Aboriginal and Torres Strait Islander people must be at the centre, not the margins, of LGBTQIA+ plans and policies

During Sydney World Pride^[1] the federal government committed to a ten-year action plan^[2] for LGBTIQA+ health and wellbeing. This included A$26 million in health research.

In the announcement^[3], the minister for health and aged care, Mark Butler, said:

While many LGBTIQA+ people live happy and healthy lives, others continue to experience discrimination, stigma, isolation, harassment and violence – all of which leads to poorer health and mental health.

Our recent report^[4], co-authored with Professor Bronwyn Carlson and Dr Terri Farrelly, showed this cohort is disproportionately impacted by discrimination and disadvantage. The combined impacts of colonialism, racism, homophobia and transphobia result in poorer health and mental health for this group.

Aboriginal and Torres Strait Islander communities are chronically over-researched. Yet there is insufficient data^[5] about Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health. The SB on the end of LGBTQIASB+ stands for Sistergirl and Brotherboy^[6]. These are Aboriginal English^[7] terms used by Aboriginal and Torres Strait Islander transgender women and men.

Research suggests Aboriginal and Torres Strait Islander LGBTQIASB+ people are at much higher risk of suicide and suicide-related behaviours.

Read more: What can we learn from the marriage equality vote about supporting First Nations people during the Voice debate?^[8]

What did our report find?

Our report found racism, discrimination and violence (including anticipation and fear of violence), social and cultural exclusion, criminalisation, incarceration, and exposure to grief and suicide all heighten the risk of suicide for Aboriginal and Torres Strait Islander LGBTQIASB+ people.

Both Indigenous people and LGBTQIA+ people experience poorer health outcomes and higher rates of health-impacting behaviours. These can arise from minority stress^[9], social exclusion, discrimination and trauma. On top of this, Aboriginal and Torres Strait Islander LGBTQIASB+ people navigate the impacts of colonialism. These include heterosexism^[10] within their own communities and racism from non-Indigenous LGBTQIA+ people and services.

The report also found that Aboriginal and Torres Strait Islander LGBTQIASB+-led research, policy, and services are urgently needed to improve mental health and health outcomes for this group.

But when the advisory committee for the national action plan was announced^[11], it included one Aboriginal organisation.

There is very limited data on Indigenous LGBTQIASB+ people

Our report found research and statistics on Aboriginal and Torres Strait Islander LGBTQIASB+ populations are impeded by binary categories of sex. Aboriginal and Torres Strait Islander people are primarily categorised as “male” and “female” in health research, rather than in terms of their gender.

Gender refers to a person’s social and cultural self, while sex is medically assigned to people at the time of their birth.

Gender and sex diverse people are often lost in statistics. Even when data is collected on these groups, non-binary sex and gender is often excluded or overlooked due to small sample sizes. This was the case with the 2021 census^[12]. Although the census collected responses on non-binary sex, it did not provide meaningful data.

Data on Aboriginal and Torres Strait Islander LGBTQIASB+ people and suicide-related behaviour is also limited. One factor is that, in Australia, information about sexuality and gender diversity is rarely recorded at death (unless specifically included by a coroner^[13]).

When Aboriginal and Torres Strait Islander LGBTQIASB+ people participate in national LGBTQIA+ health research, their involvement is merely noted without adequate discussion or action on the implications of their data.

For example, 3.7% of trans young people who were participants in the Telethon Kids Trans Pathway Report^[14] identified as Aboriginal and/or Torres Strait Islander. This is representative of the overall Australian population. However, there was no in-depth exploration of the experiences of this cohort.

This occurs because most non-Indigenous researchers and organisations are not confident or capable^[15] in reporting on Indigenous people. That’s why it is essential Aboriginal and Torres Strait Islander LGBTQIASB+ people are involved at every stage of research. This would ensure data is appropriately captured, interpreted, and reported on.

