Pride Month and COVID-19

On-Site Staff

June 30, 2020

Because of COVID-19 social isolation guidelines, many Pride parades were canceled in the US and across the globe. In response, organizations have held celebrations online, such as the Brooklyn Parade and West Hollywood Parade.

LGBT Pride is a term of promotion of the LGBTQ+ movement, which started in 1969. This movement is celebrated in June every year, hence the term "Pride Month" (1). This population has tried to show its existence and decrease public stigma and negative connotations associated with being a gay, lesbian, bisexual, or queer person through parades and peaceful demonstrations. Additionally, the movement's effort toward advocating for the human rights of LGBTQ+ community members resulted in many legal challenges throughout previous decades in many states. However, total equality is far away in all areas of life, such as in social or medical fields. In light of the ongoing COVID-19 pandemic, this brings a few problems to mind: changes to the June celebrations, LGBTQ+ individuals, and their susceptibility to COVID-19, hormonal therapy, and mental health.

LBGT events June 2020
Because of COVID-19 social isolation guidelines, many Pride parades were canceled in the US and across the globe (2). In response, organizations have held celebrations online, such as the Brooklyn Parade and West Hollywood Parade (1). Because of recent manifestations and riots that took place in many cities and towns across the USA as a result of George Floyd's death, despite the COVID-19 pandemic restrictions of social isolation, all kinds of peaceful manifestations might have undesirable social and legal connotations in the future. If this happens, it will be a significant setback for the LGBTQ+ community because the parades are an essential tool used to fight for fundamental human rights (1). LGBTQ+ pride parades of 2020 are listed on multiple websites, including The International Gay & Lesbian Travel Association, which is the world's leading network of LGBTQ+-welcoming tourism (1). As one can imagine, tourism and LGBT businesses will be negatively impacted by the coronavirus epidemic, as well.

LGBT risk of infection with COVID-19
According to the National LGBT Cancer Network, the LGBT population is more prone to get infected by the new coronavirus and to have adverse outcomes of the infection in comparison to the general population. The worse outcomes and infection rate is due to several factors: over 50% of LGBT individuals smoke, and contracting COVID-19 is especially dangerous for those who have a history of smoking (3). Also, higher rates of HIV infection exist in the LGBTQ+ community. There is data showing that unemployment is more prevalent amongst LGBTQ+ individuals compared to the general population (4). This statistic, combined with the fact that the LGBT population is less likely to have insurance and preventive services, correlates with additional health risks (5). There are possible negative impacts predicted in the upcoming months, from legal, health, and social perspectives. This population has been experiencing long-documented health disparities, the result of prolonged stigma and discrimination, which has made them prone to several comorbidities and impaired access to health care (6). Because LGBT people delay seeking medical help in fear of violence and even arrest, they are at higher risk of chronic diseases, and therefore weakened immune systems. The virus can then be contracted easily, leading this specific demographic to have worse outcomes in comparison to other populations (6). Moreover, a large percentage of the homeless population consists of LGBT group members, and access to clean water and practicing proper hygiene, which is necessary for preventing the spread of the virus, is severely limited (6). All of the above is exacerbated by the fact that many LGBTQ+ people are unemployed and live in poverty, which can further affect their mental and physical health.

Gender affirming care during the COVID-19
The CDC guidelines of postponing selective and non-life-threatening surgeries and non-emergent patient care resulted in postponing initiation of hormonal therapy treatments and maintaining the current dose of medications, which increases steadily to achieve the desired level (7). This type of interrupted care is another example of the deprioritization of LGBT needs, which are essential to these individuals (6). For example, at Boston Medical Center, gender-affirming care is focused on placing phone calls, conducting telemedicine visits, and managing hormone therapy (8). It is difficult to predict to what extent the lack of face-to-face interaction within health care will affect the LGBT people and their psychological well-being. Because mental health is an ongoing struggle for many LGBTQ+ individuals, any interruption to their medical care can result in the exacerbation of their psychological conditions. This issue will be addressed in the upcoming paragraphs.

