Lesbian, gay, bisexual, transgender, intersex or queer people
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It is difficult to estimate the number of people in Australia who are lesbian, gay, bisexual, trans or gender diverse, intersex or queer. This is due to a number of factors including an absence of questions in population-based surveys around sex, gender and identity and most studies to date focus on lesbian, gay and bisexual identities. Terminology relating to sex, gender and sexuality is continually evolving making it difficult to compare results across studies and over time (Carmen et al. 2020).
In 2019, the NDSHS reported 3.8% of participants aged 14 and over were lesbian, gay or bisexual. According to the 2016 Census, there are approximately 47,000 same-sex couples in Australia, an increase of 39% since 2011. It should be noted that this figure only includes relationships within each household and many sexual orientations or gender diverse people may not be represented in this data (ABS 2018).
Box LGBTIQ1: Alcohol and other drug use by lesbian, gay, bisexual, transgender, intersex or queer (LGBTIQ+) people
There is a lack of publicly available and comprehensive data examining the use of alcohol and other drugs by LGBTIQ+ people. The AIHW’s National Drug Strategy Household Survey (NDSHS) is the only national data source that specifically disaggregates by sexuality identity and provides comprehensive estimates. However, the NDSHS does not include estimates for people identifying as trans or gender diverse, intersex or queer.
The Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University conducts the Private Lives survey series which provides snapshots of the health and wellbeing of LGBTIQ+ people in Australia. It should be noted, the sample size of participants with an intersex variation from the Private Lives survey is very small and is not representative of the population.
The Writing Themselves In survey series reports similar information but does not include people with an intersex variation. The surveys cover a range of topics including questions on alcohol and other drug use with reporting disaggregated by:
- Gender (this includes cisgender female, cisgender male, trans woman, trans man and non-binary).
- Sexual orientation (this includes lesbian, gay, bisexual, pansexual, queer, asexual and ‘something else’).
The Private Lives survey includes people aged 18 and over and the Writing Themselves In survey includes young people aged 14–21 years, with disaggregations provided for those aged 14–17 and 18–21.
Private Lives and Writing Themselves In surveys use convenience sampling and draw participants from a range of recruitment efforts including social media, online LGBTIQA+ community networks and through promotional posters. Therefore these surveys are not considered representative of the Australian population and care should be taken when interpreting this data as results are indicative of the respondents but should not be generalised to the broader population.
Since 2010, the NDSHS has consistently shown high rates of substance use among gay, lesbian or bisexual people relative to the heterosexual Australian population (AIHW 2020, Table 8.4). These proportions have declined for smoking and alcohol use, but remain relatively stable for illicit drug use. After adjusting for differences in age, people who were lesbian, gay or bisexual were still far more likely than others to smoke daily, consume alcohol in risky quantities, use illicit drugs and use pharmaceuticals non-medically in 2019 (AIHW 2020).
Tobacco smoking
Estimates from the 2019 NDSHS indicate that daily smoking among lesbian, gay or bisexual people has steadily declined from 28% in 2010 to 16.0% in 2019 (AIHW 2020). After adjusting for age differences, lesbian, gay or bisexual people (16.7%) were still 1.5 times as likely to smoke daily as people who are heterosexual (10.8%) (AIHW 2020; Figure LGBTQ1).
Figure LGBTQ 1: Tobacco, alcohol or other drug use, by sexuality and risk behaviour or drug type, people aged 14 and over, 2010 to 2019 (age-standardised percent)
The figure shows that, in 2019, people who identified as homosexual or bisexual were more likely than were heterosexual people to be daily smokers (16.7% compared with 10.8%). Homosexual/bisexual people were also more likely to exceed alcohol guidelines for single occasion (35.4% compared with 26.1% for heterosexual people) and lifetime risk (24.6% compared with 16.9%). Recent use of any illicit drug was also more common among homosexual/bisexual people (36%) than heterosexual people (16.1%).
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In 2019, 1 in 10 (10.2%) participants of the Private Lives 3 survey reported being daily smokers (Hill et al. 2020). This is lower than the proportion of daily smokers aged 18 and over in the general Australian population (11.6%; AIHW 2020). However, there was some variation when the proportion of daily smokers in the Private Lives 3 survey was examined by sexual orientation and gender (Figure LGBTQ 2).
