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With COVID Here, Mental Health, Money Woes Grow in US Sex- and Gender-Minority Youth
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HIVR4P Virtual, January 27-28 and February 3-4, 2021
Mark Mascolini
Sex -and gender-minority adolescents and young adults in the United States endured worse mental health changes than comparison groups after the COVID-19 pandemic arrived, according to results of a 4000-person study [1]. These youth also had a harder time meeting basic expenses, and some had more sex, while condom use barely inched upward.
Risks of depression, suicide, substance use, HIV, and other sexually transmitted infections (STIs) run higher in youth, people of color, and lesbian-gay-bisexual-transgender-queer (LGBTQ) people than in older, white, heterosexual groups. The American Public Health Association warned that adding COVID to the threats already faced by gender-minority youth could pose a mental health crisis in this group.
To see whether mental health problems and economic challenges do pose greater risks to gender-minority youth in the COVID era, researchers at Chicago's CORE Center and Stroger Hospital surveyed members of the Keeping It LITE Cohort Study, which consists of 3445 sex- and gender-minority people 13 to 34 years old and at risk for HIV infection. This US national cohort has greater representation in the Midwest and South. Enrollment began in December 2017, with twice-yearly follow-up including surveys and HIV testing planned through December 2021.
For a $20 incentive, participants answered a 10-minute online survey sent and collected on an encrypted platform in May or September 2020. Of 6890 people sent a survey, 4337 (63%) responded. Similar proportions completed their survey in May or September. Among these 4337 respondents, 3477 (80%) called themselves cisgender men, 479 (11%) genderqueer, and 381 (9%) transgender men or women. Whereas 3030 respondents (70%) reported their sexual orientation as gay, 769 (18%) called themselves queer and 538 (12%) bisexual.
Responders were racially diverse: 2396 (55%) white, 811 (19%) Latinx, 526 (12%) black, and 604 (14%) another race or ethnicity. While 28% believed COVID-19 posed a major threat to their personal health in May 2020, 49% thought it posed "somewhat" of a threat. In September 2020, those proportions had shifted to 58% and 37%.
Since the pandemic began, 58% of respondents said they "have anxiety now." Logistic regression determined that odds of reporting anxiety were 43% higher in bisexual or queer respondents than in gay respondents (adjusted odds ratio [aOR] 1.43, 95% confidence interval [CI] 1.24 to 1.65) and more than 2-fold higher in transgender and gender-noncomforming respondents than in cisgender men (aOR 2.35, 95% CI 1.96 to 2.83). Overall chances of experiencing "financial distress" rose 71% after the pandemic arrived (aOR 1.71, 95% CI 1.48 to 1.97).
Since the pandemic took hold, 44% of survey respondents reported "I have depression now," with little increase from May to September 2020. Four groups proved more likely to report depression: people under 25 years old versus older (aOR 1.26, 95% CI 1.09 to 1.46), having less than a 4-year degree versus more (aOR 1.45, 95% CI 1.26 to 1.67), being bisexual or queer versus gay (aOR 1.75, 95% CI 1.52 to 2.02), and being transgender or gender-noncomforming versus cisgender male (aOR 2.80, 95% CI 2.35 to 3.32).
Slightly more than one third of respondents, 36%, reported difficulty in meeting basic expenses in September 2020. Six groups ran higher odds of difficulty in meeting expenses: people under 25 versus older (aOR 1.24, 95% CI 1.07 to 1.43), nonwhites versus whites (aOR 1.64, 95% CI 1.42 to 1.90), having less than a 4-year degree versus more (aOR 2.83, 95% CI 2.43 to 3.30), being an enrolled student (aOR 1.41, 95% CI 1.22 to 1.62), being bisexual or queer versus gay (aOR 1.67, 95% CI 1.43 to 1.95), and being transgender or gender-nonconforming versus cisgender male (aOR 1.84, 95% CI 1.55 to 2.19).
Among all respondents, more than half, 58%, reported changes in body weight. Changing behaviors included alcohol use in 40%, marijuana use in 36%, smoking cigarettes in 20%, other drug use in 12%, and household violence in 11%.
The proportion of sexually active respondents jumped from 57% in May 2020 to 73% in September 2020. More than 10% of respondents reported more oral sex since the pandemic began (17%), more general sexual activity (15%), or more anal sex (12%). Only 5.5% reported more condom use, and 8% reported more sex partners. A slim majority, 54%, reported still taking PrEP, while 20% stopped PrEP because their sexual activity changed and 6% stopped because of problems with access or insurance.
After COVID-19 arrived, 16% of survey responders said they could not get to their HIV testing center or had concerns about paying for testing. Another 13% reported worries about exposure to COVID-19 if they went to their testing center. After the pandemic struck, 12% avoided STI testing because they feared contracting coronavirus infection as a result or felt concerned about paying.
While juggling these many COVID-era concerns, more than one quarter of respondents, 29%, reported disruptions in mental health therapy or counseling, while 32% reported disruptions in gender-affirming services.
The CORE/Stroger Hospital team believes their findings "point to an acute and potentially chronic mental health crisis" among sexual- and gender-minority adolescents and young adults. Disruptions in HIV/STI prevention and treatment, and in mental health care, the researchers warned, "could lead to higher HIV/STI incidence and PrEP drop-off." Providers and public health officials should try to address these issues with input from community agencies and young people themselves.
Reference
1. Serrano PA, Daubert E, Munoz A, French AL, Hosek SG. Social, economic, mental health and medical care impacts of COVID-19 in a US cohort of sex and gender diverse adolescents and young adults at-risk for HIV. HIVR4P (HIV Research for Prevention) Virtual, January 27-28 and February 3-4, 2021. Abstract OA13.02.
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