Victoria’s Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Health and Wellbeing Action Plan 2014 –18 Accessibility To receive this publication in an accessible format email: [email protected]
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Printed by Intelligent Media, Cheltenham, on sustainable paper (1409015) Ministers’ message
The Victorian Government is committed to addressing health, mental health and wellbeing issues affecting lesbian, gay, bisexual, transgender and intersex (LGBTI) Victorians and their communities. We acknowledge that while many LGBTI people live healthy, connected, happy and positive lives, the LGBTI community, in general, experiences poorer health and wellbeing outcomes than other Victorians across a number of areas. This is particularly the case for transgender and gender diverse Victorians. At the same time, we acknowledge the strength and resilience of LGBTI individuals and communities in overcoming challenges, and recognise their diverse experiences.
Working in partnership with a range of health and community organisations, the Victorian Government delivers programs and initiatives to address health and wellbeing issues affecting LGBTI individuals and communities. This includes the delivery of targeted services that recognise the unique needs of LGBTI individuals and communities, and programs to address stigma and discrimination which directly contributes to poorer health and mental health outcomes.
In 2013 a GLBTI Health and Wellbeing Ministerial Advisory Committee was convened to provide advice to the government about how we can improve the health of LGBTI Victorians. An important focus of this committee was improving the health and wellbeing of transgender and gender diverse people. The advice of the Ministerial Advisory Committee, together with a targeted consultation with members of Victoria’s LGBTI communities, informed the development of Victoria’s Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Health and Wellbeing Action Plan 2014-18.
The Action Plan articulates the Victorian Government’s priorities for improving health and wellbeing outcomes among LGBTI individuals and communities. It is organised around five strategic priorities: the promotion of inclusive practice to improve access to mainstream health services; improving our understanding of emerging health and wellbeing issues for LGBTI communities and individuals; addressing discrimination and stigma; improving access to current and appropriate information and advice; and encouraging and supporting LGBTI specific health promotion activities. Each priority is supported by a number of strategic directions to support improved health and wellbeing.
We want to ensure that health services in Victoria are more inclusive, respectful and responsive to the health and wellbeing needs of LGBTI individuals and communities. This Action Plan sets out a path to that goal.
Hon. David Davis Hon. Mary Wooldridge Minister for Health Minister for Mental Health Minister for Ageing Minister for Community Services Acknowledgements
Thank you to the many individuals and organisations who participated in the community consultations by providing written submissions, attending community forums or being interviewed, and the members of the Gay, Lesbian, Bisexual, Transgender and Intersex (GLBTI) Health and Wellbeing Ministerial Advisory Committee who have provided advice on a range of issues covered within this plan.
In accordance with current practice in Australia and internationally and the recommendation of the GLBTI Health and Wellbeing Ministerial Advisory Committee, the Action Plan features the acronym LGBTI. Note that the Ministerial Advisory Committee retains its original title for consistency. Further, the terms Same Sex Attracted and Sex and Gender Diverse (SSASGD) are used when referring only to young people.
Current membership of the GLBTI Health and Wellbeing Ministerial Advisory Committee Chair of the Ministerial Advisory Committee • Mike Kennedy
Deputy Chair of the Ministerial Advisory Committee • Ruth McNair
Subcommittee Chairs for the Ministerial Advisory Committee • Brenda Appleton – Trans and Intersex Health and Wellbeing • Matt Dixon/Mike Kennedy – Sexual Health and HIV • Beng Eu – Drugs, Including Alcohol and Tobacco • Jennifer Majoor – Mental Health, Stigma and Discrimination • Ruth McNair – Inclusive Practice, Ageing and Youth
Members of the Ministerial Advisory Committee • Rowena Allen • Brent Allan • Tony Briffa • Rebecca Dominguez • Michael Ford • Sim Kennedy • Hilary Knack • Liam Leonard • Sharon Lewin • Madeleine Paulson • Jody Saxon-Barney • Mark Stoové • Jeremy Wiggins • Mike Williams Contents
Ministers message
Acknowledgements
What we currently do 1
Engaging LGBTI communities and individuals 2
Key initiatives to support improved health and wellbeing 2
Delivering targeted health services 3
Addressing stigma and discrimination 4
Developing policy that promotes best practice 5
Piloting new technologies and prevention approaches 6
Promoting inclusive practice 6
What is working well? 8
Listening to Victoria’s LGBTI communities 11
Key issues and themes 13
Strategic Priorities and Directions 15
Priority 1: Promote inclusive practice to improve access to mainstream health services for LGBTI communities and individuals 17
Priority 2: Improve our understanding and response to emerging health and wellbeing issues for LGBTI communities and individuals 18
Priority 3: Addressing discrimination and stigma in the Victorian health system 19
Priority 4: Improve access to current, accessible and appropriate information and advice 20
Priority 5: Encouraging and supporting LGBTI specific health promotion activities 21
The way forward 23
Appendix 1: Key health issues facing LGBTI communities and individuals 27
Appendix 2: Current LGBTI health related activities supported by the Victorian Government 31
Appendix 3: Glossary 33
Bibliography 35
What we currently do What we currently do
The Victorian Government is committed to improving the health and wellbeing of all LGBTI Victorians.
While most LGBTI people live fulfilling and healthy lives, research indicates that as a population group, Australia’s LGBTI community has poorer health and wellbeing compared with the total population1.
This poorer health and wellbeing status largely results from stigma and discrimination that LGBTI people can experience in their everyday lives, and specific health issues related to being lesbian, gay, bisexual, transgender or intersex.
Engaging LGBTI communities and individuals In recognition of the higher ill-health burden among LGBTI communities and individuals, the GLBTI Health and Wellbeing Ministerial Advisory Committee was convened in 2013 to provide advice to the Minister for Health and Ageing and the Minister for Mental Health. The Committee established five working groups to reflect the key priorities for the Committee:
• Transgender and Intersex health and wellbeing • Mental Health, and stigma and discrimination • Sexual Health and HIV • Inclusive Practice: ageing and aged care, and integrated responses to young people • Drugs, including alcohol and tobacco
The Committee played an active role in providing advice to inform the development of the health and wellbeing action plan for Victoria’s LGBTI population. This included helping to shape a targeted consultation with members of the LGBTI community and people working in the healthcare sector.
The consultation process, conducted in 2014, included three general community forums and provided an opportunity for written submissions on issues for the health and wellbeing of LGBTI communities and individuals. A wide range of experiences and views were reflected in the consultation process.
The LGBTI Health and Wellbeing Action Plan 2014 – 2018 has been developed to reflect the engagement with the LGBTI population through channels including the Ministerial Advisory Committee and consultation with diverse communities and individuals.
Key initiatives to support improved health and wellbeing Since 2010 we have invested in a wide range of innovative programs, initiatives and research projects to address some of the key health and wellbeing issues facing LGBTI communities and individuals. One of our major priority areas of investment has been in same-sex attracted and sex and gender diverse (SSASGD) youth suicide prevention initiatives and programs. We know that SSASGD young people experience high or very high levels of psychological stress as a direct result of discrimination and abuse. We want to promote strength and resilience in young people together with eliminating stigma and discrimination. That is why we have invested $4 million over four years into the Healthy Equal Youth (HEY) Project.
