POLICY DOCUMENT –
LGBTIQ Health

BACKGROUND
The New South Wales Medical Students’ Council (NSWMSC) is the peak
representative body for medical students in New South Wales (NSW).
NSWMSC encourages inclusivity and engagement of Lesbian, Gay,
Bisexual, Transgender, Intersex and Questioning (LGBTIQ) medical
students, and extends their support to the promotion of better health and
wellbeing outcomes for the wider LGBTIQ community.

Section 1: Health Concerns For Persons Identifying as Lesbian, Gay or

Bisexual

At present, approximately 3% of the Australian population aged 18 years

and above identify as same-sex attracted, bisexual or other sexual
orientation [1]. Additionally, an estimated 21% of Australian secondary
school students identify as having a sexual orientation other than
heterosexual [2]. The self-reported general health of persons identifying as
lesbian, gay or bisexual is significantly lower than the national average [3].
Similarly, persons of diverse sexual orientation are more likely to report
experiencing high or very high levels of psychological distress [3] and more
likely to report living with a mental health condition compared to the
general population [1]. It is estimated that 38% of lesbian, gay or bisexual
persons have experienced discrimination [1], while a 2008 Victorian-based
survey reported that 85% of respondents had experienced physical or
psychological heterosexist violence and 5% reported being the victim of
sexual assault in the previous 24 months [4]. The estimated HIV incidence
among gay and bisexual men undergoing repeat HIV testing at sexual health
clinics was 0.89 per 100 person-years, while an estimated 14% reported a
positive result following screening for sexually transmitted infections other
than HIV [8]. Similarly, 15% of lesbian and bisexual women reported a
positive result following screening for sexually transmitted infections other
than HIV [7].
The rate of some cancers, including anal cancer, breast cancer and cervical
cancer are greater across the lesbian, gay and bisexual community due to the
increased likelihood of possessing risk factors associated with these
particular types of cancer [9]. For example, lesbian or bisexual women are
more likely to possess risk factors predisposing them to breast and
gynecological cancers, including obesity, nulliparity or non-use of the oral
contraceptive pill [7]. Furthermore, rates of tobacco, alcohol and other drug
use is significantly high across lesbian, gay and bisexual populations [5]. An
estimated 23% of homosexual or bisexual Australians smoke tobacco daily
and almost 30% are considered lifetime risky drinkers, while rates of any
recent illicit drug use, including pharmaceutical misuse remain almost three
times greater than the general Australian population [5]. Although data
regarding homelessness is scarce, it is estimated that 1 in 4 of the 20,000
homeless young persons in NSW identify as lesbian, gay or bisexual [6].
Additionally, lesbian or gay persons (34%) and persons with 'other' sexual
orientations (21%) are more likely to report at least one past experience of
homelessness compared to the national average (13%) [1].
  

Section 2: Health Concerns for Persons Identifying as Transgender or

Intersex

Estimates regarding the number of transgender adults in Australia have

significantly increased over the past decade, with recent data suggesting 1 in
every 250 adults identifies as transgender or intersex [10]. When addressing
the health concerns and health care needs of transgender and intersex
Australians, it is necessary to appreciate their inherent underrepresentation
within collapsed LGBTIQ statistics.
Of persons identifying as transgender or intersex, over 40% have reported
thoughts of suicide or self harm in the last two weeks [11]. This is three
times higher than persons identifying as lesbian, gay or bisexual combined
and over twelve times that of the general population [11]. Furthermore,
approximately 35% of transgender persons over the age of 18 have
attempted suicide in their lifetime, which is almost eleven times greater than
the general Australian population [12]. In regard to mental health,
transgender Australians are nearly twice as likely to be diagnosed with or
treated for a mental disorder than lesbian, gay or bisexual persons, and
almost three times [13].
Transgender people are nearly twice as likely to be diagnosed or treated
with a mental disorder and anxiety compared to Lesbian and Gay people,
and nearly three times more likely than the general population [13].
Additionally, almost 60% of transgender persons aged 18 and over will be
diagnosed with depression in their lifetime [11], while over 20% of people
with intersex variations aged 16 and over have been diagnosed with
depression [13]. Similarly, 40% of transgender persons aged 18 and over
will be diagnosed with an anxiety disorder in their lifetime [11], while 13%
of people with an intersex variation aged 16 and over reported being
diagnosed with anxiety [14].

