These last two weeks the news has been tuned to the COVID-19 pandemic nearly constantly. There’s really no understating how serious the disease is or the havoc its wreaking on so many people’s lives and livelihoods.
Around the world, but especially in America, we are watching the compounded failures of capitalism and narcissistic government play out. We’re seeing issues that primarily target marginalized communities, including our own, getting hit even harder than before.
The COVID-19 pandemic is disproportionately hurting our community because of structural issues that affected the LGBTQ+ community in so many different ways before any of this started. To get some perspective on this, I spoke with Karen Lee, who works at the NYC Department of Health and Mental Hygiene and is the co-chair of Q-Wave, a NYC-based organization building strength and solidarity among queer Asians who identify as women, nonbinary, and/or trans.
LGBTQ+ People Face More Barriers When Accessing Healthcare
Health care is really the only defense we have against a pandemic, from the individual level all the way to the global. And yet, in this most basic of human rights, the LGBTQ+ community faces not one but two hurdles.
We know that the cost of health care in America is egregious and prohibitive. Compared with the rest of the country, though, the high cost of care disproportionately affects members of the LGBTQ+ community: 15% of LGBT adults are uninsured compared with 12% of the non-LGBT population. CDC data from 2015 indicates that bisexuals have higher rates of being uninsured than lesbians/gay people, and a 2017 survey conducted by NPR, the Robert Wood Johnson foundation and the Harvard T.H. Chan School of Public Health found that 22% of transgender Americans are uninsured.
An even greater proportion of the LGBTQ+ community has foregone healthcare because of the cost. According to a Monmouth University poll conducted in May 2019, 27% of Americans indicated that they or someone in their family hadn’t gone for needed health care because of cost in the past two years. In contrast, on Autostraddle’s Politics Survey, conducted December 2019 to January 2020, 63% of respondents had to make that same, difficult decision. This is consistent with the NPR/RWJ/Harvard survey, which similarly found that 56% of LGBTQ+ American adults have not gotten health care because of the cost. Based on Autostraddle’s Politics Survey, this issue disproportionately affected our bisexual and queer respondents and respondents who were transgender or non-binary.
(As a reminder, Autostraddle’s Politics Survey was completed by queer people who identify as women, nonbinary, and/or trans and for more information on who took Autostraddle’s Politics Survey, see the first post on results.)
The recently passed COVID-19 relief package includes free testing and increased federal funding but falls far short of any kind of coverage for treatment. And none of this addresses the discrimination that leads members of our community to not only forego but also be denied health care.
In Autostraddle’s Politics Survey, 11% of transgender and non-binary respondents indicated they had been refused services by a medical professional because of their gender identity or presentation and another 21% were unsure if that had happened to them. These results are also consistent with the NPR/RWJ/Harvard survey, which found that 10% of transgender Americans had been discriminated against in a health care setting. Unfortunately, this issue isn’t all that unique to the US: transgender and non-binary respondents on Autostraddle’s Politics Survey reported similar rates of being denied services and being unsure if they were denied, regardless of whether they lived in the US or in another country.
Under normal circumstances, there’s no place for transphobic health care providers who deny services, especially services that have nothing to do with a person’s gender. During a pandemic, making sure everyone has access to affordable and inclusive health insurance only becomes more urgent. Yet, we know that much of the world has a long way to go with protecting trans rights. In the US the Trump administration continues to eliminate protections for transgender people in many arenas, including health care, and trans rights are not protected in many European countries as well.
In a situation like this, Karen emphasized the importance of community health centers for LGBTQ+ individuals, which, depending on the location, may also offer services to people who are uninsured or underinsured. Community efforts are also a critical in supporting and providing services for transgender people, in particular.
A Greater Proportion of LGBTQ+ People Live with Health Issues
COVID-19 is of particular concern for people who are older or have existing health conditions, including heart disease, diabetes, asthma and lung disease. Currently, there’s no information on how COVID-19 affects people with HIV, but this population does have a higher prevalence of other health conditions.
Research has consistently shown that the LGBTQ+ population has a higher prevalence of these health conditions or risk factors associated with them, in part because of the difficulties the LGBTQ+ community faces in trying to access health care. These rates also differ for subpopulations within the LGBTQ+ community; for instance, some evidence suggests that higher rates of lesbian, gay or bisexual African Americans have diabetes than other populations and that more transgender women are living with HIV. Altogether, this puts a greater proportion of our community – and some of the most marginalized members of our community – at higher risk for serious complications if they contract COVID-19.
In addition to physical health concerns, social distancing and quarantine can have lasting, adverse effects on mental health. Here, again, the LGBTQ+ community is especially vulnerable. Prior to the pandemic, our community was already experiencing disproportionately high rates of mental health conditions, psychological distress and suicidal ideation, particularly among transgender people and bisexual people. Social distancing for the foreseeable future to prevent the spread of COVID-19 will take a serious toll on the mental health of LGBTQ+ individuals.
Karen spoke about this during our conversation:
When you already have a community that is, they feel they’re already isolated, they already feel marginalized and now government – whether it’s federal, it’s state, or local governments – are telling and recommending people to stay at home, “don’t be around other people.” I can’t even begin to imagine how incredibly lonely this can be.
