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O transexualismo (CID-10) é uma condição caracterizada por forte e persistente dissociação com o gênero atribuído. A cirurgia de redesignação sexual (CRS) e a terapia hormonal (TH) permitem que indivíduos transexuais se sintam mais congruentes com seu gênero e, por isso, têm desempenhado papel importante nos últimos 70 anos. O fator neurotrófico derivado do cérebro (BDNF) parece desempenhar um papel fundamental na recuperação do trauma cirúrgico agudo e vulnerabilidade ambiental à psicopatologia. Nós hipotetizamos que o BDNF pode ser um biomarcador de alívio do sofrimento de incongruência de gênero pós-CRS. Objetivos: Mensurar os níveis séricos de BDNF no pré e pós-operatório em indivíduos transexuais como biomarcador de alívio de estresse relacionado à incongruência de gênero após a CRS. Métodos: Trinta e duas pessoas transexuais masculino para feminino submetidas a cirurgia e tratamento hormonal foram selecionadas de nossa amostra inicial. O nível sérico de BDNF foi avaliado antes e depois da CRS pela técnica ELISA. O tempo decorrido entre as coletas de sangue pré e pós-CRS foi medido. Resultados: Não houve diferença significativa nos níveis de BDNF pré e pós-CRS ou em relação ao tempo decorrido entre a CRS e a coleta. Conclusão: O alívio do sofrimento relacionado à incongruência de gênero pós-CRS não pode ser avaliado apenas pelo BDNF. Soluções cirúrgicas podem não fornecer uma solução rápida para o sofrimento associado ao transexualismo, e a CRS pode servir como um passo em direção à, em vez de conclusão da, construção da identidade de gênero de uma pessoa. Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one’s assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. Objectives: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Methods: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post- -SRS blood collections was also measured. Results: No significant difference was found in pre-SRS or post- -SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Conclusion: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person’s gender identity.

Introduction Lorenz curves, while developed to measure income inequality, can describe the unequal distribution of sexual contacts in a population. Sexual partnerships are typically skewed with most individuals reporting few and some reporting many, but the degree of concentration is poorly understand. A better understanding has important implications for HIV and STI prevention, care and research, notably targeted PrEP and test-and-treat. Methods We analysed data collected from an ongoing national HIV behavioural surveillance programme among gay and bisexual men (GBM) conducted in offline and online community settings in 2014. Participation was voluntary, anonymous and self-reported. Data were collected on the number of condomless anal intercourse partnerships (CAIPs) in the previous six months. We aimed to (i) describe the distribution of CAIPs; (ii) measure the concentration of CAIPs using Lorenz curves; (iii) identify potential “core” groups and compare their characteristics to other GBM. Results Of 3027 GBM responding, 1575 (52%) reported at least one CAIP. Of these 1575, the median, mean and range was 1, 3.5 and 1–250 CAIPs, and the distribution was skewed with 90%, 95% and 99% percentiles being ≤6,≤10 and≤39 CAIPS respectively. An aggregate 5525 CAIPs were reported, with 9% of GBM accounting for 52% of all CAIPs (those reporting >6 CAIPs); 5% accounting for 40% of all CAIPs (those reporting >10 CAIPs); and 1% accounting for 19% of all CAIPs (those reporting 40+ CAIPs). The Gini index was 0.59 indicating high inequality. GBM in these three “cores” were more likely to be older, diagnosed HIV positive, have recent STI diagnoses and negative attitudes towards condoms and safe sex obligations. Conclusion A large volume of condomless sex partnerships in this community sample was generated by a small proportion of GBM representing highly sexually connected nodes. Clinically, interventions with these GBM such as PrEP and early diagnosis and treatment can disrupt transmission of HIV and STIs across sexual networks and must be attractive and accessible to them.

This study was intended to analyze the intersection of experience of sexual stigma low-socioeconomic status, and suicide attempt amongst young Brazilians (11–24 years old). In each of the data collection periods (2004–2006: n = 7185; 2010–2012: n = 2734), participants completed a questionnaire-based instrument. Network analysis provided support for a Minority Stress Model, oriented around whether participants had experienced sexual stigma. Although suicide attempts decreased by 20% for participants who had not experienced sexual stigma, there was a 60% increase for those who had experienced sexual stigma. Of particular note were the increases in rates of reported community and familial physical assault, molestation, and rape for those who had experienced sexual stigma. An analysis of centrality statistics demonstrated that both experiences of this Minority Stress Model were fundamentally different, and that those disparities increased over the time frame observed in this study. At the center of this model, shortest paths statistics exhibited a direct conditioned connection between experiencing sexual stigma and suicide attempts. We discuss the social and historical contexts that contributed to these dynamics, and emphasize the need for policy change.

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