1 The key health issues facing LGBTI people can be found in Appendix 1, which provides a summary of the evidence of the main health issues for LGBTI people.
2 We have also invested in initiatives designed to enhance the capacity of the youth, health and community sectors to better respond to the needs of LGBTI communities and individuals. Working in partnership with community organisations, health services and research bodies, the Victorian Government has:
• strengthened and expanded support services for SSASGD young people in metropolitan and rural areas of high need • invested in a number of initiatives to improve the experience for LGBTI young people accessing mainstream health services, including training in sexuality and gender diversity for frontline health workers • committed to challenging homophobia, biphobia and transphobia through a range of tailored programs, projects and the promotion of mainstream anti-homophobia, anti-biphobia and anti-transphobia and diversity campaigns • invested in youth group support services, and youth leadership, mentoring and peer education initiatives to reduce social isolation and encourage social connectedness and empowerment • established Victoria’s first community-based peer-led rapid HIV testing trial, representing a significant contribution to Victoria’s fight to end the HIV epidemic • developed a diversity planning and practice framework for Home and Community Care to improve access for LGBTI people • invested in the Positive Ageing program to contribute to our understanding of what is required to ensure positive experiences of ageing by people with living HIV.
Delivering targeted health services Recognising that SSASGD young people are at higher risk of anxiety, depression, self-harm, and drug and alcohol misuse, the Victorian Government has invested significant resources in suicide prevention programs.
HEY Project The Victorian Government has invested $4 million over 4 years to target suicide prevention and positive mental health programs for young people who are SSASGD through the Healthy Equal Youth Project (HEY Project), which developed in partnership with a range of LGBTI community organisations.
Programs and initiatives supported under the HEY Project have focused on improving the mental health and quality of life for SSASGD young Victorians. HEY project grants have been used to build the capacity of select organisations to increase the reach and quality of the services they provide to SSASGD young people and to increase the engagement and empowerment opportunities for SSASGD young people.
The HEY Project includes a small grants program to build community capacity at the grassroots level by providing young people and their organisations the opportunity to apply for funding to complete small community capacity building projects through a competitive grants process. Some recent examples include funding for the CREATE Foundation to undertake a project working with young people in out-of-home care who identify as SSASDG and funding for Carers Victoria to deliver a program that builds the capacity of carer support workers, respite service staff and mainstream youth workers across Victoria to engage with SSASGD young people with caring responsibilities.
3 These and many other initiatives funded through the small grants program are working, at a community level, towards improving the health and wellbeing of SSASGD young people.
Other funded services In addition to mainstream services that LGBTI Victorians access, the Department of Health provides support to a number of agencies to deliver targeted health services aimed at improving the health and wellbeing of LGBTI people and communities, including:
• Gay and Lesbian Switchboard, which provides a telephone counselling, referral and information service for Victorian and Tasmanian LGBTI communities • Victorian AIDS Council/ Gay Men’s Health Centre (VAC/ GMHC) which provides prevention, care, support and advocacy to gay men, bisexual men and men who have sex with men and undertakes sexual health promotion activities aimed at increasing public awareness of sexual health and decreasing rates of HIV and sexually transmissible infections • The VAC/GMHC will also commence offering alcohol and drug treatment services to LGBTI people • Living Positive Victoria, which provides peer support services, resource development and information dissemination, and programs such as smoking cessation workshops to improve the health and wellbeing of people living with HIV/AIDS • Southern Health Gender Dysphoria Clinic, which provides specialist assessment, diagnosis and treatment for people questioning their gender identity and seeking medical assistance with transitioning • Gay and Lesbian Health Victoria, which provides health and wellbeing resources and policy formulation, organisational training and undertakes research • Uniting Care Cutting Edge Diversity Project, Shepparton, which provides two tailored preventive support and early intervention services targeted to SSASGD young people aged 10 – 25 years with a focus on youth suicide prevention through community support and early intervention • Geelong Adolescent Sexuality Project (GASP), which provides peer support and one-on- one support for SSASGD young people, sexuality training for teachers, youth workers and organisations that work with young people, and classroom sessions on diversity and sexuality in the City of Greater Geelong
Addressing stigma and discrimination The Victorian Government has invested in programs and reforms that tackle stigma and discrimination experienced by LGBTI communities and individuals, including:
• Safe Schools Coalition Victoria, providing training, resources and support to schools to assist them in becoming homophobia and transphobia free spaces where SSASGD young people and LGBTI staff are valued • a UN Youth Human Rights Summit on SSASGD rights at home and abroad, focused on educating participants about LGBTI issues and anti-SSASGD prejudice from a local and global perspective, and to train them to tackle these issues in their local communities and on the world stage • a Theatre and Education Pilot Project YGLAM, working in partnership with the Safe Schools Coalition and four schools to explore the ways in which discrimination occurs and stimulate conversation about safety and inclusion for SSASGD young people
4 • WayOut@Cobaw Community Health, working with SSASGD young people and their local communities to raise awareness about sexual and gender identity diversity and to tackle the underlying discrimination and prejudice that can lead to poorer mental health outcomes • No To Homophobia campaign, aiming to challenge all forms of harassment and discrimination faced by LGBTI communities and individuals in order to reduce the incidence of homophobic, biphobic and transphobic harassment in Victoria • recently introducing legislation into Parliament to decriminalise historical convictions for consensual homosexual acts. The reforms will allow people who were convicted of offences to apply to have these convictions expunged through a confidential application process. The expungement scheme is due to commence in 2015 Developing policy that promotes best practice The Victorian Government partners with various health service sectors, health professionals and community representatives and research bodies to develop and promote best practice policies.
In 2013, the Department of Health published the Decision-Making Principles for the Care of Infants, Children and Adolescents with Intersex Conditions resource, which was developed in collaboration with leading experts in the field, and is intended to assist decision-makers to safeguard the best interests of young people in this complex health area. The resource synthesises the advice of Victorian Government, medical, human rights, ethical and legal experts and community advocates, and outlines best practice principles to be applied to decision-making.
In 2011, the Department of Health released a Service Guideline on Gender Sensitivity and Safety: Promoting a holistic approach to wellbeing for Victoria’s mental health and alcohol and other drug services. This guideline sets out what is required of services and individual practitioners to provide culturally-sensitive care for LGBTI people.
Working closely with beyondblue’s Victorian Centre of Excellence in Depression, Anxiety and Related Disorders, the Victorian Government has supported a number of research priorities and projects exploring the risk and protective factors for LGBTI communities and individuals experiencing depression and anxiety. These include:
• the impact of homophobic bullying during sport and physical education participation on same sex attracted and gender questioning young Australians’ depression and anxiety levels • building the evidence base of risk and protective factors for depression and anxiety for the LGBTI Community • the ALICE study: Alcohol and Lesbian/bisexual women – Insights into Culture and Emotions.
