As advocates and community members across the country have put on their public health hats and shifted into rapid response mode to provide the care, supports and resources their communities need in light of COVID-19, the shortfalls of our health care and safety-net systems have gotten more and more palpable. For LGBTQ+ people, as well as other marginalized communities, the coronavirus pandemic has not only introduced a new threat to health and economic security, but has also exacerbated barriers they were already facing in accessing the health care and social supports they need. As we continue to look toward rapid response policy options to address COVID-19, advocates also have an opportunity to think about which of these policies could and should become permanent parts of our social safety-net systems, and what our other long-term, visionary goals are for building a health care system that centers justice and equity.  

COVID-19 Inequities and LGBTQ+ Communities 

Because of stigma and intersecting experiences with racism, transphobia and other forms of oppression, LGBTQ+ people are more likely to have chronic conditions, putting them at greater risk of contracting COVID-19 in the first place. LGBTQ+ people are also less likely to have health insurance, limiting their access to COVID-19-related care if they do contract the illness. If and when LGBTQ+ people are able to access care, they are much more likely to experience discrimination in health care settings – this is especially true for trans and nonbinary individuals as well as for people of color.  

Outside of care related to COVID-19, LGBTQ+ people face greater barriers to accessing a range of physical, mental and oral health services. These barriers have only been worsened by an inability to access most routine care due to necessary public health precautions related to COVID-19; once clinics and offices re-open, there will almost certainly be a backlog of needed care and an increase in appointment wait times.  

Finally, many trans and nonbinary individuals have had to delay necessary gender-affirming health care during this crisis. Because of racism, transphobia and other forms of oppression within and outside the health care system, transgender people are much more likely to experience anxiety, depression, and other mental health conditions. Not receiving gender affirming care can negatively affect mental and emotional health, while receiving this care improves mental health. No one should have to choose between their physical and mental or emotional health. 

LGBTQ+ Communities and Social Determinants of Health  

In addition to barriers accessing health care, LGBTQ+ people also experience discrimination in other arenas that impact health. LGBTQ+ individuals are more likely to experience poverty and rates are particularly high for transgender people. COVID-19-related closures of many businesses have drastically increased the unemployment rate, putting already marginalized people at risk for further economic disenfranchisement. And, LGBTQ+ people are more likely to work in industries that have been affected by COVID-19, putting them at increased risk for being unemployed or having to risk their health and safety to work an essential job. In addition to low-wage workers, LGBTQ+ people experiencing homelessness or incarceration, sex workers, immigrants and migrant workers, people with disabilities and people of color are at particular economic risk right now. 

As a result of this economic disenfranchisement, LGBTQ+ people also face high rates of housing instability. Recommended self-isolation and stay at home orders can be difficult or impossible for people who are experiencing housing instability or homelessness and being unhoused puts people at increased risk for contracting COVID-19. Relatedly, LGBTQ+ people, especially Black queer and trans people and individuals experiencing homelessness, face some of the highest rates of police violence and other harassment and discrimination from law enforcement. They are also more likely to be incarcerated, and congregate facilities like jails and prisons are particularly vulnerable to COVID-19 outbreaks. Incarceration and increased policing may increase danger, especially in already marginalized communities, at a time when people should be able to focus on keeping themselves and their families healthy and safe. 

To combat these inequities, it is integral that advocates understand the nondiscrimination protections that are or are not in place for LGBTQ+ people in their states and advocate for more comprehensive protections, including universal coverage that includes gender-affirming care, accessible and inclusive mental health services and a wide range of nondiscrimination protections, especially for queer and trans people of color. 

Opportunities for Advocates 

Advocates should use a gender-inclusive lens when considering their COVID-19 priorities and can center the needs and experiences of LGBTQ+ communities in several ways: 

  • Figure out whether your state currently has nondiscrimination protections for transgender people in health care settings. If it doesn’t, consider connecting with state and local organizers working on this issue to think about partnerships to advance health justice in your state. 

  • When communicating about gender-affirming care in written resources, webinars or other advocacy and organizing materials, be sure to communicate that this care is medically necessary and life–saving. Consider advocating to clinics and providers that they prioritize appointments for this necessary care once they re-open. 

  • Push back against racist and queer- and transphobic rhetoric about COVID-19. Anti-Asian racism and renewed xenophobic attacks have flourished in light of COVID-19 and Asian LGBTQ+ people are particularly vulnerable. Make sure your messaging underscores that Asian people and people living with HIV are no more likely to contract or spread COVID-19. Messaging guidance from the Protecting Immigrant Families Campaign and the Opportunity Agenda can help you frame your messages.