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Ryan White and Transgender Services

April 9, 2018


Logo of National Transgender HIV Testing Day

National Transgender HIV Testing Dayis April 18

HRSA's HIV/AIDS Bureau (HAB) has multiple initiatives under way to support transgender individuals living with HIV, who comprise about 1.3% of Ryan White HIV/AIDS Program (RWHAP) clients, according to the RWHAP Annual Client-Level Data Report, 2016. The HIV care needs of transgender clients parallel those of the broader RWHAP client population in that they reflect challenges faced by economically disadvantaged minorities who often must grapple with housing issues and barriers to access to health insurance.

The HRSA fact sheetTransgender: Ryan White HIV/AIDS Program Clients, 2016 summarizes RWHAP transgender client issues as follows:

  • The majority of transgender clients served by RWHAP are from racial and ethnic minority populations
  • The majority of transgender clients served by RWHAP are low income
  • Data show that 11.2% of transgender clients have unstable housing 
  • The RWHAP transgender client population is aging 

Ryan White HIV/AIDS Program Transgender Clients

Transgender RWHAP Clients and Viral Suppression

RWHAP transgender clients have lower rates of viral suppression compared with the overall RWHAP client population: 79.4% of RWHAP transgender clients are virally suppressed while the national RWHAP average is 84.9%. However, clinical outcomes are improving across the board. According to the 2016 RSR report:

  • The proportion of RWHAP clients who achieved viral suppression has increased steadily from 69.5% in 2010 to 84.9% in 2016.
  • In 2016, among transgender women, 79% had achieved viral suppression, which is a 14% increase from the 2012 figure.

HRSA Transgender Initiatives

Clinical Quality Management

The end+disparities ECHO Collaborativeis a HRSA-supported national improvement initiative to measurably increase viral suppression rates for four disproportionately affected subpopulations of people living with HIV among Ryan White HIV/AIDS Program recipients and subrecipients. The selected HIV subpopulations are African American Women and Latinas, MSM of Color, Transgender People, and Youth. 

Special Projects of National Significance

Beginning in 2012, HRSA embarked upon a Special Projects of National Significance initiative to investigate innovations in HIV care for transgender individuals. That effort, Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative, was "a multisite demonstration and evaluation of HIV service delivery interventions for transgender women of color." Based at the University of California San Francisco, the Transgender Evaluation and Technical Assistance Center (TETAC) for the initiative coordinated 2018 National Transgender HIV Testing Day (NTHTD) activities. Campaign materials for NTHTD include a toolkit with facts sheets, research summaries, and best practices.

Transgender Health

His Health is a HRSA-funded project that brings together health care providers and advocates to improve the standard of care for Black gay men. One of the project's online continuing education programs is focused on transgender health.

Building Care/Prevention Capacity: HIV Care Continuum in Southern Metro Areas

This new project, started in 2016, is funded under the Secretary’s Minority AIDS Initiative Fund, which will implement innovative models of service delivery to improve minority population health along the HIV care continuum. The focus will be on men who have sex with men (MSM), youth, cisgender and transgender women, and people who inject drugs (PWID).

Leadership Training for People of Color Living with HIV

Called BLOC, this project also started in 2016 and is training people of color living with HIV to participate in RWHAP planning bodies, medical and support care teams, boards of directors, and other mobilization efforts to address the goals of the National HIV/AIDS Strategy: Updated to 2020. The project will also support leadership development for transgender women of color and support expansion of the capacity of HIV prevention and care delivery systems.

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