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Purpose LGBTQ people are less likely to seek support and face significant barriers in accessing affirmative family violence support services. Efforts to improve family violence service access must be grounded in the preferences of LGBTQ people themselves. Method Data from a large nationwide Australian survey of the health and wellbeing of LGBTQ adults were analysed. 4,148 participants expressed a preference for family violence service provision. Multivariable logistic regressions were used to identify factors associated with preferences for family violence service provision, comparing mainstream services that are not known to be inclusive, mainstream services that are known to be LGBTQ-inclusive, and LGBTQ-specific services. Results In total, 8.8% (n = 363) of participants indicated a preference for mainstream services, 57.5% (n = 2,383) for mainstream services that are known to be LGBTQ-inclusive and 33.8% (n = 1,402) for LGBTQ-specific services. Trans and non-binary identified people were more likely to prefer LGBTQ-specific services than cisgender participants, while bisexual, pansexual and asexual people were more likely to prefer mainstream LGBTQ-inclusive services. Participants with a regular general practitioner were more likely to prefer LGBTQ-inclusive services. Participants who had not felt supported the most recent time they reported an experience of family violence were more likely to prefer LGBTQ-specific services. Conclusion Family violence and healthcare services require training in LGBTQ issues to provide inclusive and affirming care. The findings have implications for policy and practice in family violence care and illustrate an urgent need to reform the current narrative of family violence, which frequently excludes LGBTQ communities.

Introduction Multiple jurisdictions are debating responses to United Nations calls for banning attempts at conversion of lesbian, gay, bisexual, transgender, queer and asexual (LGBTQA +) peoples’ identities to fit religious norms. This paper aimed to examine Australian LGBTQA + youths’ experiences and outcomes of religious conversion practices attempting to change or suppress their gender or sexuality. It explored how attending conversion practices related to demographic characteristics and outcomes. Methods A 2019 online health and social well-being survey promoted via diverse social media questioned 6412 LGBTQA + Australians aged 14–21 years on their experiences of sexuality or gender change or suppression practices. Descriptive and inferential analyses were performed to understand relationships between exposure to conversion practices and demographic, socio-behavioural, and health and well-being measures. Results Whilst most participants had never attended counselling, group work, programs or interventions aimed at changing their sexuality or gender identity, 4% had attended such conversion practices. Analyses showed associations between engaging with conversion practices and (1) specific demographics (being cisgender male, multi-gender-attracted, unemployed, affiliated to a religion at the personal or household level); (2) social experiences (increased exposure to social rejection, negative remarks and harassment); (3) socio-behavioural outcomes (decreased education, sport and housing opportunities) and (4) negative health and mental health outcomes (including increased suicidality and self-harm). Conclusions The paper showed that conversion practices are correlated with poor well-being outcomes, providing arguments for expanding inclusive health and mental health services allowing for affirming religious and non-religious identities for LGBTQA + youth. Policy Implications The paper provides evidence supporting bans on conversion practices.

Background Sexual minority women consume both alcohol and tobacco at higher rates than heterosexual women. However, various sociodemographic and cultural factors associated with these practices among sexual minority women in Australia are not well understood, nor are the factors associated with seeking alcohol-related support. Methods This study utilised data from cisgender sexual minority women respondents of Private Lives 3: a national, online, cross-sectional survey of the health and wellbeing of LGBTIQ adults in Australia aged 18+ conducted in 2019. Multivariable analyses were performed to identify co-existing smoking and alcohol use, sociodemographic factors associated with smoking, alcohol consumption and seeking alcohol-related support. Results Of 2,647 sexual minority women respondents, 16.90% were currently smoking tobacco, 7.67% smoking tobacco daily and 60.50% reported potentially risky patterns of alcohol consumption. Tobacco and potentially risky alcohol consumption were found to frequently co-occur. Women who identified as queer were more likely than lesbian identifying women to currently smoke tobacco and to smoke tobacco daily. Tobacco consumption was associated with increased age, unemployment, low-mid range income and secondary-school education, while potential risky drinking was associated with living in outer urban or rural areas and being Australian born . Self-reporting having struggled with alcohol in the past twelve months was associated with residential location. Less than 3% of the sample has sought help for alcohol use. Seeking support was more likely as women aged, and with potentially risky drinking, and much more likely with self-perceived struggles with alcohol. Conclusions The findings highlight the need for future alcohol and tobacco use health promotion strategies focussing on sexual minority women to attend to within group differences that relate to risk of higher consumption. They also highlight the need for approaches that empower sexual minority women to self-identify when they are struggling with alcohol use and encourage seeking support with organisations that are affirming of sexual minority women.

