# data[].attributes.body
Covid had following impact -

Diverted country's resources and in many cases HIV services were curtailed as an result of this.

The preventive measures like lockdown caused a man made recession , lowering government revenues and thus it capacity to invest in human capital.

supply chain for essential items was severely hampered and lastly

long terms effect of COVID are still getting discovered causing morbidity.

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Fardad UCD Iran: at least SDGs 1, 3, 4 and 10 were severely affected. 

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Fardad UCD Iran: at least SDGs 1, 3, 4 and 10 were severely affected. 

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The COVID 19 health crisis has highlighted a wide range of structural gaps, poverty and inequality that hinder the development of the Andean countries and limit and hinder inclusive growth.
Several SDGs were very much affected by the impact of the COVID-19 pandemic.
There was a severe disrupt of essential health services derailing hard-won progress on SDG 3. HIV prevention, testing and treatment programs were interrupted and most of its resources mobilized to attend COVID-19. The care and treatment cascades suffered great impact, with almost no HIV diagnostic services available and therefore reduction on timely ARV treatment initiation.
The data availble have also illustrated a worsening situation  on gender based violence and the confinement increased the risk for certain population groups: Femicides and complaints of violence against women, children or dependents increased, as did racism and xenophobia against migrants. (SDG 5 and 10).
The urgent need to reactivate economies in the face of unsustainable compulsory quarantines has led to de-confinement before the peak of the curve, with no guarantee of adequate biosecurity protocols for workers. Many companies have had to close and there have been massive layoffs, mainly in sectors such as commerce, hotels, restaurants, tourism and entertainment - sectors that generate most of the jobs in the region. On the other hand, low productivity and high levels of unofficial work, which were already two of the main problems characterising the Andean region’s labour markets, are worsened by the recession and economic crisis, increasing the possibilities of further undermining the already damaged workers’ rights in the face of rising unemployment and precarious employment. (SDG 8)
Although social assistance programs have been implemented in several countries during their confinements, they have often been late, insufficient, overly targeted and diminished due to corruption. Official workers have seen their incomes reduced and the informal sector has suffered from hunger and despair as they have been unable to return to their daily work.
Online work and education posed another challenge for the population, which lacks the material resources - such as computers or internet connections - as well as the knowledge to carry out their work and schooling, which increases the social divide.
In a region marked by inequality, the arrival of COVID-19 had further highlighted the lack of equity in access to healthcare and basic services. On the one hand, it shows that there are enormous territorial inequalities in Andean America, where capital cities and some regions have more and better resources and infrastructure to contain the pandemic and provide care for the sick, while rural areas do not have equipment or materials to meet the basic needs of the population during the health crisis. (SDG 10).
The pandemic has also brutally proven that the home is not a safe place for millions of women and girls. Violence against women, which already showed alarmingly high figures in the region, has only been exacerbated when women and girls have been forced to live with their aggressors without access to care and protection services. The pandemic has also highlighted, in an unprecedented way, the importance of caregivers and the low visibility that they have. The unjust social organisation of care is made evident since it is women who, whether paid or unpaid, do most of these tasks.

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The COVID-19 pandemic has had a significant impact on poverty and inequality in Morocco. The pandemic has led to a decline in economic activity, which has resulted in job losses and a decrease in household incomes. This has disproportionately affected the poor and vulnerable, who are more likely to be employed in informal sectors and to have less access to social safety nets.

The pandemic has also exacerbated pre-existing inequalities in Morocco. For example, women are more likely to be employed in informal sectors and to have lower incomes than men. They are also more likely to be responsible for unpaid care work, which has increased during the pandemic. This has made it more difficult for women to find work and to earn an income.

The COVID-19 pandemic has also had a negative impact on education in Morocco. Schools have been closed for extended periods of time, which has disrupted learning and made it more difficult for children from poor families to continue their education.

The Moroccan government has taken some measures to mitigate the impact of the pandemic on poverty and inequality. These measures include providing financial assistance to the poor, increasing access to social services, and supporting the education sector. However, more needs to be done to address the long-term impact of the pandemic on poverty and inequality in Morocco.

The following SDGs are relevant to the impact of the COVID-19 pandemic on poverty and inequality in Morocco:

SDG 1: No poverty
SDG 2: Zero hunger
SDG 3: Good health and well-being
SDG 4: Quality education
SDG 5: Gender equality
SDG 10: Reduced inequality

The Moroccan government is committed to achieving these SDGs. However, the COVID-19 pandemic has made it more difficult to achieve these goals. The government will need to continue to invest in social protection, education, and health care to ensure that everyone in Morocco has the opportunity to live a prosperous and healthy life.