The proportion of young people aged 14–17 years in the Writing Themselves In 4 survey who were daily smokers (1.8%; Hill et al. 2021) was consistent with the proportion for the general Australian population aged 14–17 years (1.9%; note this estimate has a relative standard error of 25% to 50% and should be used with caution; AIHW 2020).
E-cigarettes
In 2019, higher proportions of participants of the Private Lives 3 survey reported lifetime and current use of e-cigarettes when compared to the general Australian population aged 18 and over:
- Lifetime use – 12.9% compared to 11.4%.
- Current use – 5.7% compared to 2.6% (Hill et al. 2020; AIHW 2020).
A higher proportion of participants aged 14–17 years in the Writing Themselves In 4 survey reported current use of e-cigarettes (4.2%; Hill et al. 2021) when compared to the general Australian population in this age range (1.8%; note this estimate has a relative standard error of 25% to 50% and should be used with caution; AIHW 2020).
Of the Writing Themselves In 4 participants aged 18-21, 87% (5,540) reported never using vapes/e-cigarettes and 0.9% (58) use them daily (Hill et al. 2021, Table S3.9).
FIGURE LGBTQ 2: Tobacco smoking, alcohol consumption and drug use demographics from the Privates Lives 3 Survey, 2019
The figure shows the frequency of tobacco smoking, alcohol consumption and drug use from the Private Lives Matter 3 survey. Tobacco smoking and alcohol consumption is broken down by age, gender, residential location, sexual orientation, and state and territory. Drug use is broken down by age, gender, sexual orientation, and state and territory.
FIGURE LGBTQ 3: Tobacco smoking, alcohol consumption and drug use demographics from the Writing Themselves in 4 Survey, 2019
The figure shows the frequency of tobacco smoking, alcohol consumption and drug use from the Writing Themselves In 4 survey. Tobacco smoking and alcohol consumption is broken down by age, gender, residential location, sexual orientation, and state and territory. Drug use is broken down by age, gender, sexual orientation, and state and territory.
Alcohol consumption
New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020. Data for alcohol risk in this report are measured against the 2009 guidelines (see Box ALCOHOL1). National Drug Strategy Household Survey data relating to the updated guidelines are available in the Measuring risky drinking according to the Australian alcohol guidelines report.
Since 2010, risky drinking has been declining among lesbian, gay or bisexual people (Figure LGBTQ1). Estimates from the NDSHS showed that from 2010 to 2019, there has been a decline in the proportion of lesbian, gay and bisexual people who exceed the guidelines for lifetime (from 30% to 22%) and single occasion risk (from 45% to 38%) for alcohol consumption (AIHW 2020).
After adjusting for age differences, lesbian, gay or bisexual people are still more likely than heterosexual people to drink at risky levels (AIHW 2020).
In 2019, compared with heterosexual people, lesbian, gay or bisexual people were:
- 1.5 times as likely to exceed the lifetime risk guidelines (25% compared with 16.9%)
- 1.4 times as likely to exceed the single occasion risk guidelines at least monthly (35% compared with 26%) (AIHW 2020, Table 8.4).
In 2019, one quarter (25%) of participants in the Private Lives 3 survey reported drinking more than two standard drinks per day on a typical day (Hill et al. 2020). This is higher than the proportion in the general Australian population aged 18 and over who exceeded the lifetime alcohol risk guideline (17.6%; AIHW 2020).
Higher proportions exceeding two drinks on a typical day were reported in the Private Lives 3 survey for:
- cisgender men (38%)
- trans women (32%)
- for people who identified their sexual orientation as gay (39%) or ‘something else’ (33%) (Hill et al. 2020).
More than half (52%) of Writing Themselves In 4 participants aged 14–17 years in 2019 reported that they never drank alcohol (Hill et al. 2021). This is substantially lower than the proportion of abstainers in the general Australian population aged 14–17 years (73%; AIHW 2020).
Illicit drugs
Unlike smoking and drinking alcohol at risky levels, recent use of illicit drugs has not declined among lesbian, gay or bisexual people between 2010 and 2019. In 2019, 2 in 5 (40%) lesbian, gay or bisexual people had recently used any illicit drug, compared with 36% in 2010 (AIHW 2020).
