ABSTRACT:
This study aims to understand the perceptions of the Black homeless population served by the Street Clinic in Belo Horizonte regarding racism experienced in accessing Primary Health Care. Structural racism shapes social relations in Brazil and constitutes a central determinant of health inequities experienced by the Black homeless population. In Belo Horizonte, healthcare for this population is primarily provided by Street Clinic teams linked to Primary Health Care. Despite this service, barriers to health access persist, related to stigma, prejudice, and discriminatory practices. This is a qualitative study conducted through 14 semi-structured interviews with Black individuals (self-identified as Black or Brown) experiencing homelessness, aged 18 years or older, served by the Street Clinic in the West and Barreiro regions of Belo Horizonte. Interviews were conducted in participants' territories (public squares, sidewalks, viaducts, drug use scenes) and focused on perceptions of racism, right to health, and barriers to service access. Data were analyzed using content analysis. Results indicate that the studied population is predominantly male, with low educational attainment and predominantly engaged in informal work. The Street Clinic emerges as a central mechanism for ensuring health access. However, multiple barriers in Primary Health Care were identified, including requirements for documentation and proof of residence, delays in care, denial of reception, and prejudices related to hygiene, clothing, and homeless status. Although racism is recognized by some participants as everyday violence, its institutional dimension is often perceived covertly. The study demonstrates that racism, articulated with homelessness, constitutes a structural barrier to Primary Health Care access. Findings reinforce the need for anti-racist professional practices, service debureaucratization, and strengthening of equity-based approaches in care. This research contributes to understanding how intersecting social determinants, race and housing status, operate as access barriers, highlighting the urgency of implementing equity-oriented policies in the Brazilian Unified Health System.