Prepared by Marina Carman, Adam Bourne and Jackson Fairchild - April 2020 - Rainbow Health Victoria
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Prepared by Marina Carman, Adam Bourne and Jackson Fairchild April 2020
living with HIV who are on treatment and have an
undetectable viral load are at any greater risk at
this stage. This does make it even more important
to promote testing and early access to treatment
for those undiagnosed, and continuing access to
HIV treatment and care.
Beyond the immediate impact on health, the As data collection at health service level and
social and economic consequences of COVID-19 coronial reporting does not capture LGBTIQ
are far-reaching and leave no one untouched. identities, it will be very hard to assess the health
Media commentary and policy responses have so impacts on LGBTIQ communities in the short
far focussed on the mental health impacts of term. This is a major issue.
social distancing and concerns about an increase
in family violence – issues which affect all
Mental health
communities, but perhaps some more so than
others. Mental health is a concern across the community,
both in terms of anxiety about the disease itself
In this briefing paper, we aim to summarise and the impact of social distancing.
current research knowledge that may be relevant
to understanding how COVID-19 might impact on There is a significant body of evidence, in
lesbian, gay, bisexual, transgender, intersex and Australia and internationally, to suggest that
queer (LGBTIQ) health and wellbeing. The key LGBTIQ people experience anxiety and depression
issues presented here are relevant for all those at higher rates than their heterosexual peers and
commissioning, coordinating or delivering health are at greater risk of suicide and self-harm6,7,8.
or community services in the current context.
Young people, bisexual people, and trans and
gender diverse people are at an even higher
risk9,10,11,12.
Some studies have found significant levels of self-
harm and suicidality among people born with
Health status variations in sex characteristics. Participants
identified unnecessary medical interventions and
What we know about COVID-19 is that older other people’s attitudes as drivers of reduced
people and those with underlying health mental health and wellbeing, rather than the
conditions are at a greater risk of poor outcomes. intersex variation itself13.
People from LGBTIQ communities generally report Connection to community and peer support have
a lower rating of self-perceived health than the been found to have an important protective effect
general population1, and are known to have health for LGBTIQ people14, 15. These will be disrupted
disparities that might influence disease outcomes. with community venues closed and face-to-face
These include a greater risk for certain cancers, interaction severely limited.
asthma, obesity and cardiovascular disease2,3,4.
Smoking also appears to be a significant risk Family violence
factor for COVID-19 (given the higher risk for lung
and chest infections in general), and some Concerns have been raised by the family violence
sections of LGBTIQ communities have higher sector about an increase in intimate partner and
smoking rates than the general population. This is family violence for women and their children, and
especially the case for lesbian and bisexual an increase in the severity and intensity of
women5. violence and abuse. This is compounded by
reduced access to services and support when
Gay and bisexual men have higher prevalence isolated at home.
rates for HIV, but there is no evidence that people
2LGBTIQ people have largely been absent from this
discussion, despite the very real possibility that
Harassment and violence
their experiences may also deteriorate in the LGBTQ people generally report high levels of
current climate. Overall, long periods of time harassment, verbal and physical abuse, violence
spent at home can put pressure on relationships and sexual assault. This occurs in public and in all
and immediate families. LGBTIQ people will be areas of their lives33,34,35. It is unclear whether
impacted like everyone else, but also have some these experiences will worsen in times of
unique vulnerabilities. widespread social stress.
Intimate partner violence LGBTIQ communities have also historically
experienced criminalisation and negative
Intimate partner violence is reported at similar relationships with police36, so some aspects of the
rates in same gender relationships to heterosexual enforcement of social distancing may be
relationships16,17,18,19,20. Some studies have found distressing and difficult.
even higher rates, particularly for bisexual women
and trans and gender diverse people21,22,23,24.
Unfortunately, there is little research that
Drug and alcohol use
examines the experiences of intersex people25. There is strong evidence to suggest that many
LGBTIQ people use alcohol and illicit drugs more
Family of origin violence commonly than the general population37,38. In the
Many LGBTIQ people, particularly young people current context, there may be an increase in
living at home, hide their identities from their individuals struggling to manage their use of
‘families of origin’ out of fear and shame. In alcohol or drugs to the point where this has a
‘coming out’ within families, LGBTQ people can be negative impact on their lives. During a period of
subject to rejection, abuse and violence26,27,28. social distancing, individuals may also have less
Intersex people also report family rejection and access to resources or support networks to help
abuse, especially when they identify in ways other them manage their alcohol or drug use more
than their birth-assigned gender25. safely.
