07 Apr COVID-19 and trans people
In times of crises, it is those living in the margins that suffer the most. We have reasons to believe that trans communities are – and will be – disproportionately affected by COVID-19. This impact is being felt most severely by trans people who are homeless, sex workers, disabled, migrants, refugees, asylum seekers, poor, and/or elderly who are negatively impacted:
- By the virus itself.
We know trans people are more likely to have existing health conditions and economic instability than the general population due to the discrimination they face. This situation puts them at higher risk to become exposed to the virus and to develop severe symptoms. We encourage trans communities and their allies to identify those who are most vulnerable and to check on them regularly (see below). - By the health care system and health care providers.
We know trans people worldwide face barriers when accessing healthcare (denial of care, human rights violations within this setting, lack of insurance…). These barriers, combined with the discrimination most trans people face while trying to access healthcare, make them more reluctant to seek medical help when ill. Furthermore, provision of general and trans-related care is being severely cut in the current crisis. We urge trans communities and their allies to provide mutual support for those who may need encouragement or support to access healthcare during the crisis, and to advocate for trans-related care to be resumed as soon as the acute crisis has passed (see below). - By the socioeconomic impact of this crisis.
We know that the socioeconomic impact of the pandemic will especially hit those in the most marginalised communities. Trans people often work in the informal economy, rely on sex work, have precarious job positions, and low incomes. Those who are homeless, migrants, asylum seekers and/or disabled are more likely to be left unprotected in this crisis (see below).
We stand in solidarity with trans people worldwide affected by the COVID-19 pandemic and want them and their loved ones to be as safe as these times allow. In these challenging times, stay safe, reach out, show love, take care of each other, and support those further isolated.
Trans people: Who’s at risk?
Due to the discrimination they face, some trans people are more prone to develop severe symptoms, are more susceptible to COVID-19, and/or are more likely to suffer from disproportionate social and economic impacts. This includes:
- Chronic smokers.
LGBTQ+ people, including trans people, use tobacco at higher rates than the general population (in some regions of the world up to 50% more.) - D/deaf and disabled people.
For more information, not specific to trans people and on the European level only, you can check the resources that European Disability Forum published, their open letter addressing discrimination against persons with disabilities within COVID-19 medical guidelines, as well as the joint statement they wrote with the European Network on Independent Living and the European Deafblind Union. - Elders over 60 years old.
- Forced migrants, asylum seekers and refugees.
Those living in overcrowded conditions, camps, or precarious housing are at increased risk. For more information, not specific to trans people, check the United Nations High Commissioner for Refugees (UNHCR) webpage on the Coronavirus outbreak as well as the Resources page of the Platform for International Cooperation on Undocumented Migrants (PICUM) gathering statements and resources about the COVID-19 pandemic and its impact on migrant communities and on civil society working with migrants. - People living with HIV.
So far, there is not sufficient data proving that people living with HIV are more susceptible to COVID-19 or to develop more severe symptoms. However, people living with HIV are more prone to develop health conditions (cardiovascular or pulmonary diseases) that put them at risk to develop more severe symptoms. Furthermore, during this devastating health and economic crisis, it is even more essential, and yet challenging, for those living with HIV to maintain their medication and vaccines up-to-date. For further information, check UNAIDS set of recommendations. - Sex workers.
Since the COVID-19 outbreak and the various preventive measures applied nationally (social distancing, self-isolation, quarantine), clients and possibility to work are decreasing dramatically in most contexts worldwide. As most sex workers cannot rely on professional security (sick pay, monthly salary, unions, etc.), their livelihood and wellbeing is endangered.
For more information, not specific to trans people and on the European level only, check the Communication of the International Committee on the Rights of Sex Workers in Europe (ICRSE) and their campaign to set up emergency fundraisers to provide food and shelter for community impacted by COVID-19 as well as the blog of the Sex Worker Advocacy and Resistance Movement (SWARM). - Those experiencing homelessness or housing instability.
Trans people experience homelessness and housing insecurity at higher-than-average rates. Anyone who lacks housing in which to self-isolate, or has limited access to hand-washing facilities, is especially vulnerable.
For more information, US-based and not specific to trans people, check the following Resources to support people experiencing homelessness or the following article. - Those who are poor, from working class, and professionally and/or financially insecure.
For more information, not specific to trans people and on the European level only, check the recommendations and statement of the European Anti-Poverty Network (EAPN). - Those with diabetes, hypertension, cancer, asthma, cardiovascular disease or pulmonary disease.
Trans people have higher rates of cancer, cardiovascular disease, and pulmonary disease and hence have a higher probability to have a compromised immune system. - Those who are in detention.
For more information, US-based and not specific to trans people, check the following Resources for Correctional and Detention Facilities. - Trans and non-binary people sheltering with rejecting or abusive family.
Solidarity plans: recommendations
Cities and countries are likely to experience waves of outbreaks and stay-home orders until a COVID-19 treatment or vaccine is available. It’s important that we work together as trans people and allies to get through this pandemic together.
