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>> Taking a look at the issues to run in the health and well-being of our LGBTIQ+ communities,

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this is Well Well Well brought to you by the team from Thorn Harbor Health on Joy and the Community Radio Network.

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You're with Michael on Well Well Well, recording on the lands of the Warrangery people and broadcasting on Boonwarrongland,

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on Joy and the Community Radio Network.

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The recently released Rainbow Realities report is an in-depth analysis of large-scale LGBTIQ+ health and well-being in Australia,

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drawing upon research from private lives, writing themselves in and swash just to name a few.

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Joining me to help explore Rainbow Realities report is lead author Natalie Amos,

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research fellow with the Australian Research Centre in Sex, Health and Society at Latro University.

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Natalie, thank you so much for taking the time to chat with us here on Well Well Well.

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Yeah, thanks for having me on.

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Beautiful, so just in broad terms, what is Rainbow Realities as a report kind of all about?

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Can you share a little bit maybe about some H.O.V.

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So Rainbow Realities report was commissioned by the Department of Health and Aging,

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and it was the intention of this report is to at least pay informed

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their Government Tenia National Action Plan for LGBTIQ+ health and well-being.

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So the report is a 200-plus page report that covers new and existing findings that we have from

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at that six surveys, so three of those are housed within arches.

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We have fairly many research for the Sex, Health and Society, which is where I work,

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and they are the Private Lines 3 survey, which is Australia's largest survey of LGBTIQ+ adults,

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writing themselves in four or through Australia's largest survey of LGBTIQ+ young people,

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age 14 to 21. Pride and Pandemic, which was the survey that we ran during the pandemic of

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Pandemic experiences within the community, but you can be around mental health,

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family violence, and management strategies that people use in the pandemic.

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The survey also includes the report also includes the SWASH survey,

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which is from Housing and Sydney University,

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and is a survey of LBQ+ women's health and well-being from Sydney.

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Also from Western Australian colleagues is the Trans pathways study, which is a study of

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trending in the diverse young people, age 18, 14 to 26 years, and that was conducted in 2016,

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and we also have the Wilson kind of gym survey in there as well, which is also known as

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Landlord Knowledge, which is a survey that was dedicated to Aboriginal and Torres Strait Islander

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LGBTIQ+ experience.

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Yeah, and so this report reflects on some of those existing findings, but I think there's

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something like 50+ kind of new analysis that have been drawn through kind of comparing and

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contrasting some of those responses. Is that right? Yeah, that's right. So we kind of briefly

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give summaries of what we've already produced from these reports, and then yeah, an additional

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50 something else, and another back number of new analyses that we ran for this report to

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try to report on some more nuanced findings within the data.

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Yeah, wonderful. It is a really large-scale report. It's quite a hefty read that's really comprehensive,

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and it does cover a number of different aspects of our LGBTIQA+ communities and our health

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and well-being. So we thought we'd take some time today to kind of discuss some of the high-level

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learnings or outcomes or findings that have been found in the study. The first thing I wanted to

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talk about was the way that our community kind of connects with alcohol and other drugs.

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There are obviously high rates of alcohol and drug use in our LGBTIQA+ communities.

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Were there any important reflections on the health outcomes associated with drugs and alcohol?

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Yeah, so we do, yeah, as you said, the report does reflect that high prevalence of alcohol and other

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drug use across the community. And we see in there sort of in a potentially a normalization within

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many LGBTIQA sub-cultures of alcohol and other drugs use, but we also find associations with

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serious mental health outcomes that have increased psychological distress, and also other demographic

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factors that are linked to sort of significant disadvantage or marginal marginality within the

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community. We can't assume, of course, here that this is all very correlational research,

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so we can just say that there's an association between alcohol and drug use and those factors,

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which is to say that it may be in a response to increased mental health concerns and in response

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to that. We see increased alcohol and other drugs use. Interestingly, we also observe greater

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drug use among young trans people of all genders who had access to gender of them in care, so we see

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this outcome with a positive experience of accessing gender of them in care. But again, I think

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it's not really talking to cause, and it might be my thoughts on this is that it's more along the

