When care is withheld for political reasons, patients stop trusting their providers. When trust breaks, they stop showing up for the treatment that keeps them alive.
Today, Lambda Legal and Herbert Smith Freehills Kramer (US) LLP presented their case at a bench trial in American Academy for HIV Medicine, et al. v. HRSA, et al., the lawsuit challenging the Trump Administration’s efforts to exclude transgender patients living with HIV from the Ryan White HIV/AIDS Program and restrict the use of Ryan White funds when providing HIV care and other care for these patients. The case was brought 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 provider plaintiffs.
The Ryan White Program was built to provide integrated care for low-income people living with HIV, a population that includes a significant number of transgender people. Under the funding conditions at issue, Ryan White funding recipients cannot acknowledge or respect the identities of their transgender patients and cannot use program funds in ways that necessitate them doing so, such as by treating co-occurring conditions like gender dysphoria through gender-affirming hormones. That leaves transgender patients cut off from care Congress built this program to give them.
“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 Jose Abrigo, Senior Attorney and HIV Project Director at Lambda Legal. “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 hearing today demonstrated the importance of honoring Congress’s intent to provide full access to comprehensive healthcare for the most vulnerable communities affected by HIV,” said Jeffrey S. Trachtman, Counsel at HSF Kramer.
The Ryan White HIV/AIDS Program has served as the nation’s safety net for people living with HIV for 35 years. It supports more than half a million low-income patients through a model that lets local providers respond to what their communities actually need. That model works. Patients in Ryan White care reach viral suppression at rates above 90 percent, among the strongest results of any public health program in the country.
The Ryan White HIV/AIDS Program has always enjoyed strong bipartisan support from its inception as a safety net life-saving medical care access program for low-income Americans who otherwise cannot access care for HIV. The Trump Administration’s attempted prohibition of gender-affirming medical care under the Ryan White HIV/AIDS Program puts that access to HIV care at risk, as gender-affirming care is considered a core medical service within the program,” said Bruce Pickett, Executive Director of the American Academy of HIV Medicine. “Further, for AAHIVM provider members, this restriction creates an impossible choice: comply with federal funding requirements or fulfill their duty of care to their clients. My hope is that the court understands the stakes involved and the overreach that the administration is attempting. By keeping the Ryan White HIV/AIDS Program functioning as it was intended, we can help to ensure that every person with HIV will have access to competent, compassionate care, thereby adverting an unnecessary public health crisis in the making.”
The restrictions at issue are set forth in various agency guidance and policies, including recent General Terms and Conditions and Notices of Funding Opportunity issued by HRSA. They target acknowledgment of transgender patients’ identities, and as a result, access to gender-affirming medical care. For decades, clinicians have provided HIV care and primary care to people living with HIV based on what patients needed. This mandate takes that decision away from them.
The Ryan White Program was created as a public health intervention to address the needs of ALL low income and vulnerable populations who otherwise would not have access to life-saving care. We know that early and uninterrupted access to HIV care and treatment optimizes health outcomes for people with HIV and prevents transmission to others,” said Melanie Thompson, MD, co-chair of the HIVMA Primary Care Guidance for People with HIV panel and a past HIVMA chair. “This incredibly successful program has always been grounded in evidence-based care and treatment that is patient-centered and comprehensive, including addressing mental health and economic and structural barriers to care. Research has shown that providing comprehensive patient-centered health care services, including gender affirming medical care, to transgender people with HIV is strongly associated with higher levels of care engagement, adherence to HIV treatment, and viral suppression. It is crucial that Ryan White clinicians are able to deliver the most effective care to all patients with HIV who need it, including transgender individuals without discrimination, to improve health outcomes for ALL and to end the U.S. HIV epidemic.”
Ryan White HIV/AIDS Program was built on a simple but powerful principle: people living with HIV deserve access to comprehensive, evidence-based, person-centered care regardless of who they are,” said Dr. José M. Zuniga, President/CEO of the International Association of Providers of AIDS Care (IAPAC). “Allowing political ideology to dictate what care clinicians can provide or which patients are worthy of receiving it threatens both that principle and the extraordinary public health progress the program has made possible. 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
At the hearing/bench trial, Plaintiffs argued that HHS and HRSA unlawfully rewrote the rules of the Ryan White HIV/AIDS Program by imposing new restrictions that conflict with federal law and abandon longstanding agency policy. Plaintiffs also argued that the restrictions unlawfully target transgender people and force healthcare providers to adopt the government’s views about transgender identity, in violation of the First and Fifth Amendments. The court did not rule from the bench today, and a written decision may take time. Lambda Legal and its co-counsel remain committed to this case and will keep fighting until access to critical HIV care and comprehensive care for the transgender people living with HIV served by the Ryan White Program is secured and protected.
Read more about the lawsuit, AAHIVM v. HRSA, here: https://lambdalegal.org/case/american-academy-of-hiv-medicine-v-hrsa/
Read more about Lambda Legal’s battles against the Trump Administration here: https://lambdalegal.org/trumptracker/