Gender and racial inequalities in access to and utilization of health services are shaped by multiple factors, including professional practices and the availability of targeted care strategies. Effective procedures for welcoming patients and identifying the specific needs of these populations are essential to ensure quality care. However, the intersection between race/ethnicity, gender, and tobacco use remains underexplored in Latin America, including Brazil.To analyze population data on tobacco, use in Brazil, categorized by race and gender, and to examine access to Primary Health Care (PHC) services, with emphasis on smoking cessation programs and harm reduction strategies. Additionally, to map the existing literature on the intersections of race, gender, and access of LGBTQIA+ populations to PHC services.This was a descriptive cross-sectional study using data from the 2023 Vigitel survey, considering variables related to tobacco use, race, gender, and access to health services. The quantitative analysis was complemented by a narrative literature review on healthcare access among LGBTQIA+ populations and racial intersections.The prevalence of adult smokers was 9.3% (11.7% among men and 7.2% among women). The use of electronic cigarettes was reported by 2.1% of participants (2.9% men and 1.4% women), despite their illegal marketing in Brazil. Regarding self-rated health, 6.0% reported a poor condition; hypertension (27.9%) and diabetes (10.2%) were the most frequently reported chronic diseases. Notably, 72.9% of individuals living below the poverty line self-identified as Black, revealing an overlap between socioeconomic and racial vulnerabilities that may limit access to smoking cessation and harm reduction strategies.Despite significant advances in tobacco control, structural inequalities related to race, gender, and sexual orientation persist, influencing both consumption patterns and access to treatment. The scarcity of detailed population data continues to hinder the development of culturally sensitive and equitable public health strategies.The inclusion of race, gender, and sexual orientation dimensions in epidemiological studies and public policies is essential for promoting equitable care strategies that incorporate cessation and harm reduction approaches with sensitivity to social and cultural contexts. Policies grounded in social justice, diversity, and comprehensive care are crucial to reducing historical inequalities and strengthening Primary Health Care.