LBQ women living with a disability may be reliant on personal carers who prevent their access to the LGBTIQ community or discourage sexual expression. Homelessness is another under-recognised issue, with LGBTIQ people being over-represented among Australian homelessness populations. This particularly relates to family rejection for young people, and discrimination and violence in the private rental, social and crisis housing sectors.24 There are increasing numbers of LBQ refugees and asylum seekers in Australia who are fleeing persecution based on their sexual orientation or gender identity. They face major challenges proving their refugee status because they invariably had to hide their sexual orientation in their country of origin, and may be vilified by their cultural community in Australia.
The role of the GP
Although LBQ women are likely to have a regular GP, they are less satisfied with the care they receive than heterosexual women.25 Low satisfaction is often related to inadequate specific provider knowledge, as well as concerns regarding heterosexism (assumptions of heterosexuality) or negative attitudes. Satisfaction is associated with disclosure of sexual orientation when disclosure is met with affirming attitudes, and disclosure can result in more comprehensive, high quality primary health care.26
GPs have important roles to play above and beyond standard health care for LBQ women. First and foremost is affirmation of a woman’s sexual identity and openly displaying respect for diversity. This will overcome some of the fear that many LBQ women bring to the encounter and will encourage disclosure of other stigmatised issues (e.g. sexual abuse, intimate partner violence, substance use, homelessness, social exclusion). Recognising the role of discrimination in LBQ women’s health is critical, as is understanding their preferences for referral (mainstream or LGB-specific services).
Health promotion is important in specific areas that are often deferred by LBQ women (including cervical and breast screening). Engaging with family formation planning and helping women to build resilience to LBQ-specific stressors is also positive. Advocacy regarding legal issues can be helpful, including understanding who is the nominated next-of-kin and who are in the woman’s chosen family. Further, encouraging women to have a medical power of attorney and an advance care plan can clarify medical decision making when needed.
Various guidelines and training packages on LBQ women’s health are available for GPs in need of more detailed upskilling. The Rainbow Tick accreditation guidelines have been developed by Rainbow Health Victoria (formerly Gay and Lesbian Health Victoria) at La Trobe University, and provide important whole-of-system approaches for inclusive care. GP resources are shown in Table 2.
The health and wellbeing of LBQ women can be enhanced and maintained if they have a respectful and inclusive GP who is willing to delve a little deeper into understanding the full context of their lives. LBQ women will appreciate and welcome this approach. MT