Lesbian and bisexual women and Pap smears – some good news but concerns remain

I attended the Australasian Sexual Health conference in Sydney to share our recent analysis of data from SWASH on Pap smear testing rates for lesbian, bisexual and queer (LBQ) women. The work was initiated by a medical student from Scotland, Catriona Douglas, who did an research internship with me earlier  this year. We looked at changes in testing between 2002 and 2012, comparisons between LBQ women and the general population in NSW, and predictors of test attendance among LBQ women in NSW. This is what we found:

Sexual Health SWASH pap smear poster FINAL print

Citation: Douglas C, Deacon R, Mooney-Somers J (2014) Pap smear rates among Australian lesbian and bisexual women: some good news but disparities persist. Poster presented at Australasian Sexual Health Conference, Sydney. Download the poster here.

We’ve just started to get some media interest.

Gay New Network (SX magazine in Sydney)


Tobacco-control project targeting lesbians, bisexual and queer women

The Cancer Institute NSW (the cancer control agency for NSW) awarded an Evidence to Practice grant to ACON (NSW’s leading health-promotion organisation specialising in HIV and LGBTI health). I’m delighted to be the research partner on the grant.

The grant is titled “Tobacco-control project targeting lesbians, bisexual and queer (LBQ) women” and will run until mid-2016. The grant was awarded on evidence from the research I’ve been doing with ACON (and colleague Rachel Deacon) in the SWASH project that shows lesbian and bisexual women in Sydney are smoking at twice the rate of their heterosexual peers, and that rates have changed little despite significant mainstream public health interventions.

This grant is a real win. It is a testament to ACON’s commitment to this area, their strategic plan for 2013-2018 outlined a range of commitments to addressing smoking in LGBTI communities, including:

“seek funding to use our considerable social marketing expertise to identify and address the current high rates of smoking in our communities.”

It is also a testament to the Cancer Institute’s responsiveness to an area that has long been neglected in Australia (compared to the US, for example). And I’ve really pleased that the SWASH survey was key to providing an evidence base for a lack of movement in smoking rates among lesbian and bisexual women in Sydney.

The project will use ACON’s expertise in community-based social marketing to develop a smoking intervention to be delivered online and through community spaces and events. Will update here as the project progresses….

Fascinating Facts about Female Same-Sex Couples from the 2011 Australian Census

You’ll think twice about the next nurse, teacher, or police officer you meet… 

Last week, more data on same-sex couples was released from the 2011 Census of Population and Housing. This is the third set of analyses released by the Australian Bureau of Statistics (ABS):

  • Same-sex couple families” part of the “Reflecting a Nation: Stories from the 2011 Census” series in June 2012.#
  • Counts of Same-Sex Couples” a census factsheet in September 2012.$
  • a media release titled “Australian Social Trends: Same-Sex Couples in Australia” released July 2013.^

Data are reported by same-sex couple versus opposite-sex couple, with an occasional breakdown by gender. Although there is not enough disaggregation by gender for my liking, I’ve put these data in green. These analyses provide some interesting insights into women living in same-sex couple relationships.

How are same-sex couples identified by the census?

Since 1996 respondents have been asked to identify the relationship of each person in the household to each other person – whether you are the husband/wife, de facto partner, child, stepchild, sibling, or unrelated. In 2011, 33,714 same-sex couples were registered, an increase of 32% since the 1996 census.^ The ABS suggests this is due to “growing social acceptance [and] increased awareness that data about same-sex couples is made available from the Census, giving more reason for same-sex couples to be open about the nature of their relationship and willing to supply this information.”$

Despite there being no marriage equality in Australia and various governments working to make sure marriages from other jurisdictions are not recognized, the ABS made a bold move* for the 2011 census and reported the proportion of same-sex partners registering their relationship as husband/wife. Prior to this, these people would have been reclassified as de facto.^  The ABS  states: “The reasons why people might report that they are the husband or wife of someone of the same sex cannot be known from Census data, but may include having been married in a jurisdiction other than Australia, having registered their relationship under state or territory law, or considering that husband or wife is the term that best describes their relationship.”^

What do the census releases tell us about women in same-sex relationships?

