The experiences of individuals who are LGBTQIA+ vary considerably, not only due to sexuality and gender identity. 

These parts of an individual’s identity can interact with other aspects such as coming from a culturally and racially marginalised background. 

For example, a trans woman of colour whose second language is English will have very different social experiences from those of a trans woman born in the country in which she lives. 

We use the term ‘culturally and racially marginalised’ here to emphasise the experience of exclusion. 

We can understand how the different social and cultural identities a person has may produce unique and overlapping experiences of stigma, discrimination and marginalisation by using an intersectionality framework. 

Understanding how these categories and experiences intersect might help physiotherapists to acknowledge and appreciate that the LGBTQIA+ experience is not singular. 

This is critical because a one-size-fits-all approach to learning about the LGBTQIA+ community is not the path to providing inclusive and equitable healthcare.

People who are LGBTQIA+ but are also marginalised based on other aspects of their identity experience overlapping forms of stigma and discrimination. 

For example, an Aboriginal lesbian woman may experience racism, homophobia and sexism in society. 

The ways in which her different identities interact are always shifting.

She may feel accepted in the LGBTQIA+ community for her sexuality but experience racism within the same community. 

The recent book Growing Up Queer in Australia, edited by Benjamin Law, shares various intersectional stories of people navigating such intricacies of queer life.

The way people conceptualise gender identity and sexuality is shaped in part by the cultures they come from and the languages they speak. 

Gendered pronouns are an interesting example. 

Some languages, including Mandarin, Turkish, Swahili and Tagalog, are largely gender-neutral, meaning that they don’t have gendered pronouns (eg, he/him, she/her) or grammatical gender (words that change according to gender). 

With awareness of the importance of language increasing, we are observing a culturally driven evolution of languages that have traditionally used gendered pronouns and grammar, including German, French, Spanish and Arabic. 

In German, for example, the pronouns now used by some people who identity as non-binary are dey/dey/deyren as opposed to er (he) and sie (she).

Another important aspect of language in shaping and defining the LGBTQIA+ experience is labelling. 

Although the term LGBTQIA+ has been accepted in Western countries, other countries may not use similar terms for ‘gay’, ‘lesbian’, ‘bisexual’, ‘trans’ and so forth. 

Bronte Scott.

A man who has sex with another man may not necessarily identify with the English label of ‘gay’, ‘bisexual’ or ‘pansexual’. 

LGBTQIA+ labels (eg, ‘lesbian’) are often historically loaded, so individuals from other cultural backgrounds may not feel an affinity with them. 

Respecting a person’s preferred labels or decision not to use any labels is an essential part of avoiding imposing Western frameworks while providing care.

Another example of the impact of culture on identity and language that cannot be translated into the Western vernacular
is Aboriginal and Torres Strait Islander concepts of Brotherboy and Sistergirl. 

‘Brotherboy’ is considered a culturally, as well as a socially, accepted term to describe Aboriginal and Torres Strait Islander gender- diverse people who are masculine-spirited and take on traditional male social and ceremonial roles within the community. 

‘Sistergirl’ describes a gender-diverse person who has a female spirit and takes on traditional female roles within the community, including looking after children and family. 

‘Two-spirit’ is a term from First Nations peoples in America and Canada, used to refer to a person who has both a ‘female’ and a ‘male’ spirit. 

The Maori people of Aotearoa New Zealand have a culturally specific identify called Takatapui, which historically means ‘intimate companion of the same sex’. 

Baklâ is a Tagalog word describing a Filipino person assigned male at birth who has a feminine expression.

Baklâ is an identity built on performative cultural practice. 

These terms highlight the fluidity of gender and different cultural perceptions of identity that are not easily articulated using the ‘LGBTQIA+’ acronym.

But what does all this mean for physiotherapy, we hear you ask?

Emre Ilhan.

An understanding of intersectionality allows us as physiotherapists to consider the complexity of experiences that a client or colleague carries with them. 

As professionals who regularly interact with those who are vulnerable due to pain, immobility or injury, we must be sensitive to the person who has come to us for relief. 

While LGBTQIA+ people experience poorer health outcomes than people who are not LGBTQIA+, research shows that
it is the experiences of discrimination and stigma that lead to poor health outcomes, not the fact that they are LGBTQIA+. 

In the podcast Coming Out, Blak, Matika Little and Courtney Hagen describe themselves as being ‘multiple minority’. 

This speaks to the idea that being both lesbian and Aboriginal leads to a unique experience of discrimination that may worsen health outcomes. 

Additionally, they report that the authenticity of their identities is regularly questioned when they don’t fit into stereotypical presentations of their sexuality and cultural heritage. 

Listening and reflecting back the language clients use to describe themselves is one way to ensure that we do not misapply labels or make assumptions about people. 

Refraining from inquisition or excessive interest removes the onus on the individual to repeatedly explain or justify their cultural or social experience. 

By taking these approaches, we elevate the person-centred care to which we all aspire.

>> Bronte Scott (she/her) is a senior physiotherapist and a student facilitator at Westmead Hospital in Sydney.

>> Dr Emre Ilhan (he/him) is a lecturer and physiotherapist in the Department of Health Sciences at Macquarie University in Sydney and teaches in the Doctor of Physiotherapy program.

COURSE OF INTEREST
Australian Physiotherapy Council’s cultural safety training for physiotherapists