2.1. Health Outcomes for LGBTIQA+ People with Disability
2.2. Australia’s National Disability Insurance Scheme
3.1. Participatory Action Research (PAR) and Employing Peer Researchers
3.2. Data Collection
3.3. Data Analysis
4. Results and Discussion
4.1. Managing Multiple Identities in Practice
We don’t come out once in our life; most of us come out every day, and I have to keep doing that around my sexuality, but also around my disability. My disability is very non-visual; it’s in here [points to head], and it’s the things that I can do and the things that I can’t do… but it is difficult, in a workplace, to cover both of these [identities] at once.
I have to go back to my gynaecologist soon, because it’s time for my next check, since the last one five years ago, and since then, I’ve explored my gender, and come out, and things like that; so I’m sort of wondering if there’s any point in disclosing my trans identity, or if I should just closet myself. Because is there any point in doing the work to educate them? Because it’s almost certain they won’t know already. Or is that energy better spent on just getting through the whole experience?
So if I want to get autistic services, I don’t really talk about sexuality; if I want to go into queer spaces, I can’t really talk about disability and access… there’s not an understanding; there’s not a whole lot of cross-education.
A disproportionate number of disabled people are on Newstart, rather than DSP [Disability Support Pension], unfortunately; and that can be a really difficult landscape to navigate, as both a queer person, and a trans person, and all that kind of stuff, as well as a disabled person; because I have to disclose all those parts of identity as well as my access needs, police that they’re being met, police that I’m being gendered correctly, all of that kind of jazz; which makes every other part of life more difficult.
I think often it’s easier to be one or the other, and you don’t often get to be both. You either get to be the person with a disability, and you don’t always disclose, as others have said; or you get to be the gay person, but you don’t get your disability side of you actually acknowledged, or sort of… I don’t know. I think you often get split between the two, or between however many there are.
I want to start study soon… but I’m afraid for two reasons, because I don’t know what level of support I’ll have with access needs, and things like that, because they’re not very explicit about that before you enrol. And I’m also worried about if my trans identity will be accepted.
Whenever I need to get medical care, or therapy, or anything like that. You need to sort of pick which part is most important immediately, because there’s almost never any option that covers all the bases at once.
I recently tried coming out to my disability employment services provider, because they have really not known a lot, so I think they’ve tried to take note of what I said, but there is no place on their system where they can note my pronouns, or my actual gender, or my preferred name - my actual name that I use, rather than my birth name.
I still have anxiety about sharing my sexuality, and I live in a sexually and gender diverse household; I’m the carer of someone else with disability, and when I look for services, I actively search to see if they are LGBTI friendly; and even when I do find that they say they are, if they treat you really badly or discriminate based on the disability, I don’t then feel comfortable sharing the other part.
Knowing your accessibility needs can be really difficult sometimes, when disability is defined by what makes us frustrating for other people, as opposed to what our experiences of it actually are.
4.2. Community Services and Supports
I think there’s so many social barriers, in terms of people’s ableism and negative attitudes around disability, within the broader community, but also within the LGBTI community…there’s so many assumptions about people with disabilities, around our sexuality, our desire. Being viewed as not desirable or less than other people. You know, trying to find a relationship, but also trying to find a pash on a Saturday night is really hard.
Just because you’re disabled doesn’t mean that you’re inclusive to people with all different types of disability, and sometimes little cliques can form.
‘Inclusive’ really isn’t inclusive yet. So a lot of places are being advertised as an inclusive event, yet they’ve not actually done any research in regards to finding out about disabilities and what inclusive changes need to happen for people with disabilities to access those services. So yeah, it kind of… it raises the question of going, “Okay, well, all of these things are being promoted as accessible for us, yet they’re not.”
I think actually the best example of accessibility within the LGBTI community I think has to go to [LGBTIQA+ cultural festival] Midsumma, because they are proactively starting to make that information available in events and booklets. So when you open up the booklet, they’re starting to include wheelchair access, they’ve got Auslan there, breakout spaces, and things like that.
I got the vibes from them that they’re one of us, and I was sort of thinking, how long have they been part of the LBGTI community, and they said that they’re gay, so we had that camaraderie, and we were able to talk to each other about it, and I could add my sass, and I could hear him using that sort of language when he was interpreting for me, and I really loved that.
