Informed consent

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Informed_consent

 

Informed consent is a principle in medical ethics and medical law and media studies, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treatments, alternative treatments, the patient's role in treatment, and their right to refuse treatment. In most systems, healthcare providers have a legal and ethical responsibility to ensure that a patient's consent is informed. This principle applies more broadly than healthcare intervention, for example to conduct research and to disclose a person's medical information.

Within the US, definitions of informed consent vary, and the standard required is generally determined by the state. Informed consent requires a clear appreciation and understanding of the facts, implications, and consequences of an action. To give informed consent, the individual concerned must have adequate reasoning faculties and possess all relevant facts. Impairments to reasoning and judgment that may preclude informed consent include intellectual or emotional immaturity, high levels of stress such as post-traumatic stress disorder or a severe intellectual disability, severe mental disorder, intoxication, severe sleep deprivation, dementia, or coma.

Obtaining informed consent is not always required. If an individual is considered unable to give informed consent, another person is generally authorized to give consent on their behalf—for example, the parents or legal guardians of a child (though in this circumstance the child may be required to provide informed assent) and conservators for the mentally disordered. Alternatively, the doctrine of implied consent permits treatment in limited cases, for example when an unconscious person will die without immediate intervention. Cases in which an individual is provided insufficient information to form a reasoned decision raise serious ethical issues. When these issues occur, or are anticipated to occur, in a clinical trial, they are subject to review by an ethics committee or institutional review board.

Informed consent is codified in both national and international law. 'Free consent' is a cognate term in the International Covenant on Civil and Political Rights, adopted in 1966 by the United Nations, and intended to be in force by 23 March 1976. Article 7 of the covenant prohibits experiments conducted without the "free consent to medical or scientific experimentation" of the subject. As of September 2019, the covenant has 173 parties and six more signatories without ratification.

Assessment

Informed consent can be complex to evaluate, because neither expressions of consent, nor expressions of understanding of implications, necessarily mean that full adult consent was in fact given, nor that full comprehension of relevant issues is internally digested. Consent may be implied within the usual subtleties of human communication, rather than explicitly negotiated verbally or in writing. If a doctor asks a patient to take their blood pressure, for example, a patient may demonstrate consent by offering their arm for a blood pressure cuff. In some cases consent cannot legally be possible, even if the person protests he does indeed understand and wish. There are also structured instruments for evaluating capacity to give informed consent, although no ideal instrument presently exists.

Thus, there is always a degree to which informed consent must be assumed or inferred based upon observation, or knowledge, or legal reliance. This especially is the case in sexual or relational issues. In medical or formal circumstances, explicit agreement by means of signature—normally relied on legally—regardless of actual consent, is the norm. This is the case with certain procedures, such as a "do not resuscitate" directive that a patient signed before onset of their illness.

Brief examples of each of the above:

1. A person may verbally agree to something from fear, perceived social pressure, or psychological difficulty in asserting true feelings. The person requesting the action may honestly be unaware of this and believe the consent is genuine, and rely on it. Consent is expressed, but not internally given.
2. A person may claim to understand the implications of some action, as part of consent, but in fact has failed to appreciate the possible consequences fully and may later deny the validity of the consent for this reason. Understanding needed for informed consent is present but is, in fact (through ignorance), not present.
3. A person signs a legal release form for a medical procedure, and later feels he did not really consent. Unless he can show actual misinformation, the release is usually persuasive or conclusive in law, in that the clinician may rely legally upon it for consent. In formal circumstances, a written consent usually legally overrides later denial of informed consent (unless obtained by misrepresentation).
4. Informed consent in the U.S. can be overridden in emergency medical situations pursuant to 21CFR50.24, which was first brought to the general public's attention via the controversy surrounding the study of Polyheme.

Valid elements

For an individual to give valid informed consent, three components must be present: disclosure, capacity and voluntariness.

• Disclosure requires the researcher to supply each prospective subject with the information necessary to make an autonomous decision and also to ensure that the subject adequately understands the information provided. This latter requirement implies that a written consent form be written in lay language suited for the comprehension skills of subject population, as well as assessing the level of understanding through conversation (to be informed).
• Capacity pertains to the ability of the subject to both understand the information provided and form a reasonable judgment based on the potential consequences of his/her decision.
• Voluntariness refers to the subject's right to freely exercise his/her decision making without being subjected to external pressure such as coercion, manipulation, or undue influence.

From children

Main article: Informed assent

See also: Pediatric medicine § Pediatric autonomy in healthcare

As children often lack the decision-making ability or legal power (competence) to provide true informed consent for medical decisions, it often falls on parents or legal guardians to provide informed permission for medical decisions. This "consent by proxy" usually works reasonably well, but can lead to ethical dilemmas when the judgment of the parents or guardians and the medical professional differ with regard to what constitutes appropriate decisions "in the best interest of the child". Children who are legally emancipated, and certain situations such as decisions regarding sexually transmitted diseases or pregnancy, or for unemancipated minors who are deemed to have medical decision making capacity, may be able to provide consent without the need for parental permission depending on the laws of the jurisdiction the child lives in. The American Academy of Pediatrics encourages medical professionals also to seek the assent of older children and adolescents by providing age appropriate information to these children to help empower them in the decision-making process.

Research on children has benefited society in many ways. The only effective way to establish normal patterns of growth and metabolism is to do research on infants and young children. When addressing the issue of informed consent with children, the primary response is parental consent. This is valid, although only legal guardians are able to consent for a child, not adult siblings. Additionally, parents may not order the termination of a treatment that is required to keep a child alive, even if they feel it is in the best interest. Guardians are typically involved in the consent of children, however a number of doctrines have developed that allow children to receive health treatments without parental consent. For example, emancipated minors may consent to medical treatment, and minors can also consent in an emergency.

Waiver of requirement

Waiver of the consent requirement may be applied in certain circumstances where no foreseeable harm is expected to result from the study or when permitted by law, federal regulations, or if an ethical review committee has approved the non-disclosure of certain information.

Besides studies with minimal risk, waivers of consent may be obtained in a military setting. According to 10 USC 980, the United States Code for the Armed Forces, Limitations on the Use of Humans as Experimental Subjects, a waiver of advanced informed consent may be granted by the Secretary of Defense if a research project would:

1. Directly benefit subjects.
2. Advance the development of a medical product necessary to the military.
3. Be carried out under all laws and regulations (i.e., Emergency Research Consent Waiver) including those pertinent to the FDA.

While informed consent is a basic right and should be carried out effectively, if a patient is incapacitated due to injury or illness, it is still important that patients benefit from emergency experimentation. The Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS) joined to create federal guidelines to permit emergency research, without informed consent. However, they can only proceed with the research if they obtain a waiver of informed consent (WIC) or an emergency exception from informed consent (EFIC).

21st Century Cures Act

The 21st Century Cures Act enacted by the 114th United States Congress in December 2016 allows researchers to waive the requirement for informed consent when clinical testing "poses no more than minimal risk" and "includes appropriate safeguards to protect the rights, safety, and welfare of the human subject."

