LGBTfobia no contexto da Saúde

Hinzugefügt: 2026-05-26

[00:00:03][music] [music] [music] [music] [music] [music] [bell] Good afternoon everyone. It is with great satisfaction that we begin the web lecture "LGBTphobia in the context of health," promoted by the State Health Secretariat in partnership with Nutel UFMG, in reference to the International Day Against LGBTphobia, celebrated on May 17th. The activity aims to reinforce the importance of continuing education, promoting equity, and confronting institutional LGBT phobia within the Brazilian Unified Health System (SUS).

[00:01:29]Recognizing that access to healthcare with care, respect, and dignity is a right for everyone. We are also pleased to have members here from the Minas Gerais state technical committee for comprehensive health of the LGBT population, a space that is fundamental for collective construction and social participation. We are immensely grateful for the presence of everyone who is watching the broadcast, and especially to our guests Fernanda Coelho and Raul Capestrano, who today shared such necessary reflections for strengthening healthcare. And so, to begin our activity, we will also start with Fernanda Coelho, a bisexual feminist cis activist from the B collective, a collective of bisexual, lesbian, trans, and SIS women, a state health councilor in Minas Gerais, the main representative of bisexual women on the technical committee for the comprehensive health of the LGBT population in Minas Gerais, a member of the Technical Committee for the Comprehensive Health of the LGBT population, and also from the Ministry of Health.

[00:02:31]Fernanda. So, she will address the issue of biophobia in the context of health, especially the invisibility and specific experiences faced by the bisexual population in public services and policies. Fernanda, good afternoon. I appreciate the opportunity to be here once again. I previously participated in another webinar on this channel, which is very important. So, I've already been introduced. I'm going to talk to you today about a very specific and little-explored aspect, which is related to biphobia, when we talk about it in the context of LGBTphobia, and we're in an important month for combating LGBTphobia, and Raul, who will come later, will talk about this experience in relation to bodies involved in accidents. I made a presentation, if you could put it on the screen.

[00:03:24]Thanks.

[00:03:25]Okay, so I'm going to share some points about biphobic violence in Brazil. And to begin this speech, I wanted to start by saying that, unfortunately, in Brazil bisexual people are still killed for being who they are. And we have a day of struggle, which is April 16th, the day of struggle for justice and against misogynistic biphobia, which commemorates a very significant biphobic femicide, the femicide of Jciane Pereira Araújo, a young woman who died at age 25 in 2014 in Teresina, Piauí.

[00:04:09]This crime shocked the local population, both because of its cruelty and the way the body was found, which I won't describe here. If you want to search, you can find information about this on the internet, but with the specific mark of hate crimes, which is both violence against the body, and also the necessary mark that the perpetrator wants to leave to show that this crime is related to the victim's sexual orientation.

[00:04:49]So, the way her body was left, it very clearly indicated that her bisexuality was a determining factor in that crime. Despite it happening in 2014, no one has been punished for it yet.

[00:05:06]The jury trial never even took place.

[00:05:09]Another emblematic case that happened much earlier, which was certainly the most significant LGBT-phobic crime against parliamentarians that we have observed in Brazil, was the case of councilman Renildo José dos Santos. He was a city councilor in Coqueiro Seco, Alagoas.

[00:05:29]In 1993 he said on a local radio station that he was bisexual. After that, he was removed from his duties. He was kidnapped, he was killed, and again the violence with which his body was afflicted makes it clear that, although it was a political crime and the political context also influenced Renildo's death, it is very possible that the bisexual sexual orientation described by Renildo was a determining factor in the context of that crime.

[00:06:06]And the violence against parliamentarians, it remains very strong, merely as an attitude, as an example. Recently, we've seen a wave of Brazilian female parliamentarians suffering death threats and corrective rape threats, among them many bisexual parliamentarians, one of them from Minas Gerais, councilwoman Isa Lourença.

[00:06:32]And we often hear that Brazil is the country that kills the most LGBT people.

[00:06:39]I can't say whether this data is correct or not, but many of these studies have their own methodology that looks not at data from death certificates or public security, which are very poorly collected, but at news reports published in the media regarding these deaths. And here I bring a study that is quite relevant in relation to indicators of deaths and violence against the LGBTI population in Brazil, which is the LGBTI Deaths Observatory, but to say that sometimes the researcher's perspective makes this research biased, because, for example, in a report on violent deaths from this observatory in 2023, they said that, just like in 2022, no deaths of bisexual people had been recorded in 2023, but when we did a quick Google search, we did find deaths in that period covered by the research that identified those people as bisexual.

[00:07:48]It's important to say that absexuality is often made invisible, it 's erased, but sometimes the bias of the researcher themselves prevents the proper collection of data.

