Research with Marginalized Communities: Challenges to Continuity During the COVID-19 Pandemic

Confident futures: Community-based organizations as first responders and agents of change in the face of the Covid-19 pandemic

This comparative study of community organizations serving marginalized youth in New York City and Amsterdam utilized a novel ethnographic approach called reverse engineering to identify techniques for social change that are active in each organization, adaptable and translatable to other contexts. It found that youth-serving organizations led flexible responses to the crisis of COVID-19 as it affected those marginalized by race, immigrant status, housing instability, religion and gender. The organizations employed techniques that they had previously developed to cultivate youth well-being – among them connectivity, safe space, and creativity – to mount tailored responses to COVID-19 related crises. In New York City, these groups addressed crises of material survival resources (personal protective equipment, food, housing) whereas in Amsterdam, youth-serving organizations focused on social connections and emotional well-being as the government met more of participants’ material needs.

Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people

BACKGROUND

Transgender and nonbinary people are disproportionately affected by structural barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) crisis and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and nonbinary people in multiple countries.

METHODS

We collected multi-national, cross-sectional data from 964 transgender and nonbinary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of COVID-19. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one's gender were related to depressive symptoms, anxiety, and changes in suicidal ideation.

RESULTS

Individuals resided in 76 countries, including Turkey (27.4%, n = 264) and Thailand (20.6%, n = 205). A majority were nonbinary (66.8%, n = 644) or transfeminine (29.4%, n = 283). Due to COVID-19, 55.0% (n = 320/582) reported reduced access to gender-affirming resources, and 38.0% (n = 327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%, n = 392/856). One in six (17.0%, n = 112/659) expected losses of health insurance, and 77.0% (n = 724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36-1.97), 1.61 (95% CI: 1.31-1.97), and 1.74 (95% CI: 1.07-2.82) times higher for individuals whose access to gender-affirming resources was reduced versus not.

DISCUSSION

The COVID-19 crisis is associated with reduced access to gender-affirming resources and the ability of transgender and nonbinary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve health of transgender and nonbinary communities, increased access to gender-affirming resources should be prioritized through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.

Biometric Registration to an HIV Research Study may Deter Participation

Biometric registration may improve services associated with HIV research. A cross-sectional, observational survey was used to evaluate biometric fingerprint scanning for identification (ID) verification in the setting of an HIV prevention study. Survey outcomes were dichotomized (discouraged or not discouraged) by biometric scanning and statistical analyses were used to determine if participation decreased by greater than 10% overall and after stratifying by demographic variables and risk behaviors. 206 participants were recruited from a community-based HIV and sexual health research screening program. Participants completed a quantitative survey to assess their perceptions of biometric scanning for ID verification. The majority of participants (n = 160; 77.7%) indicated no deterrence from testing due to biometric scanning, yet a significant number (n = 45; 23.3%, P < .001) reported at least partial deterrence. Research using biometric scanning for ID verification may significantly limit access to HIV prevention services and may risk reducing meaningful participation among marginalized populations.

Tele-Mental Health Utilization Among People with Mental Illness to Access Care During the COVID-19 Pandemic

Shortly after the COVID-19 pandemic arrived at the United States, mental health services moved towards using tele-mental health to provide care. A survey about resilience and tele-mental health was developed and conducted with ForLikeMinds' members and followers. Correlational analysis was used to examine relationships between quantitative variables. A phenomenological approach was used to analyze open questions responses. Sixteen percent of participants were coping well with the pandemic; 50% were coping okay; and 34% said that they were coping poorly. Three main themes emerged from the qualitative analysis: accessibility to care; self-care strategies; and community support and relationship. The responses from participants seems to reflect the combination of two main factors-the challenges they were facing in accessing care through tele-mental health plus the mental health consequences from COVID-19. This survey reflects the importance of building innovative strategies to create a working alliance with people who need care through tele-mental health.

