History of LifeSkills

Pilot study

In 2008-2009, with funding from the Centers for Disease Control and Prevention (CDC), the Life Skills HIV prevention intervention was developed. LifeSkills is based on empowerment theory and was developed using a community-based participatory approach. Members of our community (i.e., young trans women), with guidance from a multidisciplinary research team, led the development of a holistic, theoretically-driven intervention curriculum (i.e., “LifeSkills”).

LifeSkills acknowledges the many issues that disproportionately face our trans communities, such as gender-based violence, discrimination, school drop-out, poverty, unstable housing, survival sex, the need for gender affirmation, and challenges accessing culturally competent healthcare, many of which directly or indirectly result from the  social stigma and the realities of being trans today.

The LifeSkills curriculum contains specific content regarding the context in which HIV risk takes place for many of us, including securing safe housing and employment, and directly addresses the economic allure of transactional sex work, all of which are day-to-day realities for many of our young trans women and which complicate comprehensive HIV prevention efforts.

For example, we know that transactional sex work may help solve more immediate problems in our lives, such as securing food and housing, paying for gender transitioning, and earning extra income that may help our families. Similarly, substance and alcohol use may help us to cope with depression and discrimination, yet both sex work and substance use can place us at risk for HIV or other STIs. We need to talk about it. Know our risk boundaries and limits. Care for ourselves, protect ourselves, and empower ourselves.

Empowerment includes feeling part of a sisterhood of trans women, from many generations, standing in solidarity together, celebrating our beauty and diversity, and knowing that we are worth saving.

Findings from the first study

The pilot study, led by young trans women, found that enrollment was possible, and both retention and session attendance were high (84% of participants were retained over the course of the study). See published paper by Garofalo and colleagues (2012).

The LifeSkills program’s acceptability was extremely high: greater than 90% of participants indicated that they would recommend the curriculum to other young trans women, that they had greater understanding of the issues leading to unsafe sex post-intervention, and that the intervention helped them feel better about their futures.

The majority of sexual risk behaviors assessed at follow-up showed decreasing trends in the number  of unprotected receptive anal sex acts with casual partners and number of main partners at 3-month follow-up. The LifeSkills curriculum appeared to hold great promise for decreasing sexual risk among young trans women and improving the health of our communities.

Where we are now

The current study is a randomized-controlled trial of LifeSkills funded by the National Institutes of Health (NIH). All team members in Boston and Chicago were trained by the original group facilitators of the LifeSkills pilot study.