Expert Commentary

The impact of COVID-19 on LGBTQ communities: A research roundup

“Economic effects of COVID-19 have been enormous on LGBTQ people, so it’s not just a viral reality,” says Dr. Perry Halkitis, dean of Rutgers’ School of Public Health, whose research focuses on LGBTQ populations. “It’s a social reality. It’s an economic reality. It’s a psychological reality.”

Photo by Jasmin Sessler on Unsplash

The LGBTQ population in the U.S. has been historically affected disproportionately by poverty, lack of health insurance, unemployment, and poorer mental and physical health compared with non-LGBTQ people.

The COVID-19 pandemic has only made those challenges worse.

“Economic effects of COVID-19 have been enormous on LGBTQ people, so it’s not just a viral reality,” says Dr. Perry Halkitis, dean of Rutgers’ School of Public Health, whose research focuses on LGBTQ populations. “It’s a social reality. It’s an economic reality. It’s a psychological reality.”

Moreover, LGBTQ people of color face additional risks and vulnerabilities, compared with their white counterparts, study after study has shown. While the news media has covered disparities brought to light by the pandemic among racial and ethnic minorities, there has been less coverage of the LGBTQ population.

“We know these disparities exist. We know they’re out there, but I’m not reading about it,” says Tari Hanneman, director of the Health & Aging Program at the Human Rights Campaign Foundation, an advocacy organization focused on the LGBTQ community. “There’s an old saying, ‘If you don’t count us, we don’t count.’ So it’s kind of the same thing: if journalists aren’t writing about us, it’s almost like we’re not existing.”

It’s also important to note the dearth of government data about LGBTQ people.

Most government data collection efforts focused on COVID-19 do not include sexual orientation and gender identity measures, including the U.S. Census Bureau’s Household Pulse Survey and other state and federal death and disease tracking efforts.

The lack of data hinders “efforts to incorporate the needs of LGBT populations into COVID-19 recovery efforts,” says a February report by the Williams Institute, a public policy research institute based at the UCLA School of Law focused on sexual orientation and gender identities issues.

Journalists can use academic research to better understand and report on the impact of the pandemic on LGBTQ communities. Here, we have selected seven studies and reports on this topic to help you get started.

(Note: Both LGBT and LGBTQ are acceptable acronyms, according to Associated Press style, which Journalist’s Resource follows. We have chosen to use LGBTQ, unless a study indicates otherwise.)


The Impact of the Fall 2020 COVID-19 Surge on LGBT Adults in the U.S.
Brad Sears, Kerith J. Conron and Andrew R. Flores. Williams Institute at UCLA School of Law, February 2021.

This report draws on one the most recent surveys on the impact of the pandemic on LGBTQ communities. Data are from a nationally representative survey of 12,000 adults conducted by Ipsos between August and December 2020, with 842 respondents identifying as LGBT.

The report finds that several months into the pandemic, LGBT adults were more likely to be laid off (12.4% vs. 7.8%) or furloughed from their job (14.1% vs. 9.7%), have problems affording basic household goods (23.5% vs. 16.8%) and were twice as likely to report having problems paying their rent or mortgage, compared with their non-LGBTQ peers.

It also highlights the disproportionate impact of the pandemic on LGBTQ people of color.

“LGBT people of color are more likely to experience the health and economic impacts of COVID-19 than non-LGBT White people,” the authors write, adding that they’re also more likely to get tested for COVID-19, practice social distancing and wear masks, compared with non-LGBT white people.

They add that LGBT people of color are more likely to have tested positive for COVID-19, to personally know someone who died of COVID-19, and to have experienced several types of economic instability as a result of the pandemic.

They write that the federal government should take into account the impact of the pandemic on LGBT people, specifically LGBT people of color, as it responds to the crisis and provides support to those most economically affected.

Sexual Orientation Disparities in Risk Factors for Adverse COVID-19-Related outcomes, by Race/Ethnicity
Kevin C. Heslin and Jeffrey E. Hall. CDC MMWR, Vol. 70, No. 5. Feb. 5, 2021.

This timely report by Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, examines the disproportionate health impact of the pandemic on LGBTQ adults. The report uses the Behavioral Risk Factor Surveillance System survey — a nationwide health-related telephone survey — because the “current COVID-19 surveillance systems do not capture information about sexual orientation,” the authors write.

Researchers combined data from BRFSS surveys between 2017 and 2019, which included 24,500 individuals who identified as gay, lesbian or gay, or bisexual. The report notes that “although BRFSS includes a question on gender identity, the number of respondents identifying as transgender or nonbinary was too small for reliable estimates compared with the majority cisgender population.”