Understanding the Impact of the COVID-19 Pandemic on the Mental Health of Transgender and Gender Nonbinary Individuals Engaged in a Longitudinal Cohort Study

While the COVID-19 pandemic in the United States disproportionately impacts marginalized communities, no empiric US-based research has focused specifically on transgender and gender nonbinary (TGNB) people. We examined the pandemic's impact on an established longitudinal cohort of TGNB individuals (N = 208) by administering an online survey between March-June 2020. We used multivariable linear regression to examine reduced LGBTQ/TGNB community support and disruptions in gender-affirming health care as predictors of psychological distress during the pandemic. We found that the pandemic exacerbated ongoing mental health disparities for TGNB individuals. Furthermore, reduced LGBTQ/TGNB support was associated with increased psychological distress during the pandemic. Interruption and/or delay in gender-affirming health care was not associated with increased psychological distress during the pandemic. Special attention is needed to address the unique ways in which TGNB individuals were affected by the COVID-19 pandemic. This includes increasing access to LGBTQ/TGNB community support and addressing long-standing health disparities.

Learning from lockdown - Assessing the positive and negative experiences, and coping strategies of researchers during the COVID-19 pandemic

With the disruption of nonessential research due to the COVID-19 pandemic, researchers faced unexpected changes in their work and personal life. We assessed what challenges researchers encountered during lockdown and whether gender, career level, discipline, and job-permanency influenced their experiences (negative and positive), thereby collecting empirical material which could provide valuable information for future mentoring/supporting practices. Data were collected between July-August 2020 via an online-survey, and answers from 210 respondents (78% female, 21% male, 1% non-disclosed gender) working in Animal Behaviour and Welfare (ABW, 57%), other biological sciences (37%) or social sciences (6%) were analysed. Respondents were post-graduate students (35%), research associates (35%), and professors (22%) or classified as 'other' (8%), and overall fixed-term (55%) and permanent (45%) jobholders. We expected that early career researchers, non-permanent jobholders, and female respondents would report more challenges/less positive experiences during lockdown. Due to the widespread impact of the pandemic, we predicted no effect of academic disciplines. We found great inter-individual difference in the experiences reported by the respondents, with some reporting adaptation to a new routine within a week (31% of the respondents) and/or greater efficiency working from home (19%) while others felt less efficient working from home and/or experienced a greater imbalance towards work (30%) and/or increased personal responsibilities (24%). The most commonly reported challenges were the lack of informal contact with colleagues (63%), a loss of focus due to worry or stress (53%) and/or unsuitable working environments (47%). Postgraduate students, research associates, non-permanent jobholders and ABW researchers reported more work-related challenges (p = from 0.03 to <0.0001) and were more likely to worry about the future (p = from 0.0002 to <0.0001) than other career levels, permanent jobholders, and researchers from other disciplines respectively. We found no gender effect (p = from 0.006 [NS due to Benjamini-Liu correction for multiple comparisons, 24 metrics tested] to 1.000), except that female respondents reported more personal changes affecting their ability to work than male respondents (p = 0.037). On a positive note, most respondents (83%) perceived positive changes during lockdown and 60% reported one or more coping strategies during lockdown, with exercising/outdoor activities and interacting with family/friends most commonly reported. Based on our findings, we provide recommendations for overcoming the reported Covid-19-related challenges which could further deliver valuable guidance for supporting/mentoring schemes and activities fostering a more resilient research community.

HIV prevention research and COVID-19: putting ethics guidance to the test

BACKGROUND

Critical public health measures implemented to mitigate the spread of the novel coronavirus disease (COVID-19) pandemic have disrupted health research worldwide, including HIV prevention research. While general guidance has been issued for the responsible conduct of research in these challenging circumstances, the contours of the dueling COVID-19 and HIV/AIDS pandemics raise some critical ethical issues for HIV prevention research. In this paper, we use the recently updated HIV Prevention Trials Network (HPTN) Ethics Guidance Document (EGD) to situate and analyze key ethical challenges related to the conduct of HIV prevention research during the COVID-19 pandemic as well as identify potential areas for refinement of the guidance document based on this unprecedented state of affairs.

