Dylan Kneale, Laia Bécares, Harri Weeks
These are definitely not normal times. The coronavirus pandemic is raging across the world, with some glimmers of respite only now emerging, as the ‘curve’ appears to be flattening and restrictions are being slowly eased in some countries. For weeks now we have been under lockdown and the world is wondering what the ‘new normal’ will look like.
For some groups, such as Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+, the “plus” including those in the community who don’t identify with any such label), the lockdown we are experiencing now, and the uncertain future after restrictions are lifted, may only serve to exacerbate social and health inequalities that existed before the pandemic.
The pandemic is having a differential impact across groups, and is casting a light on exclusionary practices and prejudice that are ordinarily overlooked, or accepted as inexorable. For example, the omission of deaths in care homes until very recently from UK COVID-19 mortality statistics has been viewed as tantamount to ageism by some, and certainly indicative of the value we place on the lives of older people.
As for LGBTQ+ people, decades of being invisible in health and social research means we have to draw from a limited evidence base in order to theorise the increased risks of exposure to COVID-19. However, studies do suggest higher levels of long-term chronic illness among LGB people which may place the community at additional risk. LGBTQ+ people also are more likely to smoke than others; lesbian and bisexual women are more likely to be overweight and to consume alcohol than their heterosexual peers, LGBTQ+ people are more likely to be asthmatic, and LGBTQ+ people are more likely to be immunocompromised (e.g. HIV+ with a low CD4 cell count or with untreated HIV). These are all factors more likely to place LGBTQ+ people at high risk of a poorer COVID-19 prognosis.
But it is perhaps in the impact of the lockdown itself where health and social inequalities may become most visible for the LGBTQ+ community. Several studies show a disproportionate burden of mental health issues among LGBTQ+ people, which may be exacerbated by the stress, isolation, and loneliness of lockdown. Early on in life LGBTQ+ people are more likely to experience stigma, discrimination and exclusion, mental health issues, and substance use which can lead to homelessness and make it more difficult to find a safe place to live.
During lockdown, young LGBTQ+ people may be stuck in households that are hostile to their identity, and isolated from the communities and services that usually help to see them through. Older LGBTQ+ people are less likely to own their own home than heterosexual people, suggesting lower levels of wealth, and are more likely to be living alone, the impacts of which may lead to greater feelings of isolation and loneliness. Economically, we know that overall, LGBTQ+ people tend to be in a more precarious position when compared to the heterosexual population, casting doubt on the strength of the pink pound and the ability of LGBTQ+ people and organisations to cope financially.
LGBTQ+ spaces and services, the very places where LGBTQ+ people could go to access the support and community they needed, may be those that were already in a financially precarious position before the pandemic and may remain permanently closed. At the time of writing, twelve LGBTQ+ support organisations are facing imminent closure, and recent estimates suggest 30% of LGBTQ+ organisations are operating without financial reserves.
The health system is (rightly) diverting capacity towards caring for those with COVID-19, but this, combined with mixed messages from healthcare providers, is resulting in LGB, and particularly trans, people’s specific healthcare needs not being addressed. Trans people’s access to gender identity clinics, hormones and surgery have been significantly restricted and waiting lists for transition-related healthcare, already absurdly long at 2-4 years, will spiral as a result.
The reality is that, at the moment, we do not know whether the inequalities faced by LGBTQ+ people have been exacerbated by the pandemic, and we won’t know how COVID-19 has impacted on LGBTQ+ people’s lives without further concerted data collection. Data collection on LGBTQ+ lives through national surveys has been woefully poor over recent years, and data on transgender people is almost entirely absent.
Even the data we have to hand may not provide the most accurate estimates, given the sensitivity of asking about sexuality and gender in surveys and the different ways in which people choose to identify (or not identify – ‘other’ often receives a high return in surveys). However, the research outlined above suggests that the risks of a prolonged period of lockdown, of continued social distancing, and of economic downturn, are likely to be heightened for LGBTQ+ people.
Alongside the risks, we also know that LGBTQ+ people are contributing to the response in a multitude of ways – from the massive contribution to the health service of LGTBQ+ people to local volunteering, to working in key worker roles. There are many strengths to the LGBTQ+ community that can help us in supporting each other through this pandemic. Work in progress suggests that LGBTQ+ people are drawing from a variety of sources to help manage the impacts of the pandemic on a day-to-day basis.
Some are finding that the pandemic and the resulting lockdown has slowed life down allowing them to better manage their anxiety; others are drawing comfort from other events that are happening such as observing Ramadan; and some are actively contributing to pandemic efforts in key worker roles. Others are finding it more difficult, with emerging results of an ongoing study suggesting over a third of LGBTQ+ people are reporting declines in their health status since the start of the pandemic.
In order for the documented inequalities discussed above to not be further exacerbated during and after lockdown, the government has to commit resources to support LGBTQ+ charities and services that are fundamental for wellbeing. Further data is needed to understand how LGBTQ+ people are faring during the pandemic in order to better make the case for where services need to be targeted during lockdown and beyond. If we are not counted we don’t count.
Dylan Kneale is a Principal Research Fellow at the EPPI-Centre, UCL Institute of Education, University College London. Laia Bécares is a Senior Lecturer in Applied Social Science at the University of Sussex. Harri Weeks manages The National LGB&T Partnership, the key point of contact and relationship-building between the LGBT+ sector and the health system.
Image Credit: Melissa Kleckner on Flikr