The report identifies several underlying health conditions that increase or might increase the risk for more severe COVID-19-related illness were more common among gay, lesbian and bisexual adults than those who identified as heterosexual.

Those self-reported conditions include cancer, kidney disease, chronic obstructive pulmonary disease, heart disease, obesity, smoking, diabetes, asthma, hypertension and stroke.

Moreover, “sexual minority adults who are members of racial/ethnic minority groups disproportionately affected by the pandemic also have higher prevalences of several of these health conditions than do racial/ethnic minority adults who are heterosexual,” the report shows.

The authors reiterate what other researchers have cited as the reasons behind disparities affecting LGBTQ people: “Because of their sexual orientation, sexual minority persons experience stigmatization and discrimination that can increase vulnerabilities to illness and limit the means to achieving optimal health and well-being through meaningful work and economic security, routine and critical health care, and relationships in which sexual orientation and gender identity can be openly expressed.”

The authors call for expanding sexual orientation and gender identity data collection to surveillance systems to help with decision-making during and after the pandemic.

The Disproportionate Impacts of COVID-19 on LGBTQ Households in the U.S.
Movement Advancement Project. November 2020.

This report is based on data from a polling series by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, conducted between July 1 and Aug. 3, 2020, on more than 3,400 adults, 353 of whom identified as LGBTQ. Consistent with previous research, the poll found that LGBTQ respondents are twice as likely as non-LGBTQ respondents to have very low incomes.

The report, created by a nonprofit think tank, provides a wealth of data points that can help reporters compare the impact of the pandemic on LGBTQ and non-LGBTQ communities. It also provides data based on race, income and region of the country.

The report shows 66% of LGBTQ households reported serious financial problems compared with 44% of non-LGBTQ individuals. Nearly 40% said they weren’t able to get medical care or delayed getting medical care for serious problems, compared to 19% of non-LGBTQ households.

Meanwhile, 95% of Black LGBTQ survey respondents said they face one or more serious financial problems, compared with 70% of Latino LGBTQ households and 62% of white LGBTQ participants.

The report also shows that more than one in eight LGBTQ people have lost their health insurance coverage since the pandemic started. That’s more than twice the rate of non-LGTBQ people in the polling sample.

Also, more than one in four LGBTQ households have had serious problems affording medical care — again, twice the rate of non-LGBTQ households.

The report’s findings “point to the need for targeted assistance and explicit protections from discrimination as our country continues to weather the storm and looks to rebuild,” the authors write.

Sex in the Time of COVID-19: Results of an Online Survey of Gay, Bisexual and Other Men Who Have Sex with Men’s Experience of Sex and HIV Prevention During the US COVID-19 Epidemic
Rob Stephenson et. al. AIDS and Behavior, September 2020.

This study, based on a survey of 518 gay, bisexual and other men who have sex with men conducted between April and May 2020, aims to understand changes in sexual behavior of this group and access to HIV prevention options, including pre-exposure prophylaxis, also called PrEP.

The study finds that in the early days of the pandemic men reported an increase in the number of sex partners, although the increase in unprotected sex was small. It also finds the increase in sexual behavior during COVID-19 was associated with increases in substance use.

About one-third of the men reported that the pandemic had prevented them from accessing testing for HIV or sexually transmitted infections, the report finds.

The study also finds that nearly 95% of the respondents believed it was possible to contract COVID-19 through kissing, but about half or less believed it was possible to contract the virus through all other sex acts.

About 9% of people surveyed said the pandemic prevented them from accessing their PrEP prescription and nearly one-third said that about getting tested for HIV or other sexually transmitted infections.

“There is a clear need to continue to provide comprehensive HIV prevention and care services during COVID-19, and telehealth and other eHealth platforms provide a safe, flexible mechanism for providing services,” the authors write.

They add that sexual activity and substance use behaviors may be to some degree related to the stress of the pandemic, “and therefore services should consider addressing the mental health needs of those living on lockdown, and incorporate discussions and strategies for managing stress in the delivery of HIV prevention and care services.”

LGBTQ populations: Psychologically vulnerable communities in the COVID-19 pandemic
John P. Salerno and Natasha D. Williams, Katrina A. Gattamorta. Psychological Trauma: Theory, Research, Practice, and Policy, August 2020.

This commentary highlights structural, social and individual challenges faced by LGBTQ populations during the pandemic in the United States. It also includes recommendations to mitigate the psychological effects of the pandemic-related trauma on LGBTQ individuals.

The authors write that mental health disparities among LGBTQ individuals compared with their non-LGBTQ counterparts are related to social inequities, such as higher rates of poverty and lack of insurance.