Medical sociology

Medical sociologists have studied informed consent as well bioethics more generally. Oonagh Corrigan, looking at informed consent for research in patients, argues that much of the conceptualization of informed consent comes from research ethics and bioethics with a focus on patient autonomy, and notes that this aligns with a neoliberal worldview. Corrigan argues that a model based solely around individual decision making does not accurately describe the reality of consent because of social processes: a view that has started to be acknowledged in bioethics. She feels that the liberal principles of informed consent are often in opposition with autocratic medical practices such that norms values and systems of expertise often shape and individuals ability to apply choice.

Patients who agree to participate in trials often do so because they feel that the trial was suggested by a doctor as the best intervention. Patients may find being asked to consent within a limited time frame a burdensome intrusion on their care when it arises because a patient has to deal with a new condition. Patients involved in trials may not be fully aware of the alternative treatments, and an awareness that there is uncertainty in the best treatment can help make patients more aware of this. Corrigan notes that patients generally expect that doctors are acting exclusively in their interest in interactions and that this combined with "clinical equipose" where a healthcare practitioner does not know which treatment is better in a randomized control trial can be harmful to the doctor-patient relationship.

Medical procedures

The doctrine of informed consent relates to professional negligence and establishes a breach of the duty of care owed to the patient (see duty of care, breach of the duty, and respect for persons). The doctrine of informed consent also has significant implications for medical trials of medications, devices, or procedures.

Requirements of the professional

Until 2015 in the United Kingdom and in countries such as Malaysia and Singapore, informed consent in medical procedures requires proof as to the standard of care to expect as a recognised standard of acceptable professional practice (the Bolam Test), that is, what risks would a medical professional usually disclose in the circumstances (see Loss of right in English law). Arguably, this is "sufficient consent" rather than "informed consent." The UK has since departed from the Bolam test for judging standards of informed consent, due to the landmark ruling in Montgomery v Lanarkshire Health Board. This moves away from the concept of a reasonable physician and instead uses the standard of a reasonable patient, and what risks an individual would attach significance to.

Medicine in the United States, Australia, and Canada takes this patient-centric approach to "informed consent." Informed consent in these jurisdictions requires healthcare providers to disclose significant risks, as well as risks of particular importance to that patient. This approach combines an objective (a hypothetical reasonable patient) and subjective (this particular patient) approach.

The doctrine of informed consent should be contrasted with the general doctrine of medical consent, which applies to assault or battery. The consent standard here is only that the person understands, in general terms, the nature of and purpose of the intended intervention. As the higher standard of informed consent applies to negligence, not battery, the other elements of negligence must be made out. Significantly, causation must be shown: That had the individual been made aware of the risk he would not have proceeded with the operation (or perhaps with that surgeon).

Optimal establishment of an informed consent requires adaptation to cultural or other individual factors of the patient. As of 2011, for example, people from Mediterranean and Arab appeared to rely more on the context of the delivery of the information, with the information being carried more by who is saying it and where, when, and how it is being said, rather than what is said, which is of relatively more importance in typical "Western" countries.

The informed consent doctrine is generally implemented through good healthcare practice: pre-operation discussions with patients and the use of medical consent forms in hospitals. However, reliance on a signed form should not undermine the basis of the doctrine in giving the patient an opportunity to weigh and respond to the risk. In one British case, a doctor performing routine surgery on a woman noticed that she had cancerous tissue in her womb. He took the initiative to remove the woman's womb; however, as she had not given informed consent for this operation, the doctor was judged by the General Medical Council to have acted negligently. The council stated that the woman should have been informed of her condition, and allowed to make her own decision.

Obtaining informed consents

To document that informed consent has been given for a procedure, healthcare organisations have traditionally used paper-based consent forms on which the procedure and its risks and benefits are noted, and is signed by both patient and clinician. In a number of healthcare organisations consent forms are scanned and maintained in an electronic document store. The paper consent process has been demonstrated to be associated with significant errors of omission, and therefore increasing numbers of organisations are using digital consent applications where the risk of errors can be minimised, a patient's decision making and comprehension can be supported by additional lay-friendly and accessible information, consent can be completed remotely, and the process can become paperless. One form of digital consent is dynamic consent, which invites participants to provide consent in a granular way, and makes it easier for them to withdraw consent if they wish.

Electronic consent methods have been used to support indexing and retrieval of consent data, thus enhancing the ability to honor to patient intent and identify willing research participants. More recently, Health Sciences South Carolina, a statewide research collaborative focused on transforming healthcare quality, health information systems and patient outcomes, developed an open-source system called Research Permissions Management System (RPMS).

Competency of the patient

The ability to give informed consent is governed by a general requirement of competency. In common law jurisdictions, adults are presumed competent to consent. This presumption can be rebutted, for instance, in circumstances of mental illness or other incompetence. This may be prescribed in legislation or based on a common-law standard of inability to understand the nature of the procedure. In cases of incompetent adults, a health care proxy makes medical decisions. In the absence of a proxy, the medical practitioner is expected to act in the patient's best interests until a proxy can be found.

By contrast, 'minors' (which may be defined differently in different jurisdictions) are generally presumed incompetent to consent, but depending on their age and other factors may be required to provide Informed assent. In some jurisdictions (e.g. much of the U.S.), this is a strict standard. In other jurisdictions (e.g. England, Australia, Canada), this presumption may be rebutted through proof that the minor is 'mature' (the 'Gillick standard'). In cases of incompetent minors, informed consent is usually required from the parent (rather than the 'best interests standard') although a parens patriae order may apply, allowing the court to dispense with parental consent in cases of refusal.

Deception

Research involving deception is controversial given the requirement for informed consent. Deception typically arises in social psychology, when researching a particular psychological process requires that investigators deceive subjects. For example, in the Milgram experiment, researchers wanted to determine the willingness of participants to obey authority figures despite their personal conscientious objections. They had authority figures demand that participants deliver what they thought was an electric shock to another research participant. For the study to succeed, it was necessary to deceive the participants so they believed that the subject was a peer and that their electric shocks caused the peer actual pain.

Nonetheless, research involving deception prevents subjects from exercising their basic right of autonomous informed decision-making and conflicts with the ethical principle of respect for persons.

The Ethical Principles of Psychologists and Code of Conduct set by the American Psychological Association says that psychologists may conduct research that includes a deceptive compartment only if they can both justify the act by the value and importance of the study's results and show they could not obtain the results by some other way. Moreover, the research should bear no potential harm to the subject as an outcome of deception, either physical pain or emotional distress. Finally, the code requires a debriefing session in which the experimenter both tells the subject about the deception and gives subject the option of withdrawing the data.

Abortion

In some U.S. states, informed consent laws (sometimes called "right to know" laws) require that a woman seeking an elective abortion receive information from the abortion provider about her legal rights, alternatives to abortion (such as adoption), available public and private assistance, and other information specified in the law, before the abortion is performed. Other countries with such laws (e.g. Germany) require that the information giver be properly certified to make sure that no abortion is carried out for the financial gain of the abortion provider and to ensure that the decision to have an abortion is not swayed by any form of incentive.

