The Cost of COVID-19: January 25, 2022 - ICAP GRAND ROUNDS - ICAP at Columbia University
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ICAP GRAND ROUNDS The Cost of COVID-19: Understanding LGBTQ+ Experiences in New York City January 25, 2022
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The Cost of COVID-19: Understanding LGBTQ+ Experiences in New York City Andrea Low, MD, MSc, PhD HIV Clinical and Scientific Director - PHIA Project Assistant Professor of Epidemiology, Mailman School of Public Health Principle Investigator, LEXICON Project Tuesday, January 25th, 2022
Background
• LGBTQ+ individuals face greater risk of
COVID-19 exposure and severe
outcomes due to economic and health
disparities, with risk even greater for
LGBTQ+ people of color
o People-facing essential jobs
Cahill et al, Sep 2020
o Higher economic vulnerability
o Concentration in urban areas
o Higher rates of smoking or vaping
o More comorbidities
• Data on COVID-19 burden and
vaccination uptake not routinely Cahill, Sep 2021
collected among LGBTQ+ populations in
the US and globally
Need for data on the impact of COVID-19 on SGM
NYC DOH January 2022- Cases per 100,000
New York Times, March and May 2021
Online national survey conducted in 2020
Tested positive for COVID-19
Concerned about ability to pay bills
Vaccination coverage among adults in New York City- January 2022
Tegan and Sara Foundation, 2021
Study Design
LEXICON Objectives
Primary objectives
Assess attitudes, intentions, access, and uptake
regarding COVID-19 vaccination among LGBTQ+
New York Adults
Assess COVID-19-related infection burden, and
knowledge, attitudes, and practices (including
uptake in testing and NPIs)
Secondary objectives
Determine economic, physical and mental health
impact of the COVID-19 pandemic, and estimate
correlates of these impactsStudy Design • Cross-sectional online survey [Qualtrics]: Available in English, Spanish, French and Mandarin • Target population: Self-identified LGBTQ+ persons aged 18 and older who reside in New York City • Sample size: Target 1000 • Sampling frame: ~756,000 LGBTQ+ NYC residents • Time period: 3-5 months (June – December 2021) • Compensation: $30 e-gift card for valid completion
Recruitment Methods
• Collaboration with key stakeholders and organizations in
the community (e.g., ICAP’s Harlem & Bronx Prevention
Centers, Harlem Pride, Destination Tomorrow, etc.)
• Snowball sampling
• Advertisements on social media apps and LGBTQ+ dating
apps (e.g., Grindr)
• Outreach and dissemination of materials at NYC PRIDE
Events and NYC LGBTQ+ bars and social spaces
• Qualtrics PanelHarlem Prevention Center Outreach to the Gender Minority Community
Data Collection & Management
Data Collection & Management • Self-administered electronic questionnaire using the Qualtrics platform (average time to complete ≤18 mins.) • Only personal identifiers collected were e-mail addresses (for the delivery of the incentive), phone number, zip code, and IP address
LEXICON Survey
Results
Study Participants
• A total of 1,038 participants were deemed
eligible after data validation and included for
analysis:
• Median age: 29 years (range 18-68)
• 56% of participants identified as gay or lesbian
• Sample was diverse (49% non-Hispanic (NH)
white, 19% NH Black, 24% Hispanic, 3% Asian,
5% multi-race or other)
• 9% of participants reporting being born outside
of USSexual Orientation by Race/Ethnicity n=34 n=195 n=509 n=249 n=51
COVID-19 EXPOSURE and TESTING
COVID-19 Exposure, Testing, and Test
Positivity
• Nearly 4 out of 5 (79%) participants reported having
been tested for SARS-CoV-2
• Of those tested, 31% reported testing positive
• More than half of the participants (53%) reported
having had to quarantine due to exposure to COVID-19
• Close to half (45%) of the participants knew someone
who had died due to COVID-19
• This was most commonly reported by gender
minorities (52%), and Hispanic participants (51%).COVID-19 Knowledge and Practices 71% felt that the HIV epidemic had made
Did not know someone them more conscientious about NPIs
Did not know
asymptomatic people recovered from
can transmit COVID-19 COVID-19 could get
reinfected
16%
9% of participants claimed never or rarely to
24% have worn a mask in public, and 18% claimed
to have never or rarely socially distanced.
