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In the time frame of the second decade of life (10 to 19 years of age), as defined by the World Health Organization (WHO)2, a concept also adopted by the Brazilian Ministry of Health, adolescents experience identity processes, changes and transitions in biopsychic issues and social relationships that mobilize understanding, feelings, and emotions3-4. The condition of being an adolescent and a gay may mean double vulnerability and has repercussions on increased chances of not accessing or not being accepted in the health system due to stigmas.
Primary Health Care (PHC) is described as obstructing the right to health, promoting discrimination, and producing embarrassment for gay adolescents3-4. Access to the health care system, the identification of needs, and care negligence are pointed out5 as barriers to openness and listening5) and cause adolescents and young people not to seek health services6. In this context, the fragility of the bond with health professionals/services is highlighted6.
Recent literature is scarce and lacking nursing research on gay adolescents. By surveying the main national and international databases, it is possible to observe research on this topic carried out in the United States in the last three years11-26, with the focus on the nursing care area12-31. Such pieces of research seek to understand the level of knowledge that nurses/health professionals have of LGBTQIA+ issues11-12,14,22-23, and adolescents in this group are their main target population11,13,15,17,20-26,28,30-31. These studies are conducted mainly in the school context16,20-21,25-26,29-31 and PHC17-19,28, and most of them have been quantitative11-12,15-16,19,24-25,27,29-30, when compared to qualitative ones13-14,22-23,31.
The data extracted from the interviews were transcribed and organized using Microsoft Office Word from detection and correction of linguistic errors, when vocabulary, grammar, and language vices were revised. Statement content analysis started during transcription, by writing descriptive memos that supported coding and establishment of the themes. Then, the interviews were analyzed systematically from the following steps: reiterative readings of the interview transcriptions for familiarization, highlighting excerpts that were later taken for coding; grouping of codes in order to generate initial themes from the central construct, and articulation of the elements that composed it32-33.
Stereotypes and stigmas crossed our results. This is visible when, for example, being gay is almost immediately associated with STIs, psychological distress, and family issues. These stereotypes go in the opposite direction of the openness to the other presupposed in the effectiveness of a care encounter.
STIs are on the agenda claimed for the health care for homosexuals; therefore, there is sense and meaning in considering them. One verified criticism of how this symbol directs the professional in care, with reduced opportunities to reveal needs and relational quality41. There is a danger of restricting the care service agenda to STIs, especially due to the tendency of stigma intersectionality when non-normative sexuality is present in the care scene42. It is urgent to break with the care protocol tendency and the valuation of social labels in its provision, in order for the particular to emerge in and from the relationship.
Another point highlighted was related to the adolescents seeking privacy in health appointments and confidentiality of the information provided there, elements reiterated in the literature, added to the relevance of listening and establishment of a reference professional43. In this context, being accompanied by family members is perceived as an obstacle because it generates discomfort and does not allow the adolescent to reveal himself44, perception supported by the participants of this study. Depending on the relationship between these adolescents and their families, this aspect may or may not contribute to the care for gay adolescents45, an important focus of attention for nurses.
Family resistance to approaching gender and sexual orientation with adolescents can act as a determinant for the refusal of gender diversity, favoring a social context that reinforces, reiterates, and leads to prejudice and violence47. In turn, nurses and professionals themselves are social actors who act in the opposition or reinforcement of such symbols from their actions.
Partnerships between different professionals and sectors are relevant for the integrality of care, and the school emerges as strategic for the adolescent population. The PSE is anchored in Health Promotion, which is aligned with the recognition of the space of education as valuable to promote reflections and new thoughts about life and health issues50. Thus, it is up to nurses to seek insertions anchored on the PSE and propose discussions related to gender, gender identity and sexuality in the thematic agenda, enabling dialogues perceptions to be exposed28. Health actions at school are identified as vertical, disconnected from the school curriculum, supported by a medicalizing paradigm51 and cisheteronormative perspectives of little contribution to behavioral sensitization and welcoming diversities.
Few studies address specifically one of the populations represented by each letter of the initialism LGBTQIA+, with a tendency to be approached in a generalized way, which weakens evidence and discussions about the specifics of each population. This study advanced in this direction and contributed with notes related to determinants of relational insufficiency between nurses and gay adolescents and, consequently, weaknesses in the reception of the latter, subjects of rights, worthy of experiencing equity in health. Signals for practical advances were made, especially regarding the influences of prejudice and previous judgments derived from cisheteronormative socialization. 2ff7e9595c
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