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COVID pandemic negatively affected SDG 4. In the Philippines, the Government closed schools on 9 March 2020 one month before the planned end of term, prematurely ending the school year for almost 25 million students and postponed the usual start of the 2020-2021 academic year from June to the end of August due to concerns about COVID-19. As cases are increasing, coursework will remain by distance only. At the end of the recently concluded campaign for the upcoming school year, enrolment stands at 77 per cent of the previous academic year, highlighting the serious negative impact of the pandemic on students. COVID-19 is also affecting the Alternative Learning System (ALS), which is the Government programme to respond to the needs of those who are unable to continue in formal education through alternative, flexible learning pathways. This programme typically combines self-paced study with in-person instruction by teachers in Community Learning Centres. Currently, it provides over 800,000 learners annually with a vital second chance and alternative pathway to complete their basic education.

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The COVID-19 pandemic had adverse impact on the marginalised segments of the population, who were already battling poverty, unemployment, malnutrition, and many other challenges. One example that I saw in the country I was then posted in – Papua New Guinea - and also have read about here in India is around the increased level of violence towards women and children. So this impacted on progress towards SDG 5. The impact of severe lockdowns in many parts of the country meant people were locked into one room – their routines were severely disrupted. Tensions within family units fueled escalated and opportunities to provide space in order for these tensions to cool were fewer.

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COVID had a devasting blow on the economy in Brazil leading to a recession and adding to this, multiple crises that were converging from years prior. The election of right wing president Jair Bolsonaro and the negative impact of this administration on human rights, the promotion of sustainable development and the former president's belief that COVID was nothing more than a cold. Aging health systems, rising unemployment, cuts to social policies and other inequalities further exacerbated the impact of COVID on the development of Brazil. Recession that began in 2014 along with the changes by the former president, left a country ill-equipped to confront the COVID pandemic and further set the country behind in achieving the SDGs. A recently published study on food insecurity among Transgender people during COVID showed 68.8% of the population experienced some type of food insecurity, of which 20.2% experienced a severe food insecurity. (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0284257). For the Transgender population, on the most vulnerable and populations left behind, many lost their ability to work and survive, and some had to return to their family home putting them at risk of violence and discrimination during COVID. Many became homeless.

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Sávio Marcelino Gomes,

Michelle Cristine Medeiros Jacob,

Viviany Moura Chaves,

Luciana Maria Pereira de Sousa,

Marcos Claudio Signorelli,

Daniel Canavese de Oliveira,

Clélia de Oliveira Lyra,

Luiz Roberto Augusto Noro

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Abstract

Transgender people often live with social vulnerability, largely promoted by gender-based prejudice. Our aim in this article was to raise preliminary data on how the COVID-19 pandemic and perceived prejudice have contributed to the problem of food and food insecurity in the transgender communities in Brazil. We conducted a web-based cross-sectional study, in which 109 transgender people from all regions of Brazil participated. We used the Chi-Square test and Poisson regression modeling with robust variance to estimate the association between food insecurity and the investigated factors. In our sample, 68.8% of transgender people experienced food insecurity, of these, 20.2% experienced severe food insecurity. Our results showed that the difficulties in purchasing food in the transgender community predate the COVID-19 pandemic, yet that the restrictive measures adopted have also impacted overall access to quality food. However, the main explanations for food insecurity were income and employment. In predicting food insecurity, the experiences of prejudice must be considered, and give rise to the hypothesis that specific conditions to which transgender people are exposed explain, to some degree, their vulnerability to food insecurity.

Citation: Gomes SM, Jacob MCM, Chaves VM, Pereira de Sousa LM, Signorelli MC, Canavese de Oliveira D, et al. (2023) Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS ONE 18(5): e0284257. https://doi.org/10.1371/journal.pone.0284257

Editor: Cesar Infante Xibille, National Institute of Public Health: Instituto Nacional de Salud Publica, MEXICO

Received: January 11, 2023; Accepted: March 27, 2023; Published: May 10, 2023

Copyright: © 2023 Gomes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All files are available from the Open Science Framework database (DOI: 10.17605/OSF.IO/YHNEM).

Funding: This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), for the Ph.D. scholarship to SMG (grant numbers 88887.505839/2020-00), by the CNPq through a research grant to MCMJ (402334/2021-3) and a research productivity scholarship also awarded to MCMJ (306755/2021-1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

In countries with fragile social support policies, the establishment of social distancing measures, needed to contain the COVID-19 pandemic, has only widened existing disparities. In the United States, since the start of the pandemic, inadequate state intervention to support vulnerable families has already resulted in increased food insecurity [ 1]. According to the Food and Agriculture Organization (FAO), a family is experiencing food insecurity when they do not have permanent access to culturally and nutritionally adequate food [ 2]. Brazil as well, with its limited support policies for socially vulnerable families, has also seen an increase in the prevalence of food insecurity. Currently, more than half of the Brazilian population experienced some degree of food insecurity [ 3].

