UK HIV care for transgender and non-binary people: comment on unworkable EHRC guidelines by 30 June
28 June 2025. Related: Early access, Special reports, Treatment access, Activism & advocacy.
Simon Collins, HIV i-Base
i-Base, like many HIV organisations, implicitly recognises and supports the right for people to self-determine and define their own sex, gender and sexuality.
This is an integrated part of effective HIV care which has been threatened by unworkable and inappropriate new guidelines.
Details of how to comment on these guidelines are included at the end of this article, but the deadline is 30 June 2025.
HIV care for trans and non-binary people
i-Base recognises the extensive scientific and medical research that shows that sex and gender are complex and cannot be reduced to binary options.
There is also overwhelming evidence showing that access to supportive medical services including gender affirming hormones and gender reassignment surgery leads to happier and more fulfilled lives and are options that should be widely available to anyone who needs them. Benefits include lower rates of clinical depression and anxiety, better mental and physical health, reduced suicidal ideation and suicide itself. * [1-5]
This evidence also extends to HIV care and a recent large and well-powered US study involving more than 8000 transgender, non-binary, and gender-diverse populations reported that gender-affirming therapy is associated with significantly improved HIV outcomes and higher uptake of PrEP. [6. 7]
BASHH also recognised this many years ago with recommendations for how to deliver HIV services that were maximally inclusive. [8] Sexual health is also one of the few services where data is now being collected on trans and non-binary people. This uses an activist designed two-step question: first to ask for current gender and secondly to ask for gender assigned at birth. The policy to prospectively collect data is now routinely reported in HIV statistics. [9, 10, 11]
UK Supreme Court judgement and EHRC guidance
These statements and the related information, which had been the basis of collaborate i-Base projects for many years, are relevant now because on 16 April 2025, the UK Supreme Court judgement included the following statement:
“The unanimous decision of this court is that the terms woman and sex in the Equality Act 2010 refer to a biological woman and biological sex. But we counsel against reading this judgement as a triumph of one or more groups in our society at the expense of another it is not.” [12]
Gendered Intelligence (GI), a trans-led and trans-involving charity responded with an early statement:
“The court has ruled that women’s rights based on sex do not include trans women. This judgement does not change the legal protections trans people have against discrimination and harassment on the basis of gender reassignment. It also doesn’t mean trans people can or should be regularly excluded from women’s services and spaces. The law – and common sense – still says that trans people should not be excluded without a proportionate and legitimate reason.” [13]
Unfortunately, the outcome of the Court judgement had completely the opposite effect, with interpretations of the law withdrawing basic rights from transgender and non-binary people, jeopardising their safety.
One outcome, reported by the pioneering transgender health service CliniQ based at Kings College Hospital London, has been that transgender and non-binary people are already withdrawing from healthcare services, including for HIV and sexual health, because of the fear about how they will be treated. [14]
Another disturbing example of how the judgement is being interpreted came from the police force who were one of the first public service organisations to comment. Immediately after the judgement, and well before Equality and Human Rights Commission (EHRC) guidelines, British Transport Police announced proudly that cisgender male police officers would now perform intimate body searches on trans women. This threatens all women who technically will be gendered based on the views of the police. In May, the National Police Chiefs’ Council (NPCC) stated that this policy would apply to all police forces across the UK. This is even though the court judgement didn’t require this and that trans people are still able to ask for searches to be carried out by female officers. [15, 16]
Practical impact of the court judgement and legal challenges
In their first statement on the court decision, TransActual made it clear that gender affirmation as a human right was not affected. Transgender and non-binary people are still legally protected against discrimination and still have the same rights to services as other people. [17]
However, this didn’t stop early transphobic media reports and several organisations including the police, stating they would explicitly use the ruling to carry out intimate body searches of transgender women by male officers. No consideration was made for how the police would decide on whether someone was cisgender or transgender, leaving all women vulnerable to assault.
Interpretation of the court judgement has been complicated by guidance published by the EHRC, which importantly is not statutory and has no force of law and which is now open for publication consultation. [18, 19]
TransActual also noted that it was ‘too early to say how service providers and the government will interpret this judgement’. The judgement however has led to chaotic responses that clearly now discriminate against transgender people, possibly illegally. This has led to several legal challenges against the judgement and EHRC guidance, including from the trans-led Trans Legal Clinic, the civil rights organisation Liberty and the Good Law Project. According to Jo Maugham, executive director of the Good Law Project, there’s ‘a kind of visceral cruelty’ to the EHRC’s statement. [20, 21, 22]
The latest Queer AF weekly newsletter summarises the Good Law Project concerns that segregation and outing of transgender people in public life, such as a requirement to use specific services, could itself be a criminal act in direct conflict with the UK’s obligations under the European Convention on Human Rights. The UK Gender Recognition Act 2004 makes it a criminal offence to out a Trans+ person without their permission. [23]
Implications for organisations that provide public services
The examples above show how the lack of practical guidance on the interpretation of the court judgement is impacting on the lives of transgender and non-binary people in areas that have nothing to do with protected gender-specific public spaces and services.
