Reducing HIV risk in young transgender women
A behavioral intervention program significantly reduced the sexual risk for HIV infection among young transgender women, according to the results of a Northwestern Medicine clinical trial.
The study, published in JAMA Pediatrics, is the first to demonstrate the efficacy of an intervention to reduce sexual risk among young transgender women—a population with extremely high HIV infection rates.
"More than 30 years into this epidemic, it is somewhat appalling that to-date there has not been an intervention that has been shown to be effective with transwomen, a group at very high risk for acquiring HIV, based largely upon sexual behavior. This study changes that," said first author Robert Garofalo, MD, MPH, chief of Adolescent Medicine in the Department of Pediatrics.
Transgender women's odds of contracting HIV are estimated to be 34 times greater than that of all adults of reproductive age, with research suggesting a particularly high infection rate among younger transgender women.
Still, there has been a lack of evidence-based interventions that focus on reducing sexual risk among this population.
In the current study, investigators evaluated Project LifeSkills, a novel HIV prevention program specifically targeted to young transgender women and led by peers. The group-delivered, empowerment-based curriculum included basic information on HIV but also addressed environmental factors—such as housing, medical care and employment—and promoted behavioral skills, including condom use and communication with sexual partners.
The intervention is grounded in the social realities of the population, Garofalo explained. "It was never an esoteric research project but was driven and directed by the community. Young transwomen were part of every aspect of the study—from study design, to intervention development, to recruitment and study implementation," he said.
The randomized clinical trial of the intervention included 190 sexually active transgender women between the ages of 16 and 29 at community-based sites in Chicago and Boston. Project LifeSkills was delivered in six two-hour sessions over the course of three weeks.
At one-year follow-up, the investigators found that the LifeSkills intervention resulted in a nearly 40 percent reduction in condomless sex among participants, compared to those who received standard care.
"We are so proud that it is the first evidence-based intervention for sexual risk reduction and HIV prevention for transwomen," said Garofalo, also a professor of Pediatrics in the Division of Adolescent Medicine and of Preventive Medicine. "Our hope is that LifeSkills can now be used by agencies all across the country that serve transwomen, and that it can be used in coordination with other prevention strategies like PrEP as part of more holistic approach to curb the epidemic."
Garofalo notes that the project is the result of more than 15 years of work.
"As investigators, you hope that one day your work can be used practically to help the communities you care about," he said. "For us and for this community this is a landmark moment in that this intervention is practical and one that can now be implemented in places across the U.S. and abroad that are doing HIV prevention work with young transwomen."