Lesbian health matters: activism, advocacy and inequalities

In a time of seemingly unprecedented upheaval, Lesbian Visibility Day continues to be an important day in our calendar.

Dr Claire Farrugia, Australian Research Centre in Sex, Health and Society

Lesbians are no strangers to health crises. During the HIV epidemic, lesbian activists played a role in mobilising LGBTQ communities and allies in care, support and AIDS advocacy. In lesser-known history, lesbian breast cancer activists and HIV/AIDS activists also worked together to challenge the collective invisibility of gay men and lesbian women within the medical establishment1.

Despite this historical involvement, lesbian health and wellbeing has not figured strongly in the HIV/AIDS movement. Neither has lesbian health been a defining feature of the women's health movement1. Together with gaps in mainstream health provision for lesbians2,3, a day of visibility remains important.

In fact, more recent results from Australia’s SWASH study suggest that lesbian health, particularly mental health, is growing in importance, with the proportion of sexual minority women (identifying as lesbian/dyke/gay/homosexual, queer, bisexual or other) reporting high or very high acute distress increasing from 10% in 2006 to 41% in 20184.

Private Lives 2: The second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender (GLBT) Australians2,5, run by the Australian Research Centre in Sex, Health and Society (ARCSHS), confirms that rates of diagnosis or treatment for a mental disorder were considerably higher among lesbians than gay men in early adulthood. The survey also suggests that lesbians are less likely than their male counterparts to have a high income. When it comes to aging and aged care, other ARCSHS research has shown that lesbians live in fear of experiencing discrimination in aged-care services and that the fear is justified – lesbians are also at greater risk of discrimination6.

Research suggests that the health inequalities that exist for lesbians relate closely to experiences of discrimination, homophobia and heterosexism. In SWASH, 40% of lesbians had experienced some kind of anti-LGBTQ behaviour in the past year4. These negative behaviours are also experienced within the health care system. Evidence from Australia and overseas suggests that reported discrimination leads to reduced disclosure of sexual orientation within consultations, and avoidance of routine healthcare and screening2.

Thanks to community advocacy and activism, lesbian health and health research is becoming more widely incorporated into policy, practice and research. But most studies continue to subsume lesbians under the broader LGBTQ acronym, and there is still a lot we don’t know. For example, we don’t know enough about generational differences among lesbians, why the number of respondents identifying as lesbian has decreased (dropping from 62.4 per cent in 2016’s survey to 55.4 per cent in the most recent SWASH survey4) and there is so much we don’t know about the life experiences of lesbians of diverse gender, ethnicity, religion, language and ability.

This Lesbian Visibility Day, in addition to the online marketing campaigns and lists of visible lesbians in the media, we need to centre the voices of lesbians of colour, disabled lesbians, trans and non-binary lesbians, butch lesbians and femme lesbians. This is where optimum health and wellbeing is best understood, and where changes to research, policy and practice should begin.

  1. Sullivan M. A crisis emerges: Lesbian health between breast cancer and HIV/AIDS. Journal of Lesbian Studies. 2018 Apr 3;22(2):220–34.
  2. McNair RP. Lesbian health inequalities: a cultural minority issue for health professionals. Medical Journal of Australia. 2003;178(12):643–5.
  3. Meads C, Hunt R, Martin A, Varney J. A Systematic Review of Sexual Minority Women’s Experiences of Health Care in the UK. International journal of environmental research and public health. 2019;16(17):3032.
  4. Mooney-Somers J, Deacon RM, Scott P, Price K, Parkhill N. Women in contact with the Sydney LGBTQ communities: Report of the SWASH Lesbian, Bisexual and Queer Women’s Survey 2014, 2016, 2018 [Internet]. Sydney: University of Sydney; 2018 [cited 2020 Feb 5]. Available from: https://ses.library.usyd.edu.au/handle/2123/20157
  5. Meads C, Kelly MP, Carmona C. Lesbian, gay and bisexual people’s health in the UK: a theoretical critique and systematic review. Diversity & Equality in Health and Care [Internet]. 2012 [cited 2019 Jul 10];9(1). Available from: http://diversityhealthcare.imedpub.com/abstract/lesbian-gay-and-bisexual-peoples-health-in-the-uk-a-theoretical-critique-and-systematic-review-1826.html
  6. Waling A, Lyons A, Alba B, Minichiello V, Barrett C, Hughes M, et al. Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia. Health & Social Care in the Community. 2019;27(5):1251–9.