A federal judge in Texas ruled last week that employers in the state are no longer required to provide coverage for the HIV prevention medication PrEP, as mandated by the Affordable Care Act (ACA). A Christian-owned company called Braidwood Management is one of the plaintiffs in the suit against the federal government, claiming that compulsory coverage of several preventive medications, including HIV prevention drugs, contraceptives and STD screenings, is an assault on their religious freedom.
Following Judge Reed O’Connor’s ruling on September 7, Congressman Dwight Evans tweeted “I oppose this ridiculous decision by an extreme judge to deny PrEP coverage to potentially millions of Americans, and I hope it will be overturned on appeal!”
The attorney at the helm of the suit is Conservative Jonathan Mitchell, who was the solicitor general of Texas and is known for authoring legislation that curtails abortion access in the state. While the ruling will likely be appealed, many healthcare leaders and professionals who work in organizations that provide HIV care have been particularly critical of the decision.
“This ruling, if allowed to stand, will set back efforts to end the HIV epidemic, and puts many of our community at serious risk,” said Kevin Burns, executive Director of Action Wellness, which provides linkage to HIV medical care. “It is yet another example of restrictive health care policies that are in direct opposition to sound public health policy.”
Bebashi Transition to Hope is one of several local healthcare organizations that provides PrEP to clients as well as programs to assist those without health insurance with accessing it.
“It’s disheartening and it definitely impedes on preventative care,” said Nafisah Houston, director of programs at Bebashi. “It’s dangerous to allow an employer not to provide someone with medication that can assist them.”
If current or potential PrEP users in Texas cannot access the medication through employment, they will have to rely on clinics or individual providers that offer free PrEP services, Houston said. “You can’t end the epidemic without having preventative care and preventative treatment,” she added.
The ruling targeted an aspect of the ACA that mandates coverage of other precautionary health services, including breast cancer screenings, heart disease screenings and vaccines, potentially endangering these types of preventive care.
In terms of sexual healthcare, “[the ruling] opens up a conversation on a state by state basis on the way we’ve been viewing table stakes for sexual healthcare over the last decade, whether that’s something we’re going to have to worry about moving forward,” said Dusty Latimer, physician assistant at Mazzoni Center. “Within the LGBTQ community, from a medical standpoint, we have spent a lot of time and effort trying to destigmatize accessing sexual healthcare and just have it be part of routine healthcare. One of the ways we’ve always been able to work to accomplish that is because we’ve had the backing of protections for folks.”
Science indicates that the use of PrEP has made a concrete impact on lessening new HIV infections in the U.S., said Billie Swiggard, infectious disease specialist and staff physician at Mazzoni Center. CDC data that examine HIV infections and PrEP use from 2015 to 2019 show that the rate of new infections decreased by 8% in that time period. That dip in infection rates, “cannot be attributed to anything but PrEP,” Swiggard said.
Swiggard also pointed out that “the vast majority of HIV cases around the world are transmitted via unprotected heterosexual sex.” Referring to Judge O’Connor, Mitchell and the plaintiffs in the suit, Swiggard said, “do these people not understand that the people who might benefit from PrEP might be their own children or even themselves?”
According to AIDSVu, in 2018, U.S. states with either Medicaid expansion or a PrEP Drug Assistance Program (DAP) had a 25% higher rate of PrEP use than states without those services. States with both Medicaid expansion and a PrEP DAP had a 99% higher rate of PrEP use, showing that assistance with PrEP coverage had a direct correlation to PrEP use.
“I believe that the answer is federally mandated PrEP DAP, no excuses,” Swiggard said. “You can’t use Jesus to excuse your bigotry.”
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