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Pride Month is an opportunity to celebrate the people and the history of the LGBTQ+ community. During June, we can also reflect on persisting inequities faced by LGBTQ+ populations worldwide. With this in mind, I’d love to take a moment to consider the intersection between antimicrobial resistance and LGBTQ+ health. 

For decades, public health has been interested in how social determinants influence health inequities. Countless studies have investigated how individual, socioeconomic, cultural, environmental, and other conditions affect the health outcomes of populations. However, research on the social determinants of antimicrobial resistance (AMR) is still a relatively new field.  

A 2024 from the European Observatory summarized our current understanding of AMR’s socioeconomic drivers. For example, populations living in overcrowded environments or areas with poor water, sanitation, and hygiene infrastructure have an increased risk of AMR. Poor access to healthcare can contribute to inappropriate use of antimicrobials. Researchers have also noticed gendered differences in occupational exposure to AMR and antimicrobial prescription rates. The report outlines several other drivers as well, from education level to climate change and pollution. 

Sexual orientation is an important social determinant of health, though its relationship with AMR is not explored in this European Observatory brief. This omission seems like a bit of an oversight. Research indicates that LGBTQ+ people experience and tend to have . Higher burdens of these social determinants of AMR gives at least a theoretical foundation to mention a potential link. Some epidemiological studies – in the and the , for example – have also reported higher rates of resistant infections among men who have sex with men.  

There’s good reason to investigate sexual orientation as a social determinant of AMR. Why, then, is the literature on this topic so sparce? 

Well, most AMR surveillance data doesn’t track social factors at all. According to the 2024 Tracking Antimicrobial Resistance Country Self-assessment Survey (), only 28% of countries disaggregate their AMR data by factors including sex, geographic location, and income. But an affirmative response to this question doesn’t guarantee disaggregation by every social variable; the percentage of countries disaggregating by gender and sexual orientation is likely lower than 28%. 

This paucity of data is hardly unique to AMR research. Most routine health data fails to monitor sexual orientation and gender identity, according to a recent of social determinants of LGBTQ+ health. As a result, health disparities faced by LGBTQ+ people might be overlooked or underestimated. This data blind spot hinders our ability to understand the full range of social determinants of health and address health disparities – in AMR and beyond.   

So, what’s to be done about this lack of research? The first step is awareness. We should ask why studies might not account for sexual orientation. Researchers, after all, are expected to justify their inclusion or exclusion of other social variables in their models. Why should we gloss over the omission of sexual orientation? Granted, the answer to this question will almost certainly be “we don’t have the data.” But a clamor of researchers pointing out this gap can help shift norms and spur changes in surveillance methods.  

Policy documents also have an important role to play. Explicit calls to explore and address AMR among LGBTQ+ populations can help raise the profile of this issue, spurring improved surveillance and research. Many high-level AMR policy documents – including the , the , the , and the – make calls for health equity in national and global AMR responses. However, LGBTQ+ populations are not referenced in any of these documents, nor do they call for improved surveillance of sexual orientation as a social determinant of health. 

It’s important to note that LGBTQ+ populations are not a monolith, and that the considerations around collecting data on sexual orientation will vary dramatically on a global scale. As we push for improved surveillance, we must do so in collaboration with LGBTQ+ people to ensure that data collection is safe and culturally sensitive. But hopefully, by working from the top-down and the bottom-up, we can expand our understanding of LGBTQ+ health disparities, to improve our response to AMR and other issues.