The LGBTQIA+ community makes up over 10 per cent of the Australian population. 

Among 16–24-year-olds, it could be up to 20 per cent. 

This means that a large proportion of our clients, students, colleagues and employees may be LGBTQIA+.

Unfortunately, the LGBTQIA+ community continues to face discrimination, harassment and vilification on many levels, including in interpersonal interactions and in policies that exclude or do not protect against discrimination. 

These experiences affect the health and wellbeing of members of LGBTQIA+ communities and their sense of belonging or acceptance within health settings, workplaces and educational institutions.

Microaggressions experienced by LGBTQIA+ physiotherapists, from colleagues or clients, may lead to high workplace stress and dissatisfaction and eventually to the physiotherapist leaving the profession. 

The Australian Workplace Equality Index—which looks at a range of different types of workplaces, including health services—showed that in 2023, up to 37 per cent of LGBTQIA+ employees did not feel comfortable being ‘out’ at work, citing fear of discrimination and jeopardising career progression as key reasons.

Social change is needed to ensure that people who are LGBTQIA+ thrive in society as much as their cisgender and heterosexual counterparts. One way of achieving that is through allyship.

LGBTQIA+ allies are committed to actively advocating for and supporting people who are LGBTQIA+. 

They are social change agents. 

There are many ways to be an ally, whether in the clinic, the classroom or the research team.

Allyship in the clinic

To be an ally in the clinic, make it obvious, both physically and virtually, that your practice is LGBTQIA+ conscious. 

For example, you could display the pride flag in your clinic and/or on your website. 

Make all-gender bathrooms available or offer potential workarounds like single-stall bathrooms, which don’t need to be gendered. 

Use inclusive language, including when collecting demographics and pronouns for intake forms and documentation. 

Speak out when you hear someone misgendering or using the wrong name for someone else. 

It’s also important to ensure that disrobing is not a barrier to accessing healthcare. 

Be flexible in your approach when assessing and working with clients to build rapport, comfort and safety.

Being LGBTQIA+ conscious is a collective responsibility. 

Engage all staff in ongoing training and keep up to date through sources of news and information such as the APA LGBTQIA+ Facebook group.

Allyship in the classroom

Communication in the classroom should be inclusive. 

You can actively facilitate the inclusion of LGBTQIA+ students in discussions, particularly if they lack the confidence to contribute. 

You can also normalise the use of pronouns for both staff and students. 

Ensure that content relevant to LGBTQIA+ health is incorporated into teaching; for example, design a case study of an LGBTQIA+ patient where students evaluate their unique biopsychosocial needs.

Strategies for being a visible ally in the classroom to students who are LGBTQIA+ include highlighting and discussing significant days for the LGBTQIA+ community (eg, Trans Day of Visibility or Wear it Purple Day), calling out discriminatory or microaggressive behaviour towards LGBTQIA+ students or staff and wearing rainbow apparel (eg, ally badges, pronoun pins or rainbow lanyards).

Identify and accommodate any needs that LGBTQIA+ students may have regarding disrobing or the practice of physical examination or manual techniques in class.

Allyship in the research team

Within the research team, understand and celebrate the diversity of experience and perspectives that people who are LGBTQIA+ will bring to the team (including a history of discrimination, stigma and questioning). 

Advocate for inclusive data collection policies and protocols, following the Australian Bureau of Statistics’ 2020 Standard for Sex, Gender, Variations of Sex Characteristics and Sexual Orientation Variables. 

As in other settings, speak out when you hear misgendering (deadnaming and/or using the wrong pronouns) or discriminatory or exclusive language. 

Plan for and celebrate LGBTQIA+ days of significance in the lab.

Conclusions

LGBTQIA+ inclusive practices are relevant to all areas of physiotherapy and there are several key actions that anyone can take. 

First, be a visible ally. 

Outward-facing markers of allyship are important starting points that invite LGBTQIA+ people in before authentic connection can begin. 

Second, allyship happens 24/7. 

It does not end as soon as you leave the clinic, classroom or research team, which means calling out microaggressions when you witness them and it is safe to do so. 

Finally, participate in celebrations of LGBTQIA+ experiences and perspectives. 

Allyship is not just about advocating for and empowering our LGBTQIA+ patients, clients, students, colleagues and employees. 

It includes joining LGBTQIA+ folk in celebration.

>> Professor Julia Hush APAM (she/her) is an honorary professor in the Department of Health Sciences at Macquarie University, Sydney.

>> Dr Kelly Gray APAM (she/her) is a senior lecturer and course director of the Doctor of Physiotherapy program at Macquarie University.

>> Dr Megan Ross MACP (she/her) is an APA Research Physiotherapist, the chair of the APA’s LGBTQIA+ advisory panel and a postdoctoral research fellow at the University of Queensland.

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