Some informed consent laws have been criticized for allegedly using "loaded language in an apparently deliberate attempt to 'personify' the fetus," but those critics acknowledge that "most of the information in the [legally mandated] materials about abortion comports with recent scientific findings and the principles of informed consent", although "some content is either misleading or altogether incorrect."

Within research

Informed consent is part of the ethical clinical research as well, in which a human subject voluntarily confirms his or her willingness to participate in a particular clinical trial, after having been informed of all aspects of the trial that are relevant to the subject's decision to participate. Informed consent is documented by means of a written, signed, and dated informed consent form. In medical research, the Nuremberg Code set a base international standard in 1947, which continued to develop, for example in response to the ethical violation in the Holocaust. Nowadays, medical research is overseen by an ethics committee that also oversees the informed consent process.

As the medical guidelines established in the Nuremberg Code were imported into the ethical guidelines for the social sciences, informed consent became a common part of the research procedure. However, while informed consent is the default in medical settings, it is not always required in the social science. Here, research often involves low or no risk for participants, unlike in many medical experiments. Second, the mere knowledge that they participate in a study can cause people to alter their behavior, as in the Hawthorne Effect: "In the typical lab experiment, subjects enter an environment in which they are keenly aware that their behavior is being monitored, recorded, and subsequently scrutinized." In such cases, seeking informed consent directly interferes with the ability to conduct the research, because the very act of revealing that a study is being conducted is likely to alter the behavior studied. List exemplifies the potential dilemma that can result: "if one were interested in exploring whether, and to what extent, race or gender influences the prices that buyers pay for used cars, it would be difficult to measure accurately the degree of discrimination among used car dealers who know that they are taking part in an experiment." In cases where such interference is likely, and after careful consideration, a researcher may forgo the informed consent process. This is commonly done after weighting the risk to study participants versus the benefit to society and whether participants are present in the study out of their own wish and treated fairly. Researchers often consult with an ethics committee or institutional review board to render a decision.

The birth of new online media, such as social media, has complicated the idea of informed consent. In an online environment people pay little attention to Terms of Use agreements and can subject themselves to research without thorough knowledge. This issue came to the public light following a study conducted by Facebook Inc. in 2014, and published by that company and Cornell University. Facebook conducted a study where they altered the Facebook News Feeds of roughly 700,000 users to reduce either the amount of positive or negative posts they saw for a week. The study then analyzed if the users status updates changed during the different conditions. The study was published in the Proceedings of the National Academy of Sciences. The lack of informed consent led to outrage among many researchers and users. Many believed that by potentially altering the mood of users by altering what posts they see, Facebook put at-risk individuals at higher dangers for depression and suicide. However, supports of Facebook claim that Facebook details that they have the right to use information for research in their terms of use. Others say the experiment is just a part of Facebook's current work, which alters News Feeds algorithms continually to keep people interested and coming back to the site. Others pointed out that this specific study is not along but that news organizations constantly try out different headlines using algorithms to elicit emotions and garner clicks or Facebook shares. They say this Facebook study is no different from things people already accept. Still, others say that Facebook broke the law when conducting the experiment on user that did not give informed consent. The Facebook study controversy raises numerous questions about informed consent and the differences in the ethical review process between publicly and privately funded research. Some say Facebook was within its limits and others see the need for more informed consent and/or the establishment of in-house private review boards.

Conflicts of interest

Other, long-standing controversies underscore the role for conflicts of interest among medical school faculty and researchers. For example, in 2014 coverage of University of California (UC) medical school faculty members has included news of ongoing corporate payments to researchers and practitioners from companies that market and produce the very devices and treatments they recommend to patients. Robert Pedowitz, the former chairman of UCLA's orthopedic surgery department, reported concern that his colleague's financial conflicts of interest could negatively affect patient care or research into new treatments. In a subsequent lawsuit about whistleblower retaliation, the university provided a $10 million settlement to Pedowitz while acknowledging no wrongdoing. Consumer Watchdog, an oversight group, observed that University of California policies were "either inadequate or unenforced...Patients in UC hospitals deserve the most reliable surgical devices and medication…and they shouldn't be treated as subjects in expensive experiments." Other UC incidents include taking the eggs of women for implantation into other women without consent and injecting live bacteria into human brains, resulting in potentially premature deaths.

History

Spanish

 

English

Walter Reed authored these informed consent documents in 1900 for his research on yellow fever

Informed consent is a technical term first used by attorney, Paul G. Gebhard, in a medical malpractice United States court case in 1957. In tracing its history, some scholars have suggested tracing the history of checking for any of these practices:

1. A patient agrees to a health intervention based on an understanding of it.
2. The patient has multiple choices and is not compelled to choose a particular one.
3. The consent includes giving permission.

These practices are part of what constitutes informed consent, and their history is the history of informed consent. They combine to form the modern concept of informed consent—which rose in response to particular incidents in modern research. Whereas various cultures in various places practiced informed consent, the modern concept of informed consent was developed by people who drew influence from Western tradition.

Medical history

In this Ottoman Empire document from 1539 a father promises to not sue a surgeon in case of death following the removal of his son's urinary stones.

Historians cite a series of medical guidelines to trace the history of informed consent in medical practice.

The Hippocratic Oath, a Greek text dating to 500 B.C.E., was the first set of Western writings giving guidelines for the conduct of medical professionals. Consent by patients as well as several other, now considered fundamental issues, is not mentioned. The Hippocratic Corpus advises that physicians conceal most information from patients to give the patients the best care. The rationale is a beneficence model for care—the doctor knows better than the patient, and therefore should direct the patient's care, because the patient is not likely to have better ideas than the doctor.

Henri de Mondeville, a French surgeon who in the 14th century, wrote about medical practice. He traced his ideas to the Hippocratic Oath. Among his recommendations were that doctors "promise a cure to every patient" in hopes that the good prognosis would inspire a good outcome to treatment. Mondeville never mentioned getting consent, but did emphasize the need for the patient to have confidence in the doctor. He also advised that when deciding therapeutically unimportant details the doctor should meet the patients' requests "so far as they do not interfere with treatment".

In Ottoman Empire records there exists an agreement from 1539 in which negotiates details of a surgery, including fee and a commitment not to sue in case of death. This is the oldest identified written document in which a patient acknowledges risk of medical treatment and writes to express their willingness to proceed.

Benjamin Rush was an 18th-century United States physician who was influenced by the Age of Enlightenment cultural movement. Because of this, he advised that doctors ought to share as much information as possible with patients. He recommended that doctors educate the public and respect a patient's informed decision to accept therapy. There is no evidence that he supported seeking a consent from patients. In a lecture titled "On the duties of patients to their physicians", he stated that patients should be strictly obedient to the physician's orders; this was representative of much of his writings. John Gregory, Rush's teacher, wrote similar views that a doctor could best practice beneficence by making decisions for the patients without their consent.

