Tips for Health Professionals Serving LGBTI Communities During COVID-19

Mohan Sundararaj, MBBS MPH Director of Public Health Programs, MPact

MPact has been closely following developments regarding the novel coronavirus that causes the COVID-19 disease, and particularly its impact on gay, bisexual and other men who have sex with men.

Part of a blog-series on COVID-19 tips and guidance for lesbian, gay, bisexual, transgender, and intersex (LGBTI) advocates worldwide, this next blog is targeted at health and allied professionals namely outreach workers, peer educators and navigators, HIV testers and counselors, doctors, nurses, psychologists and other allied health professionals, program managers and public health officials serving LGBTI people and their families.

To read our earlier blogs on COVID-19, click here.

If you are a health or allied professional working with the LGBTI community, check out our 10 tips below and links to specific resources below:

  1. Protect Yourself First: Health professionals, especially frontline providers and clinic-based staff play the most critical role during the pandemic as they are at the frontlines in the fight against the virus. At this time of burden to the health system and risk of burnout among frontline clinicians, it is important for providers to prioritize self-care. This includes taking the necessary precautions to protect yourself and your loved ones from COVID-19 such as wearing a mask, washing your hands for 20 seconds or using a hand sanitizer between service user visits and keeping visits brief. We recognize that availability of personal protective equipment and related regulatory policies vary greatly from country to country and that in some countries, there are serious shortages and corruption putting health workers and service users at risk. Although applying the principle of protecting oneself can look different for communities across the world, prioritize what this means for yourself and take the necessary action.
  2. Prioritize essential, urgent services: We understand you may be required to temporarily suspend certain programs at this time. At this time, LGBTI people may not only present with symptoms, fears or questions related to COVID-19, they can also present with urgent medical needs or shortages in their supply of current medications and HIV prevention commodities, if any. Occasionally, LGBTI people may also need emergency care. It is important to avoid assumptions that physical distancing measures or avoiding sex altogether can happen without difficulty for all LGBTI people. In all instances, caring for the sexual and overall health needs of all LGBTI individuals in compassionate, non-judgmental ways is key. Work with your teams to ensure that programs and services are well-prepared to support LGBTI individuals who may be running short on their prescription drugs (e.g. ARV clubs or community-based delivery) or may be experiencing COVID or other symptoms that require urgent or emergency care.
  3. Leverage online platforms for services: If you work in a setting where telemedicine is an option, you might already be transitioning services online. Virtual service delivery can be highly convenient for both the provider and the service user at a time when countries are even banning the use of public transport for long distances. However, it comes with a cost. Not only do both provider and client need fast-speed, running internet, but there are other issues for the LGBTI community to consider such as privacy, confidentiality, and data security. If telemedicine is not an option, use your phone judiciously. While most providers do not feel comfortable giving out their private number, you may be able to set-up your device to make outgoing calls without revealing your number and still be able to follow-up on your clients or patients.
  4. Preserve Supplies: Keeping LGBTI and other health services and programs running at this time automatically means taking additional measures to protect providers and service users from potential COVID-19 transmission. At this time of greater-than-usual cost burden and potential shortages, keep an inventory of the types and volume of supplies you have and what you might need to keep services running for the next few months. This includes condoms and lube, antiretroviral drugs for HIV treatment, HIV and STI testing kits, STI treatment packs and PrEP pills. Most health experts believe that COVID-19 will continue to remain a threat to many countries in the months to come. If you’re running out of supplies, strategize accurate ways of sterilizing your equipment should you need to re-use them again. Reach out to your local community and identify volunteers and supporters who can make affordable masks.
  5. Refer Vulnerable LGBTI people for COVID-19 Testing: While physical distancing measures can slow the transmission of the virus, the World Health Organization recommends diagnostic testing as a critical tool to track the virus, understand epidemiology, inform case management and suppress transmission. However, large-scale testing demands can decrease availability of molecular reagents not only for COVID-19 but also for other diagnostics while worsening the absorptive capacity of laboratory systems and infrastructure globally. To mitigate negative outcomes, the WHO recommends a graded approach for COVID-19 testing based on risk assessment, population transmission dynamics and number of cases reported in your country while prioritizing early diagnosis and treatment of the most vulnerable including those with pre-existing conditions such as diabetes, heart disease and lung disease. Learn more about the state of COVID-19 testing in your country and where it is available. If COVID-19 testing is in short supply, consider prioritizing vulnerable LGBTI people, including those at risk for developing serious complications or whose symptoms may be worsening.
