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

Condom negotiation and young women in Cambodia

A new paper from the research project I am involved with in Cambodia about young female sex workers and HIV. Drawing on the qualitative data from young women sex workers we’ve explored condom use. Originally a paper broadly about the determinants of condom use (incl alcohol and drug use by women and their clients, violence) it now focuses on the use of condoms across the relationships that young women are involved in – commercial, not commercial and those of ambiguous status.  We look at how the young women thought about their relationships – conceptualizing them as risky or not – and how that shaped their desire to use condoms as well as the strategies they employed to use them (or not).

Email me for a copy of the paper or find it here: Maher L, Mooney-Somers J, Phlong P, Couture MC, Phal S, Bates A, Sansothy N, Page K. (2013) Condom negotiation across different relationship types by young women engaged in sex work in Phnom Penh, Cambodia. Global Public Health [Epub ahead of print]

Abstract: Cambodia’s 100% Condom Use Programme is credited with an increase in
consistent condom use in commercial sexual interactions and a decrease in HIV
prevalence among female sex workers (FSWs). There has been little improvement
in condom use between FSWs and non-commercial partners, prompting calls for
more innovative approaches to increasing condom use in these relationships. To
understand why condoms are used or not used in sexual interactions involving
FSWs, we examined condom negotiation across different types of relationships.
We conducted 33 in-depth interviews with young (15 to 29 years) women engaged
in sex work in Phnom Penh. There was an important interplay between the
meanings of condom use and the meanings of women’s relationships. Commercial
relationships were characterised as inherently risky and necessitated condom use.
Despite a similar lack of sexual fidelity, sweetheart relationships were rarely
construed as risky and typically did not involve condom use. Husbands and wives
constructed their sexual interactions with each other differently, making agreement
on condom use difficult. The lack of improvement in condom use in FSWs’
non-commercial sexual relationships needs to be understood in relation to both
sex work and the broader Cambodian sexual culture within which these
relationships are embedded.

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.

Growing Up with Cancer self-portrait exhibition at Federation Square

This week the Growing Up with Cancer self-portraits are spending a week at Federation Square, Melbourne. This amazing venue gave the exhibition a whole new audience as school groups, tourists and lunching office workers made their way through the Fed Sq complex or to the Ian Potter Museum.

Two of the artist-participants (with proud mums and dads and kids) attended the Tuesday launch. We heard speeches from Michael Carr-Gregg (adolescent psychologist and long-time CanTeen supporter), Lachlan Korvin (CanTeen patient member and board member), Melia Bartholomeusz (GUWC participant and artist) and Peter Lewis (on behalf of GUWC team).

   GUWC at Fed Sq   GUWC at Fed Sq    GUWC at Fed SqGUWC at Fed Sq

The exhibition is now at the Peter MacCallum Cancer Centre (in time for the “Bridging the Gap: Meeting the needs of adolescents and young adults (AYA) wherever they receive Treatment” conference). It will be back in Sydney in May for a month at the Downing Centre.

An electronic copy of the exhibition catalogue is available here; or email me for a printed version.

Special thanks to Sandy Bliim who flew back from Nauru to set things up!


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.

Why LBQ women don’t use dental dams: Australian research on LBQ women’s sexual health

I had the pleasure of presenting at ACON’s Big Day In. ACON is NSW’s largest community-based gay, lesbian, bisexual and transgender (GLBT) health and HIV/AIDS organisation; Big Day In is their annual staff development day. I turned up early to see the L Panel – several of the organisation’s fierce women who work across programs on lesbian and same-sex attracted women health. It was led by the lovely Alan Brotherton – who chairs ACON’s Lesbian Advisory Committee. My role for the day was to give a presentation on some of the work I’ve been doing in LBQ women’s health. I wanted to talk about: What we know about sexual behaviour and sexual health in LBQ women and women’s perceptions of STI risk, and then facilitate a discussion about what these research findings mean for health promotion.

Check out the slides

Young Women’s Health Study Cambodia article

Our latest paper from the Young Women’s Health Study (YHWS) in Cambodia, has just been accepted by the Harm Reduction Journal. It’s open access so the provisional PDf is up – just click on the paper title.

Maher, L, Mooney-Somers, J, Phlong, P,  Couture, MC, Stein, E, Evans, J, Cockroft, Sansothy, NC, Nemoto T, and Page, K.(2011) Selling sex in unsafe spaces: Sex work risk environments in Phnom Penh, Cambodia. Harm Reduction Journal.

Background: The risk environment framework provides a valuable but under-utilised heuristic for understanding environmental vulnerability to HIV and other sexually transmitted infections among female sex workers. Brothels have been shown to be safer than street-based sex work, with higher rates of consistent condom use and lower HIV prevalence. While entertainment venues are also assumed to be safer than street-based sex work, few studies have examined environmental influences on vulnerability to HIV in this context.

Methods: As part of the Young Women’s Health Study, a prospective observational study of young women (15-29 years) engaged in sex work in Phnom Penh, we conducted in-depth interviews (n=33) to explore vulnerability to HIV/STI and related harms. Interviews were conducted in Khmer by trained interviewers, transcribed and translated into English and analysed for thematic content.

Results: The intensification of anti-prostitution and anti-trafficking efforts in Cambodia has increased the number of women working in entertainment venues and on the street. Our results confirm that street-based sex work places women at risk of HIV/STI infection and identify significant environmental risks related to entertainment-based sex work, including limited access to condoms and alcohol-related intoxication. Our data also indicate that exposure to violence and interactions with the police are mediated by the settings in which sex is sold. In particular, transacting sex in environments such as guest houses where there is little or no oversight in the form of peer or managerial support or protection, may increase vulnerability to HIV/STI.

Conclusions: Entertainment venues may also provide a high risk environment for sex work. Our results indicate that strategies designed to address HIV prevention among brothel-based FSWs in Cambodia have not translated well to street and entertainment-based sex work venues in which increasing numbers of women are working. There is an urgent need for targeted interventions, supported by legal and policy reforms, designed to reduce the environmental risks of sex work in these settings.  Future research should seek to investigate sex work venues as risk environments, explore the role of different business models in mediating these environments, and identify and quantify exposure to risk in different occupational settings.