Closing the Indigenous LGBQTI health Gap

Let’s dive straight in: What it heterosexism? It is the system of oppression that excludes and marginalises LGBQTI people; often unconscious and unintentional.

However, conscious heterosexist attitudes/behaviours that exclude LGBQTI mob are a form of homophobia. And, homophobia kills.

So, while Anthony Mundine effortlessly spews forth his bile in the public domain, the other real and significant damage that is being done is by the very systems in place that are meant to provide us LGBQTI mob with adequate access to health and social and emotional well-being.

In Indigenous health we hear a lot about the essential need for cultural competence, cultural appropriateness and – in the last few years – the rise of cultural responsiveness.

Cultural competency is aligned with organisational behaviours and can be seen as a measure of how effectively organisations and services engage with Indigenous peoples.

Cultural appropriateness is the assurance that services consider Indigenous peoples and the specificity of our needs.

Cultural responsiveness pays particular attention to the social and cultural factors of Indigenous people specifically in the course of the health service delivery.

Something else we also hear a lot about is that Indigenous people are not homogenous. But if you looked at our health plans, one would assume we all in fact are, or at the very least we are all straight, heterosexual, and that us Indigenous LGBQTI mob simply do not exist.

Indigenous health currently lacks the discussion and framework for cultural competence, cultural appropriateness or cultural responsiveness specific Indigenous LGBQTI needs. But that is how heterosexism works. It erases us, rendering us invisible and thus, our needs.

For Indigenous LGBQTI mob to have access to health services that are effective, high quality, appropriate and responsive we need to be included in the very plans — and their development — that spell out how this access can be achieved.

Lives are at stake and we have lost too many already. I know of four Indigenous gay men, each over 40-years old, that have died by suicide in the last half decade. And we should never forget the tragedy of Tyrone Unsworth, who also died by suicide. He was 13.

If we use the current Australian estimation that 11% of the population can be identified as LGBQTI, we can then also estimate there to be around 73,689 Indigenous Australians who too can be identified as LGBQTI. This is a significant portion of our community being excluded from our health systems’ policies. It places Indigenous rainbow mob at greater risk of suicide, self-harm, numerous other negative health ailments and negative health-related behaviours such as smoking, and unsafe drug and alcohol use. And we know those risks are already off the chart for all our mob.

And, for all this closing the gap business going on at the moment, us Indigenous LGBQTI mob may as well be surfing the waves on the Sea of Tranquillity. In the up-teen years of Close the Gap, us Indigenous LGBQTI mob haven’t even rated a mention. Neither are there provisions in policy, legislation or reports that is needed to inform such policy or legislation.

There is a wealth of evidence that tells us that heterosexist systemic exclusion is positively associated with anxiety and depression. The exclusion manifests two ways. By virtue of its existence and knowing of it and the behaviours that it supports in our health systems. Furthermore, whether it be interpersonal, environmental or systemic, the negative outcomes of heterosexism are the same.

The issues and concerns of the Indigenous LGBQTI community aren’t new. The HIV and sexual health mob started raising these close to over 20 years ago.

A previous mentor of mine once told me that if you are going to bring a problem to the table, it makes good practice to also provide a starting point toward the solution.

Therefore, over the course of the last three years I have been working on one. I have developed a inclusive practices workshop– which I believe to be the only one in the country – that is Indigenous LGBQTI specific. One that works towards ensuring and strengthening the cultural competence, cultural appropriateness and cultural responsiveness of ours, and mainstream, health settings.

It is informed by my own experiences as a service user with a lived experience of anxiety, depression and suicide ideation, as well as several years experience on the frontline in upstream suicide prevention in remote Indigenous communities, and from 10-years in health and health academia.

The workshop to date has been delivered to over 150 people in WA and SA, mostly in rural and country settings. The first workshop for 2018 is in my home town of Darwin, this week.

If there is going to be a “Close the Gap refresh” – and that seems to be the case – please don’t exclude and forget us LGBQTI mob (again).  But also, a gentle reminder, the principles of self-determination still apply: nothing for us, without us.