Commentary
Implications of the COVID-19 Pandemic on LGBTQ
Communities
Kristen D. Krause, PhD, MPH
A s of August 2020, the United States has re-
ported more than 5.5 million confirmed cases
and almost 170 000 fatalities as a result of
SARS-CoV-2 (the novel coronavirus, which causes
COVID-19).1 Since the onset of the pandemic in
early 2020, researchers have begun to delineate the
myriad economic,2 racial,3 and geographic4 health
Downloaded from http://journals.lww.com/jphmp by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60Etgtdnn9T1vLQWJq3kbRMjK/ocE on 11/28/2020
disparities associated with the overall risk for con-
tracting COVID-19. While these inequities are signif-
icant to highlight, it also imperative to acknowledge
and understand how COVID-19 has disproportion-
ately impacted lesbian, gay, bisexual, transgender,
and queer (LGBTQ) individuals and communities
who also face many of the aforementioned health
disparities.
The economic ramifications of COVID-19 will
likely be felt widespread and by all; however, LGBTQ
individuals are particularly vulnerable. In general,
LGBTQ people are more likely to struggle financially,
with 30.2% of LGBTQ Americans losing their jobs
and 17.9% reporting reduced wages.5 In addition,
20% of LGBTQ folks reported that their personal
finances are “much worse off” compared with 11%
of the general population and they are twice as likely
to believe their finances will be worse in a year from
now.5 With the global economy being at its worst
since World War II,6 it will be challenging for LGBTQ
communities to bounce back as quickly as their het-
erosexual counterparts.
There are also considerable health care access chal-
lenges to take into consideration. Prior to the onset
of the pandemic, LGBTQ individuals often reported
inadequate care due to previous stigmatizing experi-
ences in health care settings7,8 and lack of provider
knowledge on health care needs.9,10 In addition, in
Author Affiliation: Center for Health, Identity, Behavior and Prevention
Studies, Rutgers University School of Public Health, Newark, New Jersey.
The author declares no conflicts of interest.
Correspondence: Kristen D. Krause, PhD, MPH, Center for Health, Identity,
Behavior and Prevention Studies, Rutgers University School of Public Health,
One Riverfront Plaza, Ste 1020, Newark, NJ 07102
(kristen.krause@rutgers.edu).
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
DOI: 10.1097/PHH.0000000000001273
January/February 2021 • Volume 27, Number 1 Supp
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
2018, 17% of LGBTQ adults did not have any kind
of health insurance coverage compared with 12%
of the general population.11 This disparity is even
greater among LGBTQ adults of color and transgen-
der adults, with 23% and 22%, respectively, reporting
lack of health care coverage.11 Although many states
and local jurisdictions are offering free COVID-19
testing, there should be more targeted outreach to-
ward LGBTQ communities to ensure a safe and
stigma-free testing experience.12
The Intersection of COVID-19 With Other Health
Outcomes Impacting LGBTQ Communities
While COVID-19 is presently at the forefront of most
public health initiatives and programming, it is not the
only pressing health concern, especially for LGBTQ
folks. Mental health burdens in LGBTQ persons are
likely to be intensified by COVID-19.13 Researchers
in Hong Kong found that stressors specifically re-
lated to identifying as a sexual minority significantly
contributed to the variance explained by anxiety
and depressive symptoms that were beyond COVID-
19–related stressors.14 Moreover, physical and social
distancing measures while important can have a detri-
mental effect on mental health and well-being in
LGBTQ communities that already face structural and
systemic vulnerabilities.13,15 This is particularly true
for older LGBTQ adults who already face higher lev-
els of social isolation and loneliness.16-18
In addition to mental health stressors, gay men and
transgender individuals are at an increased risk for ex-
periencing violence during the COVID-19 pandemic.
