Multiple jeopardy: COVID-19 and Indigenous LGBTIQ+ lives

“Every disease has two causes. The first is pathophysiological; the second, political.” — Ramon Cajal, 1899.

The impact of COVID-19 globally has been devastating with more than 20 million confirmed infections and more than 700,000 lost lives at time of writing.

The highest rates of infection and fatality are in North and South America and parts of Asia – particularly the USA, Brazil, Mexico, and India.

But in a pandemic, some communities are at greater risk than others, like Indigenous Peoples and particularly those within LGBTIQ+ Indigenous communities. At the end of June, United Nations chief António Guterres warned the impacts of the COVID-19 pandemic are falling “disproportionately on the most vulnerable: people living in poverty, the working poor, women and children, persons with disabilities, and other marginalised groups.”

Legacies of colonisation

For Indigenous Peoples, colonisation has left a devastating legacy of concentrated and intergenerational poverty, poor physical and social and emotional wellbeing, as well as increased rates of domestic and family violence.

There are also transportation and housing issues, including high rates of homelessness, lack of access to essential services and sanitation, shorter life expectancy, inadequate access to culturally safe care, and some of the highest rates of incarceration in the world.

Indigenous Peoples also experience a more significant burden of noncommunicable and infectious diseases; but during this pandemic, evidence shows higher infection rates, more severe symptoms and higher death rates in Indigenous populations. So, the COVID‐19 pandemic is particularly threatening for the 370 million Indigenous Peoples worldwide.

Global indigenous populations

Health reporting on Indigenous populations and the COVID-19 pandemic has been insightful and deeply distressing.

In the USA, Indigenous Americans (66.8 deaths per 100,000) and black Americans (80.4 deaths per 100,000) are experiencing the highest death toll from COVID-19. The next most impacted group is Pacific Islander Americans – those people with Pacific Islander ancestry, or descendants of the Indigenous peoples of Oceania – who account for 56.7 deaths per 100,000.

Compared to white populations, this mortality rate is 3.5 times higher for Native Americans and 3.1 times higher for Pacific Islander Americans. In South America, Brazil has now had more than three and a half million confirmed COVID-19 cases.

Of those confirmed cases in Brazil, there have been more than 102,000 deaths – and according to the country’s largest Indigenous organisation, APIB, 667 Indigenous people have died from COVID-19 – including Chief Aritana Yawalapiti, one of Brazil’s most influential Indigenous leaders – with more than 24,000 confirmed cases in the community.

Mexico, Chile and Peru are also in the top 10 countries with the most confirmed cases.

As of early June, the Pan-American Health Organisation stated that Colombia had 1,534 confirmed cases, including 73 deaths reported among Indigenous people.

In Ecuador there have been 4,498 confirmed cases, including 144 deaths in Indigenous populations and in Mexico there have been 4,092 confirmed cases, including 649 deaths in Indigenous populations.

Strong indigenous leadership

Closer to home, in New Zealand, at the end of July there had been only 1,579 confirmed and probable cases of COVID-19 and 22 deaths; Māori people make up 8.5 per cent of those cases and Pasifika people 4.5 per cent. But there’s no available data on the ethnicity of those who have died.

In Australia, Indigenous leadership and expertise have been key in helping Australia’s Aboriginal and Torres Strait Islander communities avoid the COVID-19 devastation seen in the Indigenous Americas.

In the government’s latest epidemiology report, just 69 cases of COVID-19 have been recorded among Aboriginal and Torres Strait Islander peoples - 0.8 per cent of all Australian cases with zero fatalities.

The swift, community-led and culturally congruent response by Australian Aboriginal and Torres Strait Islander health professionals, health organisations and communities has been responsible for such success.

Addressing vulnerability

The epidemiological data does not highlight other factors that create additional vulnerability for Indigenous peoples during this pandemic, particularly for those who identify as LGBTIQ+.

“LGBTI people are among the most vulnerable and marginalised in many societies, and among those most at risk from COVID-19; In countries where same-sex relations are criminalised or trans people targeted, they might not even seek treatment for fear of arrest or being subjected to violence.” – UN High Commissioner for Human Rights Michelle Bachelet.

During the COVID-19 pandemic, lesbian, gay, bisexual, trans, intersex and queer (LGBTIQ+) people face significant issues.

This is particularly true when it comes to accessing healthcare, but it also includes the de-prioritisation of culturally appropriate healthcare services, stigmatisation, discrimination, hate-speech and violence, domestic and family violence and access to work and livelihoods.

Before the pandemic, LGBTIQ+ communities already experience greater social isolation, health disparities and higher incidents of moderate to severe mental health issues and suicide rates.

But were also more likely to experience high rates of poverty, higher rates of unemployment or unstable employment and increased probability of violent victimisation compared with heterosexual and cisgender (those people whose gender identity matches their sex assigned at birth) peers.

Due to familial and social rejection, many LGBTIQ+ young adults suffer higher rates of housing insecurity and homelessness.

Stay-at-home restrictions mean many LGBTIQ+ youth are confined in hostile environments with unsupportive family members or housemates that may increase exposure to violence and mental health issues.

Nuanced understanding

Being Indigenous, LGBTIQ+ people are subject to the effects of racism and heterosexism within Indigenous, LGBTIQ+, and non-Indigenous heteronormative communities that can increase their risk of harm and isolation.

For Indigenous LGBTQ+ people within Australia, these vulnerabilities are compounded by the violence of anti-Black racism and white supremacy.

This has been highlighted by national government, police and media responses to the #BlackLivesMatter and #IndigenousLivesMatter protests that directly antagonise public sentiment by linking them with outbreaks in COVID-19 transmission.

So, when discussing, planning and resourcing targeted mid-pandemic and recovery actions, it’s imperative that a culturally appropriate and intersectional response is prioritised.

An intersectional response is one that encompasses the interplay between any kinds of discrimination – whether it’s based on gender, race, age, class, socioeconomic status, physical or mental ability, gender or sexual identity, religion or ethnicity.

As its founder Professor Kimberlé Crenshaw explains, “intersectionality is a lens through which you can see where power comes and collides, where it interlocks and intersects”.

For Indigenous LGBTIQ+ people, this requires nuanced understanding and leadership from government, Indigenous health organisations and health professionals to ensure that their complex vulnerabilities are addressed and their strengths and capabilities are harnessed to promote health and wellbeing.

This means that Indigenous LGBTIQ+ people are not just included in COVID-19 pandemic discussions and progress activities, but that Indigenous LGBTIQ+ health professionals, academics and experts lead the recovery for their own communities.

The Australian Indigenous public health success with COVID-19 has already proven that self-determined communities provide the greatest outcomes for themselves – the Indigenous LGBTIQ+ community would accept nothing less.

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