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

It is difficult to estimate the number of people in Australia who identify as lesbian, gay, bisexual, transgender, 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 and the changing terminology relating to sex, gender and identity (Carmen et al. 2020).

In 2019, the NDSHS reported 3.8% of participants aged 14 and over identified as 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 some sex or gender diverse people may not be represented in this data (ABS 2018).

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.

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. 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.

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 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).

Key findings

View the People identifying as LGBTIQ+ fact sheet >

Tobacco smoking

Estimates from the 2019 NDSHS indicate that daily smoking among people who identify as lesbian, gay 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 lesbian, gay 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).

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%).

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In 2019, 1 in 10 (10.2%) participants of the Private Lives survey reported being daily smokers (Hill et al. 2020). This is slightly 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 Survey was examined by sexual orientation and gender:

  • a higher proportion of people who identified their sexual orientation as gay (13.5%) or ‘something else’ (13%) were daily smokers. Lower proportions were reported by people who identified as asexual (3.7%), lesbian (8.3%), bisexual (8.4%), pansexual (8.8%) or queer (9.5%).
  • a higher proportion of cisgender men (14.2%) were daily smokers, compared with less than 10% for cisgender women (7.7%), non-binary participants (7.9%), trans men (9.3%) and trans women (9.5%) (Hill et al. 2020).

The proportion of young people aged 14–17 years in the Writing Themselves In 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 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 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).

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 people who identify as lesbian, gay or bisexual (Figure LGBTIQ1). 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, people who identify as lesbian, gay 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 lesbian, gay 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).
  • In 2019, one quarter (25%) of participants in the Private Lives 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 survey for cisgender men (38%) and trans women (32%) and 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 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 people who identify as lesbian, gay or bisexual between 2010 and 2019. In 2019, 2 in 5 (40%) people identifying as lesbian, gay 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 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 people who identified as lesbian, gay 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 lesbian, gay 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).

In 2019, at least 2 in 5 (44%) participants in the Private Lives 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).

More than half of cisgender men (52%) and people who identified their sexual orientation as gay (51%) or queer (53%) in the Private Lives survey reported the use of drugs for non-medical purposes in the past 6 months. A higher proportion of these participants reported the use of cocaine – 14% for cisgender men and 13% each for participants who identified their sexual orientation as gay or queer. Higher proportions were reported for the use of cannabis for participants who identified their sexual orientation as bisexual (36%), pansexual (37%) or queer (38%) (Hill et al. 2020).

In 2019, over one-quarter (27%) of Writing Themselves In participants aged 14–17 years reported using any drug for non-medical purposes in the past six months. Consistent with findings from other surveys about drug use in the Australian population, the most frequently reported drug was cannabis (22%). Antidepressants (5%) followed by ecstasy (3.3%) were the next most common reported drugs for non-medical purposes (Hill et al. 2021).

More than 3 in 10 trans men (34%), cisgender men (33%), trans women (31%) and participants who identified their sexual orientation as queer (32%) in the Writing Themselves In survey reported the use of drugs for non-medical purposes in the past six months (Hill et al. 2021).

Injecting drug use

For related content on injecting drug use, see also:

Responses from the 2020 Australian Needle Syringe Program Survey (ANSPS) show that 4% of respondents identified as homosexual and 10% as bisexual. Three per cent of respondents identified their sexuality as ‘Other’ (Heard et al. 2021).

Data collection for the 2020 ANSPS was impacted by COVID-19 restrictions. The survey took place in several phases from September to December 2020, instead of the usual October timeframe. South Australia required participants complete the survey offsite due to a snap lockdown and Victoria were unable to participate due to public health restrictions (Heard et al. 2021). This should be taken into account when comparing data from 2020 with previous years.

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).