Thomas Percival was a British physician who published a book called Medical Ethics in 1803. Percival was a student of the works of Gregory and various earlier Hippocratic physicians. Like all previous works, Percival's Medical Ethics makes no mention of soliciting for the consent of patients or respecting their decisions. Percival said that patients have a right to truth, but when the physician could provide better treatment by lying or withholding information, he advised that the physician do as he thought best.

When the American Medical Association was founded they in 1847 produced a work called the first edition of the American Medical Association Code of Medical Ethics. Many sections of this book are verbatim copies of passages from Percival's Medical Ethics. A new concept in this book was the idea that physicians should fully disclose all patient details truthfully when talking to other physicians, but the text does not also apply this idea to disclosing information to patients. Through this text, Percival's ideas became pervasive guidelines throughout the United States as other texts were derived from them.

Worthington Hooker was an American physician who in 1849 published Physician and Patient. This medical ethics book was radical demonstrating understanding of the AMA's guidelines and Percival's philosophy and soundly rejecting all directives that a doctor should lie to patients. In Hooker's view, benevolent deception is not fair to the patient, and he lectured widely on this topic. Hooker's ideas were not broadly influential.

The US Canterbury v. Spence case established the principle of informed consent in US law. Earlier legal cases had created the underpinnings for informed consent, but his judgment gave a detailed and thought through discourse on the matter. The judgment cites cases going back to 1914 as precedent for informed consent.

Research history

Historians cite a series of human subject research experiments to trace the history of informed consent in research.

The U.S. Army Yellow Fever Commission "is considered the first research group in history to use consent forms." In 1900, Major Walter Reed was appointed head of the four man U.S. Army Yellow Fever Commission in Cuba that determined mosquitoes were the vector for yellow fever transmission. His earliest experiments were probably done without formal documentation of informed consent. In later experiments he obtained support from appropriate military and administrative authorities. He then drafted what is now "one of the oldest series of extant informed consent documents." The three surviving examples are in Spanish with English translations; two have an individual's signature and one is marked with an X.

Tearoom Trade is the name of a book by American psychologist Laud Humphreys. In it he describes his research into male homosexual acts. In conducting this research he never sought consent from his research subjects and other researchers raised concerns that he violated the right to privacy for research participants.

Henrietta Lacks on January 29, 1951, shortly after the birth of her son Joseph, Lacks entered Johns Hopkins Hospital in Baltimore with profuse bleeding. She was diagnosed with cervical cancer and was treated with inserts of radium tubes. During her radiation treatments for the tumor, two samples—one of healthy cells, the other of malignant cells—were removed from her cervix without her permission. Later that year, 31-year-old Henrietta Lacks died from the cancer. Her cells were cultured creating Hela cells, but the family was not informed until 1973, the family learned the truth when scientists asked for DNA samples after finding that HeLa had contaminated other samples. In 2013 researchers published the genome without the Lacks family consent.

The Milgram experiment is the name of a 1961 experiment conducted by American psychologist Stanley Milgram. In the experiment Milgram had an authority figure order research participants to commit a disturbing act of harming another person. After the experiment he would reveal that he had deceived the participants and that they had not hurt anyone, but the research participants were upset at the experience of having participated in the research. The experiment raised broad discussion on the ethics of recruiting participants for research without giving them full information about the nature of the research.

Chester M. Southam used HeLa cells to inject into cancer patients and Ohio State Penitentiary inmates without informed consent to determine if people could become immune to cancer and if cancer could be transmitted.

New areas

With the growth of bioethics in the 21st century to include environmental sustainability, some authors, such as Cristina Richie have proposed a "green consent". This would include information and education about the climate impact of pharmaceuticals (carbon cost of medications) and climate change health hazards.

Ethics of informed consent

The principle of informed consent rests in the ethical standards of autonomy and self-determination. Effective informed consent includes information dis-closure,voluntary choice,and decision-making capacity.

Capacity can be defined as the ability to understand and reason through the decision-making process so that a rational choice can be made about whether or not to consent to treatment .

Impact of the COVID-19 pandemic on the LGBT community

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Impact_of_the_COVID-19_pandemic_on_the_LGBT_community 

The ongoing COVID-19 pandemic has highlighted inequities experienced by marginalized populations, and has had a significant impact on the LGBT community. Gay pride events were cancelled or postponed worldwide. More than 220 gay pride celebrations around the world were canceled or postponed in 2020, and in response a Global Pride event was hosted online. LGBTQ+ people also tend to be more likely to have pre-existing health conditions, such as asthma, HIV/AIDS, cancer, or obesity, that would worsen their chances of survival if they became infected with COVID-19. They are also more likely to smoke.

Some countries and leaders have been criticized by human rights organizations such as the Human Rights Watch and Amnesty International for using the pandemic as an excuse to abuse or blame minority communities, including members of the LGBTQ+ community.

Background

The United Nations called for all States to urgently take into account the impact of COVID-19 on lesbian, gay, bisexual, transgender and gender diverse (LGBT) persons when designing, implementing and evaluating the measures to combat the pandemic which may affect disproportionately LGBT communities around the world.

A global survey revealed that about 30% of gay men felt unsafe at home during the pandemic. 72% of respondents said they were experiencing anxiety since the pandemic began. A review of the impact of social distancing measures on gay, bisexual, queer, trans, and two-spirit men in Canada concluded that control measures in response to the pandemic had serious potential to impact their mental, social, and sexual health.

Impact on health

COVID-19 has had a significant impact on the health of marginalized communities around the world. LGBTQ+ people are disproportionately affected by medical conditions which would affect their response to a COVID-19 infection. According to the Centers for Disease Control and Prevention (CDC):

When age, sex, and survey year are adjusted, sexual minority persons have higher prevalences than do heterosexual persons of self-reported cancer, kidney disease, chronic obstructive pulmonary disease (COPD), heart disease (including myocardial infarction, angina, or coronary heart disease), obesity, smoking, diabetes, asthma, hypertension, and stroke. Sexual minority adults who are members of racial/ethnic minority groups disproportionately affected by the pandemic also have higher prevalences of several of these health conditions than do racial/ethnic minority adults who are heterosexual.

LGBTQ+ people are less likely to have health insurance. Many reported discrimination, bias, and refusal when attempting to seek healthcare. Discrimination, stigma, or financial barriers in healthcare can cause LGBTQ+ individuals to avoid seeking care. Globally, COVID-19 delays have also further delayed gender-affirming surgeries and gender-affirming care for gender minorities, which is associated with lower mental health outcomes.

Before COVID, disparities of mental health and well-being were prevalent among the LGBTQ community but are heightened even more. A primary population that suffers from COVID-19 and campus closures include those of the LGBTQ community. During COVID, LGBTQ college students face housing insecurity, financial concerns, and, most importantly, a lack of student health insurance. Without the support of student services provided by the university, gender, and sexual minority students face difficulties in acquiring services for their healthcare needs such as hormone replacement therapy and mental health services.