First time I ever saw another LGBTI person with disability was actually on [dating app] Grindr. I’d never actually met anyone. I never actually knew there were other people out there; and when it started to show up on Grindr, that was when I was like, “Wow, there are actually other people out there.” Which is a really powerful thing.
You get to meet many people in the Deaf world, but out in regional areas, you’re the only one, essentially, so being a woman, living out there and being a lesbian, there’s not a lot of options for me out there. It’s very limiting.
I find a lot of Facebook groups really helpful. There are really specific identity-based Facebook groups, and also ones that are specifically tailored to different political leanings and things like that, so you can feel accepted in multiple facets of identity at once. Those are all our own voices, community-based spaces - they’re not set up by other people. It’s all ourselves.
My experience, when I was younger, I wasn’t sure about my identity, I was really confused. I didn’t know – I just pushed that side of myself down. I didn’t want people to tease me, I didn’t like that. I put a mask on, straight away. I wasn’t comfortable with who I was. But later, when I was older, I saw in my Deaf community that I was accepted. You know, why am I so worried about it. Why was I pretending to be straight?
Conflicts of Interest
- McNair, R.P. Multiple Identities and Their Intersections with Queer Health and Wellbeing. J. Intercult. Stud. 2017, 38, 443–452. [Google Scholar] [CrossRef]
- Crameri, P.; Barrett, C.; Latham, J.R.; White, C. It is more than sex and clothes: Culturally Safe Services for Older Lesbian, Gay, Bisexual, Transgender and Intersex people. Australas. J. Ageing 2015, 34, 21–25. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Conron, K.J.; Mimiaga, M.J.; Landers, S.J. A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health. Am. J. Public Heal. 2010, 100, 1953–1960. [Google Scholar] [CrossRef] [PubMed]
- Zeeman, L.; Sherriff, N.; Browne, K.; McGlynn, N.; Mirandola, M.; Gios, L.; Davis, R.; Sanchez-Lambert, J.; Aujean, S.; Pinto, N.; et al. A Review of Lesbian, Gay, Bisexual, Trans and Intersex (LGBTI) health and Healthcare Inequalities. Eur. J. Public Heal. 2018, 29, 974–980. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Koh, C.S.; Kang, M.; Usherwood, T. ’I demand to be treated as the person I am’: Experiences of Accessing Primary Health care for Australian Adults who identify as Gay, Lesbian, Bisexual, Transgender or Queer. Sex. Heal. 2014, 11, 258–264. [Google Scholar] [CrossRef] [PubMed]
- Pennant, M.; Bayliss, S.; Meads, C. Improving Lesbian, Gay and Bisexual Healthcare: A Systematic Review of Qualitative Literature from the UK. Diversity in Health and Care 2009, 3, 193–203. [Google Scholar]
- Wilson, N.J.; Macdonald, J.; Hayman, B.; Bright, A.M.; Frawley, P.; Gallego, G. A Narrative Review of the Literature about People with Intellectual Disability who Identify as Lesbian, Gay, Bisexual, Transgender, Intersex or Questioning. J. Intellect. Disabil. 2016, 22, 171–196. [Google Scholar] [CrossRef]
- O’Shea, A.; Frawley, P. Meanings of Gender and Disability in the Stories of Young Women with Intellectual Disabilities. J. Intellect. Disab. Res. 2016, 60, 654–675. [Google Scholar]
- William, L.; Mann, R. The Everyday Experiences of Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) People Living with Disability; La Trobe University: Melbourne, Australia, 2018. [Google Scholar]
- Dispenza, F.; Harper, L.S.; Harrigan, M.A. Subjective Health Among LGBT Persons Living With Disabilities: A Qualitative Content Analysis. Rehabil. Psychol. 2016, 61, 251–259. [Google Scholar] [CrossRef]
- Reppermund, S.; Srasuebkul, P.; Dean, K.; Trollor, J.N. Factors Associated with Death in People with Intellectual Disability. J. Appl. Res. Intellect. Disabil. 2019, 33, 420–429. [Google Scholar] [CrossRef]