Experiences of rejection are linked to significant Homelessness and economic
negative mental health impacts. By contrast,
family acceptance has been shown to have a disadvantage
significant positive impact on mental health and Growing evidence suggests that a higher
wellbeing for young people29,30,31,32. proportion of LGBTIQ people have experienced
In the context of COVID-19, LGBTIQ people may homelessness than the general population39.
be separated from friends and ‘families of choice’ Discrimination can also lead to lower incomes and
not in their household. These connections have higher unemployment, particularly for trans and
been shown to be important protective factors for gender diverse people40,41. It is unclear how
health and wellbeing12,33. COVID-19 will impact already marginalised
populations in relation to security of housing and
income.
3that intersect with being LGBTIQ. For example,
LGBTIQ people who experience disabilities may
be especially affected in the context of COVID-19,
In Australia, legal recognition and protections for
especially in terms of accessing safe and affirming
LGBTIQ people have improved significantly in the
social care.
last decade, although important gaps remain for
trans and gender diverse people, and people with
intersex variations.
However, LGBTIQ people still regularly experience There is an urgent need to secure and enhance
inequality and devaluing of their identities and LGBTIQ community-controlled health and
relationships. Experiences of homophobia, community services to meet heightened needs.
biphobia and transphobia are undoubtedly The role of these trusted and skilled services in the
associated with poorer health, and the other context of COVID-19 is more important than ever.
economic and social disparities described here. There is also an expanded role for these
organisations in fostering connection and
community to build individual and collective
resilience.
Australian and international studies show that
In addition, a focus on LGBTIQ inclusion in
LGBTIQ people under-utilise health services and
mainstream service delivery and initiatives is also
delay seeking treatment due to actual or
required. The scale of anticipated need, and the
anticipated experiences of stigma and
limited availability of community-controlled
discrimination from service providers34,42,43. Trans
services, means that LGBTIQ people require
and gender diverse young people, in particular,
access to mainstream services that are LGBTIQ-
report encountering inexperienced or transphobic
inclusive. Many services across the country have
service providers, and long waiting lists to see
taken profound steps in organisational change to
‘trans-friendly’ providers. Feeling isolated from
enable culturally safe service delivery, including
services has been found to have a significant
40 organisations that have now received the
negative impact on mental health12. These issues
Rainbow Tick. These services, and others with a
may be heightened right now due to stress and
commitment to work towards the Rainbow Tick,
social distancing.
should be encouraged to expand their role in
A major barrier for LGBTQ people seeking mental service provision for LGBTIQ communities.
health care has been found to be the lack of an
Rainbow Health Victoria recommends that all
affirmative provider6,43. This means feeling safe
those commissioning, coordinating or delivering
and supported by staff and other clients, but also
health and community services do the following:
being valued and affirmed as LGBT by the
service42. It is crucial that health and community • Acknowledge the potential for COVID-19
services are affirming of sexuality and gender to have a disproportionate impact on the
identity, and attentive to the particular pressures health, mental health and wellbeing of
experienced by LGBTIQ people. LGBTIQ communities
• Promote and enhance LGBTIQ community-
Community and advocacy organisations in
controlled and LGBTIQ-inclusive service
Australia have voiced concern that trans and
delivery
gender diverse people may be reluctant to access
• Develop messages about community
medical support for COVID-19 due to a fear of
resilience and increase initiatives to
discrimination or feeling unsafe in shared care
provide community support through
spaces. This may be particularly acute if
adaptive means
hospitalisation is required and the ability to
• Share experience and knowledge in order
advocate for oneself, or to have someone else
to develop understanding of the impacts
present to do so, may be greatly diminished.
on LGBTIQ communities in real time and
All of these issues may be further compounded effective ways to respond rapidly through
when considering other identities and experiences research, policy, resources and programs.
412. Strauss P, Cook A, Winter S, Watson V, Toussaint D,
Lin A. Trans Pathways: the mental health
experiences and care pathways of trans young
1. Perales F. The health and wellbeing of Australian people. Summary of results. Perth: Telethon Kids
lesbian, gay and bisexual people: a systematic Institute; 2017.
assessment using a longitudinal national sample.
13. Rostant J, Leonard W, Jones T. Health and
Australian and New Zealand Journal of Public
wellbeing of people with intersex variations:
Health. 2019;43:281-287.
information and resource paper. Melbourne:
2. McKay B. Lesbian, Gay, Bisexual, and Transgender Victorian Department of Health and Human
Health Issues, Disparities, and Information Services; 2019.
Resources. Medical Reference Services Quarterly.
14. Wilson C, Cariola LA. LGBTQI+ Youth and Mental
2011;30(4):393-401.
Health: A Systematic Review of Qualitative
3. Conron KJ, Mimiaga MJ, Landers SJ. A Population- Research. Adolescent Research Review. May 2019.
Based Study of Sexual Orientation Identity and
15. Barr SM, Budge SL, Adelson JL. Transgender
Gender Differences in Adult Health. American
community belongingness as a mediator between
Journal of Public Health. 2010;100,1953-60.
strength of transgender identity and well-being.
