key: cord-0970710-q4x5bum2
authors: Poteat, Tonia C.; Reisner, Sari L.; Miller, Marissa; Wirtz, Andrea L.
title: COVID-19 Vulnerability of Transgender Women With and Without HIV Infection in the Eastern and Southern U.S.
date: 2020-07-24
journal: medRxiv
DOI: 10.1101/2020.07.21.20159327
sha: e878ddbe8018e08d1395345ebd70535fbdb394e1
doc_id: 970710
cord_uid: q4x5bum2

BACKGROUND: COVID-19 is a new global pandemic and people with HIV may be particularly vulnerable. Gender identity is not reported, therefore data are absent on the impact of COVID-19 on transgender people, including transgender people with HIV. Baseline data from the American Cohort to Study HIV Acquisition Among Transgender Women in High Risk Areas (LITE) Study provide an opportunity to examine pre-COVID vulnerability among transgender women. SETTING: Atlanta, Baltimore, Boston, Miami, New York City, Washington, DC METHODS: Baseline data from LITE were analysed for demographic, psychosocial, and material factors that may affect risk for COVID-related harms. RESULTS: The 1020 participants had high rates of poverty, unemployment, food insecurity, homelessness, and sex work. Transgender women with HIV (n=273) were older, more likely to be Black, had lower educational attainment, and were more likely to experience material hardship. Mental and behavioural health symptoms were common and did not differ by HIV status. Barriers to healthcare included being mistreated mistreatment, uncomfortable providers, and past negative experiences; as well as material hardships, such as cost and transportation. However, most reported access to material and social support – demonstrating resilience. CONCLUSIONS: Transgender women with HIV may be particularly vulnerable to pandemic harms. Mitigating this harm would have positive effects for everyone, given the highly infectious nature of this coronavirus. Collecting gender identity in COVID-19 data is crucial to inform an effective public health response. Transgender-led organizations’ response to this crisis serve as an important model for effective community-led interventions.

In a few short months, more than 2.5 million people in the United States (US) have tested positive 68 for SARS-CoV-2, the novel coronavirus responsible for COVID-19; and more than 128,00 people While data on race are now reported for 7 CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020. High baseline rates of unemployment added to COVID-19-related job losses may push transgender 113 women even deeper into poverty, exacerbating food insecurity and likely increasing reliance on 114 sex work. Sex work may then increase transgender women's risk for acquiring Transgender women who were already engaged in sex work may have a reduced income due to 116 social distancing. However, criminalization of sex work precludes access to economic relief from 117 federal funds while also increasing the risk of incarceration where again, they face elevated risk of The high rate of homelessness among transgender women also puts them at substantial risk for 121 COVID-19. Regular handwashing and social distancing may be impossible without a home.

Transgender women seeking refuge in the sex-segregated shelter system often face discrimination 123 and outright denial of services. If they are able to access shelter services, they may face crowded 124 conditions that increase COVID-19 risk. Given national shortages of personal protective 125 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10.1101/2020.07.21.20159327 doi: medRxiv preprint COVID-19 Vulnerability in Trans Women 5 equipment for essential workers, it is unlikely that transgender women in shelters will have means 126 to protect themselves from COVID-19. Recent data indicate that a significantly higher proportion of people who were sheltering in place 153 (47%) reported negative mental health effects of coronavirus stress than people who were not 154 sheltering in place (37%). 18 Negative mental health effects due to social isolation and stress may 155 be particularly pronounced for transgender women with HIV who are already at high risk for 156 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020 . . https://doi.org/10.1101 and mitigating its impact on vulnerable communities will benefit everyone. Collecting gender 197 identity in COVID-19 surveillance data will be crucial to inform public health responses. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key- . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10. 1101 

Why prisoners are at higher risk for the coronaviru: 5 questions answered. The 271 Conversation

PTSD in urban primary care: high prevalence and 280 low physician recognition

PTSD: National 282 Center for PTSD

International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted

 207 TP conceived of the manuscript and led writing. AW and SR led data collection activities. AW 208 conducted statistical analyses and MM reviewed results for face validity. All authors contributed 209 to reviewing and editing drafts of the manuscript. Among co-authors, diversity existed along lines of gender identity, race, and sexual orientation. 213 Two authors identify as transgender, two identify as Black, and two identify as queer. All authors 214 are deeply committed to the health and well-being of transgender communities and strive to 215 conduct research that advances health equity. The authors would like to express their gratitude to the transgender women who take part in this 219 study. This study would not be possible without their participation. We also acknowledge the work Accessed.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020. 

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020. 

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 24, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10. 1101