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lines of young people who have access to their them in care that they need are connecting socially

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the way that young people do. And so we might see more increased drug use with their young people

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getting to be young people. Yeah, that was kind of one of my reflections in reading the report quite

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often when we talk about alcohol and other drugs in our community. It's either from kind of a

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deficit model, or we're talking about the potential negative social and economic consequences,

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health consequences. So yeah, I was really nervous to learn if there were any kind of positive

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reports of the ways that our community connect with drugs and alcohol, and it sounds like waxing

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and waning that they may be. Yeah, yes, I think so, and I think, I mean, I think this is a

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more research as well. I should kind of choose out those new answers if it's so we can really just talk

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to those in association here. But yeah, I think there is there's something to be said to their

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community connection and social connections as well as potential for being distracted.

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Yeah, and moving on, Dada from Swash, which you mentioned earlier, which is Australia's longest

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running regular survey of lesbian, bisexual and queer women, for a bi-plus people and people with

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disability would, it seemed would disproportionately experiencing intimate partner violence, was that

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was that surprising at all for the impacts of the bi-plus community specifically?

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Yeah, it's a good question, I think it in some ways reflects previous research and in some ways not,

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so it is, it is a tricky one to understand. Yes, in order that it's surprising, we too see high rates

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of family violence within the LGBTQ community forwardly. I think that this one is unclear why

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for bi-plus folks that it is higher. And again, I think it really needs more research there.

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You mentioned as well that the results around disability as well was, I think, some of the highest rates

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of family violence that we have within the community among those with disability.

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Sadly, not surprising it reflects previous research and reflects both the disability research and

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LGBTQ, LGBTQ research, but always very, very shocking. I think that finding that probably is the most

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striking to me from our data is the rate of family violence among those with disability.

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Yeah, absolutely. And I know from Pride in Pandemic that survey, in terms of the mental health of

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our community, I know LGBTQ+ communities were likely to prefer, more likely to prefer services,

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specifically that catered to them in their community. Are we at a deficit for those programs and

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services? Does this just speak to a larger need for non-mainstream services that have kind of a

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more targeted approach? Yes, absolutely. Yes, we are definitely at a deficit of LGBTQ-specific

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services and even LGBTQ-inclusive services within mainstream services. And we do see a much greater

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preference for services that are either inclusive or catered specifically to LGBTQ people,

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and that can do for across the population. So we find that trans people are more likely to prefer

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a service, but specifically LGBTQ people. And we know from community experiences that there is

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definitely that deficit, but our research also reflects that as well. So we saw a much greater

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preference for these services, but we didn't see, we didn't see because it was accessing those

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services to the same extent that they preferred those services. Yeah, did any of the analyses draw

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upon, you know, for those people who are, you know, geographically not located near an affirming service,

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and affirming service, was there any report on the experiences of those people that couldn't get

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access to a service? So interestingly, I think, as I'm testing my memory here on the data from

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what I remember from analysis is run, I think as you get further out of inner city areas,

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there tends to be more of a preference for mainstream service that is inclusive, but I think that

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that might reflect a necessity or sort of a practicality around what's available in those areas,

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where, you know, this mainstream services should really be inclusive of LGBTQ. I'm not just

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increasingly but affirming and practicing a fairly practice for LGBTQ, like plus people. So I think

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there's potentially an element of, this is my preference because it is what should be available to me,

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and practically what's accessible. Yeah, interestingly, we've had,

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probably, pandemic, we ran some focus groups as well, where we spoke to people and they're

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asking about preferences question there was, it was a bit more nuanced than what we could see coming

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through in the survey data, and there was this feeling of, I would prefer an LGBTQ-specific

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service, but acknowledging that there's just not the availability of it to the preference might

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be expressed for a mainstream inclusive service. Yeah, for a peer within a mainstream service,

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or an LGBTQ-A plus, affirming. Yeah. Yes. Yes. And that speaks to a lot of the experiences of

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our community, especially when we're talking about our mental health and the way that the onus is

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always on the person, you know, presenting at a counseling service or wherever to consistently

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validate their own experience and the emotional energy and the spoons, I guess it takes to

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make sure that you feel seen and heard within a service, you're constantly kind of explaining

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yourself and your family and your cultural background and all those things. So, yeah, when you

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only have a little bit of an appointment, it can be really time-saving to be with you. Yeah, exactly.