The number of same-sex couples in Australia in 2011

  • There were 16,131 female same-sex couples, of whom, 661 women reported their relationship as wife-wife.^
  • Same-sex partners  accounted for 0.7% of all partners (1.6% of partners aged 15–24 years).#
  • 0.9% of partner Aboriginal and Torres Strait Islander men and women were in a same-sex couple, this flattens out when you take account of age. It is worth remembering that 2.9% of all same-sex couples include an Aboriginal and Torres Strait Islander person.#
  • 0.8% of women born in Australia were living with another women.#
  • 0.5% of women born overseas were living with another women. (The most common countries of origin for women were NZ and England).#

Age differences within couples

  • The average age difference between women in a same-sex couple was 4.8 years (compared to 6.5 years between men in a same-sex couple, or 3.7 years between people in an opposite-sex couple).$
  • People in same-sex couples were in general younger than people in opposite-sex couples. The greatest number of same-sex couples were in the age group 35-44 years, followed by 25-34 and 45-54.#


  • 22% of female same-sex couples had children living with them (compared to 3% of male same-sex couples and 54% of opposite-sex couples).$
  • Same-sex couples who had children living with them were less likely to have two or more  (47%), compared to opposite-sex couples (64%).$


  • Same-sex couple partners were less religious than opposite-sex couples (48% compared to 21%); still 40% registered their religion as Christian (compared to 67% of opposite-sex couples).#
  • Same-sex couple partners were more likely to report their religion as Buddhism (4.0% compared with 2.6%).#


  • Same-sex couple partners were twice as likely to have a Bachelor degree or higher than those in opposite-sex couples (42% compared to 23%).$
  • And more than twice as likely to have a Doctoral degree (2.3% compared to 0.9%).$

Workforce participation

  • 89% of partners in same-sex couples are in the workforce, compared with 69% of those in opposite -sex couples.$
  • Partners in same-sex couples are more likely (53% )to be in skilled occupations than those in opposite -sex couples (40%).$
  • The most common occupation for women in same-sex couples was registered nurse (4.3%), with secondary school teacher (2.2%), police (2.2%), welfare worker (2.0%), primary school teacher (1.7%) and university lecturer/tutor (1.5%) all in the top ten occupations.$

Women in same-sex couples are highly engaged in looking after the health and education of the Australian community


  • Women in same-sex couples are earning more than their sisters in opposite-sex couples: three times as many earn $2000 or more per week.$
  • While women in same-sex couples are earning more than their sisters, there is still a gender pay gap: 11% of these women earn $2000 or more per week compared to 18% of men in same-sex couples and 14% of men in opposite-sex couples (and 4% of women).$


  • Women in same-sex couples shared the housework more than all other couples – 59% shared compared to 57% of male same-sex couples and 38% of opposite-sex couples.$

Geographical concentration

  • Same-sex couples are most likely to live in large cities and town – female same-sex couples account for 0.4% of couples in cities of 1million plus people.$
  • Perhaps reflecting the concentration of women in public service jobs, the greatest proportion of female same-sex couples was in ACT (0.6% of all couples in ACT), followed by… Northern Territory (0.5%; but only 0.3% of couples were male same-sex couples).$
  • While NSW had less than 4% of female same-sex couples, 34% of Australia’s female same-sex couples lived there.$

Female same-sex couples were highly concentrated in the inner west of Sydney…

  • The inner west of Sydney comprised the top ten suburbs for female same-sex couples: St Peters (6% of all couples), Newtown (5.7%), Erskineville (5.4%), Enmore (5.3%), Lewisham (4.2%), Alexandria (3.6), Tempe (3.5%), Chippendale (3.4%), Marrickville (3.2%), Stanmore (3.0%).$
  • Not to be left out, female same-sex couples made up 4.5% of couples in Daylesford-Hepburn Springs, a Victorian country town with a population of 3,200. And 1.2% of couples in Alice Springs, a central Australian town with less than 25,000 residents.$
  • 63% of people in same-sex couples had lived at a different address than at the time of the 2006 census (compared to 40% of people in opposite-sex couples).$

Who’s missing?