“Ultimately, mental health burden among LGBTQ persons (e.g., PTSD, anxiety, depression, suicidality) may be exacerbated by the psychological impact of COVID-19 pandemic trauma and its intersection with dimensions of social inequality,” the authors write.

The commentary also points to the significant psychological threats facing LGBTQ elders due to stay-at-home orders earlier in the pandemic.

LGBTQ elders are twice as likely to be single and living alone, four times less likely to have children, and more likely to be estranged from their biological families compared with their heterosexual, cisgender counterparts, according to the commentary.

“This is highly concerning because social isolation, loneliness, and existing health and mental health concerns may be exacerbated among already-vulnerable LGBTQ elders as a result of COVID-19 pandemic trauma,” the authors write.

The authors encourage mental health therapists, social service providers, employers and other institutions serving LGBTQ individuals to move toward online delivery of services “to mitigate the mental health ramifications of COVID-19 psychological trauma and social isolation.”

Mental Health Needs Among Lesbian, Gay, Bisexual, and Transgender College Students During the COVID-19 Pandemic
Gilbert Gonzales et. al. Journal of Adolescent Health, November 2020.

The study, based on an online survey of 477 LGBTQ college students in the U.S., aged 18 to 25, shows that nearly half had immediate families that don’t support or know their LGBTQ identity and almost 60% were experiencing psychological distress, anxiety and depression during the pandemic.

“To overcome the high prevalence of frequent mental distress, anxiety, and depression among LGBT students, colleges and universities should ensure that LGBT students receive mental health support during the COVID-19 pandemic,” the authors write.

They recommend telehealth options with flexible hours and identity based virtual groups that help sustain a sense of community. They add that universities should “seek to eliminate any closure-related stressors by providing housing accommodations and financial resources to those expressing need.”

Finally, they write that health-care providers should be mindful of the mental health needs of LGBTQ college students who, due to campus closures, may have returned home to unsafe or unaccepting environments.

“Our study is one of few investigations identifying the mental health needs of LGBT college students during the COVID-19 pandemic, which are substantial based on our results,” the authors write.

Addressing the Disproportionate Impacts of the COVID-19 Pandemic on Sexual and Gender Minority Populations in the United States: Actions Toward Equity
Gregory Phillips II et. al. LGBT Health, September 2020.

In this paper, researchers call on public health practitioners to serve as proponents of the LGBTQ community and other marginalized populations and amplify the voices of those advocating for health equity.

“We must recognize the architecture of our social, political, and historical conditions as precedents that create material condition under which marginalized populations could be affected disproportionately by crises such as the COVID-19 pandemic,” the authors write.

Sexual and gender minority populations — the academic term referring to LGBTQ individuals — are less likely to seek care due to stigma, discrimination and economic factors that make medical care unaffordable for them, the authors explain.

They’re also affected disproportionately by poverty, lack of insurance and unemployment, while the pandemic could cause a higher burden of poor mental health in this population.

“A lack of cultural responsiveness among health care professionals has perpetuated health disparities, combined with limitations within the epidemiological surveillance system, which have resulted in challenges quantifying the impact of COVID-19 on marginalized populations,” the authors write.

They set out four priorities for immediate action to address the needs of LGBTQ individuals: cultural competency in hospitals and health systems; improvement of data collection at local, state and federal level to include LGBTQ populations; more research on the impact of the pandemic on this group; and the creation of disaster preparedness plans that explicitly include equity-focused initiatives.

Additional resources

  • CDC’s Lesbian, Gay, Bisexual and Transgender Health page provides data and information on a range of topics related to health of this population.
  • The Substance Abuse and Mental Health Services Administration’s (SAMHSA) LGBT website includes national survey reports, agency and federal initiatives, and related behavioral health resources.
  • The Trevor Project is a national organization providing crisis intervention and suicide prevention services to LGBTQ youth.
  • The Williams Institute is a public policy research institute based at the UCLA School of Law focused on sexual orientation and gender identity issues.
  • The Human Rights Campaign is a national advocacy organization for LGTBQ individuals with many informational resources for the public and the media.
  • The Fenway Institute is a health policy organization that focuses on research, education and policy development on specific health needs of LGTBQ individuals and those living with HIV.
  • GLAAD is a media monitoring organization, founded as a protest against defamatory coverage of LGBTQ people. Its agenda has since extended to the entertainment industry and its portrayal of the LGBTQ population.
  • GLMA, previously known as the Gay & Lesbian Medical Association, is a national organization that uses the scientific expertise of a diverse multidisciplinary membership to inform and drive advocacy, education, and research.

For more on the disproportionate effects of COVID-19, see “Covid-19 has disproportionately depleted finances of Latino, Black, Native American Households: Survey.”

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