4. Simoni JM, Smith L, Oost KM, Lehavot, K, Journal of Counseling Psychology. 2016;63(1):87-
Fredriksen-Goldsen K. Disparities in Physical Health 97.
Conditions Among Lesbian and Bisexual Women: A
16. Rollè L, Giardina G, Caldarera AM, Gerino E, Brustia
Systematic Review of Population-Based Studies.
P. When intimate partner violence meets same sex
Journal of Homosexuality. 2017;64(1):32-44.
couples: A review of same sex intimate partner
5. Praeger R, Roxburgh A, Passey M, Mooney-Somers violence. Frontiers in Psychology. 2018;9.
J. The prevalence and factors associated with
17. Brown TNT, Herman JL. Intimate partner violence
smoking among lesbian and bisexual women:
and sexual abuse among LGBT people: A review of
Analysis of the Australian National Drug Strategy
existing research. Los Angeles: Williams Institute,
Household Survey. International Journal of Drug
UCLA School of Law; 2015.
Policy. 2019;70:54-60.
18. Leonard W, Pitts M, Mitchell A, Patel S. Coming
6. King M, Semlyen J, Tai S, Killaspy H, Osborn D,
forward: The underreporting of heterosexist
Popelyuk D, Nazareth I. A systematic review of
violence and same sex partner abuse in Victoria.
mental disorder, suicide, and deliberate self harm
Melbourne: Australian Research Centre in Sex,
in lesbian, gay and bisexual people. BMC
Health and Society, La Trobe University; 2008.
Psychiatry. 2008;8:70.
19. Ovenden G, Salter M, Ullman J, Denson N,
7. Plöderl M, Tremblay P. Mental health of sexual
Robinson K, Noonan K, et al. Sorting it out: Gay,
minorities: A systematic review. International
bisexual, transgender, intersex and queer men’s
Review of Psychiatry. 2015;27(5):367-385.
attitudes and experiences of intimate partner
8. Corboz J, Dowsett G, Mitchell A, Couch M, Agius P, violence and sexual assault. Sydney: Sexualities
Pitts M. Feeling queer and blue: A review of the and Genders Research, Western Sydney University
literature on depression and related issues among and ACON; 2019.
gay, lesbian, bisexual and other homosexually-
20. UNSW. Calling it what it really is: A report into
active people. Melbourne: Australian Research
lesbian, gay, bisexual, transgender, gender diverse,
Centre in Sex, Health and Society, La Trobe; 2008.
intersex, and queer experiences of domestic and
9. McNair R, Kavanagh A, Agius P, Tong B. The mental family violence. Sydney: LGBTIQ Domestic and
health status of young adult and mid-life non- Family Violence Interagency and the Centre for
heterosexual Australian women. Australian and Social Research in Health, University of NSW; 2014.
New Zealand Journal of Public Health.
21. Barrett BJ, St Pierre M. Intimate partner violence
2005;29:265-71.
reported by lesbian-, gay-, and bisexual-identified
10. Taylor J, Power J, Smith E, Rathbone M. Bisexual individuals living in Canada: An exploration of
mental health: Findings from the 'Who I Am' study. within-group variations. Journal of Gay & Lesbian
Australian Journal of General Practice. 2019;48:138- Social Services: The Quarterly Journal of
144. Community & Clinical Practice. 2013;25(1):1-23.
11. Leonard, W, Lyons A, Bariola E. A Closer Look at 22. Coston BM. Power and inequality: Intimate partner
Private lives 2: Addressing the mental health and violence against bisexual and non-monosexual
well-being of lesbian, gay, bisexual and women in the United States. Journal of
transgender (LGBT) Australians. Melbourne: Interpersonal Violence. 2017;1-25.
Australian Centre in Sex, Health and Society, La
23. Langenderfer-Magruder L, Whitfield DL, Walls NE,
Trobe University; 2015.
Kattari SK, Ramos D. Experiences of intimate
partner violence and subsequent police reporting
5among lesbian, gay, bisexual, transgender, and 34. McKay T, Lindquist CH, Misra S. Understanding
queer adults in Colorado: Comparing rates of (and acting on) 20 years of research on violence
cisgender and transgender victimization. Journal of and LGBTQ+ communities. Trauma, Violence, &
Interpersonal Violence 2016;31(5):855-71. Abuse. 2019;20(5):665-78.
24. Yerke AF, DeFeo J. Redefining intimate partner 35. Callander D, Wiggins J, Rosenberg S, Cornelisse V,
violence beyond the binary to include transgender Duck-Chong E, Holt M, et al. The Australian trans
people. Journal of Family Violence. 2016;31(8):975- and gender diverse sexual health survey: Report of
9. findings. Sydney: The Kirby Institute, UNSW; 2019.
