Drawing on responses from 396 Pacific sexuality- and gender-diverse participants in the Manalagi Survey, researchers found that nearly one in five cisgender sexual minority respondents had avoided seeing a GP, clinic or hospital due to fear of discrimination. Among transgender and non-binary participants, the figure rose to more than one in four.
Race-based discrimination emerged as the strongest predictor of healthcare avoidance. Participants who reported being treated differently from Pākehā patients or experiencing ethnic microaggressions were significantly more likely to avoid services. Transgender and non-binary respondents were particularly affected, reporting an average of 2.18 discriminatory experiences, compared to 1.15 among cisgender sexual minority respondents.
The study found that for every additional discriminatory experience reported, the likelihood of avoiding healthcare increased by approximately 60 percent.
Discrimination was also linked to increased mental health service use. Nearly one in three cisgender sexual minority respondents and more than one in three transgender and non-binary respondents reported seeking mental health support in the past year. Experiences of race-based discrimination and having symptoms minimised were associated with significantly higher use of mental health services.
Pacific peoples make up an estimated 8.9 percent of Aotearoa New Zealand’s population and already experience poorer health outcomes compared to other ethnic groups. The study concludes that racism, alongside homophobia and transphobia, compounds barriers to care for Pacific Rainbow+ communities and calls for systemic change to ensure equitable and culturally safe healthcare.
The research was authored by Patrick Thomsen, Kyle Tan, Phylesha Brown-Acton, Sam Manuela, Dion Enari, Sisikula Sisifa, Sarah McLean-Orsborn, Roannie Ng Shiu and Zerlina Wong. The PMA Knowledge Hub in the Faculty of Medical and Health Sciences at Waipapa Taumata Rau, The University of Auckland, provided additional support to the Manalagi research team.