Dr Adam Bourne is Associate Professor of Public Health and Deputy Director of the Australian Research Centre in Sex, Health & Society at La Trobe University. He lead a large program of research on LGTBIQ+ health and wellbeing, including studies of AOD use among this population.

Background
Research commonly observes higher rates of drug use among lesbian, gay, bisexual, trans or gender diverse, queer-identifying or asexual (LGBTQA+) communities compared to heterosexual and/or cisgender counterparts. However, higher rates of use do not necessarily equate to a problematic experience. Considerably less research has been conducted among LGBTQA+ youth or about patterns of harm reduction service engagement or preference.

Methods
A cross-sectional survey was conducted involving 6,418 LGBTQA+ participants aged 14-21, 5,914 of whom provided information relating to use of illicit drugs. Multivariable logistic regressions examined demographic factors and life experiences associated with drug use in the past six months and lifetime experiences of self-reported reported concern with drug use.

Results
Overall, 26.44% of participants aged 14-17 and 41.92% aged 18-21 reported any drug use in the past six months. Of these, 23.48% had been concerned about their own drug use, while 29.1% reported their family members/friends had expressed concern about their use. Higher odds of drug use were reported among cisgender men and those who had experienced homelessness or sexual harassment, with lower odds among those asexual. Higher odds of self-identified concern about drug use were observed among participants reporting experiences of physical or sexual harassment and those with higher levels of psychological distress. Higher odds of concern expressed by others were observed among 18-21-year-olds and cisgender men. Among those expressing concern, only 11.8% had accessed professional support. When asked of their preference for future service use, most indicated a service that is accredited as LGBTIQA+-inclusive or one that’s LGBTIQ-specific.

Discussion
High levels of self-perceived problematic experience with drugs among LGBTQA+ young people are accompanied by low levels of engagement with harm reduction services. A range of homophobic/transphobic experiences continue to shape drug use practices and, in this context, provision of accredited LGBTIQA+-inclusive harm reduction services is warranted.