Navigating water, sanitation and hygiene (WaSH) access at the intersections of poverty, substance use, sex work and gender: A qualitative analysis of Vancouver, Canada's washroom trailer program
Bibliographic record
Abstract
Although substantial disparities in access to Water, Sanitation and Hygiene (WaSH) facilities persist in high-income countries (HICs), few studies have explored the WaSH experiences of marginalized and criminalized communities in HICs. Our study assessed how the Washroom Trailer Program (WTP), a municipal response to large-scale closures of public washrooms during the COVID-19 pandemic, shaped experiences of health (in)equity among unhoused/precariously housed people, sex workers and people who use substances in Vancouver, Canada. Specifically, we examined how WTP interventions shaped access to WaSH services, overdose prevention, risks of gender-based violence (GBV), and connections to health care and social services. We analyzed 47 semi-structured interviews (2023-2024) with WTP users, peer staff and site operators and drew on a structural determinants of health framework and an intersectional feminist lens to delineate how structural inequities intersect and compound to shape access to and engagement with WaSH infrastructure. Our results indicate that unhoused/precariously housed women, sex workers and people who use substances face heightened gender safety concerns in their attempts to carry out regular WaSH activities, with unique gendered vulnerabilities to physical and sexual violence. We found that WTP interventions have the potential to reduce health and drug-related vulnerabilities, including risks of GBV, primarily through the integration of low-barrier gender-responsive anti-violence and harm-reduction supports alongside WaSH infrastructure. The findings of this study highlight the potential benefits of scaling and evaluating similar WaSH interventions in other urban settings in HICs as a pragmatic means of improving overall safety, health and well-being among marginalized and criminalized populations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.019 | 0.010 |
| Scholarly communication | 0.005 | 0.001 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".