Lesbian, gay, bisexual, transgender, intersex or queer people
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It is difficult to estimate the number of people in Australia who are lesbian, gay, bisexual, trans or gender diverse, 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. Terminology relating to sex, gender and sexuality is continually evolving making it difficult to compare results across studies and over time (Carmen et al. 2020).
In 2022–2023, the NDSHS reported 5.1% of participants aged 14 and over were lesbian, gay or bisexual. According to the 2021 Census, there are approximately 78,500 same-sex couples in Australia, an increase of 67.7% since 2016. It should be noted that this figure only includes relationships within each household and many sexual orientations or gender diverse people may not be represented in this data (ABS 2022).
Box LGBTIQ1: Alcohol and other drug use by lesbian, gay, bisexual, transgender, intersex or queer (LGBTIQ+) people
There is a lack of publicly available and comprehensive data examining the use of alcohol and other drugs by LGBTIQ+ people. The AIHW’s National Drug Strategy Household Survey (NDSHS) is the only national data source that specifically disaggregates by sexual orientation and provides comprehensive estimates.
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. It should be noted, the sample size of participants with an intersex variation from the Private Lives survey is very small and is not representative of the population.
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.
Private Lives and Writing Themselves In surveys use convenience sampling and draw participants from a range of recruitment efforts including social media, online LGBTIQA+ community networks and through promotional posters. Therefore these surveys are not considered representative of the Australian population and care should be taken when interpreting this data as results are indicative of the respondents but should not be generalised to the broader population.
Since 2010, the NDSHS has consistently shown high rates of substance use among gay, lesbian, or bisexual people relative to the heterosexual Australian population (AIHW 2024, Table 10.5). These proportions have declined for smoking and alcohol use but remained 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 2022–2023 (AIHW 2024, Table 10.6).
See LGBT people’s use of alcohol, tobacco, e-cigarettes and other drugs for more information.
Tobacco smoking
Estimates from the 2022–2023 NDSHS indicate that daily smoking among lesbian, gay or bisexual people has steadily declined from 28% in 2010 to 14.2% in 2022–2023 (AIHW 2024, Table 10.5). After adjusting for age differences, lesbian, gay or bisexual people (16.1%) were still 2 times as likely to smoke daily as people who are heterosexual (8.1%) (AIHW 2024, Table 10.6; Figure LGBTQ1).
FIGURE LGBTIQ1: Tobacco, alcohol, or other drug use, by sexuality and risk behaviour or drug type, people aged 14 and over, 2010 to 2022–2023 (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, the Private Lives 3 survey found 1 in 10 (10.2%) participants aged 18 and reported being daily smokers (Hill et al. 2020). There was variation when the proportion of daily smokers in the Private Lives 3 survey was examined by sexual orientation and gender (Figure LGBTQ 2).
The 2019 Writing Themselves In 4 survey found:
- 1.8% of participants aged 14–17 were daily smokers
- 5.4% of particpants aged 18-21 were daily smokers (Hill et al. 2021).
E-cigarettes/vapes
In 2019, higher proportions of participants of the Private Lives 3 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 4 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).
Of the Writing Themselves In 4 participants aged 18–21, 87% (5,540) reported never using vapes/e-cigarettes and 0.9% (58) use them daily (Hill et al. 2021, Table S3.9).
FIGURE LGBTQ 2: Tobacco smoking, alcohol consumption and drug use demographics from the Privates Lives 3 Survey, 2019
The figure shows the frequency of tobacco smoking, alcohol consumption and drug use from the Private Lives Matter 3 survey. Tobacco smoking and alcohol consumption is broken down by age, gender, residential location, sexual orientation, and state and territory. Drug use is broken down by age, gender, sexual orientation, and state and territory.
FIGURE LGBTQ 3: Tobacco smoking, alcohol consumption and drug use demographics from the Writing Themselves in 4 Survey, 2019
The figure shows the frequency of tobacco smoking, alcohol consumption and drug use from the Writing Themselves In 4 survey. Tobacco smoking and alcohol consumption is broken down by age, gender, residential location, sexual orientation, and state and territory. Drug use is broken down by age, gender, sexual orientation, and state and territory.
Alcohol consumption
New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020.
Since 2010, risky drinking has been declining among lesbian, gay or bisexual people (Figure LGBTQ1). Estimates from the NDSHS showed that from 2010 to 2022–2023, there has been a decline in the proportion of lesbian, gay and bisexual people who exceed the guidelines for risk of alcohol-related disease or injury (from 50% to 40%) (AIHW 2024, Table 10.5).