Based on legal advice, GI has produced a useful 14-page guide for organisations and professionals on a trans inclusive interpretation of Supreme Court judgment. [24]
Importantly, the judgement does not mandate that transgender people need to be excluded from single gender spaces. It does allow organisations to initiate exclusion policies but it doesn’t mandate that this has to happen. This important level of flexibility is not yet widely understood.
Please comment on the EHRC code of conduct: deadline 30 June
As a result of the court judgement, the EHRC are now updating the sections of the statutory Code of Practice for services and organisations affected by the ruling.
As part of this process the ECRC have extended the period for public feedback to 23.59 pm on Monday 30 June.
This is an important chance to comment, whether this is a response to the public outcomes or about details of the judgement. TransActual, Scottish Trans and Mermaids have produced notes about how to comment. This includes if you only have 10, 15 or 30-minutes time to be able to do this. [25]
- Please also:
- Send a copy of your response to TransActual via policy@transactual.org.uk
- Send a copy to your MP.
- Send proof of EHRC submission (ideally take a screenshot of the final submission page)
- Let TransActual know if we can share your sub with Government
- Let TransActual know if we can share/publish extracts
- Let TransActual know if you want your response anonymised for either of those
Further reading
There following opinion pieces and guidance by a range of practitioners and organisations are recommend by GI.
Trans inclusion after the Supreme Court decision: FAQs – Good Law Project
https://goodlawproject.org/resource/trans-inclusion-after-the-supreme-court-decision-faqs/
Know Your Rights Following the Supreme Court Judgement – Trans Actual
https://transactual.org.uk/know-your-rights/
What is Wednesday’s Supreme Court decision all about? – Scottish Trans
https://www.scottishtrans.org/what-is-wednesdays-supreme-court-decision-all-about/
For Women Scotland: a legal critique – Crash Wigley
https://goodlawproject.org/for-women-scotland-a-legal-critique/
Supreme Court says Equality Act definition on based on biological sex – Lewis Silkin
https://www.lewissilkin.com/insights/2025/04/23/supreme-court-says-equality-act-definition-is-based-on-biological-sex
Limits to the UK Supreme Court’s Reach: Northern Ireland, the Windsor Framework and Trans Rights by Administrative Court blog
https://administrativecourtblog.wordpress.com/2025/04/30/limits-to-the-uk-supreme-courts-reach-northern-ireland-the-windsor-framework-and-trans-rights/
Melanie Field on the UK Supreme Court judgment For Women Scotland pod
https://ohrh.law.ox.ac.uk/melanie-field-on-the-uk-supreme-court-judgment-for-women-scotland/
* Transgender identity is independent of hormone treatment or surgery, neither of which are needed to identify as being transgender or non-binary.
comments
Over the last few years, the attacks on the health rights of people who are transgender or non binary has been deliberately politicised. This includes the flawed and biased Cass report that denies access to gender affirming hormones for young people and that has been used by GP to deny services to transgender adults.
No other social group has to routinely wait five or more years for an initial consultation for gender affirming treatment, plus an additional wait once eventually added to a list for care. No other group is so extensively excluded from data collection from medical records that is critical to receiving optimal care, including to enable access essential screening and monitoring services.
These are essential issues for HIV organisations as transgender people are disproportionally affected by HIV globally and are recognised as one of the key populations by UNAIDS.
Since January 2025 the US administration has been steadily erasing transgender people from any official documents and blocking access to services and rights. This must not be allowed to continue in the UK,
References
- Powell L et al. Gender-affirming hormone therapy and impacts on quality of life: a narrative review. medRxiv [Preprint]. 2025 Mar 12:2025.03.11.25323442. doi: 10.1101/2025.03.11.25323442.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11952613/ - Mazuonow M and Larionow P. The Effects of Gender-Affirming Hormone Therapy on Quality of Life: The Importance of Research on Youth. Healthcare 2024 12(13) 1336.
https://www.mdpi.com/2227-9032/12/13/1336 - Baker KE et al.. Hormone Therapy Mental Health and Quality of Life Among Transgender People: A Systematic Review. J Endocr Soc. 2021 Feb 25(4):bvab011. doi: 10.1210/jendso/bvab011.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7894249/ - Coleman E et al. Standards of care for the health of transgender and gender diverse people. Version 8. Int. J. Transgend. Health 2022 23 S1–S259.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9553112/ - Quinn VP et al. Cohort profile: Study of transition, outcomes and gender (STRONG) to assess health status of transgender people. BMJ Open. 2017; 7, e018121.
https://bmjopen.bmj.com/content/7/12/e018121.abstract
https://bmjopen.bmj.com/content/bmjopen/7/12/e018121.full.pdf - Reisner SL et al. HIV seropositivity and viral non-suppression in transgender, non-binary, and gender-diverse people in primary care receiving gender-affirming hormone therapy in the USA between 2013 and 2019 (LEGACY): an observational, longitudinal, cohort study. Lancet HIV. 2025. (27 March 2025).
https://doi.org/10.1016/S2352-3018(25)00004-9 - Blumenthal J and Hastie E. Gender-affirming hormone therapy is a crucial component of HIV care. Lancet HIV. 12(4): E244-246. April 2025.
