This section was informed by conversations with LGBTQI+ people who use substances and kaimahi who support them in 2023.
The term "LGBTQI+" and the umbrella term "Rainbow communities" encompass a wide range of sexual orientations, gender identities, and culturally specific identities such as Takatāpui or MVPFAFF. MVPFAFF is an acronym that describes Pasifika gender and cultural identities, such as Mahi, Vaka sa lewa lewa, Palopa, Fa‘afafine, Akava‘ine, Fakaleiti, and Fakafifine. People in these communities may identify with multiple aspects of the rainbow and experience changes in their identity over time. Each group within the umbrella has distinct needs that often overlap with characteristics like age, class, ethnicity, and cultural background.
Rainbow communities often gather in spaces centered around alcohol and other drug consumption, offering pleasure, community, and relief from shame, stigma, and discrimination. Research has primarily focused on cisgender gay and bisexual men, but studies on other parts of the Rainbow community are emerging.
Key considerations:
- Understand a person’s individual context and provide relevant harm reduction information and support. Not everyone who is LGBTQI+ uses substances, but there is a higher prevalence of both substance use (frequency and amount) and substance-related harms experienced by people in LGBTQI+ communities.
- Many Rainbow-specific social spaces revolve around alcohol and other drug use. Navigating how to feel connected to community while making changes to substance use can be a complicated balancing act.
- Recognise that LGBTQI+ communities have unique experiences and challenges. For example, every time someone meets a new person, they decide whether they ‘come out’ (disclose their sexual orientation) or not. Some people may find this process easy, and others may find it difficult or distressing. Services that can provide relatable information and support for this community are essential and should complement mainstream health and social services.
- Harm reduction conversations about substance use may be more likely to happen in sexual health services, as these are often seen as safe and trusted spaces within Rainbow communities (especially for gay, bisexual, and other men who have sex with men). This is particularly relevant when someone engages in sexualised drug use.
- For some Rainbow people, their alcohol and other drug use can be tied into explorations of sexual intimacy and identity.
- Due to stigma, Rainbow communities may experience anticipated or internalised stigma. Services that work with these communities should actively counteract that by acknowledging sexual identity and diversity as an important part of someone’s identity and experience.
- In some alcohol and other drug services, explicit rules against being able to discuss sex or sexuality-related topics in group settings may prevent Rainbow service users from being able to discuss the context of their experiences.
- Be open-minded without assumptions, even if someone says they identify as heterosexual. Some people may not identify as LGBTQI+, but still feel attracted to or engage in sexual activity with the same sex for other reasons (including sex work). Sometimes, this might occur while they are under the influence of a substance. Some people may use substances to help them express their sexuality or sexual desires.
- Work with your service to have a good understanding of LGBTQI+ people and how to support them. Make it clear that your service is a safe space through displays, such as LGBTQI+ posters or Rainbow flags. Make sure toilets are accessible for people who are not cis-gendered.