“Going vaccine hunting”: Multilevel influences on COVID-19 vaccination among racialized sexual and gender minority adults—a qualitative study

Figures & data

Table 1. Participant demographics from in-depth interviews with racially/ethnically diverse sexual and gender minority people in Toronto, Canada, 2022 (n = 40).

PID	Age (yrs)	Race/Ethnicity	Gender identity	Sexuality	Currently in relationship	Education	Employment status
1	24	White	Cisgender woman	Lesbian	No	College	Disability
2	23	East Asian/White	Cisgender man	Gay	No	College	Part-time
3	23	South Asian	Cisgender man	Gay	No	College	Part-time
4	19	East Asian	Cisgender woman	Two-spirit	No	High school	Student
5	24	Black/Caribbean	Cisgender woman	Lesbian	No	College	Part-time
6	23	Black/Caribbean	Cisgender woman	Bisexual	No	College	Part-time
7	24	Black/Caribbean	Cisgender man	Gay	No	College	Full-time
8	24	White	Cisgender woman	Pansexual	No	College	Unemployed
9	23	East Asian	Cisgender woman	Two-spirit	No	College	Part-time
10	34	White	Transgender woman	–	Yes	High school	Unemployed
11	19	White	Transgender man	Other	No	High school	Student
12	42	Black/Caribbean	Transgender woman	Heterosexual	Yes	College	Unemployed
13	31	Black/African	Transgender woman	Pansexual	No	High school	Disability
14	36	Black/Caribbean	Transgender woman	Other	Yes	High school	Unemployed
15	28	Black/Caribbean	Transgender man	Other	Yes	College	Part-time
16	19	Southeast Asian	Transgender man	Other	No	High school	Student
17	38	Latinx	Transgender man	–	Yes	High school	Full-time
18	23	South Asian	Transgender man	Pansexual	Yes	College	Unemployed
19	28	Black/Caribbean	Transgender woman	–	No	High school	Unemployed
20	23	White	Transgender woman	–	No	Elementary	Disability
21	52	White	Transgender man	–	Yes	High school	Unemployed
22	25	White	Transgender woman	–	No	College	Unemployed
23	24	Black/Caribbean	Cisgender woman	Lesbian	No	College	Student
24	50	Black/Caribbean	Cisgender woman	Other	Yes	High school	Unemployed
25	24	Black/Caribbean	Cisgender woman	Two-Spirit	No	High school	Unemployed
26	30	Black/Caribbean	Cisgender woman	Pansexual	No	High school	Part-time
27	31	East Asian	Nonbinary (AFAB)	Lesbian	No	College	Unemployed
28	25	Southeast Asian	Nonbinary (AFAB)	Pansexual	No	High school	Part-time
29	25	Black/African	Nonbinary (AFAB)	Two-spirit	No	College	Part-time
30	37	Latinx	Cisgender woman	Other	Yes	High school	Student
31	25	South Asian	Cisgender woman	Two-spirit	No	College	Full-time
32	19	Southeast Asian	Cisgender woman	Lesbian	Yes	College	Part-time
33	32	East Asian	Cisgender woman	Lesbian	No	College	Unemployed
34	27	South Asian	Cisgender woman	Lesbian	No	High school	Unemployed
35	32	Black/Caribbean	Cisgender woman	Pansexual	No	High school	Unemployed
36	58	Black/Caribbean	Cisgender woman	Heterosexual	No	High school	Part-time
37	29	East Asian	Cisgender woman	Lesbian	Yes	College	Student
38	48	Black/African	Cisgender woman	Bisexual	Yes	College	Part-time
39	18	Latinx	Nonbinary (AFAB)	Pansexual	Yes	High school	Student
40	22	Black/Caribbean	Nonbinary (AFAB)	Two-spirit	No	College	Unemployed

AFAB, assigned female sex at birth.

We defer to participant self-identifications but acknowledge the problematical use of the term “two-spirit” by non-indigenous people to denote gender identity or sexual orientation.

Table 2. Structural determinants of COVID-19 vaccination.

