Trump’s HRSA Guidelines Block Trans Care in the Federal HIV Safety Net
The Trump administration’s Health Resources and Services Administration (HRSA) issued guidelines in March 2026 barring Ryan White HIV/AIDS Program grantees from acknowledging transgender identity or providing gender-affirming care using federal funds. Lambda Legal filed a legal challenge against HRSA and the Department of Health and Human Services (HHS) on behalf of national HIV medical associations and providers, several of whom are Ryan White grantees directly subject to the new rules.
The Ryan White HIV/AIDS Program is the federal government’s primary safety-net program for people living with HIV. Congress created it in 1990 with the Ryan White CARE Act, named for the young hemophilia patient and AIDS activist who died at age 18. Since then, the program has served more than 500,000 low-income individuals nationwide. Its viral suppression rate among beneficiaries exceeds 90%.
“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.”
Jose Abrigo, Senior Attorney and HIV Project Director, Lambda Legal, June 2026
That exclusion has a direct clinical consequence. Congress designed the Ryan White Program to fund care based on clinical judgment and patient need. The new HRSA guidelines override that design by making funding conditional on whether providers affirm, or even acknowledge, a patient’s gender identity.
What HRSA’s New Guidelines Require Ryan White Grantees to Do
Lambda Legal’s complaint explains 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.” The guidelines do not distinguish between gender-affirming care and other medically necessary treatment a trans patient with HIV might receive.
The practical effect is a forced choice: HIV providers who serve transgender patients must either drop federal funding or restrict care. Trans people living with HIV are among the populations most dependent on the Ryan White program, and gender-affirming care is often part of their integrated HIV treatment plan, not a separate service.
Lambda Legal’s lawsuit argues the guidelines exceed HRSA’s statutory authority and contradict the program’s founding legislation. The case is part of a broader set of Lambda Legal actions targeting the administration’s rollback of federal recognition of transgender identity across health and social programs.
What You Can Do Now
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Call your senators at (202) 224-3121 and ask them to hold oversight hearings on HRSA’s March 2026 Ryan White guidelines. Tell them the guidelines contradict the program’s congressional mandate to fund care based on clinical need, not patient identity.
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Submit a public comment at regulations.gov opposing the HRSA funding guidelines. Search “Ryan White” or the HRSA docket number. Written comments create a formal administrative record Lambda Legal and other litigants can cite in court.
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Contact your House representative at house.gov/representatives/find and ask them to sign onto a congressional letter to HRSA demanding the guidelines be withdrawn. The Ryan White CARE Act requires periodic reauthorization, and documented congressional opposition can directly affect how HRSA interprets its mandate.
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Track the Lambda Legal lawsuit at lambdalegal.org for updates on preliminary injunction hearings. A court order blocking enforcement of the guidelines before trial would restore grantees’ ability to provide care while the case proceeds.
Sources
LGBTQ Nation: Trump Seeks to Remove Trans Patients from Ryan White HIV Program Lambda Legal: Statement on HRSA Ryan White Funding Guidelines Legal Challenge HRSA: Ryan White HIV/AIDS Program Overview and Beneficiary Data Congress.gov: Ryan White CARE Act Legislative History and Reauthorizations HHS: Health Resources and Services Administration Bureau Information