Structural stigma and sexual orientation disparities in healthcare use: Evidence from Australian Census-linked-administrative data

Saxby, Karinna; New, Sonja C. de; Petrie, Dennis

doi:10.1016/j.socscimed.2020.113027

Cited by 24 publications

(31 citation statements)

References 52 publications

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“…29 To control for possible confounders that likely affect health care use, and thus our outcome variables, we controlled for a rich set of individual and regional level characteristics which have been applied in previous studies. 12,14,26 Individual level covariates included in X i were age and its square, educational attainment, ethnic background, employment status and whether the individual was born overseas. In addition, as individuals may be less likely to undergo HIV/STI testing if they are less sexually active and/or perceive they are unlikely to have been exposed, 30,31 we also controlled for sexual practices, including whether the individual had any condomless anal intercourse with casual partners and their number of different sexual partners in the previous 6 months.…”

Section: Analytical Approachmentioning

confidence: 99%

Structural Stigma and Sexual Health Disparities Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Saxby

Chan

Bavinton

2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Discrimination and stigmatization at the institutional and sociocultural level (conceptualized as "structural stigma") has been associated with adverse health outcomes among sexual and gender minorities. However, few studies explore whether structural stigma is associated with sexual health outcomes. Addressing this gap, here, we explore this relationship among Australian gay, bisexual, and other men who have sex with men (GBM)-a population disproportionately affected by HIV.Setting and Methods: Using responses from the 2017 Australian Marriage Law Postal Survey, we operationalized structural stigma related to sexual minority status as the regional percentage of votes against legalizing same-sex marriage. These responses were then linked to national HIV behavioral surveillance data from Australian GBM (43,811 responses between 2015 and. Controlling for a rich set of individual and regional level confounders, regression analyses were used to estimate the extent to which structural stigma was associated with testing for, and diagnoses of, HIV and sexually transmitted infections (STIs), and awareness and use of HIV prevention and treatment interventions (pre-exposure and postexposure prophylaxis, combination therapy, and HIV-related clinical care).Results: Australian GBM living in regions with higher levels of structural stigma were less likely to undergo HIV/STI testing, receive HIV/STI diagnoses, and be taking, or aware of, biomedical prevention strategies. Among GBM living with HIV, structural stigma was associated with a reduced likelihood of being on combination therapy and fewer HIV-related clinical visits.Conclusions: Altogether, these results suggest that structural stigma may undermine HIV prevention strategies as well as adequate management of HIV infection among GBM.

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Section: Analytical Approachmentioning

confidence: 99%

Structural Stigma and Sexual Health Disparities Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Saxby

Chan

Bavinton

2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Further, utilising mental health care may be particularly difficult for individuals and groups that experience prejudice and discrimination. For example, sexual minorities are less likely to use primary health care in stigmatising environments (Saxby, De New and Petrie 2020) and a lack of cultural inclusivity and experiences of racism have been associated with reduced health‐seeking in ATSI peoples (Shephard 2006; Si et al 2006).…”

Section: Barriers To Accessing Mental Health Carementioning

confidence: 99%

“…Analysing two‐year cohorts (based on their age at the 2016 Census) from those roughly born between 1986 and 1987 to 2000 and 2001, we analyse the proportion of people who access nervous system scripts between the ages of 10 and 30. We also explore heterogeneous patterns by gender and across key groups of interest: ATSI, regional disadvantage (as measured by the Index of Relative Socioeconomic Disadvantage (IRSD)), and access to psychologists (as measured by the density of psychologists in a given Statistical Area 3 region, 2 as per Saxby, De New and Petrie 2020).…”

Section: Empirical Evidence On Dynamics In Australiamentioning

confidence: 99%

Dynamics of Mental Health and Healthcare Use among Children and Young Adults

Butterworth

New

Schilling

et al. 2021

Australian Economic Review

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Despite the high rates of mental disorder in adolescents and young adults, treatment utilisation is low. Using Australian longitudinal administrative and survey data, we show an increasing proportion of young people are accessing nervous system scripts as they age. Younger cohorts have increasingly accessed these scripts earlier; usage is generally higher among disadvantaged groups and in regions with better mental health service access. Less than half of all young adults facing very high psychological distress in 2018 had recently accessed mental health care. Instead of professional help, young people turn to friends and family for help with personal and emotional problems.

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“…A reason for this is perhaps that the choice of a sexual orientation measure in an empirical study is often dictated by its availability within a particular dataset. For example, in international studies, the gender of a spouse is a commonly used measure to infer an individual's sexual orientation (Sabia et al., 2018; Sansone, 2019b; Saxby et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Do different means of recording sexual orientation affect its relationship with health and wellbeing?

2021

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Analyses of an individual's sexual orientation over time are desirable for policy evaluations and in estimating causal effects. We explore whether accounting for those who change sexual orientation over two time points, to create a measure of fluidity, produces substantially different results compared to sexual orientation measured at one time point and extrapolated to subsequent survey waves. We use seven waves of the UK Household Longitudinal Study which asked sexual orientation identity questions at two time points: waves three (2011–2013) and nine (2017–2019). Using the relationship with sexual orientation and various health outcomes as an empirical example, via a correlated random effects estimation approach, we find that the infrequent reporting of sexual orientation could over‐estimate the negative impact for lesbian, gay and “other” individuals and under‐estimate the negative impact for bisexuals. We further test the feasibility of the fluidity measure by examining attrition by sexual orientation identity and find small but statistically significant probabilities of attrition. Correction for attrition bias through inverse probability weighting makes little difference to the results. These results highlight the importance of accounting for changes in sexual orientation in empirical analysis and that doing so is feasible.

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Structural stigma and sexual orientation disparities in healthcare use: Evidence from Australian Census-linked-administrative data

Cited by 24 publications

References 52 publications

Structural Stigma and Sexual Health Disparities Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Structural Stigma and Sexual Health Disparities Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Dynamics of Mental Health and Healthcare Use among Children and Young Adults

Do different means of recording sexual orientation affect its relationship with health and wellbeing?

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