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Absolutely. Yeah, definitely. Given that we are currently grappling with a housing crisis,

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kind of nationally across the board, what does the report, all the analyses from this report tell

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us about our community's experiences of homelessness and housing insecurity? Are they, and are they

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different across the acronym? Yeah. So we do, we see sort of higher rates of housing insecurity,

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income insecurity within across the LGBTQ population. We do see higher rates of housing

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insecurity for trans folks, assist women, for people with disability. We also found it among

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bioplast participants as well. And I think what it really illustrates is that kind of cumulative

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impacts of multiple sources of disadvantage and the sort of barriers to accessing

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employment and housing across the community and for different intersections of the community.

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Something that really stuck out to me when kind of diving into this report, Natalie, was around the

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clarification that the survey had a really small number of intersex respondents. What kind of

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considerations are there for future surveys and meaningful engagement for our intersex communities?

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Yeah, so that's a really good question and we want to bring up so we do at least for private

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lives, three, and running themselves in four, which is the service that fit within my center.

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We did target the recruitment as LGBTIQ class, so we were hoping to recruit people from intersex

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community. We got a very small, as you said, a very small sample size that of people that did have

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an intersex variation. And they, the vast majority also identified as LGBTQ, so it was more like we

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got a sample of LGBTQ+ people within intersex variation. So we don't really, we can't

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disaggregate that data, unfortunately, or meaningfully represent that community within the data, so we

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we tend to use LGBTQ+ as the acronym. I think there are challenges in how the survey recruitment

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was framed as LGBTIQ+, so from an intersex community, might not necessarily identify with LGBTIQ.

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And it was, a lot of the advertising was done through target advertising through social media,

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so that really sort of targets those that have engaged with LGBTQ content online.

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I think what it really illustrates is that there is this very big need for

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focus targeted, specific research for intersex community. And happily, there is, has been some research,

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some recent MRFS, medical research, future fund funding for a project that will be dedicated to

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intersex community, and that's been funded to Sydney University and Morgan Carpenter, who will be

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leading that, that work in Arches will very likely get to collaborate on that. And that will be,

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we'll get a, some much larger, much need-adilise that data-cated intersex community.

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Yeah, we look forward to hearing a little bit more about that community. It is something that we,

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we talk about within community and community, it errates to us in terms of, you know, it's very

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easy to throw out the full gamut of letters of the acronym, so using the full LGBTIQ+, especially

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in services when you're looking at funding for things, but really it is important to, if, you know,

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include the eye if you're working with the eye, and if you're not working with the eye to not use it,

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which, which you guys have done in, in, in this case, so, um, yeah, so, yeah.

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So definitely looking forward to some more research and engagement in that space.

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I wanted to ask about, one of the, the themes of the report was around the relationships of our

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communities. And something that we hear anecdotally from community is that for women who have sex

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with men who have sex with men, they may be overlooked when it comes to things like accessing PEP or

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accessing PEP for preventing HIV because their HIV risk might be seen as negligible, erroneously,

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by medical practitioners. And so sometimes these women go to access to things like PEP and,

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and don't get good access to it because they're not seen as an HIV risk. But I was reading through

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the report and it seems like those women who have sex with men who also have sex with men are more

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likely to be proactive about accessing testing. So I thought that was a really interesting

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comparison. Can you flesh that out a little for us? It is, it is a very interesting finding.

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Yeah, we did find that the, the, the participants from this force said they were very proactive

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about their healthcare. We actually saw that in multiple ways, and so they're proactive about

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access in mental healthcare as well. Um, so I think that there is, yeah, it's a really nice kind of good

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new story from, from this batter as well. Um, a community also considered, or the, where the sample

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comes from, so it is very entirely feedback samples of potential, um, that it, it likely reflects

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that specific demographic of women as well. Um, but yeah, we did, we did see very sort of

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proactive healthcare. And I think that it speaks to, you know, the, the capacity of the community

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to really take charge of their healthcare and go after themselves. Um, but we do need public

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health messaging and, and healthcare training to make sure that, or LGBT people are given the,

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sort of, appropriate care and understanding of what care they made. Um, we also see, um, in the,

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in the report, we've also reported on some, some research around cervical screening access

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among LGBTQ community, where we do see a lot less cervical screening access broadly. Um,

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and this was, was something that we collaborated with, um, the cancer cancer Victoria on, who have

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actually taken that, the findings of that work to inform their public health messaging, um, to,

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sort of, um, support the way that they use in cohesive language within that space as well.

