COVID-19 and LGBTQ Populations.

June is LGBTQ Pride Month, marked by parades, marches, and celebrations each year here in Boston and around the world. This year, those events have been postponed or moved online to help prevent the spread of COVID-19.

This is only one of the myriad ways that the new coronavirus is affecting sexual and gender minority populations. Going into Pride Month, SPH experts weigh in on the difficulties and strengths of the LGBTQ community in the time of COVID-19.

CRAIG ANDRADE, ASSOCIATE DEAN OF PRACTICE:

What we know and do not know about COVID-19’s impact on LGBTQIA+ communities in Massachusetts raises significant concern. The Fenway Institute’s March 2020 report notes LGBTQ adults experience higher rates of chronic conditions, such as cardiovascular disease, obesity, cancer, and HIV/AIDS and are more likely to engage in risk behaviors like smoking, vaping, and other substance use than their straight and cisgender peers—conditions and behaviors that can increase vulnerability to this novel coronavirus.

And older LGBTQ adults already experience higher rates of social isolation than other groups, and presumed further isolated during months of prescribed physical distancing, potentially exacerbating underlying mental health issues such as suicidal ideation and substance use.

What we do not know are the facts. We do not have gender identity and sexual orientation data to help understand disparities and inequities that exist for lesbian, gay, bisexual, and transgender people in Massachusetts. Only when we collect, analyze, and report such data can we identify ways in which our COVID-19 pandemic response can be more effective and equitable. Here is where we public health practitioners can make powerful change.

Ulrike Boehmer, associate professor of community health sciences:

It is clear that COVID is a great threat to the LGBT community, given the documented high prevalence among LGBT individuals of conditions, such as cancer, that are risks of more severe COVID disease and higher mortality.

As with cancer, the LGBT community is not counted in the tallies of COVID cases and mortality. This will likely hide the disproportionate effect COVID has on the LGBT community.

There are also questions about COVID putting great strain on LGBT individuals and exposing them to discrimination. For example, will LGBT individuals feel comfortable saying, ‘I can’t do this job because my partner is immunocompromised due to cancer, HIV, etc.’?

Discrimination and fear of job loss are likely particular issues for transgender individuals, given the absence of federal laws that protect against employment and other discrimination based on gender identity.

Sarah K. Lipson, assistant professor of health law, policy & management:

My research focuses primarily on mental health and wellbeing in college student populations, and pre-COVID there were already significant mental health disparities among sexual and gender minority students.

Key risk and protective factors for LGBTQ mental health may be uniquely affected by COVID-19 and campus closures, exacerbating pre-COVID inequalities. For example, COVID-19 has resulted in higher levels of housing insecurity and financial stress for students across the country, including the disproportionate number of trans and gender nonconforming students who rely on campus housing in the absence of a permanent address and without the parental support that many other students take for granted. Many LGBTQ students rely on student health insurance for mental health services and other healthcare needs, including hormone replacement therapy. All students are struggling with social connectedness and belonging, but isolation may be especially detrimental for LGBTQ students, particularly those who lack loving familial relationships.

Colleges and universities need to routinely assess students’ needs, including asking about demographic characteristics alongside mental health outcomes and risk and protective factors. Beyond collecting and using data to inform decision-making, campuses should maintain compassionate, caring, open communication with students, acknowledging the burdens students are facing, and offer flexibility and accommodations for academics and wellbeing.

Thomas Lee, Jr. (SPH’19), academic program administrator in the Department of Global Health:

In the early weeks of the lockdown, I attended a memorial service on Facebook Live to remember and celebrate the life of Kutlwano ‘Bubbly’ Seladledi, an LGBTQIA+ activist and spoken-word poet from Botswana who passed away on April 2. Bubbly, as their name suggests, was one of the nicest, warmest, most good-humored people who welcomed me in Botswana just a few years ago. I will never forget their laugh and kind smile.

Bubbly wasn’t a direct casualty of the coronavirus. Rather, their death was the result of a hard-fought struggle with depression brought on by the stigma and discrimination LGBTQIA+ Batswana are far too familiar with. LEGABIBO, Botswana’s central LGBTQIA+ organization, understands deeply that their community’s mental health challenges do not dissipate when their country shuts down. In fact, they are often amplified by sudden social isolation and increased anxieties around employment, housing, and accessing critical health services. Stuck in difficult and unsafe home situations, LGBTQIA+ Batswana are confronted with domestic violence, suicidality, depression, anxiety, death threats, homelessness, unemployment, and hunger.

