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Multiple jeopardy: COVID-19 and Indigenous LGBTIQ+ lives

Many Indigenous communities have been disproportionately hit by the coronavirus pandemic but, in Australia, strong community leadership has been key in the successful COVID-19 response by Aboriginal and Torres Strait Islander communities.

That’s a lesson also for the health and wellbeing of Indigenous LGBTIQ+ communities in the coronavirus pandemic, writes Pep Phelan, a PhD candidate and Manager of Alumni Development at the Melbourne Poche Centre for Indigenous Health at the University of Melbourne.

In an update on an original article published by the University of Melbourne, Phelan says Indigenous LGBTIQ+ people should not be just included in COVID-19 pandemic discussions and progress activities. Indigenous LGBTIQ+ health professionals, academics and experts must be able to lead the recovery for their own communities, she says.


Péta Phelan writes:

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 nearly 30 million confirmed infection cases, and over 937,000 losing their lives (as at 18 September).

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

But in a pandemic, some communities are at greater risk than others.

In June, United Nations  chief António Guterres warned that 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 marginalized groups”.

Legacies of colonisations

For Indigenous Peoples, colonisation has left a devastating and continuing legacy. That includes  intergenerational poverty, poor physical and social and emotional wellbeing, increased rates of domestic and family violence, 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 non-communicable and infectious diseases and have faced high risks and impacts in this pandemic, with higher infection rates, more severe symptoms, and higher death rates than non-Indigenous populations in some regions.

Global Indigenous populations

The Office of the United Nations High Commissioner for Human Rights has made this clear in its June 2020 statement on COVID-19 and Indigenous People’s Rights, stating that “the COVID-19 pandemic is disproportionately affecting Indigenous peoples, exacerbating underlying structural inequalities and pervasive discrimination”.

The reports are deeply distressing.

According to recent figures, in the United States, Indigenous Americans (including American Indian and Alaska Native people who make up 81.9 deaths per 100,000) and black Americans (97.9 deaths per 100,000)  are experiencing the highest death toll from COVID-19.

The next most impacted group is Pacific Islander Americans — people of Pacific Islander ancestry or descendants of the Indigenous peoples of Oceania) — who currently account for 71.5 deaths per 100,000.

Compared to white populations (46.6 deaths per 100,000), the mortality rate is 3.3 times higher for Indigenous Americans, and 2.9 times higher for Pacific Islander Americans.

Indigenous peoples in South America have also been hit hard.

In Brazil, the Articulation of Indigenous Peoples of Brazil (APIB) estimates 32,315 confirmed cases of COVID-19 among Indigenous people, and 812 deaths, including that of Chief Aritana Yawalapiti, one of Brazil’s most influential Indigenous leaders.

In its latest (5 August) update, the  Pan-American Health Organisation said that, as of 20 July, there had been 1,453 confirmed cases, including 27 deaths, reported among Indigenous peoples of the Ecuadorian Amazon.

In Colombia, as at 6 July, there had been 1,534 confirmed cases among its Indigenous peoples, including 73 death; among Mexico’s Indigenous people, as of 26 July, there had been 5,413 confirmed cases, including 766 deaths (14.2 per cent), PAHO said.

Strong Indigenous leadership

Closer to home, in New Zealand (as at 14 September), there had been only 1,798 confirmed and probable cases of COVID-19 and 24 deaths. Māori and Pasifika populations make up 10 per cent of cases each, although there is no available data on the ethnicity of those who have died.

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

In the Federal Government’s latest epidemiology report (for the fortnight ending 30 August), just 134 cases of COVID-19 have been recorded among Aboriginal and Torres Strait Islander peoples — representing just 0.5 per cent of all Australian cases (versus 3 per cent of population).

There is also no information in the report regarding deaths, although the earlier COVID-19, Australia: Epidemiology Report 20, four iterations before, stated there had been zero fatalities among Aboriginal and Torres Strait Islander people.

It has been well established that the swift, community led, and culturally congruent response by Aboriginal and Torres Strait Islander health professionals, health organisations, and communities  has been responsible for such success to date in the pandemic.

Addressing vulnerability

The epidemiological data does not highlight other factors that create additional vulnerability for Indigenous peoples during this pandemic, particularly for those who may identify as lesbian, gay,  bisexual, trans, intersex and queer (LGBTIQ+).

The UN High Commissioner for Human Rights Michelle Bachelet has warned that LGBTIQ+ people may be particularly vulnerable during the COVID-19 pandemic.

She said:

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.”

That risk is particularly true when it comes to accessing healthcare, but 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 experienced greater social isolation, significant health disparities, higher rates of poverty, higher incidents of moderate to severe mental health issues and suicide rates, 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 based on gender identity and sexual orientation, LGBTIQ+ young adults also suffer higher rates of housing insecurity and homelessness.

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

For Indigenous LGBTIQ+ people, being both Indigenous and identifying as LGBTIQ+ can mean health and socioeconomic disparities are compounded. Indigenous LGBTIQ+ people may be subject to the combined effects of racism and heterosexism within Indigenous, LGBTIQ+, and non-Indigenous heteronormative communities which can increase their risk of harm and isolation.

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

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

When discussing, planning and resourcing targeted mid-pandemic and recovery actions for COVID-19, it is imperative that a culturally appropriate and intersectional response is prioritised.

That 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.

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 harnessed to promote health and wellbeing.

This requires 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 Aboriginal and Torres Strait Islander public health success with COVID-19 has already proven that self-determined communities provide the greatest outcomes for themselves.

Pep Phelan is a mental health and rehabilitation professional, with a strong interest and experience in the area of primary and secondary psychological trauma, and Indigenous social and emotional wellbeing.

Pep works as Manager of Alumni Development at The Poche Centre for Indigenous Health at The University of Melbourne, where she is a 2018 Leadership Fellow

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Acknowledgement
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News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
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#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
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#PreventObesity16
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#VMIAC16
#WearablesCEH
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2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
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