Sex and relationships
Quality of social life during the ongoing pandemic changed drastically for the entire population due to superimposed lockdowns worldwide and the implementation of social isolation protocols. The drastic effects of this change include romantic and sexual relationships within the LGBT community as well. According to one study surveying 318 gay and bisexual men from 47 states, over 50% said they did not have sex within the last month because of the fear of contracting coronavirus, and about 20% asked their partners if they self-isolate, wear masks, and have any respiratory symptoms (9). They are scared if they will receive help when they get sick since many live with HIV/AIDS diagnosis. Overall, these people understand the risks of contracting COVID-19 have worse outcomes due to their disadvantages in accessing health care.

Mental health during COVID-19
Mental health is a big concern for the entire population throughout the pandemic, but especially minority groups, such as the LGBTQ+ community. According to TREVOR, one of the LGBTQ suicide prevention and crisis intervention LGBTQ organizations, COVID-19 will have serious mental health implications for LGBTQ youth (10). For example, stay-at-home restrictions can increase anxiety and depression, and can also increase violence against those confined at home with non-supportive family members (6). Many mental health conditions, including depression, substance abuse, anxiety, and suicidality (11), were observed in this population at much higher rates before the pandemic. Decreased positive social interactions combined with the stress of uncertainty with the virus, will be detrimental for this population (10).

1. Gay Pride Parades & Events: 2019 & 2020 Gay Pride Calendar for the LGBTQ+ Community [Internet]. [cited 2020 Jun 26]. Available from: https://www.iglta.org/Events/Gay-Pride-Calendar
2. Burns K. What will Pride mean this year? [Internet]. Vox. 2020 [cited 2020 Jun 24]. Available from: https://www.vox.com/2020/4/29/21227999/online-pride-coronavirus-pandemic
3. National LGBT Cancer Network Coronavirus 2019: What LGBTQ+ People Need to Know [Internet]. [cited 2020 Jun 23]. Available from: https://cancer-network.org/coronavirus-2019-what-lgbtq-people-need-to-know/
4. LGBTQ people face higher unemployment amid pandemic, survey finds [Internet]. NBC News. [cited 2020 Jun 23]. Available from: https://www.nbcnews.com/feature/nbc-out/lgbtq-people-face-higher-unemployment-amid-coronavirus-pandemic-survey-finds-n1205296
5. Medical care for sexual minority women [Internet]. [cited 2020 Jun 26]. Available from: https://www-uptodate-com.unh.idm.oclc.org/contents/medical-care-of-sexual-minority-women?search=LGBT%20and%20coronavirus&source=search_result&selectedTitle=10~150&usage_type=default&display_rank=9
6. LGBTIpeople.pdf [Internet]. 2020 [cited 2020 Jun 26]. Available from: https://www.ohchr.org/Documents/Issues/LGBT/LGBTIpeople.pdf
7. For LGBTQ Patients, the Coronavirus Brings New Challenges [Internet]. [cited 2020 Jun 26]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/for-lgbtq-patients-the-coronavirus-brings-new-challenges
8. Campaign HR. An Update on Gender Affirming Care During the COVID-19 Pandemic [Internet]. Human Rights Campaign. [cited 2020 Jun 26]. Available from: https://www.hrc.org/blog/an-update-on-gender-affirming-care-during-the-covid-19-pandemic/
9. Brief_Sex_and_COVID_gay_men_McKay.pdf [Internet]. 2020 [cited 2020 Jun 24]. Available from: https://cdn.vanderbilt.edu/vu-wp0/wp-content/uploads/sites/324/2020/05/15105727/Brief_Sex_and_COVID_gay_men_McKay.pdf
10. Implications of COVID-19 for LGBTQ Youth Mental Health and Suicide Prevention [Internet]. The Trevor Project. 2020 [cited 2020 Jun 26]. Available from: https://www.thetrevorproject.org/2020/04/03/implications-of-covid-19-for-lgbtq-youth-mental-health-and-suicide-prevention/
11. Russell ST, Fish JN. Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annu Rev Clin Psychol. 2016;12(1):465–87.

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