Sex, gender and sexuality

ARCSHS is the major player in framing the agenda and delivering the evidence to understand sex and sexuality in contemporary Australia. Through national surveys of the general population, the Centre helps track patterns and practices over the life course and across time. Other research in this area involves qualitative research and evaluation. ARCSHS seeks to maintain, profile and draw upon these major research activities, while also building on areas of expertise in specific aspects of health and well-being with diverse sexual and gender minorities, including same-sex attracted and gender-questioning young people. The Centre has a focus on the intersection of sexuality and ageing, disability and mental health. Another focus on gender and its intersections with sexuality and health involves research into the conditions that normalise violence and abuse, and the ways that these cultures can be changed to promote respect and non-violence. ARCSHS research provides evidence upon which to base policy development and culture-change programs in a wide range of community, sport, workplace and education settings.

Research projects

The Australian Longitudinal Study of Health and Relationships

Researchers: Anthony Smith, Marian Pitts, Julia Shelley, Juliet Richters (University of New South Wales), Judy Simpson (University of Sydney), Wendy Heywood and Kent Patrick

This NHMRC-funded study was established in 2003 to document the natural history of sexual and reproductive health in the Australian population. Evidence provided from this study allows for more effective sexual health interventions and enables researchers to understand the links between risk events and health outcomes. In 2005, the first wave of data was collected, and the fifth and final wave of data collection was completed in 2010. The results of this ground-breaking study not only provide the foundations for future research but are used to inform government policies, health professionals and the Australian public as a whole. More than 25 articles from the study have been published to date in international journals.

Creating Healthy Workplaces: 'Y Respect Gender'

Researchers: Sue Dyson, Elizabeth Smith and Daniel Reeders

This project is part of the three-year VicHealth 'Creating Healthy Workplaces' program, which has funded five projects to study different aspects of workplace health between 2011 and 2014. One of these projects focuses on preventing violence against women and is run by the YMCA. ARCSHS is evaluating this particular project, Y Respect Gender, which addresses gender inequality and respectful behaviours. In this second year of evaluation, qualitative data collection has continued, and a full report was delivered on the baseline survey carried out in year one, to contribute to continuous improvement in the program. Regular meetings have also been held throughout the year with the project management group, which consists of the YMCA, ARCSHS and VicHealth representatives. As part of this project, ARCSHS also participates in a VicHealth 'researcher community of practice' to share learning as the different projects develop. 2014 will be the final year of the evaluation.

Does Talking About Sexuality Change the Game?: Victorian Health Promotion Foundation (VicHealth) Innovations Grant

Researchers: Gillian Fletcher and Sue Dyson

Sport is acknowledged as a site of homophobia; yet gay, lesbian and bisexual (GLB) people participate in sport across Victoria. This two-year project seeks to examine the experiences of GLB sports people and that of their straight counterparts. What benefits arise from sports participation, and what, if any, are the associated costs? A total of 26 interviews with sports people were completed in 2013, as well as a review of Australian and Victorian documents related to sport, participation and inclusion. The final year will see data collected to date used in discussions with leaders of sporting representative bodies in Victoria in pursuit of the overall research aim: development of practical, evidence-based principles for effective promotion of greater inclusion of GLB people in sport.

Evaluation of AFL Victoria's Fair Game Respect Matters Project

Researchers: Sue Dyson and Jo Grzelinska

Fair Game Respect Matters is a six-year program run by AFL Victoria in one regional and two metro community football leagues (2008–2014). The program has aimed to change cultures in community clubs to make them safer and more inclusive for women and girls. This is a primary prevention of violence against women approach that aims to spread changed social norms from settings such as community sports clubs, to the wider community. The evaluation uses a constructivist approach and has focused on the impact of the program, unexpected change, and the transferability of the program to other sports and settings. Knowledge exchange activities are planned in the first half of 2014.

Evaluation of the AFL 'Club Champions' Community Education Program

Researchers: Jo Grzelinska and Sue Dyson

In 2011, 2012 and 2013, the AFL conducted a community education program for football players from community- and state-based clubs all over Australia. The program aimed to change attitudes and behaviours concerning alcohol, illicit drugs and respectful behaviours in social settings, with a focus on relationships with women. ARCSHS was engaged to evaluate the program, which was delivered by trained, mixed-gender teams of elite players and ex-players, and women with health promotion or similar skills. The evaluation reported on the process, outcomes and medium-term impact of the program up to twelve months after the training was delivered. The report informs future education programs in community sports settings.