[00:08:03]And sometimes when we think of people who are role models in the LGBT struggle in Brazil, we think that these people are also exempt from reproducing biphobia, but that's not true. And here, using the methodology from the previous research, I present a newspaper clipping that reports, for example, a situation of domestic violence where the aggressor was a lesbian woman. The president of the commission on emotional and sexual rights in Moab, in the south of the country, who was convicted of domestic violence against her bisexual ex-girlfriend. That being said, we have health policies that take into account the existence of biphobia, often denied socially, because there is exhaustive scientific evidence and data that corroborates this, showing its existence in our daily lives beyond our practical experience. And we have both in our national policy for comprehensive LGBT health, as well as in the state policy of Minas Gerais, specifically stated as a guideline or a specific objective, that the fight against biphobia, as it is called, must be observed in this health policy.

[00:09:26]And I said that this isn't the first time I've spoken on this channel. Here's an image from 2021, where Rafa Vira and I, along with Ana Cecília Amorim, were able to discuss the holistic health of bisexual people. The topic of the class was the holistic health of bisexual people. What kind of health are we talking about? It's available, right, on the Telehealth Center of Minas Gerais' channel at UFMG. And in it we talk in more detail about specific aspects of health. It's still relevant today, so I'm not going to go back to what we discussed in that class. I will leave from the next moment. And the next moment is, for example, that a year later the Federal Council of Psychology, considering the violations of rights perpetrated also in the context of mental health care, based on a provocation made by the organized social movement, published a resolution, resolution number 8 of 2022, which guides the proper care of bisexual and non- monosexual people, because even today we find mental health professionals practicing sexual orientation conversion therapies. And when these [strategies] are directed at bisexual people, they not only try to steer these people and convert them to heterosexuality, but in other cases, they also try to convert these people and steer them towards lesbianism or towards an identity that, because it starts from the assumption that this person can be anything but bisexual, or in other cases, based on stereotypes attached to bisexuality— confusion, promiscuity, instability, absexuality— ends up being disregarded as a legitimate expression of sexuality and is read as a symptom of a disease, so that there are greater tendencies to diagnose bisexual people as having borderline personality disorder or bipolar disorder based on these premises and not necessarily because it is the correct diagnosis in that specific case. This resolution is very important, including in trying to stop new forms of sexual reorientation that have been promoted, such as, for example, more recently by some professionals in psychology and psychiatry, subcategorizing obsessive-compulsive disorder as a matter of sexual orientation, in an evident pathologization of bisexuality.

[00:12:05]Okay, now I'll move on to the definition of bisexuality.

[00:12:08]Globally, the most commonly used definitions of bisexuality are that it refers to attraction to more than one gender or attraction to similar and different genders. In Brazilian terms, these are people for whom gender is not a determining factor in attraction. Whatever it is, it's based on that old saying about people who like people. It's important to say that this is a sexual orientation that allows for fluidity. It doesn't mean that a person will like half of one gender, half of another, or 1/3 of one gender, 1/3 of another, and another third of non- binary genders; there doesn't have to be a standardization, there's no rule.

[00:12:48]Simply by not directing their affection towards a single gender, a person can be described as bisexual, which is precisely the sexual orientation that breaks with the idea of ​​binary sexual orientations.

[00:13:02]And I need to bring up the category of monosexism.

[00:13:06]We call monosexism the social structure in which it is assumed that all people are monosexual, right? right? In other words, they are attracted to only one gender, considering homosexuality as natural and the norm, and absexuality as an invalid, nonexistent, illegitimate, or less valuable identity than lesbian, gay, and heterosexual identities. And biphobia is precisely what reverberates from this monosexism. It is precisely the manifestation of monosexism in our social, institutional, and interpersonal practices, through this everyday discrimination, ranging from payment, invalidation, exclusion, hostility, stigmatization, symbolic or institutional violence.

[00:13:56]And speaking of institutional violence, I bring you an example of the erasure of bisexuality in healthcare systems. In this slide, I'm showing the PrEP dashboard from the Ministry of Health, specifically a section with data about people using PrEP. If we look more closely, we can see that there's a section where they present data on PrEP users by population, and there they identify people as gay and other MSM, those genders. MSM are men who have sex with men, who make up almost the vast majority of people who access prep school, including cisgender heterosexual men, followed by cisgender women, transgender women, and other gender identities. First, we observe that female identities here are not defined solely by sexual orientation. Regarding men, trans men also do not have their sexual orientation reported, only men with gender. But even regarding genders, we observe that when we think of an acronym, right, LGBT, LGBT+, LGBTQI+, LGBTQI, APN, etc., the only sexual orientation that appears in all these acronyms that is erased in this system is bisexuality. Because we know about gay men, we know about heterosexual men, but we don't know about these MSM, which is a category used in public health. We understand your need, but we don't know how many of these men are bisexual. And this erasure is curious because if we look back to the beginning of the AIDS epidemic, we remember that sexually transmitted men were often pointed to as vectors of the disease, as the bridge that carried this ghettoized disease to Brazilian homes. Here I include a newspaper clipping to illustrate how intense and serious it was. This is a newspaper clipping showing a billboard erected in the south of the country in the 1980s with the words in large letters: "Attention bisexuals, make your choice." She or he is not the transmitter of AIDS. And it's curious that in the 80s and 90s, bisexuals were singled out to be stigmatized and blamed for an epidemic that wasn't their responsibility. In 2026, we see a system that talks about PrEP, that specifically addresses the need for HIV transmission prevention, and it names bisexuality, perpetuating this pattern and this biphobic stigma that we can't overcome even when we talk about this specificity. But this stereotype of the ST vector transcends bisexual men and also applies to bisexual women.

