Canceled plans, postponed events and social unrest are now familiar hallmarks of 2020. The year when the unpredictable managed to become… predictable. The year of the digital pivot, of the health care hero, parents turned teachers and generally rising to the challenge. One could argue it has been the shortest (or longest) six months in human history. Our world has evolved in previously unimaginable ways and that includes public health and wellness.
COVID-19 has illuminated several significant inequalities in healthcare. And, gender and sexual minorities are among the communities hit hardest due to disparities amplified by COVID-19. Roseman University Associate Professor of Pharmacy Practice, Christina Madison, BS, PharmD, BCACP, AAHIVP, recently joined Communications and Project Specialist, Joslyn Hatfield for a discussion exploring the topic at SQ:UAD Festival. Hosted virtually, the one-day festival included workshops, panels and other creative discussions to provide community and connection for queer womxn, non-binary and trans individuals.
The Center for Disease Control (CDC) cites the coronavirus disease 2019 (COVID-19) pandemic as significant stressor and emphasizes that fear and anxiety about contracting the disease coupled with the overall uncertainty of a pandemic, can become overwhelming and cause strong emotions in adults and children. Public health actions, such as social distancing, can make people feel isolated and lonely and can amplify mental health concerns.
LGBTQ+ individuals are up to 2.5 times more likely to experience symptoms of depression and anxiety than their straight or gender-conforming counterparts, even in the absence of a global pandemic. LGBTQ+ persons are also among the vulnerable populations identified by the Substance Abuse and Mental Health Services Administration (SAMHSA) at-risk for experiencing disparities in behavioral health overall. This includes access to quality care delivered by culturally competent practitioners and services suited to the specific needs of this population.
To begin the discussion, Dr. Christina Madison provided the historical context of infectious disease globally and discussed how the COVID-19 pandemic compares to others in recent history including Ebola, SARS, H1N1 and HIV. “From a public health perspective, the response to COVID-19 has been atypical as compared to the responses to other communicable infectious diseases on this scale,” said Dr. Madison. “At this moment in time we have not been operating in the typical space that we normally do when we think about containing communicable infectious disease.”
For example, when HIV began to ravage LGBTQ+ communities, there was a push to isolate the virus and develop medication therapies. This was critical because not only was the virus claiming lives, but it also severely weakened the immune systems of infected patients, which increased the risk of mortality from separate, opportunistic infectious diseases such as tuberculosis. “This was a lesson learned during the onset of the AIDS epidemic,” said Dr. Madison. “As a medical community, we learned that the immediate response to an outbreak should be to determine how the disease is transmitted and to develop a comprehensive containment strategy.”
Above all else, the key to managing any outbreak of infectious disease is a swift response, including identification of the transmission method and containment of confirmed infections. “For instance, when the Ebola virus reached America, there were only two deaths here,” explained Dr. Madison. “SARS and MERS were largely contained in Asia,” she continued. “That was in large part due to the public health response to those outbreaks.”
A key component to such a response is public perception and overall confidence in the quality of public health information and sources. Early and frequent communication of verifiable facts and general transparency can mitigate anxiety often associated with the uncertainty of a public health crisis.
“It’s important for leaders and public health officials to be honest about what is known and what isn’t,” said Dr. Madison. “The information we have in the early stages of an outbreak can be replaced by better, more specific data as things evolve,” she continued. “It’s important to talk about mitigation in those terms and acknowledge that this can be frustrating for the community as they try to adhere to evolving guidelines.”
“There is a historical trauma at play in the current healthcare landscape for sexual and gender minorities,” said Dr. Madison. “Mainstream health care has not done enough to make these individuals feel safe, seen and understood.” This is still a significant barrier to LGBTQ+ individuals seeking care. The health implications to delaying or refusing care in a global pandemic can have dire individual and public health outcomes.
Yet, hope remains. COVID-19 has inspired a new generation of frequent and thorough hand washers. Hygiene practices are trending and overall sanitation is up. The pandemic has sparked a renewed dedication of resources and capital to the sciences and the shared experience of navigating a global pandemic has united individuals like never before. While legitimate risk remains, COVID-19 has provided an unprecedented opportunity to identify and address health care disparities among vulnerable populations by increasing access to quality care delivered by culturally competent practitioners.