LGBTQ+ people are more likely to be immunocompromised and disabled compared to the general population. Understanding the association of health conditions with marginalized populations is important when addressing the impacts of COVID-19. The Centre for Disease Control and Prevention reported that 90 percent of hospitalized patients were those who had at least one underlying condition before contracting COVID-19. Because LGBTQ+ people are more likely to have pre-existing health conditions, it worsens their chances of survival if they became infected with COVID-19. LGBTQ+ people have elevated rates of depression and substance abuse. Social distancing may worsen these conditions. Being a member of two demographics which both tend to be more economically vulnerable (for example, being both LGBTQ+ and an immigrant, or a racial minority), contributes to health vulnerabilities. LGBTQ+ seniors are more likely to encounter isolation and therefore other health issues.

National health organizations warned that some members of the LGBTQ+ community may be "particularly vulnerable" to the effects of the disease. Reasons for the increased risk include higher rates of cancer, HIV, and smoking, as well as health care discrimination. LGBTQ+ people smoke at rates 50 percent higher than the general population. LGBTQ+ youth have elevated rates of homelessness, and infection is more likely in spaces such as homeless shelters where social distancing is more difficult.

More than 100 LGBT rights organizations signed an open letter asking U.S. public health officials to address this issue. Signatories included GLAAD, the Human Rights Campaign, and Lambda Legal. The letter was organized by the LGBT National Cancer Network with support from GLMA: Health Professionals Advancing LGBTQ Equality, the National Queer Asian Pacific Islander Alliance, the New York Transgender Advocacy Group, Services & Advocacy for GLBT Elders (SAGE), and Whitman-Walker Health.

Sexual and Reproductive Health Challenges

With added stress, LGBTQ individuals face greater threats to more severe COVID symptoms and higher mortality rate. A disruption to healthcare systems has put a halt to many gender-affirming services and health care treatments. This poses an additional risk factor for those with HIV who will face challenges in communicating with their healthcare provider and obtaining any sort of medications. Transgender people also face the possibility of postponing any surgeries or a halt in their hormone therapies.

Men who have sex with men and trans women are key populations that are vulnerable to HIV. Disruptions to HIV-related services are attributed to travel bans, lack of transportation, and the lack of legislation and policies in implementing further access to such services. Despite hormone and gender-affirming treatments being inaccessible before the pandemic, they have been further postponed or unavailable to transgender individuals. Transgender people as sex workers face a rising challenge in obtaining their sexual and reproductive health rights. As a result of the discrimination and stigma associated with transgender people, they are hesitant to seek medical help.

Impact on social support

Many people felt the impacts of social isolation during lockdowns because of less socialization time with friends and family. Lockdowns limited social support networks in a variety of ways. LGBTQ+ people often identify receiving social support from chosen family, which are people in their social networks they feel safe with and affirmed by. Lockdown restricted the social networks of LGBTQ+ people. Overall, gender and sexual minorities experienced lower perceived social support during the pandemic compared to their heterosexual and cisgender counterparts.

LGBTQ+ Youth There are also concerns about reduced social support and resources that are available for LGBTQ+ people during COVID-19, particularly those who are homeless and in unsafe family environments. Some students were forced to stay with unsupportive families and were sent home early from campus to families that do not support them, which increased depression and anxiety. COVID-19 has led to an increase in family violence in which LGBTQ+ youth are victimized. During the pandemic, many LGBTQ+ people, especially youth turned to social media for community, affirmation, and support. Online-text based platforms that allowed LGBTQ+ youth to chat helped to increase youth's sense of safety due to not fearing being overhead by family. Also, online text-based platforms offered youth a safe space to connect without the fear of contracting and spreading COVID-19.

The social isolation limited the social support from peers, family, and friends. Those that lack a supportive family connection, are disproportionately affected most with mental health and well-being issues as well as a sense of belonging. Unprecedented times such as these can place a toll on family ties and the already present social support system LGBTQ individuals have. For youth who do not feel safe coming out to their families face an additional toll on their mental and physical health.

LGBTQ+ Seniors Ageist attitudes have been especially prevalent during COVID-19. Seniors and people who are immunocompromised are more vulnerable to severe illness from COVID-19. Many pre-existing barriers and inequities were exacerbated during COVID-19 for older populations. Some older trans people expressed feeling a lack of social support because of experiences of both transphobic discrimination and ageism. For some seniors, connections to LGBTQ+ communities felt severely disconnected because of COVID-19, which restricted access to activities and interactions in queer community. Compared to heterosexual and cisgender seniors, LGBTQ+ older adults are more likely to live alone and experience higher social isolation. Also, about a quarter of seniors feel that they have no one to call in the case of an emergency. As such, some older adults may have less support and access to services during COVID-19. Older LGBTQ+ adults are also more likely to be estranged from biological families and rely more on chosen family supports as they age. During COVID-19, some LGBTQ+ older adults relied more on the help of chosen family than biological family support.

Despite numerous challenges during the pandemic, LGBTQ+ communities have shown resiliency and found ways to adapt through personal strength, community care, and acceptance.

Many LGBTQ+ dating websites have shared ways to prevent coronavirus infections.

Kyle Casey Chu, a writer from San Francisco, documented the ways in which the pandemic, particularly but not exclusively the requirement for people to wear masks when socializing in public, impacted traditional gay sexual behaviours in an August article for Xtra!.

Economic and employment impact

COVID-19 has resulted in job losses and financial insecurities, especially for marginalized populations. Before the pandemic, trans and non-binary people were commonly low-income and underemployed because of systemic discrimination. In addition, members of the LGBTQ+ community tend to be employed in industries which are more likely to have been economically impacted negatively by the COVID-19 pandemic. For example, 40 percent of LGBTQ+ people reported working in person jobs that were highly affected by COVID-19, such as in hospitals or food services. A global study on gay men found that many experienced job losses because of COVID-19 and had issues receiving COVID-19 related funds. In the study, men reported cutting meals and expected their income to decline by 30 percent. LGBTQ+ Americans were slightly more likely to experience job loss due to COVID-19, compared to the general population. Also LGBTQ+ themed organizations, businesses, and communities have been impacted both by COVID-19 itself and its economic impact at disproportionate rates. Gay bars such as the Stonewall Inn have required fundraising to stay afloat, and some without considerable fundraising capability have closed permanently.

Africa

South Africa

Discrimination on the basis of sexual orientation or gender identity is a legitimate reason to claim asylum in South Africa. According to Human Rights Watch, these asylum-seeking refugees come from other parts of Africa such as "Zimbabwe, Democratic Republic of Congo, Malawi, and Nigeria". Many of the LGBT refugees who move to South Africa work in the service sector. Some work as sex workers. Victor Chikalogwe of PASSOP said that COVID-19 lockdowns made living hard to sustain for this demographic. These refugees were uniquely vulnerable during the COVID-19 pandemic because they were ineligible for receiving food aid.

