The American lesbian, gay, bisexual, and transgender (LGBT) community is in a medical and political crisis. Prior to the coronavirus (COVID-19) pandemic, politics and widespread discrimination lead to significant disparities in LGBT medical rights and healthcare outcomes. These pre-existing LGBT healthcare disparities have since become exacerbated by the pandemic. Often overlooked in larger discussions about LGBT people and the pandemic is a larger social problem: LGBT healthcare disparities amplified by the pandemic are set to magnify LGBT social and political inequality on a national scale. In addition, the pandemic has contracted space in public discourse and media coverage - which is needed to advance LGBT equality - creating new opportunities for exploitation to advance anti-LGBT political agendas.
Prior to the advent of COVID-19, many LGBT people faced the detrimental effects of widespread discrimination. Before the pandemic, a majority of LGBT Americans also found themselves living in states without legal protection from job discrimination. LGBT people can be evicted from their homes or be denied the right to adopt children for the “crime” of being who they are. Many LGBT people report being the targets of hate speech and hate crimes, to the point that many live in a constant state of fear of being attacked or murdered for walking down the street or engaging in public displays of affection with their loved ones. Research from the Williams Institute found that LGBT people are twice as likely to have experienced lifetime homelessness and earn as much as 32 percent less than their heterosexual counterparts. LGBT people continue to be denied basic services, such as the ability to purchase food, to order a wedding cake, or hire wedding photographers. In recent years, there has also been a steady wave of attempts to legitimize anti-LGBT discrimination through claims of “religious freedom” to deny LGBT people their constitutionally protected right to equal treatment under the law.
Situated in and reflecting this larger discriminatory context, the LGBT community also faced significant healthcare disparities. Before the pandemic, many LGBT people had difficulty finding LGBT-safe healthcare providers and faced an absence of federal laws prohibiting healthcare discrimination based on gender identity and sexual orientation. A majority of LGBT adults also have medical conditions like asthma, heart disease, HIV, and diabetes that, according to the Center for Disease Control, make them especially susceptible to the deadly coronavirus. While there is no evidence that LGBT people are any more likely to catch the coronavirus than the general population, LGBT people face unique circumstances that affect them disproportionately and which can exacerbate the individual and broad scale impact of the coronavirus. LGBT people, for example, report lower levels of self-rated health than their heterosexual counterparts. LGBT people are 50 percent more likely to use tobacco than the general population. About 65 percent of LGBT adults have pre-existing medical conditions like diabetes, asthma, heart disease, or HIV. Members of the LGBT community are at higher risk for homelessness, poor mental health, suicidal ideation, and mental health disorders like depression and anxiety. With the growing impact of the novel coronavirus, the LGBT community faces new threats and a contraction of critically needed resources and space in which scholars, advocates, citizens, and policy makers can discuss and effect social change.
A growing body of research reveals that the coronavirus pandemic is exacerbating pre-existing LGBT healthcare disparities. Research briefs show that LGBT people are experiencing disproportionately higher rates of wage reduction (30 percent), job loss (18 percent), and difficulty finding food (33 percent) during the pandemic. LGBT people are also experiencing increased difficulties in accessing healthcare: 14 percent report difficulties obtaining routine medications, 24 percent report difficulty accessing medical care, and 59 percent are avoiding visiting their doctors and dentists for routine medical care. Older LGBT people view themselves as being especially at risk due to COVID-19. A research brief on LGBT Tennesseans, for example, found that 83 percent agreed that COVID-19 is a significant threat to their health and 70 percent view the coronavirus as a significant threat to their lives.
According to the American Medical Association and separate research conducted by OutRight Action International, which holds United Nations consultative status, the pandemic has led to LGBT people delaying care-seeking due to concerns with discriminatory treatment. LGBT people, who are disproportionately affected by HIV and AIDS, have reported encountering problems obtaining HIV medications, HIV prophylaxis preventatives (PrEP), and HIV care. Reports further reveal interruptions in hormone treatments and gender-affirming care and indefinite postponements of potentially lifesaving gender-affirmation surgeries among transgender individuals. Public health messages about the coronavirus have also focused heavily on the elderly to the exclusion of at-risk populations like those in the LGBT community. While health experts believe that donor antibodies of those who have recovered from the coronavirus can help others resist the virus, discriminatory bans against gay and bisexual men who have recovered from the coronavirus remain in effect and prevent them from donating blood and plasma without first going through a three-month period of sexual abstinence.
