Prepared by Marina Carman, Adam Bourne and Jackson Fairchild - April 2020 - Rainbow Health Victoria

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Prepared by Marina Carman, Adam Bourne and Jackson Fairchild - April 2020 - Rainbow Health Victoria
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

                                                      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

LGBTIQ 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

that 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
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
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.

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Rainbow 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



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