Section 3: Marriage Equality Statement

Under the current legislation, the Marriage Amendment Act (2004), which
made amendments to the original Marriage Act (1961), the law states that
“marriage means the union of a man and a woman to the exclusion of all
others, voluntarily entered into for life.” Therefore, same-sex couples are
legally unable to be wed in Australia. The NSWMSC supports the
Australian Medical Association’s recent position statement announcing their
support to amend the Marriage Act (1961) to recognise the “right of any
adult and their consenting adult partner to have their relationship
recognised… regardless of gender.” [15].

Section 4: Australian Healthcare System and the LGBTIQ Community

Members of the LGBTIQ community are more likely than the general
Australian population to report negative experiences with healthcare
providers [16]. Lesbian, gay and bisexual Australians have reported
delaying seeking healthcare because of reasons directly pertaining to their
sexual orientation [16]. Lesbian and bisexual persons are more likely to
report lower continuity of and satisfaction with healthcare compared to
exclusively heterosexual persons [17]. Non-disclosure of sexual orientation
to medical professionals, which is often attributed to fear of negative or
  

pathologizing responses or inappropriate questioning, has been associated

with poor mental health, lower levels of screening and less preventative care
[18], [19]. Conversely, disclosure of sexual orientation to medical
professionals who had supportive and sensitive approaches was directly
related to positive perceptions of the therapeutic relationship [19].
Transgender and intersex persons report significant experiences of
discrimination across a range of healthcare settings [20]. Specifically,
gender diverse Australians report incidences of hostility and the refusal of
medical professionals to provide medical care [20]. Accordingly,
transgender and intersex members of the LGBTIQ community cite fear of
being stereotyped, pathologized, judged or being met with ignorance as
reasons for nondisclosure of sexual identity [20]. Similarly to the
experiences of lesbian, gay and bisexual persons, the wellbeing of gender
diverse Australians and the quality of healthcare offered to this population is
directly associated with the perceived quality of the therapeutic relationship.
A recent study suggests that feelings of comfort and respect between gender
diverse persons and healthcare providers are positively correlated with
mental wellbeing, while perceived experiences of discrimination were
negatively correlated with mental wellbeing [21]. Transphobia, like all
forms of prejudice, is multidimensional and inexperience with transgender
patients and ignorance plays a significant role in clinician prejudice and
incompetency [22].

Section 5: Medical School Curriculum and the LGBTIQ Community

Unfortunately, current medical student experience with LGBTIQ specific
curriculum is limited. Although detailed description of current LGBTIQ
curriculum across NSW medical schools is unavailable, a recent Australian
Medical Student Association (AMSA) survey was conducted to investigate
student perceptions of quality and quantity with regard to LGBTIQ specific
curriculum [23]. The survey indicated that the majority of Australian
medical students would like more teaching on the topic than they are
currently receiving [23]. Additionally, a recent cross-sectional survey sent to
medical school curriculum administrators in Australia and New Zealand
highlighted the scarce exposure to LGBTIQ-specific health issues [24].
Approximately 60% of medical schools reported spending 0-5 hours on
LGBTIQ-specific content throughout the preclinical phase, while only 33%
of schools reported having specific LGBTIQ modules integrated into the
course [24].
Many transgender and intersex persons report their doctor had little to no
knowledge about or experience with treating transgender persons at the
beginning of the therapeutic relationship [25]. As a result, transgender and
intersex persons report a desire for their doctors to be taught how to treat
and manage gender diverse patients during medical school [25]. However,
current medical school curriculum focusing on transgender and intersex
persons is largely absent and inadequate, with no Australian and New
Zealand medical schools rating current teaching practices regarding gender
identity and diversity as ‘very good’ [24].
To bridge the gap between health inequities facing the LGBTIQ community,
Australian medical school curriculum must aim to address sexual orientation
and gender diversity as an important social determinant of health. Australian
medical schools should aim to liaise with the LGBTIQ community to
  

develop a structured syllabus detailing and presenting health and health care
specific lessons in a non-discriminatory and non-stereotypical manner
during the preclinical phase. Furthermore, skills in culturally sensitive and
responsive clinical practice should be refined through increased exposure to
LGBTIQ patient centred care during the clinical phase.