[00:17:03]Here I present a booklet that was created by the Ministry of Health some years ago, discussing lesbian and bisexual women in social control and health.

[00:17:14]And it's a very beautiful booklet, a very affectionate booklet, a very interesting booklet that was built with social participation, but it's a booklet that states in a certain passage, which I highlight here for you, that lesbian women should only think about preventing sex with other women if they are having sex with bisexual women. And to summarize, that's what it says in this excerpt that you can read on the screen and that I've highlighted.

[00:17:46]This is quite problematic because it goes against scientific evidence, places blame and responsibility on only one segment, and perpetuates biphobia at a time when it shouldn't be happening, with the endorsement of the Ministry of Health. And it's worth mentioning that bisexual people, bisexual women, have been building and shaping health policy from the very beginning. That's why there's even talk of biphobia in national politics, but at times this representation is discontinued.

[00:18:16]And when it is discontinued, it's important to say that sometimes in a meeting that we fail to attend, in a space that we fail to observe, years of work are lost, and we see systems like PrEP being implemented without the sexual orientation category. We see a booklet from the Ministry of Health that was supposed to celebrate the social participation and social control of lesbian sexual women, corroborating biphobia without scientific basis. I think it's important to mention, since I talked about PrEP, that if I'm not mistaken, one of the first confirmed reports of HIV transmission between women involved two women who were in a stable relationship, were married, and healthcare professionals told them that they had no chance of infecting each other with the virus, and that they didn't need to worry about prevention. And guess what? The disease was transmitted, a DNA test for the virus was performed, and it was confirmed that the transmission occurred within the context of that relationship without prior prevention guidelines from healthcare professionals.

[00:19:27]But since we need to think about scientific evidence, I wanted to talk a little about some data we have on the LGBT population, more specifically the bisexual population in Brazil. I present here a pioneering study conducted in Latin America and published in the journal Nature. It was carried out using the snowball sampling method, personally interviewing over 6,000 people across all regions of Brazil. He noted that approximately 12%, no, he observed that 12% of the Brazilian population was LGBT.

[00:20:04]Of those 12%, 2.2% would be bisexual people.

[00:20:11]This study found that 0.70% of men and 1.42% of women were bisexual. So, we're talking about a significant number of people.

[00:20:21]Another study that is conducted every year and also provides data on the LGBT population in Brazil is the data from the IPS surveys.

[00:20:31]In the 2025 survey, Brazil was the country that reported the highest percentage of LGBT adults, with 15% among the 26 countries surveyed, making it the country with the highest rate.

[00:20:48]This research, however, also showed that, although we have more LGBT people, we are in a country that criminalizes LGBTphobia, and LGBT people in Brazil tend not to reveal their sexual orientation or gender identity to everyone. So when we compare the list of 26 countries, we're at the lower end of the average for countries where people feel more authorized and free to admit and reveal their sexual orientation and gender identity to everyone in society.

[00:21:24]In 2023, this research further stratified this data and found that 7% of the adult Brazilian population identified as bisexual, 5% as homosexual (lesbian laws), 1% as pansexual, and 1% as asexual. I didn't talk about pansexuality, but there is also a non-monosexual identity.

[00:21:47]Pansexuals are people who are attracted to all genders or regardless of gender. So, these are non- monosexual people who are also affected by monosexism, and this can be added to the spectrum of absexuality.

[00:22:02]We have this research finding that 8% of the population falls within the scope of nonsexuality.

[00:22:11]On average worldwide, IPSUS observed that bisexual women would account for 4%, because that data wasn't disaggregated, right? In this specific study, bisexual women and men, pansexuals plus 1%, and gay and bisexual men were in identical percentages.

[00:22:31]And now, getting more specifically into the topic of biphobia, Brazil was once again the country that had the most positive response to a question asked in this survey, which was whether you have a relative, friend, or coworker who is bisexual. And so, out of the 26 countries, Brazil was the one where people knew the most bisexual people, whether relatives, friends, or work colleagues.

[00:23:05]But if we look at the data from a World Bank study this year that discusses the costs of LGBT phobia in Brazil, we see that, when focusing on sexual orientation, bisexual women and men tend to be less open about their sexual orientation in the workplace and tend to feel a greater need to specifically conceal their bisexual identity.