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Yeah, absolutely. Uh, and we've previously worked with cancer cancer

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Victoria on our, um, public service announcement campaign, which really was their kind of first

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venture into, uh, the inclusion of, uh, of trans men specifically in their, um, in the campaigning to,

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sort of, getting access to, uh, cervical cancer screening for all people who have, um, who have a

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cervix. Um, I wanted to, I wanted to ask about, um, thinking about gender, affirming care in

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private lives, um, one of the really stand out statistics I was reading was around, um, only one

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third of trans adults had ever experienced gender euphoria. So, you know, a real alignment with their

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gender. What, what did the report have to say about kind of the protective factors that allow

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people to have, you know, better health outcomes for our trans and gender diverse communities?

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Yeah, um, these, some of the trans-assuming, affirming care, uh, research that we've

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reported in this report is one of my favorite. Um, we, we do definitely see for adults being able to

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access, um, the different forms of gender affirmation. Um, so whether that's legal affirmation,

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or social affirmation, um, or medical affirmation was associated with feeling gender euphoria. Um,

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you also see that experience of gender euphoria associated with positive mental health outcomes as well.

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Um, and we also see other benefits of having access, um, gender, thinking care, particularly among,

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among young people we reported on whether they, um, and those who desired access to, um, whether

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it's social, medical, illegal gender affirmation, if they had access to the forms of care that they

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desire, the forms of affirmation, sorry, that they desire they were, um, less likely to experience,

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suicidality, um, and homelessness, but particularly if they had felt supported to

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affirm in those ways, so we asked, we asked young people, um, who had wanted to affirm their gender

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in these ways, whether they had felt denied the lateral control to access it, or whether they

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had felt supported, and overwhelming, we see that those who have felt supported to access that care,

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whether it's, whether it's medical affirmation, legal affirmation, or social affirmation,

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they experienced, um, less suicidality, less psychological distress, low anxiety, greater happiness,

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less homelessness, and I think one thing that really stood out for me as well was that they experienced

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less verbal abuse in the past 12 months, um, so there's this really, you know, it was very important

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to be able to access that care, and it's usually important to feel supported for access that care.

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Yeah, there were also some really interesting, um, kind of key findings around, um, you know,

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things like social connection and attending, I think, um, uh, community groups and events,

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and how that kind of offered, uh, kind of a protective factor for trans communities as well.

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Yeah, so we see across the population as well, we see sort of a mix, it makes back around accessing,

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um, community support in that sometimes community support, we see higher rates of suicidality,

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those that engage with community support, but really that is very likely to affect those that are

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experiencing from former distress or speaking out community for support, um, to manage that,

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and we do see, um, particularly those suicidality who, who had connected with LGBTQ community,

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has had more positive, um, health and wellbeing outcomes. Uh, so yeah, it does, there is everything

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in the report as well of how important it is to be able to, um, access community support

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and engage in community. Yeah, definitely. And, um, obviously one of the reports that, uh, the

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surveys that this report draws from is, uh, Pride and Pandemic, so looking at the impacts of the

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COVID-19 pandemic on our communities, was there anything that was, um, that kind of stood out to you

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in terms of the ways that, uh, you know, the, the decreased social connection, um, played habit

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amongst our communities during that time? Yeah, yeah, so again, kind of, uh, the pandemic was a

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bit of an interesting time in that, yeah, absolutely. We saw, um, that isolation and, and

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lack of ability to connect with community, um, definitely seems to have played had an impact on

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on wellbeing. Also, um, you know, having young people stuck at home with families that aren't

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necessarily supportive of them and not being able to access friends or, or even to be out of the

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house to, to, in, in spaces that are more affirming of their identities, um, on the, sort of, on the

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flip-top, we also saw, um, increasing online spaces of connection and, and, to some, particularly,

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in rural, remote areas, we, people sort of spoke to us of how beneficial it was to finally have this

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online way of connecting with people where they didn't have to travel into inner city areas.

