A US judge has ruled that the country’s employer healthcare plans covering the main HIV prevention drugs violates the right to religious freedom, after a group of Texas Christians sued in 2020 over coverage of HIV pre-exposure prophylaxis, or PrEP.
Under American law, employers are required to cover certain preventive services and medications in their insurance plans, but the group argued the drug can “facilitate or encourage homosexual behaviour”.
PrEP is recommended for adults who are at high risk of contracting HIV. It can reduce infection risk by as much as 99% when taken as prescribed, according to the US Centres for Disease Control and Prevention (CDC).
The CDC has attributed its growing use as a key factor in declining HIV infections, reports BBC News, with nearly 2.8m people around the world relying on the drug, according to the Global PrEP tracker database.
Plaintiffs in Texas argued that the system by which the government decides what preventive services must be covered by employer insurance plans is unconstitutional.
The lawsuit filed by Austin attorney Jonathan Mitchell – who is credited with devising the state’s six-week abortion ban – unites self-proclaimed Christian businesses and employers.
One plaintiff, Dr Steven Hotze, said covering PrEP for his employees would be contrary to his “sincere religious beliefs”, adding that common over-the-counter medications like Truvada and Descovy can “facilitate or encourage homosexual behaviour”.
Plaintiffs also wrote that they “do not need or want” to cover the drug in insurance plans “because they are in monogamous relationships with their respective spouses” and “because neither they nor any of their family members is engaged in behaviour that transmits HIV”.
CDC data shows that nearly one in five new HIV cases in the US is now among women, the vast majority coming through heterosexual contact.
But Judge Reed O'Connor ruled that the government cannot require “private, religious corporations” to cover the drug “with no cost-sharing and no religious exemptions”.
He wrote that PrEP specifically violated the plaintiffs’ constitutional rights under the Religious Freedom Restoration Act. The RFRA is frequently invoked in challenges to abortion access and gender-affirming care for transgender people.
Medical experts had earlier slammed the lawsuit as a threat to the entire framework of coverage for preventive services.
The American Medical Association and a coalition of 60 medical organisations wrote in July that one adverse ruling could mean “patients would lose access to vital preventive healthcare services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, obesity, diabetes, preeclampsia, and hearing”.
The federal government is expected to appeal the ruling.
BBC article – HIV drug mandate violates religious freedom, judge rules (Open access)
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US study finds PrEP regimen works
PrEP reduces HIV diagnosis rates in US cities by almost 16%
PrEP reduces HIV infections by over 95% in US ‘real world’ study