While anti-LGBT discrimination is well-documented and research documenting the health consequences of the coronavirus on the LGBT community is growing, rarely considered in public debate is how the coronavirus is contracting critically needed resources, like time, money, and space - such as in venues for social discourse and debate - with which to advocate for LGBT rights. With significantly poorer heath, less social and political support, and typically lower income, the pandemic is having the effect of decreasing resources many LGBT people need to support or participate in LGBT advocacy. For example, funds that might otherwise go towards investing in LGBT rights organizations and pro-LBGT political candidates are being diverted to coronavirus medical treatment, to create a personal financial safety net, and to support affected friends and family members. With the LGBT community’s few resources becoming fewer, and with many self-isolating or practicing social distancing, many LGBT individuals are not as able to participate as they otherwise would in LGBT rights protests and annual national pride events that occur in major cities. This contraction in advocacy potential is significant because advocacy and pride events help to build and maintain a critically needed collective identity around which to mobilize and advance LGBT causes.
This shrinkage of critically needed resources and participation in advocacy is amplified by the contraction of space in public discourse and media coverage in which to publicize, debate, and advance LGBT causes. Broad news coverage of the pandemic pushes the unique needs and vulnerabilities of the LGBT community out of sight and out of mind in the public eye. This media coverage of COVID-19 further has the effect of insulating the position of those who most ardently oppose LGBT rights and who benefit from homophobia in national institutions like government, the economy, marriage, and education. Extensive coronavirus media coverage has also created a new opportunity and cover for anti-LGBT politicians to attack LGBT people while no one is looking. While the nation reeled from the first wave of COVID-19, for example, the Trump administration took steps toward finalizing a rule to rewrite Affordable Care Act Section 1557 provision so as to enable health care providers to discriminate against those in need on the basis of their sexual orientation or gender identity under the pretext of “religious freedom.”
RECOMMENDATIONS AND SOLUTIONS
Response to the LGBT-coronavirus crisis requires coordinated and systemic efforts to mobilize community members, healthcare providers, media outlets, and policy makers alike. Specific social action and policy recommendations include:
1. Pass federal legislation and enact policies that protect LGBT people and all citizens regardless of their sexual orientation or gender identity.
Congress must pass the Equality Act, a bill which extends the 1964 Civil Rights Act to ban discrimination in housing, credit, education, adoption, jury service, and basic services based on gender identity and sexual orientation. The president must also reinstate protections for LGBT people and prohibit discrimination based on sexual orientation and gender identity like the Affordable Care Act Section 1557 prohibition of discrimination against LGBT people in health insurance coverage and medical care. State and federal policies that allow discrimination based on gender identity and sexual orientation help to create the LGBT community’s health disparities and increase the community’s vulnerability to the coronavirus and the recession growing in its wake. Additionally, laws and policies that allow anti-LGBT discrimination are inherently unconstitutional as they violate the Equal Protection clause of the 14th Amendment, which holds that a governmental body cannot deny citizens equal protection under the law. Systematic reviews should also be conducted on all legislation, both enacted and proposed, to ensure accountability to the Constitution and equal protection of LGBT people. America cannot be a nation of laws unless it's laws protect all its citizens equally.
2. Include LGBT individuals and LGBT leaders in policy decisions.
The voices and lived experiences of LGBT people are central to appreciating how the coronavirus affects the LGBT community. Failing to include LGBT people in discussions about their own healthcare and other needs decisions sends the signal that LGBT people should be ignored and treated like second-class citizens. This ensures the continuation of unfair and dangerous policies and practices and the continued marginalization of LGBT people. Electing more LGBT leaders, hiring more LGBT people to work in the White House and on Congressional staff, training current White House and Congressional staff on LGBT issues, bringing on members of the LGBT community as policy advisors, and political officials working more closely with organizations like the Victory Fund, which works to increase the number of LGBT people in all levels of government, are concrete steps to remedy this issue.
