Inclusive practice ‘isn’t a checkbox’

Australians who identify as bi+ experience far poorer sexual health and safety outcomes than people in the general population, reporting higher levels of sexual violence, psychological distress and illicit drug use, according to a new study.
 
The findings of the Bi+ Sexual Health and HIV study of sex, health and relationships of 2100 people within Australia’s bi+ community, conducted through a survey by the Kirby Institute and the University of New South Wales (UNSW), point to an ‘urgent need’ for the recognition of the growing cohort’s specific health needs, say researchers.
 
Bi+, a community created umbrella term encompassing sexual identities such as bisexual, pansexual, queer and fluid, represents ‘the largest population group within the LGBTQ+ community’, according to the study’s chief investigator, Associate Professor Benjamin Bavinton.
 
‘The more we understand about people with bi+ identities, the better equipped we are to challenge historical and harmful stereotypes, combat stigma, and design better health services,’ he said.
 
The study reveals bi+ people are highly engaged with health services, with 72% of participants having a regular GP.
 
It found 89% of respondents had accessed a sexual health-related service at least once in their lifetime. General practice was the most commonly accessed, at 82%, followed by sexual health clinics at 47%.
 
Chair of RACGP Specific Interests Sexual Health Medicine Dr Sara Whitburn told newsGP that while many GPs are ‘very committed’ to inclusive care, GP training ‘hasn’t always kept pace with evolving understandings of sexuality and gender’.
 
‘This research is important because it highlights that bi+ people are engaged with healthcare, but the care they receive doesn’t always reflect their needs,’ she said.
 
‘Sexual health training [for GPs] has historically focused on risk categories rather than individualised, inclusive conversations.
 
‘As a GP, the report reinforces that inclusive practice isn’t a checkbox; it’s an ongoing process of learning, reflecting, and adapting.’
 
Of the survey participants, 63% reported experiences of adult sexual violence perpetrated against them, while 28% reported psychological distress and 24% recent illicit drug use.
 
While cis bi+ women had higher levels of engagement with healthcare, they also experienced higher rates of illicit drug use, sexual violence perpetrated against them and STI diagnoses. 
 
Trans and non-binary/gender diverse bi+ participants reported feeling more included in and engaged with LGBTQ+ communities but also reported higher rates of sexual violence perpetrated against them, and poor mental health. 
 
Cis bi+ men were less likely to be connected to LGBTQ+ community and sexual health care in general. 
 
Less than half of survey respondents (47%) felt welcome in LGBTQ+ sexual health services and only 41% felt general sexual health services were knowledgeable and inclusive of bi+ people.
 
Dr Whitburn said the lack of understanding felt by bi+ patients in health services could be due to ‘assumptions’ of a patient’s partner being either opposite-sex or same-sex, ‘which can exclude or erase bi+ experiences’.
 
She said the lower connection to services of cis bi+ men suggests ‘missed opportunities for engagement’.
 
‘GPs can be a way to reach people who may not identify with existing LGBTQA+ spaces,’ she said.
 
‘Forms, intake questions, and conversations may not reflect fluid or multiple partner genders over time. Reviewing and updating forms and assessments, as research identifies areas for improvement, can assist with maintaining holistic and inclusive care.’
 
Dr Whitburn said the higher rates of sexual violence reported, particularly for bi+ women and transgender and gender-diverse people, means sexual health consultations ‘must go beyond screening and include routine, sensitive enquiries about safety’.
 
She said that while it is ‘positive’ to see general practice is the most accessed health service by bi+ people, the report also shows ‘continuing research and education are needed to improve care specifically for bi+ people’. 
 
Dr Whitburn said GPs could be better supported to meet the needs of bi+ patients with funded sexual health and LGBTQIA+ health training, ‘so GPs feel confident providing inclusive, up‑to‑date care’.
 
‘We also need higher Medicare rebates for longer consultations, because inclusive, non‑judgemental sexual health conversations take time to do properly,’ she said.
 
Log in below to join the conversation.

Bi+ gay illicit drug lesbian LGBT LGBTIQA+ non-binary queer sexual violence transgender