84% 76%
Knew asymptomatic Knew someone who
people can transmit recovered from
COVID-19 COVID-19 could be
reinfected
Did not know
Did not know vaccines vaccinated individuals
prevented severe illness needed to follow other
NPIs
22% 19%
78% 81%
Knew vaccinated
Knew vaccines individuals needed to
prevented severe illness follow other NPIsVACCINATION
COVID-19 Vaccination and Intent
• 81% had received at least one dose of a COVID-19 vaccine
o 52% reporting having received the Pfizer/BioNTech vaccine
o No difference by gender identity
• Vaccination rates lowest among:
o Households with yearly income less than $25,000
o Participants without a college degree
o Divorced/separated participantsReasons for Vaccination or Intention to get Vaccinated among LEXICON Participants (n=943)
Reasons for Vaccine Hesitation among LEXICON Participants (n=85)
Factors Associated with Not being Vaccinated
• Multivariable logistic regression:
Most important factors were socio-
economic:
o Not having health insurance
o Household incomeEFFECTS OF THE COVID-19 PANDEMIC
Economic and Other Effects of COVID-19
These effects were particularly severe
among gender minorities:
o More job loss (45% versus 32% among cisgender
participants)
o More moderate or severe financial hardship (59%
versus 45%)
o More threats of eviction (25% versus 15%)
o More physical violence (21% vs 11%)
Some racial/ethnic minorities also suffered more job
loss:
o 24% of Hispanic,
o 21% of NH Black,
o 33% of other race/ethnic groups
o 14% of NH White and 9% of Asian participants.
And23% did not have health insurance
27% felt discriminated against due to their sexual or gender
identity. It was higher in gender minorities (33%)
17% felt discriminated against based on race; with 32% of NH Black
reporting discrimination
Access to 67% felt that the pandemic did NOT impact their access to STI or
Health Care
HIV testing services
44% of men with casual sexual partners no STI or HIV
testing in the past 6 months, and 17% in the past year
PLWH, 30% reported difficulty in accessing their
antiretroviralsMental Health Impact of COVID-19 57% screened positive for
possible generalized
At some point in their lives: anxiety disorder
One in four (25%) participants reported
having been diagnosed with depression
28% of participants diagnosed with
anxiety
36% of participants reported
Based on PHQ-2 Screening Tool: drinking excessively daily or
weekly
55% of participants screened positive for
likely ongoing depression
Highest in Hispanic persons (63%), gender
minorities (62%) and
Pansexual/Queer/Questioning persons
(69%)CONCLUSIONS
LEXICON Study: Key Takeaways
• LGBTQ+ NYC adults are economically vulnerable, reporting significant
negative pandemic effects
• These were particularly severe among gender minorities
• LGBTQ+ people in NYC have comparable rates of vaccination to other
adult populations in the city, with similar gaps in coverage.
• Socio-economic factors, lack of health insurance, and a bisexual sexual
identity strongly associated with not being vaccinated
• Almost a quarter of participants reported having no health insurance.
More than one if four (27%) experienced discrimination due to their
sexual or gender identity while seeking COVID-19 services
• More than half of LEXICON participants screened positive for possible
depression. Anxiety disorders were common, with significant overlap
between depression and anxiety.
• The highest rates of mental health issues and violence were seen among
gender minorities and Hispanic participants.Acknowledgements
• The LEXICON Study team
• LEXICON Advisory Group
• The Rockefeller Foundation
• Bronx and Harlem Prevention Center Staff
• LGBTQ+ Persons in NYC who partook in this
study and shared their data
• LGBTQ+ Community Organizations in NYC
The LEXICON TeamThank You! Q/A & Discussion
Join us on February 22, 2022 ICAP GRAND ROUNDS Topic to be announced soon!
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