3. Include LGBT needs in public health response, research, and coronavirus relief packages.
Public health officials must guarantee that the needs of the LGBT community are actively considered and included in public health response to the coronavirus. Doctors and researchers must develop new research that uncovers how the coronavirus impacts LGBT people individually and collectively, and to develop best practices to reduce the virus’ impact. Congress must also include language that guarantees LGBT rights and protections in future coronavirus relief packages. Relief packages must also include funding specifically earmarked for organizations and facilities that provide healthcare, housing, job placement, loans and economic assistance, educational assistance, counseling, and other forms of critically needed resource assistance to the LGBT community. With the LGBT community’s increased vulnerability and with insufficient coronavirus tests available, the availability of masks and tests must be increased, and concentrated efforts must be made to ensure that tests and masks are available to LGBT individuals. LGBT people also need information about the coronavirus tailored to the unique needs and circumstances of the LGBT community as well as dedicated communications on the benefits of social distancing.
4. Media outlets must cover LGBT issues during the pandemic.
The impact of the coronavirus has left America, and indeed the world, in a state of collective shock. Understandably, media outlets have shifted much of their coverage to meet the demand of a public clamoring for news about the latest developments. This shift of public attention, and in turn of public discourse, has created an exploitable opportunity for anti-LGBT political officials and organizations to ram through anti-LGBT legislation and policies while collective attention is distracted. This is evidenced, as noted above, by the Trump administration’s attack on LGBT rights during the pandemic. The failure of the news media to adequately cover LGBT issues and needs, including those related to the coronavirus, has the compounded effect of shifting social debate away from LGBT issues and needs. This in turn insulates and advances the unearned privilege of those who oppose LGBT rights. Left unchecked, this lends to a cycle in which less LGBT issue coverage may contribute to worsening LGBT health and social justice outcomes, potentially increasing the effects of COVID-19 on an already at-risk population. Media outlets, writers, and journalists must make a concerted effort, such as by setting minimum percentage of LGBT news stories covered every day, to ensure continued coverage of issues bearing on LGBT rights, including but not limited to the virus’ impact on LGBT individuals. A 2017 Gallup poll found that about 5 percent of Americans identify as LGBT. Media outlets setting a minimum 5 percent of stories dedicated to LGBT people and issues would help ensure proportionate LGBT media coverage.
5. Social justice organizations must find new ways to lobby elected officials, engage the LGBT community, and develop a long-term strategy for success.
LGBT social justice organizations face a predicament like none they have ever witnessed. Bans on public gatherings, organizations and businesses going under or moving online as workforce has become partially remote, and social distancing have effectively erased the ability of many LGBT social justice organizations to engage in traditional lobbying and organizing methods like field canvassing, in-person protests, in-person fundraising events, in-person strategizing and coordination, and in-person meetings to lobby political leaders. It is imperative that LGBT social justice organizations develop new means of maintaining and building the active participation of their bases and to lobby elected officials. A good starting point is to draw upon existing research to determine the effectiveness of various online and telephone-based lobbying and organizing and to sponsor new research in these areas. LGBT organizations must also be willing to embrace new methods of organizing and community engagement that go beyond their current methods. This may include, for example, holding pride events on YouTube, Facebook, or Twitter, hosting online meetings and events that incentivize active participation from LGBT individuals, organizing “Twitter storms,” in which a short period of increased tweeting can draw media attention to LGBT issues, organizing mass letter writing campaigns and mass calling of elected officials at strategic moments, and more.