People with intersex variation/s have sex characteristics determined by reproductive anatomy or chromosomal, gonadal, or hormonal expressions that are not typical of medical and societal norms for male or female bodies and are widely subjected to irreversible medical interventions at an early age to reinforce sex assignment. These interventions may be accompanied by experiences of lack of autonomy for the individual and, at times, lack of fully informed consent on the part of the individual or their parents/carers. People with intersex variations additionally experience high rates of mental health concerns relating to stigma, discrimination and poor healthcare experiences. The intersections between LGBTQ identities and intersex variations are poorly understood but are important given a high proportion of people with intersex variations identify as LGBTQ. This study explored associations between healthcare experiences and mental health outcomes among 46 LGBTQ people aged between 18 and 67 years old with intersex variations in Australia. Findings provide evidence of associations between suicidal thinking, suicidal attempts, depression or anxiety and negative healthcare experiences, including limited autonomy and consent, and challenges accessing psychological support. These highlight the need for further research and proactive intervention to advance human rights and improve health outcomes for this population.

Introduction: Correlates of suicidal ideation and suicide attempts among a large cross-section of trans and gender diverse populations in Australia were examined. Methods: A national survey was conducted that included 1466 trans and gender diverse participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. Results: Overall, 62.4% reported suicidal ideation and 9.5% suicide attempt in the past 12 months. The likelihood of suicidal ideation was higher for younger participants or those who felt treated unfairly or socially excluded due to their gender identity in the past 12 months. It was lower for those with a postgraduate degree, who felt accepted by family or work, or who felt their gender identity was respected when accessing a mainstream medical clinic in the past 12 months. The likelihood of suicide attempts was greater for those aged younger or who had recently experienced sexual harassment based on their sexual orientation or gender identity, and lower for those who were non-binary. Conclusion: Urgent attention for suicide prevention is necessary for trans and gender diverse communities. These findings point to a range of risk and protective factors, which may help inform the targeting and design of suicide prevention strategies.

Social capital has been positively associated with reduced HIV risk. However, few studies have investigated if associations vary between men who have sex with men (MSM) or heterosexual alters (possessors of actual resources embedded within social capital networks) and HIV risk-taking behaviors. In a cross-sectional survey of 1564 MSM in Greater Tokyo, we investigated whether social capital ascertained from MSM or heterosexual alters influenced HIV risk-taking behaviors (i.e., consistent condom use and lifetime HIV testing). Multiple logistic regression revealed that MSM with high levels of social capital from heterosexual networks were twice as likely to report consistent condom use with casual male partners, while MSM who reported high levels of social capital from MSM networks were over twice as likely to have tested for HIV yet were half as likely to use condoms consistently with regular male partners. Associations between MSM, social capital, and HIV testing indicate the potential for integrating social capital enhancement programs into current HIV interventions.

Summary It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant’s confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care.

High rates of illicit drug use have been reported among gay and bisexual young men, however limited research has examined patterns of drug use among the broader population of lesbian, pansexual, trans and gender diverse, asexual and queer (LGBTQA) young people. We examined factors associated with illicit drug use in the past 6 months and lifetime experiences of self-reported concern with drug use among LGBTQA youth in Australia.A cross-sectional survey was conducted involving 6418 LGBTQA participants aged 14-21 years, 5914 of whom provided information relating to their use of illicit drugs. Multivariable logistic regressions examined demographic factors and life experiences associated with drug use in the past 6 months and lifetime experiences of self-reported concern with drug use.Overall, 26.4% of participants aged 14-17 and 41.9% aged 18-21 reported any drug use in the past 6 months, of whom 23.5% had ever been concerned about their drug use. Cannabis use was most commonly reported (28.3%), followed by ecstasy/MDMA (7.1%), antidepressants (5.6%) and LSD (3.5%). Higher odds of drug use were reported among cisgender men and those who had experienced homelessness or sexual harassment in the past 12 months. Higher odds of self-identified concern about drug use were observed among participants reporting challenging life experiences.Rates of illicit drug use among LGBTQA young people in this study were considerably higher than those observed in general population youth studies in Australia and were further elevated among those who had experienced LGBTQA-related prejudice or harassment, or homelessness.

