Key messages

  • LGBTI people may not disclose their sexual orientation, gender identity or intersex status to service providers.
  • Practitioners unaware of sexual health issues facing LGBTI people can compound underutilisation of health services and non-disclosure about sexual practices and sexual risks.
  • Sexual health can be impacted by risk-taking behaviours associated with social marginalisation, stigma and discrimination.
  • When taking a person’s sexual history, service providers should use non-judgemental, sensitive and inclusive language.
  • Health professionals should seek information, advice, referral options and training to provide an appropriate sexual health service to people who are LGBTI.
Many people who are LGBTI may not disclose their sexual orientation, gender identity or intersex status to service providers. Because sexual practice does not always follow an individual’s sexual orientation, a focus on sexual behaviours is often the best way to address sexual health issues.

Men who have sex with men (MSM)

 Compared with the general adult male population, sexually active men who have sex with men (MSM), including trans men, have higher rates of blood borne viruses (BBV) and sexually transmissible infections (STI). In Victoria, MSM is the population most affected by HIV. Unprotected anal intercourse with casual or anonymous partners is the most commonly reported exposure to HIV in Victoria. Since 2008, Victoria has seen a shift to a younger age at diagnosis among men reporting male-to-male sex with the median age for males being 35.

There are several known risk behaviours that influence HIV transmission which include the rate of HIV testing; risk reduction practices such as choosing a partner based on their HIV status; people living with HIV, living longer and healthier lives and remaining sexually active for longer, increasing the risk of infection at a population level; and other STI such as syphilis.

Early detection of HIV and STI and early treatment commencement and support for HIV is integral in the management of MSM’s sexual health needs. MSM should be tested in accordance with the Sexually Transmissible Infections in Gay Men Action Group (STIGMA) guidelines.

Women who have sex with women (WSW)

Women who have sex with women (WSW) can transmit infections through sexual contact and their rates of STI are similar to those amongst heterosexual women. Specific infections that can be transmitted include herpes, human papilloma virus (HPV), candida and organisms associated with bacterial vaginosis. STIs that are less commonly transmitted but still possible include chlamydia, gonorrhoea and blood-borne viruses. There are often misconceptions of very low risks of STIs (including HPV infections) in WSW. Lesbian and bisexual women who experience a lack of social support and social acceptance around the coming out period may require a more considered sexual health assessment in order to determine levels of risk taking behaviour. Research suggests that WSW practise safe sex inconsistently and have a low rate of STI testing.

Transgender and Intersex people

Sexual health risks for transgender and intersex people will depend on their individual anatomy and the particular sexual behaviours they engage in. As trans, gender diverse and intersex people experience the same diversity in sexual orientation as the general population, a focus on sexual behaviours is often the best way to address sexual health issues. For example, a trans man who identifies as gay may have the same sexual risks as MSM, but his individual level of risk will depend on his particular anatomy and the specific behaviours he has engaged in. For some people with intersex variations, their sexuality, sexual behaviours and anatomy may be affected by surgical or other medical treatment administered when they were children or in later life. Services therefore need to be aware of, and sensitive to, both physical and behavioural diversity when working with trans, gender diverse and intersex people and structure sexual health questions, information and testing accordingly.

Other sexual health issues

Exposure to sexually transmissible infections should be considered as a health issue for all who are or have been sexually active, as sexual practices and gender of partners may be fluid throughout the lifetime. Young people in particular carry a disproportionate burden of sexual ill-health and age appropriate sexual health screening is recommended.

Sexual health can be impacted by risk-taking behaviours associated with social marginalisation, stigma and discrimination. Practitioners unaware of sexual health issues faced by people who are LGBTI can compound their underutilisation of health services and non-disclosure about sexual practices and sexual risks. When taking a person’s sexual history, service providers should use non-judgemental, sensitive and inclusive language and allow individuals to disclose their full sexual history if they wish to do so.

There may also be specific sexual health issues for people who are LGBTI in institutional settings, such as prisons, remand centres and aged care settings. Health professionals working in these settings are encouraged to seek information, advice, referral options and training where available to be able to provide an appropriate sexual health service to people who are LGBTI.

Other issues for people who are LGBTI using sexual health services that would require sensitive and inclusive practice include intimate partner violence, sexual assault and treatment after exposure to HIV. Individuals may experience distress, regret, anxiety and confusion in these circumstances, which can be made worse by having to recount details in a non-inclusive emergency setting.

