COVID-19 Vulnerability of Transgender Women With and Without HIV Infection in the Eastern and Southern U.S.

Abstract

Background: COVID-19 is a new global pandemic and people with HIV may be particularly vulnerable. Gender identity is not reported, therefore data are absent on the impact of COVID-19 on transgender people, including transgender people with HIV. Baseline data from the American Cohort to Study HIV Acquisition Among Transgender Women in High Risk Areas (LITE) Study provide an opportunity to examine pre-COVID vulnerability among transgender women. Setting: Atlanta, Baltimore, Boston, Miami, New York City, Washington, DC Methods: Baseline data from LITE were analysed for demographic, psychosocial, and material factors that may affect risk for COVID-related harms. Results: The 1020 participants had high rates of poverty, unemployment, food insecurity, homelessness, and sex work. Transgender women with HIV (n=273) were older, more likely to be Black, had lower educational attainment, and were more likely to experience material hardship. Mental and behavioural health symptoms were common and did not differ by HIV status. Barriers to healthcare included being mistreated mistreatment, uncomfortable providers, and past negative experiences; as well as material hardships, such as cost and transportation. However, most reported access to material and social support - demonstrating resilience. Conclusions: Transgender women with HIV may be particularly vulnerable to pandemic harms. Mitigating this harm would have positive effects for everyone, given the highly infectious nature of this coronavirus. Collecting gender identity in COVID-19 data is crucial to inform an effective public health response. Transgender-led organizations' response to this crisis serve as an important model for effective community-led interventions.

Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review

“…The research investigated a range of topics including, mental health and stress [20,21,23,24], access to health care [22,25], experiences of stigma [26], factors impacting medication adherence [27] and social precarity [28]. One US study involved a case series of PLHIV who had been diagnosed with COVID-19 [9] and three studies focused on unique subgroups of PLHIV, including African American and Latinx PLHIV [29], PLHIV with substance use disorders [30] and transgender women living with and without HIV [28].…”

“…One study involved semi-structured qualitative interviews with 15 racially diverse PLHIV who had been part of an HIV care intervention [29]. A number of studies involved existing cohorts, including a sample of transgender women living with HIV [28], an Australian cohort of gay men and MSM who were recruited in 2014 [33], and two studies involved surveys of older PLHIV who were participants of previous studies [24,34]. One study involved a wellbeing trial, cancelled due to COVID-19, that engaged participants in a survey to measure the impacts of the new pandemic on their mental health and HIV care outcomes [24].…”

Gender-affirming care, mental health, and economic stability in the time of COVID-19: a global cross-sectional study of transgender and non-binary people

“…Prior to the COVID-19 pandemic, transgender and non-binary individuals experienced barriers to care, greater mental health challenges, and economic vulnerabilities caused by stigma, discrimination, and minority stress. 17–19 Transgender and non-binary populations face a scarcity of clinicians trained in gender-affirming practices and widespread transphobia among healthcare staff, both of which make healthcare less accessible. 20–22 Yet access to gender-affirming healthcare (e.g., chest/breast surgery), services (e.g., hair removal), and goods (e.g., binders and packers) can substantially improve the quality of life and mental health of transgender and non-binary populations, who frequently have elevated levels of depression, anxiety, and suicidal ideation.…”

COVID-19 Vaccine Acceptance among an Online Sample of Sexual and Gender Minority Men and Transgender Women

“…SGM are also more likely to experience homelessness that may increase exposure to COVID-19. Disproportionate rates of mental health disorders and victimization are worsening among SGM in the setting of social isolation due to pandemic restrictions [ 45 , 46 , 47 , 48 ]. Decreased access to health services and delays in seeking care may have grave consequences for SGM who are more likely to have comorbidities, such as asthma and cardiovascular disease, which increase risk of severe COVID-19 disease [ 9 , 17 , 44 , 48 , 49 , 50 ].…”