Prologue

As this report was nearing completion, the enormous impact of the COVID-19 pandemic battering the United States was becoming clear, transforming lives and affecting every sector of society. At the time of this writing, more than 5 million Americans have been diagnosed with the infection, and more than 200,000 have died. Tens of millions of people have lost their jobs, and aspects of health, economic status, and social life have changed drastically for families and communities across the country. Black, Hispanic/Latinx, Native American, and other disadvantaged populations have been disproportionately affected by the COVID-19 pandemic, due largely to inequities in social determinants of health, such as poverty and health care access.¹

There are many reasons to believe that lesbian, gay, bisexual, transgender, queer, intersex, and non-binary people (LGBTQI+) might also be at high risk for COVID-19. There are LGBTQI+ groups that have higher rates of cardiovascular disease, respiratory disease, and HIV; that have higher poverty rates; and that lack adequate health insurance coverage (Alzahani et al., 2019; Caceres et al., 2017; Williams Institute, 2019). Little is known about COVID-19 rates of transmission, morbidity, or mortality among individuals who identify as LGBTQI+: currently, only California, Pennsylvania, Nevada, and the District of Columbia collect sexual orientation and gender identity data in context of the coronavirus pandemic, and even these states have not yet reported those data. Because LGBTQI+ identities are

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¹ See https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html.

seldom recorded in public health surveillance and medical records, sexual and gender diverse people often remain essentially invisible in context of the COVID-19 pandemic.

In May 2020, deep into the pandemic, an unarmed Black man named George Floyd was taken into police custody on the streets of Minneapolis and suffocated by a white police officer who knelt on his neck for more than eight minutes, until he was dead. The grief and outrage that followed led to an international outpouring of protest and activism and underscored the ways in which racial, ethnic, and other identities can have a dramatic effect on health and well-being in the United States (NASEM, 2016). Then in June 2020, which is commonly regarded as LGBTQI+ pride month, at least five transgender people of color—Dominique “Rem’mie” Fells, Merci Mack, Riah Milton, Brian “Egypt” Powers, and Brayla Stone—were brutally murdered.² These events highlight the ways in which violence has historically been and continues to be used as a tool of suppression towards LGBTQI+ populations and populations of color within the United States.

These two sets of events—the COVID-19 pandemic and the demonstrations of violent racism—point to the need for heightened awareness of the social and structural inequities that exist for LGBTQI+ people and for people of color and, especially, for sexual and gender diverse people of color. Too often, inequities cannot be identified because of failures to collect and measure sexual orientation and gender identity information. The systematic application of standardized measures of sexual and gender diverse status in governmental and health care delivery data systems would be a critical step towards promoting much-needed research on the health and well-being of LGBTQI+ populations.

REFERENCES

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² For information on the individual events, see https://www.hrc.org/resources/violenceagainst-the-trans-and-gender-non-conforming-community-in-2020.