At the intersection of health, law and sexuality

At the intersection of health, law and sexuality

A sociologist, Professor Gary Dowsett is an expert in health and sexuality and has spent over 30 years researching the HIV epidemic in Australia and internationally.

We spoke with Professor Dowsett about his research career, how attitudes towards LGBT health have changed, and how there’s still a long way to go.

What Australian laws that govern sexuality are problematic?

The primary issue that is of concern at the moment in Australia is the Marriage Act, and the fact that same-sex marriages are not allowed in Australia despite the majority of the population supporting marriage equality.

There are also different laws in the states and territories in relation to the adoption of children, some of which need to be changed. For example, same-sex couples who have been acting as foster parents for young people in trouble, often over many years, are unable to adopt those children in a number of states at the moment. Same-sex couples who would like to have a child through assisted reproduction, surrogacy or adoption also face difficulties.

Another example is when one partner in a same-sex relationship has children from a previous relationship and the current same-sex partner wishes to adopt the child so they’re both equally parenting.

Until last year, the age of consent in Queensland was discriminatory in relation to gay sex, where the age of consent was 18 compared with 16 in other jurisdictions. One of the pieces of legislation that was involved in changing that law in Queensland in 2016 was a health legislation bill — an example of how health, law and sexuality intersect in Australia.

What changes have you seen during your career?

Most of my academic career has been spent researching HIV/AIDS in Australia. When one thinks back to 30 years ago when I started in this field, one remembers how horrible it was at the beginning of the epidemic when people called AIDS ‘the gay plague’ even though it wasn’t gay-specific infection. No-one would link heterosexuality to herpes or chlamydia all the time. These are sexually transmissible infections and anyone can get them – it’s the same with HIV.

Today, we see less of the intense homophobia with which Australia responded to the HIV epidemic at the beginning, but there is still little recognition of the struggle that the whole HIV/AIDS sector went through working to prevent HIV and working to support people living with HIV.

Now, I’m doing work with gay men who have been diagnosed and treated for prostate cancer. This is largely an older group of men; it’s the gay liberation generation of men who were in their 20s and 30s in the ‘60s and ‘70s and are now in their 60s and 70s. These men are not backward in coming forward about their sexuality.

Many of  these men, however, are still experiencing, if not homophobia, then certainly, heterosexism in the medical and health services they receive. By that I mean, assumptions are made that any patient who comes into a clinic is heterosexual and that his partner is female. There is little recognition that his kind of sexual life and sexuality, which might be severely impacted by a diagnosis or treatment for prostate cancer, may not be a ‘traditional’ heterosexual one.

This heterosexism may not be homophobic at base, but gay men living with prostate cancer almost have to go back into the ‘closet’; every step back there makes it twice as difficult to have his needs understood.

It is almost incumbent on every gay man being treated for this disease to ‘come out’ to each and every health professional in order to have his case dealt with adequately. Surely, we should be well and truly more advanced in our health services after 30 years of HIV/AIDS to have overturned  assumptions of universal heterosexuality.

At the least, a question about sexuality should become an ordinary part of a diagnosis discussion: ‘Okay, it looks like you have prostate cancer. Now, I need to ask you: are you heterosexual, homosexual or bisexual, because that’s going to make a difference for you later on after treatment’. It should be part of the screening.

So, there’s still a long way to go?

We’ve got a long way to go in that field yet, and I would imagine that is true in other fields, for example, in mental health issues that relate to sexuality.

While the LGBT population generally have somewhat worse mental health outcomes, we know that this shifts over the lifecycle. We didn’t know until we did research that young bisexual women had the worst outcomes compared with other sexuality groups.

This is where, again, to me sexuality opens up a whole series of doors and windows onto cultural life. If you think about the cultural life of Australia in relation to health policy and the provision of services in health and social welfare through a sexuality lens, then you can start understanding the ways in which sexuality is one of the central underpinnings of our policies and our responses.

You only have to think about the training needs of health and welfare professionals. How much training are our medical, health and welfare professionals receiving on human sexuality and on Australian sexual diversity to know how to do their jobs well?

I’m sure many of them would want to know, but where are our policies on training to make sure that the services we provide in the health and social welfare sectors are meeting the needs of Australians – a diversity of Australians?

This is a policy question ultimately, because it’s about funding for training. It’s about the policy settings that ensure that health and welfare in Australia are delivered on a fully equal basis, and that people are entitled to whatever support or assistance they need from the health and welfare system on an equal basis as Australian citizens.

Lastly, you’re the Deputy Director at the Australian Research Centre in Sex, Health and Society (ARCSHS). Could you tell us about what ARCSHS does and some of the Centre’s key achievements?

I’ve been at ARCSHS as Deputy Director for 20 years, so I’ve seen it grow from a small centre to a very large centre that works on issues of sexuality, health and broader issues in ‘the social dimensions of human relationships’ — that means we look at issues of not only sexuality and gender but also disability, race, ethnicity, and across age groups and generations.

We also work in women’s health and men’s health. We’ve undertaken national surveys of human sexual behaviours and relationships. We’ve had a small international programs over the years, mainly working in HIV/AIDS in South Africa, South East Asia and South Asia.

I think we’ve been quite significant in our work in Victoria, particularly in sexuality education and in gender and sexuality issues in Victoria. We did a lot of the original work on gay and lesbian health and participated in the development of the original gay and lesbian health reports in Victoria that provided the basis for current LGBTI health policy in Victoria, which is one of the first in the world.

To learn more about the role sexuality plays in society, watch the video from our 2017 Bold Thinking Series event: Health, Law and Sexuality.