25. OII. OII Australia’s response to NSW discussion 36. Dwyer A, Ball M, Bond C, Lee M, Crofts T. Exploring
paper on domestic and family violence. Sydney: LGBTI police liaison services: Factors influencing
Organisation Intersex International Australia and their use and effectiveness according to LGBTQ
ACON; 2009. people and LGBTI police liaison officers. Canberra:
26. Asquith NL, Fox CA. ‘No place like home: Criminology Research Council; 2017.
Intrafamilial hate crime against gay men and 37. Ritter A, Matthew-Simmons F, Carragher N.
lesbians’. In: Dwyer A, Ball M & Crofts T, eds. Monograph No. 23: Prevalence of and interventions
Queering Criminology. London: Palgrave for mental health and alcohol and other drug
Macmillan; 2016. p. 163-82. problems amongst the gay, lesbian, bisexual and
27. D’Augelli A, Grossman A, Starks MT. Families of transgender community: A review of the literature.
gay, lesbian, and bisexual youth. Journal of GLBT DPMP Monograph Series. Sydney: National Drug
Family Studies. 2008;4(1):95-115. and Alcohol Research Centre; 2012.
28. Smith E, Jones T, Ward R, Dixon J, Mitchell A, Hillier 38. Roxburgh A, Lea T, de Wit J, Degenhardt L. Sexual
L. From blues to rainbows: The mental health and identity and prevalence of alcohol and other drug
well-being of gender diverse and transgender use among Australians in the general population.
young people in Australia. Melbourne: Australian International Journal of Drug Policy. 2016;28:76-82.
Research Centre in Sex, Health and Society, La 39. McNair R, Andrews C, Parkinson S, Dempsey D
Trobe University; 2014. (2017). Stage 1 Report - LGBTI Homelessness:
29. Ryan C, Russell ST, Huebner D, Diaz R, Sanchez J. Preliminary findings on risks, service needs and
Family acceptance in adolescence and the health use. Melbourne: GALFA LGBTI Homelessness
of LGBT young adults. Journal of Child and Research Project; 2017.
Adolescent Psychiatric Nursing. 2010;23(4):205-13. 40. Conron K, Scott G, Stowell GS, Landers SJ.
30. Katz-Wise SL, Rosario M, Tsappis M. Lesbian, gay, Transgender health in Massachusetts: Results from
bisexual, and transgender youth and family a household probability sample of adults. American
acceptance. Paediatric Clinics of North America. Journal of Public Health. 2012;102:118-22.
2016;63(6):1011-25. 41. Mizock L, Mueser KT. Employment, mental health,
31. McConnell EA, Birkett MA, Mustanski B. Typologies internalized stigma, and coping with transphobia
of social support and associations with mental among transgender individuals. Psychology of
health outcomes among LGBT youth. LGBT Health. Sexual Orientation and Gender Diversity.
2015;2(1):55-61. 2014;1(2):146-58.
32. Robinson BA. Conditional families and lesbian, gay, 42. Pennant ME, Baylis, SE, Meads, CA. Improving
bisexual, transgender, and queer youth lesbian, gay and bisexual healthcare: a systematic
homelessness: Gender, sexuality, family instability, review of qualitative literature from the UK.
and rejection. Journal of Marriage and Family. Diversity & Equality in Health & Care 2009;6:193-
2018;80(2):383-96. 203.
33. Leonard W, Pitts M, Mitchell A, Lyons A, Smith A, 43. Waling A, Lim G, Dhalla S, Lyons A, Bourne A.
Patel S, et al. Private lives 2: the second national Understanding LGBTI+ Lives in Crisis. Melbourne:
survey of the health and wellbeing of gay, lesbian, Australian Research Centre in Sex, Health and
bisexual and transgender (GLBT) Australians. Society, La Trobe University, and Lifeline Australia;
Melbourne: Australian Research Centre in Sex, 2019.
Health and Society, La Trobe University; 2012.
6Rainbow Health Victoria is a program that supports lesbian, gay, bisexual, transgender, intersex and queer
(LGBTIQ) health and wellbeing through research and knowledge translation, training, resources, policy
advice and service accreditation through the Rainbow Tick. We are located at the Australian Research Centre
in Sex, Health and Society at La Trobe University, and are funded by the Victoria Government.
Carman M, Bourne A, Fairchild J. COVID-19: impacts for LGBTIQ communities and implications for services: A
Research Briefing Paper by Rainbow Health Victoria. Melbourne: Rainbow Health Victoria, Australian Research
Centre in Sex, Health and Society, La Trobe University, 2020.
T: (03) 9479 8700
E:
W:
7You can also read