Uganda

On 29 March 2020, 23 gay men and trans women were detained by police at an LGBT+ shelter in Kampala, Uganda, run by the non-profit Children of the Sun Foundation. Those detained were accused of violating social distancing requirements, and 4 were released due to ill health. Human Rights Watch called the charges a "bogus pretext" to harass LGBT+ people. The local mayor was allegedly filmed striking one of those detained with a cane, and those detained were apparently forced to reveal their faces to a camera. The African director at Human Rights Watch called for the gay youth to be released. The United Nations Working Group on Arbitrary Detention as well as the Joint United Nations Programme on HIV/AIDS condemned the arrests The detained people as well as the Human Rights Awareness and Promotion Forum alleged that the group suffered "cruel and inhuman" torture while in prison. Reportedly, thirteen gay men, two bisexual men, and four trans women were among those detained, and they were all homeless. They won USh 5,000,000/= (or US$1,365) each in a case against government officials, for denying them access to lawyers. Homosexuality is illegal in Uganda, and it is seen by many Ugandans as imported from the West.

Asia

GagaOOLala, described by Reuters as "Asia's first LGBT+ video streaming platform, dubbed the continent's 'gay Netflix'", expanded with the hope of reaching people who are isolating because of the pandemic.

Indonesia

The LGBT community in Indonesia faced especial challenges related to employment, including those who work as street musicians or sex workers. Some in Indonesia's transgender community, including those of waria background, raised money to provide food aid and masks to people who required them.

Israel

Israel Gay Youth, speaking to Army Radio, reported soaring depression, family violence, and suicidality among LGBT+ teens in Israel amid stay-at-home orders. The CEO of Israel Gay Youth noted that many of the calls they received were from teens of Arab and Haredi descent, while noting that "no community is free of homophobia."

Japan

A survey in Japan indicated that LGBT people in the country were concerned that being infected with COVID-19 could lead to them being outed, due to authorities tracing where the infection may have originated. Some were also concerned about whether they might be able to access information about their partner while hospitalized, or take part in decision-making concerning their hospitalized partner.

South Korea

In May 2020, an outbreak connected to LGBT-friendly nightclubs in Seoul prompted a backlash and concerns over privacy. The incident was reportedly fueling homophobia in the country and resulted in what was described as "many malicious reports towards gay men." The atmosphere of stigma and taboo around the subject of being LGBT in South Korea caused potentially infected South Koreans to be reluctant to get tested or submit to contact tracing, risking further spread of COVID-19. "Gay club" and "gay coronavirus" were among the most searched terms on South Korean social media following the incident, according to The Washington Post. The outbreak caused anti-gay rhetoric on South Korean social media. Gay men were stalked on dating apps, facing potential exposure. South Korean press have reportedly contributed to the air of stigma, including by publishing personal information about those who were infected. Some gay South Koreans expressed anxiety and even suicidality over the situation, fearing job loss and public outing. Authorities combed through mobile phone data in an attempt to identify people who did not volunteer themselves. South Korean authorities also introduced "anonymous testing", requiring only a phone number to come forward, in order to mend fears of outing.

Turkey

A top Turkish Muslim scholar and President of the Directorate of Religious Affairs, Ali Erbaş, said in a Ramadan announcement on 8 May 2020 that the country condemned homosexuality because it "brings illness", insinuating that same-sex relations are responsible for COVID-19. Turkish President Recep Tayyip Erdoğan backed Erbaş, saying that what Erbaş "said was totally right."

Europe

Downloads for Grindr and Scruff, two gay dating apps, decreased in Italy and Spain.

Hungary

On 30 March, Hungary's National Assembly passed a bill permitting Prime Minister Viktor Orbán to rule by decree for the indefinite period of the country's state of emergency. This bill controversially made the deliberate distribution of misleading information relating to the pandemic an imprisonable offense, drawing widespread criticism from opposition parties for the law's potential for abuse.

Orbán's government introduced an omnibus bill on 31 March which included a provision that would remove legal recognition for transgender people by changing the country's civil registry to explicitly refer to "sex at birth" ("szuletesi nem") instead of "nem" (which can refer to both sex and gender) and removing the ability to amend the register. The bill would also prevent transgender people changing their name to one matching their gender identity, as Hungarian law requires given names to match that of their legal sex. The omnibus bill was passed into law on 19 May.

Portugal

A study by the Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto (FPCEUP) aimed at "assessing the psychological health and social support networks" of LGBT+ young people who live with their parental figures during the COVID-19 pandemic concluded, based on a survey of 632 young LGBT+ people, who most did not feel comfortable in their families during confinement. Of the people surveyed, 59% said they were uncomfortable in the family and three out of 10 felt "quite uncomfortable" living at home with parental figures during social confinement. In addition, 35% of young people felt "suffocated" because they were unable to express their identity within the family, whereas in the case of young people whose family was aware of their identity, 35% stated that they "deal badly or very badly " thereby. This study, with a longitudinal and intercultural character, also concluded that six out of 10 participants considered that the pandemic had "greatly" affected their lives. With regard to social support networks, half of the young people admitted to feeling isolated from their friends and 35% "extremely isolated" from their partners. "As for the present study, if for some young people the covid-19 pandemic had no impact on their social support networks, an important proportion felt quite isolated from their friends", says FPCEUP.

Ukraine

Patriarch Filaret, a prominent religious leader in Ukraine who heads the UOC-KP, claimed that COVID-19 was "God's punishment for the sins of men", linking it to same-sex marriage. He was sued by Insight, a Ukrainian LGBT+ group, for his comments. Patriarch Filaret later tested positive for COVID-19, and was hospitalized. A spokeswoman for Amnesty International Ukraine said about the matter that Filaret's comments "are very harmful because they could lead to increased attacks, aggression, discrimination and acceptance of violence against certain groups."

United Kingdom

Plymouth Citybus' "Pride bus" before a controversial rebranding

In the United Kingdom, sexually active gay and bisexual men were restricted from donating plasma for a National Health Service's (NHS) coronavirus research trial. This is because the research trial followed the same rules as the existing blood donor rules.

More than a hundred pride events were postponed or cancelled, including Pride in London, Birmingham Pride, Manchester Pride, Leeds Pride, Brighton Pride and the national UK Pride event which was to take place in Newcastle upon Tyne. Other pride events, including Bristol Pride, announced that their events were to be online-only.

Traditional seven-colour rainbows were used to show support for the NHS, with some using the LGBT rainbow flag for the same purpose. Plymouth Citybus rebranded their "Pride bus" to celebrate the NHS instead, leading to accusations of straightwashing before an apology from the company.

In London, LGBTQ venues received a total of £225,000 in emergency funding to help with financial issues pertaining to the pandemic. Among those who received funds was the Royal Vauxhall Tavern, South London's oldest surviving gay venue.

North America

Canada

In 2020, Canadian health professionals and researchers noted that LGBTQ+ people in Canada were uniquely vulnerable to both contracting COVID-19 and suffering under social-distancing regulations. LGBTQ+ people, they argued, are more likely to be immunocompromised and or suffer trauma during quarantine from isolation from community or proximity to unaccepting family members.

Pride Toronto, Canada's largest and most prominent Pride Festival, officially cancelled its pride events, such as the Dyke March, Trans March and the Pride Parade, as did Fierté Montréal.

