Stigma affecting the health of Australians in same-sex relationships

The Monash University study, which used Census data to compare the health outcomes of same-sex couples to heterosexual counterparts in their areas, found the effects of stigmatisation are strongest for people with lower income, less education and reduced access to GPs and other healthcare providers.
 
By using the results of the 2017 marriage equality plebiscite and Census-linked-administrative data of 9,336,811 Australians in relationships, researchers were able to measure the extent to which structural stigma – ‘no’ votes against same-sex marriage – was associated with healthcare and prescription medicine use among 83,519 people in same-sex relationships.
 
It found that as structural stigma increases, compared to their heterosexual peers, Australians in same-sex relationships:
 
•             are less likely to visit the doctor, and use fewer general practice and pathology services if they do
•             use more scripts for mental health disorders (such as antidepressants and anti-anxiety medication)
•             are more likely to report having a disability or to have received disability support payment.   
 
Responding to the findings, lesbian and bisexual women’s health GP and University of Melbourne Associate Professor Ruth McNair told newsGP it is ‘imperative’ doctors in areas with high levels of stigmatisation encourage patients in same-sex relationships to be more proactive with their health.
 
‘In an environment of high stigma people will be more vigilant in the healthcare setting about everything – they will only attend for acute or urgent issues, and tend to stay away for routine care,’ she said.
 
‘The level of trust will be lower and the expectation of discriminatory treatment will be higher.
 
‘Practices needs to very actively demonstrate their LGBTQI inclusive credentials through direct advertising to the LGBTQI community, and visual representation in imagery and brochures in the waiting room.’
 
Associate Professor McNair said employing LGBTQI staff to better represent the community can also have a powerful impact, and that all of these measures must be accompanied by staff training.
 
‘[Training should include] how to use appropriate language and managers, and how to create a culturally safe environment in the clinic [that has] a no tolerance approach to negative attitudes, doctors and other clinical staff,’ she said.
 
‘Being aware of specific measures to take with LGBTQI patients, in this context especially around mental health needs [and] which counsellors are LGBTQI knowledgeable, [is also important].’
 
Of the 83,519 individuals in same-sex relationships captured by the study, 6550 women (8%) and 5411 men (6%) lived in regions with high structural stigma.

Study co-author and PhD researcher Karinna Saxby said sociocultural factors that disadvantage minority groups can contribute to health inequalities by inducing pathophysiological stress responses, risky health behaviours and apprehension to seek appropriate healthcare.

‘Altogether, our research suggests that although sexual minorities in stigmatised regions are in poorer health and therefore arguably have greater healthcare needs, they are less likely to access primary healthcare services,’ Ms Saxby said.

‘This highlights the need for policies to reduce structural stigma, improve access to healthcare and, more broadly, interventions to reduce the health and healthcare disparities in sexual minorities.’

Aside from structural reforms, Associate Professor McNair is a ‘strong believer’ in the advocacy roles GPs can play in these communities.
 
‘The first step is creating a welcoming and safe environment in their own practices [to] demonstrate how it can be done,’ she said.
 
‘GPs can also talk with local businesses about stepping up and discuss LGBTQI needs such as housing security, reducing job discrimination, [and] working with local schools to be more supportive of LGBTQI young people and their families.
 
‘This is even more important in areas of high stigma.’
 
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