QTransgender people and transgender people across the United States have been more vulnerable to contracting and dying from Covid-19 than their heterosexual and cisgender counterparts, several new studies have found, with barriers to medical care and rates high underlying conditions exacerbating the toll of the pandemic.
Much of the impact of the coronavirus pandemic on LGBTQ + Americans remains unknown. Few national Covid-19 surveys ask people about their sexual orientation or gender identity; it is not known how many LGBTQ + people have contracted coronavirus, or how many have died from it.
But a series of research reports in recent weeks have confirmed that the pandemic has worsened inequalities.
A study released by the Centers for Disease Control and Prevention (CDC) in February found that gay, lesbian and bisexual people in the United States have higher rates of underlying illnesses like asthma, cancer, and illness. heart conditions that put them at a higher risk of being hospitalized or dying. of Covid-19,
The Williams Institute at the University of California, Los Angeles reported the same month that LGBTQ + people of color were twice as likely as non-LGBTQ + white people to test positive for the coronavirus.
A study published late last year found that trans women living in cities like Boston, Miami, New York and Washington not only had higher rates of underlying illnesses, but also faced huge barriers to accessing health care – with nearly a fifth of the 1,020 women surveyed. report abuse by health professionals. Transgender women living with HIV were the most vulnerable to Covid-19, according to the report.
A study published in the journal Vaccines in March found that distrust of the medical establishment fueled reluctance to vaccinate among LGBTQ + adults.
Together, the reports reinforced what experts and public health advocates have been saying all year – that the pandemic has worsened the health disparities that LGBTQ + people face.
“We’re seeing big disparities,” CDC member Kevin Heslin said. Covid-19 response team. “The health needs of LGBT people, the health needs of trans people in particular, are just not being met. People are dying. “
Discrimination drives inequalities
“What really brings everyone together under this LGBTQ + umbrella is the experience of discrimination,” said Tonia C Poteat, a public health researcher at the University of North Carolina who led the recent report on the experiences of trans women in eastern and southern cities. .
This discrimination fuels economic inequality and affects the ability of queer Americans to respond to the challenges brought on by the pandemic. Even before the pandemic hit, the Williams Institute study found that nearly one in 10 LGBTQ + people were unemployed and more likely to live in poverty than straight and cisgender people. After the outbreak of the pandemic, LGBTQ + people of color were more likely to be laid off or on leave, and more likely to have difficulty paying their rent or mortgage.
Job losses have resulted in the loss of many health insurances, experts and advocates have said – and the pandemic and its economic fallout have made even limited health care options less accessible. Sexual and gender minorities are also more likely to be victims of abuse or mistreatment by doctors. “Trans women go for routine care and are treated in a non-human way,” said Poteat.
Discrimination also has a direct impact on people’s health. Researchers have found that experiencing systematic stigma and abuse over and over again on a daily basis can flood the bodies with stress hormones, overload the immune system, raise blood pressure, and ultimately cause damage to the heart and kidneys.
“We are often sidelined when it comes to public health,” said Juniper Yun, program associate at Transgender District, a community group in San Francisco. The fact that the coronavirus crisis has exacerbated inequality “has been really disappointing,” Yun added, “especially since this is not the first pandemic our community is facing.”
For many, the past year has been a flashback to the HIV epidemic of the 1980s. But even now, people living with HIV, whether or not they identify as LGBTQ +, are more likely to be diagnosed with Covid-19, to be hospitalized and to die in hospitals from Covid-19, according to a study in New York. Trans women living with HIV were particularly vulnerable, according to another study.
“The same demographic that is still disproportionately affected by HIV is also disproportionately affected by Covid. This includes people of color, people living in poor communities, people without housing, people without access to the Internet, ”said Jamie Baker, director of advocacy group Being Alive Los Angeles.
The trauma spawned more trauma, said Héctor Ramírez, whose brother Eduardo died of Covid-19 in Los Angeles earlier this year.
Mental health issues, drug addiction and years of living on the streets left Eduardo in poor health, Ramírez said. Severely immunocompromised from complications from HIV, Eduardo had been terrified of contracting the virus and had avoided medical appointments for months. When he contracted Covid-19, his health deteriorated rapidly. In his final hours, his family was on the phone with him – they could hear him screaming in pain as medical staff moved him from his apartment, in an ambulance. Eduardo died at 35, just weeks before he became eligible for the Covid-19 vaccine.
“How many more must die?” Ramírez asked.
The pandemic has claimed the lives of many prominent HIV activists – including Garry Bowie, a Los Angeles-based advocate who ran Being Alive. Bowie has worked for decades to combat the stigma associated with an HIV diagnosis – and to help Angelenos living with HIV find health care, housing and emotional support. “He wouldn’t let anyone go alone,” her husband Jeff Wacha said – and it was cruel fate in the midst of the pandemic that Bowie had to die alone, that his loved ones had to cry in quarantine.
Vince Crisostomo, director of the San Francisco Aids Foundation, said images of Covid-19 patients dying in overcrowded hospitals brought back memories of HIV / AIDS wards filled with sick patients. The Trump administration’s initial inaction on the pandemic reminded him of how Reagan administration officials were going to joke and dismiss the HIV crisis, and the anti-Asian hatred directed at him over the past year sounded like the hatred and stigma he faced for being gay in the country. Eighties and nineties, Crisostomo said. Since last year, he says, he constantly feels “on the verge of a nervous breakdown.”
Finding solutions in the data
Experts and public health advocates have said the first step in addressing the disparities is to collect more data. Researchers used to consider it inappropriate or offensive to ask questions about sexual orientation and gender identity, said Poteat, a researcher at the University of North Carolina – but recently activists rejected this idea.
“The numbers and the data will give us a way to stand up for our people, raise money – and hold government entities to account,” said Yun, from the transgender district. The organization, which has provided resources and facilitated self-help for transgender, transgender and intersex people in the Tenderloin neighborhood of San Francisco, recently used available data on the disproportionate toll of Covid-19 on trans people from color to lobby officials to fund more vaccination sites in the region.
In California, Governor Gavin Newsom signed into law a bill requiring health care providers to collect and report gender identity and referral as well as other public health data, including data Covid-19 – but the policy has been implemented unevenly. In this state and the United States, there is no record of the number of LGBTQ + people who have died.