Women are four times more likely than men to experience food insecurity worldwide. This inequality can be attributed to two main factors: 1) food insecurity often results from negative social, political, and economic conditions that disproportionately affect certain groups, and 2) women in many countries are disadvantaged compared to men in terms of education, income, and support networks, among other things [ 4]. However, gender-based studies on food insecurity have often adopted a categorical paradigm, which assumes the existence of only two gender categories: men and women. This categorical thinking has informed statistical differences in studies and health policies, such as the higher rates of hunger among women compared to men. The main limitation of categorical thinking is that it underestimates diversity within gender categories, such as the differences between hegemonic and subordinate masculinities or between lesbian and heterosexual women. A relational approach to gender provides a more sophisticated means of identifying the magnitude of social problems. This approach considers the effects of large-scale patterns found in politics, economics, and culture on masculinity and femininity patterns among populations, regardless of their biological sex [ 5- 7].

In addition to the categorical thinking prevalent in population-based research on food insecurity, we also believe that considering the division between cisgender and transgender identities can reveal specific exposure factors for minority gender populations. Studies prior to the pandemic suggest that in gender minorities, such as the transgender population, food insecurity is an important indicator of social vulnerability [ 8- 10]. This population has been historically excluded from the health, education, and social assistance sectors, resulting in worse rates of violence, stigma, and long-term illness, as well as school dropout and unemployment [ 11]. These factors, together with perceived prejudice [ 12], which occurs when transgender people identify episodes of exclusion against themselves, make the transgender population vulnerable to food insecurity. However, we lack baseline data to monitor the effects of the COVID-19 pandemic in this specific group, or to investigate predictive factors for food insecurity in the transgender community. The main problem associated with the lack of information is the invisibility of this group in terms of measures (i.e. in public policies and contingency plans) that might help reduce the impact of the pandemic and the consequent perpetuation of historically unequal situations. Since the beginning of the pandemic, gender researchers have called for monitoring the health condition of transgender persons, considering their specificities [ 13].

Thus, our objective was to estimate the frequency of food insecurity in a sample of transgender people and to investigate its associations with dietary change and with prejudice as perceived in Brazil during the COVID-19 pandemic.

Methods

Study design

We conducted an online cross-sectional study, using a non-probabilistic sample.

Participants

We conducted an online recruitment of adult transgender people (> 18 years old) who lived in Brazil at the time of the study. We asked people about their gender identity (trans men, trans women, travestis (a Brazilian identity), gender non-conforming, or other non-cisgender identities. For the analyses, we considered them all as transgender people.

Data collection

We used social media such as Instagram, Twitter, Facebook, and WhatsApp to recruit participants between the months of October and December 2020. We used social media platforms because of their potential for recruiting members of stigmatized groups successfully [ 14]. We gained the support of national LGBT social movement networks, public outpatient clinics specializing in healthcare for the transgender population, and researchers with a network of participants contacted in previous research. We considered as eligible for the study people who met the following criteria: (1) living in the national territory, (2) being 18 years of age or older, and (3) identifying themselves as being a transgender person. Participation in the survey was completely voluntary and confidential.

Instruments and variables

Our theoretical model ( Fig 1) is based on the assumptions detailed below. The COVID-19 pandemic has presented considerable impacts on food and nutritional insecurity of the Brazilian population, and may also have affected the transgender community [ 3]. The main factor that differentiates the transgender community from the cisgender population is an prejudice based on gender identity [ 12]. Work, education, and income [ 3], as well as transgender vulnerabilities [ 15, 16] are important variables in explaining food insecurity.

Our dependent variable was food insecurity. To measure it, we used the Brazilian Food Insecurity Scale (EBIA), in its reduced eight item version [ 17]. The quality and psychometric properties of this abbreviated scale in the Brazilian context have been evidenced in national surveys since 2004, making the EBIA the official Brazilian tool to determine food insecurity levels in the population. We classified degrees of food insecurity based on the final scale score, with the following cutoff points: Food security (0), mild (1-3), moderate (4-5), and severe food insecurity (6-8). Afterward, we grouped the different levels of food insecurity into a single category. The EBIA assesses an individual's perception of their food insecurity for the three months prior to application.

As independent variables, we considered socioeconomic characteristics (income, education, and work), any dietary changes since the beginning of the COVID-19 pandemic, and perceived prejudice. We asked participants for self-declarations of gender and color. We used tertiles to analyze income. For education, we considered access to university education and basic education (primary and secondary school). We measured dietary changes based on three variables: 1) ability to purchase food; 2) access to diversified food; 3) access to food one considers healthy. These three variables were measured with reference to the period before the COVID-19 pandemic and the period after the onset of the pandemic. We classified these changes and created three variables: "Change in the ability to purchase food," "change in food diversity," and "change in the ability to access healthy food." These were divided into three categories: "no difficulties before or after," "began to have difficulty," and "it remains as difficult as it was before." Likewise, we measured employment losses from the variables "worked before the pandemic" and "worked after the onset of the pandemic," and further categorized a new dummy variable we called "lost my job during the COVID-19 pandemic" (Yes or No).