[00:23:34]Certainly as a reflection of the impacts of biphobia and monosexism in these environments. This doesn't pass through people's lives without affecting their health. We had a workers' health conference last year, and certainly this increased need to hide and become invisible in the workplace demands specific actions focused on the health of workers, particularly bisexual individuals.

[00:24:06]I'll go back to that Nature study I presented to provide some data. In this research, she observed that bisexual people, mainly women, but also bisexual men, tended to be more likely to be not in a romantic relationship when compared to heterosexuals and gays and lesbians.

[00:24:35]And with regard to psychological violence, which this research also measured, transgender women reported being twice as likely to experience or suffer psychological violence than the category observed as the standard, which was bisexual, cisgender men.

[00:25:00]And one point we talk about a lot is related to sexual violence, because when we think about the stereotypes surrounding bisexuality, we often see the issue of promiscuity, right? The idea that bisexual people will be promiscuous, the idea that bisexual people will be unfaithful, the idea that saying you're bisexual is almost an invitation to group sex or sex with anyone at any time, when in fact bisexuality is just another way for sexuality to manifest itself and doesn't necessarily mean the sexual practices of that person, who can be bisexual and can also be asexual, but anyway, most likely due to all these stereotypes. Bisexual people, bisexual women— foreign research has already exhaustively corroborated this— suffer disproportionately more sexual violence than other women when considering sexual orientation.

[00:25:59]And this study showed that in Brazil, bisexual women are more than three times more likely to suffer sexual violence than heterosexual women, and more than twice as likely to suffer sexual violence than lesbian women. What's interesting about this study is that it also presented data showing that bisexual men reported higher rates of sexual violence compared to gay men in Brazil. This study, focusing on Brazil, showed that bisexual men are more than six times more likely to suffer sexual violence than cisgender men, and bisexual women are almost 13 times more likely to suffer sexual violence than cisgender men, who were taken as the standard in this specific study.

[00:26:48]Data from the Brazilian public health system (SUS) confirms this information. Here I present an epidemiological bulletin that compiled SUS (Brazilian Public Health System) notifications from 2015 to 2021 and observed that the registration of sexual violence against bisexual women is significant in adolescence and adulthood. Sexual violence, which simply disappears in old age, is erased. And physical violence, which was already significant in other age groups, is increasing disproportionately.

[00:27:20]This study, which he observed through a comparison with lesbian, transvestite, and transgender women, showed that the highest proportion of victims of sexual violence was among bisexual women compared to other subgroups, and that physical violence perpetrated against elderly bisexual women exceeded the physical violence reported against lesbians, but also against transvestite transgender women. It's clear that bisexuals are also transvestites and transsexuals of those genders. But the raw data was presented in this way, and in any case, it is very relevant data.

[00:27:57]And so, knowing my time is up, I wanted to tell you that biphobia doesn't begin in healthcare services or during patient reception, but these services can either reinforce or reduce it. Therefore, it is very important that in healthcare settings we do not assume homosexuality, and that we understand that a large range of people in Brazil identify as bisexual.

[00:28:25]So this needs to be taken into consideration when welcoming them. And besides, don't assume homosexuality, because sometimes you look at a person's face and say, "Oh, it's a [ __ ], it's a lesbian." And you're already assuming that this [ __ ] and this lesbian are lesbians and gays, but they're not. That gay guy might be bisexual, and that lesbian might also be bisexual. Or that person you read as heterosexual, they could also be bisexual, whether that woman, that man, or that non- binary person. Don't assume a person's sexual orientation based on their romantic partner, okay? Because the person is married to someone of a different gender, that is, heterosexual. Even that relationship is n't one, because people have sexual orientations, relationships, kisses, affections, that's not it. So don't assume that a person is monosexual just because they are in a same-sex relationship. And don't assume she's of the same gender or a different gender, because the experience of bisexuality comes from that place. Don't assume your partner is gay, because you might end up paying the price for being bisexual. Practice attentive listening, remembering the importance of confidentiality in these conversations, and understand the specificities of healthcare.

[00:29:37]Then I recommend you go back to that first video we made, Rafa and I, we talked a lot about this. And acknowledge that biphobia can impact health.

[00:29:47]The request that the person is making to you may have nothing to do with the fact that they are bisexual, but it could have everything to do with it. The only way you'll know is by talking to them and getting to know them better.

[00:30:00]And that's it. It is our commitment to demand public policies for all LGBT people and more. We need to consider the specific needs of people of all genders— women, men, non- binary, bisexual people—in order to reduce the biphobic violence that affects us.

[00:30:21]Fight against LGBT issues and further phobia. Remember that this B stands for bisexual and this B stands for combating biphobia, which involves listening, understanding, and seeing without the veil of monosexism.

[00:30:35]And here I'm just sharing the references I used with you, and I appreciate the opportunity. I am open to dialogue.

