The Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and Asexual (LGBTIQA+) community consists of people from many distinct groups, each with different needs and considerations.
There are no nationally available cancer datasets for LGBTIQA+ people; however, it is broadly estimated that 3.5%–11% of people in Australia are of diverse sexual or gender identity.[53]
People identifying as belonging to diverse populations may identify across multiple priority population groups. This intersectionality can result in compounding impacts of social, cultural, commercial and environmental determinants of health on cancer experiences and outcomes.
Certain cancers disproportionately affect LGBTIQA+ people, including breast, ovarian, and anal cancers.[54] Additionally, LGBTIQA+ people are more likely to avoid or delay participation with health services, including cancer screening programs, due to fear of discrimination and health professionals having inadequate knowledge and skills around inclusivity and the specific needs and preferences of LGBTIQA+ people.[55][56]
LGBTIQA+ people experience a disproportionate cancer burden and face unique challenges, such as higher rates of cancer-related distress and sexual concerns, lower levels of family support, poorer mental health, and more difficulties in accessing general health care or cancer services. LGBTIQA+ people also experience gaps in information when communicating with health providers and report lower levels of satisfaction with cancer care.[54][55][57][58]
LGBTIQA+ people continue to experience discrimination, harassment, and hostility in many parts of everyday life, including when accessing health services.[55][59]
The Australian Cancer Plan aims to create community-led partnerships to address inequities in cancer outcomes for LGBTIQA+ people. This includes designing targeted and inclusive screening programs, developing education and training regarding inclusive practices for healthcare providers, and developing co-designed cancer information that is relevant to LGBTIQA+ people and their unique needs. Improved data access and collection will inform measurement of cancer risk factors, cancer incidence, and cancer experiences among LGBTIQA+ people so they have better access to appropriate care and services across the cancer continuum.
Year: 2022-32
Author: Department of Families, Fairness and Housing, State Government of Victoria
Pride in our future: Victoria's LGBTIQ+ Strategy 2022–32, provides the vision and plan to drive equality and inclusion for Victoria’s diverse lesbian, gay, bisexual, trans and gender diverse, intersex and queer (LGBTIQ+) communities within all aspects of government work over the next decade.
Year: 2020
Author: National Disability Insurance Scheme, Australian Government
The National Disability Insurance Agency (NDIA) LGBTIQA+ Strategy seeks to address challenges and strengthen opportunities so that LGBTIQA+ people achieve the best outcomes from their National Disability Insurance Scheme (NDIS) plan.
Year: 2019
Author: Department of Health and Aged Care, Australian Government
The Actions to Support LGBTI Elders: A Guide for Aged Care Providers provides a strategy for aged care providers to deliver more inclusive services to lesbian, gay, bisexual, trans and gender diverse, and intersex elders.
Year: 2022
Author: NSW Ministry of Health, NSW Government
The NSW LGBTIQ+ Health Strategy 2022–2027 provides direction to all NSW Health organisations and staff to collectively deliver the best care to LGBTIQ+ people and work with them to achieve optimal health and wellbeing.
Year: In development
Author: Australian Centre for the Prevention of Cervical Cancer
The National Strategy for the Elimination of Cervical Cancer will aim to eliminate cervical cancer for all people with a cervix across the diverse communities in Australia.
Year: 2023
The National Consultation on the Health and Wellbeing of LGBTIQ+ People will be undertaken in partnership with community-led organisations, LGBTIQA+ Health Australia (LHA) and the Australian Federation of AIDS Organisation (AFAO), to consult on the unique health and mental health issues and barriers to access and care faced by LGBTIQ+ Australians.
Year: 2022-32
Author: Department of Families, Fairness and Housing, State Government of Victoria
Pride in our future: Victoria's LGBTIQ+ Strategy 2022–32, provides the vision and plan to drive equality and inclusion for Victoria’s diverse lesbian, gay, bisexual, trans and gender diverse, intersex and queer (LGBTIQ+) communities within all aspects of government work over the next decade.
Year: 2020
Author: National Disability Insurance Scheme, Australian Government
The National Disability Insurance Agency (NDIA) LGBTIQA+ Strategy seeks to address challenges and strengthen opportunities so that LGBTIQA+ people achieve the best outcomes from their National Disability Insurance Scheme (NDIS) plan.
