Session: COVID-19 Impacts and the Pandemic Response Among Racialized Sexual and Gender Minority Populations: A Community-Based, Peer-Delivered e-Health Intervention (#SafeHandsSafeHearts) (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

Background and Purpose: Universalizing platitudes about the COVID-19 pandemic notwithstanding, a prominent U.S. public health researcher has underscored, "we are not all in this together." COVID-19, much like HIV before it--it's 'curve flattened' except for those at the most marginalized sociodemographic intersections--has highlighted the fault lines of marginalization that produce rampant health disparities. In the U.S. and Canada, COVID-19 exerts a disproportionate impact on Black/African American, Latinx, indigenous, and sexual and gender minority communities, among others. These populations experience elevated rates of physical and mental health conditions owing to ongoing adverse social determinants of health (SDOH)--such as unstable employment and housing, residential segregation, lack of access to healthcare, and systemic racism, homophobia, and transphobia--which increase risks for negative COVID-19 outcomes. This symposium presents findings from #SafeHandsSafeHearts, a unique university-community collaborative project that aimed to examine and address the COVID-19 pandemic among racialized sexual and gender minority populations in Toronto, Canada.

Methods: #SafeHandsSafeHearts was designed and implemented by a multidisciplinary team of researchers, practitioners, and trainees, with the goal of reducing psychological distress and increasing COVID-19 knowledge and protective behaviors among predominantly racialized LGBTQ+ individuals amid the pandemic. The intervention was based on motivational interviewing and psychoeducation, which have demonstrated effectiveness across many health domains, and in eHealth interventions, among various LGBTQ+ populations. MSW interns and community-based peer counselors received training on COVID-19, the intervention, and research ethics, and ongoing clinical supervision. After completion of screening and a baseline survey (n=202), the intervention was implemented in three sequential 1-hour online modules conducted every two weeks, followed by post-intervention (2-week) and follow-up (2-month) surveys. A customized, mobile-optimized, web-based platform enabled self-administered online screening, baseline and post-intervention surveys, designed to navigate rolling lockdowns in Toronto. The four presentations draw on theory (i.e., structural violence) and analyses of baseline and outcome data from #SafeHandsSafeHearts to: 1) characterize the sample and impacts of the pandemic on SDOH; 2) examine associations between COVID-19-related stress and mental health; 3) explore pandemic-related risks of intimate partner violence; and 4) evaluate the effectiveness of the intervention on psychological distress, COVID-19 protective behaviors and knowledge outcomes.

Results: We identified pervasive pandemic-related impacts on economic, housing, and food insecurity, and access to healthcare among racialized LGBTQ+ individuals. Loneliness and social isolation, and COVID-19 stress were significantly associated with depression and anxiety. The pandemic and related responses exacerbated risks of intimate partner violence. Overall, #SafeHandsSafeHearts was effective in significantly reducing depression and anxiety over time, with no statistically significant increases in COVID-19 knowledge. Significant increases in protective behaviors were identified at 2-month follow-up.

Conclusion and Implications: #SafeHandsSafeHearts highlights the exacerbation of social-structural inequities, mental health risks, and IPV among racialized LGBTQ+ populations in the COVID-19 pandemic, as well as the effectiveness of a culturally tailored, community-based and peer-delivered eHealth intervention in significantly reducing psychological distress. Our findings suggest an urgent need to consider the impacts of structural violence on pandemic-related risks, and the imperative of including marginalized communities in developing culturally appropriate pandemic preparedness and responses.