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Commentaries

Implications of the COVID-19 Pandemic on LGBTQ Communities

Krause, Kristen D. PhD, MPH

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Journal of Public Health Management and Practice: January/February 2021 - Volume 27 - Issue - p S69-S71
doi: 10.1097/PHH.0000000000001273
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As of August 2020, the United States has reported more than 5.5 million confirmed cases and almost 170 000 fatalities as a result of SARS-CoV-2 (the novel coronavirus, which causes COVID-19).1 Since the onset of the pandemic in early 2020, researchers have begun to delineate the myriad economic,2 racial,3 and geographic4 health disparities associated with the overall risk for contracting COVID-19. While these inequities are significant to highlight, it also imperative to acknowledge and understand how COVID-19 has disproportionately impacted lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals and communities who also face many of the aforementioned health disparities.

The economic ramifications of COVID-19 will likely be felt widespread and by all; however, LGBTQ individuals are particularly vulnerable. In general, LGBTQ people are more likely to struggle financially, with 30.2% of LGBTQ Americans losing their jobs and 17.9% reporting reduced wages.5 In addition, 20% of LGBTQ folks reported that their personal finances are “much worse off” compared with 11% of the general population and they are twice as likely to believe their finances will be worse in a year from now.5 With the global economy being at its worst since World War II,6 it will be challenging for LGBTQ communities to bounce back as quickly as their heterosexual counterparts.

There are also considerable health care access challenges to take into consideration. Prior to the onset of the pandemic, LGBTQ individuals often reported inadequate care due to previous stigmatizing experiences in health care settings7,8 and lack of provider knowledge on health care needs.9,10 In addition, in 2018, 17% of LGBTQ adults did not have any kind of health insurance coverage compared with 12% of the general population.11 This disparity is even greater among LGBTQ adults of color and transgender adults, with 23% and 22%, respectively, reporting lack of health care coverage.11 Although many states and local jurisdictions are offering free COVID-19 testing, there should be more targeted outreach toward LGBTQ communities to ensure a safe and stigma-free testing experience.12

The Intersection of COVID-19 With Other Health Outcomes Impacting LGBTQ Communities

While COVID-19 is presently at the forefront of most public health initiatives and programming, it is not the only pressing health concern, especially for LGBTQ folks. Mental health burdens in LGBTQ persons are likely to be intensified by COVID-19.13 Researchers in Hong Kong found that stressors specifically related to identifying as a sexual minority significantly contributed to the variance explained by anxiety and depressive symptoms that were beyond COVID-19–related stressors.14 Moreover, physical and social distancing measures while important can have a detrimental effect on mental health and well-being in LGBTQ communities that already face structural and systemic vulnerabilities.13,15 This is particularly true for older LGBTQ adults who already face higher levels of social isolation and loneliness.16–18

In addition to mental health stressors, gay men and transgender individuals are at an increased risk for experiencing violence during the COVID-19 pandemic. In Colombia, Panama, and Peru, physical distancing rules are being implemented and enforced on the basis of a binary understanding of gender,19,20 meaning that essential services can only be accessed on alternate days of the week.21 These policies had a severe impact on the Peruvian transgender community as policing of the laws has resulted in public humiliation and physical assault, among other transphobic actions.21 In the United States, there is a growing concern that shelter-in-place orders will increase the risk and occurrence of intimate partner violence among gay men.22

It is also well documented that LGBTQ people are at a higher risk for different chronic illnesses including various respiratory conditions (eg, asthma and chronic obstructive pulmonary disease),23 diabetes,24 and cardiovascular disease,25 all of which are risk factors for COVID-19.26 Given that 37% of LGBTQ adults smoke compared with 27% of the general population,11 this is particularly concerning because COVID-19 spreads primarily through the transfer of respiratory droplets from person to person and can cause significant lung damage.27 Taken together, the numerous mental and physical health conditions impacting this population underscore the importance of having a clear understanding of the impact of COVID-19 on LGBTQ people.

Missing Key Demographic Information on COVID-19 Testing Forms

To recognize the implications of COVID-19 on LGBTQ communities, we need to know how many LGBTQ folks have tested positive for the virus. This is extremely challenging because there is no uniform system of collecting general demographic data throughout the United States, and, often, questions on sexual orientation and gender identity (SOGI) are not included on testing forms. At the time of this writing, there are only a handful of states and districts collecting or are planning to collect SOGI data including California,28 Pennsylvania,29 and Washington, District of Columbia.30 LGBTQ advocates have been pushing lawmakers and health officials in other states such as New York,31 New Jersey,32 and Massachusetts33 to include SOGI items on COVID testing forms, with little success to date. While this information undoubtedly is important, there are other obstacles facing LGBTQ communities with regard to data that also need to be addressed.

Moving Forward: Ensure LGBTQ People Are Counted

Until SOGI is recognized as an innate aspect of a person's identity and overall being, we will continue to face an uphill battle to ensure we are equitably counted where it matters the most. The majority of current public health surveillance systems in place throughout the United States do not incorporate basic demographic data on LGBTQ people.30 Moreover, many health care institutions do not uniformly collect SOGI data in their patient record systems.30 Similar to other demographic data on race/ethnicity or marital status, asking questions around SOGI should be commonplace in these systems and automatically included. While privacy issues around this information are often cited as a reason to not include it,34 individuals can always have the option of not answering those particular questions as they do for all other demographic inquires.

Although adding these questions to public health surveillance systems is crucial, these efforts are simply not enough. LGBTQ people will continue to be unjustly impacted by myriad inequities until we are counted correctly in the US Census and the American Community Survey.35 If the federal government will not take action, state and local governments can issue executive orders or pass legislation to properly ascertain the most important data points on LGBTQ individuals and communities. In doing so, some institutions and organizations may have to rise up and meet the potential challenge to update outdated forms and technology. The benefits of having this information in a consistent and uniform manner can help facilitate information sharing between public health departments, researchers, and clinical care providers in order to provide better care and reduce the inequities experienced within LGBTQ communities.36

Conclusion

In times of crisis and turmoil, it is imperative that scientists, other researchers, and public officials have access to information that can help protect and serve the most vulnerable populations and communities. In the case of the COVID-19 pandemic, we are currently forced to make educated assumptions on how the virus will disproportionately impact LGBTQ communities because the necessary data on sexual orientation or gender identity are not regularly being collected on COVID testing forms. This is just a microcosm of the overall structural inequities around LGBTQ data collection that must be addressed in the United States. As such, we must keep advocating for SOGI items to be included on all health-related intake forms and on national surveys in order to combat the injustices facing some of the most marginalized groups among us.

References

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