Year: 2019
Author: Department of Health and Aged Care, Australian Government
The Actions to Support LGBTI Elders: A Guide for Aged Care Providers provides a strategy for aged care providers to deliver more inclusive services to lesbian, gay, bisexual, trans and gender diverse, and intersex elders.
Year: 2022
Author: NSW Ministry of Health, NSW Government
The NSW LGBTIQ+ Health Strategy 2022–2027 provides direction to all NSW Health organisations and staff to collectively deliver the best care to LGBTIQ+ people and work with them to achieve optimal health and wellbeing.
Year: In development
Author: Australian Centre for the Prevention of Cervical Cancer
The National Strategy for the Elimination of Cervical Cancer will aim to eliminate cervical cancer for all people with a cervix across the diverse communities in Australia.
Year: 2023
The National Consultation on the Health and Wellbeing of LGBTIQ+ People will be undertaken in partnership with community-led organisations, LGBTIQA+ Health Australia (LHA) and the Australian Federation of AIDS Organisation (AFAO), to consult on the unique health and mental health issues and barriers to access and care faced by LGBTIQ+ Australians.
LGBTIQA+ people are at greater risk of specific cancers including breast and cervical cancers, but participation in cancer screening programs is low among this community.
Stakeholders proposed that LGBTIQA+ inclusivity, visibility, and knowledge in cancer prevention and screening programs (including ensuring transgender people are invited to access relevant targeted programs) is needed to increase LGBTIQA+ peoples’ participation in these programs.
LGBTIQA+ people are at greater risk of specific cancers including breast and cervical cancers, but participation in cancer screening programs is low among this community.
Stakeholders proposed that LGBTIQA+ inclusivity, visibility, and knowledge in cancer prevention and screening programs (including ensuring transgender people are invited to access relevant targeted programs) is needed to increase LGBTIQA+ peoples’ participation in these programs.
Stakeholders highlighted that LGBTIQA+ people have multiple identities that require unique healthcare navigation needs which are not currently addressed within the health system.
The LGBTIQA+ community experiences discomfort due to stigma and discrimination when accessing health care services. LGBTIQA+ people present late to health services and experience delays in diagnosis in response to these barriers.
Culturally appropriate care and services that reflect LGBTIQA+ peoples’ needs and preferences in a health system designed to respect and understand people’s unique circumstance will improve experiences and equitable outcomes. Healthcare professionals should be equipped to understand and support issues related to gender identity and sex, including use of preferred pronouns.
LGBTIQA+ people face discrimination and culturally unsafe or inappropriate interactions in their cancer care. In particular, transgender people and people with intersex variations experience the highest levels of discrimination. Additionally, it was noted that LGBTIQA+ people have many unmet needs in their cancer care experience, including more limited access to follow-up care, and reluctance to discuss sexual health issues.
Increased data collection regarding sexuality and gender inclusivity, including in health surveys, registries, and patient records would improve understanding of the cancer care needs and lifestyle behaviours of this priority population group. Collection of this data would improve the measurement of cancer risk factors, cancer incidence, and cancer experiences among LGBTIQA+ people.
Stakeholders also pointed to the need to invest in research to better understand cancer risks and experiences of LGBTIQA+ people.
Stakeholders identified the need for the cancer care workforce to better understand diagnostic and treatment needs of LGBTIQA+ people. Improved understanding of the needs of LGBTIQA+ people could reduce misinformation around screening participation (such as cervical screening for transgender people), stigma, and discrimination. Implementing regular LGBTIQA+ inclusion and diversity training for cancer care professionals would help to reduce such barriers and discrimination towards LGBTIQA+ people.
The Australian Cancer Plan considers an intersectional and health equity approach for Aboriginal and Torres Strait Islander people. This is more than recognising the multiple backgrounds, experiences, and ways Aboriginal and Torres Strait Islander people identify. This approach addresses the way membership of multiple groups may impact people's health and wellbeing needs and ability to access care.
Implementation of each action should consider the compounding impacts of intersectionality across other priority population groups.