The isolation is further exacerbated by the closure of community centers and universities. While these measures are taxing for everyone, they are particularly harmful to LGBTQ+ people because so many are often distanced or estranged from their families. Many LGBTQ+ individuals also rely on these organizations for their social networks, mental health services and in the case of some college students, housing.
Acknowledging this challenge, mental health professionals and community organizations like Q-Wave are transitioning their services to remote platforms and teleservices. For some people living in abusive, toxic or unaccepting circumstances, though, these services may now become inaccessible. Given the circumstances, though, there are few viable alternatives.
Here at Autostraddle, we’re providing COVID-19-specific resources to build even stronger online connections during this time of social distancing.
The LGBTQ+ Community Experiences Greater Economic Vulnerability
The COVID-19 pandemic puts into sharp relief how unsustainable it is to attach people’s livelihoods to consumption. Tens of thousands of people have lost their jobs in the US alone because of the pandemic, and there is probably no quantifying how many people have lost additional income streams that they needed to live. Economists fear that globalization itself my be at risk, and though I’m no big fan of the global economy, I can’t deny that as global economies tumble, low income people around the world will be the hardest hit.
Economic inequities have always disproportionately affected the LGBTQ+ community worldwide, and the COVIDI-19 pandemic only escalates the situation. In the United States, for example, nearly a quarter of LGBT adults have household incomes below $24,000, compared with 18% of the non-LGBT adult population. Lower income jobs are often blue collar or in the service industry, where “remote work” is not possible so workers are either getting laid off and losing their primary sources of income or being put at risk as their employers recklessly proceed with business. Neither option is great. Sex workers are especially vulnerable to the health risks and the economic impacts of the pandemic.
The recently passed COVID-19 relief legislation in the US includes paid sick leave for most employees at companies with 500 or fewer people, including part-time and gig economy workers. Democrats are already looking into passing additional legislation to extend paid leave to more workers (as in their original bill).
The situation has become dire enough that even Donald Trump and Boris Johnson have expressed support for universal basic income although the question of whether either government will actually deliver on this in a meaningful way remains open. Justin Trudeau just put forward a relief package that includes payments for lower income households.
All this economic uncertainty takes a further toll on the physical and mental health of the LGBTQ+ community. While governments may step up and offer some relief, the community is already coming together to support each other through mutual aid projects. Vanessa provided information on many of these earlier this week and will continue to update the post as more becomes available. Shelli compiled a list of resources for paying bills and will continue to update the post as more information becomes available.
Queer Asians Are Facing the Dual Threats of Racism and Homophobia
Trump’s a racist, and I have no expectations of that changing. I am, however, incredibly disappointed that widespread racism against people of Asian heritage, which started long before COVID-19 ever spread outside China, has not subsided.
Part of what makes racism so pernicious is its inescapability. Asians who grapple with, or in some cases internalize, the model minority myth experience this through the lens of their families having made countless sacrifices to “belong” and that simply never enough. Even in times and places where Asians are used as a cover for anti-black racism, Asians’ standing in the racial hierarchy is eternally precarious. One mispronounced word or one strong smelling dish or one virus can unravel it all.
Karen shared how she thinks about some of the racist attacks against East Asians because of the COVID-19:
So you take East Asians, or any Asians because people don’t know the difference between Chinese or any other Asian groups. You have – this might be a generalization, but – you have this one ethnic group who tried so exceptionally hard to assimilate to the fact where they were willing to give up their citizenship to their countries, they’re willing to teach their children and their grandchildren to not speak their native tongues. They tried so hard to assimilate into America and be upstanding citizens and not to offend others. And, then this happens and it’s almost like this racism is just resting underneath your skin.
These experiences of racism have led to isolation of Asians – again, long before COVID-19 spread outside Asia – as Asians circulated messages within the community about attacks that were happening, felt apprehensive about coughing or sneezing in public and cautioned each other not to go out when they were sick with regular cold symptoms.
But racism and discrimination are even more challenging for queer Asians to navigate because of the seeming incompatibility of queerness and Asian-ness in both mainstream queer and mainstream Asian culture. Queer Asians experience an even greater sense of alienation, as Karen describes:
I grew up on the West coast; I grew up in San Francisco and moved to New York and so I’m always, I’m always searching for this idea of belonging and what is home. And when I came to New York, I recognized my privilege because I grew up in San Francisco where being queer and Asian – there were spaces for that in San Francisco. But, I can’t imagine many other cities or places in the United States where there are safe spaces for being queer and Asian because often times you think of queerness as a white thing and then when you think of Asian-ness you don’t see any room for queerness in that.
All of this has also laid bare some of the fissures within marginalized communities. Karen recounted that some of the recent attacks against Asians were instigated by other people of color and how disheartening that was to see. At the same time, these experiences of discrimination and hate-based attacks are experiences shared by many other communities as well:
This is daily life for some people who live on the margins, such as trans women, people of color, black folks, refugees, Jewish people. They face this on a daily basis, so it’s kind of like if people can understand – if Asians, East Asians can understand that there is this racism, this discrimination, this hatred that exists every single day for other folks – I’m hopeful that we can build solidarity.
Ultimately, that solidarity is the only thing that will get all of us through these uncertain times.