A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal

Abstract

Background: The ramifications of the existing crisis caused by the coronavirus pandemic are sensed in all walks of life. Among the various efforts made to curb the spread of this novel infection, the development of COVID-19 vaccines had a profound role in flattening the pandemic curve. Even though the rapid vaccine drive received a highly welcoming response among people, the reluctance and ignorance of a part of the population towards available safe vaccines stand as impediments to achieving the desired outcome. The LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) communities are the least studied groups in this regard. Objective: The purpose of this study is to extensively review and report on COVID-19 vaccine uptake and refusal among the LGBTQIA+ population and enumerate the factors contributing to vaccine hesitancy. The study extends further to outline a conceptual framework for interventions to enhance COVID-19 vaccine acceptance among the LGBTQIA+ population. Methods: We performed a systematic search using key terms on Google Scholar and PubMed. The obtained results were filtered using the eligibility criteria framed for this study. The initial search provided an extensive result of 4510 articles which were later screened at various levels to arrive at the final inclusive collection of manuscripts adding to 17. The studies were analyzed by the authors individually, and the data were categorized using variables. The results are interpreted using charts and graphs. The whole manuscript has been structured in accordance with the PRISMA extension for scoping reviews. Result: The comprehensive search yielded 17 eligible articles for this review. Most of the studies were conducted in the United States (n = 17), and predominantly cross-sectional studies have been conducted. The major comparative factor was the HIV status of the LGBTQIA+ population. HIV-affected patients were more willing to take up COVID-19 vaccination. However, social stigma, discrimination, lack of access and non-prioritization in vaccine drives were found to be the major factors contributing to vaccine hesitancy among this population. Conclusion: The invention of the COVID-19 vaccination revolutionized the healthcare systems burdened with COVID-19. Although this is a breakthrough scientific contribution, many factors are associated with the rate of vaccine acceptance, especially among sexual and gender minorities. The reviewed studies have revealed numerous factors that influence vaccine uptake and refusal with the commonest being concerns on discrimination, social stigma, inequitable access to healthcare, vaccine safety, efficacy, potency, side effects and lack of trust in medical workers. These impediments in vaccine coverage should be meticulously addressed to ensure optimum LGBTQIA+ physical and mental health as well as for providing non-discriminative, equitable and quality healthcare service regardless of the gender or sexual orientation of individuals.

Predicting the Influences of Depression and Sexual Stigma on Motivation to Get Vaccinated against COVID-19 in Lesbian, Gay, and Bisexual Young Adults: A 4-Year Follow-Up Study

“…In line with the findings of a previous study [ 21 ], we discovered that compared with female sex, male sex was associated with greater MoVAC-19. In addition, older age was positively associated with greater MoVAC-19.…”

“…Other studies have also identified unique factors associated with MoVAC-19 among LGB individuals. For instance, a review study of 17 articles revealed a cross-sectional association of concerns regarding social stigma due to sexual minority status with reduced intention to get vaccinated against COVID-19 among LGB individuals [ 21 ]. Perceived sexual stigma may prevent LGB individuals from accessing appropriate vaccine knowledge and administration information [ 20 ].…”

COVID-19 vaccine hesitancy among the Chinese elderly: A multi-stakeholder qualitative study

“…This phenomenon is not limited to the Chinese elderly, but is also a global problem, as survey data reveal it exists across various populations. 6–11 This problem may impedes coverage of vaccination and the establishment of herd immunity, affecting the achievement of anti-pandemic efficacy. 12 Understanding the factors contributing to this hesitancy is essential for developing targeted public health intervention strategies.…”

Disruption of gender‐affirming health care, and COVID‐19 illness, testing, and vaccination among trans Australians during the pandemic: a cross‐sectional survey

“…Little is known about the health care experiences of Australian trans people later in the pandemic. Overseas, social stigma, fear of discrimination, and mistrust of health care professionals contributed to COVID‐19 vaccine hesitancy among trans people 9 . Further, trans people often report chronic illness and mood disorders, 4,5,10 both known risk factors for post‐COVID‐19 syndromes (long COVID) 11,12 .…”

“…Overseas, social stigma, fear of discrimination, and mistrust of health care professionals contributed to COVID‐19 vaccine hesitancy among trans people. 9 Further, trans people often report chronic illness and mood disorders, 4 , 5 , 10 both known risk factors for post‐COVID‐19 syndromes (long COVID). 11 , 12 Disruptions to gender‐affirming health care would also be anticipated, as well as increased discrimination in health care, the result of difficulty in providing training to health care providers in trans‐affirming health care, compounded by COVID‐19‐related priority shifts.…”