We encourage trans communities and their allies to collaboratively create “solidarity plans” to stay connected and provide mutual support through this worldwide crisis. These plans should be tailored to the needs and contexts of those who are most vulnerable, and include plans to check in on at-risk community members regularly to make sure they are in the safest and most comfortable situations possible. There are many ways to develop these plans even if you cannot meet in person:
- Create online chat groups to stay in touch with your support system (friends, chosen family, co-workers, roommates or flatmates, neighbours…). Educate your friends about what groups may be most vulnerable to COVID-19 and work together to identify the most vulnerable people in your community. Make a plan to make sure each of those individuals are contacted regularly by you and your support system.
- Create an emergency contact list of healthcare providers (if possible LGBTQI-friendly or trans-friendly healthcare providers; if not, healthcare providers you usually go to or feel comfortable going to) and important numbers outside of your support system. Share the list with people you are regularly in contact with.
- If possible and if needed, reach out to a trans or LGBTQI+ group based in your city, country or region. TGEU has 141 member organisations scattered in 44 countries in Europe and Central Asia. More than the half are trans-led groups and some of them are led by and focused on trans sex workers, trans forced migrants, asylum seekers or refugees, trans D/deaf and disabled people, and more… The closest groups or organisations to you might be able to support you or might already offer COVID-specific services to trans people. More information on each organisation’s backgrounds and contacts (website, Facebook or Twitter) can be found on our website and interactive map.
- For allies, raise awareness of the crisis’ effect on those of communities that are most vulnerable. Use your social and peer networks to share initiatives and campaigns run by trans people who are most at-risk, support their activities, and donate to their crowdfunding campaigns. For more information on these initiatives, you can check our dedicated COVID-19 Resources webpage.
Healthcare recommendations
The COVID-19 pandemic is currently overwhelming healthcare systems around the world. In many places health services are being restricted to prioritise those directly affected by the virus. This is having an impact on many people’s access to healthcare, including the trans community.
We are closely following the situation to better understand how access to healthcare is being impacted by the pandemic and what can be done to improve it. We are aware that accessing healthcare at the moment poses a strain for most trans people, both when it comes to general healthcare and trans-related services.
1. General healthcare
Many trans people avoid or delay going to the doctor out of fear of being discriminated against. This is more likely to happen to those who have (great) difficulty making ends, belong to a sexual or disability minority group, or those who identify as having poor health. Discrimination in healthcare settings is common and, especially now, this may discourage trans people from trying to access care and add an extra burden when doing so.
2. Trans-specific care
Trans-specific care is being greatly affected by COVID-19 and physical distancing restrictions. In-person appointments related to hormone treatments, surgeries and psychotherapy or counselling are being canceled or delayed. This is impacting trans people’s physical and mental health. In addition, putting trans people’s physical changes on hold also puts them at risk of facing more discrimination and violence. Travel restrictions may also limit some people’s ability to access care.
Good practice examples are showing us the great benefit of telehealth (i.e. phone or online healthcare) and we strongly encourage providers to make use of it. This practice is becoming widely used. The World Professional Association for Transgender Health (WPATH) is also actively promoting and supporting it.
Recommendations:
- Be aware of your health needs at the moment but also think in advance about your mid- and long-term needs (e.g. hormones, mental health support, surgeries, medical and non-medical supplies such as vaginal dilators or binders). It may take longer than usual to receive medications or medical supplies, so you may want to pre-order or stock up on prescriptions where possible.
- Create a list of resources and support networks to develop a plan based on your individual needs. This may include reaching out through phone or email to your medical provider to clarify how to manage your appointments, how to get your prescriptions, how to get an injection, whether to change your hormones to gel or discuss telehealth options. If needed, look for support and resources from trans or LGBTIQI+ organisations that are close to you, as they may be properly ready to help you. Being in touch with other members of the community may be incredibly important for learning about resources and for mental health support (more on this in “Solidarity Plans: recommendations”). We strongly encourage you to ask for help when you need it. These are difficult times and it is essential that we take care of ourselves and others around us.
- Pack a bag with items you might want if you need to go to the hospital suddenly. Include something to eat and drink in case you have to wait to see a doctor, a charger for your phone, emergency contacts, toothbrush, and anything else that would make you more comfortable.
We are aware that the socioeconomic consequences of this crisis and the measures that are being taken in response to it are impacting trans people’s health. Being deprived of basic rights and needs such as food, income, or shelter clearly affect physical and mental health. Specific difficulties may arise for some trans people given the measures that are being taken. Some may face isolation or loneliness, may be forced to live together with people who do not respect their gender identity, may have to hide their gender identity, be taken away from their support networks or even face violence in their own homes. Generally, the use of segregated facilities (e.g. bathrooms, hospital wards) exposes trans people to discrimination and violence. This situation may worsen now as access to those is more frequent and people are not allowed any company or support. All of these challenges should be taken into account when thinking about trans people’s needs and support strategies.
We are actively analysing the impact of this crisis on trans people’s health and have partnered with the University Medical Center Hamburg-Eppendorf to better understand what is happening and how to best tackle this issue. The information that results from the study will be used by us and other trans organisations and healthcare providers to improve access to care for trans communities. We would really appreciate it if you could complete this survey.