People encountering knowledgeable, sensitive and inclusive services are more likely to adhere to treatment protocols and to attend health services in future when they might need to.

HIV medication and testing

  • Pre-exposure prophylaxis, or PrEP, may be taken as a daily pill by people who are at high risk for HIV transmission to significantly reduce the chance of becoming infected. PrEP will be available to 2600 at risk Victorians through the PrEPX public health research study, commencing in July 2016. To register for the study, go to http://www.alfred.org.au/Page.aspx?ID=832
  • Non-occupational post-exposure prophylaxis (NPEP) is a course of anti-HIV medication commenced within 72 hours of exposure to HIV and taken for 28 days with the aim of reducing the risk of acquiring HIV. NPEP is taken primarily for sexual and injecting drug use exposures in the community and is reserved for exposures where the HIV risk is significant.
  • The NPEP 24-hour telephone information line 1800 889 887 is staffed by registered nurses who are experts in HIV, NPEP and sexual health. The nurses have access to an Infectious Diseases Consultant for further expert advice where necessary.
  • Victoria has rapid HIV testing with results available in 30 minutes; however, some results may need to be confirmed by further blood tests. Rapid HIV testing is not listed on the Medical Benefits Scheme.

Clinics

Please note that LGBTI services are offered at a number of sexual health clinics in Victoria.
Metropolitan Melbourne

Northside Clinic
370 St Georges Road, Fitzroy North
Tel: 03 9485 7700 

The Centre Clinic
rear of 77 Fitzroy Street, St Kilda
Tel: 03 9525 5866

Prahran Market Clinic 
Prahran Central Shopping Centre
Mezzanine Level, 325 Chapel Street, Prahran Vic 3181
Tel: 03 9514 0888

Melbourne Sexual Health Centre
580 Swanston Street, Carlton
Tel: 03 9341 6200

PRONTO!
175 Rose Street, Fitzroy Vic 3065
Tel: 03 9416 2889

ERA Health (Dr Forgan-Smith):
563 Bourke Street, Melbourne VIC 3000
Tel: 03 9944 6200

Family Planning Victoria
Box Hill clinic (for everyone), education services and resource centre
901 Whitehorse Rd, Box Hill, 3128
Tel: 03 9257 0100 or freecall 1800 013 952

Action Centre (for people under 25)
Level 1, 94 Elizabeth St, Melbourne, 3000
Tel: 03 9654 4766 or freecall 1800 013 952

Regional Victoria

Geelong Sexual Health Clinic
Kardinia Health
2-18 Colac Rd, Belmont 3216
Tel: (03) 5202 9333
Fax: (03) 5202 9399

Bendigo Primary Care Centre
123 Arnold St, Bendigo Vic 3550
Tel: 03 5441 8622

Ballarat Community Health Centre Sexual Health Clinic
710 Sturt Street, Ballarat Vic 3350
Tel: 03 5338 4540

Eaglehawk STI/BBV Service
Seymour Street, Eaglehawk Vic 3556
Tel: 03 5434 4300

Gateway Community Health Sexual Health Clinics

Wangaratta
(GP and Community Health Nurse)
1st Floor, corner Ovens & Faithful Streets, Wangaratta
Tel: 03 5723 2000

Myrtleford
(Community Health Nurse)
32 Smith Street Myrtleford
Tel: 03 5731 3500

Wodonga
Clinic 35
155 High Street, Wodonga
Tel:02 6022 8888 or free call 1800 657 573

References

Anderson, S., McNair, R., and Mitchell, A., 2001, Addressing health inequalities in Victorian lesbian, gay, bisexual and transgender communities, Health Promotion Journal of Australia,11(1):32.

Rosenstreich, G., Comfort, J., and Martin, P., 2011, Primary health care and equity: the case of lesbian, gay, bisexual, trans and intersex Australians, Australian Journal of Primary Health 17(4):302-308.

Pandya, A., 2014, Mental health as an advocacy priority in the lesbian, gay, bisexual, and transgender communities, Journal of Psychiatric Practice 20(3):225-227.

Leonard, W., 2002, What's the difference: Health Issues of major concern to gay, lesbian, bisexual, transgender and intersex (GLBTI) Victorians, Ministerial Advisory Committee on Gay and Lesbian Health, Melbourne.