Lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) people living in rural and regional Australia face significant challenges accessing safe and inclusive health care.
Repeated experiences of stigma and discrimination, as well as social exclusion and isolation, regularly result in poor health and wellbeing. Digital health services have the potential to improve health outcomes for LGBTIQ+ people.
In 2020, LGBTIQ+ Health Australia was invited to partner with the Australian Digital Health Agency to explore opportunities for expanding digital health services for older Australians. Through a community consultative approach, details of the barriers to digital health services for all LGBTIQ+ people emerged, along with ideas about how online technologies could address the care gap.
At the core of digital health provision is My Health Record (MHR). Concerns about security breaches of government data and individual breaches of privacy mean that LGBTIQ+ people living in rural and regional settings, particularly in small communities, are wary of the possible adverse consequences of disclosing their sexuality, HIV status or gender identity. Individuals weigh this risk against the advantages of coordinated care resulting from having their whole story in one place.
Delivering critical services through technology platforms offers LGBTIQ+ people the opportunity to access specialist practitioners who understand their health needs. Rural and regionally based LGBTIQ+ people may have difficulty finding suitable mental health services, for instance, particularly in a crisis. LGBTIQ+ organisations regularly bridge this gap. QLife (qlife.org.au) provides Australia-wide, anonymous LGBTIQ+ peer support and referral for people wanting to talk about sexuality, identity, gender, bodies, feelings or relationships via telephone and webchat, and provides resources and referrals.
Privacy concerns for those living in small communities may prevent transgender and gender diverse people consulting local doctors and, while some gender-affirming services can be delivered remotely, there is a need to see doctors face-to-face, to establish trust and rapport. Again, LGBTIQ+ community organisations, like ACON (acon.org.au) in New South Wales, provide lists of suitable doctors, including some based in the regions.
Not all health services lend themselves to digital delivery. LGBTIQ+ people are less likely to use preventive health services in any setting, which can only be exacerbated by the challenges of accessing these services in rural and regional areas. As an example, lesbian women are more than twice as likely as heterosexual women to have never had cervical screening. Sexual health services require in-person attendance.
Older and disabled people who require care and support must access services through the My Aged Care and National Disability Insurance Scheme portals. LGBTIQ+ people in regional areas report difficulties accessing these systems, due to poor network coverage, limited technology skills and the cost of internet access. Despite considerable efforts to reform these systems, LGBTIQ+ people continue to experience inflexible parameters for articulating their needs and an inability to identify service providers who embrace diversity.
The right of LGBTIQ+ people to feel safe, included and respected represent a challenge to digital health service providers. Building on the considerable work already done, consulting communities and embedding needs into system design and delivery will enable LGBTIQ+ people living in rural and regional areas to use both digital and physical health services to live their best lives.