New guidance for the federal Ryan White program restricts access to comprehensive health care services to transgender people living with HIV, explicitly undermining the program’s purpose.
Today, Lambda Legal and Herbert Smith Freehills Kramer (US) LLP (HSF Kramer) filed a lawsuit on behalf of national HIV medical associations and providers challenging new federal funding guidelines that restrict the use of Ryan White HIV/AIDS Program funds in the treatment of low-income transgender patients living with HIV. The lawsuit was filed on behalf of leading national HIV medical organizations, including the American Academy of HIV Medicine (AAHIVM), the HIV Medicine Association (HIVMA), and the International Association of Providers of AIDS Care (IAPAC), as well as two provider plaintiffs.
The Ryan White Program funds were specifically intended to have an integrated model of care providing primary care and addressing the social determinants of health confronting low-income people living with HIV – of which a significant number are transgender – including environmental and mental health factors. However, under the new funding guidelines promulgated by the U.S. Department of Health and Human Services, Ryan White funding recipients cannot acknowledge or respect the identities of their transgender patients or use funding for gender-affirming medical care, denying low-income transgender people living with HIV the comprehensive healthcare the programs were created to provide.
“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.”
“We are proud to continue Kramer Levin’s decades-long partnership with Lambda Legal as part of HSF Kramer, a global firm with the same longstanding commitment to LGBTQ equality, and to help advocate for the most vulnerable communities affected by HIV,” said Jeffrey Trachtman, Counsel at HSF Kramer.
The Ryan White HIV/AIDS Program is the federal government’s primary safety-net program for people living with HIV. For 35 years, it has served more than half a million low-income individuals nationwide and supports a network of medical care, medications, and related services. Congress designed the Ryan White HIV/AIDS Program to provide flexible, locally driven, comprehensive care for people living with HIV — and that model has made it one of the most successful public health programs in the nation’s history. By empowering local providers to respond to the real needs of their communities through an integrated healthcare model, the Program has achieved record-breaking viral suppression rates exceeding 90% among patients receiving care. And this administration is trying to undermine the very principles that has made the program so successful.
“The Ryan White Program was created as a public health intervention to address the needs of low income, vulnerable populations who otherwise would not have access to life-saving care. We know that HIV suppression optimizes health outcomes for people with HIV as well as 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. “The remarkable success of this program lies in its adherence to the highest standards of evidence-based care and its patient-centered, comprehensive approach to care, 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 be allowed to continue to deliver the most scientifically appropriate treatments for all patients, including transgender individuals, without discrimination if we are to improve health outcomes for all and end the U.S. HIV epidemic.”
The challenged funding restrictions, issued through recent General Terms and Conditions and Notices of Funding Opportunity, prohibit providers from using federal funds from the HIV program to cover related comprehensive care for transgender patients by targeting acknowledgement of transgender people’s identities and gender-affirming medical care. This approach deviates from longstanding program implementation, which has allowed clinicians to determine care based on patient needs and a comprehensive approach that addresses social determinants of health for people living with HIV, such as their housing, other health conditions, mental health, etc.
“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,” said Bruce Packett, Executive Director of the American Academy of HIV Medicine. “Gender-affirming medical care is not a peripheral service meant to be offered when the political headwinds allow for it. 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.” Transgender people living with HIV rely on Ryan White services at higher rates due to barriers in accessing insurance and care and being disproportionately low-income. Providers have found that access to gender-affirming medical care supports patient engagement in treatment and ongoing care.
“For decades, the Ryan White HIV/AIDS Program has demonstrated that patient-centered, comprehensive care is essential to improving HIV outcomes and reducing health inequities.” said Dr. José M. Zúñiga, President/CEO, International Association of Providers of AIDS Care “Restricting access to gender-affirming medical care for transgender people living with HIV is inconsistent with both established public health evidence and the intent of the program itself. Policies that exclude already vulnerable communities from medically necessary care threaten progress toward ending the HIV epidemic. IAPAC is joining this lawsuit to defend evidence-based care and the integrity of one of our nation’s most successful public health programs.”
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 Ryan White HIV/AIDS Program statute. Congress designed the program to support medically necessary HIV-related care based on clinical judgment and patient need. The complaint also challenges the restrictions as arbitrary and capricious, alleging that the agencies failed to provide a reasoned explanation for the policy change and did not adequately consider its impact on patients, providers, and public health outcomes. In addition, the lawsuit asserts that the Notices of Funding Opportunity violate the plaintiffs’ First Amendment rights by compelling them to adopt the government’s position regarding transgender people. The complaint further alleges that the restrictions discriminate against transgender people in violation of the equal protection component of the Fifth Amendment. The plaintiffs ask the court to block enforcement of the funding restrictions and ensure that the Ryan White HIV/AIDS Program continues to operate in accordance with federal law.
Read more about the lawsuit, AAHIVM v. HHS, here: https://lambdalegal.org/case/american-academy-of-hiv-medicine-v-us-dept-health-and-human-services/.
Read more about Lambda Legal’s battles against the Trump Administration here: https://lambdalegal.org/trumptracker/