Challenges and inclusive practices for LGBTQIA2S+ scientists in the American Physiological Society

INTRODUCTION

Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and two spirit (LGBTQIA2S+), inclusive of gender nonbinary (GNB) and gender nonconforming (GNC) people (see definitions in Table 1), have historically been excluded in science, technology, engineering, mathematics, and medicine (STEMM) disciplines (3). Please note that the definitions in Table 1 are likely to vary according to the social, cultural, and political context and most closely reflect current Western cultural context. Recent studies have found that LGBTQIA2S+ scientists, at all levels, experience more harassment and negative influences on their STEMM career and retention (3, 4). These barriers are compounded by the lack of LGBTQIA2S+ demographic data from institutions and federal agencies [National Science Foundation (NSF)/National Institutes of Health (NIH)] (5). Concurrently, studies have demonstrated that diversity in research teams breeds creativity and enhances creative thinking, as well as problem solving (6), both of which are of critical importance in the STEMM workplace. The LGBTQIA2S+ population in the United States (US) is growing, with a recent US census survey estimating there to be at least 20 million LGBTQIA2S+ adults in the United States, living in every state, and comprising ∼8% of the US population (7). Importantly, the LGBTQIA2S+, GNB, and GNC communities are interwoven among all other communities, with LGBTQIA2S+, GNC, and GNB people found in all racial and ethnic groups, nationalities, religions, socioeconomic status, and disability status. Therefore, when we call for inclusion and equity of these communities in STEMM, it is inherent that we include LGBTQIA2S+ scientists, and especially those with intersectional identities from other communities marginalized from STEMM such as black, Latinx, and indigenous individuals. This editorial will seek to outline the importance of promoting inclusion of LGBTQIA2S+ individuals in professional societies and will outline potential actions that should be initiated.

Table 1.

Definitions within the LGBTQIA2S+ community

Glossary of Terms
Gay	A term used to describe boys/men who are attracted to boys/men but often used and embraced by people with other gender identities to describe their same-gender attractions and relationships. Often referred to as homosexual, although this term is no longer used by the majority of people with same-gender attractions.
Lesbian	A term used to describe women who are attracted to women: applies for cisgender and transgender women. Often referred to as homosexual, although this term is no longer used by the majority of women with same-gender attractions.
Bisexual	People who experience sexual, romantic, physical, or spiritual attraction to people of their same gender and toward another gender.
Man who is transgender	Someone who identifies as male but was assigned female sex at birth.
Woman who is transgender	Someone who identifies as female but was assigned male sex at birth.
Queer	Historically a derogatory term used against LGBTQIA+ people, it has been reclaimed by these communities. Queer is often used to represent all individuals who identify outside of other categories of sexual and gender identity. Queer may also be used by individuals who feel as though other sexual or gender identity labels do not adequately describe their experience.
Intersex	Individuals who were born with any of several sex characteristics, which can include chromosomes, gonads, or genitals that according to the Office of the United Nations High Commissioner for Human Rights, “do not fit typical binary notions of male or female bodies.”
Asexual	People who experience little to no sexual attraction toward another individual, regardless of gender identity or sexual orientation.
Two Spirit	“Two spirit” refers to an indigenous person, typically from North America, who identifies with a diverse range of sexualities and/or gender identities/expressions or spiritual identity and may encompass same-sex attraction and a wide variety of gender variance.
Gender Identity	A person’s inner sense of being a girl/woman, a boy/man, a combination of girl/woman and boy/man, or something else, or having no gender at all. Everyone has a gender identity.
Gender Nonbinary	A term used by some people who identify as a combination of woman and man, as something else, or as having no gender.
Gender Nonconforming	A term used by some people who identify and, in particular, express this identity outwardly, as a combination of woman and man, as neither, or as something else.
Sex	Context-dependent biological characteristics (chromosomes, gonads, external and internal genitalia, etc.) that exist on a spectrum of traits but are often reduce to a binary system of male and female. Synonymous with “sex assigned at birth.”

Adapted from Caceres et al. (1) and Streed et al. (2).

