People identifying as lesbian, gay, bisexual, transgender, intersex or queer

According to the 2016 Census, there are approximately 47,000 same-sex couples in Australia, an increase of 42% since 2011 (ABS 2017). This may be an underrepresentation as it is known that people identifying as lesbian, gay, bisexual, transgender, intersex or queer (LGBTIQ) may hide their sexuality or gender identity due to discrimination, harassment or hostility (Australian Human Rights Commission 2014).

Box LGBTIQ1: Alcohol and other drug use by people identifying as lesbian, gay, bisexual, transgender, intersex or queer (LGBTIQ)

There is a lack of publicly available and comprehensive data examining the use of alcohol and other drugs by people identifying as LGBTIQ. The AIHW’s National Drug Strategy Household Survey (NDSHS) is the only national data source that specifically disaggregates by sexual identity and provides comprehensive estimates. However, the NDSHS does not include estimates for people identifying as transgender, intersex or queer.

Since 2010, the NDSHS has consistently shown high rates of substance use among people who identify as gay, lesbian or bisexual relative to the heterosexual Australian population (Table S3.60). 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 homosexual 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 people who identify as homosexual or bisexual has steadily declined from 28% in 2010 to 16.0% in 2019 (AIHW 2020). However, after adjusting for age differences, people who identify as homosexual or bisexual (16.7%) were still 1.5 times as likely to smoke daily as people who identify as heterosexual (10.8%) (AIHW 2020; Figure LGBTIQ1).

Alcohol consumption

Risky drinking has been declining among people who identify as homosexual or bisexual since 2010 (Figure LGBTIQ1). Estimates from the NDSHS showed that from 2010 to 2019, there has been a decline in the proportion of homosexual and bisexual people who exceed the NHMRC guidelines for lifetime (from 30% to 22%) and single occasion risk (from 45% to 38%) for alcohol consumption (AIHW 2020).

However, after adjusting for age differences, people who identify as homosexual or bisexual are still more likely than heterosexual people to drink at risky levels (AIHW 2020). In 2019, compared with people who identified as heterosexual, people who identified as homosexual or bisexual 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%) (Table S3.60; AIHW 2020).

Illicit drugs

Unlike smoking and drinking alcohol at risky levels, recent use of illicit drugs has not declined among people who identify as homosexual or bisexual between 2010 and 2019. In 2019, 2 in 5 (40%) people identifying as homosexual or bisexual 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 homosexual 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 people who identified as homosexual or bisexual had recently used any illicit drug, compared with 16.1% of heterosexual people (Table S3.60). Compared with people who identified as heterosexual, people identifying as homosexual or bisexual 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%) (Table S3.60; Figure LGBTIQ1) (AIHW 2020).

Figure LGBTIQ1: Recent tobacco, alcohol and other drug use, by sexuality and drug type/risk behaviour, people aged 14 and over, 2010 to 2019 (age standardised per cent)

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%).

People who inject drugs (PWID)

Responses from the 2019 Australian Needle Syringe Program survey show that 5% of respondents identified as homosexual and 10% as bisexual. One per cent of respondents identified as transgender (Heard et al. 2020). More information on people who inject drugs is available in the People who inject drugs section.