In Colombia, Panama, and Peru, physical distancing
rules are being implemented and enforced on the basis
of a binary understanding of gender,19,20 meaning that
essential services can only be accessed on alternate
days of the week.21 These policies had a severe impact
on the Peruvian transgender community as policing of
the laws has resulted in public humiliation and physi-
cal assault, among other transphobic actions.21 In the
United States, there is a growing concern that shelter-
in-place orders will increase the risk and occurrence
of intimate partner violence among gay men.22
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S70 Krause • 27(1 Supp), S69–S71
It is also well documented that LGBTQ people are
at a higher risk for different chronic illnesses including
various respiratory conditions (eg, asthma and
chronic obstructive pulmonary disease),23 diabetes,24
and cardiovascular disease,25 all of which are risk fac-
tors for COVID-19.26 Given that 37% of LGBTQ
adults smoke compared with 27% of the general
population,11 this is particularly concerning because
COVID-19 spreads primarily through the transfer of
respiratory droplets from person to person and can
cause significant lung damage.27 Taken together, the
numerous mental and physical health conditions im-
pacting this population underscore the importance of
having a clear understanding of the impact of COVID-
19 on LGBTQ people.
Missing Key Demographic Information on
COVID-19 Testing Forms
To recognize the implications of COVID-19 on
LGBTQ communities, we need to know how many
LGBTQ folks have tested positive for the virus. This
is extremely challenging because there is no uni-
form system of collecting general demographic data
throughout the United States, and, often, questions
on sexual orientation and gender identity (SOGI) are
not included on testing forms. At the time of this
writing, there are only a handful of states and dis-
tricts collecting or are planning to collect SOGI data
including California,28 Pennsylvania,29 and Wash-
ington, District of Columbia.30 LGBTQ advocates
have been pushing lawmakers and health officials in
other states such as New York,31 New Jersey,32 and
Massachusetts33 to include SOGI items on COVID
testing forms, with little success to date. While this in-
formation undoubtedly is important, there are other
obstacles facing LGBTQ communities with regard to
data that also need to be addressed.
Moving Forward: Ensure LGBTQ People
Are Counted
Until SOGI is recognized as an innate aspect of a
person’s identity and overall being, we will continue
to face an uphill battle to ensure we are equitably
counted where it matters the most. The majority of
current public health surveillance systems in place
throughout the United States do not incorporate ba-
sic demographic data on LGBTQ people.30 Moreover,
many health care institutions do not uniformly collect
SOGI data in their patient record systems.30 Similar
to other demographic data on race/ethnicity or mar-
ital status, asking questions around SOGI should be
commonplace in these systems and automatically in-
cluded. While privacy issues around this information
Copyright © 2021 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Commentary
are often cited as a reason to not include it,34 indi-
viduals can always have the option of not answering
those particular questions as they do for all other de-
mographic inquires.
Although adding these questions to public health
surveillance systems is crucial, these efforts are sim-
ply not enough. LGBTQ people will continue to be
unjustly impacted by myriad inequities until we are
counted correctly in the US Census and the Ameri-
can Community Survey.35 If the federal government
will not take action, state and local governments can
issue executive orders or pass legislation to properly
ascertain the most important data points on LGBTQ
individuals and communities. In doing so, some in-
stitutions and organizations may have to rise up and
meet the potential challenge to update outdated forms
and technology. The benefits of having this informa-
tion in a consistent and uniform manner can help
facilitate information sharing between public health
departments, researchers, and clinical care providers
in order to provide better care and reduce the in-
equities experienced within LGBTQ communities.36
Conclusion
In times of crisis and turmoil, it is imperative that
scientists, other researchers, and public officials have
access to information that can help protect and serve
the most vulnerable populations and communities. In
the case of the COVID-19 pandemic, we are currently
forced to make educated assumptions on how the
virus will disproportionately impact LGBTQ commu-
nities because the necessary data on sexual orientation
or gender identity are not regularly being collected on
COVID testing forms. This is just a microcosm of the
overall structural inequities around LGBTQ data col-
lection that must be addressed in the United States. As
such, we must keep advocating for SOGI items to be
included on all health-related intake forms and on na-
tional surveys in order to combat the injustices facing
some of the most marginalized groups among us.
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