- Trollor, J.; Srasuebkul, P.; Xu, H.; Howlett, S. Cause of Death and Potentially Avoidable Deaths in Australian Adults with Intellectual Disability using Retrospective Linked Data. BMJ Open 2017, 7, e013489. [Google Scholar] [CrossRef] [PubMed]
- Fredriksen-Goldsen, K.I.; Kim, H.-J.; Barkan, S.E.; Muraco, A.; Hoy-Ellis, C.P. Health Disparities Among Lesbian, Gay, and Bisexual Older Adults: Results From a Population-Based Study. Am. J. Public Heal. 2013, 103, 1802–1809. [Google Scholar] [CrossRef]
- Coleman-Smith, R.S.; Smith, R.; Milne, E.; Thompson, A.R. ‘Conflict versus Congruence’: A Qualitative Study Exploring the Experience of Gender Dysphoria for Adults with Autism Spectrum Disorder. J. Autism Dev. Disord. 2020, 50, 2643–2657. [Google Scholar] [CrossRef][Green Version]
- Latham, J.R.; Holmes, M.M. Intersex Ageing and (Sexual) Rights. In Addressing the Sexual Rights of Older People: Theory, Policy, and Practice; Hinchliff, S., Barrett, C., Eds.; Routledge: Abingdon, UK, 2018; pp. 84–96. [Google Scholar]
- Carpenter, M. The “Normalization” of Intersex Bodies and “Othering” of Intersex Identities in Australia. J. Bioethical Inq. 2018, 15, 487–495. [Google Scholar] [CrossRef][Green Version]
- Latham, J.R. Making and Treating Trans Problems: The Ontological Politics of Clinical Practices. Stud. Gend. Sex. 2016, 18, 40–61. [Google Scholar] [CrossRef]
- Latham, J.R.; Barrett, C. We’re People First: Trans Health and Ageing - An Evidence-based Guide to Inclusive Services; La Trobe University: Melbourne, Australia, 2015. [Google Scholar]
- McConnell, E.A.; Janulis, P.; Phillips, G.; Truong, R.; Birkett, M. Multiple Minority Stress and LGBT Community Resilience among Sexual Minority Men. Psychol. Sex. Orientat. Gend. Divers. 2018, 5, 1–12. [Google Scholar] [CrossRef]
- Correro, A.N.; Nielson, K.A. A Review of Minority Stress as a Risk Factor for Cognitive Decline in Lesbian, Gay, Bisexual, and Transgender (LGBT) Elders. J. Gay Lesbian Ment. Heal. 2019, 24, 2–19. [Google Scholar] [CrossRef]
- Fredriksen-Goldsen, K.I.; Emlet, C.A.; Kim, H.-J.; Muraco, A.; Erosheva, E.A.; Goldsen, J.; Hoy-Ellis, C.P. The Physical and Mental Health of Lesbian, Gay Male, and Bisexual (LGB) Older Adults: The Role of Key Health Indicators and Risk and Protective Factors. Gerontology 2012, 53, 664–675. [Google Scholar] [CrossRef][Green Version]
- Waling, A.; Lim, G.; Dhalla, S.; Lyons, A.; Bourne, A. Understanding LGBTI+ Lives in Crisis; La Trobe University & Lifeline Australia: Melbourne, Australia, 2019. [Google Scholar]
- Australian Social Inclusion Board indicators working group. A Compendium of Social Inclusion Indicators ‘How’s Australia Faring? Commonwealth of Australia: Melbourne, Australia, 2009. [Google Scholar]
- Frawley, P.; Dyson, S.; Robinson, S.; Dixon, J. What Does It Take? Developing Informed and Effective Tertiary Responses to Violence and Abuse of Women and Girls with Disabilities in Australia; Australian National Research Organisation for Women’s Safety Limited (ANROWS): Sydney, Australia, 2015. [Google Scholar]
- United Nations Department of Economic and Social Affairs. Policy Imperatives for Leaving No One Behind; United Nations Publications: New York, USA, 2016; pp. 121–140. [Google Scholar]
- Abbott, D. LGBTIQ+ Disabled People and Self-Directed Social Care Support; University of Bristol: Bristol, UK, 2017. [Google Scholar]
- Mulé, N.J.; Ross, L.E.; Deeprose, B.; Jackson, B.E.; Daley, A.; Travers, A.; Moore, D. Promoting LGBT Health and Wellbeing Through Inclusive Policy Development. Int. J. Equity Heal. 2009, 8, 18. [Google Scholar] [CrossRef][Green Version]
- Leonard, W.; Pitts, M.; Mitchell, A.; Lyons, A.; Smith, A.; Patel, S.; Couch, M. Private Lives 2: The Second National Survey on the Health Wellbeing of Gay, Lesbian, Bisexual, Transgender Australians; La Trobe University: Melbourne, Australia, 2012. [Google Scholar]
