Audience
About 25 women were present, including:
Rhonda Brown who is Ruth’s partner, family therapist,
nursing background, now researching lesbian families
Sue Dyson who was visiting San Francisco from Melbourne
for the American Public Health Association Conference that had just
finished. Sue has worked in lesbian health for many years and is now
researching lesbian disclosure within health care.
Researchers from UCSF including Patty Robertson,
Co-director or LHRC; Dixie Horning, Director of the National Center of
excellence in women’s health; Rani Eversley, social scientist involved in
quantitative analysis
Members of the LHRC leadership circle including Jan
Corlett, Michelle, Betty Sullivan, Grace and Mary-Anne
Lesbians from the community – most over the age of 40,
with one younger couple and their new baby
Policy in Australia
Ruth started with an overview of current policy directions
for lesbian health in Australia. There are few policies at federal level
that are inclusive of sexuality minorities, with a lack of a Bill of Rights,
no federal anti-discrimination policy inclusive of sexuality, and no
relationship registration or same-sex marriage even close to the horizon.
Australia currently has a very conservative federal government, whereas all
of the state governments are quite progressive and have initiated
legislative reform to recognize same-sex relationships over the last 5
years.
Health policy is largely devoid of lesbian issues. The
Australian Medical Association passed a position statement on sexual
diversity and gender identity in 2002. This is the first medical body to
recognize the unique needs of our population and recommend specific training
in the area. None of the medical colleges or universities that are
responsible for training has yet produced policies, although the College of
General Practitioner’s has one in draft. The Australian Lesbian Medical
Association (ALMA) formed in 1999 and has developed a commitment to not only
support its 150 members but also advocate for improved policy and education
regarding lesbian health. Ruth is currently in her 3rd
year as Convener of ALMA.
The state government of Victoria, in Australia’s
southeast, convened a Ministerial Advisory Committee on Gay and Lesbian
Health in 2000, of which Ruth is a member. The terms of reference of this
committee was to formulate an action plan which would be the basis of GLB
health policy in the state, and the first such policy to be developed in
Australia. The committee had a strong commitment to consultation with the
LBG communities, and expanded the brief to include transgender and intersex
people. The first step was gathering public submissions regarding issues for
LGBT people. From these, 5 key health issues were identified as priorities
for research and policy development:
mental health including disturbingly high rates of
depression and anxiety and difficulty accessing public counselling
services
drug and alcohol use, which is high amongst all areas of
the LGBT community
sexual health including not only STIs but also access to
safe sex information, youth support in coming out, safety during
insemination
lifestage issues including adolescence, relationships,
reproduction and family formation, mid life and ageing
physical health including access to hormone and surgical
care for transgender people, risks for cancer, health screening and
concerns about unnecessary surgery in young children with intersex
conditions.
The highest level of concern was access to sensitive
health care providers across all of these areas. Wide-ranging literature
reviews were then undertaken to understand Australian and international
research and look to international policy and health delivery models.
After 3 long years of development, consultation, research
and more consultation, the government committed one million dollars to the
development of a Gay and Lesbian health and wellbeing policy and research
Unit. This will be based in Melbourne commencing in 2004, and is the first
of its kind in Australia. It will be a clearing house for LGBTI Australian
research for ready access to consumers, researchers and providers. It will
develop standards for LGBTI sensitive health care and LGBTI research, and
assist in training health care providers.
Lesbian Health care
What about the reality of health care for Australian
lesbians and bisexual women? Most women access general practice, which is
the main form of primary medical care. This is a very accessible system, in
which every patient receives a government rebate for each consultation with
a GP (as part of the universal health care system called Medicare). Some GPs
do not charge anything else above the rebate, however increasing numbers are
charging the patient a gap payment. This is not covered by health insurance,
which only covers in-patient health care, some counselling and other
ancillaries. In large cities such as Sydney and Melbourne, there are 3-4
general practices that have developed expertise in lesbian and gay health.
These tend to be located in the inner city and attract patients from far and
wide. The majority of women shop around for sensitive care from GPs in their
local area, many finding this difficult and some finding ‘gems’.
Community health centres also exist and some of these
still have medical staff. These centres generally charge no gap payment, are
multi-disciplinary and often offer community outreach programs and health
promotion initiatives. There has been just a hand-full of such centres that
have developed an interest in lesbian health care and targeted the lesbian
community.
There is very little lesbian-specific health care provider
training at any level of education. Many doctors still wonder what all the
fuss is about, what the difference is for lesbians, why they should bother
doing training. Others claim to have no lesbian or bisexual patients.
The women’s health movement has helped through the
establishment of women’s health centres that serve as a resource for
information and support (although not direct health care). A minority of
these have developed lesbian-specific resources and even training. There is
no lesbian-specific comprehensive health care service in Australia.
Lesbian Health Research
Ruth has been involved in a particularly exciting research
project, comparing non-heterosexual women with heterosexual in a large
national longitudinal women’s health study. To date, analysis has found that
younger non-heterosexual women have a higher prevalence of mental health
problems and substance use. The research team is preparing to look at body
image, exercise, reproductive issues, cervical screening and health service
usage, so we will be able to answer loads of questions about the health
status of Australian lesbians and bisexual women.
In preparation for this talk, Ruth emailed the Lesbian
Health Researcher email list regarding their thoughts on the challenges and
strengths for lesbian health in Australia. Seven women replied with
insightful comments. Challenges include the lack of lesbian health
curriculum, and the resistance to maintaining existing modules with a
constant need to prove their legitimacy. This is an endemic problem in all
disciplines. Health care delivery is a problem, with a tendency to neglect
areas outside of the inner city, and a lack of consistency of approach from
women’s health centres. Some rural lesbian health is delivered in close
association with HIV services, which can be problematic. The importance of
creating a specific focus on lesbian health, as well as LGBTI was emphasised,
as women’s issues tend to be lost in the queer agenda.
Lesbian health research was identified as a growing and
vibrant area in Australia, with multiple projects at undergraduate and
postgraduate level. The research is in diverse areas, with particular
strengths in lesbian families research and health services research.
However, gaps were seen in rural and aboriginal lesbians, and also needing
to focus on issues of chronic illness, violence and ageing and their impact
on individuals and families. More research is also needed in areas such as
wellbeing, identity and daily life, rather than focusing always on illness.
A particularly strong message was the importance of
collective action to increase the recognition of lesbian health issues, and
not being afraid to use personal experience. This includes the need to
improve networks and communication between lesbian health researchers,
practitioners and the community. Initiatives such as the lesbian researchers
email list, and occasional national conferences help to connect people,
however for most people they are still the only person researching lesbian
health in their institution, and the lack of support and guidance can be
damaging.
Lesbian sexual health
Having outlined issues of policy, health care and
research, Ruth then opened a discussion on lesbian sex and sexuality. Ruth
was writing a chapter for a medical text-book on lesbian and bisexual
women’s sexuality, and was keen to gain input regarding important issues to
include, and whether there were issues that should not be included. There
was a strong feeling that nothing should be excluded, so as to provide
readers with a comprehensive picture. A range of important areas were
discussed including female ejaculation, types of orgasm, the impact of
ageing and menopause (with some research that indicates that lesbians have a
more satisfying sex life after menopause than heterosexual women), and the
reduced emphasis on orgasm as an end-point in sex. Issues regarding
relationships including partner violence were felt to be important to
include, as were self-esteem and body image.
