Lambda Legal leads case, charging that a new federal policy threatens access to medically necessary care for trans folk and undermines the purpose of Ryan White
The LGBTQ+ legal group Lambda Legal and a prominent law firm have filed a lawsuit challenging a federal policy that bars the use of Ryan White CARE Act funds for gender-affirming care for low-income transgender people living with HIV who receive services through Ryan White-funded clinics and programs.
The suit, The American Academy of HIV Medicine et al. v. U.S. Department of Health and Human Services et al., was filed June 10 on behalf of HIV medical organizations and care providers.
Lambda’s partner in the case is HSF Kramer US, the American division of Herbert Smith Freehills Kramer, a global law firm based in London, England, and Sydney, Australia. The U.S. division has offices in Washington, D.C., New York City and in Silicon Valley, and specializes in complex corporate litigation and white-collar defense, frequently taking on pro bono advocacy work involving LGBTQ+ rights and gender equity.
Gender-affirming care can include services from hormone therapy to mental health counseling. These services have long been covered by Ryan White for transgender people in addition to core HIV treatment, much as the program covers treatment for other non-HIV-specific conditions like diabetes or heart disease. A 2020 study calculated that about 11,000 transgender Americans living with HIV were receiving care through Ryan White.
At a June 11 virtual press conference about the suit, reps from Lambda Legal and Herbert Smith Freehills Kramer said they were “cautiously optimistic” that the courts would not only swiftly issue a preliminary injunction against the ban (meaning a temporary freeze on it while courts hear the case) but a permanent rejection of it.
“We put forth the best legal arguments we could,” said José Abrigo, Lambda Legal’s HIV project director. The government has two weeks to respond to the litigators’ request for the preliminary injunction.
The plaintiffs argue that the ban is unlawful because Congress, which appropriates funding for Ryan White, never said the money couldn’t be used for gender-affirming care.
The ban “undermines the very purpose of the RWCA program,” Abrigo said, because RWCA has long functioned to cover all aspects of keeping people with HIV in the program healthy, from stable housing and transportation to health visits to nutrition, dental health and mental health.
The Ryan White program is based on the idea that “you must treat the whole person,” Abrigo said. Therefore, gender-affirming care such as hormone treatment and talk therapy are key to keeping trans people with HIV healthy overall, not only staying virally suppressed on HIV meds.
“One transgender woman told me, ‘I’d rather die as a woman than live as a man,” Abrigo said. “Behind every policy debate are real people trying to live healthy and authentic lives.”
The ban on Ryan White funding for gender-affirming services, which was put in place in April 2025 and extended to other components of the program on June 8, is in keeping with a sweeping and ongoing Trump administration effort to block federal funding of any kind from going to healthcare or health research for trans people (as well as other groups that the administration labels as “diversity, equity and inclusion” populations, such as those who are LGBTQ+ and/or people of color).
Potential serious consequences for ignoring the ban
Plaintiffs in the case include the American Academy of HIV Medicine (AAHIVM), the HIV Medicine Association (HIVMA) and the International Association of Providers of AIDS Care (IAPAC).
During the virtual press conference, representatives of those groups said they weren’t sure if or how Ryan White-funded clinics nationwide were complying with or flouting the federal ban.
But they said the ban was serious and that providers caught ignoring it—such as via evidence in patients’ electronic medical records, which capture gender markers and services rendered—could lead to those providers losing Ryan White funding for not only gender-affirming care but all services at their clinics.
“We are talking about the force of law here,” said Atlanta HIV care provider Melanie Thompson, MD, co-chair of HIVMA’s Primary Care Guidance for People with HIV panel and a past HIVMA chair. If clinics receiving Ryan White funds “decide to continue to provide [gender-affirming] care, maybe they will be identified and maybe they won’t—but the penalty for being found out is severe and puts an entire program’s funding in jeopardy,” she said.
Dr. Thompson worried that news of the ban could scare transgender patients out of showing up for other care—and possibly going off their HIV meds, which could put them at risk for not only becoming ill but transmitting HIV to others. “Even just going to a visit becomes threatening,” she said.
The ban also means the Ryan White program cannot cover premiums for private health insurance plans (as it usually does) if trans patients are going to use those plans to cover gender-affirming care, the reps on the call said.
In a press release issued June 10 by Lambda Legal, Bruce Packett, executive director of the American Academy of HIV Medicine, said, “Four-in-ten AAHIVM members rely on Ryan White funding, and of those, 40% voluntarily report providing gender-affirming medical care. The actual number of clinics providing those services is potentially even higher.”
“Gender-affirming medical care is not a peripheral service meant to be offered when the political headwinds allow for it,” he continued. “Under Ryan White’s own framework, it is a core medical service; it is primary healthcare that is evidence-based, medically necessary, and, in many cases, lifesaving.”
While transgender people make up about 1% of the U.S. population, trans women have rates of HIV disproportionately larger to their numbers, partly because, due to job and education discrimination, they are more likely to engage in sex work for survival.
Also, because they are often low-income and uninsured, a disproportionate number of people living with HIV rely on care through Ryan White, which has income eligibility cutoffs.
POSITIVELY AWARE will continue reporting on this story as it develops.