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Ryan White and Transgender People

April 5, 2019


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The HIV care needs of transgender clients parallel those of the broader Ryan White HIV/AIDS Program (RWHAP) client population. In that they reflect challenges faced by economically disadvantaged minorities. Many of whom must grapple with housing issues, and barriers to access to health insurance. HRSA's HIV/AIDS Bureau (HAB) has multiple initiatives under way to support transgender individuals living with HIV. They comprise 1.8% of RWHAP clients.

National Transgender HIV Testing Day is April 18

Below are select characteristics of RWHAP transgender clients, based on available data:

  • 88.1% are transgender women, 10.0% are transgender men, and 2.0% had an unknown or other gender identity.
  • 88.4% are from racial and ethnic minority populations
  • Most are living at or below the 100% federal poverty level (77.3% for transgender women and 65.5% for transgender men) 
  • One-fourth (24.9%) of transgender female clients have temporary/unstable housing; 17.6% of transgender male clients have temporary/unstable housing 

RWHAP Transgender Clients and Viral Suppression

RWHAP transgender clients have lower rates of viral suppression compared with the overall RWHAP client population. 80.9% of RWHAP transgender clients are virally suppressed while the national RWHAP average is 85.9%. However, clinical outcomes among RWHAP clients are improving, including transgender clients. (From 2010 to 2017, overall RWHAP client viral suppression rates increased from 69.5% to 85.9%.). This information is from the RWHAP Annual Client-Level Data Report, 2017

However, viral suppression is lagging for specific RWHAP transgender populations. Viral suppression was lowest among transgender clients aged 20–24 years (70.9%), those 25–29 years (74.0%), and those with temporary housing (73.3%) and unstable housing (65.0%) 

HRSA Transgender Initiatives

SPNS Innovations in Care for Transgender Women of Color

The SPNS initiative, Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative (2012-2017), produced a series of Intervention Manuals. They outlined innovative interventions to improve timely entry, engagement and retention in quality HIV care for transgender women of color living with HIV.

Clinical Quality Management

The end+disparities ECHO Collaborative is a HRSA-supported national improvement initiative. It's goal is to measurably increase viral suppression rates for four disproportionately affected subpopulations of people living with HIV among RWHAP recipients and subrecipients.

The selected HIV subpopulations are:

  • African American Women
  • Latinas
  • MSM of Color
  • Transgender People
  • Youth 

Transgender Health

His Health is a HRSA-funded project. It 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 technical assistance project, started in 2016, is funded under the Secretary’s Minority AIDS Initiative Fund. Participants are implementing 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
  • People who inject drugs (PWID)

Leadership Training for People of Color Living with HIV

Called "BLOC", this project also started in 2016.

It is training people of color living with HIV to participate in:

  • RWHAP planning bodies
  • Medical and support care teams
  • Boards of directors
  • Other mobilization efforts

To address the goals of the National HIV/AIDS Strategy [Updated to 2020]. The project will support leadership development for transgender women of color. It will also support expansion of the capacity of HIV prevention and care delivery systems.

AETC National HIV Curriculum: Sexual and Gender Minorities

The NHC includes a training module covering HIV among sexual and gender minorities. Health care professionals may receive continuing education credits for completion of the segment. Topics include epidemiology, HIV risks, barriers to care, and successful care approaches.

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