The project findings and recommendations will inform policies, programs and practices, as well as the development of training modules and resources.
5 Piloting new technologies and prevention approaches In 2013 the Victorian Government, in partnership with community and researchers, established PRONTO!, Australia’s first community-based, peer-led rapid HIV and syphilis testing trial. The provision of affordable, accessible, convenient rapid HIV testing, which can deliver a result in 20 minutes or less. There are many reasons people don’t test, or don’t test regularly – including difficulty in appointments, fear of stigma and discrimination and the time taken to wait for a result.
The Victorian Government is working to remove barriers to HIV testing, normalise the process and improve testing rates amongst gay men and men who have sex with men in order to shrink the pool of people who have undiagnosed HIV and reduce the rates of HIV transmission. Increasing both the rate and frequency of testing for at risk populations enables earlier detection and treatment commencement for HIV. The sooner a person knows their HIV positive status, the sooner they can start HIV treatments and stay healthy. Rapid HIV testing at PRONTO! is a service delivered by peers in a non-clinical setting, providing an alternative option to test for HIV, making it easier for people to test without inconvenience, fear or judgement. This is an important step in the Victorian Government’s prevention strategy to reduce incidence of infection in Victoria and get more gay men and people at risk of HIV testing – and testing more frequently. The Department of Health supports a combined prevention approach to reducing HIV transmissions and improving health outcomes for people living with HIV. This includes:
• increasing voluntary HIV testing in people at risk of HIV • reducing the proportion of people with undiagnosed HIV infection • achieving earlier diagnosis • rejuvenating the HIV partnership response • increasing the proportion of people with HIV on treatment leading to a reduced viral load at an individual and population level • maintaining and seeking to increase safe sex and safe injecting practices in at-risk populations • reducing HIV-related stigma and discrimination
The Department of Health has supported a demonstration study in partnership with researchers, private enterprise and affected communities to explore the use of pre-exposure prophylaxis (PrEP). The PrEP study aims to examine if PrEP can be implemented feasibly, safely and effectively in Victoria through a program targeted at the populations at highest risk of HIV acquisition.
Promoting inclusive practice Inclusive practices that make people feel more comfortable using mainstream health services can be important to improving the health and wellbeing of LGBTI communities and individuals. The Victorian Government partners with key community agencies to undertake work with the ageing and aged care service sector and mainstream health service providers to develop inclusive practice aimed at improving the experiences of LGBTI people when accessing health services.
6 Mainstream health services, mental health, alcohol and other drugs services Recent reforms have strengthened the capacity of mental health services to identify specific needs at a regional level and respond appropriately. Other mental health and alcohol and other drugs services supported by the Department of Health include:
• Zoe Belle Gender Centre, which works with mainstream health and human service providers to improve support to the sex and/ or gender diverse community by developing resources and training, working in and with the sex and/or gender diverse community and supporting the activities of its youth organisations • Minus 18, which provides an online network and convenes safe and inclusive events for SSASGD young people, develops resources and delivers workshops in order to reduce social isolation and tackle discrimination • Gay and Lesbian Health Victoria which provides training to healthcare services, develops health resources and manages an information clearinghouse. As part of the HEY Project, Gay and Lesbian Health Victoria is also supported to provide SSASGD youth mental health training to mainstream youth mental health services in Victoria including headspace. The Department of Health has also supported Gay and Lesbian Health Victoria to develop a drug and alcohol LGBTI training module and to provide training for twelve drug and alcohol services across Victoria • Rewired, which is a program run by the Victorian AIDS Council for men who have sex with men to address methamphetamine use. Ageing and aged care The Victorian Department of Health has developed the Home and Community Care (HACC) Diversity planning and practice framework to support HACC organisations improve access to a wider range of HACC services for eligible people with complex needs due to diversity. Inclusion of LGBTI in the development of the diversity planning guide and talking about LGBTI issues to the HACC funded sector has generated considerable interest from funded organisations, many of which have included a focus on improving service responses to LGBTI clients in the 2012-2015 diversity plan, and annual diversity plan reviews.
The Department of Health, in conjunction with Gay and Lesbian Health Victoria and the Municipal Association of Victoria, has also developed and piloted the Creating gay, lesbian, bisexual, transgender and intersex inclusive Home and Community Care services (The HACC Pack) training resource, including the roll out of a series of workshops.
The Victorian Government in partnership with Alfred Health and key community stakeholders is undertaking research into the impacts of ageing on people living with HIV. The Positive Ageing Project will provide a better understanding of the experiences of ageing by people with HIV, together with opportunities for action to inform the policy and program responses to issues of ageing in people with HIV.
A list of current LGBTI health activities supported by the Victorian Government is provided in Appendix 2.
2 The HACC program is jointly funded by the Commonwealth and Victorian governments
7 What is working well? This section highlights how Victorian Government investment and partnerships with the health sector and other community agencies have resulted in the more effective provision of health services.
LGBTI Diversity Planning – Home and Community Care Services In 2012 the Victorian Department of Health introduced diversity planning and practice into the Home and Community Care (HACC) program.
The HACC program provides funding for services that support older and frail people, with moderate, severe or profound disabilities and younger people with moderate, severe or profound disabilities and their unpaid carers. HACC services provide basic support and maintenance to people living at home to help avoid premature or inappropriate admission to long-term residential care. The HACC program has identified five special needs groups that may experience particular difficulty in gaining access to HACC services:
• people from Aboriginal and Torres Strait Islander backgrounds • people from culturally and linguistically diverse (CALD) backgrounds • people with dementia • people living in rural and remote areas • people experiencing financial disadvantage (including people who experience, or are at risk of, homelessness)
The HACC program is committed to respecting the diversity of the Victorian population and to removing perceived or actual barriers such as lack of confidence, lack of information or a belief that a service will not respond to their needs which may impede a person’s willingness or ability to access a service.
Diversity planning and practice includes the HACC special needs groups and the characteristics within and across these groups. Diversity planning and practice also addresses other groups who may experience barriers to accessing services, including LGBTI people and people living with HIV.
Gay and Lesbian Health Victoria report that many older LGBTI people grew up knowing that they could be imprisoned or forced to undergo medical ‘cures’ if they revealed their sexual orientation or gender identity. The legacy of this experience means that many older LGBTI people feel unsafe about disclosing their sexual orientation and/or gender identity to service providers. Some people will go to lengths to hide their identity from HACC workers before they arrive at their homes. For example some older gay and lesbian people feel it necessary to remove photos of partners or social occasions. Some gay men do not disclose their sexual identity because they fear HACC services assume that they are HIV positive and could withdraw services because they fear contagion.
8 Case study The North and West Metropolitan Region of the Victorian Department of Health included the LGBTI community in its 2012-2015 HACC Diversity Plan. This prompted a Banyule City Council in Melbourne’s north eastern suburbs to introduce a LGBTI lens onto the delivery of the Council’s HACC services.