When adjusted for age, stability in recent drug use is relatively consistent across drug types between 2016 and 2019, with the exception of:
- non-medical use of pharmaceuticals, which fell from 12.2% in 2016 to 6.3% in 2019
- inhalants, which rose from 5.9% in 2016 to 9.9% in 2019 (AIHW 2020).
Estimates from the NDSHS show that lesbian, gay and bisexual people continue to be more likely than heterosexual people to use a range of illicit drugs (AIHW 2020). In 2019, after adjusting for age differences, 36% of lesbian, gay or bisexual people had recently used any illicit drug, compared with 16.1% of heterosexual people (AIHW 2020, Table 8.4).
Compared with people who identified as heterosexual, lesbian, gay or bisexual people were:
- 9.0 times as likely to have recently used inhalants (9.9% compared with 1.1%)
- 3.9 times as likely to have recently used meth/amphetamine (5.1% compared with 1.3%)
- 3.5 times as likely to have recently used hallucinogens (4.9% compared with 1.4%)
- 2.6 times as likely to have recently used ecstasy (7.4% compared with 2.9%) (AIHW 2020, Table 8.4; Figure LGBTQ1).
In 2019, at least 2 in 5 (44%) participants in the Private Lives 3 survey reported using one or more drugs for non-medical purposes in the previous 6 months. The most frequently reported drugs were cannabis (30%), ecstasy/MDMA (13.9%) and cocaine (9.6%) (Hill et al. 2020). These were also the most common drugs reported for non-medical purposes in the general population (11.8% for cannabis, 4.5% for cocaine and 3.1% for ecstasy; AIHW 2020).
The Private Lives 3 survey reported cannabis use was higher for participants who identified their sexual orientation as queer (38%), pansexual (37%) or bisexual (36%). Cocaine use was higher among participants who identified their sexual orientation as queer or gay (both 13%) and bisexual (8.1%) (Hill et al. 2020).
More than 3 in 10 trans men (38%), cisgender men (43%), trans women (41%) and participants who identified their sexual orientation as queer (38%) in the Writing Themselves In 4 survey reported the use of drugs for non-medical purposes in the past six months (Table S3.9; Figure LBGTQ3).
The most frequently consumed drugs by Writing Themselves In 4 participants aged 14–17 years were cannabis (22%), antidepressants (5%) followed by ecstasy (3.3%) (Hill et al. 2021; Figure LBGTQ3).
Injecting drug use
For related content on injecting drug use, see also:
Responses from the 2022 Australian Needle Syringe Program Survey (ANSPS) show that 4.9% of respondents identified as gay or lesbian and 10% as bisexual (Heard et al. 2023).
Due to public health measures implemented during the COVID-19 pandemic, the number of respondents for 2020, 2021, and 2022 was lower than in previous years. This should be considered when comparing data with previous years (Heard et al. 2023).
Treatment
The majority (66%) of participants in the Private Lives 3 survey who sought professional support for their drug use did so from a mainstream service. Four in ten (40%) sought support from a mainstream service known to be LGBTIQ-inclusive and 8% from a service that caters only to lesbian, gay, bisexual, transgender and/or intersex people (Hill et al. 2020).
Australian Bureau of Statistics (ABS) 2018. Census of Population and Housing: Reflecting Australia - Stories from the Census, 2016. ABS cat. no. 2071.0. Canberra: ABS, Viewed 23 November 2021.
AIHW (Australian Institute of Health and Welfare) 2020. National Drug Strategy Household Survey 2019. Drug statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW. Viewed 16 July 2020.
Heard S, Zolala F, Maher L, 2023. Australian Needle Syringe Program Survey National Data Report 2018–2022 Sydney: Kirby Institute, UNSW Sydney. Viewed 14 August 2023.
Hill AO, Bourne A, McNair R, Carman M & Lyons A 2021.Private Lives 3: The health and wellbeing of LGBTIQ people in Australia. ARCSHS Monograph Series No. 122. Melbourne, Australia: Australian Research Centre in Sex, Health and Society, La Trobe University.
Hill AO, Lyons A, Jones J, McGowan I, Carman M, Parsons M, Power J, Bourne A. 2021. Writing Themselves In 4: The health and wellbeing of LGBTQA+ young people in Australia. National report, monograph series number 124. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University.