Life Skills: Evaluation of a Theory-Driven Behavioral HIV Prevention Intervention for Young Transgender Women

Abstract

Young transgender women are at increased risk for HIV infection due to factors related to stigma/marginalization and participation in risky sexual behaviors. To date, no HIV prevention interventions have been developed or proven successful with young transgender women. To address this gap, we developed and pilot tested a homegrown intervention "Life Skills," addressing the unique HIV prevention needs of young transgender women aged 16-24 years. Study aims included assessing the feasibility of a small group-based intervention with the study population and examining participant's engagement in HIV-related risk behaviors pre-and 3-months-postintervention. Fifty-one (N=51) young transgender women enrolled in the study. Our overall attendance and retention rates demonstrate that small group-based HIV prevention programs for young transgender women are both feasible and acceptable. Trends in outcome measures suggest that participation in the intervention may reduce HIV-related risk behaviors. Further testing of the intervention with a control group is warranted.

HIV Prevention Among Transgender Populations: Knowledge Gaps and Evidence for Action

“…Few evidence-based HIV prevention interventions have been developed for and tested among transgender people [38, 39]; and only one intervention from the U.S. Centers for Disease Control compendium of evidence-based prevention interventions, (SISTA) has been formally adapted for transgender women (T-SISTA) [40]. Table 1 provides the results of a scoping review of evidence-based transgender-specific HIV prevention interventions, organized by intervention approach: (1) Behavioral: interventions that primarily employ individual behavior change approaches to target knowledge, attitudes, and HIV risk behaviors; (2) Biomedical: interventions that promote use of biomedical HIV prevention and care methods such as pre-exposure prophylaxis (PrEP) as well as engagement, retention, and adherence to HIV treatment (i.e.…”

“…For example, some interventions included small group sessions on transgender pride, skill building (e.g., how to access medical care, employment, and housing), communication and respect [39], as well as sessions on substance use [43, 44], social support [44, 45], and personal growth [44]. A few interventions also facilitated referral to social services [43, 45, 46], including substance abuse treatment [43], and met practical needs such as showers or clothing [43].…”

“…However, these aspects of the intervention were often not specifically evaluated. When psychosocial factors were evaluated, they seldom resulted in significant improvements [39]. The short-term and individual nature of these behavioral interventions may have limited their ability to meaningfully address more distal psychosocial drivers of HIV.…”

HIV epidemics among transgender women

“…A strengths-based approach is especially important for transgender women, given the high levels of stigma and marginalization the community often faces. One example of such an intervention is Life Skills, a peer-led group intervention designed by and for young transgender women [45]. …”

Considerations for the design of Human Immunodeficiency Virus (HIV) prevention programs for lesbian and bisexual women

“…Discrimination and violence against the identity of vulnerable populations (MSM and transgender people) have been widely included in HIV prevention 31 . In these interventions, participants appreciated when they are taught how to access existing resources and social networks, as well as discussing the social expectations about love and intimacy 32 .…”