MAIN BODY

Necessary actions taken for HIV prevention research studies due to the COVID-19 pandemic involve an array of ethical issues including those related to: (1) risk mitigation; (2) behavior change; (3) compounding vulnerability; (4) community engagement; (5) trial reopening; and 6) shifting research priorities.

CONCLUSIONS

In the context of the dueling HIV and COVID-19 global pandemics, research teams and sponsors must be nimble in responding to the rapidly changing environment by being sensitive to the associated ethical issues. The HTPN EGD provides a rich set of tools to help identify, analyze and address many of these issues. At the same time, future refinements of the HPTN EGD and other research ethics guidance could be strengthened by providing explicit advice regarding the ethical issues associated with disrupted research and the reopening of studies. In addition, additional consideration should be given to appropriately balancing domains of risk (e.g., physical versus social), addressing the vulnerability of research staff and community partners, and responding to un-anticipatable ancillary care needs of participants and communities. Appropriately addressing these issues will necessitate conceptual work, which would benefit from the careful documentation of the actual ethical issues encountered in research, the strategies implemented to overcome them, and their success in doing so. Throughout all of these efforts, it is critical to remember that the HIV pandemic not be forgotten in the rush to deal with the COVID-19 pandemic.

The Productivity of Medical Publication on COVID-19 in the First Half of 2020: A Retrospective Analysis of Articles Available in PubMed

Background

The control of the coronavirus disease 2019 (COVID-19) pandemic depends on the profound investigation of the virus biology and its consequences. We aimed to analyze the COVID-19 research productivity of authors representing different countries and associations between the number of articles and COVID-19 spread.

Methods

We retrieved all articles on COVID-19 indexed in PubMed between 31 December 2019 and 30 June 2020. We identified the countries of individual authors’ affiliations. We performed the R Spearman rank correlation test between the number of articles with at least one author from a country per one million citizens and Human Development Index (HDI), a number of COVID-19 cases and deaths per one million citizens before 1 July 2020.

Results

Overall, we identified 27,815 articles, including 18,225 original contributions, 2,449 reviews, and 69 meta-analyses on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The highest productivity characterized the authors coming from China (n = 11,519 articles with at least one author), followed by the United States of America (n = 9,666) and Italy (n = 7,261). The number of articles on COVID-19 associated with HDI (Rs = 0.79), the numbers of cases (Rs = 0.47), and deaths (Rs = 0.46) (all p < 0.001).

Conclusions

Early COVID-19 researches were most often authored by researchers from highly developed countries and those affected by the rapid initial spread of SARS-CoV-2.

Gender-affirming care, mental health, and economic stability in the time of COVID-19: a global cross-sectional study of transgender and non-binary people

BACKGROUND

Transgender and non-binary people are disproportionately burdened by barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) pandemic and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and non-binary people globally.

METHODS

We collected global cross-sectional data from 964 transgender and non-binary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of the COVID-19 pandemic. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one's gender were related to depressive symptoms, anxiety, and changes in suicidal ideation.

RESULTS

Individuals resided in 76 countries, including Turkey (27.4%,n=264/964) and Thailand (20.6%,n=205). A majority were non-binary (66.8%,n=644) or transfeminine (29.4%,n=283). Due to the COVID-19 pandemic, 55.0% (n=320/582) reported reduced access to gender- affirming resources, and 38.0% (n=327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%,n=392/856). One in six (17.0%,n=112/659) expected losses of health insurance, and 77.0% (n=724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36-1.97), 1.61 (95% CI: 1.31-1.97), and 1.74 (95% CI: 1.07-2.82) times higher for individuals whose access to gender- affirming resources was reduced versus not.

DISCUSSION

The COVID-19 pandemic has reduced access to gender-affirming resources and the ability of transgender and non-binary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve transgender and non-binary health globally, increased access to gender-affirming resources should be achieved through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.