Socially distant and out of reach: Unintended consequences of COVID-19 prevention efforts on transgender and gender non-binary populations in Puerto Rico.
Socially distant and out of reach: Unintended consequences of COVID-19 prevention efforts on transgender and gender non-binary populations in Puerto Rico.
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在社会上遥不可及的：COVID-19的预防措施对跨性别和性别非二元人口的意外后果。
DOI：
10.1016/j.jsat.2020.108209
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发表时间：
2021-03
影响因子：
3.9
通讯作者：
Rodríguez-Díaz CE
中科院分区：
文献类型：
--
作者：
Melin K;Santiago Quiñones D;Rodríguez-Díaz CE
在美国，药物使用障碍不成比例地影响少数群体和社会弱势群体，特别是那些处于种族和性少数地位交叉点的群体。在经历了长达一个多世纪的美国政府统治、最近的金融危机、2017年的毁灭性飓风以及2019年底和2020年初的一系列地震之后，目前的COVID-19大流行只是最近破坏波多黎各当地医疗保健系统的灾难。然而，目前的紧急情况和强加的社交距离措施的影响只会加剧变性人和性别不符合（GNC）人口的潜在脆弱性，这些人口在最近的其他灾难中暴露出来。在波多黎各治疗阿片类药物使用障碍（OUD）患者的诊所和提供者不得不制定自己的安全方案，以限制病毒的传播，同时试图优化当前的治疗方案，以保持患者的稳定。尽管采取了这些措施，我们还是观察到当地组织与已经失去联系的跨性别者和患有OUD的GNC个人进行外展的能力有所下降。例如，由于政府从2020年3月15日开始实施宵禁，一些从事跨性别和GNC性工作者外展的提供者已经完全取消了夜间外展。此外，一项调查波多黎各所有丁丙诺啡处方者的研究项目发现，很少有人接受过治疗这一弱势群体的培训，甚至更少有人报告说，他们目前正在为变性人或GNC个人提供治疗。如果波多黎各要解决已知受药物使用障碍影响不成比例的人口代表性严重不足的问题，波多黎各必须解决结构性因素，以防止这种差距在我们的医疗保健系统将面临的不可避免的未来灾难中进一步扩大。
Substance use disorders in the United States disproportionately affect minorities and socially vulnerable populations, particularly those at the intersection of racial and sexual minority status. Preceded by over a century-long subjugation to the U.S. government, a recent financial crisis, the devastating hurricanes of 2017, and a string of earthquakes at the end of 2019 and early 2020, the current COVID-19 pandemic is only the most recent disaster to disrupt the local health care system in Puerto Rico. However, the effects of the current emergency and imposed social distancing measures have only exacerbated the underlying vulnerabilities of the transgender and gender non-conforming (GNC) population made bare during these other recent disasters. Clinics and providers who treat patients with opioid use disorder (OUD) in Puerto Rico have had to develop their own safety protocols to limit the spread of the virus while trying to optimize current treatment protocols to maintain the stability of their patients. Despite these measures, we have observed a reduction in the ability of local organizations to outreach to already disconnected transgender and GNC individuals with OUD. For example, due to the government-imposed curfew that began March 15, 2020, some providers engaged in outreach with transgender and GNC sex workers have eliminated nighttime outreach completely. Additionally, a research project surveying all buprenorphine prescribers in Puerto Rico has found that few have received training in treating this vulnerable population, and even fewer report that they are currently providing treatment for transgender or GNC individuals. If Puerto Rico is to address this problem of gross under-representation of a population known to be disproportionately affected by substance use disorders, Puerto Rico must address structural factors to prevent this disparity from widening further during the inevitable future disasters our health care system will face.
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