[00:30:46]Thank you very much, Fernanda. These considerations are extremely important for service practice. And to continue here now, I'm going to call on Raul, who is a researcher, educator, doctoral candidate in education at the PPGD of UFO, the Federal University of Uberlândia, in the area of ​​science and mathematics education, with a master's degree in education and a bachelor's degree in philosophy from UFMG. Her research interests focus on the intersections between body, gender, sexuality, and educational processes from an engaged perspective. He has a solid track record in social control and the formulation of equity strategies in Minas Gerais, representing trans men and the AfroLGBT segment on the state technical committee for comprehensive LGBT and Black population health, collaborating in the qualification of indicators and care protocols in the SUS (Brazilian Public Health System).

[00:31:35]Today, Raul will talk to us about the bodies that matter in health, between the norm and lived experience. Raul, welcome!

[00:31:45]Hello, hello everyone.

[00:31:49]Ah, I'd like to start by thanking you for the invitation, right? Thank you to everyone behind this event, organizing it and committing to its success.

[00:32:04]Well, I feel grateful for the existence of this space. I always like to state that the existence of this space is extremely important for promoting lives.

[00:32:16]And I count, I see myself as one of them, as one of the lives promoted from the existence of spaces that discuss differences, right, and discuss the right of differences to live and experience, right, all inclusive health spaces, right? I also wanted to emphasize my responsibility as a member of the state technical committee for comprehensive LGBT health, as the main representative of the Trans Men segment.

[00:32:48]It's always important to remember that being in this place and fighting for the existence, continuity, and production that this place promotes is about representing transmasculine people in the state of Minas Gerais. This is a huge responsibility, and my effort is always to live up to having been placed in this position in the best way possible, trying to pass on the best effort possible, you know? I'd like to take this opportunity to say that I intend to speak freely, because it corresponds to the commemoration of May 17th, in the sense of talking about a day dedicated to combating LGBT phobia. So, to talk about this, I reserve the right to speak with a certain freedom, thinking more in terms of reflection, bringing more reflections, because it's an important day for me and it became important since I became aware of the importance of discussing these issues of struggle, right? And especially because he is also someone affected by them. I'm going to talk to them in a personal way, because I think that when we talk to people in healthcare, to healthcare professionals, about the right of LGBT people to have, to occupy, to experience this space, we're saying that we need to talk about proximity, right? And as for how much we... I can say, I think it's qualified to say the word "implores."

[00:34:42]so that this possibility exists, that this possibility actually happens. Why? Because we want more LGBT people going to health centers, going to institutions, seeking support on issues related to their health, and not elsewhere.

[00:35:10]We're talking about people who haven't had that experience, who become recognized as LGBT people, and who, after their first experience, give up on continuing in those places and among those people. We want these people not to give up, we want them to go and stay, to understand that it's a place that understands them. And we also want people who have already gone through this to be able to reconsider, to believe in this institution again, and to attend again.

[00:35:45]Well, we have a colleague on the committee, right, who questioned me a few days ago, asking why I don't seek out the services in my region to deal with health issues, primary care, even though I am who I am, speak the way I speak, know what I know, and I seek out and continue to seek out the Transgender clinic in Uberlândia. I am currently in the city of Uberlândia for matters that are not necessarily related to my gender transition. And I told him that, even in primary care, in some places in Uberlândia, I don't feel comfortable talking about myself. I could use all my knowledge to try and improve that space in some way. I could, but sometimes, depending on what I'm committed to, depending on how tired I am, depending on how exhausted I am, I don't want to talk about it. I don't want to have to go through a training process before dealing with something related to my health.

[00:37:02]So sometimes, it's not what I want to do, and I have the right to do that, right?

[00:37:08]But I do try, depending on the issue and my availability, to increase the turnover of my population in this service.

[00:37:19]Yes, thinking about it in terms of reflection, right? When we talk, when I say that I propose a discourse that aims to address the importance of health in relation to norms and the lived body, I wanted to bring up a first point—I don't know if the people listening or watching are familiar with it—but there's a text by Clarice Lispector called Mineirinho. And it was the text that I first came into contact with.

[00:37:52]moments before I took the ENEM exam, right? Well, it was a text that a colleague who was a monitor at a preparatory course for the ENEM exam, exclusively for Trans People in Belo Horizonte, recommended to me because he had difficulty explaining to me what philosophy was. It was from a text by Lispector that I, from that tiny text by Lispector, came to understand, in a way that touched my emotions, what philosophy was and its understandings, and my own understandings of philosophy. Finally, this text will discuss justice and how sometimes the idea of being inside a house, of following moral standards and everything that says or is consistent with the understanding of morality, right? The extent to which that gives a distorted image of justice creates a distorted perception, because ultimately, if we really analyze the facts, what we believe we are experiencing as justice is not necessarily justice. And I strongly agree with an idea or understanding of justice that is related to justice as a feeling.

[00:39:11]So, I don't know who has ever been through this, where you have someone you trust, someone you like, who looks you in the eyes and tells you to trust them, and then a moment later they do the opposite. She provokes or takes some action that she doesn't respond to, or she doesn't follow through on because she made a commitment to you, and you get disappointed.

