Not all people bear the burden of the global pandemic and the effect of related state responses equally. The pandemic is deepening inequalities for those living in poverty with a disproportionate effect on women, lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) people, displaced and homeless people, and those with disabilities, among other marginalised groups.
Women are at higher risk of infection because of gender norms that encourage them to take on roles as caregivers. Nurse practitioners and community-based healthcare workers are at the frontline, increasing the risk of infection. One of the unintended consequences of global stay-at-home policies has been a spike in gender-based violence, especially intimate partner violence. The gendered effect of national responses lead to a greater burden of childcare on women with the closing of schools and day care and detrimentally affected people who do not get paid sick leave or family responsibility leave. An analysis is required of how the Covid-19 pandemic and its response is a gendered phenomenon in terms of its differential effect on men, women and children.
Sexual and gender minorities experience a range of intersecting oppressions on the basis of race, class, gender, immigrant status and health status among others, along with homophobia and transphobia. The Covid-19 global response is being implemented in a wide range of social and political contexts, including both democratic and authoritarian societies. The African continent has multiple states that are authoritarian and state responses to Covid-19 are being used as a means to clamp down on free speech and civil society, including LGBTIQ civil society. For example, in Uganda LGBTIQ people have been arrested and accused of spreading Covid-19. In South Africa, homophobic and transphobic police-perpetrated brutality is widespread and may contribute to LGBTIQ persons’ risk when confronted with authorities enforcing Covid-19 restrictions.
People living in poverty
Public health guidelines developed in Global North contexts become less feasible in settings marked by extreme economic inequalities. The reduction of transport and the shutting of business increases work insecurity, especially for people in part-time, low income and service jobs. Reduced income, increased unemployment and the ensuing economic hardship are detrimental to getting access to health services, including and beyond Covid-19 related services. For instance, in terms of sexual and reproductive health, the option to stock up on contraceptives, condoms, spermicide and lubrication among others is not feasible because of cost, interruptions in supply chain, no insurance coverage and reimbursement for more than one month’s supply for those who have private medical insurance. Some sectors are acutely affected with little to no government protection against loss of income. National lockdowns mean sex workers are without income, yet the criminalisation of sex work means they are excluded from emergency social protections, leaving them unable to provide for themselves or their families. Overall, the economic effect of the Covid-19 response is not distributed equally across income groups and employment sectors.
Displaced and homeless persons
Migrant, internally displaced, refugee and homeless people face particular risks during states of national lockdown and the economic effect of the pandemic itself contributes to increased homelessness. Where displaced or homeless persons are relocated to temporary shelters to reduce Covid-19 risk, these efforts have in some instances inadvertently increased the risk through overcrowding, poor sanitation and inadequate health services at facilities. “Vagrancy” legislation increases the vulnerability of homeless persons and in South Africa, draft amendments to section 22 of the Streets, Public Places and the Prevention of Noise Nuisances Bylaw in Cape Town have been criticised for permitting search and seizure without a warrant and for formalising the forced removal and displacement of people who are homeless. In Thailand, the imposition of Covid-19 related curfews has led to homeless people being fined or arrested for being on the street at night. Responses to Covid-19 should be sensitive to heightening xenophobia or scapegoating of migrants, refugees and homeless persons who are viewed as flouting regulations, despite lacking the means to adhere to these.
Persons with disabilities have an increased risk of Covid-19 infection as a result of physical contact with caregivers, barriers to preventative information and hygiene practices, and in some instances respiratory conditions related to certain impairments, according to the International Disability Alliance. Current containment measures such social distancing or self-isolation cannot realistically be implemented, the United Nations Human Rights Office of the High Commissioner stated. Restrictions on movement may cut people with disabilities off from family and social support networks and many lack the resources to meet their care needs through other means. South African data show that households of people with disabilities earn significantly less income than those without, with women with disabilities even less financially insecure. The effect of the pandemic requires a disability-inclusive response.
All of the above point to the necessity of a human rights-led and intersectional approach to understanding the different ways in which the Covid-19 pandemic is affecting a wide range of already marginalised and excluded groups. Measures that restrict human rights should be proportionate and applied in a non-discriminatory way. Blanket restrictions overlook the realities of marginalised groups and may compound existing inequalities. The role of the policy and military in enforcing Covid-19 related restrictions foreground important questions about democracy and civil liberties during a global pandemic.
In the 40 years since the global response to the HIV pandemic began, much has been learned about how best to ensure an equitable and rights-based global pandemic response. Central to such a response is that it is evidence based, locally contextualised, protects the most vulnerable and develops agency for change and health in people. In the absence of such strategies, interventions undermine trust between groups, between groups and government officials, and erode social cohesion.
Previous pandemic responses have also foregrounded the necessity of considering existing inequalities, concerns about livelihoods and employment, the negative effects of stigma and discrimination, and barriers to healthcare. Without consideration of these factors, pandemic responses run the risk of being ineffective at best and harmful at worst. The global, supranational bodies such as UNAIDS and the World Health Organisation, along with nongovernmental organisations and academic researchers, have issued guidelines in ensuring a necessary balance between public health and human rights in times of global pandemic. These include:
- Engage communities in responses to build trust, maximise the effectiveness of interventions and reduce unintended harm;
- Take a broad understanding of community health to include access to employment and healthcare, availability of adequate sanitation and infrastructure and the role of social factors such as gender roles;
- Gender is an intersecting component of broader structural inequalities. Engage with how issues of poverty, nationality, immigration status, sexual and gender identity, and homelessness, among others, determine experiences of the global pandemic. This includes collecting diverse data to analyse not only disproportionate effects but also interactions between inequalities, which do not exist in silos but instead intersect to compound vulnerability;
- Draw on human rights expertise and include substantive participation from people and organisations representing marginalised groups to expand decision-making;
- Pay close attention to possibilities of stigma and discrimination and to combatting it when it emerges; and
- Encourage oversight, including court review, of human rights restrictions to protect public health. Any restrictions must have exemptions for particular vulnerable groups where necessary and avoid criminalisation of people breaching restrictions because this disproportionately affects those most vulnerable.
Professor Finn Reygan and Dr Ingrid Lynch work at the Human and Social Capabilities Division in the Human Sciences Research Council