National HIV medical associations and providers are challenging the Trump administration’s new federal funding guidelines that target transgender identity assisted by the Ryan White HIV/AIDS Program.
The new regulations bar organizations that access the decades-old program, including several of the plaintiffs, from acknowledging transgender identity and providing gender-affirming care to patients.
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The new guidelines were issued in March.
A statement from Lambda Legal that refers to the Health Resources and Services Administration (HRSA), a bureau of the Department of Health and Human Services (HHS), explains that “Defendants have adopted a policy that HRSA funding recipients may not acknowledge, affirm, or respect the identities of transgender people, and may not use federal funding in a way that promotes so-called ‘gender ideology,’ including through the provision of gender-affirming medical care.”
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“This is just one piece of the Trump administration’s broad campaign to erase the identities of transgender people and limit their ability to participate in public life, including by limiting access to the medical care some transgender people need to live authentically as themselves,” Lamba Legal added.
The Ryan White HIV/AIDS Program was established by Congress in 1990 with the Ryan White CARE Act, named for the young AIDS activist who suffered from hemophilia. He died at 18 after an HIV-related infection.
Congress designed the program to support medically necessary HIV-related care based on clinical judgment and patient need, Lambda said. The program is the federal government’s primary safety-net program for people living with HIV, including more than half a million low-income individuals served nationwide since the program’s inception.
A model of “flexible, locally driven, comprehensive care for people living with HIV” has made the Ryan White HIV/AIDS Program one of the most successful public health initiatives in U.S. history, with viral suppression rates of more than 90% in the program’s beneficiaries, according to the most recent data.
“In one sweeping move, the Trump administration is attempting to rewrite a public health program in a way that excludes patients who depend on it,” said Jose Abrigo, Senior Attorney and HIV Project Director at Lambda Legal. “The Ryan White Program is a success precisely because of the way it has been structured. It has for three decades been a safe haven for people living with HIV grounded in clinical judgment and comprehensive patient needs. These restrictions interfere with that framework and place transgender patients at risk of losing access to care.”
The lawsuit alleges that HHS and HRSA violated the Administrative Procedure Act by exceeding their statutory authority and imposing funding conditions that conflict with the program’s Congressional statute.
The complaint also challenges the restrictions as “arbitrary” and “capricious,” with no “reasoned explanation” beyond the president’s so-called “gender ideology” executive order, which, like all similar executive orders, lacks the force of law.
“The Challenged Conditions would require HIV care providers to refuse to acknowledge, affirm, or respect the identities of their transgender patients and would forbid these providers from using Ryan White funding to provide transgender patients with gender-affirming hormone therapy — even though the Ryan White Statute explicitly contemplates such care as an outpatient service provided as part of a patient’s primary care,” the lawsuit states.
“These actions, in turn, risk exacerbating the HIV epidemic by making it less likely that transgender patients will engage with HIV care, reducing adherence to HIV treatment regimens, and increasing the likelihood of HIV transmission in the broader community,” the lawsuit continues.
“Defendants’ actions are not just unconscionable; they are unlawful,” the lawsuit adds. “They flaunt the text, purpose, and structure of the Ryan White statute as well as statutory and constitutional guarantees against discrimination.”
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