Saúde sexual de mulheres lésbicas e bissexuais no Brasil : prevenção, acesso e trajetórias

Abstract

The present disertation aimed to analyse the characteristic of access, prevention and trajectory of Brasilian Lesbian and Bissexual women in the Brasilian health system. The study used a mixed, explanatory and sequential method that was divided in three consecutives phases: quantitative, qualitative and data triangulation. The sample were composed by 1,225 Brasilian Women , over eighteen years old, that have sexual relations with other womans. The data collection was executed online between june and september, 2020 using Qualtrics e Google Meet. The quantitative phase used an exclusively quantitative instrument , created by the authors ,composed of six dimensions : sociodemographic data, belives about sexual relations betwen woman, knowledge of transmission of Sexually Transmited Infections (STI) and prevention strategies, types of sexual pratices , evaluation of satisfaction in ginecological apoinments and self-percived general and mental health and Covid-19. In the Qualitative phase, were conducted semi-structured interviews with 12 sample participants. Descriptives and inferential analysis were performed at quantitative data and subject analysis was performed on the qualitative data. This project was approved by the PUCRS research ethics committee and all participants signed a free and informed consent form before starting to participate in the research. The results are organized in a theoretical study "Health acess for lesbian and bisexual women" and two empirical studies "Lesbian and bisexual women perceptions about risk and preventive strategies for Sexually Transmitted Infections (STI)" and "Inequalities in the access to gynecological care by lesbian and bisexual women in Brazil: Mixed method study ”. The invisibility of especifical health pratices for lesbians and bissexual women were present in all three studies.The participants perceived themselves at risk for STIs and showed knowledge about preventive strategies for sex between women. However, the use of these strategies was almost null in the sample due to the difficulty of adaptation and the lack of specific inputs. The variation in access between the different experiences of the participants was significant. Being a lesbian, living in the North, Northeast or Midwest regions of the country and having exclusively public health coverage were the main predictors of irregular access to gynecological care. The intersection of life experiences and markers made it possible to expand the analytical field and the complexity of the determinations of access to health in the sample. The relevance of this dissertation relies on the visibility of marginalized experiences in the health system, which can act as a tool for dialogue, denunciation and construction of programmatic agendas.