LGBTQ+ People
Priority Area

The LGBTQ+ is one of the acronyms used when referring to the many and diverse peoples and communities who identify as lesbian, gay, bisexual, trans/transgender, intersex, queer and other sexuality (including asexual), gender and bodily diverse”. (AIHW, 2024) The diversity, non-homogeneous nature and diverse needs of LGBTQ+ communities was highlighted by participants in subject matter expert and service provider consultations conducted by Healthy North Coast as part of the needs assessment.

The barriers faced by LGBTQ+ individuals in accessing healthcare are often compounded when these individuals belong to other marginalized groups. LGBTQ+ people who also identify as culturally and linguistically diverse, are experiencing homelessness, are exiting prison, have disabilities, or are facing domestic and family violence often encounter multiple layers of discrimination, stigma, and neglect in healthcare settings. These intersectional factors create unique and complex health disparities that must be addressed with tailored, culturally competent care.

The LGBTQ+ peoples on the North Coast region face significant health disparities, particularly in relation to mental health, substance use and access to inclusive healthcare. Barriers such as a lack of culturally competent care, discrimination and limited service availability in regional and rural areas further compounds these challenges. The ageing LGBTQ+ population and the high prevalence of domestic violence underscore the need for tailored services that address the unique needs of this diverse community. By improving access to healthcare services, enhancing provider competence through training and actively engaging with this community, we can ensure that LGBTQ+ peoples receive the care and support they need to thrive.

Collecting comprehensive data on health needs of LGBTQ+ peoples is challenging, given the diversity of these communities and small sample size in regional areas. However, ongoing consultation with LGBTQ+ individuals and organisations is critical to understanding their specific needs. This collaboration will ensure that healthcare services, policies and resources are better tailored to support the wellbeing of LGBTQ+ people across the North Coast.

Healthy North Coast is committed to enhancing equity for LGBTQ+ people and the implementation of the National Action Plan for the Health and Wellbeing of LGBTIQA+ People 2025-2035 (Department of Health and Aged Care, 2024) and the NSW Health LGTBIQ+ Strategy 2022-2027 (NSW Ministry of Health, 2022) in collaboration with regional partners. This includes training primary care providers in gender affirming care, collaboration with local health districts (LHDs) and ongoing collaboration with ACON, the leading provider of community health services for LGBTQ+ people in NSW.

On the North Coast, LGBTQ+ survey respondents reported mental health and alcohol and other drug concerns as more serious issues compared to the general population:

• A large percentage (61%) of the 297 LGBTQ+ participants identified mental health as a primary concern, compared to 39% in the general population. This was supported by the Private Lives 3 survey, which revealed high rates of psychological distress (57%), depression (61%) and anxiety (47%) among LGBTQ+ peoples.
•  A total of 47% of LGBTQ+ participants raised concerns about alcohol and drug use through the survey, more than the 31% of the general population. The Private Lives 3 survey confirmed that 17% of LGBTQ+ respondents struggled with alcohol management, while 44% used drugs for non-medical purposes.

These figures highlight the urgent need for accessible, tailored mental health and alcohol and other drug (AOD) services that can support LGBTQ+ individuals in addressing these challenges (Hill, Bourne, McNair, Carman, & Lyons, 2020).

Gay, bisexual and other men who reported male-to-male sexual contact are disproportionately affected by the human immunodeficiency virus (HIV) (CDC, 2024). People living with HIV are at an increased risk of developing dementia, a condition known as HIV-associated dementia. HIV can impact the brain, leading to cognitive decline, memory loss and other neurological impairments. While antiretroviral treatments have considerably improved the life expectancy of people with HIV, long-term HIV infection can still cause neurological damage, even in individuals with undetectable viral loads. Studies suggest that HIV-associated dementia is more common among those who have had the virus for many years, especially if they have not consistently received treatment or if treatment started later in life (Dementia Australia, 2024).

The risk of developing dementia in LGBTQ+ communities is also heightened by other factors, such as coexisting conditions like substance use, depression and social isolation – issues that are prevalent in LGBTIQ+ populations, particularly among transgender and gender-diverse individuals. When these challenges are combined with the stigma and discrimination often experienced by LGBTQ+ people, the risk for dementia, including HIV-associated dementia, becomes even more critical (AIHW, 2024). LGBTQ+ people with dementia may experience unique challenges to living with memory problems directly related to their sexual orientation and/or gender identity. This can include forgetting who knows about their sexual orientation and gender identity and being unsure about who to trust with this disclosure (AIHW, 2024).

Comprehensive and tailored healthcare services that address both the neurological and social aspects of health are essential. These services should aim to reduce risks associated with substance use, depression and isolation and improve overall quality of life for people living within the LGBTIQ+ community.

Accessing appropriate healthcare remains a significant barrier for LGBTQ+ people, especially in regional areas. Consultation participants reported negative experiences with healthcare providers due to a lack of understanding of LGBTQ+ health needs, as well as discrimination and marginalisation. This has resulted in reluctance to seek care, even when needed.

The ageing LGBTQ+ population faces additional challenges, especially in regional areas. Many older LGBTQ+ people lived through periods of significant social stigma and discrimination, leading to isolation and compounded mental health struggles. Older LGBTQ+ people may face unique challenges in accessing services that are inclusive of their needs, further exacerbating their vulnerability. Participants in subject matter expert and service provider consultations echoed these concerns for LGBTQ+ communities.

Domestic and family violence is a major issue in Australia, affecting individuals, families and communities across all demographic and socioeconomic backgrounds, encompassing multiple sectors including health (Australian Institute of Health and Welfare, 2024). The domestic violence data provided in this report is the rate of domestic violence-related assault incidents recorded by NSW Police per 100,000 population (NSW Bureau of Crime Statistics and Research, 2024).

The North Coast region has experienced an increase in domestic and family violence. From April 2023 to March 2024, the region reported 575 incidents per 100,000 people, considerably higher than the NSW average of 447. This represents an 18% increase in the last 3-year period from April 2020 to March 2021, which is higher than the 13% increase for NSW. Within the North Coast the local government area (LGA) of Kempsey recorded the highest rate with 1,148 incidents per 100,000 people, almost double the regional average. Other LGAs with higher rates than the regional average are Coffs Harbour (950), Richmond Valley (772) and Clarence Valley (710).

Notably, Clarence Valley has seen the highest increase in domestic and family violence in the last 3 years, with an 82% increase in the rate. Coffs Harbour, Kempsey and Port Macquarie-Hastings follow, with increases ranging from 37% to 30%. The greatest reduction in the rate of domestic and family violence were in Nambucca Valley (14%), Tweed (13%) and Lismore (12%), with reductions also in Ballina (6%), Bellingen (5%) and Kyogle (4%) (NSW Bureau of Crime Statistics and Research, 2024).

The impact of domestic and family violence on the North Coast is further highlighted by community concerns and recent natural disasters. In the Better Health Community survey, 19% of participants identified domestic and family violence as a significant issue in their community. Research following the 2022 North Coast floods indicates an increase in family and domestic violence rates in some areas.

• AIHW. (2024). LGBTIQ+ communities. Retrieved October 2024.
• Department of Health and Aged Care. (2024).
• NSW Ministry of Health. (2022). LGBTIQ+ Health Strategy.
  

Throughout this document ‘survey’ refers to the 2024 Better Health Community survey undertaken as part of the Health Needs Assessment 2025-28 consultation process.