Subtheme	Illustrative Quotations
Physical unavailability and inaccessibility	“ … at one point we were kind of like going vaccine hunting because I wasn’t … living in a postal code where we were eligible for it yet and so we were going to other clinics to try and see if we can get” (P2, 23 y/o, East Asian/White, cisgender man, gay) “There were absolutely not enough pop-up clinics, especially within racialized areas” (P3, 23 y/o, South Asian, cisgender man, gay)
Information access	”…education was lacking. Awareness is lacking. I don’t really blame the people, I blame the systems in place” (P3, 23 y/o, South Asian, cisgender man, gay) “I definitely know like other grannies who came to Canada like a long time ago, and they mainly stay in the East Asian or the Chinese community and they can’t really speak English. … sometimes it was hard for them to even just get the notification or understand the policy. Second, understanding where do you even get the vaccine? And when they get there, there’s no translation service, so they can’t even communicate.” (P9, 23 y/o, East Asian, cisgender woman, two-spirit)
Digital/internet access	“I had to sit on the portal and refresh for days and days to get an appointment” (P8, 24 y/o, White cisgender woman, pansexual) “I think the government website … for some reason seems to be the most inaccessible; these are websites that have important information, and you would think that website would be developed with that in mind, you know?” (P6, 23 y/o, Black/Caribbean, cisgender woman, bisexual)
Insurance and immigration	“ … my partner who was going through the immigration process and at the time didn’t have an OHIP (government health insurance) card had a harder time accessing something as basic as a vaccination… a lot of those people were left out. … when there were requirements made, asking for the copy of your status. (P8, 24 y/o, White, cisgender woman, pansexual) “I don’t have like a third or a booster just because I changed provinces and there’s some issue with accessing it right now.” (P27, 31 y/o, East Asian, nonbinary [AFAB], lesbian)
Indirect vaccination costs	”…for a lot of people who’ve been on (welfare), just being able to afford the bus fare to get the vaccine was challenging” (P1, 24 y/o, White, cisgender woman, lesbian) ”…we stood in the rain for 6 hours so that she can get one. … because Pfizer was in high demand” (P32, 19 y/o, Southeast Asian, cisgender woman, lesbian)
Structural racism, transphobia, and homophobia	“When you go back in your history and you see the studies that they did on Black people, and what they did to the Africans, you are gonna be very hesitant to take any vaccine” (P14, 36 y/o, Black/Caribbean, transgender woman) “Folks are normally misgendered and sometimes it can be a very toxic space…to be in” (P23, 24 y/o, Black/Caribbean, cisgender woman, lesbian)

Table 3. Social and community determinants of COVID-19 vaccination.

Subtheme	Illustrative Quotations
Trust in vaccine recommender	“A family doctor, because they have the medical experience…and I trust them” (P1, 24 y/o, White, cisgender woman, lesbian) “…not the government health professionals, the actual doctors – I listened” (P21, 52 y/o, White, transgender man)
Family and community influence	“Seeing folks in my community doing it…helped me be like, okay, I’m gonna do this as well” (P27, 31 y/o, East Asian, nonbinary [AFAB], lesbian) “Thankfully my family, like they don’t understand the science too much, but being a student in the sciences, when I told them they were never against any vaccine. Like they got me and my sister vaccinated for everything when we were kids.” (P40, 22 y/o, Black/Caribbean, nonbinary [AFAB], two-spirit)
Altruism	“We don’t mind, we want to keep our community safe” (P38, 48 y/o, Black/African, cisgender woman, bisexual) “To protect my family from infection, to protect myself from infection, to limit the spread of COVID-19.” (P3, 23 y/o, South Asian, cisgender man, gay)

Table 4. Individual-level determinants of COVID-19 vaccination.

Subtheme	Illustrative Quotations
Vaccine hesitancy	“I didn’t want to take it at the very beginning. … it showed up too fast. I don’t know. Everyone doesn’t know. Even those experts don’t know if there are unknown side effects” (P37, 29 y/o, East Asian, cisgender woman, lesbian) “As of right now, I still feel very strongly like, no, this isn’t for me! … as a Black person, the healthcare system doesn’t care about me” (P34, 27 y/o, South Asian, cisgender woman, lesbian)
Perceived threat of COVID-19	“I was really scared because I saw a lot of people dying from it” (P25, 24 y/o, Black/Caribbean, cisgender woman, two-spirit) “After looking at how many people kind of died from it and how ill people seriously got from getting COVID, I opted to get the vaccine because I would rather have gotten the vaccine instead of gotten COVID.” (P35, 32 y/o, Black/Caribbean, cisgender woman, pansexual)
Personal research/scientific literacy	“I trust papers way more than people specifically. So yeah, I trust clinical trials” (P9, 23 y/o, East Asian, cisgender woman, two-spirit) “I followed the science behind vaccines for years before the pandemic, so I really wasn’t all that concerned.” (P1, 24 y/o, White, cisgender woman, lesbian)

Figure 1. Multilevel determinants of COVID-19 vaccination among marginalized sexual and gender minority adults.