Special Report: COVID-19 and the LGBTQ Community

Long before COVID-19 became a household name in the United States, another virus known as the human immunodeficiency virus (HIV) made a mark on the LGBTQ culture almost 40 years ago. The epidemic that ravaged the lives of the queer community, most of them being gay men, placed a permanent mark on their psyches. More than 700,000 people in the United States have died from HIV since the epidemic first began. Many of those in the LGBTQ community who are not HIV+ live with the daily decision of taking a medication to prevent the spread of the disease.

Because of the impact of HIV, the emergence of COVID-19 has led some to experience trauma-related symptoms as the eerie unknowingness of the virus reflects that of HIV when it first began. Doctors attempted to identify the cause of the illness and piece together symptoms. Because of a lack of knowledge, many thought it affected only gay men, leading HIV to be initially coined gay-related immunodeficiency (GRID). The understanding of how HIV was transmitted came later. Today, those living with HIV around the world have their own reasons to be particularly fearful of COVID-19 depending on their immune status and susceptibility. This fear has driven some into further isolation and separation from their community.

Many LGBTQ people have tense relations with their biological family, given the lack of general acceptance of those who have diverse sexual orientations and gender identities. Because of this, LGBTQ people have adapted by creating families of choice—nonbiological connections with friends with whom they have close and familial-like relationships. Although these relationships might be the most important ones many LGBTQ individuals have, they often do not live together as a traditional family would. Because of the COVID-19 quarantine requirements and physical distancing restrictions, LGBTQ people are now finding themselves cut off and physically separated from their strongest social supports.

I’d like to share a few examples of how memories of the AIDS epidemic and isolation have affected LGBTQ individuals. Charles is a 65-year-old gay man in New York City. He grew up in the Midwest and moved to New York to find a more supportive environment. During the 1980s, as Charles was starting to explore his sexuality, the AIDS epidemic started. No one understood what it was or why it affected gay men so much. The majority of the friends and lovers Charles had come to know and love started to die. By the time the decade had ended, Charles had acquired HIV himself and lost many of those in his social support network.

Today, Charles is living alone and retired. He spent time working to build new friendships and loving relationships. As COVID-19 started to spread across New York City, Charles was reminded of his experience with HIV. He heard on the news that COVID-19 was more serious for those with existing health problems or compromised immune systems—much like his. He started to quarantine himself. Despite having phone calls with his friends, Charles missed human connection. Some of his older friends started to become ill, and a few of them died. Charles was reminded of the friends he had lost before, instilling a sense of hopelessness and despair. Stories like Charles’ are all too common during the COVID-19 pandemic.

Sammie, a 27-year-old woman of trans experience, works in a restaurant in San Francisco. They (Sammie’s pronouns are “they,” “their,” “theirs,” and “themself”) had moved there to get trans-affirming health care, which included therapy and hormones. They were kicked out of their parents’ house when they came out several years ago. Since then, they had been living paycheck to paycheck but paying all their bills on time.

When the COVID-19 pandemic hit, Sammie lost their job. The restaurant they worked for was already having financial difficulties, and the owner decided to close it permanently. Sammie lost their paycheck as well as access to health care. Their therapist, whom they had been seeing weekly, was available only through virtual visits. Despite keeping their head above water recently, they worried that mental health problems from which they had suffered before—like depression and anxiety—would come back. They were also worried that they wouldn’t be able to afford the medications and therapy that had been helping them. Because of quarantine, they couldn’t leave their home or see their friends. They found themself more isolated than they had ever felt before. Their story is similar to many LGBTQ youth who were just trying to survive before the pandemic. The experience of COVID-19 is proving to add more stress to their lives, causing many to become depressed, anxious, or worse.

LGBTQ individuals have been shown to experience higher rates of depression, anxiety, substance abuse, and suicidality. Because of the aforementioned situations—reemergence of trauma related to the historical HIV experience and isolation from families of choice due to pandemic restriction—LGBTQ people might likely experience a worsening of symptoms already affecting them. LGBTQ people in treatment for psychiatric symptoms will need more help at a time when that help seems to be more scarce.

COVID-19 has confined many Americans to their homes, and visits with health care professionals have largely gone virtual. For LGBTQ people, there was already a lack of access to care from health care professionals who are affirming of their sexual orientation and gender identity. Now the pool of available appointments is shrinking further as health care facilities try to function in a nonphysical space. Those who had access to care before are finding it harder to get available appointments, and many who were without health care professionals will find it more difficult to establish some form of care.

Beyond the mental health implications of COVID-19 in the LGBTQ community, there are socioeconomic factors that will emerge showing further disparities. Many LGBTQ people work in service industries, including bars and restaurants, which have been heavily hit by pandemic restrictions. Those same LGBTQ people are now finding themselves without work and thus income, and benefits are starting to run out. Homelessness and poverty, already disproportionally prevalent in the queer community, are likely to get worse. These financial stressors will further impact the mental health of those already symptomatic, and new cases of depression, anxiety, substance use, and suicidal ideation will likely increase. The mental health of many might move closer to a breaking point. Dangers already present before, such as the risk of suicide, have become even more prevalent.

The definition of internalized homophobia and transphobia is the existence of internal stress from having a different sexual orientation or gender identity compared with the larger population. Being LGBTQ alone can incite prejudice and discrimination from the external world, leading these individuals to blame themselves and experience further injury to their self-esteem. Intersectionality refers to having more than one minority identity, and those with multiple identities experience additional stress. Because of this, for example, members of the LGBTQ community who are also members of racial minorities are particularly vulnerable at this time.

Members of the Black and Latinx communities who are also LGBTQ are likely dealing with stress from numerous sources. All aspects of vulnerabilities mentioned before add to the stress that comes along with being a member of a racial or ethnic minority. In addition, the recent increase in attention around the Black Lives Matter movement has led some to feel more support, but others, depending on their geographic location, might find themselves more at risk. Racial attitudes across the country could expose members of the LGBTQ community to further verbal and even physical violence. These threats might come not only from the general population, but also from those whose job it is to serve and protect individuals.