An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts) (Preprint)

BACKGROUND Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (i.e., LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to healthcare, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expectable excess burden of COVID-19 and public health-recommended protective measures. OBJECTIVE We will conduct a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health-recommended protective behaviors and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect. METHODS SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor-delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure and content were pilot tested with LGBT+ individuals in Toronto, Canada before adaptation and roll-out in the other contexts. The primary outcomes are COVID-19 knowledge (index based on U.S. CDC items), protective behaviors (index based on WHO and U.S. CDC guidelines), depression (PHQ-2) and anxiety (GAD-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll N = 310 participants in each city, age 18 years and older, one-third cisgender gay, bisexual and other men who have sex with men, one-third cisgender lesbian, bisexual and other women who have sex with women, and one-third transfeminine, transmasculine and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control group. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts has 3 sessions delivered weekly over three successive weeks. Exit interviews will be conducted online with 3 subgroups (n = 12 per group; N = 36 in each city) of purposively selected participants, to be informed by RCT outcomes and focal populations of concern. RESULTS The RCT was funded in 2020. The study protocol was registered with ClinicalTrials.gov (NCT04870723). The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by December 31, 2021. CONCLUSIONS The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered e-Health intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries. CLINICALTRIAL NIH U.S. National Library of Medicine, ClinicalTrials.gov: NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723

Queer expectations: An empirical critique of rural LGBT+ narratives

Much of the body of literature on LGBT+ populations within the United States place urban areas and so-called gayborhoods as goals and eventualities, paralleling early US studies on immigration. Using a multistage, mixed-methods approach, consisting of secondary analysis of the Pew 2013 Study of LGBT Persons ( N = 1197) and in-depth interviews (35 gay men, 2 trans-identifying individuals, 1 heterosexual woman, and 2 lesbians), we found that rural LGBT+ residents engaged in both short-term and long-term travel to mitigate feelings of being spatially segregated from the loci of gay social life—what Ghaziani (2019a) refers to as cultural archipelagos. However, rural residents also used their geographical location to resist dominant narratives about LGBT+ life. Some of our respondents felt that living in rural areas better situated them to be activists and advocates for LGBT+ rights, while others simply did not feel they could be comfortable within more urban contexts. These findings suggest that rural LGBT+ residents may have delinked their sexual selves with their cultural and political selves, thus illustrating the plurality of rural queer voices that exists. As we also argue, while residence category should be considered as influencing one’s experience, care must be used to avoid overly deterministic accounts. Finally, this article extends earlier work by Brekhus (2003), Mattson (2015), and Ghaziani (2019a) by presenting the meaningfulness of travel to and from queer cultural strongholds.

Health Care Expenditures and Financial Burden: A Comparison of Adults in Same-Sex Couples and Different-Sex Couples

We used data from the 2014-2017 Medical Expenditure Panel Survey to compare health care expenditures and financial burden between adults in same-sex couples ( n = 514) and adults in different-sex couples ( n = 41,043). Compared with men in different-sex couples ($3,994), men in same-sex couples ($6,896) were more likely to spend more on health care, especially on prescription medications ($2,745 vs. $1,050), which was primarily driven by antiviral medications ($1,061 vs. $35). Women in same-sex couples ($5,886) reported similar health care expenditures compared with women in different-sex couples ($5,619). However, women in same-sex couples were significantly more likely to experience financial burden compared with women in different-sex couples (25.7% vs. 11.3%). We speculate that the disparities reported here are due to a variety of issues, including elevated health needs requiring prescriptions for lesbian, gay, bisexual, and transgender (LGBT) men and lower incomes for LGBT women. More research is needed to understand health services utilization and expenditure patterns among LGBT populations.

Doing and Negotiating Transgender on the Front Line: Customer Abuse, Transphobia and Stigma in the Food Retail Sector

Despite growing research on LGBT+ populations, few studies have examined transgender individuals’ specific workplace experiences, whose voice is often subsumed in a wider category. This article presents the story of Kathrine, a female transgender food retail worker, and discusses the abusive, discriminatory and transphobic behaviour of customers, which has received limited attention in the sociology of service work literature. The article reveals the stigmatization of transgender employees by customers, which is expressed through micro-aggressions, such as mis-gendering, mocking and harassing, and is often neglected and/or tolerated by management. Kathrine discusses the coping strategies she utilizes to reduce the negative consequences of the stigma, and to negotiate and protect her gender identity. These include confronting and/or refusing to serve transphobic customers, reflecting her resilience towards discrimination and abuse. The article calls for further research to understand transgender service employees’ experiences and the complexity and diversity of coping strategies used by stigmatized workers.

The Influence of Emerging Adulthood on the Risky and Dangerous Behaviors of LGBT Populations

During emerging adulthood, traditional social bonds and turning points may be delayed, not present, or may not work in the same manner as they had for prior generations, leading many to engage in risky and dangerous behaviors. Lesbian, Gay, Bisexual and Transgendered emerging adults may be at particular risk for engaging in risky and dangerous behavior during emerging adulthood due to the lack of social bonds, reaching of turning points, as well as the historic stigmatization of these populations. Focusing on LGBT populations in the United States, the influence of emerging adulthood on risky and dangerous behaviors is presented; a theoretical examination of the relationship between LGBT populations and risky and dangerous behaviors is provided; the influence of emerging adulthood on LGBT populations is explored; research on the role of emerging adulthoods influence on the risky and dangerous behaviors of LGBT populations is presented; and theoretical and policy implications are offered.

Applying a Capabilities Approach to Understanding Older LGBT People’s Disclosures of Identity in Community Primary Care

Internationally, there is increasing recognition that lesbian, gay, bisexual and trans (LGBT) populations experience substantial public health inequalities and require interventions to address these inequalities, yet data on this population is often not routinely collected. This paper considers the case study of the UK, where there are proposals to improve government and health data collection on LGBT populations, but also a degree of apparent uncertainty over the purpose and relevance of information about LGBT status in healthcare. This paper applies a health capabilities framework, arguing that the value of health information about LGBT status should be assessed according to whether it improves LGBT people’s capability to achieve good health. We draw upon 36 older LGBT people’s qualitative accounts of disclosing LGBT status within UK general practice healthcare. Participants’ accounts of the benefits and risks of disclosure could be mapped against multiple domains of capability, including those that closely align with biomedical accounts (e.g., longevity and physical health), but also more holistic considerations (e.g., emotion and affiliation). However, across all domains, individuals tend to assess capabilities at an individual level, with relatively little reference to population-level impact of disclosure. Clearer articulation of the benefits of disclosure and data collection for the collective capabilities of LGBT populations may be a beneficial strategy for improving the quality of information on LGBT populations.