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Start with three things you can do today. Order a free HIV self-test to your door[8], reach trans peer support at 877-565-8860[9], and get into Ryan White HIV care — federal eligibility turns on an HIV diagnosis, income, and local residency, and gender identity is not an eligibility factor[7]. Federal grant terms now restrict gender-affirming care specifically; ask the clinic how current funding rules affect each service and how it will help you stay in HIV care.
Start here: testing, peer support, and a therapist directory
A free HIV self-test, mailed to you. Together TakeMeHome ships free HIV self-tests anywhere in the United States and Puerto Rico. The screen asks three things: you live in the US or Puerto Rico, you are 17 or older, and you have not ordered in the past 90 days. Check the current ordering and privacy information before supplying a delivery address[8]. The CDC-funded program delivered roughly 440,000 tests in its first year, and 24.1% went to people who had never tested before[8].
Trans peer support: 877-565-8860. Trans Lifeline is a peer support line run by and for trans and questioning people — its stated mission is to connect “trans people to the community support and resources we need to survive and thrive”[9]. Hours have changed more than once, so check translifeline.org before you call.
A therapist who already gets it. The National Queer and Trans Therapists of Color Network keeps a searchable directory of queer and trans mental health providers of color[11]. Use it instead of cold-calling a general directory and explaining yourself to five people.
What Ryan White covers — and what it does not
Ask for a Ryan White eligibility review. Core eligibility factors include: a documented HIV diagnosis, low income as your local program defines it, and residency as your local program defines it within its service area. Gender identity is not an eligibility factor. Documentation, other available coverage, and local service availability also matter[7]. The program is a major HIV-care safety net, but access to a particular clinic or service is not automatic[6].
Gender-affirming care is a different story, and you should know it before you walk in. In April 2025 HRSA's HIV/AIDS Bureau wrote to Ryan White awardees that program funds “are not authorized for procedures or interventions beyond the scope of outpatient care” and that “the prohibition on surgeries and inpatient care, irrespective of setting or anesthesia, remains absolute”[4]. Then, effective March 11, 2026, HRSA added Section 5 to its FY2026 General Terms and Conditions, directing recipients toward “Applying sex-based definitions grounded in biological reality” and toward not supporting some interventions for gender dysphoria in minors — HRSA's words, in HRSA's document, not ours[5].
The practical translation: do not expect a Ryan White program to pay for surgery or inpatient gender-affirming care. Hormone therapy and other outpatient services depend on your clinic and your state. Ask your case manager what their current grant terms allow, and ask them to tell you the other funding routes in the same conversation.
Trans-competent HIV clinics you can call
Callen-Lorde, New York. Its trans health program lists primary care, chest and breast health, hormone care, pelvic wellness exams and Pap tests, STI screening and treatment, and HIV testing, treatment and prevention including PrEP and PEP, plus harm reduction counseling, care coordination, and referrals for benefits, insurance, and housing[12]. That is the model to look for: one door, both kinds of care.
Other long-standing LGBTQ+ health centers with HIV programs include Whitman-Walker Health in Washington, DC; Fenway Health in Boston; Howard Brown Health in Chicago; APLA Health and the Los Angeles LGBT Center; and Lyon-Martin Health Services in San Francisco. Service lines and new-patient status shift, so call and ask two questions: do you treat HIV here, and do you provide or refer for gender-affirming care.
If none of those are near you, search HRSA's Ryan White provider and support-services directory — ask the local program about eligibility, enrollment documents, available services, and other insurance[7], and ask separately about gender-affirming services under the current funding rules[6].
What the surveillance data actually says
Two numbers get quoted constantly and they measure different things. Nationally, in 2022, transgender people accounted for 2% (928) of 37,981 new HIV diagnoses in the United States and six territories and freely associated states — 869 among transgender women and 59 among transgender men[1].
Separately, CDC's first National HIV Behavioral Surveillance cycle among transgender women (NHBS-Trans, 2019–2020) found that 42% of participants with a valid test result tested positive for HIV — but that is a respondent-driven sample in seven US cities (Atlanta 58%, New York City 52%, Philadelphia 51%, New Orleans 45%, San Francisco 41%, Los Angeles 33%, Seattle 21%), not a national prevalence estimate[2]. Within that same seven-city sample, 62% of Black or African American participants, 35% of Hispanic or Latina participants, and 17% of White participants tested positive[3].
These estimates describe particular populations and years; they do not predict an individual person’s HIV status. A separate 2019 meta-analysis of U.S. studies from 2006–2017 reported laboratory-confirmed prevalence of 14.1% among transgender women. Its pooled estimate for Black transgender participants was 44.2%, based on only four studies with a wide confidence interval. These published figures are available in CDC Stacks. They are not current, nationally representative prevalence estimates.[13]
Your rights while the rules are being fought over
The restrictions are in court. On June 10, 2026, Lambda Legal filed a federal lawsuit challenging the FY2026 grant terms and the new conditions attached to Ryan White funding opportunities, with the American Academy of HIV Medicine, the HIV Medicine Association, and the International Association of Providers of AIDS Care as plaintiffs. The district court held a bench trial on September 23, 2026. The case page reviewed on September 28 does not report a final judgment[6]. A trial does not itself lift the restrictions; check the case updates and your clinic’s current funding terms[5].