Several pride festivals announced plans to proceed with online "digital pride" festivals. These include Pride Toronto, Vancouver Pride, Calgary Pride, Sudbury Pride, and Capital Pride in Ottawa. Pride Toronto's plans included an "online pride parade" hosted by comedian Brandon Ash-Mohammed on June 28, which included video of registered participants delivering Pride-related messages for broadcast both as an online stream and a live special on CFTO-DT and CP24.

Online drag balls, featuring prerecorded video performances by all 12 queens from the first season of Canada's Drag Race, were produced by both Pride Toronto in June and Fierté Montréal in August. Canadian drag queens have also coped with the pandemic by creating and touring drive-in drag shows, including a national Canada's Drag Race Live at the Drive-In tour featuring the Canada's Drag Race contestants, as well as livestreaming performances on social networking platforms such as Instagram, Facebook Live or Twitch.

Vancouver Pride was targeted by scammers who posted fraudulent posters around the city's West End soliciting donations via Bitcoin.

Glad Day Bookshop announced various plans to support LGBTQ artists and performers during the pandemic and the associated shutdown of most venues that they depend on for income, including a crowdfunded Emergency Survival Fund to provide loans and grants, and GD TV, a Zoom-based online channel for LGBTQ artists, writers, musicians, dancers and drag queens to livestream readings and performances. The Toronto Queer Film Festival launched the Queer Emergencies Fund to offer grants to LGBTQ filmmakers for the creation of new short works, and the Inside Out Film and Video Festival announced a program offering production grants of up to $2,500 to projects impacted by pandemic-related shutdowns.

The vulnerability of many LGBTQ businesses was spotlighted in early May when Pegasus, a popular bar in Toronto's Church and Wellesley village, announced that it was at risk of closing because its landlord was refusing to participate in the Canada Emergency Commercial Rent Assistance program. The federal government program had been designed to help protect small businesses from closure by subsidizing their rent during the shutdown, but still leaves businesses vulnerable because it requires buy-in from the landlord as well. The 519 community centre followed up with an open letter suggesting that the entire Church and Wellesley village was in danger of disappearing if the federal and provincial governments did not take steps to improve their protection of small businesses. In early June, it was announced that the landlord had finally agreed to participate in the program.

Residents of the neighbourhood have also noted a significant increase in crime and violence, related in part to an impromptu encampment of homeless people setting up tents in Barbara Hall Park.

Twisted Element, a gay bar in Calgary, Alberta, similarly went through bureaucratic hassles as it attempted to shift its business model from a nightclub to a pub-style restaurant so that it could remain in operation.

Several residents of Toronto launched Club Quarantine, a popular Zoom-based online club night which quickly attracted an international following and highlighted a different DJ each night. The bars in Toronto later participated in the city's new CaféTO program, which permitted the creation of temporary outdoor patios at street level.

In June, singer-songwriter Safia Nolin announced Saint-Jeanne, an LGBTQ-inclusive Saint-Jean-Baptiste Day livestream scheduled for June 24. The event was hosted by Kiara, a Montreal drag queen who was also featured in the first season of Canada's Drag Race, and the performance lineup included comedians Tranna Wintour and Karl Hardy, actress and writer Gabrielle Tremblay, songwriter and producer Annie Sama (Apigeon), rapper Backxwash, singer Jeremy Dutcher and drag queens Matante Alex and Gisèle Lullaby. On June 24, CBC Gem and Buddies in Bad Times collaborated on Queer Pride Inside, an online event hosted by Elvira Kurt and featuring performances by Beverly Glenn-Copeland, Teiya Kasahara, Yovska, Ivan Coyote, Les Femmes Fatales, Gay Jesus, Cris Derksen, Luna Dubois, Pearle Harbour, Tawiah M'carthy, Stewart Legere, Alexis O'Hara, Trey Anthony and Ryan G. Hinds.

A virtual edition of We're Funny That Way!, Toronto's annual LGBTQ comedy festival, was also produced for streaming by CBC Gem. Performers included Maggie Cassella, Katie Rigg, Carolyn Taylor, Gavin Crawford, Lea DeLaria, Colin Mochrie, Kinley Mochrie and Deb McGrath, who were all collectively nominated for Best Performance in a Variety or Sketch Comedy Program or Series at the 9th Canadian Screen Awards. The special won the award for Best Performing Arts Program.

Toronto's annual Hallowe'en street party on Church Street was cancelled in both 2020 and 2021; in 2021, however, some small-scale events, including drag shows, a drag brunch at Glad Day and a Hallowe'en party at the Storm Crow Manor pub, were staged.

A feature radio documentary on CBC Radio One's The Doc Project in May 2021 centred on the effects of the pandemic on Canadian drag icon Michelle DuBarry, now believed by many to have abandoned her drag career entirely.

With Pride Toronto again cancelled in 2021, the second "Virtual Pride" was hosted by Canada's Drag Race Season 1 winner Priyanka, with performers including Allie X, iskwē and Gary Beals. Despite the lack of an official Pride celebration, some small-scale Pride events were casually organized by their own participants, including a Dyke March and a No Pride in Policing rally.

United States

Health clinics specializing in LGBTQ related care are utilized by approximately 13% of lesbian, gay, and bisexual individuals in the U.S. Nearly 40% of transgender people reported using an LGBTQ clinic for healthcare in the past five years. Many of these clinics have struggled amid the pandemic. The Callen-Lorde Community Health Center is one such clinic. They have had to shift to virtual healthcare. Revenues for the center reportedly plummeted by 60%.

LGBT+ Asian-Americans have reportedly faced increased discrimination in line with xenophobia and racism related to the pandemic, described as a 'double whammy' of homophobia and racism by Hieu Nguyen, who founded Viet Rainbow in Orange County, California.

Shuttering of Gender-Sexuality Alliance clubs in schools during the pandemic caused many LGBT students to lose connection with their local LGBT community. However, moving these clubs online increased interaction with LGBT students from other parts of the world. Research indicates that GSA clubs reduce discrimination against gay students, and also reduces suicidality.

The San Francisco Department of Public Health published a news release called "Trans Care During COVID-19", which noted the higher proportion of transgender people with HIV/AIDS. New York's Callen-Lorde Community Health Center considered extending HIV medication prescriptions and reducing in-person visits to practice social distancing.

In Florida, several attendees of Miami's annual Winter Party Festival tested positive for coronavirus, according to event organizer National LGBTQ Task Force. Shannon Bennett, a gay man and deputy sheriff with Broward Sheriff's Office, is "believed to be the first such line-of-duty death from COVID-19 in Florida".

In early July, a beach party on Fire Island reportedly attended by many gay men, received criticism for violating social distancing and masking protocols.

American drag queens incorporated their performance into volunteering for charities such as Meals on Wheels amid the pandemic causing club shows to go on hiatus.

LGBTQ+ bars and restaurants

LGBTQ+ themed bars, nightclubs and restaurants already faced difficulties prior to the COVID-19 pandemic, and have been in decline since approximately 2002. In the 1980s, there were more than 200 lesbian bars in the US, and as of November 2020 there were about 15.

