The Guardian
Pandemic worsens health gap fueled by barriers to care and underlying conditions Zina Goodall carries a rainbow flag through San Francisco’s Castro District. Several new studies point to the vast health disparities LGBTQ+ people face amid the pandemic. Photograph: Jeff Chiu/AP Queer and transgender people across the US have been more vulnerable to contracting and dying of Covid-19 than their straight, cisgender counterparts, several new studies have found, with barriers to medical care and high rates of underlying conditions exacerbating the pandemic’s toll. Much about the impact of the coronavirus pandemic on LGBTQ+ Americans remains unknown. Few national surveys on Covid-19 ask people about their sexual orientation or gender identity; it’s unclear how many LGBTQ+ people have contracted coronavirus, or how many have succumbed to it. But a slew of research reports in recent weeks have confirmed that the pandemic has heightened inequities. A study published by the Centers for Disease Control and Prevention (CDC) in February found gay, lesbian and bisexual people in the US have higher rates of underlying conditions like asthma, cancer and heart disease that put them at higher risk of being hospitalized or dying of Covid-19, The Williams Institute at the University of California, Los Angeles, reported that same month that LGBTQ+ people of color were twice as likely as white, non-LGBTQ+ people to test positive for the coronavirus. A study published late last year found that trans women living in cities including Boston, Miami, New York, and Washington not only had higher rates of underlying conditions, but also faced massive barriers to accessing healthcare – with nearly a fifth of the 1,020 women surveyed reporting mistreatment from medical professionals. Transgender women living with HIV were the most vulnerable to Covid-19, the report found. A study published in the journal Vaccines in March found that mistrust of the medical establishment fueled vaccine hesitancy among LGBTQ+ adults. Together, the reports have reinforced what public health experts and advocates have been saying all year – that the pandemic has worsened health disparities that LGBTQ+ people face. “We are seeing stark disparities,” said Kevin Heslin, a member of the CDC’s Covid-19 response team. “The health needs of LGBT people, the health needs of trans people especially, are just not being met. People are dying.” ‘We are all human’ billboards light up in Pride colors in New York in June. Photograph: Noam Galai/Getty Images Discrimination drives inequities “What really brings together everybody 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 cities across the east and south. That discrimination fuels economic inequality, and affects queer Americans’ ability to respond to the hardships brought on by the pandemic. Even before the pandemic hit, the Williams Institute’s study found, nearly one in 10 LGBTQ+ people were unemployed, and they were more likely to experience poverty than straight and cisgender people. After the pandemic hit, LGBTQ+ people of color were more likely to be laid off or furloughed, and more likely to have trouble paying their rent or mortgage. Job losses have resulted in many losing health insurance, experts and advocates said – and the pandemic and its economic fallout have made even limited healthcare options less accessible. Sexual and gender minorities are also more likely to experience abuse or mistreatment from doctors. “Trans women are going for routine care and being treated in a nonhuman way,” Poteat said. Discrimination also has a direct impact on people’s health. Researchers have found that experiencing stigma and systematic abuses over and over again on a daily basis can flood bodies with stress hormones, overtax the immune system, drive up blood pressure and ultimately cause damage to the heart and kidneys. “We are often pushed to the wayside when it comes to public health,” said Juniper Yun, a program associate at the Transgender District, a community group in San Francisco. That the coronavirus crisis has exacerbated inequities “has been really disappointing”, Yun added, “particularly because this is not the first pandemic our community has faced.” Compounding traumas For many, the past year has played out like a flashback to the 1980s HIV epidemic. But even now, people living with HIV, whether or not they identify as LGBTQ+, are more likely to receive a diagnosis of, be hospitalized with, and die in hospitals of Covid-19, a study in New York found. Trans women living with HIV were especially vulnerable, another study found. “The same demographic that’s still being disproportionately affected by HIV are also being disproportionately affected by Covid. That includes people of color, people in poor communities, unhoused people, people without internet access,” said Jamie Baker, director of the advocacy group Being Alive Los Angeles. Trauma has begotten more trauma, said Héctor Ramírez, whose brother Eduardo died of Covid-19 in Los Angeles earlier this year. Mental health challenges, substance abuse and years of living on the streets had left Eduardo in ill health, Ramírez said. Severely immunocompromised due to complications from HIV, Eduardo had been terrified of contracting the virus and avoided medical appointments for months. When he did contract Covid-19, his health deteriorated rapidly. In his last hours, his family was on the phone with him – they could hear him screaming in pain as medical workers moved him from his apartment, into an ambulance. Eduardo died at age 35, just weeks before he would have become eligible for a Covid-19 vaccine. “How many more have to die?” asked Ramírez. The pandemic has claimed the lives of many prominent HIV activists – including Garry Bowie, a Los Angeles-based advocate who used to lead Being Alive. Bowie worked for decades to fight the stigma attached to an HIV diagnosis – and help Angelenos living with HIV find healthcare, housing and emotional support. “He wouldn’t let anybody go off alone,” said Jeff Wacha, his husband – and it was a cruel fate amid the pandemic that Bowie had to die alone, that his loved ones had to mourn in quarantine. For many, the Covid pandemic has felt like a flashback to the HIV/Aids epidemic. Photograph: Jeff Chiu/AP Vince Crisostomo, a director at the San Francisco Aids Foundation, said images of Covid-19 patients dying inside overcrowded hospitals brought back memories of HIV/Aids wards filled with sick patients. The Trump administration’s initial inaction against the pandemic reminded him of how officials in the Reagan administration would joke about and dismiss the HIV crisis.And Anti-Asian hate directed at him over the past year resembled the hate and stigma he faced for being gay in the 80s and 90s, Crisostomo said. Since last year, he said, he has felt constantly on the “edge of a nervous breakdown”. Seeking solutions in data Public health experts and advocates said the first step to addressing disparities is to collect more data. Researchers used to consider it inappropriate or offensive to ask about sexual orientation and gender identity, said Poteat, the University of North Carolina researcher – but recently, activists have been pushing back against that idea. “Numbers and data will give us a way to advocate for our people, to collect money – and to hold government entities responsible,” said Yun, of the Transgender District. The organization, which has been providing resources and facilitating mutual aid for transgender, gender-variant and intersex people in San Francisco’s Tenderloin neighborhood, has recently used available data on the disproportionate toll of Covid-19 on trans people of color to lobby officials to fund more vaccination sites in the area. In California, Governor Gavin Newsom signed into a law a bill that required healthcare providers to collect and report gender identity and orientation along with other public health data, including Covid-19 data – but the policy has been unevenly implemented. In that state, and across the US, there is no account of just how many LGBTQ+ people have died.