Know-your-rights help. Advocates for Trans Equality (A4TE) is the organization to go to for law and policy tools; it was formed in 2024 by the merger of the National Center for Transgender Equality and the Transgender Legal Defense and Education Fund, so bookmarks pointing to “NCTE” now lead here[10]. The Transgender Law Center works the same terrain.
If a clinic turns you away. Get the reason in writing, ask which funding rule they are applying, and call a legal organization the same week. Being transgender is not an exclusion in the federal Ryan White eligibility criteria; ask for help finding a provider and an available funding route[7].
Florida and other states: same federal floor, different local rules
Ryan White sets a federal floor, but two of the three eligibility factors — low income and residency — are defined by your local program, and programs may add administrative requirements[7]. That is why the same question gets different answers in Miami and Minneapolis. State law adds a second layer: Florida, for example, currently enforces restrictions on gender-affirming care for adults while an appeal is pending, while HIV-treatment eligibility and gender-affirming-care restrictions must be checked separately. The federal grant-terms litigation, by contrast, applies nationwide[6]. If you are in Florida, read our Florida page next; if you are worried about immigration status, read the medication-access page.
Related questions
Does Ryan White pay for gender-affirming surgery?
No. HRSA's HIV/AIDS Bureau told Ryan White awardees in April 2025 that program funds are limited to outpatient scope and that the prohibition on surgeries and inpatient care, regardless of setting or anesthesia, remains absolute. Hormone therapy and other outpatient services depend on your clinic and your state, so ask your case manager what their current grant terms allow.
Can a Ryan White program deny me because I am transgender?
Core federal eligibility criteria address HIV diagnosis, income, and residence; gender identity is not an exclusion. Programs may require documents and a review of other coverage and local services. If you are told otherwise, ask for the reason in writing and contact a legal organization such as Advocates for Trans Equality or Lambda Legal.
Is it true that 42% of transgender women in the US are living with HIV?
No. That 42% figure comes from CDC's NHBS-Trans cycle, a respondent-driven sample of transgender women in seven US cities in 2019 and 2020 — not a national estimate. Nationally, transgender people accounted for 2% (928) of the 37,981 new HIV diagnoses reported in 2022 in the United States and six territories and freely associated states.
How do I get a free HIV test without insurance or ID?
Order a free self-test through Together TakeMeHome. The eligibility screen asks only that you live in the US or Puerto Rico, are 17 or older, and have not ordered in the past 90 days. Check the current ordering and privacy information; eligible participants receive the test by mail.
Related from RiseUpToHIV
References & Sources
- CDC — Fast Facts: HIV in the United States (April 2024; 2022 data). This is the source for 928 diagnoses, including 869 among transgender women and 59 among transgender men; it is not a 2026 prevalence estimate. ↩
- CDC Stacks — HIV Surveillance Special Report No. 27 (NHBS-Trans, 2019–2020). Seven-city respondent-driven sample of transgender women: 42% of participants with a valid result tested positive, with city-level figures. Not a national prevalence estimate. ↩
- CDC Stacks — NHBS-Trans surveillance report (race and ethnicity breakdown). Within the same seven-city sample: 62% of Black or African American, 35% of Hispanic or Latina, and 17% of White participants tested positive. ↩
- HRSA HIV/AIDS Bureau — Letter to Ryan White awardees (April 2025). Funds limited to outpatient scope; “the prohibition on surgeries and inpatient care, irrespective of setting or anesthesia, remains absolute.” ↩
- HRSA — FY2026 General Terms and Conditions, March 11, 2026 update. Section 5, “Alignment with HRSA Funding Priorities,” including the quoted sex-based-definitions language. Quoted here as federal policy text, not adopted as this site's usage. ↩ ↩
- Lambda Legal — American Academy of HIV Medicine et al. v. HRSA et al.. Case history and September 23, 2026 bench trial; reviewed September 28. Follow the case page for later orders. ↩↩↩↩
- HRSA HAB — PCN 21-02, Determining Client Eligibility and Payor of Last Resort (rev. 03/13/25). Three eligibility factors: documented HIV diagnosis, low income as defined by the recipient, and residency as defined by the recipient within its service area; recipients may add administrative requirements. ↩ ↩ ↩ ↩ ↩
- Together TakeMeHome — free HIV self-tests by mail. Eligibility: US or Puerto Rico address, age 17 or older, no order in the past 90 days. First-year delivery of roughly 440,000 tests, 24.1% to first-time testers, is reported in CDC's MMWR 2024;73(24). ↩ ↩ ↩
- Trans Lifeline — peer support, 877-565-8860. Peer support line by and for trans and questioning people. Hours have changed; confirm current hours on the site before calling. ↩ ↩
- Advocates for Trans Equality (A4TE) — About Us. Formed in 2024 by the merger of the National Center for Transgender Equality and the Transgender Legal Defense and Education Fund; law and policy tools for trans people. ↩
- National Queer and Trans Therapists of Color Network — directory. Searchable directory of queer and trans mental health providers of color. ↩
- Callen-Lorde Community Health Center — Trans Health. Published service lines include primary care, hormone care, STI screening, and HIV testing, treatment, and prevention including PrEP and PEP. ↩
- Becasen et al. Estimating HIV prevalence among the U.S. transgender population: systematic review and meta-analysis, 2006–2017 (2019). Historical pooled estimates, not a representative national survey. ↩
Community publications like POZ, Positively Aware, and TheBody inform framing and lived-experience context on RiseUpToHIV. Every clinical, epidemiological, or public-health claim above is anchored to a primary source.