I can go back to my research, but there is also extensive research on access to health and social services for sex workers all over the country. There are a lot of reasons. There are passive barriers as well as active barriers that come in the way.
Passive barriers might be things like the geographic location of the place, or the hours they're open, or the fact that they are only for a specific gender, which might make it difficult for people to access those services. It could also be stigma, fear of stigma—and it's not just people being sensitive. There are horrifying experiences of stigma in all health and social services, even in very progressive ones.
One thing that is very specific in Winnipeg that I think exists everywhere, from the literature, is that there will be specific services that are for people in the sex trade, but they will only be open to people who have a specific experience in the sex trade. For example, they will implicitly or explicitly tell people that they have to refer to their experience as exploitation or human trafficking in order to receive services. Sometimes that is something that is implied, or they will counsel people in that way. That makes it difficult for people to go there. That was the situation in Manitoba at the beginning of my research, where there were no services offered.
Finally, I would say that the context of criminalization also is a huge barrier, because it makes people worried that disclosing that they are sex workers, which sometimes is relevant to do, might lead to inappropriate involvement of different agencies or services such as law enforcement or child protection services that might be inappropriately called.