‘As expected, the initial reaction amongst some staff was “Why do we have to do this, we already treat everyone the same” and “We do not have any LGBTI clients”’.
Professional training in LGBTI inclusive health and human services provided by the Australian Centre in Sex, Health and Society (LaTrobe University) ‘has given us enough knowledge to know how to address these statements’. It ‘gave us an insight into the problems faced by the ageing LGBTI community and what their concerns might be around accessing community services’. ‘Talking about the subject and content of the training helped towards familiarising our HACC staff with the term LGBTI. Many staff had no idea what this meant’.
‘We gradually introduced LGBTI into our service provision. We explained some of the concerns that our LGBTI clients may have accessing services’. ‘We produced a draft Diversity Statement including LGBTI, and asked for staff input around the wording’. ‘During group meetings we used some of the examples from the training about real LGBTI HACC recipients and their experiences with HACC providers. This has really helped our direct support workers understand why this is such an important issue’.
Banyule City Council’s HACC managers have commenced adding inclusive service clauses to all of their HACC documentation, including position descriptions, agency service agreements, staff interview questions, and support worker and team leader manuals.
Banyule City Council has also recently established a LGBTI Advisory Committee to provide advice and information on issues facing the LGBTI community and on the development and implementation of the Council’s Inclusion, Access and Equity Plan.
9 Service accreditation (The Rainbow Tick) The Rainbow Tick consists of six standards against which services can be formally accredited to demonstrate LGBTI inclusive practice and service delivery. Services can include the six standards as part of their cycle of service accreditation or can apply to do the Rainbow Tick as a stand-alone assessment subject to ongoing reassessment and quality review. Services that receive The Rainbow Tick will have the opportunity to be listed in a national register of LGBTI accredited organisations.
The Rainbow tick is a world first and was developed by GLHV in consultation with Quality Innovation Performance (QIP).
The six LGBTI inclusive standards which service are assessed against are: 1. Access and intake processes 2. Consumer consultation 3. Cultural safety 4. Disclosure documentation 5. Professional development 6. Organisational capacity
GLHV has an audit tool that organisations can use to assess their current level of LGBTI inclusive practice. The audit tool is available for download as a PDF. GLHV also offers staff training and professional development on LGBTI issues and inclusive practice and a HOW2 program that assists organisations in meeting each of the six standards. http://www.glhv.org.au/GLBTI-inclusive-practice
LGBTI community input into creating inclusive health services In 2010 Peninsula Health, the major health care provider serving the metropolitan and rural areas of Victoria’s Mornington Peninsula established a Gay, Lesbian, Bisexual, Transgender, Intersex, and Queer Community Advisory Group (GLBTIQ CAG).
The GLBTIQ CAG provides a mechanism to communicate with and respond to the community issues and needs of consumers, carers and members of the community, it provides advice on how to create inclusive, more welcoming environments and appropriate care and treatment services.
The Community members and services providers of the GLBTIQ CAG work diligently to improve health and wellbeing outcomes for the GLBTIQ local community.
The CAG members promote GLBTIQ issue through a newsletter, and have presented at conferences and to executives of Peninsula Health.
They have advocated for improved youth services across the region, hold an annual health and wellbeing forum for GLBTIQ community, and developed a ‘rainbow’ mural; which is displayed in Mental Health.
The group are currently working towards the rainbow tick accreditation for Mental Health and are working to improve HIV awareness and prescribing for the region.
10 Listening to Victoria’s LGBTI communities Listening to Victoria’s LGBTI communities
As part of our commitment to improving the health and wellbeing of Victoria’s LGBTI communities, the Victorian Government wanted to hear the views, perspectives and experiences of individuals, community organisations, service providers and clinicians.
Between January and May 2014, the Department of Health undertook a targeted community consultation with LGBTI-specific and mainstream service providers and clinicians, and members of Victoria’s LGBTI communities. The purpose of the consultations was to inform participants about the development of the LGBTI Health and Wellbeing Action Plan, Victorian Government priorities and activity in LGBTI health and to obtain community perspectives on:
• health and wellbeing issues, including health system issues of concern for LGBTI individuals and communities • possible gaps in service provision, coordination and planning for LGBTI sub-populations • priorities for future action
Individuals, organisations, health services and clinicians were invited to provide written submissions via the Department of Health website or in hard copy, and to attend community forums or participate in interviews.
The consultation forums attracted 140 participants representing a wide variety of experiences and views, with separate consultations held with service providers and consumers. Participants in forums were asked to identify issues relating to their health and their experiences, particularly of the health system. Twenty-eight written submissions were received from individuals and organisations.
Three general community forums were held, with two in Melbourne and one in regional Victoria.
Recognising diversity within diversity The Victorian Government knows that “LGBTI” encompasses a diversity of communities and individuals, some who share similar experiences and others who don’t. Recognising that these communities and individuals have varied health and wellbeing needs, as well as acknowledging the rich diversity of experiences and views, the Department of Health held a number of targeted consultation forums.
These included forums specifically for parents of transgender and gender diverse children, transgender and gender diverse adults, people with intersex variations, bisexual men and women, and Aboriginal and Torres Strait Islander people. This approach enabled participants to share very specific experiences and raise issues in a safe space that might otherwise not have been heard in the general community forums. These forums provided important insights into many of the challenges faced by individuals and families as they navigate Victoria’s health system. A number of participants commented on the importance of having the opportunity to raise specific issues through the consultation process.
12 Key issues and themes Participants in the consultation process generously shared their insights and experiences. A wide range of issues was raised through the community consultation process including some that are outside the scope of this plan. While there were some of very specific issues raised by different sections of the LGBTI community, a number of common themes emerged out of the community consultation process.
These included:
The importance of knowledge, understanding and awareness, particularly amongst health service providers, of the diverse and specific health and wellbeing needs of LGBTI individuals and communities.
Access to appropriate information for service providers, individuals and families. Participants identified the need for access to up-to-date, accessible and appropriate information and advice on a range of issues, particularly for complex and less common issues.
The need for professional education and training for service providers. Participants identified the importance of improving attitudes and behaviours in health services, with some reporting experiences of stereotyping, discrimination and labelling in the health system. Focussed staff training and professional development were identified as key to the development of appropriate health services, particularly in relation to:
• challenging heteronormative assumptions, homophobia, biphobia and transphobia • understanding multiple marginalities and how these may play out for different people • strategies for inclusiveness, including creating inclusive environments and clinical practices • cultural competence regarding specific health and wellbeing issues of LGBTI individuals
Access to appropriate services, care and support Participants highlighted the importance of timely access to appropriate health services, especially for transgender and gender diverse children, and children and adults with intersex variations. Access to surgical, mental health and service providers with expertise in presenting conditions was also identified as important. Support programs and services, including peer support groups, were highlighted as crucial for individuals experiencing isolation, helplessness and anxiety.