Section 6: Current Experiences of LGBTIQ Medical Students

An estimated 5% of medical students identify as a sexual minority [26].
This group of students notoriously experience a significantly greater risk of
depression, anxiety, and low self-rated health than their heterosexual student
counterparts [26]. Poor mental health among sexual minority medical
students may lead to greater burnout and attrition from medical school,
which in turn may diminish the diversity of the physician workforce [27].
Diversity, including sexual orientation diversity, among physicians is
important to the provision of accessible, quality care to the wider
community [28].
Medical education programs should implement policies that promote the
equal treatment of lesbian, gay, bisexual, and transgender medical students,
through the adoption of non-discrimination policies, that include sexual
orientation and gender identity/expression as protected classes, offering
school-sponsored health insurance to students’ same-sex and different-sex
partners on an equal basis, and including coverage of gender affirmation
health care services in school-sponsored health plans [29]. Given that bias
against lesbian and gay individuals persists among heterosexual medical
students despite shifts in public opinion over the past decade [30] medical
schools can also promote respectful interactions among students by
implementing diversity programs and adopting a zero-tolerance policy
toward discrimination and harassment. In addition, medical schools can
increase the visibility of sexual and gender minority people by hiring openly
LGBT faculty and staff, creating LGBT resource centers, and including
instruction on the health of LGBT people as part of the general curriculum.

 
  

POSITION STATEMENT

The physical, mental, emotional and social health and wellbeing of the
Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning (LGBTIQ)
community is integral to medical education and the medical profession. The
current LGBTIQ specific curriculum delivered across NSW medical schools
is insufficient and unable to address the role of the health sector in
perpetuating current health inequities experienced by persons of diverse
sexual orientation, sex or gender identity.
This policy affirms NSWMSC’s commitment to promoting the health and
wellbeing of the wider LGBTIQ community. NSWMSC believes all NSW
medical schools and teaching institutions should revise current LGBTIQ
curriculum and develop a structured syllabus aimed at creating responsive
and informed medical professionals. NSW medical schools should aim to
develop the skills of current medical student cohorts in practising non-
discriminatory, safe and effective health care capable of addressing existing
health inequities across the LGBTIQ community. Additionally, this policy
highlights NSWMSC dedication to advocating for and facilitating the
inclusivity and support of medical student members of the LGBTIQ
community. The promotion of positive experiences and outcomes for
medical students identifying as LGBTIQ is integral to improving the
diversity of the medical workforce.
  

POLICY

NSWMSC calls upon:

1. The Federal Government to:

1.1. Legislate marriage equality by amending the Marriage Act
(1961) to recognise the legal union of an adult and their
consenting adult partner, regardless of gender.

2. The NSW State Government to:

2.1. Provide funding for organisations that support the needs of the
LGBTIQ community, in areas such as housing, mental heath
services, and so on.

3. NSW Medical Schools to:

3.1. Recognise and appreciate the inherent role of medical
professionals in perpetuating health inequities faced by
members of the LGBTIQ community.
3.2. Liaise with members of the LGBTIQ community to develop a
structured public health curriculum focused on LGBTIQ as a
social determinant of health.
3.3. Liaise with members of the LGBTIQ community to develop a
structured LGBTIQ health curriculum applicable to both
preclinical and clinical phase medical students.
3.4. Address LGBTIQ health inequities in a non-discriminatory
manner, by recognising the inherent diversity within the
population and avoiding perpetuating negative stereotypes or
pathologizing.
3.5. Provide communication skills workshops for medical students
for eliciting a patient’s sex as well as gender and understanding
the increased risk of mental health disorders in particular
demographics.
3.6. Establish an anonymous reporting system to address concerns
of discrimination faced by medical students identifying as
members of the LGBTIQ community in both nonclinical and
clinical teaching environments.
  

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This policy was ratified at the NSWMSC Council 3 meeting on October 15th
2017.
_____________________________________________________________
Authored by:

Tereza Pejovska Zoe Wood

The University of Notre Dame, The University of Notre Dame,
Sydney Sydney
   

Under the supervision of:

Liam Mason
NSWMSC Advocacy Officer 2017
_____________________________________________________________
Media Contacts:

Liam Mason Ashna Basu

Advocacy Officer 2017 President 2017
NSWMSC NSWMSC
M: +61 432 949 086 M: +61 452 568 694
E: advocacy@nswmsc.org.au E: president@nswmsc.org.au
 

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