[00:39:39]It's a betrayal, in this case, as we usually say, or other actions, or behaviors of people that cause them to dig into something we trusted deeply. This shakes us up, doesn't it? When you have a bond with someone, and suddenly that person brutally cuts that bond, it shakes you up. And what emerges beyond trauma is a desire for reparation, a desire for the person to reappear and admit, you know, that they did this, that they did that, and that they regret it. But depending on what it is, that person may not necessarily take responsibility, nor may they want to. And we find ourselves in a situation where we have nothing to do, right? What else to do, except to stop, sit down, uh, cry and lament. And I usually say that this upheaval is ours, it's a feeling of justice that we seem to live in harmony with in our daily lives, but when someone shakes that feeling, we feel like we have no ground beneath our feet and we believe that the other person can come and fix it, but that it wouldn't be important if we looked at ourselves and tried to fix it or tried to see how it works and fix it in our own way. But this type of shock, or the reasons why we suffer this shock, don't always have such a practical solution— I'm not saying it's easy, but so practical that we could handle it ourselves. I'm talking about institutional justice or injustice, right? So, when I think that someone from our population seeks healthcare services and expects that the need that brings them to the service will be met, and not that their way of being or existing will be questioned, right? When we consider that she might become frustrated because she goes due to suffering and returns home burdened with two, we're saying that her sense of justice has been shaken, and possibly this person will no longer return to the job, sometimes not even for that specific issue, nor for other reasons. So, uh, thinking, for example, about actions that we sometimes believe aren't problematic, right? Because sometimes we believe that we are completely free from prejudice and discrimination.

[00:42:18]We believe that we're not the ones who reproduce this, but sometimes we reproduce it in a very unconscious way, right? Sometimes we ask a question that presupposes a gender identity that isn't present, sometimes we make a comment, even in a friendly way, presupposing a sexual orientation that isn't present. And sometimes we make comments that imply the person should follow certain labels or present themselves aesthetically in a way that isn't what they want, right? So sometimes, in our jokes, whether we want to or not, unconsciously, we demand a binary from the other person, a normative binary that doesn't exist. So, being aware, holding ourselves accountable, or trying to stay vigilant about how we talk and speak to others is related to our responsibility when we say: "I, this is the profession I chose."

[00:43:27]Here I will carry out this work and here I will perform the service, right? And I think it's these attitudes that determine whether or not the other person will reciprocate.

[00:43:40]So, who is the other, male and female?

[00:43:43]They are bodies, bodies of those who live and sometimes even bodies of those who coexist with the well-known or talked-about dissensions or differences. I say "known" and " spoken about" because when I'm in my circle of people I love, who are diverse—whether they're immediate family, friends, or acquaintances— we've already created an environment, a moment, or a system, so to speak, in which we treat each other, talk, and interact without those demands. It doesn't matter to us whether we talk about who we like or dislike. It does n't matter to us whether we talk about how we behave sexually or not. It does n't matter to us whether we talk about how we want to dress or not, or why we want to. So, in this universe that we've created, these requirements aren't in place. And so we experience, let's say, a kind of freedom within this chaotic world. Now, when I think about giving up that freedom to look for a job, knowing that I'll be questioned, judged, and categorized there, just the understanding that this could happen discourages me, and sometimes I don't even want to do it. Perhaps I was asked why I didn't like going to a certain event space here in Uberlândia. I said I didn't like it, but I didn't know why.

[00:45:14]And then I remembered, when I arrived at that place, I accepted the invitation, I arrived at that place, I went to the bathroom and the bathroom only had urinals. And then I remembered, I don't like this space because it was built in a way that will remind me who I am. And it's not because I don't like being a trans person and I don't care about saying that I am. I say this, and I say it with great joy. Actually, I don't even like to say I'm a man or I'm a woman, I prefer to say I'm trans.

[00:45:48]Now, it's one thing for me to be able to talk about this as something from my own life that I can share, and it's quite another for the space that forces me to remember it in order to be aware of the limitations that society imposes on me. So, in that sense, that's why I didn't like that place. And in the same way, that's why I'm going to think about whether or not to seek healthcare, whether or not to self-medicate, whether or not to do this, because I prefer this comfortable situation among my loved ones to having to, unfortunately, experience a possible moment of criticism, questioning, or embarrassment.

[00:46:28]And then I'll give some examples of people and how these institutions can or cannot define these relationships, right? I'll give Joy as an example. Joy is a transgender colleague of mine; I'm using a pseudonym. He's a trans colleague who was keen to have a hysterectomy, and he managed to get it done at the Uberlândia Trans Clinic, which is Crash, the clinic linked to the Hospital das Clínicas service, right?

[00:46:59]And he had post-operative complications.

[00:47:02]And because of these complications, he had to seek care at the gynecology department of the Hospital das Clínicas, and not at the outpatient clinic, due to the day he experienced the complication; the outpatient clinic operates on a specific day of the week.