The need for more research and better data collection practices Participants identified the importance of research into emerging health and wellbeing issues to support evidence based policy making, and to contribute to the development of resources and training materials to increase knowledge, understanding and awareness amongst health service providers of the diverse and specific health and wellbeing needs of LGBTI individuals and communities.
Stigma and discrimination Participants highlighted the importance of addressing stigma and discrimination. A number of participants reported experiencing stigmatising attitudes and overt discrimination in a wide variety of settings and places, including verbal and physical abuse, bullying (including in social media) and denial of access to goods and services.
13
Strategic priorities and directions Strategic priorities and directions
Our goal is to ensure that health services in Victoria are more inclusive, respectful and responsive to the specific and diverse health and wellbeing needs of LGBTI individuals and communities. The LGBTI Health and Wellbeing Action Plan is organised around five high level strategic priorities. The priorities were developed to respond to issues highlighted by the targeted consultation and to reflect the advice of the GLBTI Health and Wellbeing Ministerial Advisory Committee. Each strategic priority is supported by a number of strategic directions designed to improve the overall health and wellbeing of Victoria’s LGBTI communities.
Strategic priorities Outcomes
Promote inclusive practice to improve LGBTI communities and individuals in access to mainstream health services Victoria are able to access appropriate for LGBTI communities and individuals and sensitive healthcare
Improve our understanding of emerging The development of a robust and health and wellbeing issues for LGBTI rigorous evidence base that can usefully communities and individuals inform healthcare system responses
LGBTI individuals and communities feel Address discrimination and stigma safe living in the community and are not fearful of expressing their identities
Improve access to current, accessible Up-to-date and appropriate and appropriate information and advice information and advice is available
The reduction of preventable health Encourage and support LGBTI specific conditions and risk taking behaviours health promotion activities among various LGBTI communities
16 Priority 1: Promote inclusive practice to improve access to mainstream health services for LGBTI communities and individuals Community consultations identified that access to non-judgemental and supportive services and service providers is essential. There is a need for mainstream and specialised services to be culturally competent and accessible to all LGBTI people, including sub-populations such as the transgender and gender diverse population. Service providers who are open, understanding, do not stereotype or assume heterosexuality and are prepared to learn are valued and respected.
Our directions for 2014–18 Examples of current Where to next? good practice
Build on initiatives and programs The Victorian guide to LGBTI Identify and assess the most that promote inclusive practices inclusive practice for health and effective approaches for within health services human services has provided promoting inclusive practices accessible guidelines enabling within health services services to become more welcoming and responsive to LGBTI people
Promote the development of Zoe Belle Gender Centre works Identify opportunities for the inclusive policies, guidelines and with mainstream health and development of on-line training resources to improve access to human services providers by modules and resources to mainstream health services for developing resources and training assist health organisations LGBTI communities to improve health services for to develop inclusive policies transgender and gender diverse and practices, especially for people transgender and gender diverse people where a particular need has been identified
Encourage partnerships within, GASP and Diversity provide Investigate and scope effective and between services, including sexuality training for teachers, methods of linking mainstream those in rural areas, to enhance youth workers and organisations health services to LGBTI service options and referral that work with young people in specialist services pathways Geelong and Shepparton
Encourage professional SSCV improve the health of Encourage professional education and training in SSASGD youth by provide mentoring and exchange creating an inclusive practice training, resources and support programs environment to assist schools to become homophobia and transphobia free spaces
Promote the development GLHV have developed The Further refine best practice of cultural awareness and Rainbow Tick accreditation approaches to working with competence program to encourage LGBTI LGBTI communities and friendly organisations individuals
17 Priority 2: Improve our understanding and response to emerging health and wellbeing issues for LGBTI communities and individuals Research and data collection are required to inform program development and service delivery, including research into specific sub-populations and multiple marginalities.
Our directions for 2014–18 Examples of current Where to next? good practice
Promote quality research This Victorian Government Build on and strengthen projects that focus on supports beyondblue’s Victorian partnerships with research addressing specific health and Centre of Excellence in institutions and bodies to wellbeing issues for the LGBTI Depression, Anxiety and Related identify and support ongoing community, including barriers to Disorders, to have a priority priorities and projects on accessing advice, information, focus on LGBTI research. This emerging issues support and care includes supporting a number of research priorities and projects exploring the risk and protective factors for LGBTI communities and individuals experiencing depression and anxiety The Victorian Government supports GLHV to run a LGBTI health information clearing house, providing resources for individuals, organisations and health care workers
Build on our current knowledge Through consultations In partnership with the base and improve data conducted for this plan, a wide community and relevant collection practices range of issues and evidence organisations, continue to have been identified refine our approach to data collection
18 Priority 3: Addressing discrimination and stigma in the Victorian health system Increasing understanding and tolerance in the broader community is leading to greater acceptance, but stereotyping, discrimination and labelling frequently occur in the health system, media and general community. Improving attitudes and behaviours in the health system and media would positively influence broader community attitudes.
Our directions for 2014–18 Examples of current Where to next? good practice
Build on successful initiatives The Rainbow Network, the Safe Explore the effectiveness of and mainstream campaigns Schools Coalition Victoria and partnerships with community challenging homophobia, the Zoe Belle Gender Centre organisations and businesses transphobia and biphobia in have all worked to challenge in areas of identified need areas of identified need homophobia, transphobia and biphobia in a range of settings
Build resilience and good mental The HEY project has worked Improve our understanding of health to mitigate the impact across Victoria to build resilience the protective and risk factors of stigma and discrimination and good mental health for to build resilience to mitigate experienced by many LGBTI SSASGD young people the impact of stigma and individuals and communities discrimination
Continue to work with The Victorian Government Promote the importance of communities to challenge supports GLHV, who run the peer-led support networks, discrimination and stigma HOW2 Create a LGBTI inclusive programs and resources in service course for health services. challenging discrimination and This is offered on a user-pays addressing stigma model
19 Priority 4: Improve access to current, accessible and appropriate information and advice The community consultation identified that there is a general lack of information and advice across a range of topics relevant for LGBTI individuals and communities. This is particularly problematic when issues are complex and less common.
Access to accurate information that takes account of factors such as age and level of understanding is crucial for people to be in control of their own lives. Information can be accessed in different ways, including through service providers, printed and web based resources, peers, support groups and social media.
Our directions for 2014–18 Examples of current Where to next? good practice
Build on current best practice The development of a best Promote the further resources and information practice guide to LGBTI development of information, inclusive practice for health guidelines, fact sheets, and and human services training materials for clinicians and services providers
Explore innovative approaches Information is provided that is Identify opportunities to utilise to making up to date information accessible to LGBTI individuals new digital technologies and advice available to and communities. This includes and web-based platforms to individuals and communities Minus 18, which provides an deliver information to LGBTI when and where they need it online network for SSASGD communities young people, and the GLHV clearing house
Assist health care providers, Individuals and communities are Build partnerships between communities and individuals supported to make informed the health sector and LGBTI make the most informed choices through the provision communities to support choices to improve their health of responsive and accessible inclusive practice and wellbeing services. For example, the HACC Diversity planning and practice guides service delivery to diverse groups including the LGBTI community
20 Priority 5: Encouraging and supporting LGBTI specific health promotion activities Recognising the diverse and specific needs of LGBTI sub-populations was identified by the community consultation as an important area for focus. Tailoring health promotion activities to specific sub-populations will support improved health and wellbeing outcomes for LGBTI individuals and communities.
