Vulnerability to COVID-19-related Harms Among Transgender Women With and Without HIV Infection in the Eastern and Southern U.S.

Abstract

Background: COVID-19 is a new pandemic, and its impact by HIV status is unknown. National reporting does not include gender identity; therefore, data are absent on the impact of COVID-19 on transgender people, including those 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 factors that may increase vulnerability to COVID-19-related harms among transgender women. Setting: Atlanta, Baltimore, Boston, Miami, New York City, Washington, DC. Methods: Baseline data from LITE were analyzed for demographic, psychosocial, and material factors that may affect vulnerability to 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 behavioral health symptoms were common and did not differ by HIV status. Barriers to health care included being mistreated, provider discomfort serving transgender women, 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 benefit 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.

Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people

“…Prior to the emergence of COVID-19, transgender and nonbinary individuals experienced barriers to care, greater mental health challenges, and economic vulnerabilities caused by stigma, discrimination, and minority stress [17][18][19]. Transgender and nonbinary 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][21][22].…”

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

“…We encourage future research to apply sociobehavioral perspectives to examine how these vaccine-related considerations affect COVID-19 vaccine adoption. Fourth, our study sample included few gender minority individuals (n = 58), who may be particularly vulnerable to pandemic harms, and our results may not be generalizable to larger gender minority populations [ 42 ]. Lastly, our analysis compared outcomes between race categories among SGM populations, which limits our understanding of variability within racial groups that may help identify strategies to combat COVID-19 inequities.…”

Examining the elevated risk of COVID-19 in transgender communities with an intersectional lens

“…Living with HIV might increase one's risk for experiencing severe COVID-19 illness (CDC 2020e). Trans women living with HIV (relative to those not living with HIV) are far more likely to be unemployed and homeless (Poteat et al 2020) and therefore, might be less likely to receive necessary medical care should they contract the COVID-19 virus.…”

“…In the mental health arena specifically, when care is accessible, trans people are pathologized solely for being trans as gender dysphoria is conceptualized as a psychiatric disorder (American Psychiatric Association 2013). On a more structural or macro-level, trans people (and especially trans PoC) frequently live in poverty (Badgett et al 2019;Poteat et al 2020) and, therefore, are un-or underinsured, and nonbinary people and trans men are especially likely to lack access to counseling or mental health care (Jarrett et al 2020). Historically, unequal systems have engendered medical mistrust among marginalized communities, especially since the powers that established these systems are responsible for substantiating and reinforcing discrimination against them (Jaiswal and Halkitis 2019).…”

“…Education levels are highly associated with income status (Jackson and Holzman 2020) as many fields with the most lucrative job opportunities require college degrees (e.g., nurses, physician assistants; Bureau of Labor Statistics 2020). Importantly, preliminary data suggest that COVID-related job losses and furloughs intensify poverty among trans people, and trans women and trans PoC in particular (Poteat et al 2020;Sears et al 2021).…”