When someone who is high risk does contract the virus, it is really important to seek care early, and that is unlikely to happen for many transgender people.
For weeks now, I’ve read articles and social media posts declaring the COVID-19 pandemic the “great equalizer” because of how broadly it’s ravaged people living all over the world, forcing closures and causing illness and economic devastation for so many. But the reality is that the pandemic impacts different communities in unique ways—and when it comes to looking at folks’ health outcomes, the pandemic has emphasized and exacerbated the many disparities that transgender people living in the South have been facing for years.
We’ve long discussed these disparities at the Campaign for Southern Equality, where I serve as the Director of Community Health Programs. In my time as an activist and advocate for LGBTQ Southerners, I’ve seen the many ways that the community faces discrimination, harassment, and a lack of competency around basic health issues. It’s critical that we begin this conversation with a foundational understanding that trans and queer people are not starting on a level playing field in nearly every arena in life—especially in health and health care.
It’s worth highlighting, of course, that there’s very limited data on COVID-19 patients’ sexual orientation and gender identity, largely because states and other officials are declining to collect the data from patients. Whereas we’re able to track major trends when it comes to patients’ race and income, we’re not able to do the same for LGBTQ identity, a missed opportunity that leaves us in the dark about some of the specific numbers on the pandemic.
Despite this, we know some key things about transgender Southerners’ baseline access to quality health care, and the most important element to realize is that we’re starting with a much smaller pool of providers who are competent and friendly providers.
Anti-LGBTQ bias and a lack of nondiscrimination protections leave transgender Southerners vulnerable to being dismissed or outright denied in healthcare settings, and that translates to worse experiences: More than one-quarter of trans respondents to the 2019 Southern LGBTQ Health Survey said they rarely or never feel comfortable seeking care in their home communities, and more than three-quarters said that being in the South always or often makes it harder to access quality care.
These roadblocks will likely become even more unmanageable because of the Trump Administration’s rollback of the Affordable Care Act’s Section 1557, which extends federal nondiscrimination protections to LGBTQ patients. A final order on this is coming soon, which would be shameful in any context but especially reckless in the middle of a global pandemic.
When we are able to access affirming care, it’s frequently from small, indie reproductive health clinics whose very existence has also been jeopardized by the pandemic, with many clinics struggling to keep their doors open. Many that are open right now are even more overworked and understaffed than usual.
The most recent data from the US Trans Survey by the National Center for Trans Equality shows us that 40% of trans people delayed seeking care when they needed to purely out of fear of discrimination. And now that we’ve got even less access to our friendly providers—plus an increased and very real fear of contracting the coronavirus (or spreading it if we have it), I think it’s safe to say we are even more likely to delay seeking care. When someone who is high risk does contract the virus, it is really important to seek care early, and that is very unlikely to happen for transgender people.
In addition to fear of medical mistreatment, trans and queer people experience choinic underemployment and unemplyment. We are much less likely to have access to health insurance through an employer, or to be able to afford visits to the doctor, transportation, medication, and all of the other expenses that come with healthcare.
With every additional marginalized identity a transgender person holds, the impact of COVID-19 is worse and worse. If you are black or brown, don’t speak English as a first language, are an elder, are disabled, or have chronic illnesses, the likelihood that you are experiencing or might experience these issues compounds exponentially.
And on top of all of this, trans and queer people experience elevated rates of houselessness, and many people in the community engage in survival sex work to make ends meet. For these folks, the constant drumbeat of being told to “stay home” illustrates a pervasive misunderstanding of the realities that so many people every day; “Stay home” is literally not an option for people who are houseless.
One of the key takeaways from the Campaign for Southern Equality’s research is just how important peer support is, especially for our community. Now, we’ve also got limited access to that, with many places that had become community havens—like bars, coffee shops, and some community centers—closing their doors indefinitely and even permanently. That’s why we’re offering things like The Front Porch, a virtual gathering series at Campaign for Southern Equality—to still hold virtual space for LGBTQ folks to come together and support each other.
The healing that our community members offer to each other cannot be overstated. We are and always have been the solution we need. Even in the face of these overwhelming disparities, transgender Southerners are still thriving every single day, fighting against the odds to live beautiful, fulfilling lives. We are finding ways to show up for each other—from meal delivery programs and sewing masks to sending each other money and just simply making time to check in and love on each other.
Trans and queer Southerners are truly the most inspirational people I know, and watching the way we’ve all been stepping up to care for each other through this time—even when up against the unique strains that COVID-19 has emphasized—reminds me just how resilient we really are.