After adjusting for age differences, lesbian, gay or bisexual people are still more likely than heterosexual people to drink at risky levels (AIHW 2024).
In 2022–2023, compared with heterosexual people, lesbian, gay or bisexual people were:
- 1.2 times as likely to exceed the risk guidelines (38% compared with 31%)
- 1.3 times as likely to consume more than 4 standard drinks a day at least monthly (32% compared with 26%) (AIHW 2024, Table 10.6).
In 2019, one quarter (25%) of participants in the Private Lives 3 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 3 survey for:
- cisgender men (38%)
- trans women (32%)
- 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 4 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 increased among lesbian, gay or bisexual people between 2010 and 2022–2023. In 2022–2023, almost half (47%) lesbian, gay or bisexual people had recently used any illicit drug, compared with 36% in 2010 (AIHW 2024, Table 10.5).
When adjusted for age, stability in recent drug use among gay, lesbian or bisexual people is relatively consistent across drug types between 2019 and 2022–2023, with the exception of cocaine, which rose from 8.0% in 2019 to 12.5% in 2022–2023 (AIHW 2024, Table 10.6).
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 2024). In 2022–2023, after adjusting for age differences, 42% of lesbian, gay or bisexual people had recently used any illicit drug, compared with 17.3% of heterosexual people (AIHW 2024, Table 10.6). Compared with heterosexual people, lesbian, gay or bisexual people were:
- 8.6 times as likely to have recently used inhalants (8.6% compared with 1.0%)
- 6.5 times as likely to have recently used methamphetamines or amphetamines (5.9% compared with 0.9%)
- 3.5 times as likely to have recently used ketamine (4.5% compared with 1.3%)
- 3.4 times as likely to have recently used ecstasy (6.7% compared with 2.0%)
- 2.6 times as likely to have recently used cannabis (27.7% compared with 1.4%) (AIHW 2024, Table 10.6; Figure LGBTQ1).
In 2019, at least 2 in 5 (44%) participants in the Private Lives 3 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).
The Private Lives 3 survey reported cannabis use was higher for participants who identified their sexual orientation as queer (38%), pansexual (37%) or bisexual (36%). Cocaine use was higher among participants who identified their sexual orientation as queer or gay (both 13%) and bisexual (8.1%) (Hill et al. 2020).
More than 3 in 10 trans men (38%), cisgender men (43%), trans women (41%) and participants who identified their sexual orientation as queer (38%) in the Writing Themselves In 4 survey reported the use of drugs for non-medical purposes in the past six months (Table S3.9; Figure LBGTQ3).
The most frequently consumed drugs by Writing Themselves In 4 participants aged 14–17 years were cannabis (22%), antidepressants (5%) followed by ecstasy (3.3%) (Hill et al. 2021; Figure LBGTQ3).
Injecting drug use
For related content on injecting drug use, see also:
Responses from the 2022 Australian Needle Syringe Program Survey (ANSPS) show that 4.9% of respondents identified as gay or lesbian and 10% as bisexual (Heard et al. 2023).
Due to public health measures implemented during the COVID-19 pandemic, the number of respondents for 2020, 2021, and 2022 was lower than in previous years. This should be considered when comparing data with previous years (Heard et al. 2023).
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).
Australian Bureau of Statistics (ABS) (2022) Same-sex couples living together in Australia. ABS Website, accessed 1 February 2024.
AIHW (Australian Institute of Health and Welfare) (2024) National Drug Strategy Household Survey 2022–2023. AIHW, accessed 13 February 2024.
Heard S, Zolala F, Maher L, (2023). Australian Needle Syringe Program Survey National Data Report 2018–2022 Sydney: Kirby Institute, UNSW Sydney. Viewed 14 August 2023.
Hill AO, Bourne A, McNair R, Carman M & Lyons A (2021).Private Lives 3: The health and wellbeing of LGBTIQ people in Australia. ARCSHS Monograph Series No. 122. Melbourne, Australia: Australian Research Centre in Sex, Health and Society, La Trobe University.
Hill AO, Lyons A, Jones J, McGowan I, Carman M, Parsons M, Power J, Bourne A. (2021). Writing Themselves In 4: The health and wellbeing of LGBTQA+ young people in Australia. National report, monograph series number 124. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University.