Forced to operate remotely, LEGABIBO staff are working diligently to continue to provide psychosocial support, offer sexual and reproductive health services, assist on domestic violence cases, distribute food parcels, and link persons to emergency shelter. In an already difficult and often hostile environment, LEGABIBO and LGBTQIA+ organizations worldwide are working even harder to keep queer people safe during the COVID-19 pandemic.

Bubbly will be remembered by their friends and colleagues for “their quest for social justice for the LGBTQIA+ community and their involvement with many initiatives that sought to promote inclusion and connect each and every one of us to love, dignity, and Botho.” I hope we can honor Bubbly by remembering that, while we may be physically apart, we are not alone. Our communities need each other now more than ever.

If you or someone you know is feeling hopeless or suicidal, contact The Trevor Project’s TrevorLifeline 24/7 at 1-866-488-7386, via chat at TheTrevorProject.org/Help, or by texting START to 678-678.

Julia Raifman, assistant professor of health law, policy & management:

The dynamics of COVID-19 and its economic ramifications are shaped by our existing social context. In many states, that is a context in which LGBTQ people have unequal rights to employment, to housing, and even to health care.

As the whole US population experiences an increased risk of losing their jobs, losing homes, and facing food insecurity, that risk is only elevated for LGBTQ people. The Trump administration has rolled back several policies protecting transgender people from discrimination in health care and in homeless shelters, which many more people are likely to need in the wake of COVID-19. LGBTQ people may also face rejection from their families and have less of a support network on which they can rely in times of health or financial crises.

Our unequal structural context has already shaped a disproportionate burden of depression and suicidality for LGBTQ people that is likely to be exacerbated by the deleterious mental health effects of COVID-19, physical distancing, and financial distress.

Marginalization has also contributed to the high burden of HIV among men who have sex with men. While it is unclear whether COVID-19 poses additional risk for people living with HIV, it is clear that COVID-19 has disrupted the health system, making it much more challenging for people living with chronic conditions like HIV to see their healthcare providers in person or feel safe going to a pharmacy to obtain their medications. Similarly, COVID-19 makes it more challenging for people taking PrEP to prevent HIV to obtain their medications. Disruptions to healthcare systems have also caused many transgender people to have to postpone surgeries and experience interruptions with hormone therapies.

HAROLD COX, ASSOCIATE PROFESSOR OF COMMUNITY HEALTH SCIENCES:

As is too often the case, the LGBTQ population will be neglected and will suffer and die in silence from COVID-19. Data are needed to accurately understand how the LGBTQ population is impacted.

Many LGBTQ people are poor, have limited access to health resources, and face negative stigma in receiving health and housing services. Policymakers must consider the unique needs of the LGBTQ population when making policy decisions about COVID-19.

Please don’t let this request fall on deaf and uncaring ears.

Kimberly Nelson and Allegra Gordon, assistant professors of community health sciences:

KN: We’re particularly concerned about the potential short- and long-term impacts of COVID-19 on the wellbeing and health of LGBTQ adolescents. Adolescence is such a critical developmental period, where youth are figuring out who they are, experiencing multiple important developmental milestones, and achieving increasing levels of independence. Interruptions to these developmental processes during the COVID-19 pandemic is likely to have long-lasting effects on their health.

AG: In a groundbreaking study Kim is leading on sexual minority male youth, we’re seeing really concerning narratives from these youth about the impacts of COVID-19 on their mental wellbeing related to being isolated from their social support networks (their peers) while spending much more time with families. For many youth, their families can be tremendous support systems. But for youth who do not feel safe coming out to their families or who have families that are unsupportive, we’re very concerned about the toll on their mental health.

KM: Ultimately, paying particular attention to the impact of COVID-19 on the health of LGBTQ youth, who were already experiencing multiple substantial health inequities, and providing them with affirming social support will be critical to decreasing the potential deleterious effects of COVID-19 on their mental and physical health.

AG: LGBTQ youth have long demonstrated how resilient they are in the face of many forms of stressors. The history of the past half century teaches us that LGBTQ young people have often led the way in creating community support networks against all odds, and we know that LGBTQ youth have in the past decade been very successful at creating online outlets for self-expression, community connectedness, visibility, and support, even when they weren’t able to find those things in their home or school environment.

We believe that LGBTQ youth are already creating brilliant new ways to adapt to this challenging time, and our job as public health researchers and practitioners will be to do everything in our power to support and nurture those endeavors going forward.

—Michelle Samuels