Exploring the Relationship between Hazardous Drinking, Depression and Anxiety in Lesbian, Bisexual and Same-sex Attracted Women: Culture, motivation and behaviour

Researchers: Ruth McNair (University of Melbourne), Dan Lubman (Turning Point Alcohol and Drug Centre), Tonda Hughes (University of Illinois), Kelsey Hegarty (University of Melbourne), William Leonard, Rhonda Brown (Deakin University), Amy Pennay (Turning Point Alcohol and Drug Centre)

The study looks at the reciprocal influence of hazardous alcohol use, depression and/or anxiety among women of minority sexual orientations. The study explores the cultural significance of alcohol use among lesbian, bisexual and same-sex attracted women, and the relationships between their experiences of discrimination, stress and abuse, and hazardous drinking and mental health problems. The study looks at the barriers these women face in accessing mental health services and, in particular, a perception that mental health-care professionals lack cultural awareness of and sensitivity to their issues. The project is funded for two years (2012–2013) by beyondblue as part of its Victorian Centre of Excellence in Depression, Anxiety and Related Disorders grants round.

Fair Go, Sport! (Phase 2): Evaluation

Researchers: Gillian Fletcher and Lottie Turner

The Fair Go, Sport! project, implemented by the Victorian Equal Opportunity and Human Rights Commission, is drawing attention across the country for its innovative approach to increasing awareness of sexual and gender diversity, and promoting safe and inclusive environments in sports settings. In 2013, the project implemented a pilot in a school setting and extended from its initial focus on hockey to other sporting codes. This second phase was evaluated by ARCSHS and the reports will be available in early 2014.

From Private Lives to Public Policy: Improving the mental health and well-being of lesbian, gay, bisexual and transgender (LGBT) Australians

Researchers: Anthony Lyons and William Leonard

This project extends Private Lives 2: The second national survey of the health and well-being of LGBT Australians and is funded by beyondblue and the Movember Foundation. The project is a targeted study of the mental health of gay, lesbian, bisexual and transgender Australians, with particular focus on links with resilience, stigma, social support, LGBT community connectedness, and health service use. It involves a detailed analysis of data from the Private Lives 2 survey to deliver a national community report and a series of academic publications that provide much-needed knowledge of factors related to the mental health of LGBT populations and practical guidance for improving health outcomes. This project began in December 2013 and will continue in 2014.

The Healthy Equal Youth Project (The HEY Project): A Victorian same-sex attracted and sex and gender diverse (SSASGD) youth suicide prevention initiative

Researchers: William Leonard

The HEY Project is an initiative funded by the Department of Health, Victoria, and aimed at reducing self-harm and suicide among SSASGD youth and improving their mental health. The project is funded for four years (2011–2014) at a total cost of $4 million. The project involves funding of seven separate agencies and programs with proven expertise and success in working with, and on behalf of, SSASGD young Victorians. The project aims to increase the capacity of each of these organisations to address a particular area of need among SSASGD youth. It also aims to encourage these agencies to work in partnership with each other, and with mainstream youth and youth mental health services, to build an SSASGD youth platform within the mainstream youth sector. Gay and Lesbian Health Victoria in partnership with the Youth Affairs Council of Victoria is responsible for project management and coordination.

Male Sex Workers and HIV and STI Risk Project

Researchers: Garrett Prestage (ARCSHS and Kirby Institute)

This study explores the circumstances and contexts of male-to-male sex work in New South Wales and Queensland. It explores how male sex workers and their clients form their beliefs about HIV and risk, and how they negotiate sex in the context of sex-work encounters and with other partners, and compares these with men not engaged in male-to-male sex work, either as workers or clients. There has also been little investigation into how male sex workers obtain HIV-prevention information and resources, and whether they do so differently with respect to their professional and private lives. It will also investigate the idea that the way that men identify themselves, in terms of both their sexuality and their involvement with sex work, will influence what resources and information they believe they need, and how and where they will obtain them. The study aims to recruit at least 200 men who have engaged in sex work, as well as a sample of male clients of male sex workers, and a sample of men who have not engaged in male-to-male sex work as either workers or clients. They will complete a self-administered questionnaire online. In addition, about 15 in-depth interviews with individuals who have recently engaged in male-to-male sex work will be conducted. Participants will be recruited through community organisation programs servicing men engaged in male-to-male sex work, as well as through more broad-based publicity. Recruitment into this study commenced in November 2013.

