Chicago
Jane Hereth, Clinical Research Coordinator
Lark Mulligan, Research Associate
Ebonii Warren-Watts, Research Associate
Boston
Bianca Aponte, Research Associate
Emilia Dunham, Senior Research Associate
Nelisa Rash, Research Associate
Jackie White, Project Manager
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“Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.
Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”
--World Health Organization, 2002
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 Transgender women have HIV prevalence rates as high as or higher than other high-risk populations in the U.S.
 Meta-analysis of 29 studies
 >25% laboratory-confirmed HIV seropositive
 Racial/Ethnic disparities
 Black/African American trans women
 > 50% laboratory-confirmed HIV seroprevalence
 High rates of unrecognized HIV infection (>10%), with the largest percentage among young transgender women ages 29 and younger
Herbst et al., 2008; Schulden et al., 2008
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 According to the CDC, there are no theoretically-driven, evidence-based HIV prevention interventions for transgender communities
 Need for comprehensive HIV prevention programs to meet the unique needs of young trans women
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 CDC-funded pilot study 2008-2009 in Chicago
(PI: Robert Garafalo, MD)
 Community-based participatory research principles
 Young trans-identified staff led the writing of intervention
 Based in empowerment theory
 Holistic, theoretically-driven curriculum grounded in the lived realities many young trans women face
 Focuses on day-to-day issues facing young trans women that can complicate comprehensive HIV prevention efforts
 “With” not “on” trans communities
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 Enrollment and retention was possible
 51 participants enrolled in 6 months
 Retention and session attendance were high
 84% of participants were retained over the study
 The participants liked it!
 More than 90% of participants:
▪ Would recommend to other young trans women
▪ Better understood the issues surrounding unsafe sex
▪ Felt better about their futures
Garafalo et al., 2012 6

 Following the intervention (3-month follow-up), participants reported reduced sexual risk
 Decreased…
▪ # of times participants had receptive anal sex with casual partners
▪ #of main partners
 LifeSkills was acceptable and feasible
 Warrants testing in a larger efficacy trial
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 To test whether the LifeSkills curriculum works to reduce HIV risk for young trans women ages 16-24 at risk for HIV acquisition or transmission
 Two U.S. cities: Boston and Chicago
 Enroll 375 young trans women
 5-year research grant – R01
National Institute of Mental Health – randomized controlled trial
Investigators:
M. Mimiaga
S. Reisner
Investigators:
R. Garafalo
L. Kuhns
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 Enroll 375 young at-risk trans women ages 16-24
 Randomize participants (like the flip of a coin)
 Three “arms” (e.g., different types of programs):
 Program 1: Standard-of-care program (N=150)
 Program 2: 6-session group-based LifeSkills intervention (N=150)
 Program 3: 6-session group-based general health program (N=75)
 All three programs receive HIV and STI (Chlamydia and gonorrhea) testing and pre-post test risk reduction counseling
 4 assessments: baseline, 4, 8, 12 months post-intervention
 Primary outcome: Number of unprotected anal or vaginal sex acts in the past 4 months
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First Visit
Lasts 2 hours ($25)
Consent/Assent
Fill out Questionnaire
STI/HIV Testing
Second Visit – Randomization
(flip of a coin)
Lasts 20 min or 2 hours
Program 1: Control
Lasts 20 minutes ($10)
Program 2: “LifeSkills”
6 group sessions, 2 hours each
(2 sessions x 3 weeks)
($10 per session; $10 for completing 2 sessions in a row)
N=150 N=150
Program 3: General Health
6 group sessions, 2 hours each
(2 sessions x 3 weeks)
($10 per session; $10 for completing 2 sessions in a row)
N=75
4 Month Visit
Lasts 2 hours ($50)
Fill out Questionnaire
STI/HIV Testing
8 Month Visit
Lasts 2 hours ($50)
Fill out Questionnaire
12 Month Visit
Lasts 2 hours ($50)
Fill out Questionnaire
STI/HIV Testing
Participants in Program 1 and 3
Offered LifeSkills Sessions
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Lark Mulligan
Jane Hereth Amy
Johnson
Ebonii Warren-Watts
Robert
Garofalo
Lisa Kuhns
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Nelisa Rash
Bianca Aponte
Emilia
Dunham
Jackie White
Sari
Reisner
Matthew
Mimiaga
Mick Rehrig
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Begins March 8, 2012
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 Organizations and programs
 Peer groups
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 Healthcare providers
Begins March 8, 2012
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 Network and make referrals
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 Hand them out, make visible, give to colleagues, etc
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Begins March 8, 2012
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Session Title
1 Pride
2
3
4
5
Communication and
Respect
Skill Building around
Navigating
Employment, Housing and Healthcare
Knowledge and Self-
Protection
Partner Negotiation
6 Tying it all Together
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These are programs not studies for trans women, but may have research component
Programs provide direct service and often have more flexibility, but research is often a good step toward creating programs
When LifeSkills can’t help, we refer to partner organizations
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 Research studies can affect community resources and programs by showing need for more funding
 They can help contribute to public awareness
 They can add to scientific knowledge
 They can affect law and policy
But we don’t have a lot of them!

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Fact sheets for policy makers
 Mass. drew state data to write their own, which were used to strengthen support for the Trans Rights Bill.
(Another study showed 76% MA residents in favor of the bill.)
 Topic specific generated for gov’t agencies (SAMHSA)
Allows for adding to the literature on trans health
Helps policy advocacy: commitment to data collection (HHS), trans veterans health rights,
Office of Personnel Management

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www.ProjectLifeSkills.org
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Chicago
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Jane Hereth: JHereth@luriechildrens.org
Lark Mulligan: LMulligan@luriechildrens.org
Ebonii Warren-Watts: EWatts@luriechildrens.org
Boston
 Bianca Aponte: baponte@fenwayhealth.org
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Emilia Dunham: edunham@fenwayhealth.org
Nelisa Rash: nrash@fenwayhealth.org
Jackie White: jwhite@fenwayhealth.org
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Children's Memorial Hospital
2300 Children's Plaza
Chicago, IL 60614
Call or Text: 773.245.3755 (773.24LFSKL)
Email: lifeskills@childrensmemorial.org
Facebook: https://www.facebook.com/missylifeskills
Fenway Health
1340 Boylston Street
Boston, MA 02215
Call or Text: 617.299.9013
Email: lifeskills@fenwayhealth.org
Facebook: https://www.facebook.com/lifeskillsboston
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