O acolhimento na atenção básica: repertórios de violências de acesso perpetradas à população LGBTQIA+ e aos trabalhadores da saúde

Abstract

This research investigates the challenges faced by Family Health Strategy (ESF) teams in providing care to the LGBTQIA+ population in Primary Healthcare Units (UBS) in Juiz de Fora, within the context of the Brazilian Unified Health System (SUS). The study, qualitative and exploratory in nature, employs a methodology inspired by ethnography, taking as its epistemic and methodological bases the (auto)bixar-grafia, as proposed by Tales/Tallýz Mann Pereira, and situated knowledges in the perspective of Donna Haraway. The discussion also adopts Favero’s “dirty psychology” and pajubariana ethics, bringing to light the subjectivities of both the interviewees and the researcher. The perspectives of critical and intersectional psychology, as developed by Nogueira and Butler, provide theoretical support for deepening the debate. The central focus lies on how structural and cultural forms of violence that affect Brazilian public healthcare directly impact the quality of care and, consequently, the access of the LGBTQIA+ population to health services. The precarization of SUS, aggravated by underfunding and political denialism, undermines the quality of Primary Care (AB) and hinders the effective implementation of equitable health policies, such as the National Humanization Policy for Care and Management in the Unified Health System (PNH) and the National Policy for Comprehensive Health of Lesbians, Gays, Travestis, and Transsexuals (PNSILGBT). The analysis is based on interviews with healthcare professionals from UBSs, examining how these challenges interfere with the welcoming and support offered to the LGBTQIA+ population, considered vulnerable due to multiple forms of violence that operate both at the individual and institutional levels. In addition, this work incorporates a critical reflection on the role of the researcher in the production of knowledge, employing methodologies and theoretical frameworks drawn from queer theories that articulate personal experiences with the investigative process. This epistemological construction is informed by these methodologies, valuing the production of knowledge from references that intersect LGBTQIA+ subjectivities. The study also employs Foucauldian discourse analysis to understand how norms and regimes of power are reproduced or contested in the daily practices of healthcare. The findings of this research show that LGBTQIA+ people in Juiz de Fora continue to face barriers in accessing healthcare, marked by prejudice, inequality, and the absence of updated policies. The study also identified the precarization of working conditions among healthcare teams, which directly impacts the care provided. On the other hand, practices of welcoming and reception proved to be powerful pathways for resistance and transformation in the everyday life of healthcare services.