Navigating lines of flight through the healthcare system: LGBTQ+ resistance and the reinvention of access

This study analyses how LGBTQ+ healthcare users and healthcare professionals navigate and reconfigure access to healthcare within Brazil's Sistema Único de Saúde (Unified Health System) in contexts shaped by institutional LGBTQ-phobia. The study employed a qualitative intervention-research design informed by cartography. Fieldwork was conducted in a family health clinic in northeastern Brazil and combined participant observation with semi-structured interviews with LGBTQ+ healthcare users and healthcare professionals. The analysis conceptualises access not as a linear process but as a set of negotiated pathways, mapped as five routes of access to healthcare: facilitated access; access 'by force'; unnoticed access; access through detours; and access through support networks. These routes reveal how access is continuously produced through relational practices, micropolitical negotiations and collective arrangements that both reproduce and disrupt institutional norms. The findings position agency as a central analytical axis, demonstrating how subjects and professionals actively invent alternative forms of care in response to institutional violence and exclusion.