America’s LGBTQ population faces a perfect storm of factors that put them at high risk for COVID-19, a respiratory infection that is primarily spread through person-to-person contact, according to a report released Friday by the Human Rights Campaign. That’s why the organization is calling on federal and state policy makers to address the health and safety needs of the LGBTQ population, in the face of the novel coronavirus.

Research shows that 37 percent of queer and trans individuals report being daily smokers, as opposed to just 27 percent of non-LGBTQ people. LGBTQ people are also 50 percent more likely to have asthma. Both of these groups—smokers and individuals with a history of respiratory ailments—are among those most profoundly impacted by coronavirus, according to public health officials. Meanwhile, LGBTQ people “are less likely to have health coverage… and have a variety of chronic illnesses.”

HRC also noted that LGBTQ people are more likely than the average person to lack health insurance—with 17 percent uninsured versus about 8.5 percent of Americans in general—and are less likely to seek treatment from a doctor when they get sick, largely out of fear of discrimination. A report from the Center for American Progress published in 2017 found that one in four LGBTQ individuals had faced harassment, abuse, or mistreatment in health care settings within the past year because of their sexual orientation or gender identity.

HRC President Alphonso David said the reality is that 29 states in the U.S. still don’t have inclusive civil rights laws at the statewide level, meaning that LGBTQ people continue to “face discrimination in employment, housing, public accommodations, credit, [and] education.”

“There is no federal law that expressly prohibits discrimination based on sexual orientation and gender identity,” David said, adding that it could impact the ability of people to receive medical treatment if they contract COVID-19. “If I live in one of those 29 states where there are no affirmative protections and I’m facing discrimination in the allocation of services, where do I go?”

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To prevent queer and trans people from being turned away from healthcare providers or hospitals during the coronavirus outbreak, nearly a dozen U.S. senators, including Bob Menendez, Chuck Schumer, Elizabeth Warren, and Kamala Harris, wrote a letter on Thursday calling on the federal government to reverse its rollback of LGBTQ nondiscrimination protections. Last June, the Department of Health and Human Services issued a proposed rule that would allow health care workers to refuse treatment to individuals on the basis of their religious faith.

In the letter, signatories warn that the rule leaves “LGBTQ people without access to the health services they need.”

LGBTQ advocacy groups said, however, that one segment of the community needs particular attention amid the coronavirus outbreak: people living with HIV.

Carl Baloney Jr., vice president of policy and advocacy for AIDS United, noted that this population is generally “at risk of serious complications from COVID-19.” People living with HIV generally already have “compromised immune systems,” Baloney Jr. said. Because of that, according to the Centers for Disease Control and Prevention, their bodies can be especially vulnerable to opportunistic infections. Some research has indicated that people with HIV may not face any greater risk of infection from COVID-19 than members of the general public if they are routinely taking antiretroviral medications as prescribed and are not otherwise immunocompromised, according to the CDC. However, the New York City Department of Health and U.S. Department of Health and Human Services caution that any disruptions in an individual’s medication, such as a sudden loss of insurance, could put them at greater risk for contracting coronavirus.

“We insist upon the same level of caution as with anyone else within who are immunocompromised,” Baloney Jr. said. He noted that early clinical trials to test whether HIV-prevention medications like Kaletra can help prevent coronavirus transmissions have been inconclusive.

Further complicating matters is that many people living with HIV are vulnerable to COVID-19 in more than one way. Of the estimated 1.1 million Americans who are HIV positive, 16 percent of that population is over the age of 65. That age group has among the highest mortality rates from coronavirus in the U.S., accounting for approximately 80 percent of all deaths.

Tez Anderson, founder of the nonprofit Let's Kick A.S.S. for long-term survivors and a survivor himself, said he and other advocates are concerned about older adults who have been living with HIV for decades.

“Our immune systems have been through hell and back,” Anderson said. “Facing a new virus like this would be scary and could be very fatal to us.”

That’s why AIDS United and other groups like Black AIDS Institute, Whitman-Walker Health, and the Southern AIDS Coalition, urged the federal government to ensure that any coronavirus relief package includes resources for those most affected by COVID-19. A comprehensive plan that meets the needs of people living with HIV should include accessible testing for coronavirus, rental assistance, and lifting refill limits on HIV-prevention medications, according to these organizations.

“The continued safety, health, and wellbeing of everyone in the United States, especially those living with HIV, rests in the hands of a comprehensive response, and the time to act is now,” they said in a March 17 letter.

A trillion-dollar stimulus plan is currently being finalized in Congress, one that could include payouts to every American, in order to help sustain those who may find themselves out of work as coronavirus continues to spread across the country. As of Thursday, there have been over 61,000 confirmed cases of COVID-19 in the U.S. and 500 deaths. With many individuals reporting that they have not been able to get tested for coronavirus despite showing symptoms, those figures could be much higher.

At the end of the day, David said, the Trump administration will be responsible for addressing this crisis—whether it’s for LGBTQ people, individuals living with HIV, or any other affected community. The president spent weeks downplaying the risk of COVID-19 and spreading misinformation and has now taken to blaming China and state governors for escalating rates of transmission.

“[The Trump administration] did not respond in the way that they should have,” he said. “They still are not responding in the way that I think is appropriate, and unfortunately, people are still dying. They should have taken a much more aggressive, science-based approach in addressing this crisis.”