Read more: New research shows how Indigenous LGBTIQ+ people don't feel fully accepted by either community^[16]

The impact of racism and discrimination

Aboriginal and Torres Strait Islander LGBTQIASB+ people commonly report experiencing racism and discrimination not only in the wider community, but also within LGBTQIA+ communities^[17]. They also struggle with acceptance^[18] in both Indigenous and LGBTQIA+ spaces.

Our report^[19] drew from existing work by Aboriginal LGBTQIASB+ researchers about the difficulties for Aboriginal and Torres Strait Islander LGBTQIASB+ people who often have to choose between^[20] either Indigenous or LGBTQIA+ services when accessing mental health support. This means choosing between adequate support^[21] as an Indigenous person or an LGBTQIA+ person. Very few services successfully do both.

Our research^[22] also demonstrates poor health outcomes and increased vulnerability to suicide are outcomes of racism, discrimination, marginalisation, homophobia and transphobia.

Colonialism is the root cause^[23] of discrimination and violence towards Aboriginal and Torres Strait Islander LGBTQIASB+ people. It is also the cause of poor health outcomes^[24] for Aboriginal and Torres Strait Islander people more broadly.

Aboriginal and Torres Strait Islander LGBTQIASB+ communities at the forefront

Aboriginal and Torres Strait Islander LGBTQIASB+ people must be treated as a priority group in the national action plan.

Aboriginal and Torres Strait Islander LGBTQIASB+ people need to be able to design and steer research and policy making at every level. Governments should invest in Aboriginal and Torres Strait Islander community-controlled health organisations to improve capacity to service our communities.

If this doesn’t happen, Aboriginal and Torres Strait Islander LGBTQIASB+ people need their own national plan. Improving health and mental health outcomes for Aboriginal and Torres Strait Islander LGBTQIASB+ people is urgent, and we can’t afford another ten plus years at the margins of national LGBTQIA+ policy.

If this article caused distress for readers, these are some available helplines: 13Yarn Lifeline QLife^[25][26][27]

References

1. ^{^} Sydney World Pride (www.mardigras.org.au)
2. ^{^} ten-year action plan (www.health.gov.au)
3. ^{^} announcement (www.health.gov.au)
4. ^{^} report (www.indigenousmhspc.gov.au)
5. ^{^} insufficient data (www.mdpi.com)
6. ^{^} Sistergirl and Brotherboy (www.abc.net.au)
7. ^{^} Aboriginal English (indigenousx.com.au)
8. ^{^} What can we learn from the marriage equality vote about supporting First Nations people during the Voice debate? (theconversation.com)
9. ^{^} minority stress (www.sbs.com.au)
10. ^{^} heterosexism (indigenousx.com.au)
11. ^{^} announced (www.health.gov.au)
12. ^{^} 2021 census (www.abs.gov.au)
13. ^{^} unless specifically included by a coroner (pubmed.ncbi.nlm.nih.gov)
14. ^{^} Telethon Kids Trans Pathway Report (www.telethonkids.org.au)
15. ^{^} not confident or capable (www.mdpi.com)
16. ^{^} New research shows how Indigenous LGBTIQ+ people don't feel fully accepted by either community (theconversation.com)
17. ^{^} within LGBTQIA+ communities (journals.sagepub.com)
18. ^{^} struggle with acceptance (theconversation.com)
19. ^{^} Our report (www.indigenousmhspc.gov.au)
20. ^{^} have to choose between (www.ecu.edu.au)
21. ^{^} choosing between adequate support (researchdirect.westernsydney.edu.au)
22. ^{^} Our research (www.indigenousmhspc.gov.au)
23. ^{^} root cause (pipewrenchmag.com)
24. ^{^} poor health outcomes (www.tandfonline.com)
25. ^{^} 13Yarn (www.13yarn.org.au)
26. ^{^} Lifeline (www.lifeline.org.au)
27. ^{^} QLife (qlife.org.au)