All the single ladies… Now put your hands up

The 2011 Australian census can only tell us about people in same-sex couples – that’s “two people of the same-sex who report a de facto or married partnership in the relationship question on the Census form” – and who are “usually resident in the same household”.# This means we have no insights into the lives of Australian:

  • Single lesbian or bisexual women
  • Single lesbian or bisexual women with children
  • Lesbian or bisexual women who are in couple relationships but who do not usually reside in the same household
  • Lesbian or bisexual women who are in relationships comprising more than two people

How is this all helpful?

Check out this great discussion paper from the national LGBTI Health Alliance on why this matters and some of the complexities around capturing accurate, useful and meaningful data about lesbian, gay, bisexual, trans/transgender, intersex and other sexuality, sex and gender diverse peoples.

I’m a social researcher working in health and I’d like to have access to reliable data on lesbian and bisexual women. I run  (with colleagues) a biennial survey of lesbian and bisexual women’s health (I’ve written several blog posts about this work). If we can use the census to work out how representative our samples are (I’ll write about this when we do it) then we can be confident about the validity and usefulness of the data we collect. And others can act on it, including those making policy that affects lesbian and bisexual women’s lives and health providers caring for their health and wellbeing. This is especially important as long as lesbian and bisexual women are not identified in national data sets. I’d love to hear about the information about lesbian and bisexual women you’d find useful for the area you work in.

*The fact sheet goes so far as to pointedly state: “However, there is still no Australian legislation to allow same-sex marriage or legal recognition of same-sex marriages performed overseas”.$
Data sources – The ABS has done all the hard work here, I’ve merely collated and pulled data on women. Thanks for that ABS, I really really appreciated your efforts.
$ Counts of Same-Sex Couples
Same-sex couple families. Reflecting a Nation: Stories from the 2011
Australian Social Trends: Same-Sex Couples in Australia

Homophobia in our healthcare system – Sydney Morning Herald

Homophobia in our healthcare system – a very worthwhile read from Friday’s Daily Life, Sydney Morning Herald. Written by Melissa Davey (coincidentally a student at Sydney School of Public Health), it was prompted by a very interesting research article on lesbian mothers’ experience of the healthcare system. What I especially liked about the research article is the researchers’ description of four different ways women experienced homophobia: exclusion from services and healthcare; heterosexual assumption; inappropriate questioning and outright refusal of services. I suspect they resonate for many same-sex attracted women (so not limited pregnancy).

The researchers echo a point ACON has been making for a while (indeed they cite ACON’s historic “Turning Point : Lesbian Health Strategy“):

Fundamentally, the distinctive healthcare needs of lesbian women go unnoticed, are deemed unimportant or are simply ignored

As a reminder, those distinctive healthcare needs include significantly higher rates of smoking, risky drinking, illicit drug use, psychological distress… We don’t have evidence to show the impact of some of these lifestyle risk factors (tobacco, alcohol) because NO ONE IS COLLECTING THE DATA, but we know that they are likely to produce higher rates of  cardiovascular disease, cancer, etc.

Lower rates of Pap smears in women without a history of sex with men suggest there is still education to be done. The comments on the Daily Life blog repeat myths about lesbian women not needing Pap smears. Even though the message has been pretty clear for a while:

Western Australian Cervical Cancer Prevention Program

PapScreen Victoria – although note the curious choice of ‘sexy’ imagery

Women’s Health Queensland

South Australian Cervical Screening Program

Cervical Screen NSW

ACON community forum on lesbian and gay drug trends – TUESDAY @ Oxford Hotel

Lesbian and Gay drug trends forum
Lesbian and Gay drug trends forum

Delighted to have been invited to speak at this community forum with Dr Toby and Miss Tokyo and community representatives… SWASH survey has a lot of data on alcohol, tobacco and other drug use. The main message from me will be: we need to talk about smoking… twice the rate. Still.