Individual differences in attachment differentially predict dating motivations and behaviors among heterosexual individuals. Remarkably, little research has examined such topics in men who have sex with men (MSM). In a sample of 118 MSM, we examined whether individual differences in attachment were differentially associated with motivations for using Grindr, a widely used geosocial networking application (GSNA) among MSM, and whether these motivations, in turn, predicted problematic Grindr use and depression. Data were collected in 2019. Attachment anxiety was associated with use of Grindr for self-esteem enhancement; this motivation, in turn, predicted more problematic Grindr use and higher depression. Attachment anxiety was also associated with problematic Grindr use via use of Grindr for companionship purposes. Those higher in attachment avoidance reported using Grindr for escapism and due to the ease of communication it affords; these motivations, in turn, were associated with greater problematic Grindr use. There were also indirect effects of attachment avoidance on symptoms of depression via escapism. Results suggest that attachment insecurity is associated with maladaptive motivations for GSNA use, and these motivations may place MSM at greater risk for depression and problematic GSNA use. Implications for social policy and professional practice are discussed, including the importance of clinicians assessing for problematic patterns of GSNA use and the need for practitioner training to include a focus on the unique predictors of mental health and well-being among gender and sexual minorities.

Dominant framings of intimate partner violence (IPV) construct the experience as one where a cisgender man enacts violence against a cisgender woman. While often the case, this framing obfuscates the experiences of people who identify as lesbian, gay, bisexual, transgender diverse, or queer (LGBTQ) and may challenge their ability to conceive of their relationship-based experiences as abusive or violent. The extent to which hostile experiences from family of origin violence (FOV) members are conceived or named as violence is also unclear. A large, online, national survey of LGBTQ adults separately assessed experiences of IPV and FOV in two ways: a direct question relating to abuse from a partner/s or family member/s, and a second question (asked irrespective of the previous answer) which sought to establish experience of a nuanced list of abusive acts that can constitute violence (including emotional abuse, LGBTQ-specific forms of violence, and enforced social isolation). Following comparison of responses, multiple regression analyses were performed to assess variation by demographic characteristics. Among the full sample of 6,835 individuals, when asked directly, 30.93% ( n = 2,108) of participants indicated that they had ever experienced FOV and 41.73% ( n = 2,846) indicated that they had ever experienced IPV. However, when asked about experiences of FOV using the second nuanced question, 43.18% ( n = 2,675) responded in ways that indicated that they had ever experienced FOV and 60.71% ( n = 3,716) with respect to IPV. The recognition of violence, as indicated by responses to the direct question varied by numerous characteristics, including age, gender, and educational attainment. These findings indicate some LGBTQ people may struggle to recognize or name their family or relationship experiences as abusive or violent, which may complicate their ability or willingness to access professional support. More expansive framings, policies, and responses to IPV and FOV are required.

Suicide is a major public health problem in Japan, where mortality rates are among the highest in the world. Globally, men who have sex with men (MSM) report elevated rates of suicidal ideation and attempts compared to their heterosexual peers. However, there is a paucity of research on suicidal ideation among MSM in Japan, where MSM continue to experience significant stigma and discrimination, and where resources are limited for MSM-specific mental health support. This study examined the prevalence and correlates of recent suicidal ideation among MSM in Greater Tokyo. We recruited 1,657 MSM for an anonymous, online, cross-sectional survey posted on social mobile applications popular with MSM in Japan (e.g., Grindr, 9Monsters) from November 2015 through January 2016. Recent suicidal ideation, measured as suicidal thoughts in the preceding two weeks, was reported by almost one-third (31%) of participants. Participants who reported unemployment or part-time employment (compared to full-time employment) and knowing a heterosexual person who restricted their freedom or excluded them from a group had higher odds of suicidal ideation. Being aged 46 years or older, reporting good health, and having a medium or high level of access to social capital networks with other MSM were associated with reduced odds of suicidal ideation. Our findings indicate that suicide prevention interventions with MSM in Greater Tokyo and similar urban settings in Japan should work to enhance MSM social networks as a protective factor; attend to employment concerns, particularly in younger MSM; and augment current efforts to address stigma and discrimination in the community.

Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) people with disability report greater levels of abuse than those without disability.This study sought to further understand these experiences by examining factors associated with experiences of abuse among LGBTQA+ adults who reported a disability in Australia.A national survey was conducted that included 2629 LGBTQA+ people who reported a disability aged 18 years and older, with data collected on experiences of verbal abuse, sexual assault, and social exclusion in the past 12 months as well as demographic characteristics.Of participants with disability, 42.5% reported experiencing verbal abuse, 17.4% sexual assault, and 50.3% social exclusion based on their sexuality or gender identity in the past 12 months. From multivariable analyses, verbal abuse was significantly more likely among trans women and non-binary participants and among those classified with more severe disability. Sexual assault was significantly more likely among those who lived in a rural area or had a higher income. Social exclusion was significantly more likely among those who were trans woman or non-binary, identified as bisexual, aged 18-24 years, or born in an English-speaking country other than Australia.These findings illustrate contexts for heightened risks of specific forms of abuse and highlight an urgent need to understand and address experiences of abuse and their consequences among LGBTQA+ people with disability.