Bars of various backgrounds across the United States have faced especial difficulties during the COVID-19 pandemic. LGBT bars often carry additional sentimental or historical value to their clientele, and are often used as a cornerstone of LGBTQ+ community building and social support for people who disproportionately may not receive that support elsewhere.

Some bars have permanently shut down due to financial difficulties amid COVID-19. Others have managed to survive, often through restructuring of how they serve clients or through fundraising, grants, and government loans. A study indicated that businesses run by women or minorities may be on the receiving end of discrimination when trying to receive PPP loans, which would uniquely affect many LGBT themed bars and other businesses.

The historic Stonewall Inn was among those poorly affected by public health restrictions, leading to closed doors and outstanding bills. A fundraiser raised money for the bar's staff. A lesbian bar, Henrietta Hudson, hosted Zoom calls to cheer up regulars and raised money through GoFundMe in order to keep the bar afloat. Manhattan and Brooklyn gay bars faced similar problems. Ginger's Bar, one of the last of three lesbian bars in New York City and the last one standing in its Brooklyn neighborhood, faced potentially permanent closure.

Various other gay bars across New York City experienced difficulty. Black-owned gay bars, also faced financial adversity in the face of the pandemic, including two in Harlem. The Alibi Lounge was affected by city mandates in March 2020, applied for government assistance, and set up a community fundraiser, which raised $165,000. Black LGBTQ+ Americans were disproportionately affected economically by the pandemic according to a survey released by the Human Rights Campaign. Black LGBTQ+ bars provide a space for people who may have faced racial prejudice in other gay bars. Therapy, a Hell's Kitchen gay bar, closed in March 2020 due to financial difficulties following from the pandemic.

Las Vegas Lounge, a trans bar which was the target of a 2018 shooting, applied for a loan through the PPP, but were denied. The bar, which had been open since the 1990s, subsequently closed permanently in May 2020. At least four gay bars in West Hollywood and one in North Hollywood were closed permanently. Two gay-themed Latino nightclubs in Greater Los Angeles hosted live-streaming shows to support performers who could not normally perform their jobs due to shutdowns.

A queer bar, The Stud, organized resources to keep the local nightlife community in San Francisco afloat. Fundraising in Portland, Columbus, Seattle, and Chicago was also set up to support local nightlife communities. Grand Central, an LGBTQ nightclub in Mount Vernon, Baltimore, was permanently closed after 30 years of business. The Portland location for CC Slaughters closed indefinitely, though hoping to one day reopen. Portland's Local Lounge closed in late 2021.

Guava Lamp, a Houston bar and nightclub, closed. Its space was to be occupied by a Latin gay club, Papi's Nite Club. Badlands, a 45-year-old San Francisco gay bar and nightclub closed permanently and claimed it would be replaced by a new bar. Austin, Texas bar BT2 closed permanently. Albuquerque Social Club of Albuquerque, New Mexico originally planned to close forever, but made a comeback after aggressive community fundraising.

The Lesbian Bar Project was established to save and celebrate the 15 or so remaining bars in the United States catering to queer women, regarding them as important landmarks for the community. Lea Delaria and Jägermeister have partnered with the project. Among other bars to benefit from the project has been Seattle's The Wildrose, the last lesbian bar standing in Washington state. My Sister's Room, a lesbian bar in Atlanta, had four employees test positive for COVID-19 and temporarily shut down. They have since reopened, overhauled the bar, and received grant money. Houston's only lesbian bar, the Pearl Bar, was among those who received emergency "Queer to Stay" grant money sponsored by the Human Rights Campaign, allowing them to stay afloat. Sue Ellen's, a lesbian bar in Dallas, was closed on governor's orders, but opted out of donations from the Lesbian Bar Project in order to lend that support to other businesses instead.

In Orlando, Florida, a gay resort known as Parliament House announced it would close after 45 years but had plans for the future and would reopen at some point (as a bar-only location). The resort site would be demolished, while its iconic neon sign would be saved with assistance from the City of Orlando.

Mark Robertson, who co-owns three gay bars across Chicago, estimated he would lose $250,000 in March 2020 after Illinois ordered bars and restaurants to close as a public health precaution. He estimated this would jump to $350,000 in losses if closures extended to two months out from that point. LGBTQ themed dance parties have adapted by experimenting with digital events.

Gay bars outside of large cities often fared worse, due to having less of an audience to raise money from. Bars in smaller cities are often the only LGBTQ+ address for multi-county regions, according to The Conversation. Attitudes Nightclub, the oldest gay bar in St. Louis, Missouri, closed permanently. The Aut Bar of Ann Arbor, Michigan, shut down permanently. Night Shift 2.0, a gay nightclub in Baltimore, announced it would not reopen.

Stonewall Gives Back

"Stonewall Gives Back! A Live-Streaming Concert for the LGBTQ+ Nightlife Community", or simply "Stonewall Gives Back", was a fundraiser held on April 23, 2020. The event was organized by World of Wonder and the Stonewall Gives Back Initiative, a charity affiliated with the Stonewall Inn, and hosted on the WOWPresents YouTube channel. It was announced on April 20 and benefited "LGBTQ nightlife industry professionals" applying for emergency assistance as a result of the COVID-19 pandemic. Beneficiaries were granted to "US residents who have worked for at least 12 months in LGBT+ nightlife and for whom it is a main source of income". Hosted by Michelle Visage and Tyler Oakley, the event featured performances and appearances by Allie X, Shoshana Bean, Betty Who, Greyson Chance, Kristin Chenoweth, Alan Cumming, Todrick Hall, Carlie Hanson, Darren Hayes, Cyndi Lauper, Leland, Lorna Luft, John Cameron Mitchell, MUNA, Our Lady J, Nina West, Peppermint, Kim Petras, Matt Rogers, Troye Sivan, Pabllo Vittar, and Rufus Wainwright. Erich Bergen served as executive producer.

Oceania

Australia

In March 2020, Australian gay pride event known as the Rainbow on the Plains Festival was cancelled due to the pandemic.

New Zealand

In New Zealand, some rules for blood donations from men who have sex with men were eased due to shortages resulting from the COVID-19 pandemic.

LGBTQ+ support organizations in New Zealand have expressed concern about isolation and unsafe homes during COVID-19 lockdown. A survey revealed that about 9 percent of respondents had a family member who was violent towards them.

South America

Some countries in South America are considered extremely dangerous for sexual and gender minorities because of the high amount of transphobic violence and hate crimes. For example, Brazil reported 124 murders of trans people in 2019. COVID-19 measures have brought new challenges to the LGBTQ+ community, such as a gender based curfew aimed at controlling COVID-19 cases, which has led to police abusing trans people. Also, there are significant barriers to changing gender on IDs. In Peru, for example, individuals must go in front of a judge and may require gender affirming surgery in order to request ID changes. Policies with these requirements often exclude non-binary individuals. Police harassment towards trans people has been prevalent while enforcing gender based curfew COVID-19 restrictions. Trans women have been harassed and detained by police for going out on a women's day as set by the curfew.