Recently, a federal district court judge in Texas ruled that a provision in the Affordable Care Act ("ACA", aka Obamacare) requiring employer-sponsored health insurance to cover PrEP "substantially burdens the religious exercise" of private employers.
This means that if a court finds the religious beliefs of your privately-operated employer–grocery store, IT firm, warehouse, call center, daycare center, basically most (but not all) employers–to be "sincerely held," then your employer can get off the hook for covering your medically-necessary healthcare.
Jonathan Mitchell, the lawyer representing the private employers in the case and Texas' previous solicitor general, argued in court that PrEP "facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman." Judge Reed O'Connor, appointed by George W. Bush, agreed with this blatantly homophobic, inhumane, out-of-touch argument. Mitchell is also responsible for drafting Texas' notorious SB8, the first bill to effectively ban abortion: the fights for queer justice and reproductive justice are interconnected.
The ACA provision in dispute requires most health insurance plans to include HIV testing for folks between the ages of 15 and 65, and PrEP for those considered at high risk of HIV. According to the most recent CDC data (2020), there are 300,000 Americans using PrEP. On its face, this may seem like an impressive figure–but in reality, it reflects only 25% of the 1.2 million people for whom PrEP is recommended.
As with most things, when that 25% is broken down by race and transgender status, it is clear that PrEP coverage in America is vastly unequal. Of people recommended and prescribed PrEP, 66% of white people go on to use it, while only 9% of Black folks and 16% of Latinx folks do so. Four in ten transwomen have HIV; only 32% of HIV-negative transwomen use PrEP. Without insurance coverage, PrEP can cost up to $21k annually. And yet, the populations living in the deepest need, BIPOC and LGBTQ+ folks, are the same populations that are both least likely to use recommended PrEP and the least likely to have employer-sponsored health insurance.
SisterLove contends that use is low among these populations largely because systemic racism and homophobia, as demonstrated in this federal court opinion, keeps care out of certain peoples' hands. We urge the Department of Health and Human Services to appeal this decision, so that thousands of workers can access life-saving, preventative treatment.
To learn more about PrEP, check out our PrEP info center.
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