A gênese da Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais no Brasil.

Abstract

The present work sought to understand how the genesis and institutionalization of the Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais in Brazil. It was a socio-historical research, from 1978 to 2018. Data production was carried out based on documentary analysis, bibliographic research and in-depth interviews with 25 agents selected by intentional sampling among the agents who participated in or influenced the emergence of the aforementioned policy. The theoretical framework of Pierre Bourdieu's reflexive sociology and the contributions to the sociological analysis of health policies by Patrice Pinell supported the analysis. It was found that the emergence of the Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais (PNSI-LGBT) in 2009 has as its antecedents the emergence of the Brazilian homosexual movement in 1978 and the construction of violence against the LGBT population as a social problem that deserved State recognition, in the period from 1978 to 2002, the health demands of this group became issues of interest to agents from different social fields, such as bodily changes in trans and transvestite people, the health of lesbian and bisexual women, and the response to the epidemic of HIV/AIDS, the latter responsible for the first actions of the health bureaucracy focusing on the LGBT population. The emergence of politics had as conditions of historical possibilities for its emergence the arrival in the field of power of left-wing parties, the strengthening of the space of human rights in the bureaucratic field and the entry of agents linked to Brazilian health reform in the bureaucratic field of health. The social space constituted in the bureaucratic field of health of interest to politics was characterized by being feminine, formed mainly by cisgender women of different sexual orientations and coming from the feminist movement, the movement for Brazilian health reform and/or the AIDS space. Belonging to the LGBT population, even though it played a role as symbolic identity capital allowing entry into this space, did not guarantee the occupation of dominant positions. It is also observed that the social space of interest in politics is basically composed of the bureaucratic field of health and the militant space, with reduced participation from other fields. The main issues in dispute were related to the naming of the target population of the policy and the struggles between the subgroups that make up the LGBT acronym to consider their specificities as priority health problems for the policy. The health specificities of trans and transvestite people constituted a specific subspace around them through the Processo Transexualizador. This subspace consists of fiercer disputes and with the participation of the medical, bureaucratic, legal and scientific fields, and the militant space. The medical field occupied a dominant place, imposing its point of view on transsexuality, based on psychiatric diagnosis, on the State. The period of institutionalization of the PNSI-LGBT occurred between 2011 and 2016 and was characterized by a period of continuities and ruptures due to the increased influence of the conservative fraction of the political field on policies. of health. The intensification of the dispute with the conservative fraction of the political field and its arrival at the dominant pole between 2016 and 2018 represented a period of closure of possibilities for PNSI-LGBT with the weakening of its institutionalization process.