In regional Australia, access to gender transition related healthcare can be a major headache, but it's not just trans patients who encounter issues.
Teddy Cook, a team leader for regional outreach with an LGBTI health service, ACON, told SBS there were still real issues with gay, lesbian and bisexual health in regional Australia.
“I’ve heard reports of very homophobic doctors refusing STI screenings,” he said.
Historically, surveys have found that Australians in rural areas are more likely to be in the closet and are more guarded about their sexuality.
In tight-knit communities, some fear that being open with a doctor about their LGBTQIA+ status could lead to being outed.
"There are guys who don't even identify as gay who are having sex with men, and that can be isolating," Cook said. Such men who have sex with men - 'MSM' in sexual health jargon - may not be identifying with health messaging aimed at minorities.
When SBS asked one 'man who has sex with men' about his sexual health, he told us he'd never had an STI test. Most of the sex he has is safe, he told us.
"I don't have a personal doctor and in all honesty, I don't think our hospital even caters for STI checks," he said. "I wouldn't be surprised if I get sent all the way to Wagga Wagga."
Access to testing is available through any GP, Cook said, but promotion and education on sexual health can be limited. In small communities there can be actual or perceived confidentiality issues, and only some towns have dedicated sexual health clinics, he said.
But Cook says he doesn't want to paint too bleak a picture, things are improving.
"Nurses and doctors at regional sexual health clinics are absolutely committed to protecting confidentiality and are very dedicated to providing judgement-free, positive sexual health information, safe sex resources, testing and treatment," he said.
Mental health is another key issue. Studies have repeatedly shown that Indigenous and rural LGBTQIA+ Australian are at greater risk of self harm and suicide.
A 2010 survey of over 3,000 LGBTQ students found that nearly a quarter of rural participants had attempted suicide, compared to 15 per cent in urban areas.
The same study found that 37 per cent of rural participants had self harmed, compared to 28 per cent in urban areas.
"I used to hate myself pretty intensely, because of my sexuality, in my rural high school. I used to cut my thighs in an attempt to punish myself, inflict pain in anger," Paul, a gay 18-year-old told researchers.
"I was hospitalised after one very memorable day at school because events led me to decide enough was enough. I don't really like to talk about it so not many people know, even my close friends. I told them all I contracted glandular fever," he said.
Just as in cities, however, life is definitely getting easier for LGBTQIA+ Australians. SBS spoke to a number of adult trans women and gay men who live openly in regional areas and were encouraged by strong community support.
Some people experience problems, they admit, but many dispute the 'metronormativity' that says that rural people are closed minded on LGBTQIA+ issues.
"I don't think of myself as any different," a fifth generation farmer from a small town in central-west NSW told SBS.
"The whole town knows I prefer guys, no one cares, I'm just me."
To get tested, or just for a chat:
Find your nearest sexual health clinic here
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