Saúde da população LGBTQIA+ no SUS: pesquisa inter(in)venção com usuários e profissionais da Atenção Primária

Abstract

Since 1990, Brazil has maintained a Unified Health System (SUS), in which Primary Health Care (PHC) constitutes one of the main entry points. PHC is responsible for providing healthcare within the territory, ensuring access without any exclusion on the basis of gender, race/ethnicity, sexual orientation, or gender identity. Nevertheless, the cisheteronormative matrix— that operates according to cisgender and heterosexual norms—constitutes the everyday practices of SUS. Against this backdrop, the research was guided by the following central question: what challenges and possibilities regarding healthcare for the LGBTQIA+ population are encountered in SUS’s primary care? The primary objective of this doctoral research was to analyze the challenges and possibilities concerning healthcare for the LGBTQIA+ population in SUS’s PHC. The specific objectives were: (i) to examine the experiences of LGBTQIA+ individuals seeking healthcare in PHC; (ii) to discuss the health needs of the LGBTQIA+ population and their articulations with the National Policy for Comprehensive Health of Lesbians, Gays, Bisexuals, Travestis, and Transsexuals (PNSILGBT); and (iii) to reflect on the impacts of PHC experiences on the health of LGBTQIA+ people, considering strategies for confronting the difficulties and challenges reported by participants, while engaging with the perspectives of both LGBTQIA+ individuals and PHC professionals. Methodologically, the study adopted a qualitative approach aligned with intervention research, grounded in subaltern feminist frameworks such as Black feminism and transfeminisms. The empirical field was constructed from the trajectories and experiences of LGBTQIA+ individuals in PHC in São Gonçalo do Amarante (Ceará, Brazil), as well as professionals working in primary care in the same municipality. Data collection involved semistructured interviews with ten (10) LGBTQIA+ individuals and a workshop with twenty-three (23) PHC professionals. The analysis articulated Psychology and gender studies with the field of collective health, dissident sexualities, cisheteronormativity, and intersectionality. Findingsreveal the presence of multiple expressions of LGBTQIA+phobia within PHC, including lack of welcoming, invisibilization of sexual orientations and/or gender identities, disrespect for social name and pronoun usage, and the persistent association of LGBTQIA+ people with HIV/AIDS. The main health demands identified included sexual and reproductive health, mental health, and issues related to gender transition processes. With regard to strategies for confronting LGBTQIA+phobia in PHC and addressing the challenges identified, the study highlights the importance of continuous professional education and training, guaranteed access and welcoming practices in Basic Health Units (UBS), effective implementation of the PNSILGBT, and educational initiatives in diferente spaces. The study concludes that health practices remain strongly structured by cisheteronormativity, which underscores the urgent need to challenge and transform the field of collective health. It is essential to dismantle practices of neglect toward LGBTQIA+ users, to create fissures in the everyday reproduction of cisheteronormativity within PHC, and to advance the effective realization of SUS principles in the care provided to this population.