On September 8th, 2022 Judge Reed O’Connor ruled that a Texas company’s requirement to cover HIV preventative services under the Affordable Care Act violates the company’s religious freedom. 

The pandemic of HIV/AIDS has been a global problem since 1981 and only in recent years has the public felt comfortable talking about it.  

HIV, standing for Human Immunodeficiency Virus, is a blood disease that leads to AIDS (acquired Immunodeficiency syndrome). Aids causes the immune system to fail, making it difficult to fight off infections. 

During its prime in the 1980s, HIV and AIDS were known as the “gay disease.” Scientists didn’t know much about it at the time, but many infractions were showing up within gay/LGBTQ+ communities. Later the public learned that the virus is passed through unprotected sex and that it can be transmitted by anyone, not just gay people; in fact, the majority of HIV transmissions are through heterosexual intercourse. 

With the lack of knowledge of the disease, plus the added level of homophobia, the public stigma surrounding the disease created a nation-wide scare. Since then, the virus has killed 38 million people worldwide. 

In 2012, the FDA approved PrEP (Pre-exposure prophylaxis) for treating HIV. 

“PreP is a once-daily pill or an injection that you take to prevent HIV infection,” Katie Macomber said. Katie has a degree in Epidemiology and 20 years of experience working in HIV/STI Prevention.

“PRE-EXPOSURE means you have to take it before you have an exposure—not after, and it’s only effective if you take it every day.”

This drug has been approved by the FDA, recommended by the CDC, and is even covered under the Affordable Care Act. The ACA states that no person can be dropped coverage because of a pre-existing condition, which includes people with aids. The ACA also covers preventative services such as HIV testing and the coverage of PrEP. 

Despite this guaranteed coverage, the recent ruling in Texas claims that the requirement for a company’s insurance to cover HIV preventative services, such as PrEP, violates their religious freedom. 

The plaintiff, Braidwood Management Inc., is a small Texas-based company with about 70 employees. They stated that the mandate “forces religious employers to provide coverage for drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”

Judge Reed O’Connor, who filed the ruling, has yet to issue a “public injunction,” so as of September 13, this only affects Braidwood Management Inc. However, if this elevates within the courts, basic preventative services can be cut off for many people in need. 

“This could mean that if a teacher needed to access PrEP and worked, for example, for a private school, the school could choose not to include PrEP as part of its coverage,” Macomber said. “PrEP is a really important tool to prevent HIV, just like birth control is a really important tool to prevent pregnancy and a colonoscopy is a really important tool to prevent Colon cancer.”

“If this affects all states nationally, and if it includes ACA health plans and private employer health plans, it would limit the number of people who could access PrEP.  This would be especially significant in states that don’t have Medicaid expansion.”

In 2019 the US Department of Human Health and Services announced a goal to end the HIV/AIDS epidemic by 2030.

“Increasing the number of people on PrEP is a part of the plan to End HIV by 2030,” Macomber said. “There are multiple strategies in the Ending the Epidemic plan (including testing and linkage to care) but increasing access to PrEP is one of them.”

This ruling of course revisits the stigma that started in the 1980s while spreading through gay communities. The stigma was so popular due to the lack of knowledge the public had. 

“In order to end HIV by 2030, we have to reduce stigma, and this ruling infers that PrEP is only for men who have sex with men … [those people] could be afraid to use their insurance to access medication because their employer would know.”

Like stated above, it is unsure how this will affect other states and specific communities, but we understand what may be at risk. 

“People are afraid that judgements are being applied to that list of tools that traditionally have been covered by all insurances (Medicaid, Medicare, ACA plans and private insurance) and that PrEP is just the start of it.”