Improving Online Therapy for Mood Disorders among Lesbians and Gay Men

Researchers: Anthony Lyons, Tomas Rozbroj, Marian Pitts, Anne Mitchell , Marina Carman and Helen Christensen (Black Dog Institute)

This project, funded by beyondblue, aims to improve online therapies for depression and anxiety by identifying ways to make them more inclusive, appropriate and effective for lesbians and gay men. Beginning in June 2013, the project involves two main phases. The first phase comprises an audit of web- and app-based therapeutic interventions to assess how effectively these meet the needs of lesbians and gay men, such as MoodGym and other popular programs. The second phase comprises focus groups with lesbians and gay men to explore strategies for making online therapy gay-friendlier. Both phases commenced in 2013. Findings from this project will be used to develop an online toolkit to provide researchers, clinicians and organisations with guidelines and recommendations for developing therapeutic web- and app-based interventions that are inclusive, appropriate and effective for lesbians and gay men.

LGBTI Mental Health Promotion Framework

Researchers: William Leonard

Gay and Lesbian Health Victoria has been commissioned by the National LGBTI Health Alliance to produce Australia's first National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Mental Health Promotion Strategy. The project has been overseen by an LGBTI Mental Health Promotion Framework Task Group and is funded through the Commonwealth Department of Health and Ageing.

From Blues to Rainbows: The mental health needs of young people with diverse gender identities

Researchers: Lynne Hillier, Anne Mitchell, Elizabeth Smith and Tiffany Jones (University of New England)

This project explores the mental health needs and protective factors of gender diverse, trans*, and intersex young people in Australia. Australian research with same-sex attracted and gender-questioning young people in 2010 demonstrated that gender diverse, trans* and gender-questioning young people were at greater risk of suicide and self-harm than their same-sex attracted peers. It was also found that these young people were more likely to take a stand against discrimination and to be engaged in activism of various kinds. With funding from beyondblue, the study involves both qualitative and quantitative methods to investigate not only the mental health needs of 14–21 year olds in this cohort, but also the factors that contribute to positive mental health outcomes (for example, involvement in activism and supportive/inclusive school and healthcare policies, practices and experiences). The project is overseen by a group of gender diverse, trans* and intersex people (including young people) who have provided advice and guidance on the survey and interview questions. The results of the research will be used to improve policy, service planning and training for both health and school professionals, which will help to meet the needs of these young people.

Mental Health, Resilience and Sexual Recovery among Gay Men with Prostate Cancer

Researchers: Gary Dowsett, Garrett Prestage, Duane Duncan and Daniel du Plooy

This study investigates the experiences of Australian gay men, and their partners, following a diagnosis of, and treatment for, prostate cancer. A review of the medical and health literature revealed that little is known about gay men's experiences or those of their partners. This study focuses on gay men's mental and sexual health, particularly on experiences of depression and sexuality side-effects following prostate cancer treatment. The study employs a qualitative methodology, using in-depth individual interviews and electronic diary-keeping to provide new evidence to strengthen both mainstream and gay-community health service responses to the needs of these men. The study is funded by a grant from beyondblue through its National Priority Driven Research Program–Men's Stream (funded by The Movember Foundation), from 2013–2015.

