Research on gender affirmative models (GAM) of training and service provision is emerging. This study aims 1) to summarize 2018–2019 survey data on GAM training and service provision at Southern HIV Service Organizations (HSOs) in the U.S. South and 2) identify barriers in the region. Methods. Data were collected from Southern HSOs ( n =207). Relations between GAM training and service provision were examined through frequency distributions and logistic regressions. Results. Few (46.6%) received training. Most (73%) used clients' asserted names and pronouns. Only 62% engaged with transgender, nonbinary, and gender nonconforming (TGNC) communities and 55% provided a gender autonomous (i.e., based on self-determination) facility. Gender affirmative model-trained HSOs had at least twice the odds of implementing GAM elements compared with non-trained HSOs. Barriers included funding (61%), expertise/knowledge (59%), capacity/staff-ing (52%), and political climate (23%). Discussion . This study identifies gaps and highlights the urgent need for funding, training, and meaningful TGNC community partnerships.