We measured gender-based prejudice using the Perceived Prejudice Scale [ 18], which measures the frequency of perceived experiences of sexual fetishism, job rejection, verbal violence, physical violence, and police violence (because of being transgender); as measured from 0 = never, 1 = once or twice, 2 = often, and 3 = always. We categorized each total score based on a method suggested by the authors who validated the scale, into quartiles, for low, medium, high, and extreme perceived prejudice.

Statistical analysis

We described the study variables in absolute and relative frequency. We performed bivariate analysis using Pearson's Chi-square test and standardized residuals to verify association strengths between the variable categories. We used Poisson regression with robust variance to build an association model between food insecurity, dietary changes as a result of the COVID-19 pandemic, and perceived prejudice. This was adjusted for income, education, and the impact of the pandemic on employment. This method had already been suggested for cross-sectional studies [ 19- 22] because of its potential to directly measure the Prevalence Ratio (PR) and to use its respective corrected 95% confidence intervals (95% CI). Further, a high frequency for the food insecurity outcome might overestimate association measures when using concurrent methods (i.e. Odds Ratio). The theoretical model we tested is described in Fig 1. The variables in the model were selected by the Forward Selection method, using epidemiologic and statistical criteria. We evaluate the predictive power using the ROC Curve, considering the model's probability of estimating the food insecurity in the sample.

Ethics

We followed the Brazilian Resolution No. 466/12 on ethical research conduct, in addition to the recommendations for research with a transgender population [ 23] and the Declaration of Helsinki as revised in 2013. All written participants' consent was obtained. Our research was approved by the Ethics and Research Committee of Potiguar University (Approval No. 4,312,698).

Results

Population characteristics

Our questionnaire was answered by 112 transgender people. After excluding duplicates, 109 participants remained, 53.2% (95% CI 43.69-62.50) trans men, 29.4% (95% CI 21.47-38.72) trans women, 6.4% (95% CI 3.01-13.00) travestis, 7.3% (95% CI 3.67-14.43) non-binary, and 3.7% (95% CI 1.36-9.51) other, different identities. These participants were distributed across all of Brazil: 51.4% (95% CI 41.91-60.75) in the Northeast, 8.3% (95% CI 4.31-15.25) in the North, 5.50% (95% CI 2.41-11.85) in the Midwest, 14.68% (95% CI 9.12-22.78) in the Southeast, and 20.18% (95% CI 13.59-28.91) in the South. Of these, 58.7% (95% CI 49.12-67.69) declared themselves as black (black or brown). The first tertile of the population reported a per capita income of up to 91.58 USD per month, the second tertile reported a per capita income of between 91.59 USD and 240.14 USD per month, and the third tertile reported a monthly per capita income of 240.15 USD and above. As for education, 55% had university education (including incomplete and complete) and 45% had only basic education (primary and secondary).

Reliably characterizing the Brazilian transgender community is still a challenge. However, our aim in this study was only to provide initial data on the phenomenon of food insecurity and its associated factors. We believe that, though preliminary, our estimates can help other researchers to carry out more robust sampling and sampling plans.

Food insecurity and potential effects of the COVID-19 pandemic

Of the study population, 68.8% (95% CI 59.37-76.9) experienced some degree of food insecurity, of which 20.2% (95% CI 13.59-28.91) experienced severe food insecurity ( Fig 2). When evaluating dietary changes caused by the COVID-19 pandemic within the sampling, we saw that the pandemic affected food purchasing power by 15.6% (95% CI 9.85-23.81), food diversity by 15.7% (95% CI 9.85-23.81), and access to healthy foods by 11% (95% CI 6.30-18.54).

Food insecurity and prejudice based on gender

Self-reported gender bias was quite frequent in our study population. Of the different manifestations, gender-based fetishism was one of the most frequent forms of prejudice in the daily life of the community, with 11% reporting feeling affected by this bias always, and 38.5% reporting feeling affected often. This was followed by the perception of rejection at work due to gender prejudice, reported in our sample with a frequency of 10%, and as often as 26.6%. Gender-based physical violence was the least reported, although participants who experienced food insecurity reported higher frequencies of simple prejudices, whether strong or extreme. The opposite behavior occurred with participants having food security, who mainly reported experiences categorized as low prejudice ( Table 1).

Food insecurity associated factors

In our bivariate analysis, income, education, work, and factors related to the pandemic were associated with food insecurity (p<0.05), but prejudice was not ( Table 1). According to which, the 1st income tertile, access only to basic education, and being unemployed within the COVID-19 period were the socioeconomic categories most associated with food insecurity. We used the crude variables to food changes to fulfill the chi-square test. People who reported difficulties to purchase food and accessing diverse and healthy food during the COVID-19 pandemic were associated with food insecurity. In relation to experiences of prejudice, despite the absence of any association, the group reporting a lower frequency of prejudice presented a higher probability of experiencing food insecurity.