The Second Australian Study of Health and Relationships

Researchers: Anthony Smith, Juliet Richters (University of New South Wales), Chris Rissel (University of Sydney), Richard de Visser (University of Sussex, UK), Judy Simpson (University of Sydney), Andrew Grulich (Kirby Institute) and Paul Badcock

The Australian Study of Health and Relationships is our most important study of sexual and reproductive health. Conducted once a decade, it provides a snapshot of the sexual health and well-being of the Australian population and provides information essential for the development of policy and the delivery of sexual and reproductive health programs across Australia. The survey is anonymous, and people aged 16-69 from randomly selected households are personally invited to take part. The survey is designed to reflect the experiences of all Australians regardless of their relationship status or whether they are sexually active. In order to achieve this, the interview is specifically tailored to the history the participant reports and does not ask questions that, given the history of the participant, are not relevant. The types of questions that might be asked include a sexual history, partnership status, health status, recent sexual activity, sexual difficulties, reproductive history, sexual coercion and intimate partner violence, information about sexually transmissible infections, and knowledge and attitudes related to sexuality and sexual health.

Sexual Health and Ageing: A resource kit targeting depression and anxiety among older gay, lesbian, bisexual, transgender and intersex Australians

Researchers: Briony Dow (National Ageing Research Institute), Catherine Barrett, Phil Maude (RMIT), Jean Tinney (National Ageing Research Institute) and Carolyn Whyte

This project is funded by beyondblue and is a collaboration between the National Ageing Research Institute, Val's Café and RMIT. The project will interview 40 older LGBTI Australians to draw on their strategies for managing discrimination and preventing depression and anxiety. This information will form the basis of educational resources, which will be piloted and evaluated in workshops for service providers, lectures for undergraduate students, and a community forum for LGBTI communities. The project provides the opportunity to learn from older LGBTI people about strategies for handling challenging times and to share lessons with service providers who can build on the strengths of older LGBTI people.

Sexual Health and Ageing: How to address sexuality after stroke

Researchers: Catherine Barrett, Marian Pitts and Carolyn Whyte

This research and interdisciplinary practice-change project is a collaboration with the Victorian Stroke Network. The project aims to build the capacity of stroke clinicians to provide clients and their partners with information on sexuality after stroke. Nineteen clinicians from eight stroke services around Victoria are participating in the project as co-researchers and change facilitators. The clinicians were supported to conduct a needs analysis in their service, including an organisational audit, staff survey and patient interviews. Data from this needs analysis were then utilised to educate staff and inform service improvements. Outputs from the project to date include: a guide to interdisciplinary practice and sexuality after stroke; a program logic model; a staff survey tool; and an organisational audit tool. In 2014, the program participants will share their work at a state conference for stroke clinicians and write about their achievements in a report on the project.

Sexual Health and Ageing: Preventing the sexual assault of older women

Researchers: Catherine Barrett, Jean Tinney (National Ageing Research Institute), Rose Mann (University of Melbourne) and Philomena Horsley

The project was funded by the Department of Families, Housing, Community Services and Indigenous Affairs. It involves collaboration with the National Ageing Research Institute, the McCaughey Centre and the Centre for Women's Health, Gender and Society (all at University of Melbourne), Alzheimer's Australia, and the Council on the Ageing, Victoria. The project aims to strengthen the community's ability to prevent the sexual assault of older women in aged-care services and the broader community. The first stage of the project involves interviews and a survey to gather evidence from older women, their families, service providers and the broader community on the context of sexual assault. This stage of the project was completed in 2013 and will form the basis of a national strategy for the primary prevention of the sexual assault of older women. To accompany the strategy, new resources and an educational program will be developed. As the first project to provide an evidence base and strategy for the primary prevention of the sexual assault of older women, it has generated significant community interest. A project support network has been established to engage stakeholders, who are considered pivotal to the development and successful implementation of the strategy.

Sexual Health and Ageing: LGBTI-inclusive Home and Community Care services

Researchers: Pauline Crameri, Catherine Barrett and Carolyn Whyte

This project is a partnership with the Municipal Association of Victoria, with funding from the Department of Health, Victoria. The project initially sought to work with Home and Community Care (HACC) Assessors to develop their capacity to conduct LGBTI-inclusive assessment. However, feedback from pilot workshops highlighted that the project focus needed to include all HACC staff to ensure that LGBTI-inclusive services could be provided to LGBTI clients who disclosed at assessment. As a result, the project scope was broadened to support the development of LGBTI HACC services. The project involved working with HACC services to understand how the National Standards for LGBTI-inclusive action apply to HACC services, and developing a related resource or HACC Pack. A capacity-building approach has been taken, with education and support provided to over 80 change facilitators to assist them to become resource people within their service. Many of the facilitators have gone on the deliver education in their workplace and build organisational interest in achieving a Rainbow Tick, or increasing their commitment to LGBTI-inclusive services.

