Some LGBTQIA+ identities seem more vulnerable to Long Covid. But why?

It has been widely acknowledged that the pandemic has hit minority groups particularly hard. The emerging findings from the ongoing US Household Pulse Survey highlight further health inequalities among those with Long Covid symptoms. Here are the causes that research points to, as well as what can improve health outcomes for the bi+ and trans communities. 

*Some terms used in this article:

Bi+ : although the survey gave three broad categories for participants’ sexual orientation, there are many words that people use to define their sexuality. Bi+ is an umbrella term that includes various ways that people experience sexual and emotional attraction to more than one gender. Pansexual, fluid, queer, and asexual are some of these terms, as well as bisexual.

Cisgender: when someone identifies their gender and identity as being the same as the sex that they were assigned at birth. 

LGBTQIA+ Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, +more gender/sexual identities.

Transgender (or trans): when someone identifies their gender and identity as being different from the sex that they were assigned at birth.

The Household Pulse Survey

The United States Census Bureau launched the Household Pulse Survey in April 2020 to collect information about the impact of the Covid pandemic on US households. The survey gathers data from adults across all fifty states via a 20-minute online survey about various aspects of people’s lives, including health. Questions about Long Covid symptoms were added in June 2022, with further questions added in September about their effect on carrying out day-to-day activities. 

According to the latest published survey data, (from 14-26 September 2022):

• The national estimate for the number of participants who reported that they were experiencing Long Covid symptoms was 14.2%.

• Broken down into gender identity, 10.8% of cisgender male participants, 17.2% of cisgender female participants, and 21.4% of transgender participants reported Long Covid symptoms.

• Broken down into sexual orientation, 13.6% of straight participants, 16.1% of gay participants, and 20.6% of bisexual participants reported Long Covid symptoms.

These results were similar compared to those from the other periods when data was collected (see the table on this page). In all periods, bisexual and transgender respondents were more likely to report Long Covid symptoms and, with no biological reason for this, questions are being asked as to why.

Stigma in healthcare settings (and wider society)

In the US and the UK, many LGBTQIA+ people have unacceptably faced discrimination and prejudice. Many trans individuals have been misgendered, refused treatment, encountered medical bias, or suffered transphobic abuse whilst accessing healthcare. 32% of trans people in the UK say they have received unequal treatment in medical settings. US transgender adults are less likely to attend medical appointments; when fear of discrimination stops someone from getting treatment and support, their path to recovery may be affected.

Bi+ people often feel stigmatised because of myths and stereotypes around bisexuality, and bi-erasure, all of which can come from both straight and gay communities. Being vulnerable to both homophobia and biphobia, trauma is a common experience for bi+ people too. Healthcare providers do not always ask about sexual orientation, missing opportunities for gay, lesbian and bi+ people to access LGBTQIA+ support even when it exists.

For trans people and bi+ people, negative experiences like these can be highly invalidating. Many LBGTQIA+ people have already had a rocky journey towards knowing their identity, with bi+ and trans people at risk of poorer health outcomes generally. Prejudice-related stressful events are particularly damaging to wellbeing. 

As Covid long-haulers can also experience a lack of understanding from health professionals, LGBTQIA+ people with long covid may be exposed to prejudice two-fold. Medical providers need more education around both Long Covid and LGBTQIA+ issues.

Post-exertional malaise

Many people with chronic illness describe a temporary or permanent worsening of their symptoms after doing something that involves mental, emotional, or physical exertion. Many Covid long-haulers are familiar with this post-exertional malaise and may likewise have had it triggered by stressful incidents in medical settings.  

Dealing with unsympathetic care providers, or navigating the bureaucracy around accessing care, can be draining, frustrating and confusing. For long-haulers in marginalised groups who may face the kinds of additional barriers described above, this can mean even more exertion — so greater risk of the health consequences of that. 

Further health and social inequalities

The LGBTQIA+ community have long been exposed to income and housing insecurity, as well as workplace prejudice. This has similarly been reported by those with chronic illness, so those who fall into both groups may again feel doubly discriminated against. The stress of fearing or encountering these attitudes creates more mental and emotional exertion, exacerbating symptoms or prolonging recovery. Sadly, many LGBTQIA+ people are estranged from their families, meaning that there may be less support around them when they are unwell.

The effects of encountering prejudice might be further increased for LGBTQIA+ people who have Covid (or Long Covid) and are in other marginalised groups as well. In the Household Pulse Survey, higher rates of Long Covid were also reported among those with disabilities, and those from some minority backgrounds. 

Lockdowns created stress for LGBTQIA+ people not out to those they were living with, particularly if having their sexuality or gender identity discovered would have compromised their safety. This would have posed particular risks for trans and bi+ individuals, who are at greater risk of experiencing domestic violence. LGBTQIA+ young people may have withheld information from health providers – or avoided getting help at all – because of fear of being outed to their parents or guardians. 

Resources for support and change

It’s natural to feel troubled and angry that health inequalities are so strongly influenced by non-inclusive health service structures, individual prejudices and wider social systems. However, this gives possibility for real change. Whilst improvements to policy, funding and social attitudes must form part of this, here are some resources for both LGBTQIA+ long haulers and their allies:

• Here’s some tips for stronger allyship from Imperial College London, with specific advice on being an ally to the bi+ and trans communities.

• The LGBT Foundation published this article about affirming identity during the pandemic lockdowns. Some advice may be useful for anyone self-isolating, or minimising face-to-face socialising. 

• This article from Barnardo’s was again written during the 2020 lockdowns, but lists various LGBTQIA+ helplines and other sources of support at the end.

• The Cranky Queer is an online resource for chronic illness from a queer perspective, with creative and spiritual approaches.  Follow the link to subscribe to a newsletter and other information.

• The Long Covid Survival Guide is written by queer author Fiona Lowenstein, and due for release next month. More information, and links to pre-order, can be found on their website.

Although the Household Pulse Survey collects only US data, the factors contributing to the health inequalities it shows are relevant in the UK too. The stress, fear and exertion that many LGBTQIA+ individuals suffer due to others’ attitudes towards sexual and gender identity risks vital healthcare not being received. Whether access to treatment is denied or avoided, missing out on care may impact both short and long term health outcomes. With bi+ and trans individuals already vulnerable to poorer health than other sexual and gender identities, and Long Covid still very prevalent, the unique needs of these communities need attention.

Covid Aid’s support community is inclusive of everyone and has been designed as a fully inclusive space to service the needs of all who have suffered – whoever they are, wherever they live, and whatever their circumstance.