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Um, so there was that, that benefit for those that didn't previous that have access to community,

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now, now having access to community, um, more easily. Um, and I think that, I think it's, hopefully,

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continued to pass the pandemic that we, we've maintained both that, that, um, and online spaces

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for those that can't access it, but also, again, it illustrates that we just need, we need more of it,

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we need, we need more, um, queer-friendly spaces and affirming spaces across all regions of the

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country. Yeah, definitely. Natalie, I wanted to ask about some of the key findings relating to,

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we obviously have an aging population in, uh, in Australia and we have an aging population

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of, you know, things like people living with HIV and trans communities that, um, we, we haven't

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experienced to such a degree before. Do you know, can you speak to some of the kind of general

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responses to how LGBTQ A plus, um, older people have, you know, responded to things like loneliness

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and belonging and, um, and social isolation and those things? Yeah, so we do, we do actually have

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an interesting finding with, with the older, um, LGBTQ A plus adults, um, from the private legs

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three, Dara, so out sample, um, where we actually found that they appeared to be, um, less likely than

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younger, uh, cohorts to report feelings of loneliness, um, and they also generally had a greater number

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of queer friends. Um, so I think I would potentially reflect that sort of the role of, of community

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connectedness as a way of navigating the, um, kind of, sidele and institutional discrimination

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that they might have experienced, or they potentially had time to kind of build these close connections

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that have limited and experiencing that loneliness. Um, I think it's also probably important to,

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to take into consideration again the sample that we, that we are drawing from, which were,

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the all collected online, so it's potentially older folks who are more connected in online spaces as well.

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Uh, uh, and that's how they would have come across this day, which most likely have been through, um,

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Facebook, or Facebook, or Facebook, or other sites. Um, but we did also see within, within the older,

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the older cohort, that is when they did experience greater loneliness, um, this was also associated

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with experiencing unfair treatment due to their, their sexuality or their gender identity.

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Yeah, and was that specifically related to things like mainstream services or?

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Uh, so we asked it is a very broad question, actually, about have you ever experienced unfair treatment?

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Yeah, so it could, it could be within services it could just be, um,

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societal and general public. Yeah, exactly.

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Yeah, I'm not sure what the, um, kind of the age range of, um, of,

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folklore in all of the surveys kind of combined, but did you have any reflections on the experiences

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of older LGBTQ, A+ people in, um, in, you know, homes and care and care settings?

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Was that reflected on any of the findings?

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Yeah, unfortunately, I think that given, given the nature of how we collected this sample,

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I think that, I think, yeah, again, this probably is, well, definitely need for more effect in that

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space that would be more dedicated and targeted and probably recruited in a different way.

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We didn't know settings rather than just recruiting online.

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Thank you so much to Natalie and also research fellow at the Australian Research Centre in Sex Health

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and Society at Latrobe University. Thanks so much for joining us here on Well, Well, Well,

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before I let you go, if people want to deep dive into this report as a whole or connect more with some

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of the, the surveys that kind of reflected in these analyses, where can people go to find out more?

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Yeah, we do actually have a dedicated web page now through the,

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I'll just, I'll just sort of, through the Latrobe University, what's that for Rainbow Realities?

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I think probably the easiest way, which is what I do is just Google Latrobe Rainbow Realities and

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it should come up and there on the website you can access the full 200+ page reports. Wonderful.

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Thank you so much again for your time to join us to discuss Rainbow Realities here on Well, Well, Well.

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Thanks so much for having me on.

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Thanks for listening to Well, Well, Well, Your Show for LGBTQ Health and Wellbeing

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presented by Joy sponsor, Thorne Harbour Health. For more on these topics and much more,

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check out Thorn Harbor on social media at Thorne Harbour or via the website thornharbour.org.