Sexual Health and Ageing: LGBTI-inclusive Aged Care Assessment Services (ACAS)

Researchers: Pauline Crameri, Catherine Barrett, Carolyn Whyte and Tim Firth (Western Health)

This project was funded by the Department of Health, Victoria, to support Aged Care Assessment Services (ACAS) in Victoria develop LGBTI-inclusive assessment practices and services. To guide the project, a survey of ACAS Assessors is being conducted, particularly to identify barriers to LGBTI-inclusive assessment. A set of fact sheets will then be developed to guide assessment and a series of workshops facilitated to educate ACAS Assessors and support them to become resource people within their services. The partnership with an ACAS service has assisted in ensuring the project activities address the needs of assessors, as well as fostering recognition for state-wide experts within the field. The project outputs are expected to generate interest nationally, given the focus on LGBTI-inclusive assessment with the development of a National LGBTI Ageing and Aged Care Strategy and the development of a Gateway for aged care and the My Aged Care website.

Sexual Health and Ageing: Discrimination, depression, anxiety and older LGBTI people

Researchers: Catherine Barrett, Carolyn Whyte, William Leonard and Jude Comfort (Curtin University)

This project was a collaboration with Curtin University and funded by beyondblue. The project involved interviews with 12 older LGBTI people in three states, the analysis of themes from these interviews, and the construction of small case studies to highlight the links between discrimination and mental health. The inclusion of participant narratives in the report aimed to raise the visibility of older LGBTI Australians and assist service providers to empathise with the experiences of discrimination.

Sexual Health and Ageing: Supporting the development of LGBTI-inclusive aged care services in Australia

Researchers: Catherine Barrett, Carolyn Whyte and Pauline Crameri

This project was funded through the Aged Care Service Improvement and Healthy Ageing Grants Fund, administered by the Commonwealth Department of Health. The project aim is to support the development of LGBTI-inclusive services nationally. As a result, we are undertaking the following projects:

  1. Dementia Project: in partnership with Alzheimer's Australia, we will conduct research to understand the needs of older LGBTI people with dementia and develop a guide to LGBTI-inclusive services for people with dementia
  2. Carers Project: in partnership with Carers Australia, we will conduct research to understand the needs of the carers of older LGBTI people and the needs of older LGBTI people who are carers. The research will be utilised to develop a guide to LGBTI-inclusive services for carers. An information booklet and workshop will also be developed specifically for carers by Carers Victoria
  3. Gender Project: in partnership with organisations supporting transgender and intersex people, we will conduct research to understand the needs of older trans and intersex people. This information will be utilised to develop a guide to providing inclusive aged care services for older trans and intersex people
  4. Sexuality Project: in partnership with the Council on the Ageing (COTA) Victoria, we will research older people's needs related to sexuality and diversity. A module on Sexuality and Ageing will be developed in consultation with older people for COTA's Challenging Ageing education program. The education will include information about sexual and gender diversity and will be delivered to groups of older people
  5. The Film Project: in partnership with organisations supporting older LGBTI people, we will produce a film on the needs of older LGBTI people. The film will increase visibility of older LGBTI people in the broader community and will be packaged with an education kit for use by aged care services
  6. How to create an LGBTI-inclusive aged care service: this twelve-month program will coach up to 20 aged care services through the practical steps involved in becoming LGBTI-inclusive. The program involves five workshops over a twelve-month period and phone support in between. The aged care program will be piloted in Victoria and then offered to other states and territories

Conference: A national conference on LGBTI Ageing and Aged Care will be facilitated in 2014 and 2015. The two-day conference will focus on practical information to support the development of LGBTI-inclusive aged care services.

