A federal judge in Boston questioned the legality of Trump administration restrictions on certain federal HIV-care funds during a bench trial on Wednesday, Sept. 23, scrutinising conditions affecting providers that serve transgender people living with HIV.
US District Judge William G. Young challenged the government's authority to impose the restrictions through the Ryan White HIV/AIDS Program, which supports medical care and related services for low-income people living with HIV.
President Donald Trump signed Executive Order 14168 on Jan. 20, 2025, directing federal agencies, as permitted by law, to end federal funding of what the order calls 'gender ideology.' The order also directs agencies to apply sex-based definitions in federal policies and documents.
The US Department of Health and Human Services and the Health Resources and Services Administration later imposed challenged grant conditions. According to Lambda Legal, HRSA issued new general terms on March 11, 2026, and HHS and HRSA issued Ryan White funding notices on June 8 restricting the use of programme funds for gender-affirming medical care.
Trump HIV Funding Restrictions Face First Amendment Scrutiny
Young, who was appointed by President Ronald Reagan, questioned a Justice Department lawyer about the legal basis for the restrictions. 'Where does he get off issuing this?' Young asked while discussing Trump's executive order, according to Reuters.
The judge also questioned guidelines that providers say prevent them from acknowledging or respecting transgender patients' identities, including by using preferred pronouns. Reuters reported that Young said such restrictions appeared to intrude on doctor-patient relationships, 'even as a matter of empathy.'
Young suggested that the challenged policy could violate the Administrative Procedure Act by placing an unconstitutional burden on the plaintiffs' free-speech rights. The plaintiffs also allege that the restrictions exceed the agencies' statutory authority, violate the Fifth Amendment's equal protection component and run afoul of Section 1557 of the Affordable Care Act.
The lawsuit was brought by the American Academy of HIV Medicine, the HIV Medicine Association, the International Association of Providers of AIDS Care and individual providers. Lambda Legal and Herbert Smith Freehills Kramer (US) LLP represent the plaintiffs.
The plaintiffs are asking the court to block enforcement. They argue that the conditions force providers to choose between complying with federal grant requirements and providing care they consider clinically appropriate.
The administration disputes the challenge. Justice Department lawyer Peter Goldstone argued that the plaintiffs lack standing because no provider has yet lost funding because of the restrictions, Reuters reported.
Ryan White Funding at Centre of Legal Dispute
The case does not concern a blanket prohibition on transgender people receiving HIV treatment. It centres on conditions attached to specified Ryan White funding and how those conditions affect providers serving transgender patients.
The Ryan White HIV/AIDS Program supports medical and related services for people living with HIV. HRSA says its Part B supplemental funding is intended to help jurisdictions provide a comprehensive continuum of high-quality care and treatment to low-income people with HIV.
Lambda Legal argues that the new conditions undermine that model by restricting acknowledgement of transgender identities and use of Ryan White money for gender-affirming medical care. Jose Abrigo, counsel and HIV project director at Lambda Legal, said respect from providers is part of making care accessible to transgender people living with HIV.
Bruce J. Packett II, executive director of the American Academy of HIV Medicine, said the restrictions leave providers facing what he described as an 'impossible choice' between federal funding requirements and their duty of care.
The government has defended the restrictions as an implementation of Trump's executive order and its federal funding priorities. The order directs agencies to ensure federal funds are not used to promote what it defines as gender ideology.
Young did not rule from the bench. Reuters reported that he said he would decide the case 'as rapidly as I can' but agreed, at the parties' request, to delay a decision until after Oct. 2 while the administration considers the plaintiffs' latest settlement proposal. The case remains pending in the U.S. District Court for the District of Massachusetts.
