At her last doctor’s appointment, Erica Tyler, who lives in Brooklyn, N.Y., joked that she didn’t want to get vaccinated for Covid-19 “because another foot might grow out of my forehead. And I’m not ready for that.”
Ms. Tyler, 68, a cancer survivor who has diabetes and high blood pressure, lost her wife to a heart attack nearly a year ago and has been staying home throughout the pandemic to avoid becoming infected with the coronavirus. But when the vaccine became available, she did not rejoice.
“I was resistant,” Ms. Tyler said. She described feeling unsettled by the push to vaccinate minorities, especially given how Black people have been underserved or mistreated by the medical establishment in the past.
“I felt that they were trying to storm people who they wanted to eliminate out of society,” she said, namely “the elderly and the Black people.”
Research has shown that sexual and gender minorities, and especially people of color, are more vulnerable to becoming infected with the coronavirus and also more likely to have underlying conditions that could make them severely ill if they were to contract Covid-19. But many of the very people who are most at risk within these communities are also hesitant to take the vaccine, according to a recent study and interviews with health care workers as well as people of color who identify as lesbian, gay, bisexual, transgender or queer.
“There’s an overarching mistrust around vaccination,” said Anthony Fortenberry, the chief nursing officer of the Callen-Lorde Community Health Center, which provides medical care to L.G.B.T.Q. people in New York City. “They’re not sure if they want to get it.”
Each of the three Covid vaccines currently available in the United States has been shown to be remarkably good at preventing serious illness and death. At Callen-Lorde, Mr. Fortenberry said he has counseled patients about the efficacy of the vaccine, eventually easing their fears.
“They are not quick conversations,” he said. “They are addressing someone’s personal experiences and their history of discrimination.”
But not everyone has a health care provider with whom they feel comfortable sharing their concerns.
“I worry that without those conversations happening, people will continue to not get vaccinated,” he said.
So far about 54 million people in the United States have received at least one dose of a Covid-19 vaccine, and of those nearly 28 million have been fully vaccinated. At Callen-Lorde and other medical centers that treat many L.G.B.T.Q. patients, health care workers say they have seen a higher demand for the vaccine among white patients compared to patients of color.
L.G.B.T. people of color were twice as likely as white non-L.G.B.T. people to test positive for Covid-19, according to a Williams Institute study published in February. Even though Black people are more at risk for contracting the disease, concerns about the vaccine are especially prevalent among this population, experts say. In a study published this month in the journal Vaccines, 1,350 men and transgender women who predominantly identified as gay or bisexual reported how likely they would be to get a Covid‐19 vaccine. The Black participants expressed significantly more vaccine hesitancy than their white peers, the study found.
Health care workers are encountering the same resistance in their patients. “Some people just literally said, ‘Well, no — Trump was involved in getting this vaccine going so I’m not going to get the vaccine,’” said Jill Crank, a nurse practitioner at Johns Hopkins Community Physicians in Baltimore.
Studies show that hesitancy about the Covid vaccine occurs across all demographic groups, including those in the medical profession. About three in 10 health care workers are hesitant about getting the vaccine, according to a survey published in December by K.F.F. (previously the Kaiser Family Foundation) compared to about a quarter of the general population.
Dezjorn Gauthier, 29, a Black transgender man who lives about 20 minutes from Milwaukee, said that although he is currently eligible to get the vaccine, he doesn’t want it.
“Right now it’s a no-go,” said Mr. Gauthier, a model and business owner who has Covid-19 antibodies because he contracted the coronavirus last year. The vaccine’s development moved “so rapidly and so quickly, it just has me a little bit hesitant,” he said, adding that he’s also unsure about the vaccine’s ingredients. “There’s a fear in the community.”
For members of the L.G.B.T.Q. community, and especially people of color, the hesitancy stems, in part, from pre-existing mistrust in the medical establishment, the experts said.
The infamous Tuskegee study, which took place from 1932 to 1972, is one of the most egregious examples of racial discrimination in health care. The researchers recruited African-American men, some of whom were infected with syphilis, to observe the course of the disease. But the researchers did not disclose what they were studying or give the participants proper treatment, even as the men suffered and experienced severe health problems.
