and correlates of accessing emergency income supports among women sex workers in Vancouver, Canada. Data were drawn from a longstanding community-based open cohort (AESHA) of cis and trans women sex workers in Metro Vancouver from April 2020–April 2021 (n = 208). We used logistic regression to model correlates of access to COVID-19 income supports. Among 208 participants, 52.9% were Indigenous, 6.3% Women of Colour (Asian, Southeast Asian, or Black), and 40.9% white. Overall, 48.6% reported accessing income supports during the pandemic. In adjusted multivariable analysis, non-injection drug use was associated with higher odds of accessing COVID-19 income supports (aOR: 2.58, 95% CI: 1.31–5.07), whereas Indigenous women faced reduced odds (aOR 0.55, 95% CI 0.30–1.01). In comparison with other service workers, access to income supports among sex workers was low overall, particularly for Indigenous sex workers, demonstrating the compounding impacts of colonization and disproportionate criminalization of Indigenous sex workers. Results highlight the need for structural supports that are low-barrier and culturally-safe to support sex workers' health, safety and dignity.