[00:47:17]The wall of the gynecology department in the outpatient clinic is the same wall as the braided outpatient clinic.

[00:47:29]The wall has gynecology on the left and outpatient services on the right.

[00:47:36]It was because of a wall that he stopped receiving the treatment he had throughout the surgery and started receiving the opposite treatment when we sought help for post-operative issues, facing a nurse who said: "If you're here, you're a woman, period. And I don't respect you, I don't respect your name." And look, he had a name, he has a corrected name, and at no point was there any possibility of his registered name being exposed, because all the documents are corrected. But even so, she said: "I don't address you by any name, but I won't address you by that name, because you are not who you say you are." She also mentions the case of a child who sought help from the service, a child who is from a family in which she has a twin sister, and these children went to the service. The parents sought services from the outpatient clinic. It wasn't due to medication, hormone therapy, or surgery, nothing like that. People, children, and families seek outpatient care because they are looking for help with a social transition. to be able to cope with school, family, neighbors, etc. And these children went to the clinic because one of them revealed, you know, that she was a transgender child and all that this entailed.

[00:49:02]And the sister took it upon herself to defend her brother at school.

[00:49:09]The sister knew that her brother was shy enough not to be able to handle certain issues, right? And we ca n't blame him, after all they are children, they were children who at the time were about 4 or 5 years old. And every time the sister saw a situation that would embarrass her brother, the sister, a sister who was 4 or 5 years old. And this sister began to experience mental health problems, anxiety, and nervousness.

[00:49:39]A child who lives with another child, and through that close interaction carries the suffering of the other child in their own body, right? Another example is Carlos, a teenager who is followed by the clinic and always goes to the clinic with his mother. And the mother was the first cisgender person I knew who was able to use her chosen name, and the suffering of having to claim her chosen name as a cisgender person, you know? Because she takes on her son's role and she also takes on the suffering, right? So she picks up on everything that her son goes through, and laments and suffers along with him, right? So, who's in?

[00:50:29]Who are the people who commit themselves to dealing with those who will be in this space and bring up all these issues related to differences in that space? It is the one who understands that what she does goes beyond her technical training. She is the kind of person who truly takes responsibility for whom she wants this world to be.

[00:50:54]And I know some people who do this very well, which is why I sought, for example, to do my doctorate here in Uberlândia. I found in a teacher from Uberlândia a way of doing things, of talking about science, of talking about health in a way and with a teaching methodology that recognizes the diversity of bodies.

[00:51:17]which does not lead to the exclusion of bodies and which places the diverse body within science.

[00:51:23]She often says, and I really like this, that the body of education and science, or the body of health services, or the body of training in biology, is the body produced by the history of science, which is a history that seeks a hegemonic knowledge. It's a story that treats the body as a universal entity. It's a story that understands the body as having a structure that is known as healthy, but that society doesn't reflect.

[00:51:56]Bodies are diverse. The bodies that are in the classroom, the bodies that are in the homes, the bodies that are in the world, are diverse. And who are we going to talk to, thinking in the context of education, who are we going to talk to about bodies? For people who have these body types. And what kind of bodies do we want to talk about to people who have diverse bodies, regarding diverse bodies? And I think the same approach should apply to healthcare. What kind of bodies do we want to care for in healthcare?

[00:52:25]And what kind of bodies do we ensure that these bodies are? We want to take care of bodies that need care, and we want those bodies to become bodies that want to live in themselves, or that are, or try to achieve, a universal example of a binary body that doesn't exist, right?

[00:52:46]And what I also notice, thinking about health in a broader sense, thinking about proximity, is that people who are often not people from diverse backgrounds—when I talk about my advisor, when I talk about a work colleague, when I talk about other people I see working in the field, right?

[00:53:05]The people involved are not necessarily LGBT, but they share a close and committed relationship. They share a closeness and a commitment to not forcing themselves to say that differences are there and that they are part of our coexistence, of all coexistences. And what I see in these people is that they are tired.

[00:53:24]They are tired because they work alone. They are the people who are in the health service and who are running a project, but they see themselves as alone in this project. They are in school, they are involved in an initiative, but they find themselves alone in this initiative.

[00:53:41]And it's not because other people disagree with the topic. Sometimes they agree and even clap, but that's not all we need, just applause.

[00:53:50]We need commitment; we need people who actually do what they say should be done. I think that whoever watches this video lesson will probably be someone who is committed in some way, because someone who isn't, let's be honest, doesn't even care. But those who are committed to wanting to know, what I ask here is that they also be committed to doing, that they take on the stance, the stance of doing what they believe needs to be done, right? It's not just about talking and doing. And so I'm going to go back a little to Lispector's text, because that's what it's about. At the end of the text, she says: "We don't want the house. This house that has all this idea of ​​justice and that in reality isn't just. We don't want the house, we want the land, right? We want that place that truly looks at reality and transforms reality. We want the land.