Our directions for 2014–18 Examples of current Where to next? good practice
Encourage innovative, creative The VAC conducts innovative Work with organisations and cutting edge health health promotion targeting gay supported to undertake promotion approaches, men. For example the Drama health promotion activities strategies and campaigns to Downunder campaign to reduce to develop specific activities address a range of LGBTI health transmission of STIs and HIV and campaigns tailored to and wellbeing issues has been running successfully addressing a range of LGBTI for many years health and wellbeing issues
Identify specific health and Living Positive Victoria is one Work in partnership with wellbeing risks amongst of a number of supported research organisations, LGBTI communities that could organisations that address institutions and stakeholders be targeted through health specific LGBTI health issues. to identify new and emerging promotion and awareness For example they provide health and wellbeing issues campaigns smoking cessation workshops to and risks amongst particular improve the health and wellbeing population groups within the of people living with HIV broader LGBTI community
Ensure our health promotion The Department maintains Review current approaches approaches, activities and regular contact with funded and identify areas for efforts are responsive and LGBTI agencies to remain improvement relevant informed of current LGBTI health issues
21
The way forward
23 The way forward
This plan sets the broad policy framework for improving the health and wellbeing of Victoria’s LGBTI communities. The Department of Health will continue to work in close partnership with health and aged care services, clinicians and healthcare workers, community organisations, and research bodies to achieve the outcomes set out in this action plan.
There are a wide range of existing organisations and forums, funded through a diverse set of arrangements, currently contributing to service delivery, program development and policy for the LGBTI community. The Department of Health will work with these organisations, using existing forums where possible, to implement the directions of this plan.
The goal of this work will be to identify key priorities for implementation that build on and complement the work of the sector. Recommendations from the GLBTI Ministerial Advisory Committee along with other advice, reports and evidence will inform this work.
Implementing the Action Plan
Short-term actions
Priority 1: Promote inclusive practice to improve access to mainstream health services for LGBTI communities and individuals
Promote current best practice guides for LGBTI health Continue to support The Rainbow Tick program, and additional organisational culture change work Support the HOW2 program to provide participants with strategies and tools to implement LGBTI inclusive practices, protocols and procedures within their organisations Revise the guide to LGBTI inclusive practice for health and human services, and promote the use of the revised guide
Priority 2: Improve our understanding and response to emerging health and wellbeing issues for LGBTI communities and individuals
Continue to support beyondblue in their work identifying LGBTI research needs and supporting research projects that produce a better understanding of LGBTI health needs Use information collected through recent LGBTI community consultations and other state supported activities to inform future research directions
24 Priority 3: Addressing discrimination and stigma in the Victorian health care system
Using evidence, identify areas of greatest need, and identify mechanisms for encouraging partnerships between business and the community sector to create LGBTI welcoming environments Support the development of new resources and the promotion of new and existing resources designed to counter homophobia, transphobia and biphobia Supporting an inclusive approach to the implementation of best practice guidelines in addressing sexuality after stroke Continue to support current work to provide more effective and accessible mental health services for SSASGD young people and reduce stigma and discrimination in settings where young people spend time Continue to support high profile LGBTI community events that raise the visibility of the LGBTI community and ensure their voices are heard in the broader community Encourage health services across Victoria to become welcoming, accessible and effective for LGBTI people through: • promotion of the guide to LGBTI inclusive practice for health and human services • the HOW2 program which provides training, strategies and tools to implement LGBTI inclusive practices, protocols and procedures within organisations • supporting The Rainbow Tick program
Priority 4: Improve access to current, accessible and appropriate information and advice
Revise the guide to LGBTI inclusive practice for health and human services to ensure it remains up to date and takes into account recent changes in LGBTI health management Identify guides to LGBTI best health practice and promote these to health care professionals through existing channels Use existing on-line platforms such as the Better Health Channel to distribute information to LGBTI individuals and communities Continue to support and promote other existing dedicated LGBTI web-based channels to promote guides and resources that promote LGBTI good health
Medium-term actions
Priority 1: Promote inclusive practice to improve access to mainstream health services for LGBTI communities and individuals
Review current consumer participation mechanisms and identify ways for greater consideration of LGBTI issues to ensure these needs are being considered Develop information and resources for transgender and gender diverse people, and distribute these resources, including through the Better Health Channel Expand accessibility of LGBTI specialised services through mechanisms such as Telehealth Examine ways LGBTI health best practice can be incorporated into current clinical practitioner IT systems Explore options for including LGBTI health as part of the core curriculum for undergraduate health professionals
25 Priority 2: : Improve our understanding and response to emerging health and wellbeing issues for LGBTI communities and individuals
Address key data gaps, including those related to transgender and gender diverse people
Priority 3: Addressing discrimination and stigma in the Victorian health care system
Explore options to support and expand LGBTI peer support activities in Victoria, particularly for trans, gender diverse and intersex Victorians, and Same Sex Attracted and Sex and Gender Diverse young people
Priority 4: Improve access to current, accessible and appropriate information and advice
The provision of responsive and accessible services through supporting planning and practice guides for service delivery to diverse groups including the LGBTI community
Priority 5: Encouraging and supporting LGBTI specific health promotion activities
Tailor existing health promotion and prevention activities to incorporate LGBTI specific issues Identify any gaps in current risk reduction activities and develop responses that address any gaps in a timely and effective way Examine current work targeting LGBTI sub-populations, such as Aboriginal gay men, bisexual men and MSM to ensure current actions remain effective
Long-term actions
Priority 2: Improve our understanding and response to emerging health and wellbeing issues for LGBTI communities and individuals
Monitor current LGBTI health research and seek ways to incorporate findings into the health system to ensure it is providing effective care to LGBTI people
Priority 4: Improve access to current, accessible and appropriate information and advice
Develop better care pathways for diverse groups within the LGBTI community
Priority 5: Encouraging and supporting LGBTI specific health promotion activities
Work in partnership with LGBTI community organisations to ensure that health issues particular to LGBTI people are being targeted through health promotion Monitor new and ongoing LGBTI health research to identify emerging and existing health issues that require attention Commit to evaluating health promotion activities to ensure they are appropriate and effective for LGBTI people
26 Appendix 1: Key health issues facing LGBTI communities and individuals
While most lesbian, gay, bisexual, transgender and intersex (LGBTI) people live fulfilling and healthy lives, research indicates that as a population group, Australia’s LGBTI community has poorer health and wellbeing compared with the total population (Leonard, Pitts et al. 2012). The interaction of other factors such as socioeconomic status or ethnicity can have a compounding effect or be a protective factor, exacerbating or preventing, poorer health and wellbeing.