Our theoretical model explains up to 88.46% (CI 82-95) of food insecurity in our sample of Brazilian transgender individuals, in according to ROC area. The per capita income and employment are the best predictors to food insecurity prevalence ( Table 2). As for income, its progressive reduction presents a higher PR for food insecurity, an inverse relationship. Being unemployed at the time of the survey also contributed to a greater PR. Regarding the variables on food changes during the COVID-19 pandemic, the model demonstrates that persons who were difficulties purchasing food, accessing food diversity, and accessing healthy food were respectively 1.15, 1.20, and 1.25 more chances of food insecurity. In the final model, prejudice remained without significance. Our regression model demonstrated the Deviance goodness-of-fit 41.53, with chi2 > 0.05, and the Akaike's information criterion 213.53.

Discussion

In our study population, factors related to the COVID-19 pandemic further aggravated common vulnerabilities experienced before the pandemic. Prior to the pandemic, difficulties in the ability to purchase food contributed to a higher frequency of food insecurity in our sample. During the pandemic, limited access to healthy and diverse foods increased this frequency. In our final model, the main factors affecting food insecurity were income and employment. The frequency of perceived prejudice was not associated with food insecurity.

Our research fills three gaps in the scientific literature about food insecurity in the Brazilian transgender community: 1) an estimate of the frequency of food insecurity in this population; 2) the impact of the pandemic on access to food; and 3) the association between gender-based prejudice and food insecurity. Our estimated food insecurity frequency of 68.8% in a community sample will allow further research to use sampling and sampling plans that ensure randomness and population representativeness, which are important for generalizing conclusions. Further study must consider the effects of the COVID-19 pandemic on the transgender diet. However, a lack of baseline data would preclude such a comparison. Finally, we also tested the association between perceived prejudice and food insecurity. The lack of association we found may indicate that the factors related to food insecurity in the Brazilian trans community may be more structural ones, linked to public policies and social protection models, and thus less perceived at the individual level.

In Brazil, women experience higher levels of food insecurity than men, but we do not have national data on transgender people. In a survey conducted during the same period as our research, the prevalence of food insecurity among women was 64.1%, while among men it was 47.5% [ 3]. Unequal relationships in the economy, education, and support networks contribute to the exacerbation of gender inequalities in determining food insecurity [ 4]. Our survey showed a higher frequency of food insecurity among transgender people compared to cisgender men and women interviewed, however, these data need to be confirmed in a national population-based survey.

Transgender people are commonly vulnerable to food insecurity. Data from a study carried out in the United States, and using a population and recruitment method similar to ours, revealed a food insecurity prevalence of 10 percentage points above that found in our Brazilian study [ 8]. When interviewed, transgender people experiencing food insecurity attribute the difficulty in accessing food to limited opportunities for education, training, and employment due to gender stigma. Financial help from family members is generally not an option, due to exclusion from the family as a result of breaking gender norms that are widespread in Western culture. Likewise, this community is also excluded when trying to access local food assistance, especially when there is no state mediation [ 9].

In our study population, the experience of food insecurity was associated with the level of living and working conditions of social determinants of health. Unemployment and income were positively associated with food insecurity. This relationship occurs directly and is manifested by the difficulty of physical access to food. In our bivariate analysis, education was also associated with food insecurity, however, the association did not hold when we included other social determinants such as employment. Our interpretation is that unemployment overlapped with access to higher education. In our population of transgender individuals, 43.7% of those experiencing food insecurity had access to higher education, but 89% of those experiencing food insecurity were unemployed.

The political and economic scenario in Brazil has also contributed to the worsening of food insecurity in the transgender population and to gender-based prejudice. Since 2004, public sector agencies have pursued policies to promote food security and combat gender discrimination. However, several crises since 2015 have led towards establishment of a neoliberal state and dismantling of those public policies [ 24, 25]. One of the best measured results in the country was the progressive increase in food insecurity after 2018, with food insecurity levels returning to the levels of 2004, before the establishment of the most important food security policies [ 3].

Transgender communities are historically exposed to experiences of prejudice which mediate the vulnerability of this population to various social problems, such as hunger. According to the Minority Gender Stress Theory [ 26], research comparing cis and transgender people demonstrates that the trans community experienced higher rates of social rejection by people and institutions. This rejection negatively influences levels of education, income, and social support from friends, family, and the state. This research supports the hypothesis that the determinants of gender inequality in food insecurity, including income, work, education, and social support, may be even more important to the transgender population due to the role of social rejection in worsening them.