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Introduction To examine demographic and psychosocial correlates of suicidal ideation and suicide attempts among a large cross-section of sexual orientation populations in Australia, including lesbian, gay, bisexual, pansexual, queer, and asexual (LGBQ) people. Methods A national survey was conducted involving 5,174 cisgender LGBQ participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. Results In all, 37.2% reported suicidal ideation and 3.9% a suicide attempt in the past 12 months. The likelihood of suicidal ideation was greater for those who identified as queer or felt treated unfairly or socially excluded due to their sexual orientation, and lower for those in a committed relationship, who felt part of LGBTIQ communities, or felt accepted in family, work, and health services. The likelihood of suicide attempts was greater for those aged younger or had recently experienced verbal abuse or social exclusion, and lower for those in a committed relationship or who felt part of LGBTIQ communities. Limitations Participants were recruited largely through paid Facebook advertising and the sample may therefore not be representative of all LGBQ adults in Australia. However, a representative population-level study would require the collection of population demographic data to provide the necessary and sexual identity is not included in the Australian Census. Conclusion These findings highlight an urgent need for supporting LGBQ people and may help inform tailored support services, including culturally-safe suicide prevention programs. These could involve peer support, trauma-informed counselling, supporting committed relationships, and addressing marginalization in the wider community.

This study aimed to examine correlates of lifetime and past-year HIV testing among men who have sex with men (MSM) in Japan. A unique, anonymous online self-report survey was conducted in 2015. A total of 776 participants completed the survey and answered questions on sociodemographic information, HIV-testing experience, history of syphilis, experience talking about HIV, recognition of AIDS-related community-based organization (CBO) materials, and sex behaviors. HIV-testing experience and related factors were assessed for two groups: regional cities and Tokyo and Osaka. A Poisson regression analysis revealed that higher lifetime HIV testing was associated with older age, previous syphilis diagnosis, and experience talking about HIV. Moreover, higher HIV testing in the past year was associated with experience talking about HIV with friends and recognition of HIV-related CBO materials. Increased dissemination of HIV-related information provided by CBOs may, therefore, be an effective prevention policy intervention targeted at Japanese MSM to promote regular testing and maintain their interest in HIV issues.

Men who have sex with men (MSM) are disproportionately burdened by the human immunodeficiency virus (HIV), accounting for 78% of all Japanese male HIV cases in 2016. Over 30% of newly identified HIV infections in Japan are diagnosed as AIDS annually, suggesting a large proportion of people living with HIV were unaware of their own infection status. An estimated two-thirds of Japanese men who have sex with men (MSM) are not attached to the gay community, and previous studies have largely sampled gay venues, thus, previous studies have likely failed to reach many men in this population. This study therefore examined HIV testing prevalence and correlates among MSM in Greater Tokyo who use gay mobile geo-social networking applications (gay mobile apps), which have been found to increase access to MSM not traditionally accessible through venue-based surveys. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, the prevalence of lifetime and six-monthly HIV testing was 72.8% and 29.7% respectively. In multiple regression analysis, higher lifetime HIV testing was associated with older age, education, HIV knowledge, anal intercourse with regular and casual male partners, and gay venue attendance. Testing was negatively associated with regular male partner condom use, marriage, residing outside central Tokyo and having both male and female partners. These results indicated that MSM who use gay mobile apps in Greater Tokyo do not meet the CDC yearly testing recommendations for high risk populations. Considering limited HIV prevention funding in Japan for MSM, moderate lifetime and recent testing, and the large number of gay mobile app users, utilization of popular gay mobile apps to promote nearby HIV testing facilities may be an effective prevention policy to target non-community attached MSM, particularly at-risk youth and individuals at risk of sudden-onset AIDS.

This study examined the prevalence and factors associated with inconsistent condom use among men who have sex with men (MSM) who use gay mobile geo-social networking applications (gay mobile apps) in Greater Tokyo. Among a sample of 1657 MSM recruited through advertisements on gay mobile apps, inconsistent condom use was reported by over one-third (37%) of participants with regular male partners, 18% with casual male partners, and 20% with female partners. In multiple regression analysis, inconsistent condom use with both regular and casual male partners was more commonly reported among participants without a university education, and among participants reporting lower self-efficacy for safer sex. Inconsistent condom use with casual male partners was more commonly reported among participants living in the central 23 wards of Tokyo. Inconsistent condom use with regular male partners was more commonly reported among participants who identified as a member of the gay community, and who only had male partners. These results indicate that a substantial proportion of Greater Tokyo gay mobile app users use condoms inconsistently, particularly with regular partners, and may be at risk for HIV. This paper provides useful information to help design tailored strategies to reduce inconsistent condom use.