Avery Belyeu was anxious as she drove up to the mobile coronavirus testing site and rolled down her window to talk to a doctor in full protective gear. She had a fever and cough but was hesitant to get tested. Belyeu, along with an estimated 77 percent of trans Texans, does not have formal identification to match the name and gender she prefers. Going to a new health-care provider, she knew, meant having to explain her identity and the risk of being discriminated against. But her fear of the virus compelled her to go through with the test; later, it came back negative.

“I’m very privileged in the fact that I do have health insurance,” Belyeu, who lives in Tarrant County and is the regional director of Lambda Legal, a LGBTQ advocacy organization, said. “However, I was extremely nervous because I was sent to a testing location that’s not my typical physician’s office where they know who I am and they know my identity.”

Belyeu’s story is similar to that of many trans Texans during the COVID-19 crisis, which has exacerbated the inequities the community had to face before the pandemic. UCLA’s Williams Institute estimates that there are 125,350 adults in Texas who identify as transgender—the second largest population in the country behind California. When it comes to receiving aid, and health care in particular, the community is often overlooked and discriminated against, in ways that make it more vulnerable during times of crisis.

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In Texas, before the pandemic, trans people had more than four times the statewide rate of unemployment and double the rate of poverty, and were more likely to experience homelessness and health problems. Though there’s no record of the percentage of trans Texans who don’t have health insurance, according to the Williams Institute, 26 percent of LGBT Texans are uninsured, compared with 17.7 percent of all Texans.

But even if they are insured, many trans Texans, like Belyeu, might be resistant to seek out coronavirus-related care. “I have heard from trans people who delayed going to receive testing either because they didn’t have health insurance, they were concerned about whether or not they would have access to testing, and delayed doing that for some time,” Belyeu said. “And I think that that’s really the norm.”

Before the pandemic, 22 percent of trans Texans did not see a doctor when they needed to because of fear of being mistreated as a transgender person, according to the 2015 Transgender Survey. The survey also found that 20 percent of trans Texans were denied coverage by their insurance because of their gender identity, and 30 percent of those who saw a health-care provider reported having at least one negative experience—verbal harassment, assault, refusal of treatment—related to being transgender.

There are community clinics around the state that focus on providing trans-affirming health care, and most have been able to stay open by providing telemedicine services. However, a majority of them are located in large metros, and not all are providing tests for COVID-19. In rural parts of the state, access to those same facilities can be few and far between.

Dr. Kelly Bennett is one of the few doctors in Lubbock who provides trans health care. She says many of her patients refuse to see any other doctors because of their anxieties ranging from overt discrimination to being misgendered or having to educate health providers about trans people. She’s even had new patients reach out then drive to see her from as far as Midland and Odessa (about two hours away) during this time. “Patients are concerned that something will be done incorrectly,” Bennett said. “And they just don’t want to explain [their gender] to somebody they’ve never met, especially through the phone or on an awkward Zoom visit.”

The gaps and barriers between trans Texans and services providing health care, mental-health care, and direct aid have resulted in organizations like Lambda Legal, a national legal organization litigating and advocating for LGBTQ people, to call for Governor Greg Abbott to expand health insurance to all Texans during the global pandemic. (They have not received a response from Abbott and are planning to raise the issue again to the Texas Health and Human Services executive council.) In recent years legislation has been drafted to address the inequities trans Texans face—calling for a transgender health-care committee and task forces—but has not passed.

In lieu of state support, nonprofits and grassroots organizations across Texas have been left to pick up the slack.

The Montrose Center in Houston, which serves the LGBT community at large, has long had a disaster relief program for this very reason. Back in 2005, when busloads of survivors arrived in Houston during Hurricane Katrina, many trans individuals were turned back from shelters and denied clothes of their choice based on their gender identity. “Anytime there’s an economic impact or a disaster that disrupts the economy,” said Kennedy Loftin, chief development officer at the Montrose Center, “that community, which in some cases is already living on the margins, is just going to be more impacted every time.”

Prior crises informed how the Montrose Center would handle the effects of COVID-19. They’ve continued to operate since stay-at-home orders took effect, with most case managers working remotely. In general, they’ve seen an uptick in the need for basic necessities like food and shelter, but for the trans community, they’ve seen an increase in mental health issues and suicides in particular.

The Montrose Center has also created a nonprofit incubator program, providing free resources, connections, and support to smaller organizations that focus specifically on serving transgender Texans and communities of color.

One organization receiving aid from the center, Save Our Sisters United, a Houston-based group for trans people of color, has in turn been providing direct financial assistance to its community.

When the pandemic started, Atlantis Narcisse, the organization’s founder, immediately thought of the members of her community who were sex workers, gig workers, and service industry workers. With a grant from the Simmons Foundation, an organization that assists underfunded marginalized groups in Texas, her organization has provided its first direct assistance fund for food, hotel rooms, and medication like HRTs (hormone replacement therapy). “This has never been done—something that was for us by us,” Narcisse said.

The organization has helped trans Texans like Alyssa Gamble, who was laid off in March from her housekeeping job at the Hilton hotel in downtown Houston, weeks before the city’s stay-at-home order went into effect. In one fell swoop, Gamble lost her job, health care, and income to pay rent. Save Our Sisters was able to give her $150—enough to get groceries and feminine hygiene products she needed before her unemployment money came through. She’s currently still unemployed and is receiving public assistance to pay for her housing and necessities.

Other aid groups have begun organizing online. Danny Roe, the assistant director of student diversity initiatives at Texas A&M Galveston, leads a trans support group. Its biweekly hour-long chats on Zoom have been a bright spot for members—some are in quarantine with family members who aren’t accepting of them. Roe told me that one member became depressed because the coronavirus forced her long-planned appointment for electrolysis for facial hair removal to be pushed back. Others haven’t been able to see their trans-affirming primary care physicians because of their lack of telemedicine services and restrictions on running bloodwork.

“All of these combined organizations and efforts versus the kind of funding that you see traditionally be passed down from either state, local, or federal coffers, it’s really a drop in the bucket,” Emmett Schelling, executive director the Transgender Education Network of Texas, said. “This is our community trying to do everything we can to meet people with just a little bit of assistance for them to survive through this. And unfortunately, we have to do this because we can’t rely on the systems that everybody else relies on.”