In our study, we measured perceived prejudice at the individual level, which does not seem to adequately explain the link between food insecurity and sexual and gender minority experiences of prejudice. Perception of prejudice modulates in relation to individual social conditions, and income and education are important factors in one's perceptions of oppression experienced in everyday life [ 27]. Further, the relationship between stigma and food insecurity seems not to be located in the individual sphere, but systemically, since in trans communities, economic and political factors interfere collectively in one's quality of life, employment opportunities, education, and income [ 15, 28].

The quality of life of transgender people is associated, in many cases, with gender transition, which has costs that can compete with food costs. About 80% of transgender people require gender affirming procedures, which range from name changes in official documents, to the use of hormones, to surgical procedures [ 29]. The costs of these procedures vary depending on the level of social protection afforded for transgender people in each country. In Brazil, many of these procedures can be performed free of charge in the national health system, but they are not yet widely available and long processing times of at least 2 years are common [ 25]. In other countries, payments and co-payments for procedures can reach up to 23,000 USD [ 30]. Further, even when their needs are covered by public health systems, barriers of access, stigma, and discrimination can prevent transgender people from accessing covered services, necessitating payments to private providers for required services [ 31, 32]. As with all personal costs, direct health costs are associated with food insecurity [ 33], so the need to perform gender affirming procedures can increase this insecurity [ 34].

The COVID-19 pandemic significantly affected access to food for the transgender population. Brazilian data reveals that the prevalence of food insecurity in the general population increased from 36.6% in 2018 to 55.2% by the end of 2020 [ 3]. In our population, the prevalence of severe food insecurity was 20%, double the national estimate of 9%. Research on the impact of the pandemic on the living conditions of the LGBT population reinforces our hypothesis. In a sample of 10,065 people from the sexual and gender minority community, one in five people had a source of income. One out of four transgender people had lost their job due to the pandemic, and, of these, 53% would not have been able to meet basic needs for more than a month. Added to these financial difficulties, the weakening of support networks during the pandemic further intensified the state of vulnerability [ 16]. In addition, that study documents declining mental health, increasing violence, and deprivation of social protection of transgender people during the pandemic [ 35].

In our study population, access to food, and the quality and diversity of diets were affected by the COVID-19 pandemic. Studies prior to the pandemic showed that trans communities with difficult access to food began to change their consumption towards ultra-processed, high-calorie, and low-cost foods, this as a way to guarantee quantity, even while reducing quality [ 36]. Consumption profile changes as a result of physical insecurity or prejudice are common [ 37], and may explain the dietary changes in our sample.

We highlight as a limitation of our study, the convenience sampling and the online application form. However, we justify their use on account of the lack of previous studies permitting knowledge of the frequency of food insecurity in the Brazilian trans community, and also by concerns related to risk of COVID-19 transmission. In addition, we limited some variables in the regression model (i.e., race and location) because our sample is small, so we needed to select the most important variables, as we explain in our theoretical model. We understand that these questions limited our power of generalization, but we consider the study to be an important first step towards forming a more concrete Brazilian research agenda on the subject.

Conclusion

Transgender people live in conditions of vulnerability to food insecurity and the indicator is important for monitoring living conditions in this community. Relative to the general population, the frequency of food insecurity was high, and associated (in part) with the impacts of the first year of the COVID-19 pandemic. Food insecurity is a multifactorial problem, and social exclusion is considered one of its causes. Therefore, experiences of prejudice must be considered a contributing factor to economic inequalities and raise the hypothesis that specific conditions to which transgender people are exposed partially explain their food insecurity. To address this, we recommend further studies using methodologies that can demonstrate how prejudice impacts the income and work of the transgender population. Additionally, we suggest conducting studies with larger sample sizes to test the association between different categories of prejudice and food insecurity.

Based on our study, nutritional-epidemiological research can test hypotheses involving determination of food insecurity in the transgender community. Our frequency estimations can be used in sampling plans and sampling forms, allowing study designs that take into account randomness and sample representativeness. Thus, previous experience should support future research designs, to take into account the specificities of research within the transgender population, and important predictors and/or covariates to be considered.

Acknowledgments

The authors thank Dr. Angelo Roncalli, Dr. Marcos Pereira, and Dr. Rodrigo Viana for his methodological support, and Teacher Jonathan for his language support.

References

1. 2. FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2021. Rome: FAO, IFAD, UNICEF, WFP and WHO; 2021. 240 p.

2. 3. Rede Brasileira de Pesquisa em Segurança Alimentar e Nutricional. Insegurança Alimentar e Covid-19 no Brasil. 2021.

3. 5. Banerjee P, Connell R. Gender Theory as Southern Theory. In: Risman BJ, Froyum CM, Scarborough WJ, editors. Handbooks of Sociology and Social Research. Second Edi. Switzerland: Springer; 2018. p. 57-68.

