Inequalities in the health and wellbeing of people reporting a minority sexual identity during the first year of the COVID-19 pandemic in Britain: findings from a quasi-representative webpanel survey (Natsal-COVID)

Abstract Background Evidence suggests that people reporting a minority sexual identity (that is gay, lesbian, bisexual or another sexual minority), are more likely to experience poorer health and wellbeing compared to heterosexual people. Understanding whether inequalities by sexual identity were present during the COVID-19 pandemic is important for informing interventions that address such disparities. Methods We analysed data from 6,016 sexually experienced people aged 18–59 years who participated in Britain’s Natsal-COVID Wave 2, a cross-sectional, quasi-representative webpanel survey, carried out one year after Britain’s first national COVID-19 lockdown. We estimated adjusted odds ratios (AOR) for reported general, mental, and sexual health indicators among gay/lesbian and bisexual participants, stratified by gender and compared to their heterosexual counterparts, using binary logistic regression. We also examined clustering of poor health indicators within and across health domains. Results 96.2% of participants self-identified as heterosexual or straight, 1.8% as gay or lesbian, 1.4% as bisexual, and 0.7% as other. All sexual minority participants had higher odds than heterosexuals of reporting a physical or mental health condition or illness lasting for 12 months or more. Bisexual participants had higher odds of screening positive for anxiety and depression. A higher proportion of bisexual men reported at least one new condomless partner since the start of the COVID-19 lockdown, relative to heterosexual men (AOR 2.40, 95% CI 1.23–4.65). Gay men had higher odds of reporting having accessed at least one STI service (AOR 9.01, 5.24–15.49) and having tried but been unable to access at least one STI service (AOR 2.81, 1.21–6.52), both since lockdown. Sexual minorities did not differ from heterosexuals in reporting distress about their sex lives or perceiving that their sex life worsened during the pandemic. A higher proportion of sexual minority participants reported multiple co-existing poor health indicators across health domains compared to heterosexuals, and this was particularly marked among bisexual women. Conclusion We found evidence that sexual minorities tended to experience worse health compared to heterosexuals during the first year of the pandemic, and poor health indicators often co-occurred within and across health domains. These inequalities may persist over time and be exacerbated during potential future pandemics, underscoring the need for sustained attention and mitigation.