Racial and ethnic minority communities that lack internet access have been left behind in the race to get a COVID-19 vaccine. The average monthly cost of internet access, about US$70, can be out of reach for those who can barely afford groceries.
Reporters and scholars have written about the effects of lack of internet access in rural areas in the U.S. and developing countries, but they have paid less attention to the harm of lack of internet access in racial and ethnic minority communities in major cities.
We are researchers who study health disparities. We are concerned that even when vaccinations are offered in these communities, those at greatest risk of COVID-19 may be unable to obtain appointments without the help of family or friends. This includes racial and ethnic minority communities and older adults, the age group that is currently being vaccinated.
In 2018, more than one in four Medicare beneficiaries had no digital access at home.
Our research suggests that a lack of internet access may be an important reason. And for the almost 13.8 million older adults in the U.S. who live alone, asking for help may not be an option.
The computer as COVID-19 connector
During the pandemic, the internet has been an indispensable health tool for millions.
Telehealth services, where health care services are delivered to patients and providers separated by a distance, have provided a safe way for patients to make appointments for COVID-19 testing and other types of medical care. There was a 154% increase in telehealth visits during the last seven days of March 2020 compared to the same period in 2019. This was most likely due to public health mandates that required a shift away from in-person care.
In addition, patients receive communications from their providers through email and other messaging systems that offer access to health care, health information and test results. And, departments of public health and the Centers for Disease Control and Prevention have relied on their websites, online events and social media to educate the population about COVID-19. Access to the internet is essential during a pandemic.
This has been particularly true as the vaccine has been rolled out. Signing up for the vaccine has predominantly occurred online. This means that far fewer older adults from under resourced racial and ethnic minority communities have been able to make appointments.
In 2018, more than one in four Medicare beneficiaries had no digital access at home. Those without digital access were more likely to be 85 or older, members of racial or ethnic minority communities and from low-income households.
How internet access can determine health
Over the years, medical and public health experts have identified social factors – structural racism, a person's neighborhood, access to fresh food, exposure to toxins, income and education – that play a major role in health. These factors are often called the social determinants of health. Experts consider structural racism, or racism ingrained in social, business, educational and health policy and practice, to be one of the most damaging determinants. These factors in turn ultimately lead to more disease and death, as they have with COVID-19.
Internet access is emerging as a new determinant of health — Photo: Nasir Kachroo/NurPhoto via ZUMA Press
Early data on the case numbers and deaths from COVID-19 showed that structural racism likely increased exposure to the coronavirus among racial and ethnic minority communities. And racial gaps also impeded access to testing and affected the quality of care.
The pandemic has also illuminated the risk of infection to our aging population. However, research has placed less emphasis on how aging affects some populations more than others, such as the effects of structural racism and income.
Now, it appears that internet access is emerging as a new and troublesome determinant of health. This appears to be particularly true for under resourced racial and ethnic minority communities and aging populations.
Although people can make appointments for a COVID-19 vaccine by telephone, call centers are frequently overwhelmed. Hold times can be extremely long. Access to the internet, having an internet-enabled device and understanding how to use both have been necessary to sign up for the vaccine. Many advocacy groups and public health experts have begun to see internet access as a fundamental civil rights issue.
Policymakers must identify lack of internet access as a barrier and protect against its effects.
During the fall of 2020, we looked at this issue in more depth with Black and Latino individuals who are HIV positive and at risk for a cardiovascular event. In our research, we found that 17 out of 30 patients had no internet, no computer or lacked knowledge of how to use the internet or a computer. They, like many people with health issues or from under resourced racial and ethnic minority communities, are affected by numerous social determinants that amplify the negative health consequences they experience.
While online health services could be used to increase access and retention in care among vulnerable groups, not having access widens existing disparities.
To address the internet gap, we believe that policymakers must identify the lack of internet access as a barrier and protect against its effects. This could include reserving vaccines in under resourced racial and ethnic minority communities for residents and designating senior hours for those 65 and older.
Policymakers could also mandate timely reporting of demographic information, even within medical settings, to monitor equity. Public health administrators could also partner with organizations that work with vulnerable populations, such as Meals on Wheels, to deliver food and vaccines to individual homes.
Departments of public health also could work with organizations and trusted community leaders to produce culturally consistent multimedia information on vaccinations and other health topics. They could also arrange for billboards, freeway signs and posters at local restaurants.
In addition, health care professionals and organizations can help by teaching patients about government subsidies and internet programs for low-income individuals from internet service providers. They can also provide training on how to use the internet, which would be at least a good beginning for these vulnerable groups.
Tamra Burns Loeb, Adjunct Associate Professor - Interim; UCLA Center for Culture, Trauma, and Mental Health Disparities, University of California, Los Angeles; AJ Adkins-Jackson, Research Fellow at Massachusetts General Hospital, Harvard Medical School, Harvard University, and Arleen F. Brown, Professor of Medicine, University of California, Los Angeles
This article is republished from The Conversation under a Creative Commons license. Read the original article.
The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.
Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.
Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."
Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.
Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.
Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.
Oppressive home situations
As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.
Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.
Calls from lesbians and trans men to prevent forced marriages during lockdowns.
Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.
"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."
Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."
Lack of spaces
Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.
"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.
The pandemic has forced some queer people to come out
Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.
Lockdowns force coming out
According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.
"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.
Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.
Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.
"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.
The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling
In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.
"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."
Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.
Medical care is dismal
Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.
Isolation triggered my depression
"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.
What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.
During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.
As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."
Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.
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