HIGHLIGHTING THE PROBLEMS: LACK OF INCLUSIVE SPACES AND SOCIETAL ACCEPTANCE

LGBTQIA2S+ individuals in STEMM programs have been demonstrated to drop out at higher rates than their cisgender-heterosexual peers, despite being more likely to report participating in undergraduate research programs, one of the leading factors enhancing STEMM student retention (8, 9). Moreover, a significant predictor of student retention is sense of belonging (8). Creating inclusive environments for LGBTQIA2S+ individuals to foster sense of belonging is a necessary yet challenging task due to many factors. A recent social climate survey of US adults found that although the majority of adults believe LGBTQIA2S+ individuals should have legal protections for civil rights, 54% of surveyed individuals strongly or somewhat agreed with the statement “LGBTQ people make expectations about gender and how to interact very complicated” (10). In addition, 29% of people reported they would be “very or somewhat uncomfortable learning a family member is LGBTQ,” and 25% reported they would be “very or somewhat uncomfortable seeing a gay/lesbian coworker’s wedding picture.” These statistics highlight that although a slight majority of people believe LGBTQIA+ individuals have rights, they may not be willing to foster welcoming academic and professional environments in STEMM to create inclusive spaces for student career development and employee retention.

A CALL TO PROMOTE LGBTQIA2S+ INCLUSION IN THE AMERICAN PHYSIOLOGICAL SOCIETY

Although LGBTQIA2S+ individuals have been historically excluded from academia and STEMM, a good place to enhance the inclusion of LGBTQIA2S+ individuals in STEMM is in academic professional societies. The American Physiological Society (APS), which comprises ∼10,000 members (11), is the largest society in North America for those who study physiology, the scientific study of biological function. Professional societies like APS are focused on the connectedness of their membership providing opportunities to integrate scientists with historically marginalized identities into the field. Although in recent years diversity, equity, and inclusion efforts by the society have yielded an increase in the number of cisgender women, Black, Latinx, and other scientists of color joining and holding leadership and committee positions within the society. For example, more cisgender women have held the office of president in the 21st century than in the entire 20th century. Despite these advances, there has been a lack of data collected on how LGBTQIA2S+ are represented within society leadership and committees and within the membership at large. More encouraging progress has been made recently with respect to inclusion of LGBTQIA2S+ individuals, in particular with the recently established APS Charles J. Bates Memorial Award for LGBTQIA2S+ scholars, in remembrance of a member’s nonbinary child, to support APS members from the LGBTQIA2S+ community.

In academic environments, high-quality interactions between students and their faculty lead to greater student retention and sense of belonging (12). As such, it should follow that inclusion and sense of belonging in academic professional societies, which begins with undergraduate and graduate student members, will be enhanced by the internal promotion of senior LGBTQIA2S+ members to visible leadership roles. Moreover, to better understand the internal demographics of the society, APS should seek to collect data on how its members identify, as currently, no data exist on the LGBTQIA2S+ identities within APS. Collecting such data would facilitate opportunities for internal professional networking among its LGBTQIA2S+ membership, potentially enhancing sense of belonging through direct-paired mentorship programs where senior LGBTQIA2S+ members can play supportive roles for junior members. The need for these workshops and discussions is high, as historically the LGBTQIA2S+ community has lower health outcomes due to a lack of understanding of their unique health needs due to low access to and biases within healthcare and from exclusion in clinical trial demographics (1, 13).

A CALL TO ACTION AS A WAY TO MOVE FORWARD

In an attempt to create safe spaces that foster diverse and creative thinking and the open inclusion of LGBTQIA2S+ individuals, we propose the following list of action items.

1. A set of policy implementations for the protection of individuals according to sexual orientation and gender identity.

