Narrativas de trabalhadoras/es pertencentes a uma Unidade de Saúde da Família no cuidado em saúde de mulheres lésbicas e bissexuais na cidade de Manaus, Amazonas

Abstract

Throughout history, lesbian and bisexual sexual orientation has been permeated by resistance and prejudice that shape the experiences of these women in various social spheres, including the healthcare field. This context contributes to the erasure of their specific needs and the ineffectiveness of public policies targeting this population. It is therefore necessary to rethink the biomedical and heteronormative models that underpin healthcare and build more inclusive practices capable of recognizing the plurality of experiences and identities. Considering the transformative potential of Primary Care, especially within the scope of the Family Health Strategy, this study aimed to analyze the narratives of workers at a Family Health Unit about the care of lesbian and bisexual women. This is a qualitative study with an ethnographic approach, using participant observation and semi-structured interviews with 15 workers, including doctors, nurses, nursing technicians, social workers, and community health agents. The narrative analysis, guided by Schütze's contributions, was grounded in social constructionism and articulated with bisexual and lesbian-feminist epistemologies. From this, three analytical cores were constructed based on the empirical material: (1) Perceptions of health needs and demands; (2) Technical, ethical, and moral challenges in care; and (3) Educational trajectories and experiences sensitive to diversity. It was from the workers' narratives that the discourse of non-difference initially prevailed; however, this positioning did not remain throughout their statements, as the workers understood that lesbian/bisexual women suffer prejudice and discrimination, require better reception and differentiated sexual education, and that within the clinics, they are understood as subjects who mobilize reflections and new practices within the logic of care. In terms of difficulties, it is noticeable how lesbian/bisexual women are identified by workers in three ways: through their performances, portraying the lesbian as a masculinized subject and the bisexual as hypersexualized; through the disruptions and disruption of the heteronormative flow that these women bring to care dynamics, marked

by fear, denial, or discomfort during routine exams; and finally, through recognizing their same- sex families within their care areas. This recognition is not direct and has little influence on

comprehensive care planning. Despite these barriers, movements of openness, internal tensions, and partial recognition were also identified, pointing to the possibility of transformation in practices. It is concluded that health care for lesbian and bisexual women is still hampered by structural, symbolic, and formative limitations and will only be effective and qualified when workers problematize their discourses and recognize their leading role in building a truly equitable SUS. However, possibilities for shifts and resignifications in professional practices are also evident, indicating that the recognition of diversity, the expansion of training processes and the strengthening of public policies are possible and necessary paths.