CDC Designates HIV Prevention in Young Transgender Women Effective

November 15, 2018

Behavioral intervention produced significant reduction in HIV risk in a randomized clinical efficacy trial

Project LifeSkills, a behavioral intervention to prevent HIV in young transgender women, was designated by the HIV/AIDS Prevention Research Synthesis (PRS) project at the U.S. Centers for Disease Control and Prevention (CDC) as showing the best evidence of efficacy. In a randomized clinical efficacy trial, this intervention resulted in nearly 40 percent greater reduction in sex acts without a condom during the 12-month follow-up period compared to the standard preventive care. Findings were published in JAMA Pediatrics.  

“Our study was the first to demonstrate the most robust evidence of efficacy for a behavioral intervention to reduce sexual risk for HIV infection and transmission in young transgender women,” said lead author Rob Garofalo, MD, MPH, Head of Potocsnak Family Division of Adolescent and Young Adult Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “The CDC designation also is the first in the agency’s history for transgender women, a population of highest risk of HIV acquisition.”

HIV prevalence in transgender women in the U.S. is nearly 22 percent. This population has 34-fold increased odds of HIV infection compared with all adults of reproductive age.

Project LifeSkills is a peer-led intervention that is delivered in two-hour, small group sessions twice a week for three consecutive weeks. It provides education on HIV transmission mode and related risks, motivates participants to protect themselves with condoms, and empowers them to communicate about safe practices with sexual partners. The curriculum was developed by Dr. Garofalo and team with community participation, and it is grounded in the social realities of young transgender women. Content addresses specific environmental factors faced by this population, such as securing safe housing, accessing medical care and obtaining employment. The curriculum also directly addresses the lure of commercial sex work, a complex HIV risk for young transgender women.

“We believe our intervention was successful because it was delivered by peers, focused on empowerment and addressed important practical needs of young transgender women,” said Dr. Garofalo, who also directs the Gender Development Program, as well as the Center for Gender, Sexuality and HIV Prevention at Stanley Manne Children’s Research Institute at Lurie Children’s.

The study was conducted in collaboration with researchers at Brown University and The Fenway Institute.

Complete information about the PRS efficacy review process, methods, and criteria as well as the Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention can be found on the CDC website: http://www.cdc.gov/hiv/dhap/prb/prs/index.html. Project LifeSkills will be added to the Compendium website and highlighted as an evidence-based intervention (EBI) for researchers, policy decision makers, and prevention providers.

Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through the Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals in the U.S.News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 212,000 children from 49 states and 51 countries.