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(25)00067-0/fulltext - BASHH. BASHH recommendations for integrated sexual health services for trans including non-binary people. (undated but pre-2020)
https://www.bashh.org/_userfiles/pages/files/resources/bashh_recommendations_for_integrated_sexual_health_services_trans_including_nonbinary_people_2019.pdf - Gender identity and why it is important to ask about
https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/submit-data/data-quality-of-protected-characteristics-and-other-vulnerable-groups/gender-identity - NHS Data Model and Dictionary
https://www.datadictionary.nhs.uk/attributes/gender_identity_code.html
https://www.datadictionary.nhs.uk/attributes/person_stated_gender_code.html - Gov.uk. Official StatisticsHIV testing PrEP new HIV diagnoses and care outcomes for people accessing HIV services: 2024 report.
https://www.gov.uk/government/statistics/hiv-annual-data-tables/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2024-report - Supreme Court. For Women Scotland Ltd (Appellant) v The Scottish Ministers (Respondent). (16 April 2025).
https://supremecourt.uk/cases/uksc-2024-0042 - Gendered Intelligence. UK Supreme Court judgement on women and sex in the Equality Act 2010. (16 April 2025).
https://genderedintelligence.co.uk/news/19-uk-supreme-court-judgement-on-women-and-sex-in-the-equality-act-2010 - Personal communication, Michelle Ross, founder and director of CliniQ, Kings College Hospital. (25 June 2025)
- LBC news. First police force changes search guidelines for trans women in wake of Supreme Court gender ruling. (17 April 2025).
https://www.lbc.co.uk/news/uk/transgender-women-supreme-court-ruling-british-transport-police/ - National Policing News. Police search guidance following Supreme Court decision. (22 May 2025).
https://news.npcc.police.uk/releases/new-police-search-guidance-following-supreme-court-decision - UK Supreme Court judgement on women and sex in the Equality Act 2010 (16 April 2025)
https://genderedintelligence.co.uk/news/19-uk-supreme-court-judgement-on-women-and-sex-in-the-equality-act-2010 - EHRC. An interim update on the practical implications of the UK Supreme Court judgment. (25 April 2025)
https://www.equalityhumanrights.com/media-centre/interim-update-practical-implications-uk-supreme-court-judgment - TransActual. Statement on EHRC ‘guidance’ on single sex spaces. (26 April 2025).
https://transactual.org.uk/blog/2025/04/26/statement-on-ehrc-guidance-on-single-sex-spaces/ - Liberty. LIBERTY launches legal action against EHRC over ‘unlawful’ code of practice consultation. (30 May 2025).
https://www.libertyhumanrights.org.uk/issue/liberty-launches-legal-action-against-ehrc-over-unlawful-code-of-practice-consultation/ - Good Law Project. We’re bringing a legal challenge to the EHRC’s ‘Interim Update’. (16 M8ay 2025).
https://goodlawproject.org/were-bringing-a-legal-challenge-to-the-ehrcs-interim-update/ - Good Law Project. Legal challenge: EHRC guidance is either wrong in law or breaches human rights. (6 June 2025).
https://goodlawproject.org/legal-challenge-ehrc-guidance-is-either-wrong-in-law-or-breaches-human-rights/ - QueerAF. Understand the LGBTQIA+ news: Potential for criminal liability for organisations that follow EHRC’s interim update. (7 June 2025).
https://www.wearequeeraf.com/understand-the-lgbtqia-news-potential-for-criminal-liability-for-organisations-that-follow-ehrcs-interim-update/ - Gender Intelligence. Maximising trans inclusion after the Supreme Court Judgment. Version 1.1. (21 May 2025).
https://genderedintelligence.co.uk/page/how-to-maximise-your-trans-and-non-binary-inclusion-in-light-of-the-for-women-scotland-v-scottish-government-supreme-court-judgment
https://genderedintelligence.co.uk/page/how-to-maximise-your-trans-and-non-binary-inclusion-in-light-of-the-for-women-scotland-v-scottish-government-supreme-court-judgment/download_pdf (PDF) - TransActual. Responding to the EHRC consultation: What do I say?
https://transactual.org.uk/equality-act-campaign/responding-to-the-ehrc-consultation/ - TransActual. Responding to the EHRC public consultation on the updated Code of Practice. (3 June 2025).
https://transactual.org.uk/equality-act-campaign/ehrc-consultation-guidance/