Health Care Needs and Access during the COVID-19 Pandemic: Differences between Transgender, Gender Diverse, and Cisgender Adults

Background and Purpose: Transgender (trans) individuals experience elevated health concerns relative to their cisgender counterparts. Access to care is critical for health screenings and treatment, but trans communities face significant barriers to care. The COVID-19 pandemic may have exacerbated existing barriers for trans people, with potential consequences including worsening health disparities and forgone COVID-19 related care. This paper examines differences in health care needs, barriers to care since March 2020 (onset of the COVID-19 pandemic), and COVID-19 related testing and health by gender identity—comparing outcomes of cisgender, trans, and gender diverse participants.

Methods: This study utilizes data from Wellness with Pride, a study that expanded upon the National Health, Aging, and Sexuality/Gender Study to include those age 18 and older. Data were collected in 2020. The current analytic sample included cisgender, trans, and gender diverse participants (N=650) who responded to questions around their demographic characteristics, service needs, preventive care service use, and health care access. Participants also answered questions related to COVID-19, including being tested and infected with COVID-19. Frequencies and percentages for variables were calculated, and differences in demographic characteristics, health care access, and COVID-19 outcomes across cisgender, trans, and gender diverse participants were compared using Chi-square (χ²) tests.

Results: Most participants were cisgender (n=480; 74%). About 19% were trans (n=126) and 7% (n=44) were gender diverse. Related to health care access, both trans and gender diverse respondents needed health (trans: 57.1%; gender diverse: 54.6% vs. cisgender: 41.9%) and mental health services (trans: 68.3%; gender diverse: 65.9% vs. cisgender: 39.2%) at higher rates than cisgender participants, but also reported having difficulty locating services since the start of the pandemic at higher rates than cisgender (trans: 71.9%; gender diverse: 71.4% vs. cisgender: 51.5%). Since March 2020, trans and gender diverse participants had higher rates of generally experiencing a health care barrier than those cisgender (trans: 80.8%; gender diverse: 77.3% vs. cisgender: 63.9%). Both trans and gender diverse participants also had higher prevalence of the following specific barriers: affordability, deciding care could wait, and being afraid to go to the doctor. Cisgender participants had higher rates of reporting that they had definitively not contracted COVID-19 (68.8% vs trans: 50.8%; gender diverse: 56.8%). Interestingly, trans respondents had higher rates of responding that they had probably yes (10.3%) or probably no (31.8%) contracted COVID-19 compared to cisgender respondents (probably yes: 4.4%; probably no: 19.9%).

Conclusions and Implications: Findings show that although trans and gender diverse participants needed health and mental health care at higher rates, they generally reported experiencing more barriers to care since the onset of the COVID-19 pandemic. These barriers could result in widening health disparities, many of which the CDC have identified as associated with serious COVID-19 illness. Addressing these barriers is imperative as many trans respondents were uncertain about their COVID-19 status. The uncertainty may also point to barriers to testing. Even though there were no differences in the report of ever being tested, participants may not have been tested every time that they experienced a potential exposure.