“Outras Geografias” na metrópole carioca: a população LGBTI+ e a busca por uma cidade justa

Abstract

In Brazil, the Federal Constitution of 1988 establishes health as a duty of the State and a right for all citizens, regardless of sex, race, income, occupation, or any other social parameters. That is, people’s needs for health (individually or as groups) must be taken into account, even if they differ from those of majority groups. Equal opportunities concerning the health system should be available for everyone. The guarantee of equal health care, without privileges or prejudices, is a principle of social justice. But does health care and service provision for the LGBTI + population, and especially for transvestites and transsexuals, match their needs and expectations? Our search for an answer to this question led us to carry out, at first, an epistemological discussion between geography, gender, and health, bringing the gendered and sexualized subjects to the scientific debate. Then, we explored the issues of territorial justice and local governance to understand the local health management at the Family Health Center in Lapa (“CSF-Lapa”) configuration - one of the objects of this study that led us to briefly assess the historical aspects of the central region of the City of Rio de Janeiro, in order to geographically and historically place it as a space of the carioca bohemia and to investigate the reasons that attract transvestites and transsexuals to that region. These are some of the aspects that partially explain the particularity of the CSF-Lapa to be configured as a singular space with a medical-preventive methodology approach for the trans population living in that neighborhood – an aspect that we have ascertained through conducting an empirical research by interviewing 15 trans people (10 transvestites and 5 transsexuals) in order to verify, through their narratives, how the public health policies reaches this group at different levels (primary, secondary and tertiary) of the health sector. The research results show advances in the effective implementation the trans population health rights with regards to the provision of these services at the primary level when combined with the performance of special reception services for these people (due to the fact that CSF- Lapa is a Health School Center), with a local governance (composed of agents from the City of Rio de Janeiro and UNESA, in partnership with Luana Muniz) that promotes a fair territory in which health right is instituted just as the right to a fair city for transvestites and transsexuals. When we analyze medium and high complexity services (secondary and tertiary levels) of the public health network in the City of Rio de Janeiro, however, we notice that the health professionals lack of prepare (due to the lack of educational programs on transgender health) for meeting the trans population specificities is a huge obstacle to guaranteeing these citizens' rights to health and to live in a fair city.