   • APS Code of Conduct: While existing language outlines on harassment encompasses offensive, demeaning, or discriminatory behaviors based on sexual orientation, gender identity, and gender expression, APS should expand upon this clause to include a reporting mechanism for harassment in keeping with the precedent set by the National Institutes of Health and National Science Foundation, to include APS-funded research and other internal programs, and discussion regarding retaliation and society actions to be taken to protect victims of harassment.
   • Community-centered unconscious bias training: mandatory for anyone serving APS in a reviewer capacity for award abstracts, serving on committees, or elected to leadership positions at APS, as well as all APS staff. Unconscious bias training should also be available for all APS members. In addition, the training can be concomitant with gender equity training and training aimed at reducing conscious and unconscious biases surrounding race and ethnicity.
   • Collection of identity data: the systematic collection of data on individuals gender identities, pronouns, and gender-neutral titles. Surveys can be used to understand the identities of the membership for purposes of name badges at meetings. Importantly, gender-neutral options should be available including “Mx.” Alongside gendered titles like “Mr., Mrs., or Ms,” an option of “other” should not be used as it quite literally othering individuals identifying as outside the gender binary (GNB and GNC).
   • Sensitivity to Asian, African, Pacific Islander, and Indigenous American cultural constructs of gender: the social construction of gender and sexuality in the United States, Canadian, and European cultures is not compatible with many other cultures. In an effort to decolonize gender and science, the society, a global institution, should also endeavor to be inclusive of gender identities outside of our Westernized view of gender and sexuality. Members may be from those global regions or from indigenous cultures that have a range of identities for sexuality, gender, or other designations for nonbinary and transgender individuals.
2. Research-based efforts to enhance equity and inclusion of LGBTQIA2S+ individuals.

   • Research-oriented seminars and workshops aimed to enhance scientists’ understanding of how to design appropriate preclinical studies with animal models and inclusive practices for human and clinical studies regarding sexual orientation and gender identity. These activities should highlight the need to produce science that improves the lives of community members and not the etiology of these identities, which can be used to justify eugenists practices against the community.
   • In particular, seminars on and funding for research that supports actions being challenged by anti-LGBTQ groups, such as the safe use of puberty blockers and hormone-affirming therapy for transgender youth (14).
3. Educational efforts for equity by the teaching section and affiliates therein of APS.

   • The teaching section of APS stands to play an influential role in the way medical physiology and pathophysiology are taught in both undergraduate and medical school curricula in the United States. As such, there should be research and curricular design efforts by these members to include knowledge on the health of LGBTQIA2S+ populations in modern premedical and medical education. The proper education of future clinicians regarding the specific needs of these populations will reduce health disparities that currently exist and combat bias in the healthcare field.
   • The teaching section of APS in conjunction with the broader APS community stands to play a larger role in public education and health literacy of laypersons, particularly through community outreach efforts to enhance societal acceptance and understanding of the LGBTQIA2S+ community. Local community outreach efforts by members are more likely to reach small communities normally outside of the range of broad APS communications.

CONCLUSIONS AND SUMMARY

APS stands to play a significant role in promoting belonging, dignity, and equity in STEMM and in the next generation of physiologists by creating inclusive spaces for the community, facilitating networking of LGBTQIA2S+ scientists, and developing fair and equitable policies for internal governing affairs. The vocal and visible inclusion and celebration of LGBTQIA2S+ individuals in the APS community can help to enhance the community for all members and, as such, should become a high-priority item for APS leadership. As such, we the authors hope this editorial begins the conversation about helping and that we can use this as a jumpstart for actions that get us to inclusivity and equity.

GRANTS

J.D.M. reports support from National Heart, Lung, and Blood Institute Grant T32 HL007224-45. T.A.R. is supported by National Institute of Health Grants R01MH123544 and P30ES005022 and United States Department of Agriculture–National Institute of Food and Agriculture Grant NJ06195. M.L.B. is supported by National Cancer Institute Grant 1R01CA244271 and American Cancer Society Grant RSG-20-017-01-CCE.

DISCLOSURES

No conflicts of interest, financial or otherwise, are declared by the authors.

AUTHOR CONTRIBUTIONS

J.D.M., M.L.B., and T.A.R. drafted manuscript; J.D.M., M.L.B., and T.A.R. edited and revised manuscript; J.D.M., M.L.B., and T.A.R. approved final version of manuscript.