“A gente não é fabricada numa linha de produção pra ser tudo igual”: desafios, potencialidades e resistências na saúde de mulheres bissexuais em Manaus/AM

Abstract

Bisexuality is shaped and constructed by historical and social contexts, and the marginalization and erasure of bisexual people from academic, medical, social, and political spheres has reinforced stereotypes that are harmful to bisexual health, such as claims of illegitimacy, links to promiscuity, confusion, indecision, and association with sexually transmitted infections. As for women, fetishization and hypersexualization also lead to vulnerabilities in mental, sexual, and reproductive health, as well as violence. Even in this scenario, it is common for the debate on bisexual health to be ignored or only mentioned as part of a list in health booklets, policies, and practices, which creates a gap between the doctrinal principles of the Unified Health System (SUS) and the concrete reality. In the context of Amazonas, despite achievements such as the State Policy for Comprehensive LGBTI+ Health, challenges persist in access to health care for the groups that make up the acronym, including bisexuals. In this sense, the general objective of this dissertation is to analyze the health care experiences of women who identify as bisexual and/or pansexual and/or who relate to people of more than one gender and reside in the city of Manaus/AM. When thinking about care experiences, we start from the conception that health can be produced both by health professionals and services and by the subjects themselves. We used the narrative method proposed by Jovchelovitch and Bauer for individual narrative interviews and analyzed the discourses of the twelve research participants in light of post-structuralist feminist concepts, the expanded concept of health in Public Health, and theoretical contributions on bisexuality. The results were analyzed based on the stages proposed by Fritz Schütze for narrative analysis, and three major themes of discussion were constructed: 1) health needs – what they demand; 2) challenges and potentialities in accessing health – what they encounter; and 3) recognition, subjectivities, and health production – how they (re)exist. The narratives demonstrated the recurrence of psychological suffering, sexual and psychological violence in childhood, adolescence, and intimate partnerships, and sexual and reproductive health impacted by the association of bisexuality with sexually transmitted infections. The challenges included structural and geographical problems of the Amazonian SUS, as well as professionals unprepared to deal with the demands and disclosure of (bi)sexuality. At the same time, professionals and services interested in women's sexual and emotional histories offered adequate assistance and were important for the continuity of care. Recognition as a bisexual/pansexual woman enabled new subjective meanings and participation in feminist and LGBTI+ social movements, as well as support networks, formed strategies to resist and produce health. The trajectories demonstrated the importance of paying close attention to the singularities of bisexual women in the Amazon for the construction of care policies and practices that truly serve them in a comprehensive and equitable manner.