According to the Centers for Disease Control and Prevention, HIV infections have declined about 12% overall between 2018 and 2022. And that’s attributed at least partially to the availability of PrEP medication.
When taken as prescribed, the medication diminishes the risk of getting HIV from sex by about 99%.
Steven Hotze – under his Christian healthcare firm Braidwood Management – filed a lawsuit in 2020 challenging the requirement that his company insurance plan covers PrEP. He claims that the government has violated his religious beliefs by making him support LGBTQ+ sexual activity.
Sam Levin, a correspondent for The Guardian US, has been following the latest in the U.S. Supreme Court case. Listen to the interview above or read the transcript below.
This transcript has been edited lightly for clarity:
Texas Standard: Well, first, remind us what exactly PrEP does and when the preventative medication became common for health care plans to cover it.
Sam Levin: PrEP is an HIV-prevention medication that is widely used across the country and the world and it has been approved for use for years under the Affordable Care Act, known as Obamacare, and has had huge progress in helping prevent the spread of HIV and reducing new transmission of HIV.
So tell us more about why this Texas-based doctor is filing a lawsuit. What is he hoping to accomplish and why?
So Dr. Steven Hotze has spent years targeting PrEP access and targeting LGBTQ+ health care more broadly. He has argued that it is religious discrimination for the government to require that private employers like him cover PrEP through their health care plans, through their company.
And so he has been fighting this battle for years, and at this point in the case has focused on a more technical argument about essentially the task force in the government that recommends this care, arguing that that task force is not constitutional. So that’s the issue before the Supreme Court.
But more broadly, he’s targeting preventative health care services coverage through the Affordable Care Act, which is care that millions, tens of millions of Americans rely on.
Well, what do public health officials say about how this would impact HIV prevention and treatment efforts?
There was a Yale study in 2023 that estimated the loss of free PrEP coverage could result in more than 2,000 preventable HIV infections within one year. And more broadly, the loss of this access to free preventative health care could lead to 39 million people losing access to these threatened services.
So the case started as a case that was focused on PrEP, but it ended up expanding much more broadly to a wide range of areas of coverage that people depend on: cancer screenings, diabetes screenings, help for obesity interventions, STI screenings, counseling for alcohol use, contraception, vaccinations, medications to reduce heart disease risks…
All of this, which many people have come to rely on as getting free access through their health care plans, are threatened by this case.
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Is there any indication how the court may rule?
The court expressed some skepticism in oral arguments earlier this year, so for advocates there’s some hope that a ruling might go in their favor and that PrEP coverage will continue to be maintained through this ruling. But it remains to be seen.
We’ve obviously seen the courts have repeatedly ruled against LGBTQ rights more broadly, and there were some conservative justices who seemed to be siding with this doctor and with the folks who are arguing against access to this care. And so it is an open question how this case will be resolved.
Either way, depending on the ruling, what are advocates most concerned about going forward?
I think if you talk to advocates for HIV prevention access and this work, regardless of the outcome of this case, they’re looking more broadly at the increasing attacks on health care access and on LGBT rights more broadly.
And so even if in this case, this specific provision of the Affordable Care Act remains in effect, there’s widespread concern about other ways in which the federal government under the Trump administration is targeting LGBTQ rights at the federal level.
And so looking at employment discrimination and looking at access to this health care through other means and looking at all these ways in which trans people in particular and the queer community more broadly is being targeted by this government, there are great concerns. I think there’s all these different avenues in which folks will be watching the aftermath of this case, regardless of the outcome.