Key health issues for LGBTI include:
• Poor mental health - people across the LGBTI spectrum are more likely to experience poor metal health as a result of discrimination. Transgender and gender diverse people are particularly badly effected • Illicit drug use – rates of illicit drug use are believed to be higher, particularly amongst gay men, and even more so amongst gay men living with HIV • Smoking and alcohol misuse – rates of smoking and alcohol misuse are also believed to be much higher, particularly amongst lesbians and bisexual women, and they are less likely to seek treatment • HIV is more prevalent amongst gay men than any other sub-population in the community, and rates of sexually transmissible infection are higher amongst gay men and bisexual women • The risk of breast cancer and cervical cancer is higher for lesbians.
Following is a summary of what the literature tells us about the evidence regarding the key health issues for LGBTI communities and individuals.
Stigma and discrimination Research identifies stigma and discrimination as major factors impacting on the health and wellbeing of LGBTI communities and individuals (Couch, Pitts et al. 2007; Barrett 2008; Hillier, Jones et al. 2010; Leonard, Pitts et al. 2012). While there is much greater recognition and acceptance of diversity within the Australian community than has historically been the case, stigma and discrimination persist as significant issues for many LGBTI communities and individuals.
Stigma and discrimination can manifest in:
• homophobic, biphobic and transphobic harassment • verbal abuse and violence • fear of the consequences of disclosing sexuality and/or gender identity • not feeling accepted • exclusion from the mainstream and lack of recognition of the individual, and • limited access to, and lower usage rates, of some healthcare services
Stigma and discrimination can cause fear, hypervigilance, anxiety, internal conflict, risk taking behaviours, self-harm, and social isolation, all of which contribute to poorer health and wellbeing.
27 Identity-specific health issues Gay men and men who have sex with men (MSM) Gay men and MSM are at more risk of contracting HIV and other sexually transmissible infections (STIs) than heterosexual people because of the high rates of infection amongst this relatively small population group. At the end of 2013, there were approximately 6,885 people living with HIV in Victoria. Between 2008-2012, 91% of all newly acquired HIV transmissions were among men and the significant proportion of these infections were the result of male-to-male sex (76% in 2012) (Centre for Population Health 2014).
Some evidence also suggests that gay men and MSM use recreational drugs at a higher rate than the general population and lesbians, bisexual women and transgender people (Leonard, Dowsett et al. 2008). In 2014, HIV-positive men were more likely to report drug use compared with HIV- negative men and HIV-positive men remain considerably more likely to report any injecting drug use compared with HIV-negative men (14.3% vs. 2.0% in 2014) (Lee, Mao et al. 2014).
Lesbians Some Australian research indicates that lesbians have higher rates of smoking and hazardous alcohol use than heterosexual women; however there is limited evidence about the reasons (Hyde, Comfort et al. 2009; Hughes, Szalacha et al. 2010). Some researchers point to stress, particularly minority stress, including experiences of discrimination (Hughes, Szalacha et al. 2010; Johnson, Hughes et al. 2013). There is also some suggestion that smoking and alcohol consumption have been normalised as part of group identity formation, to a greater extent than in the wider community (Tucker, Ellickson et al. 2008).
Lesbians have also been at greater risk of breast cancer and cervical cancer, which may be explained by higher risk factors such as smoking, limited access to health promotion and lower rates of testing (McNair, Szalacha et al. 2011). However, more recent research suggests that this trend may be abating, reporting that the instances of these types of cancers and testing rates are similar between lesbians and all women (Leonard, Pitts et al. 2012).
Some research also suggests that lesbians are more likely than other women to have experienced violence and abuse, both from strangers and within relationships (Pitts, Smith et al. 2006; Leonard, Pitts et al. 2012). It can be very difficult to access counselling and support for these issues from providers who understand the context, particularly in relation to intimate partner abuse where appropriate professional support for female victims and female perpetrators may be lacking (Hyde, Comfort et al. 2007)
28 Bisexual men and women Some Australian research indicates that bisexual men and women may experience marginalisation and isolation from the LGBTI community (as well as the mainstream community), reporting less connection to the LGBTI community and fewer friends from the LGBTI community (Leonard, Pitts et al. 2012). This research also indicates that bisexual men in particular are more likely to hide their sexuality from family and those closest to them, and are less likely to have a regular GP than gay men, lesbians and bisexual women (Leonard, Pitts et al. 2012). These Australian researchers also find that bisexual men and women have poorer mental health compared with gay men and lesbians (Leonard, Pitts et al. 2012).
Bisexual women are more likely than lesbians to experience abnormal Pap tests and sexually transmissible infections (McNair, Szalacha et al. 2011) and similarly to lesbians, recent Australian research finds that bisexual women also smoke at higher rates and consume greater levels of alcohol compared with women generally. Again, some researchers point to minority stress while others argue variance in cultural practice (Tucker, Ellickson et al. 2008; Hughes, Szalacha et al. 2010; Johnson, Hughes et al. 2013).
Transgender and gender diverse people Available Australian research indicates that transgender and gender diverse people’s mental health, wellbeing and physical health is markedly worse than that of the general population and other sub-populations of the LGBTI community such as gay men and lesbians (Couch, Pitts et al. 2007; Leonard, Pitts et al. 2012). Some researchers have linked this health status to the disproportionate discrimination, harassment and violence experienced by these individuals (Hillier, Jones et al. 2010; Robinson, Bansel et al. 2014).
Key factors affecting transgender and gender diverse people’s health and wellbeing have been reported to include being able to transition to one’s affirmed gender and high levels of discrimination, harassment and violence (Grant, Mottet et al. 2011; McNeil, Bailey et al. 2012). Key structural barriers that can affect the health and wellbeing for some individuals include the potentially high cost of medical treatment required to transition to one’s affirmed gender (Hewitt, Paul et al. 2012); administrative processes that can make it difficult for people to change their sex on official documentation (Couch, Pitts et al. 2007); and access to health sector workers with knowledge about transgender-specific needs (Couch, Pitts et al. 2007).
People with intersex variations Australian research reports difficulties in recruiting intersex respondents in LGBTI research (Leonard, Pitts et al. 2012). Therefore a key issue is a lack of knowledge, including research and data. While intersex people experience stigma and discrimination like others in the LGBTI community, the intersex community also experiences some unique health issues that impact health and wellbeing.
There is substantial debate about the appropriateness and efficacy of surgical interventions on infants and children to ‘normalise’ genitalia, based on psycho-social rationales, which can result in a loss of sexual sensation and/or sterilisation and/or ongoing genital surgeries throughout childhood and adulthood (Victorian Department of Health 2013).
29 Clinical knowledge is often limited because there are a large number of intersex variations. Some research suggests that some intersex variations mean that the individual is at higher risk of some cancers compared with the general population (Looijenga, Hersmus et al. 2010; Pleskacova, Hersmus et al. 2010). However, this literature is contested (Senate Community Affairs References Committee 2013).
