by Domonique Noel for New Jersey Policy Lab
Across the globe, the COVID-19 pandemic has made a drastic impact on the lives of LGBTQ+[1] people in several unforeseen ways. One of those ways is in healthcare delivery, as an increasing number of healthcare providers and patients of all identities are now relying on telehealth or telecommunication technology to get healthcare while practicing social distancing. Using telehealth, many providers have reported reaching more vulnerable and hard-to-reach populations by addressing and reducing numerous barriers to care. In the state of New Jersey, telehealth interventions are particularly useful in reaching the LGBTQ+ community, representing 343,000 residents (4.1% of adults). This research is part of a larger effort — led by Dr. Soumitra Bhuyan and funded by the New Jersey Policy Lab — to understand the use of telehealth during the COVID-19 pandemic.
When it comes to improving LGBTQ+ health outcomes using telehealth interventions, it is essential to provide healthcare in a comprehensive and affirming way, including services for primary, behavioral, and mental health. Through the use of telehealth, healthcare providers are reducing barriers experienced by LGBTQ+ people in terms of transportation cost, travel distance, traffic, time, and engagement in healthcare. By administering care using telehealth, providers can bring their services to their LGBTQ+ patients, which encourages more preventative care use, decreases emergency care usage, and lowers stress and fear associated with healthcare visits. Among people living with HIV, telehealth is beneficial in reducing no-show visits, increasing comfort levels among patients, and encouraging regular medication adherence. However, there are limitations due to 1) decreased income and internet access among those whose employment has been impacted by the pandemic and 2) limited reliability and quality of technological devices. If designed with these unique needs and barriers in mind, telehealth interventions can be a useful tool for addressing healthcare disparities in the LGBTQ+ community.
Prior to the COVID-19 pandemic, LGBTQ+ people suffered from limited access to culturally competent healthcare providers, especially those living in rural areas. LGBTQ+ people reported past negative experiences where providers blamed their LGBTQ+ identity for their healthcare issues, made false assumptions and/or were dismissive. In addition, the challenges experienced by LGBTQ+ people have been compounded by the high rates of HIV infection and stigma which have plagued this group for decades, with 69% of new HIV diagnoses in the US being among gay and bisexual men in 2019 and 2% of new HIV diagnoses in the US being among transgender people in 2018.
As a community that experiences high rates of HIV infection and exposure, many LGBTQ+ people are at increased risk during the COVID-19 pandemic. The high rates of tobacco use (linked to the tobacco industry’s marketing tactics targeting this group), high rates of obesity, diabetes, and other chronic health conditions, and work in industries severely affected by the pandemic contribute to the increased vulnerability to COVID-19 among the LGBTQ+ community. To improve LGBTQ+ healthcare outcomes using telehealth, providers and policymakers must identify current access barriers, examine existing telehealth policies and interventions, and understand the needs and life experiences of the LGBTQ+ community.
Domonique Noel is a Master of Health Administration student at the Bloustein School.