Sexual Well-being and Ageing: A study of older Australian women

Researchers: Marian Pitts, Victor Minichiello, Gail Hawkes (University of New England), Rachel Thorpe, Bianca Fileborn and Catherine MacPhail (University of New England)

This study of the sexuality of older women is the first to examine a significant cohort of women now entering old age: the women who demanded freedom of sexual expression in the swinging sixties. They present a unique and historic opportunity to explore the subjective world of the first generation of post sexual-liberation women growing old sexually. We have interviewed 60 women born between 1930 and 1950, living in New South Wales and Victoria, to identify and challenge the complex relationships between ageism, sexism and sexual subjectivity. In addition, 100 older women were invited to participate in an online discussion of their understandings and experiences of sex and sexuality. Journal articles and policy briefings will be developed from these findings.

The project hosts the Women's sexual well-being and ageing blog to facilitate discussion around the key themes of the project. The discussion will contribute to our understanding of the complex relationships between ageism, sexism and sexual subjectivity, and to develop a conceptual framework that advances our understanding of sex and sexuality in older women.

Testing and Developing a Community Resilience Tool in Rural Communities

Researchers: Anthony Lyons, Gillian Fletcher, Amanda Kenny (La Trobe Rural Health School), Marco Amati (La Trobe Faculty of Humanities and Social Sciences), Jane Farmer (La Trobe Rural Health School), Julie Rudner (La Trobe Faculty of Humanities and Social Sciences), Lisa Bourke (University of Melbourne), Kaye Knight (La Trobe Rural Health School) and Emily Bariola

This project is funded by the La Trobe University Research Focus Area 'Building Healthy Communities'. The project pilots a Collective Resilience Assessment (CRA) tool, developed by Gillian Fletcher, Anthony Lyons and Emily Bariola, and assesses associations between collective resilience, community activities, and health and well-being in two rural Victorian communities. The CRA tool is an innovative approach to understanding resilience, which has strong policy and practice implications. Current tools focus on individual-level resilience, while government policy emphasises collective resilience for overcoming community problems. The project began in November 2013. It comprises a household survey, face-to-face interviews, and a community mapping exercise using a geographic information system to locate community activities and journeys spatially, and to assess areas of high and low collective resilience. Data collected from this project will further refine and extend the CRA tool and provide new information for understanding collective resilience in rural communities.

Understanding the Support Needs of LGBT Young People from Refugee and Newly Arrived Backgrounds

Researchers: Olivia Noto, William Leonard and Anne Mitchell

The three-month pilot study explores the support needs of LGBT young people from refugee and newly arrived backgrounds. The study was prompted by anecdotal reports that services delivered to refugee and newly arrived young people do not consider the needs of LGBT young people or those who may be questioning their sexual feelings and/or gender identity. The report aims to document relevant resources and services, identify gaps, and make recommendations about further activities and projects that could be undertaken to improve the outcomes for these young people. The project was funded through the Asia Altman Sub-fund from the Australian Communities Foundation.

Women's Health West 'United – Preventing Violence Together' Project Evaluation

Researchers: Sue Dyson, Elizabeth Smith

Women's Health West, a women's health service in the west of Melbourne, have been funded to coordinate a prevention of violence against women program with fourteen local government and non-government organisations in 2013–2016. The project is known as United, and uses an equity approach to address gender inequalities within workplaces. ARCSHS has been engaged to evaluate the project. In 2013, the evaluators conducted two reflection workshops with stakeholders from the project and a survey of staff in the fourteen participating organisations, forming the baseline for the evaluation in the coming years.

Work, Love and Play: Understanding resilience in same-sex parent families

Researchers: Amaryll Perlesz (Bouverie Centre), Andrew Bickerdike (Relationships Australia), Jen Power (Bouverie Centre), Marian Pitts and Margot Schofield (La Trobe School of Public Health and Human Biosciences)

Same-sex attracted parents and their children can experience discrimination within health, welfare, education and legal systems. This national and international longitudinal study—the largest ever conducted with same-sex parented families—examines family patterns and relationships, and factors supporting resilience in same-sex attracted parents and their children. The study explores ways that health and community service providers can enhance the health and well-being of same-sex parented families. A major outcome of the study is the development of Good Practice Guidelines for working with same-sex parented families that will inform policy and practice in a range of sectors, including health, counselling, education and courts.