Intersection with life experiences and other identities Where a person is born, grows, lives, works and ages can impact on their health and wellbeing. Gender and sexuality, Aboriginality3, ethnicity and language, income or wealth, education attainment, employment and housing all have a direct impact on health and wellbeing (Wilkinson and Marmot 2003).
‘Multiple marginalities’ have been found to compound the effect on an individual’s health and wellbeing, however there is very little research examining multiple marginalities in relation to sexual orientation or gender diversity. For example, disabilities and minority ethnicity may interact to increase marginalisation and adversely affect health. The Australian evidence is mostly limited to examining the health and wellbeing of gay men and men who have sex with men, and lesbians from culturally and linguistically diverse backgrounds (Reeders 2010; Poljski 2011).
Improving responsiveness: the LGBTI Health and Wellbeing Action Plan The research demonstrates that meeting the diverse health care needs of LGBTI individuals and communities requires an approach that encompasses targeted initiatives with the promotion of accessible and inclusive mainstream services. The LGBTI Health and Wellbeing Action Plan will support specific health promotion activities improved access to current and appropriate information and inclusive practice and actions to address discrimination and stigma. Improved understanding of emerging health and wellbeing issues for LGBTI communities and individuals will inform policy and service delivery. Through these priorities, the LGBTI Health and Wellbeing Action Plan will promote services that meet the specific and diverse needs of LGBTI individuals and communities.
3 Aboriginal refers to people who identify as Aboriginal, Torres Strait Islander or both Aboriginal and Torres Strait Islander.
30 Appendix 2: Current LGBTI health related activities supported by the Victorian Government
Activity Agency Target audience Key objective
Healthy Equal Youth (HEY) Gay and Lesbian SSASGD young Youth suicide prevention through Same-sex attracted and sex Health Victoria people building an SSASGD youth and gender diverse (SSASGD) platform within the mainstream Youth Affairs Council youth suicide prevention project youth sector and improving the of Victoria (YACVic) quality of mental health and Safe Schools support services provided to Coalition this group. Rainbow Network Minus 18 Zoe Belle Gender Centre Cobaw Community Health - WayOut UCCE - Diversity Shepparton
Sexual Health and Family Planning SSASGD youth Primary prevention of HIV/ Diversity program Victoria BBVs among rural SSASGD young people and their social networks. Aims to increase skills of local communities to promote diversity and community care
Workforce training, research Gay and Lesbian All LGBTI Agency focused on enhancing and resource development Health Victoria and promoting the health and (GLHV) wellbeing of LGBTI people in Victoria through research, resource development and workforce training
Creating LGBTI inclusive HACC GLHV with MAV Local government Improving aged care for services training resource LGBTI people
HIV care and prevention, Victorian AIDS Gay men Develop and implement HIV health promotion Counci health promotion campaigns, provide mental health and alcohol and drug treatment for gay men Provide care to people living with HIV
Telephone counselling Gay and Lesbian All LGBTI Provide telephone counselling Switchboard/Q Life and information to LGBTI people across a range of issues.
31 Activity Agency Target audience Key objective
Peer support and health Currently being Bisexual men A needs analysis is currently promotion redeveloped being conducted, and existing peer support services for bisexual men will be developed to better reflect current needs
Rural peer support and health Country Awareness Rural gay men CAN provides information, promotion Network (CAN) education, support, referrals and advocacy to Victorian rural/ regional communities about sexual health
Transgender and gender Monash Gender Transgender people Providing assessment, primary diverse clinical services Dysphoria Clinic - and tertiary care to transgender Monash Health and gender diverse people
Royal Children’s Hospital Gender Centre
32 Appendix 3: Glossary
Affirming gender: The process of adopting a way of life or body that matches a person’s sense of their gender (see Transsexual).
Bisexual: A person who is sexually and emotionally attracted to people of both sexes.
Biphobia: The fear and hatred of bisexual people and of their sexual desires and practices.
‘Coming out’: The process through which an individual comes to recognise and acknowledge (both to self and to others) his or her sexual orientation/gender identity/intersex status.
Cross-dresser: A person who has an inescapable emotional need to express their alternate gender identity and be accepted in that role on a less permanent basis.
Cultural competence/awareness/sensitivity: Minority sexual orientation and gender identity encompass cultural issues as they often convey specific values and social affiliations, of which services should be aware.
Gay: A person whose primary emotional and sexual attraction is towards people of the same sex. The term is most commonly applied to men, although some women use this term.
Gay, Lesbian, Bisexual, Transgender and Intersex (GLTBI): In accordance with current practice in Australia and internationally and the recommendation of the GLBTI Health and Wellbeing Ministerial Advisory Committee, the Action Plan features the acronym LGBTI. Note that the GLBTI Ministerial Advisory Committee retains its original title for consistency. Further, the terms Same Sex Attracted and Sex and Gender Diverse (SSASGD) are used when referring only to young people.
Gender identity: A person’s sense of identity defined in relation to the categories male and female. Some people may identify as both male and female while others may identify as male in one setting and female in other. Others identify as androgynous or intersex without identifying as female or male.
Heterosexism: The belief that everyone is, or should be, heterosexual and that other types of nonheteronormative sexualities or gender identities are unhealthy, unnatural and a threat to society. Heterosexism includes homophobia, biphobia and transphobia and a fear of intersex people who challenge the heterosexist assumption that there are only two sexes.
Homophobia: The fear and hatred of lesbians and gay men and of their sexual desires and practices.
Internalised homophobia: The internalisation by lesbians and gay men of negative attitudes and feelings towards homosexuality.
Internalised transphobia: The internalisation by transgender people of negative attitudes and feelings towards transgenderism.
Internalised biphobia: The internalisation by bisexual people of negative attitudes and feelings towards bisexualism.
Intersex: A biological condition where a person is born with reproductive organs and/or sex chromosomes that are not exclusively male or female. The previous term for intersex was hermaphrodite.
33 Lesbian: A woman whose primary emotional and sexual attraction is towards other women.
Men who have sex with men: Men who engage in sexual activity with other men, but who do not necessarily self-identify as gay or bisexual.
Queer: An umbrella term that includes a range of alternative sexual and gender identities, including gay, lesbian, bisexual and transgender.
Same-sex attraction: Attraction towards people of one’s own gender. The term has been used particularly in the context of young people whose sense of sexual identity is not fixed, but who do experience sexual feelings towards people of their own sex.
Transgender: A person who does not identify with their gender of upbringing. The terms male-to female and female-to-male are used to refer to individuals who are undergoing or have undergone a process of gender affirmation (see Transsexual).
Transphobia: Fear and hatred of people who are transgender.
Transsexual: A person who is making, intends to make, or has made the transition to the gender with which they identify.
Women who have sex with women: Women who engage in sexual activity with other women, but who do not necessarily self-identify as lesbian or bisexual.
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36