At-Risk Substance Use Among Trans and Gender Diverse Adults in Australia: Findings From the Private Lives 3 Survey

Trans and gender diverse (trans) people face substantial health and social inequities, yet limited data exist regarding substance use patterns among this population in Australia.

Data were sourced from Private Lives 3, a large national survey of LGBTQ+ adults residing in Australia. Trans participants self-reported sociodemographic characteristics, experiences of discrimination, harassment, violence or exclusion, perceived acceptance and affirmation, psychological distress, sexual assault history and substance use behaviours. Multivariable regression analyses identified factors associated with potentially problematic illicit drug use (DAST-10 ≥ 3), potentially hazardous drinking (AUDIT-C ≥ 3), and daily smoking of cigarettes or other tobacco products.

Of 1506 trans participants, 23.7% screened positive for potentially problematic illicit drug use, 49.8% for potentially hazardous alcohol use and 8.5% smoked daily. Potentially problematic illicit drug use was associated with unstable housing (aPR = 1.44, p = 0.001), psychological distress (aPR = 1.39, p = 0.022) and sexual assault history (aPR = 1.51, p = 0.001). Potentially hazardous alcohol use was less prevalent among those with affirming partners (aPR = 0.81, p = 0.001) and asexual identity (aPR = 0.65, p = 0.016), but more prevalent among those with a sexual assault history (aPR = 1.17, p = 0.012). Daily smoking was associated with unstable housing (aPR = 1.82, p = 0.002) and sexual assault history (aPR = 2.09, p = 0.002).

At-risk substance use among Australian trans adults was most associated with sexual assault and unstable housing, but not gender identity, perceived acceptance, or most experiences of discrimination, harassment, violence, or exclusion. These findings differ from many US studies and may reflect regional sociocultural, legal or healthcare differences, or unmeasured determinants. These findings highlight the need for routine substance-use screening, trauma-informed care, and housing and sexual assault support initiatives for trans Australians.