I’ll be interested to hear people’s sense of why this might be and – more importantly – what we might do about it. I’ll do a write up here. ACON have done a lovely design job on my slides, I’ll post them here after the forum.

At the intersection of marginalised identities – paper on LGBT injecting drug users with hepatitis c

A paper based on work we presented at the Social Research Conference on HIV, Hepatitis C and Related Diseases, Sydney, last year. Email me for a copy of find it here:

Deacon, R, Mooney-Somers, J, Treloar, C, & Maher, L. (2013) At the intersection of marginalised identities: Lesbian, gay, bisexual and transgender people’s experiences of injecting drug use and hepatitis C seroconversion Health and Social Care in the Community. doi: 10.1111/hsc.12026. [Epub ahead of print]

Abstract: While the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the wellbeing of LGBT populations. While some kinds of drug-use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi-structured interviews to explore participants’ understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity.

Community was central to the participants’ accounts. Drug-use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream; enacting LGBT community norms of behaviour; and connection through shared drug-use. Participants also described feeling afraid to come out about their drug-use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the PWID community. Thus the combination of being LBGT/living with HIV (a “gay” disease) and injecting drugs/living with HCV (a “junkie’s” disease) left them in a kind of no man’s land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health care for LGBT people who inject drugs.

Questions in the house about lesbian and bisexual women’s health

21 June 2012, Ms Clover Moore (Member of the New South Wales Legislative Assembly (until September 2012) and Lord Mayor of the City of Sydney) asked a question of Jillian Skinner (Minister for Health, and Minister for Medical Research):

“With respect to the joint Sydney University and ACON “Health Check – Sydney Women and Sexual Health” survey which identified that marginalisation and invisibility result in higher rates for some health conditions and lower rates of help seeking:

  • What key health concerns were identified in the Sydney Women and Sexual Health survey?
  • What action has been taken to ensure that all health services acknowledge and provide appropriate treatment to lesbian women?
  • What action has been taken to ensure that lesbian women are aware of health issues and treatments, and seek treatment?
  • What action has been taken to address:
    – lower rates of cervical cancer screening;
    – problematic alcohol, tobacco and other drug use;
    – mental health support;
    – violence against lesbians including domestic⁄family violence;
    – obesity and overweight concerns?
  • What changes have been made to health services in the inner city based on these findings?
  • What support does the Government provide to specialist lesbian health services and programs?
  • What further action does the Government propose to address these concerns?

26 July 2012, Jillian Skinner responded:

“I am advised:

(1), (5) and (7) Summary results of “Health Check – Sydney Women and Sexual Health Survey 2010” are available at http:⁄⁄www.acon.org.au⁄sites⁄default⁄files⁄SWASH%20Report%20Card.pdf

(2) and (3) NSW Health’s services acknowledge and provide appropriate treatment to all patients regardless of their sexual orientation.

(4) (a) Initiatives undertaken by the NSW Cervical Screening Program include:

  • implementation of a mass media social marketing campaign, Peace of Mind.
  • new reminder strategies targeting women who participate in cervical screening outside the recommended two-year period, including in collaboration with general practitioners.
  • redevelopment of the Program website to ensure it is engaging, accessible, culturally appropriate and supports key promotional strategies, includes an enhanced Pap test provider search tool and a message recommending to lesbians and other same-sex attracted women to participate in biennial screening for cervical cancer.

The Cancer Institute NSW has made available to health professionals and community groups a brochure, Lesbians need Pap tests too, which addresses misconceptions that may prevent lesbians and other same-sex attracted women from participating in screening for cervical cancer.


  • The NSW Tobacco Strategy 2012-2017 sets out the broad range of Government action to reduce the harm associated with tobacco use.
  • The Opioid Treatment Program provides assessment, treatment, and referral services to an already marginalised drug-using population, around a third of whom are women.
  • The NSW Health Club Drugs campaign targets the Gay, Lesbian, Bisexual and Transgender (GLBT) community and raises awareness of the risks and harms associated with the use of “Club drugs” which include ecstasy, methamphetamine (speed, base, crystal, ice), cocaine and GHB.
  • There are a number of drug and alcohol treatment services that target women, both in the government and non-government sector. There are a number of residential rehabilitation services specifically for women within NSW. These treatment programs may include beds for women and their children, as well as women participating in the diversion programs – MERIT and Drug Court.

