Highlights LGB people experienced general and sexual minority-specific stressors during COVID-19. Depressive and anxiety symptoms during COVID-19 were higher than those in normal times. Health problems and reduced social contact were related to poorer mental health. Sexual minority-specific stressors explained mental health beyond general stressors. Timely, accessible mental health care is needed to address COVID-19-related stressors.

Background: Lesbian, gay and bisexual (LGB) people often face individual-and system-level barriers in health care. However, LGB people's experiences of health care in non-European and non-American settings have been scarcely studied. In China, while it has been estimated that there are at least 70 million gender and sexual minorities, there has been no larger-scale study on LGB people's experiences of health care beyond a focus on gay men and HIV. This study is the first larger-scale quantitative study to investigate LGB people's experiences of health care in China, where non-heterosexuality is officially silenced and the needs of non-heterosexual people are largely ignored by service providers. Methods: An online survey was designed in joint partnership by academic, community groups and the United Nations Development Programme. Targeted and snowball sampling was adopted for participant recruitment. Such unique cross-sectoral partnership made this research possible in the authoritarian state of China where data collection on LGB people is extremely rare. For the analysis in this paper, a sample of 15,611 Chinese LGB people were included. Frequency and descriptive statistics were conducted to describe the LGB respondents' demographic characteristics and their experiences in health care settings. Chi-square tests were conducted to test how experiences vary across LGB people with different demographic characteristics. Results: More than three quarters of the respondents said they would be willing to disclose to their medical care providers their sexual orientation if asked. However, only 5.7% of the respondents said that medical care providers ever asked them about their sexual orientation. About 8.0% of the LGB people surveyed reported having experienced negative treatment in medical care settings. Six percent (5.7%) of the Chinese LGB people said in accessing mental health care services, they were recommended, coaxed into, or provided conversion therapy for sexual orientation, gender identity or gender expression.

A community-driven survey of 106 transgender people (the first such survey in Hong Kong) showed that: (1) more than half the sample (50.9%) had a university degree or higher qualification; (2) despite this, 43.4% had a monthly income below HK$6,000 (about USD$775); (3) 66% reported "fair" or "poor" quality of life; (4) 67% of the sample (87.1% of respondents aged 15-24 years) had contemplated suicide; and (5) 20.8% of the sample (35.5% of respondents aged 15-24 years) had attempted suicide. It was found that (1) those who were single, had a lower monthly income, and identified as transgender women reported lower quality of life; and (2) those who were younger and on a lower income expressed higher suicidality. The findings suggest that service providers and policy makers urgently need to address the mental health needs of transgender people, particular younger transgender people.

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The impact of the COVID-19 pandemic on sexual and reproductive health and rights is a significant public health issue. HIV/AIDS related services have been severely disrupted during the pandemic in different aspects. This paper highlights how privacy concerns affected HIV service provision during COVID-19 in Hong Kong, by sharing the experience of AIDS Concern Hong Kong. Based on our experience of working with our local MSM clients, temporary closure of center-based testing, venue-based testing in gay saunas, and mobile testing, meant that MSM could not easily go to a safe space to get anonymous and gay-friendly testing. To mitigate this, AIDS Concern Hong Kong put effort into promoting and making self-testing available during periods of testing center closure. We also made sure that people can choose to have test kits delivered to an anonymous pick-up station.