4. 6. Connell R, Pearse R. Gender in World Perspective. 3o edition. Cambridge: Polity; 2014. 192 p.

5. 16. Vote LGBT. Diagnóstico LGBT+ na pandemia de Covid-19. 2020.

6. 29. Radix AE. Medical Transition for Transgender Individuals. In: Eckstrand KL, Ehrenfeld JM, editors. Lesbian, Gay, Bisexual, and Transgender Healthcare. Switzerland: Springer International Publishing; 2016. p. 351-61.

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Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic

# data[].attributes.attachment_link.description
Transgender people often live with social vulnerability, largely promoted by gender-based prejudice. Our aim in this article was to raise preliminary data on how the COVID-19 pandemic and perceived prejudice have contributed to the problem of food and food insecurity in the transgender communities in Brazil.

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Like everywhere in the world, COVID-19 had a significant impact on the lives of PLHIV and key populations, who already faced serious challenges in accessing health services (as well as education and employment, etc.) due to stigma, discrimination, and social exclusion. Restricted movement under COVID-19 further disrupted critical services for these populations but also led to creative efforts to respond to the situation (e.g. virtual platforms and helplines). Pakistan was also noted by WHO for having managed the COVID-19 response relatively well through a national coordination mechanism (National Command and Operation Center/NCOC) that now serves as an inspiration and example that could be followed to effectively tackle other infectious diseases including HIV.

Negative economic consequences of COVID-19 have been amplified by political instability and other governance challenges are major obstacles in achieving most SDGs in both countries (e.g. SDGs 1, 2, 3, 4, 5, 6, 8, 9, 10, 11, 13, 15, 16, 17).

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The COVID 19 has impacted negatively many SDGS . Zambia economy is based on agriculture and Mining . Looking at Economic Growth , the inflation rate moved from 10% in 2019 to 40% in 2021 and GDP reduced from 4% in 2018 to -2% in 2021. The SDGs 3 and 4 have been also impacted . with the close of school during COVID 19 , drop out school particularly for girls has increased , Teenage pregnancy increased reaching 40% in some provinces. The new government has increased investment in Education since 2022 by making Education free for all in primary and secondary school to ensure all children to access to Education . More than 30,000 new teachers have been recruited . The allocation to health has also increased by 25% in 2023 Budget to mitigate impact of COVID 19.

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Covid-19 pandemic has impacted the progress in the SDG agenda in Ghana in many areas.Some examples are indicated - below:
- Proportion of expenditure on education and social protection reduced between 2019 and 2020 while that for health increased mainly due to COVID-19 related expenditure.
- Skilled birth coverage improved from 55.5% in 2016 to 59.1% in 2019but declined to 58.7% in 2020.
- Net enrolment ratio (NER) in education generally declined at all levels indicating that some school going age pupils are still not in school. COVID-19 pandemic partly contributed to the drop in the NER in the last two years -the largest drop was at the KG level from 71.4%to 49.5%.

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The UN and its partners in Mozambique are working to achieve the Sustainable Development Goals. 17 ambitious and interconnected goals that address the key development challenges faced by people in Mozambique and around the world. For example, the UN engagement in post-cyclones support and recovery are unique achievements in delivering on the 2030 Agenda, linking humanitarian response, recovery and resilience in a single effort

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The levers of economic growth in Mali have been strongly affected by COVID-19. The brakes brought to global economic activity and international trade were directly felt by Malian households, who saw their situation deteriorate. The health crisis has thus caused an increase in the number of poor people by nearly 900,000 people, hampering the progress made over the last decade in terms of poverty reduction.
The fall in economic activity and the slowdown in international trade have mechanically reduced tax revenues. The financing of the emergency response plan against COVID-19 (2.3% of GDP) widened the budget deficit which stood at 5.5% of GDP in 2020. Public debt increased to reach 44.1% of GDP.

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In Armenia, the first reported
COVID-19 case was registered on 1 March 2020 and local transmission has been registered since 11 March 2020. Every region (marz) of Armenia has been affected, and the country holds one of the highest positions in the region for infected persons per 100,000 people.
The COVID-19 pandemic is far more than a health crisis; it has created unprecedented global socio-economic challenges. While the long-term impact remains uncertain, it is clear that it will exacerbate existing vulnerabilities and threaten the achievement of the Sustainable Development Goals by 2030. The overall trend in Armenia’s economic development before the COVID-19 pandemic has been
positive, with a high economic growth rate, a steady increase in exports, decreasing unemployment and increasing GDP per capita in most marzes.The immediate social impact of the COVID-19 crisis is assessed for important dimensions of social life, namely health, education, income and social capital.
The spread of the coronavirus and correlated economic hardships impacted the health of people living in Armenia more than the actual impact on people suffering from COVID-19.
The findings from the household survey suggest that 40% of respondents experienced mental and/or emotional health issues after COVID-19 began to spread.
While the capacities of the health care system in Armenia were strengthened during the pandemic, the need exists to consider expanding decentralization and other factors to make health services agile and accessible for everyone during crises.
PLHIV encountered problems with getting their medications. Those living outside Yerevan experienced problems with accessing treatment in Yerevan due to restrictions of movement set by the lockdown. To prevent health complications relevant NGOs ensured that these individuals living throughout Armenia received their medications.

