Last month, the Health Resources and Services Administration (HRSA) released a letter encouraging Ryan White HIV/AIDS Program (RWHAP) service providers to leverage their existing infrastructure to provide access to gender affirming care and treatment services for transgender and gender diverse people with HIV. This guidance supports HRSA’s efforts to address health disparities and reduce barriers to lifesaving HIV care, medication, and support services for people of transgender experience with HIV so they can lead long, healthy lives.

The letter issued by HRSA’s HIV/AIDS Bureau reaffirms the importance of providing culturally affirming health care and social services to the transgender community as a key component of improving their lives. This includes housing, behavioral and mental health services, and medical care and medication, all of which are fundamental to reducing health disparities and improving HIV-related outcomes among transgender people.

RWHAP Initiatives to Support Transgender People with HIV

The RWHAP program serves more than 50 percent of all people with diagnosed HIV in the United States. Of the more than 561,000 people served by the RWHAP in 2020, 2.1 percent, approximately 11,600 were transgender. A number of HRSA funded initiatives support patient-centered, trauma-informed, and inclusive environments of care for transgender RWHAP clients to help reduce medical mistrust and other barriers to antiretroviral therapy adherence. Some examples of our work include:

• Using Evidence-Informed Interventions to Improve Health Outcomes for People Living with HIV (E2i)Exit Disclaimer Initiative: A project funded by the RWHAP Part F Special Projects of National Significance (SPNS) to identify and provide support for the implementation of evidence-informed interventions to reduce HIV-related disparities and improve health outcomes. One of E2i’s focus areas is improving HIV outcomes for transgender women.
• HIV Care Continuum Interventions for Transgender Women: A Topical Review: A recently published manuscript from the E2i project that outlines findings from a literature review on interventions designed to improve at least one HIV care continuum outcome or address one barrier to achieving HIV care continuum outcomes among transgender women with diagnosed HIV in the United States.
• A previously funded RWHAP Part F SPNS initiative, the Transgender Women of Color Initiative, focused specifically on transgender women of color with HIV. Each of the initiative’s nine demonstration sites developed innovative models for linking and retaining transgender women of color in HIV care. The intervention manuals from these demonstration sites are available on the TargetHIV websiteExit Disclaimer.
• The RWHAP Services Report (RSR): This report fills an important gap in national HIV data about transgender people with HIV. The RSR uses a two-step method for determining gender identity, which first identifies sex assigned at birth, followed by current gender identity (male, female, transgender female, transgender male, and other gender identity). To explore RWHAP client characteristics and outcomes, please see our RWHAP Compass Dashboard and the 2020 RWHAP Annual Client-Level Data Report.

Among transgender clients receiving RWHAP HIV medical care in 2020, 84.5 percent were virally suppressed, which is higher than the national average among all people with diagnosed HIV in the U.S., but it is lower than the national RWHAP average (89.4 percent). We recognize that we need to do more to support this community. To help achieve the goals of the National HIV/AIDS Strategy, including achieving health equity and ending the HIV epidemic, we will continue to support and share evidence-based, evidence-informed, and emerging interventions that focus on improving the health and lives of transgender and gender diverse people with HIV.

Access the Gender Affirming Care in the RWHAP letter.