LGBTQIA+ Health and Inclusive Healthcare

This collection of resources aim to support GP supervisors in their teaching and supervision of registrars who are providing medical services to lesbian, gay, bisexual, trans and non-binary, queer, intersex, asexual and other (LGBTQIA+) patients in general practice.

The LGBTQIA+ community, like many marginal groups, are vulnerable to significant health disparities when compared with the heterosexual community. While some patients will confidently self-identify with their GP, many will not offer this information willingly unless they feel safe and comfortable to do so. LGBTQIA+ inclusive healthcare literacy puts vulnerable patients at ease and enables important patient history disclosure and the possibility of delivering better health outcomes for this patient cohort.

The two core resources are the GPSA Guide to LGBTQIA+ Health and Inclusive Healthcare in General Practice and the Clinical Guide to the Health Needs of People with Intersex Variations.

You can view an extended range of resources on this page.

LGBTQIA+ health and inclusive healthcare in general practice: An introduction to teaching and learning 

This guide is a comprehensive resource for GP supervisors to support their teaching and supervision of registrars providing medical services to LGBTQIA+ patients in general practice.
LGBTQIA Healthcare

Health needs of people with intersex variations

This clinical guideline provides an overview of intersex variations, medical diagnosis, surgical and hormonal interventions, psychosocial context, and a collection of further resources.

LGBTQIA+ Key Terms and Definitions

Diverse sexual orientation, gender identity and sex characteristics are all included in the LGBTQIA+ acronym. A Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables has been produced by the Australian Bureau of Statistics (ABS) in 2020 and provides a useful starting point of terms for clinicians to gain an understanding of the appropriate terminology.

The Victorian Government LGBTQIA+ Inclusive Language Guide expands on the above definitions, detailing this in the table on the right:

LGBTQIA+terms

Why Teach LGBTQIA+ Inclusive Healthcare?

Teaching LGBTQIA+ inclusive healthcare provides confidence and competence in your registrar’s ability to deliver appropriate care. A GP or practice nurse may be the first person someone talks to about their emerging diverse sexual orientation or gender identity, and this could happen at any age. Having a health professional who affirms their identity can be very therapeutic.

There are two major reasons for making the effort to know about an individual patient’s LGBTQIA+ status in clinical practice: 

  1. It provides a more holistic context about the life of that person, which is often desired by patients. 
  2. There are major health disparities for LGBTQIA+ people that require our attention and care.

Areas of Heightened risk:

Depression, anxiety, suicidality

Smoking, alcohol and drug use

Poorer sexual health

Increased instances of abuse

STIs

Reduced screening practices
 

What is LGBTQIA+ Inclusive Healthcare?

LGBTQIA+ inclusive care requires a whole of practice approach, so that the person’s journey through the clinic is safe. Encouraging disclosure of LGBTQIA+ identities starts at the front door, as they need to feel they will be acknowledged and supported. This is particularly important for LGBTQIA+ patients who may have experienced negative attitudes from healthcare providers in the past.

In helping to create an inclusive environment, there are a range of readily available Australian tools to assist. One example is the Rainbow Tick, an accreditation program and framework for planning and implementing organisational change to facilitate LGBTQIA+ inclusive services. Another is the Pride in Health online benchmarking. Intersex community organisations offer the ‘Yellow Tick’ to improve understanding of the health needs of people with intersex variations.

LGBTQIA+ Health Priorities

Children can become part of LGBTQIA+ families using multiple strategies, including assisted reproductive technologies, surrogacy, adoption, fostering, co-parenting, being a known sperm or egg donor and sexual intercourse

Further information on contraception, fertility, and pregnancy as part of LGBTQIA+ inclusive healthcare can be found in the GPSA Guide, free to download here.

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The roles the GP can play in LBQ contraception, fertility, and pregnancy:

  • Discussing options such as home insemination, clinic-based insemination, IVF, fostering, adoption, surrogacy within a same sex couple.
  • Safety planning if a known sperm donor is involved including STI, genetic and sperm testing for the donor.
  • Usual pre-conception care.
  • Referral to LGBTQIA+ inclusive fertility services if IUI or IVF and/or clinic-recruited sperm donor are needed.
  • Pregnancy care and referral to LGBTQIA+ inclusive obstetric services.
  • Caring for the children and family over the long term.
  • Discussing options such as home insemination, clinic-based insemination, IVF, fostering, adoption, surrogacy within a same sex couple.

Registrars should be comfortable asking questions related to sexual behaviour in a safe and appropriate manner. For patients who are trans and gender diverse, and when asking about the gender of partners, using the terms “assigned male at birth” or “assigned female at birth” can be a useful way of asking about sexual practices and knowing the relevant anatomy while respecting the gender identity of all concerned.

Further information on sexual health as part of LGBTQIA+ inclusive healthcare can be found in the GPSA Guide, free to download here.

Advice about safer sex is important. For some people, exploring their new sexual identities can involve unfamiliar sexual behaviour and this could expose them to new STI risks. If this is happening with your patient, it may be important to sensitively discuss risk and to offer regular STI testing. 

 

PrEP should be actively offered to men who have sex with men, trans and gender diverse people, and people who inject drugs who are at risk of HIV transmission. Similarly, PrEP can be commenced at patient request or if there is potential risk of HIV exposure in the future. As of 2021, PrEP is on the general PBS schedule and can be prescribed by any general practitioner.

Further information on STIs as part of LGBTQIA+ inclusive healthcare can be found in the GPSA Guide, free to download here.

LGBTQIA+ people are much more likely than the general population to smoke, drink potentially risky levels of alcohol and use illicit drugs. Reducing smoking, alcohol and drug use involves addressing an individual’s mental health, underlying issues, and setting up adequate supports. It is important to know services that are LGBTQIA+ friendly where individuals can get support if they are struggling with alcohol and other drugs. Facilitating connection to the LGBTQIA+ community outside of contexts involving alcohol and drug use can be a powerful protective factor for gay and bisexual men. Likewise, affirming an individual’s identity and recognising the impact of stigma, marginalisation and homophobia can facilitate care and recovery.

LGBTQIA+ statistics

Further information on smoking, alcohol, and drug use as part of LGBTQIA+ inclusive healthcare can be found in the GPSA Guide, free to download here.

LGBTQIA+ people are now a specific target group and listed as ‘high risk’ in the National Cervical Screening Program.  Cervical screening tests should be offered to all trans people who:

Men who have sex with men (MSM) and transgender people may be at risk of ano-rectal Human Papilloma Virus (HPV) infection through anal sex. This is the same type of virus that causes cervical cancer. Further information on cancer screening as part of LGBTQIA+ inclusive healthcare can be found in the GPSA Guide, free to download here.

One of the main health inequalities facing LGBTQIA+ people relates to their mental health. LGBTQIA+ people are much more likely than non-LGBTQIA+ people to experience depression, anxiety, and suicidality. This stems from often repeated experiences of trauma, discrimination, and marginalisation due to their minority sexual orientation, sex characteristics or gender identity, which is often termed minority stress. These experiences also differ within the subgroups and are much more likely for trans or non-binary people, and pansexual, bisexual, or queer people. Peer support is increasingly important in mental healthcare and recovery. This can be very important for many LGBTQIA+ people as it enables sharing of information, finding like-minded peers, and improving self-worth. Further information on mental health as part of LGBTQIA+ inclusive healthcare can be found in the GPSA Guide, free to download here