[00:55:01]And the appeal I have here for everyone is that we want the land. That 's it.

[00:55:16]Thank you very much, Raul, for your considerations. The user's perspective is also very important within the service.

[00:55:24]Uh, we have some considerations here in the chat, for you, Raul, if one of the fundamental organizational principles of the SUS (Brazilian Unified Health System) is decentralization. Ideally, we should be able to make the UBS (Basic Health Units) the primary spaces for reception instead of the outpatient clinics.

[00:55:41]A meeting appearing.

[00:55:49]The answer to the question for me, isn't it, Ana?

[00:55:53]That 's it, I think that... I think not entirely, you know, Alice? Uh, for example, I really like to discuss the issue of quotas, I like to discuss exclusive training spaces, I like to discuss these issues, but..." I like to think about the importance of both spaces.

[00:56:18]I think it's important to consider that the service has to be prepared, right? I think the existence of clinics, the existence of exclusive spaces, initially, is also seen as a place of training so that we can expand this knowledge, expand this recognition, these actions, and thus cause this general transformation. But at the same time, it's important to have spaces that have exclusive dedication, because we have knowledge to produce.

[00:56:50]We need to produce knowledge that corroborates precisely this expansion, right?

[00:56:57]So, for example, when we talk about, oh, it's important to have a space, a school exclusively for deaf people, or it's important that these people interact with other people, right, in conventional schools? I believe both, I believe that people have to interact with others in conventional spaces and people need, they need third spaces to be able to bring forth, bring forth, and record their own knowledge, which I think is much more powerful when it is discussed and concentrated among themselves.

[00:57:33]So I am in favor Regarding the existence of both spaces, the existence of both spaces for everyone.

[00:57:39]I am universally integral, right? Indeed.

[00:57:42]Fernanda, what is the importance in Minas Gerais of having a specific axis on our LGBTI health in the municipal and state health conferences preparing for the 11th State Health Conference?

[00:57:57]We have advanced in state policy in relation to national policy in some specific areas of health for our LGBT population in general and also for bisexual people.

[00:58:10]When we published the policy in 2020, two years later we were already starting to finance this policy within the scope of primary care and health promotion. We have a national policy since 2011 that has no funding.

[00:58:25]In the area of ​​health promotion, we have some funds allocated to the transsexualization process through the accreditation of clinics and hospitals, but we don't see this policy as a whole being financially incentivized.

[00:58:41]From the moment that in the state of Minas Gerais we have specific resources for municipalities to implement this... Regarding politics, we have to monitor this. And monitoring, social control, is mainly done through health conferences. That's why it 's so important for this conference to have this focus, this focus that wouldn't be at the national level, because there's no funding at the national level, but at the state level we do have it, we even have incentives for municipal health equity committees. In the last annual management report, in the last RAG, we had notified 714 municipal health committees. These committees have participation from society, in addition to working people.

[00:59:26]So this is already being done with some social participation in the municipalities, in most of them, but we need effective social control. We need the councils, the conferences focusing on this. So I think this is a fundamental space for this, for us to see how this funding is being applied, so we can influence and improve this implementation. And also nationally, the national policy is being updated from LGBT to LGBT and more.

[00:59:53]With this conference, we will have proposals that will allow us to, when the national update comes, or even before, From there, depending on what the state understands, we can also update our policy, because today it doesn't include any provisions regarding the health of intersex people, of asexual people, who are also people who knock on the doors of the service, are being solemnly ignored and pathologized.

[01:00:17]Many times they have specific demands, right? Raul brought this up very well, the importance of arriving and being welcomed. So this conference will be fundamental for us to be able to move forward in this, monitor how this resource is being implemented, invested, advance the policy and even update our policy for specificities that we haven't contemplated until now and also for populations that were not previously included and may be in the future.

[01:00:45]Thank you very much, Fernanda. Uh, I see there's another question in the chat for the state LGBT operational plan, you can request it here from the equity coordination. The email is políticasdequidade, all together@saude.

[01:01:02]Uh, and just to finish, I would just like to reflect on what appeared in the two speeches, which is about the Welcoming, the importance of welcoming in the service, right? So, that we can bring this into practice, in the service at the front line, in management, and that we can implement this health system that was adopted by the 853 municipalities of Minas Gerais, and that we understand the importance of including it in our planning, right?

[01:01:35]And so, just to finish, I would like to thank Fernanda and Raul for their reflections, their contributions, and their partnership, right, for years here with the State Health Secretariat. I would also like to thank Nutel, UFMG, for the partnership and support in carrying out this webinar, the Technical Committee on Comprehensive Health of the LGBT population, for the collective composition of this debate, and all the people who followed this transmission. May this lesson provoke necessary reflections in everyone for the development of future work, and may it be just the beginning of a long journey to make it more inclusive and welcoming.

[01:02:20]Thank you very much to everyone who... You've been with us this far. Good afternoon.

[01:02:24]Thank you so much, Fernanda. Thank you so much, Raul.

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