Australians in same-sex relationships who experience ongoing stigmatisation in their communities visit the GP less often, use more antidepressant medication and are more likely to have poorer health, compared to their heterosexual counterparts, a new study by Monash University has found.

Researchers found that same-sex couples living in locations where high levels of stigmatisation are present were less likely to use primary health care services and, in the case of gay men, were less aware of or adherent to HIV-related medication.

The study was conducted by PhD researcher Karinna Saxby along with Dr Sonja de New and Associate Professor Dennis Petrie from the Centre for Health Economics in the Monash Business School, and published to coincide with the International Day Against Homophobia, Transphobia and Biphobia 2020 on 17 May.

Researchers mapped the results of the 2017 Australian Marriage Law Postal Survey to the nation’s largest administrative dataset of same-sex relationships, containing 83,167 records.

They then measured the extent to which structural stigma – ‘no’ votes against same-sex marriage – was associated with healthcare and prescription medicine use among individuals in same-sex relationships. Across the nation, on average, 38 per cent of Australians voted ‘no’.

The research examined how stigma was related to the likelihood of visiting a GP and the number of visits; the use of nervous system scripts, the majority of which are used to treat mental health disorders; the likelihood of reporting a disability; HIV medication; and changes in pathology related care, including services for sexual health checks.

The study found that as structural stigma increases, compared to their heterosexual peers, Australians in same-sex relationships:

• are less likely to visit the doctor and use fewer GP and pathology services if they do;
   
• use more scripts for mental health disorders (such as antidepressants and anti-anxiety medication); and
   
• are more likely to report having a disability or to have received disability support payment.   

“The lesbian, gay and bisexual (LGB) community have worse health outcomes than their heterosexual counterparts. Sociocultural factors that disadvantage minority groups can contribute to these health inequalities by inducing pathophysiological stress responses, risky health behaviours and apprehension to seek appropriate healthcare,” Ms Saxby said.

“Our results suggest that individuals in same-sex relationships in stigmatised regions are in poorer health and have an increased use of medications for mental health disorders, such as antidepressants, but are less likely to seek proper help.”

Of the 83,519 individuals in same-sex relationships, 6,550 (8 per cent) women and 5,411 (6 per cent) men lived in regions with high structural stigma.

In regions where stigmatisation was low, researchers found that women in same-sex relationships used more scripts for mental health disorders and were less likely to visit a GP than their heterosexual counterparts.

In regions with a higher percentage of no votes, women in same-sex relationships used even fewer GP services but also filled more scripts for mental health disorders.

Similarly, men in same-sex relationships in high-stigma regions used fewer GP and pathology services but more scripts for mental health disorders than their heterosexual counterparts.

In particular, the researchers found that these effects of stigmatisation were strongest for individuals in same-sex relationships with lower income, less education and those living in regions with less access to GPs and other healthcare providers.

“Altogether, our research suggests that although sexual minorities in stigmatised regions are in poorer health and therefore arguably have greater healthcare needs, they are less likely to access primary healthcare services,” Ms Saxby said.

“This highlights the need for policies to reduce structural stigma, improve access to healthcare and, more broadly, interventions to reduce the health and healthcare disparities in sexual minorities.”