While many people hold out hope that the pandemic will subside, it is imperative to think ahead to the possibility that additional pandemic waves will hit America, such as in the winter months during flu season, for years to come. Even if the pandemic subsides over the next one to three years, the LGBT community’s loss of life, time, resources, manpower, and more are likely to be felt much longer. A full recovery may well take decades, if it happens at all. There simply are no guarantees. As such, LGBT social justice organizations should not remain content to be in hibernation or in limited operations during the pandemic, as some are doing, but should instead begin formulating short and long-term strategies to ensure their continued operations and abilities to effectively mobilize individuals, lobby politicians, and advocate for LGBT causes.
6. Address the root causes of anti-LGBT discrimination.
Any social actions or policy decisions that fail to address the root causes of discrimination against LGBT people are doomed to perpetuate the very problems they seek to address. Furthermore, LGBT discrimination does not exist in a vacuum. It instead intersects with, overlaps, and contributes to the perpetuation of discrimination against women, people of color, people with disabilities, and other marginalized groups--all of which count LGBT people among their ranks. To understand discrimination against LGBT people, new research on the root causes of homophobia are critically needed, and such research should consider the multiple forms in which homophobia intersects with and contributes to other forms of discrimination. To address the causes of homophobia, we also need dedicated funding to develop and implement educational programs at the local, state, and national levels to disabuse people of the false and negative stereotypes about LGBT people that they have been led to believe.
Badgett, M. V. Lee, Soon Kyu Choi, and Bianca D. M. Wilson. 2019. “LGBT Poverty in the United States: A Study of Differences Between Sexual Orientation and Gender Identity Groups.” Williams Institute. Retrieved May 13, 2020 (https://williamsinstitute.
Department of Justice. 2018. “FBI Releases 2018 Hate Crime Statistics.” Retrieved May 13, 2020 (https://www.justice.gov/
Eadens, Savannah. 2020. “LGBTQ People May Be “Particularly Vulnerable” to Coronavirus Pandemic. Here’s Why.” USA Today. Retrieved May 13, 2020 (andemic/2863813001/" target="_blank" rel="noopener" data-saferedirecturl="https://www.google.com/url?q=https://www.usatoday.com/story/news/nation/2020/03/18/lgbtq-coronavirus-community-vulnerable-COVID-19-pandemic/2863813001/&source=gmail&ust=1599782993453000&usg=AFQjCNGIkXxnd49oRLaJE84Jzm68cWp7AA">https://www.usatoday.com/
Fredriksen-Goldsen, Karen I., Jane M. Simoni, Hyun-Jun Kim, Kere Lehavot, Karina L. Walters, Joyce Yang, Charles P. Hoy-Ellis, and Anna Muraco. 2014. “The Health Equity Promotion Model: Reconceptualization of Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Disparities.” American Journal of Orthopsychiatry 84 (6): 653-663.
Kristen, Elizabeth and Davis Nahmias. 2019. “The Writing on the Wall: The Future of LGBT Employment Antidiscrimination Law in the Age of Trump.” Berkeley Journal of Employment and Labor Law 39 (1): 89-116.
McKay, Tara, Jeff Henne, Gilbert Gonzales, Rebecca Quarles, and Sergio Garcia. 2020. “The Impact of COVID-19 on LGBTQ Americans.” Retrieved June 11, 2020 (http://nebula.wsimg.com/
McKay, Tara. 2020. “Older LGBTQ Tennesseans and COVID-19.” Retrieved June 15, 2020 (http://nebula.wsimg.com/
Mize, Trenton D. 2016. “Sexual Orientation in the Labor Market.” American Sociological Review 81 (6): 1132-1160.
National Center for Transgender Equality. 2020. “The Coronavirus (COVID-19) Guide.” Retrieved May 12, 2020 (https://transequality.org/
OutRight Action International. 2020. “Vulnerability Amplified: The Impact of the COVID-19 Pandemic on LGBTIQ People.” Retrieved June 17, 2020 (https://
Sherrel, Devon. 2019. “A Fresh Look”: Title VII’s New Promise For LGBT Discrimination Protection Post-Hively.” Emory Law Journal 68: 1101-1144.
Contributing Editor: DaShanne Stokes, Ph.D.
DaShanne Stokes, Ph.D., (http://www.dashannestokes.com
Photo by Al drago for The New York Times