- Gill, M. Already Doing It: Intellectual Disability and Sexual Agency; University of Minnesota Press: Minneapolis, USA, 2015. [Google Scholar]
- Tune, D. Review of the National Disability Insurance Scheme Act 2013: Removing Red Tape and Implementing the NDIS Participant Service Guarantee; Commonwealth Department of Social Services: Canberra, Australia, 2019. [Google Scholar]
- Hepburn, J.; Despott, N. LGBTIQA+ Victorians with Disability: Submission to the Victorian Government for the Victorian LGBTIQ Strategy; Inclusion Melbourne: Melbourne, Australia, 2020. [Google Scholar]
- Coghlan, D.; Brydon-Miller, M.; Liamputtong, P.; Lall, N. Experiential Knowing. In The SAGE Encyclopedia of Action Research; SAGE Publications: Thousand Oaks, CA, USA, 2014; pp. 323–325. [Google Scholar]
- Frawley, P.; Bigby, C. Inclusion in Political and Public Life: The Experiences of People with Intellectual Disability on Government Disability Advisory Bodies in Australia. J. Intellect. Dev. Disabil. 2011, 36, 27–38. [Google Scholar] [CrossRef][Green Version]
- Duffy, S. The Value of Citizenship. Res. Pr. Intellect. Dev. Disabil. 2017, 56, 1–9. [Google Scholar] [CrossRef]
- O’Shea, A.; Latham, J.R.; Beaver, S.; Lewis, J.; Mountford, R.; Rose, M.; Trezona, A.; Frawley, P. More Than Ticking a Box—LGBTIQA+ People with Disability Talking About Their Lives: Understanding Experiences in Healthcare and Community to Improve Services for All, Findings and Recommendations from a Victorian Research Project; Deakin University: Geelong, Australia, 2020. [Google Scholar]
- Owen, A.; Friedman, C. Nominal Group Technique as Participatory Action Research: Adults with Intellectual/Developmental Disabilities’ Perceptions of Sexuality; SAGE Publications: Thousand Oaks, CA, USA, 2017. [Google Scholar] [CrossRef]
- Nind, M. What Is Inclusive Research? Bloomsbury Academic: Sydney, Australia, 2014. [Google Scholar]
- Nind, M. The Practical Wisdom of Inclusive Research. Qual. Res. 2017, 17, 278–288. [Google Scholar] [CrossRef][Green Version]
- Chevalier, J.M.; Buckles, D.J. Participatory Action Research; Routledge: London, UK, 2019. [Google Scholar]
- Avery, S. Culture Is Inclusion: A Narrative of Aboriginal and Torres Strait Islander People with Disability; First Peoples Disability Network Australia: Sydney, Australia, 2018. [Google Scholar]
- Braun, V.; Clarke, V. Successful Qualitative Research: A Practical Guide for Beginners; SAGE: London, UK, 2013. [Google Scholar]
- Neale, J. Iterative Categorization (IC): A Systematic Technique for Analysing Qualitative Data. Addiction 2016, 111, 1096–1106. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Srivastava, P.; Hopwood, N. A Practical Iterative Framework for Qualitative Data Analysis. Int. J. Qual. Methods 2009, 8, 76–84. [Google Scholar] [CrossRef][Green Version]
- Goffman, E. Stigma: Notes on the Management of Spoiled Identity; Touchstone: New York, USA, 2009. [Google Scholar]
- Orne, J. Queers in the Line of Fire: Goffman’s Stigma Revisited. Sociol. Q. 2013, 54, 229–253. [Google Scholar] [CrossRef]
- Rakidzic, S.; O’Shea, A. The Rubix Cube. In Cultural Competence in Counselling and Psychology; Hutton, V., Sisko, S., Eds.; Palgrave Macmillan: London, UK, 2020; in press. [Google Scholar]
- Robinson, S.; Frawley, P.; Dyson, S. Access and Accessibility in Domestic and Family Violence Services for Women with Disabilities: Widening the Lens. Violence Against Women 2020, 1–19. [Google Scholar] [CrossRef]
- Jamieson, D.; Mason, J. Investigating the Existence of the Diagnostic Overshadowing Bias in Australia. J. Ment. Heal. Res. Intellect. Disabil. 2019, 12, 58–70. [Google Scholar] [CrossRef]
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