Considering First Nations LGBTIQ+ identity in anti-racist healthcare: Relations between comfort in healthcare, microaggressions and wellbeing

Abstract

First Nations scholars and practitioners have increasingly called for anti-racist healthcare to address disparate health outcomes between First Nations and non-First Nations Australians. However, these arguments largely miss the significant negative impact that colonial heterosexism and cisgenderism (i.e. discrimination and marginalisation of queer and transgender peoples) have on LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex, queer/questioning) First Nations peoples’ wellbeing. To address this gap, survey data from 63 First Nations LGBTIQ+ adults in Western Australia were utilised to illustrate the impact of racism, heterosexism and cisgenderism in healthcare settings on First Nations LGBTIQ+ peoples’ wellbeing. This study examined relations between participant wellbeing and 1) their comfort in being asked about their LGBTIQ+ and First Nations identity by a health provider, and 2) their experiences of race-based and LGBTIQ+-based discrimination (microaggressions) in broader community settings. Higher comfort in being asked about LGBTIQ+ identity was associated with higher wellbeing, whereas experiencing LGBTIQ+-based microaggressions within First Nations communities was associated with lower wellbeing. These findings add to the literature by showing that First Nations LGBTIQ+ patients experience additional discrimination. This paper also discusses findings with reference to settler-colonial racism (i.e. the racism enacted against First Nations LGBTIQ+ peoples to maintain settler norms and control) and offers suggestions for updating anti-racist healthcare.