Advancing LGBTQI+ Equity in Neurology

Understanding the disparate experiences and needs of the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual/gender minoritized (LGBTQI+) community is essential to ensure an inclusive environment for LGBTQI+ learners and colleagues and to provide equitable neurologic health care.Equity for LGBTQI+ neurologists and neurologic patients alike remains aspirational at a time when escalating anti-LGBTQI+ legislative and cultural climates are affecting the health of LGBTQI+ people.This is true across the United States and internationally.In line with the American Academy of Neurology's (AAN) mission to enhance member career fulfillment and promote brain health for all, the AAN is committed to supporting LGBTQI+ AAN members and to promoting equitable neurologic care for all LGBTQI+ people. Structural and Social Factors Affecting LGBTQI+ EquitySocial determinants of health, created by structural forces such as homophobia, transphobia, endosexism (structural erasure of intersex people), misogyny, white supremacy, and structural discrimination, produce the societal conditions and downstream effects, such as interpersonal discrimination, which drive disparities in neurologic health equity for LGBTQI+ people 1-5 and inequitable experiences for LGBTQI+ neurologists 6-10 (Figure 1).These structural forces determine differential access to resources that directly and indirectly affect health, such as housing, education, employment opportunities, patient autonomy, carceral liberation, and access to high-quality and affordable health care including gender-affirming care.They are present throughout the society and operate within the LGBTQI+ community as well.They create social stigma that affects the psychological and physical safety of LGBTQI+ learners and clinicians as they navigate the neurology workforce. Advancing LGBTQI+ Equity for Patients With Neurologic ConditionsMore individuals are openly identifying as part of the LGBTQI+ communities than ever before.According to a 2023 Gallup survey, approximately 7.6% of the United States population, or 25 million individuals, identify as LGBTQI+, including over 1 in 5 people in Generation Z. 11 This percentage has more than doubled since 2012, when Gallup first began to ask about sexual orientation and gender identity. 11BTQI+ people experience both disparate access to neurologic care and adverse outcomes in neurologic care.There are some areas of neurology in which these disparities have been