HIV medical groups argue the administration’s new rules threaten patient trust and decades of progress in HIV treatment
Arguments were presented on September 22 at a bench trial in American Academy for HIV Medicine, et al. v. HRSA, et al., a lawsuit challenging the Trump administration’s policies that prevent transgender people living with HIV from getting full access to care through the Ryan White HIV/AIDS Program. The administration prohibits medical providers funded by the Ryan White program from acknowledging or respecting the identities of their transgender patients, and bans Ryan White funding from treating gender dysphoria through gender-affirming hormones. The restrictions are included in the most recent General Terms and Conditions and Notices of Funding Opportunity, issued March 11 by the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration, commonly known as HRSA.
The case was brought by Lambda Legal and a private law firm on behalf of the American Academy of HIV Medicine (AAHIVM), the HIV Medicine Association (HIVMA), the International Association of Providers of AIDS Care (IAPAC) and individual providers.
In opening statements, plaintiffs argued that HHS and HRSA issued restrictions that conflict with federal law and abandon long-standing agency policy. Plaintiffs also said the new rules violate the First and Fifth amendments by forcing healthcare providers to adopt the Trump administration’s views about transgender identity, and explained that the Ryan White Program was created to provide integrated care for low-income people living with HIV, which includes a high percentage of transgender people.
Lambda Legal said this new restriction cuts off transgender patients from care that Congress intended to give them, and limits the HIV and primary care that clinicians have provided for transgender patients for decades.
“The Ryan White Program succeeds because it puts patients first. It gives doctors and local providers the flexibility to meet people where they are, earn their trust, and keep them connected to lifesaving HIV care—especially patients who already face stigma, discrimination and barriers to care,” said José Abrigo, senior attorney and HIV project director at Lambda Legal, in a prepared statement. “For transgender people living with HIV, being respected by a provider is not incidental to care; it is part of what makes care accessible and effective. These new restrictions put politics ahead of our nation’s efforts to end the HIV epidemic, disrupt successful strategies to maximize viral suppression, deprive transgender patients living with HIV of the comprehensive care that the Ryan White Program is supposed to provide, interfere in the relationship between patients and their providers and threaten the success of a public health program that has worked for decades.”
The Ryan White HIV/AIDS Program has enjoyed strong bipartisan support since it was created in 1990 as a “safety net lifesaving medical care access program for low-income Americans who otherwise cannot access care for HIV,” Bruce J. Packett II, executive director of the American Academy of HIV Medicine, said in the release.
José M. Zuniga, MPH, PhD, and president/CEO of IAPAC, said that allowing political ideology to dictate what care clinicians can provide threatens both the principles of the Ryan White Program and the public health progress achieved it. “Transgender people living with HIV should not be forced to choose between having their identities respected and accessing the lifesaving care they need. We hope the court will protect not only the communities directly harmed by these restrictions, but also the integrity of a program that for more than three decades has demonstrated what is possible when science, compassion and human dignity guide our response to HIV,” he said.
In an email to POSITIVELY AWARE, Packett said the trial went well and that the judge asked thoughtful questions. “This is definitely encouraging, especially since it seemed that the government had trouble outlining a clear defense of the policy we’re challenging, and we’re optimistic about a positive outcome,” Packett wrote.
Packett added that it’s not yet clear what the scope of a ruling might be, nor when it will be issued. “The government’s funding guidelines that we are fighting against restrict the use of Ryan White HIV/AIDS Program funds in the treatment of low-income transgender patients with HIV. Depending on how the court rules, relief could potentially extend broadly for everyone using Ryan White funding or could be limited to only just the members of the plaintiff medical organizations.”
Opening arguments were heard in U.S. District Court in the District of Massachusetts in the courtroom of Judge William G. Young. Appointed by President Ronald Reagan in 1985, Young has leaned more progressive in his rulings, notably in recent high profile cases against the Trump administration.
Almost immediately after assuming office in January 2025, President Trump targeted transgender Americans with an executive order that blocked gender-affirming care for anyone under 19 years old, and directed federal agencies to curb the availability of puberty blockers, cross-sex hormones and surgical procedures. Following up, HHS and the Centers for Medicare & Medicaid Services (CMS) proposed rules barring hospitals from performing these procedures and blocking federal funding for them. Also in January 2025, the administration deleted massive amounts of health data, including HIV surveillance statistics, from federal websites, a move that appeared to be intended to eliminate information related to transgender health, gender identity and racial/sexual equity. A court order issued February 11, 2025, mandated the restoration of that data.