  6. Stay up-to-date on current clinical guidance: COVID-19 is a new disease and we’re still learning of ways to assess, manage and treat the illness. If you are a frontline provider or are an expert fielding questions about COVID-19, stay up-to-date with guidelines from your government and if they are unavailable or inadequate, review guidelines from the WHO or the U.S. Centers for Disease Control and Prevention. This includes ensuring your knowledge is accurate and current about the incubation period, clinical progression of disease ranging in mild, moderate and severe features of COVID-19, laboratory findings, management of COVID-19, risk factors for severe illness, and issues specific to recovery. If you’re a public health practitioner, you might be interested in tracking investigational therapeutics linked to COVID-19 as well.
  7. Enforce a Zero-Stigma Policy: The principle of doing no harm applies at the time of COVID-19. LGBTI people have typically reported disproportionate levels of stigma and discrimination when approaching the healthcare system. This is likely to increase during a pandemic that adds costs to or redirects resources within a healthcare system. Being explicit about your non-discrimination policy, reassuring clients of privacy and confidentiality, and not assuming their sexual or gender identities, can go a long way in inspiring trust among LGBTI individuals seeking care and open up about their unique health needs. At a time when physical distancing measures are enforced by law, LGBTI people can easily feel stigmatized for presenting with STIs or a drug overdose. Health professionals who create a welcoming environment and fight stigma in all its forms, including sexual stigma and stigma associated with drug use and COVID-19, can make a big difference in enabling health access for LGBTI people.
  8. Reinforce relevant skills: You may be an amazing outreach worker, community healthcare worker, peer educator, PrEP navigator, HIV physician or in-patient nurse. Regardless, this might be a good time to consider expanding and strengthening relevant skills – such as good counseling techniques or effectively delivering services online or general LGBTI health. Remember the WHO definition of sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexualityand sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.  LGBTI individuals who already face harsh discrimination from society may be at greater risk for developing mental health challenges. It may be worse for those that are also sheltering-in-place with a homophobic or transphobic family or abusive partner for example and experiencing violence. Basic counseling from you as their provider can assist them to better access coping skills and strategies. Similarly, not all providers are equipped with virtual delivery of services or with knowledge concerning LGBTI health more generally. Here are some resources for you to expand relevant professional skills:
  9. Advocate with decisions-makers: For many health professionals, their roles do not end with the health system. It extends to conducting human rights advocacy on behalf of LGBTI and vulnerable communities targeting governments, policy-makers and high-level decision makers. Health professionals’ voices are critical to ensure that COVID-19-related communications, investments and policies are inclusive of LGBTI communities and do not worsen the existing disparities for LGBTI communities. If you’re new to advocacy and looking for opportunities or ideas, reach out to your local LGBTI organization. Look out for an upcoming blog from MPact on human rights and COVID019.
  10. Focus on holistic health: While COVID-19 is a virus, its impact on the world has reinforced the need for integrative approaches to health that consider the biological, psychological, social and spiritual aspects of individual and community well-being. Think about ways in which you can integrate evidence-based body-mind interventions such as mindfulness, meditation, yoga, acupuncture, and exercise to your clinical practice or program. Mental and sexual health, even during quarantine are critical dimensions to overall LGBTI health. Find ways of approaching these issues using non-judgmental, person-centered, strengths-based, and sex-positive methods with appropriate referrals to empower your LGBTI community to optimize their holistic health. To get some ideas for how you can do this, check out our most recent blogs on holistic health and sexual health.

We thank you for your service to the LGBTI community!

In solidarity,

The MPact Team

Many thanks to our Expert Reviewers
Chris Akolo, MD, FHI 360
George Ayala, PsyD, MPact
Stefan Baral, MD MPH, Johns Hopkins University
Angel Fabian, MD MNA, MPact
Mark Pakianathan, MBChB, MRCP, MPH, Guy’s and St Thomas’ NHS Foundation Trust
Kenneth Mayer MD, Fenway Health
Claudio Msengezi, CENTA
Stephen Leonelli, MPA, MPact
Greg Tartaglione, MPact

To read our earlier blogs on COVID-19, click here.