Acesso da comunidade LGBTQIA+ às Unidades de Atenção Primária à Saúde do município de Fortaleza-Ce: uma análise da perspectiva dos usuários LGBTQIA+

Abstract

Introduction: Inequities in access to the Unified Health System (SUS) by the LGBTQIA+ population within the scope of Primary Health Care (PHC) constitute a serious and persistent problem. SUS, based on the principles of equity, universality, and integrality, aims to reduce inequalities and meet health needs comprehensively. However, the specific demands of the LGBTQIA+ population still face significant barriers in accessing services, reflecting discrimination, prejudice, and insufficient implementation of public policies, such as the National Policy for Comprehensive Health of the LGBT Population (PNSI LGBT). This policy aims to reduce historical inequalities in healthcare for the LGBTQIA+ population, but its implementation remains limited. Objective: To analyze how access barriers, especially those related to LGBTphobia, influence the quality of access for LGBTQIA+ individuals in Primary Health Units (UAPS) in the city of Fortaleza, Ceará. Methodological Approach: This qualitative study was conducted in Fortaleza, Ceará, with 21 LGBTQIA+ service users aged over 18 years, identified through social media and LGBTQIA+ social movements. In-depth interviews were conducted between July and August 2024, and data were analyzed using the thematic content analysis method. The interpretation of findings was enriched by dialogue with the concepts of Pierre Bourdieu and Judith Butler. Bourdieu's concept of symbolic violence was employed to understand how cisheteronormative practices and norms normalize inequalities and exclusions in health services. Butler’s perspective contributed with the concepts of gender performativity and gender intelligibility, which helped interpret how social norms shape experiences of exclusion and inclusion faced by the LGBTQIA+ population in Primary Health Units (UAPS). The study was approved by the Research Ethics Committee of the Federal University of Ceará, as per opinion number 6,934,406 and CAAE 80146424.1.0000.5054. Presentation of findings: The findings of this study indicate that access barriers, such as prejudice and discrimination, are still prevalent, particularly for trans and travesti individuals, who report fears of disrespect when seeking care in PHC. Nevertheless, some improvements were noted, such as respect for the use of social names, driven by state legislation enacted after 2019. The association between the LGBTQIA+ population and sexually transmitted infections (STIs) remains strong, perpetuating stigmas and constraining users. Additionally, the lack of professional preparation to address the specific needs of the LGBTQIA+ population reinforces the avoidance of public health services in favor of private providers. Professional qualification, from academic training to continuing education, humanized care, and more effective and efficient legislation are critical to overcoming these barriers and implementing existing policies. Final considerations: Despite progress, PHC settings remain spaces of vulnerability for the LGBTQIA+ population, where prejudice and discrimination persist. This research underscores the importance of strengthening inclusive public policies and consolidating actions that promote inclusion, equity, and respect in health services. This study contributes to the scientific debate and the development of strategies that realize the principles of SUS in addressing the health of the LGBTQIA+ population.