1. Queer in the Community David Mills and Keiran Rossteuscher

2. AIDS ACTION AIDS Action Council of the ACT Located at Westlund House, Acton PLWHA ACT and SWOP ACT Free counselling Workshops (Stepping Out, Out There, Looking Out, Together) Safe sex products Free resources and publications Free Legal Clinic Community Space Volunteering and training

3. AIDS ACTION Introducing gender and sexuality Disparities in health and service access Inclusive service provision

4. AIDS ACTION What is GLBTI? Gay Lesbian Bisexual Transgender Intersex but wait, there’s more…

5. AIDS ACTION The Sexual Trichotomy Sexual Identity (how we self and publicly identify) Sexual Behaviour (the sexual contacts we have) Sexual Orientation (who we are attracted to)

6. AIDS ACTION Identity “ I think of myself as a lesbian because my attraction to men is generally small, rare and squashable. In my case, even though I have a boyfriend I still think of myself as a lesbian. As a general rule (98% of the time) I am ONLY attracted to the same sex, occasionally (rarely) I might be attracted to the opposite sex (as I have a boyfriend currently)” Mary 16 yrs

7. AIDS ACTION Sex Gender Sexuality MasculineFeminine MaleFemale Heterosexuality Transgender Intersex Gay, Lesbian & Bisexual

8. AIDS ACTION Homophobia Ignorance, hatred or intolerance of people who are same sex attracted Overt (violence) covert (no appropriate health information) Heterosexism Normalising or privileging heterosexuality and binary gender roles Marginalising or persecuting those who are not heterosexual Heteronormativity Assumption that all people are heterosexual Forces people to declare that they are the ‘other’

9. AIDS ACTION Homophobia In Australia 35% of Australians aged 14 and above believe that homosexuality is immoral This belief is more widely held in rural areas than in large cities Mapping Homophobia In Australia (2005) Flood & Hamilton

10. AIDS ACTION Discrimination Perceived Real Reduced access to appropriate healthcare Compromised health outcomes

11. AIDS ACTION Good or excellent self-rated health

12. AIDS ACTION People who identify as LGBT are more likely to… be target of bullying, harassment or assault engage in recreational drug use (both licit and illicit) be affected by mental illness engage in self harm and suicidality be affected by homelessness increased levels of STI’s

13. AIDS ACTION PLEASE NOTE! Most GLBTI people are not unhappy with their identity, but instead with the way they are treated because of it!

14. AIDS ACTION Health – women Same sex attracted women (aged 22 – 27) were more likely to report: Being depressed (38% vs 19%) Higher levels of anxiety (17.1% vs 7.9%) Self-harm or suicide attempt in last 6 months (12.6% vs 2.7%) Women’s Health Australia Longitudinal Study, McNair et al. 2003

15. AIDS ACTION Have you ever been depressed?

16. AIDS ACTION Suicide attempts 528 young adults – up to 30yrs (m=21yrs) Bisexual/undecided female 34.9% Bisexual/undecided male 29.4% Lesbian female28% Gay male 20.8% Heterosexual female 8.3% Heterosexual male 5.4% Nicholas and Howard 2001

17. AIDS ACTION Women’s Health Australia Longitudinal study of the health of Australian women (n 40,000) Analysis of the same sex attracted women in the younger cohort of the study (22 – 27 in 2000) showed that these women were significantly more likely to report: Risky alcohol use (7% compared to 3.9%) Marijuana use (58.2% compared to 21.5%) Other illicit drugs (40.7% compared to 10.2) Injecting drug use (10.8% compared to 1.2%) (Hillier et al, 2003)

18. AIDS ACTION Young People National study of same sex attracted young people, n = 2000 7% males, 14% females injected drugs; 15% weekly (vs. 1%-2% in general pop’n). 33% had shared injecting equipment. Young people in rural areas were more likely to have injected than those in metropolitan areas. Hillier et al, 2003

19. AIDS ACTION Smoking In a study of drug use in the gay community lesbians generally had the highest rates of tobacco use with the 30 – 39 age group smoking at a higher rate over a higher period of time. ( Murnane 2000) The 2004 Sydney Women and Sexual Health Survey found rates of 34% for smoking compared to and ABS figure of 24% for Australian women generally. (Richters et al 2000)

20. AIDS ACTION Modifying daily activities at least sometimes

21. AIDS ACTION Barriers to service use for GLBTI clients GLBTI people’s fears of discrimination (or experience of discrimination) cause them to use health services less, and they are likely to present later with a problem which is therefore less amenable to treatment. GLBTI patients are likely to be especially conscious of protecting their privacy in medical records. The potential disclosure of their sexual orientation on medical records may be a factor in their willingness to discuss it openly (Mulligan EA & Braunack-Mayer A 2004)

22. AIDS ACTION Inclusive Service provision There are some very simple elements of service provision which all professionals can undertake. Taken together they can make a real difference to GLBTI clients

23. AIDS ACTION Practical things you can do Create a welcoming environment using posters or pamphlets Use intake forms which don’t exclude. Language which does not foreclose on any disclosure eg “partner” without a gender assumed.

24. AIDS ACTION Elements of inclusive service provision Guarding against heterosexual assumptions e.g. questions about contraception, pregnancy. Not assuming that identity implies a particular sexual history. Reassurance relating to confidentiality and record keeping. Not being afraid to ask about an issue if you are unsure.

25. AIDS ACTION Resources Hillier, L et al. (2003) Women’s Health Longitudinal Study Hillier, L et al. (2005) Writing Themselves in Again Pitts, M et al (2006) Private Lives Study Gay and Lesbian Health Victoria (GLHV)