Many healthcare organizations now recognize the need for LGBTQIA diversity training. However, surface discussion of explicit bias rarely shifts the needle on more insidious microaggressive environments, cultures and norms.

In “That’s So Gay! Microaggressions and the Lesbian, Gay, Bisexual and Transgender Community”, intersectional activist Dr. Kevin Nadal discusses the impact of microaggressions on the LGBT community. Nadal and others define microaggressions as:

“…brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial, gender, sexual-orientation, and religious slights and insults to the target person or group.”
(Dr. Derald Sue)

Microaggressions and LGBTQIA Health

Microaggressions can have a profound impact on the healthcare experience of an LGBTQIA-identified individual. Research published in the Journal of Bioethical Inquiry has identified four (4) of Nadal’s LGBT-specifc microaggressions as commonplace in health systems and consequential for LGBTQIA health.

  1. endorsement of heteronormative of gender normative culture and behaviors
  2. discomfort with or disapproval of LGB or transgender experience
  3. environmental microaggressions
  4. systemic microaggressions

The first two categories are rather self-explanatory: there’s more to sex than a penis and a vagina (heteronormative) and more to gender than a man and a woman (gender normative). The last two can be a bit more abstract and refer to “slights, insults, and invalidations communicated through the organization of space, printed materials, art, and other media,” as well as, “institutional organization and policy”.

Regardless of the source—healthcare provider, environment or institution—these biases have real consequences. Direct impacts on individual health (i.e., minority stress), as well as indirect impacts (e.g., healthcare avoidance), compound the vast array of health disparities seen in the LGBTQIA community.

Microaggressions and Diversity Training

The Good: Education and awareness can expand access to resources, reduce “unexpectedness” of LGBTQIA patients, and increase patient-centeredness. Training can also broaden understanding of discrimination and bias in healthcare.

The Not So Good: Challenging service providers who are passionate about their good intentions and lack of explicit biases can result in backlash and defensive posturing. Often, these providers are seen as the worst perpetrators of implicit microaggressions by their own LGBTQIA patients and are the most resistant to change. Additionally, ethicists assert that “brief training sessions cannot undo patters of perceiving, thinking and behaving.”

The Recommendation: LGBQIA diversity trainings should incorporate blameless language, stressing the ubiquitous nature of hetero and gender normative microagressions. A forward-thinking focus on personal responsibility and prevention can reduce stigma and raise collective action. Trainings should workshop a multi-systems approach that incorporates interpersonal, environmental, and systemic perspectives. Lastly, service providers should be encouraged to consider their own social context as an environment where microagressive behaviors might percolate.


Read more in the Journal of Bioethical Inquiry here:

You can learn more about the LGBTQIA diversity training services offered by QSPACES here: