Characterizing Health Care Access among Cisgender Female Sex Workers with Substance Use Histories in Baltimore, Maryland.

Cisgender female sex workers (FSW) have low rates of health care utilization and persistent health disparities. The study uses baseline data from a structural intervention to understand health care access with cisgender FSW with substance use histories (N=370) in Baltimore, Maryland. The four outcome categories measuring health care access in the past six months were: no health care use/barrier to care (16% of sample), no use/no barrier (24%), use/barrier (25%), use/no barrier (36%, most able to access care). Using multinomial logistic regression, we found client-perpetrated violence, depressive symptoms, non-medical prescription opioid use, and history of drug use disclosure to providers associated with higher odds of being in groups with diminished health care access compared with use/no barrier. Colocating mental health and violence support with existing services used and trusted by FSW may remove structural and logistical barriers to care. Integrating harm reduction in health care settings can destigmatize substance use, fostering openness for substance use disclosure.