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South Sudan’s economy is heavily reliant on oil revenue. Pre-covid, the economy of South Sudan had recorded a strong growth pickup, with real GDP growth estimated at 9.3 percent in FY2019/20 but a contraction of -3.4 percent was projected in FY2020/21. Oil production was estimated at 62.1 million barrels in FY2019/20, representing a 26.5 percent increase from 49.1 million barrels realized in FY2018/19. However, oil production declined to about 58 million barrels in FY20/21, as COVID-19 restrictions impacted movement of machinery and OPEC+ production cuts affected production. With COVID-19 restrictions delaying new investment, activity in the oil sector is not expected to improve until FY2022/23 when oil production is projected to rise to 60.2 million barrels.

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The impact of COVID19 cuts across a wide range of SDG Goals and particularly on SDGs1, 2, 3 4 and 5 without any order of priority.
In this submission I will focus on SDG4. The closure of schools as a result of measures to curtail the further spread resulted in interruption of education. In Malawi this requires proving alternate or virtual learning modalities such as online . Although this was laudable, the cost of internet, online learning tools and equipment were not affordable by many especially in the rural areas with limited access to internet and electricity. There were reported cases of increased child marriage, and teenage pregnancies.

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COVID-19 has slowed down the effort to reduce poverty (SDG 1) in Chad. As the social protection system weak and not well structured and due to restriction in place during the pandemic many people working in the informal sector were not able to operate for their daily meal. Many daily workers lose their jobs or their incomes.

The health (SDG 3) sector was also impacted by the loss of the health workforce due to the pandemic. The movement restriction has hampered the access and the utilization of health services such Maternal and child health, reproductive health service, TB, and HIV services

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Impact of COVID-19 on SDG agenda progress- Martin Odiit UCO Tanzania

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Impact of COVID-19 on SDG agenda progress- Martin Odiit UCO Tanzania

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Tanzania, like the rest of the world, experienced slow down in its progress towards national development goals and the SDGs due to the COVID-19 pandemic. These include reports of slowed economic growth due particularly to impacts on tourism and hospitality sector and reduced agricultural trade. There were also reports of increased gender based violence.

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Guatemala just submitted its national voluntary review of the SDGs implementation (NVR 2023). Areas with most progress include poverty reduction, social protection, food and nutritional security and access to health services. The launch of the Great National Crusade for Nutrition is an illustrative example as it effectively combating malnutrition in vulnerable children.Areas with least progress include employment and investment, institutional strengthening, security and justice.

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Argentina, a country committed to the 2030 agenda, experiences an increase in poverty. Alberto A Stella

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Argentina, a country committed to the 2030 agenda, experiences an increase in poverty. Alberto A Stella

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Argentina is a country highly committed to the 2030 agenda. However, the consequences of the pandemic have deepened the economic crisis and the ability to recover. Today it is estimated that more than 38% of the population is below the poverty line, with great geographical differences, with the poorest provinces in the northern regions of the country being the most affected.

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Plutôt un exemple positif de Togo:
Au Togo, la pandémie de Covid-19 a représenté un défi inédit, non seulement sanitaire mais aussi socio-économique. Elle a montré la nécessité de renforcer la protection sociale et la résilience des acteurs économiques et des ménages face aux chocs exogènes. La crise a servi de laboratoire pour l’innovation socio-économique et digitale avec la mise en place d’un revenu universel de solidarité pour aider les citoyens privés d’activités génératrices de revenu par le confinement. La plateforme numérique Novissi a permis d’octroyer une aide financière de 13,3 milliards de F CFA (20,2 millions d’euros) à 820 000 personnes à travers un système de transfert monétaire direct, sans jamais les rencontrer. Cette action, combinée à d’autres mesures de soutien économiques financées par l’État, a permis au Togo d’échapper à une récession que beaucoup jugeaient inévitable. L’économie togolaise a ainsi enregistré une croissance positive de 1,8 % en 2020, et a crû de 5,3 % en 2021.

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Impact of COVID-19 pandemic on Tourism in the Caribbean, Richard AMENYAH

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Impact of COVID-19 pandemic on Tourism in the Caribbean, Richard AMENYAH

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Tourism is a major foreign exchange earner for most Caribbean countries. The COVID-19 pandemic significantly disrupted social and economic life due to lockdowns and stoppage in international air and sea travels. This has led to enormous shrinking in their economies in GDP terms. Majority of the countries are now recovering the loss in their market shares through tourism.