The racial bias still found in medical care as well as the modern-day discrimination faced by sexual and gender minorities adds an additional burden.
“The fear of being rejected is already there,” Ms. Crank said. “They may have already been rejected by their families, friends, co-workers — so it can cause a deep depression and lack of trust in anyone, including health care workers.”
There are additional, different concerns about the vaccine among transgender people, advocates say, especially those who have received silicone injections or hormone replacement therapy.
“How does that affect somebody who has been on estrogen for the last 20 years?” asked Maria Roman-Taylorson, a transgender person and the vice president and chief operations officer of the TransLatin@ Coalition, a nonprofit agency that provides social services to transgender, gender nonconforming and intersex people in Los Angeles. “There’s no data at all.”
Dr. Kenneth Mayer, the medical research director at Fenway Health, a community health center in Boston where half of the patients identify as L.G.B.T.Q., said there’s no reason to believe that hormones or silicone would interact with the vaccine.
“There’s not something intrinsic about being transgender that would make somebody more likely to respond poorly to the vaccine or have more side effects,” said Dr. Mayer, whose institution has enrolled over 200 participants in the largest, most recent AstraZeneca Covid-19 vaccine trial.
Ms. Roman-Taylorson said she was initially hesitant to get vaccinated, but eventually decided to do it because she knew she needed to stay healthy to lead her agency.
“I felt the benefit outweighed the risk,” she said. But, she added, “there’s some folks even within our organization who are not willing to take it because they don’t trust the process. They don’t trust how it’s been developed.”
Although the vaccine was developed and manufactured quickly, “the safety steps were definitely not cut,” Dr. Mayer said, citing the independent data safety monitoring board that examines the data and the Food and Drug Administration’s stringent vetting process.
“I really think this is an example of science going right,” he added.
However, Dr. Mayer and others say there is a dearth of data about the L.G.B.T.Q. population. Representatives from both Pfizer and AstraZeneca said that they have not asked vaccine study participants to report their sexual orientation or gender identity. (Johnson & Johnson and Moderna did not immediately respond to emails asking about the demographic information they collect.) In addition, these categories are not included on the C.D.C.’s Covid-19 case report form, and only a handful of states and the District of Columbia have been working to collect such data when testing for Covid-19.
Public health experts say vaccination is safe and that there are a number of reasons to believe that if sexual and gender minorities don’t get vaccinated, they are more at risk of contracting Covid and becoming severely ill than the general population.
Last month the Centers for Disease Control and Prevention released a report concluding that gay, lesbian and bisexual people in the United States had higher rates of self-reported underlying conditions like cancer, heart disease and obesity than heterosexual people and are also more likely to be smokers. These conditions put adults at increased risk for severe illness from Covid-19, the report said. The C.D.C. says that people with these types of conditions should receive the vaccine earlier than the general population.
In addition, a recent study from New York State found that Covid patients with H.I.V. had higher rates of severe disease requiring hospitalization than those without an H.I.V. diagnosis. Men who have sex with men have the most new H.I.V. diagnoses in the United States, federal data shows.
Socioeconomic status and geographic location can create additional health vulnerabilities, said Sean Cahill, director of health policy research at the Fenway Institute, a branch of Fenway Health that does policy analysis, conducts research and offers educational training around the world.
According to a Human Rights Campaign Foundation analysis, L.G.B.T.Q. people are twice as likely to work in frontline professions like food service and retail as non-L.G.B.T.Q. people, which can raise the risk of exposure to the coronavirus. Many sexual and gender minorities live in urban areas, where physical distancing measures are harder to maintain, Dr. Cahill said.
Even those who can socially distance harbor skepticism about the need to vaccinate.
“My girlfriend and I live a very secluded life but wear masks and protection everywhere we go,” said Rayshawn Stallings, 30, a transgender Black man who lives in Pensacola, Fla. “No one enters our home and we have no contact with anyone other than each other. So why would we need to get the vaccine?”
As for Ms. Tyler, in Brooklyn, after speaking with seven of her friends who had taken the vaccine, none of whom had troubling side effects, she changed her mind and decided to get vaccinated. She received her first dose in February and is scheduled to get the second in mid-March.
“I did not want to cut short my living by having to hide in my house,” she said. “So I took a leap of faith.”