(In)visibilidade no cuidado às mulheres lésbicas no Sistema Único de Saúde (SUS): o olhar de estudantes universitárias

Abstract

Despite the growing recognition of female homosexuality, significant gaps persist in the healthcare provided to lesbian women within the Unified Health System in Brazil, revealing fragilities in the reception and provision of comprehensive care for this population. Studies indicate that this invisibility stems from institutional and professional unpreparedness, culminating in deficient care, discrimination, and neglect of specific needs. This study aimed to analyze the experiences of lesbian university women regarding their care within Brazil's Unified Health System, seeking to understand the fragilities and potentialities of this care, propose recommendations for its improvement, and construct strategies to address the challenges. This is a descriptive, exploratory study with a qualitative approach, grounded in Serge Moscovici's Social Representation Theory. Participants included nine cisgender lesbian women, aged between 21 and 34, affiliated with public higher education institutions in Santa Catarina and users of Brazil's Unified Health System. Data collection occurred through semi-structured interviews, application of the Free Word Association Test, and a sociodemographic questionnaire. The data was subjected to Bardin's Content Analysis, specifically Thematic Categorical Analysis. The results revealed an ambivalence between gratitude for the existence of Brazil's Unified Health System and frustration with the deficiencies encountered. In the Free Word Association Test, "prejudice" was the most evoked word, followed by "access" and "unpreparedness," indicating that invisibility is interpreted as a consequence of structural discriminatory attitudes. Four thematic categories emerged: (1) Demands of lesbian women in Brazil's Unified Health System, highlighting heteronormative presumption, intersectional discrimination, and barriers to access; (2) Fragilities in care, emphasizing misinformation about safe sexual practices, professional unpreparedness, symbolic violence, inappropriate curiosity, and the absence of specific guidelines; (3) Potentialities, identifying generational renewal of professionals and increased academic visibility as signs of transformation; (4) Building a more inclusive Brazil's Unified Health System, with participant suggestions including continuous professional training, non-presumptive humanized care, creation of specific protocols, awareness campaigns, mental health attention, and inclusion of women with diverse gender expressions. Intersectional analysis revealed that Black lesbian women face additional barriers due to the overlay of racism and LGBTphobia. It was found that withdrawal from services due to fear of discrimination increases avoidable vulnerabilities. The research shows that the identified fragilities do not stem from the constitutional principles of Brazil's Unified Health System, but from their insufficient implementation. The construction of a more inclusive Brazil's Unified Health System for lesbian women constitutes an ethical and political imperative, essential for realizing the principles of universality, integrality, equity, and social participation that underpin the Brazilian public health system.