Today, March 31st, is Transgender Day of Visibility (TDOV), an annual day created to celebrate and empower the transgender community, and an opportunity to acknowledge and honor our contributions to history and society. TDOV also asks us to consider what happens when transgender people experience social invisibility—the systemic and institutional denial of needs—and challenges us to think about our responsibility to make public systems more responsive to the needs of all people, especially the needs and well-being of members of the transgender community. At CSSP, on this TVOD, we are thinking about how the coronavirus pandemic lays bare the continued institutional discrimination that transgender people face on a daily basis when trying to access all systems, but particularly the U.S. health care system.
The U.S. health care system is one of the largest and farthest-reaching systems in our country and impacts the well-being of all people at one point or another in their lives. However, every day—even when we’re not faced with a pandemic—some individuals are disproportionately denied access to comprehensive, affirming health care including those who are experiencing low incomes and identify as LGBTQ+. Unfortunately, this system is not equipped to handle even the slightest pressure placed upon it and today—with the COVID-19 health crisis—we are seeing what happens when an ill-equipped system is thrust into a situation and expected to handle extreme pressure. Because hospitals and facilities lack access to even the most basic safety equipment and life-saving medical equipment like respirators are in short supply, medical providers are unable to properly care for themselves or patients during this outbreak. Because of this, people across the country are having their medical needs put on hold. The COVID-19 pandemic is a blacklight across all facets of our society, throwing into sharp relief the cracks in our systems and where they fail to support our most vulnerable populations.
While everyone is at risk of falling victim to COVID-19, we know that there are some populations who are more vulnerable than others due to discrimination which occurs at a systematic, structural level. According to a letter released by a coalition of more than 100 LGBTQ+ and LGBTQ+ supportive health care organizations, as well as an issue brief released by the Human Rights Campaign (HRC), the LGBTQ+ community is one such population. As argued in a federal lawsuit filed on March 19, 2020, LGBTQ+ people are more vulnerable as long as they continue to face discrimination by health care providers, and as a result, 18 percent of LGBTQ+ individuals reported reluctance to seek medical care unless it is urgent, and sometimes not even then. This is especially true for transgender people. Further, due to discrimination against the transgender community, we are disproportionately more likely to experience difficulties with finding employment. This means that even if transgender people can find affirming health care providers, they often still cannot receive services because they do not have access to health insurance. These fears are especially heightened as we experience the threat of COVID-19 under an administration that has issued many attacks on the rights and protections transgender people have only just broken ground on.
The events of TDOV serve as an outward acknowledgement that transgender people not only matter but deserve equity. This is critically important today as the Trump administration has systematically and intentionally worked to remove critical protections and rights that protect vulnerable populations, including access to affirming health care. However, at a time when we must all prioritize our own health and the health of our communities by staying home and sheltering in place, we must be even more intentional about the mission of TDOV. We must take action to advance equity from transgender people and make visible the systemic oppression transgender people still face.
Beyond the risks to our physical health, COVID-19 also poses several threats to our mental health. One of these risks is a global, indefinite postponement and often cancelation of gender confirmation procedures. These procedures are considered an effective and, in many cases, essential treatment of gender dysphoria by the transgender individuals who seek out these procedures, as well as by the World Professional Association for Transgender Health (WPATH), and by many health professionals and insurance providers, because of their ability to alleviate the mental health concerns associated with experiences gender dysphoria. As hospitals attempt to manage the overwhelming number of COVID-19 cases, these delays and cancellations may result in dangerous or even life-threatening situations with regards to the mental health of the transgender individuals who are impacted. This disappointing set-back will come to many transgender individuals as yet another obstacle after fighting insurance companies and providers, lengthy waitlists for appointments and clearances, and pushing through red tape to get on the books for these appointments. In addition to procedures, COVID-19 is impacting the ability of transgender individuals to access necessary care such as hormone replacement therapy (HRT), HRT injections, and the regular required testing of hormone levels to receive such prescriptions. While some can administer their injections at home, many receive injections at clinics. And because clinics and hospitals are overburdened in response to COVID-19, receiving HRT shots could mean risking exposure to the infection due to longer wait times at emergency or urgent care clinics.
Another risk is that of isolation. As a result of CDC guidance to practice social distancing, many transgender support groups and community spaces are closing their doors and events—such as those to celebrate Transgender Day of Visibility—are being cancelled. These spaces and events are not just a matter of socializing but are a critical way that the transgender community connects to resources and services, while also supporting one another through frequent discrimination. Often as a result of rejection and discrimination on the basis of their gender identity, nearly 50 percent of transgender individuals experience depression or anxiety, compared to approximately seven percent and 18 percent of the U.S. general population, respectively. Mental health issues are especially profound for transgender youth. According to a 2019 report by the Trevor Project, 78 percent of transgender youth report being the subject of discrimination due to their gender identity, and consequently more than half of transgender youth have seriously considered suicide.
The Families First Corona Virus Response Act and CARES Act will expand unemployment benefits, paid medical and family leave, COVID-19 testing and treatment for those who are uninsured or covered by Medicaid, and funding for community providers, telehealth, mental health providers, and suicide hotlines. The National Center for Transgender Equality (NCTE) has created a suggested action plan for transgender individuals to follow to stay safe during this time. The Centers for Disease Control and Prevention (CDC) also has guidance on how to keep ourselves and others safe. However, because the government response has arrived late to this pandemic, we already know this will not be enough. As explained in CSSP’s policy response to COVID-19, we need to do more to protect low-paid workers, transgender women of color, transgender immigrants, transgender people in institutional settings, and transgender adults and youth experiencing homelessness. These protections must include increased federal funding to communities and expanded public benefits such as food assistance and cash assistance that provide resources directly to low income transgender people. Without more deliberate policies to protect the health and the rights of those most at risk, we will likely mourn many more lives lost in November on Transgender Day of Remembrance.