(c) ACON has developed a Mental Health and Wellbeing Strategy 2010-13 to support their work to promote mental health and wellbeing, and reduce the impact of mental health problems on GBLT communities through direct activity, partnerships and service development.

NSW Health provided funding of $450,000 under the NGO Grant Program for the ACON Peace of Mind Mental Health Literacy Project, from 1 January 2011 to 30 June 2012, with two primary aims:

  • To develop and pilot a mental health information and promotion program (adapted from an existing recognised evidence based training package) to ensure relevance and specificity for GLBT communities.
  • To develop and implement a strategic promotion and partnership campaign.

Workshops have been held to pilot the training package. Further information is available on the ACON website: http:⁄⁄www.acon.org.au⁄home

(d) NSW Health’s response to violence against lesbians is guided by the NSW Strategic Framework 2007-2012 Working Together: preventing violence against GLBT people and the NSW Health Policy and Procedures for Identifying and Responding to Domestic Violence 2003.

Local Health Districts undertake a range of actions including targeted activities such as community information resources, and activities incorporated into other relevant policies and strategies such as workplace bullying and harassment policies.

NSW Health’s Education Centre Against Violence (ECAV) provides training for health staff and interagency partners on working with clients in same sex relationships who experience domestic violence.

(e) NSW 2021 sets out targets to reduce overweight and obesity in children and adults. The NSW Ministry of Health has commenced the preparation of a new cross government overweight and obesity plan.

(6) The NSW Government provides funding to ACON through the NSW Ministry of Health Non Government Organisation Grant Program to support programs to prevent the transmission of blood-borne viruses and sexually transmissible infections in lesbian and same-sex attracted women.”

Women’s Western Australian Sexual Health (WWASH) Survey 2010


I am super excited at the arrival of the final report coming out of the 2010 Women’s Western Australian Sexual Health (WWASH) Survey. This is the Perth version of the Sydney Women and Sexual Health (SWASH) survey – same survey questions, different location – which we (Rachel Deacon and myself) conducted with Jude Comfort of the WA Centre for Health Promotion Research at Curtin University. The report includes comparative stats between Perth and Sydney; the first time this kind of work has ever been done in Australia (because we have big enough numbers). Report available here.


At the intersection of two marginalised identities – conference paper

At the 12th Social Research Conference on HIV, Hepatitis C and Related Diseases, Sydney today, watching my colleague Rachel Deacon presented our paper “At the intersection of two marginalised identities: Lesbian, gay, bisexual and transgender people’s experiences of injecting drug use and hepatitis C seroconversion”


Introduction: Although international research shows higher levels of injecting drug use and hepatitis C virus (HCV) infection among lesbian, gay, bisexual and transgender (LGBT) populations, there is limited social research on the experiences of LGBT people who inject drugs (PWID) or live with HCV.

Approach: An Australian qualitative study of understandings and experiences of HCV in people provided an unexpected data set of 8 LGBT injectors living with hepatitis C. This paper presents findings of an opportunistic thematic analysis of these data.

Findings: We argue that same-sex relationships as a social context for injecting has important implications for health promotion and health provision around risk reduction practices, understanding initiation to injecting, injecting as a relationship practice in creating intimacy, and relationships as a source of support during HCV or drug treatment. Many of our participants described tensions around their place in two communities, an LGBT community and a community of people who injects drugs. The loss of connection to a chosen community means the absence of vital support networks, which may place additional stressors on those considering HCV or drug treatment.

Implications: We argue that meeting the needs of this population involves health professionals developing relationships with LGBT community health organisations, and developing capacity in providing LGBT health care, while LGBT community organizations must raise awareness of hepatitis C in LGBT communities. It is vital that we reduce stigma and potentially negative consequences for people whose experiences exist at the intersection of these two marginalised identities.