Sexual Orientation, Gender Identity, and COVID-19 Vaccine Skepticism: A Global Assessment [ID 2683475

Abstract

INTRODUCTION: The effect of sexual orientation (SO) and gender identity (GI) on pandemic-related behaviors is poorly understood, with conflicting prevention adherence in communities. We sought to delineate how SOGI relates to COVID vaccine skepticism to understand sexual orientation’s effect on COVID risks. METHODS: This analytical cross-sectional study in seven languages examined SOGI and COVID-19 vaccine skepticism in 158 countries. SO was the primary independent variable, with 4,360 people self-identifying as heterosexual, lesbian/gay, bisexual, queer, or another SO. Primary outcome was a summative scale of six four-point Likert-scale questions ascertaining COVID-19 vaccine skepticism (VSS; range: 0–18). Multivariate logistic regression rendered adjusted odds ratios (aORs) with 95% CIs. Our IRB determined that STUDY00004825 met federal/university criteria for exemption. RESULTS: Heterosexual men had the highest mean VSS (mVSS: 7.6; 95% CI, 7.3, 7.9), significantly higher than heterosexual women (mVSS: 6.7; 6.5, 6.9), lesbian women (mVSS: 4.8; 3.2, 6.4), and gay men (mVSS: 4.6; 3.5, 5.7). mVSS for people identifying as bisexual was 5.4 (95% CI, 4.9, 6.1), as queer was 4.5 (3.3, 5.7), and as another SO was 5.8 (4.8, 6.8). Adjusting psychosocial factors, social media use, perceived oppression, science/health care attitudes, geography, and gender, heterosexuals (aOR 2.6; 95% CI, 1.5, 4.5) and bisexuals (aOR 2.9; 1.4, 5.8) were significantly more likely to have VSS over mean than did lesbians/gays. CONCLUSION: Those with lesbian/gay SO were significantly less likely than those of other SOs to be skeptical of the COVID vaccine, even after controlling for important confounders, including gender. Better understanding dynamics in lesbian/gay communities that promote lower vaccine skepticism could help generate novel public health strategies for the LGBTQ+ and other communities.