COLUMBUS, Ohio (WCMH) — A federal ruling has struck down provisions requiring health insurance to provide free preventive care services, jeopardizing access in Ohio to screenings for cancer and medications that prevent HIV infection. 

Bottles of HIV antiviral drug Truvada are displayed at Jack’s Pharmacy in San Anselmo, California. (Photo Illustration by Justin Sullivan/Getty Images)

U.S. District Judge Reed O’Connor blocked a mandate under the Affordable Care Act providing preventative healthcare, such as mammograms and medicines to avoid cardiovascular disease, at no extra cost to patients. He agreed with the plaintiffs who refused to buy health insurance that provided coverage for contraceptives and screenings for sexually transmitted diseases, and wrote requiring insurance to cover drugs that prevent HIV, known as PrEP, violates religious rights. 

“Coverage for [HIV] services violates [the plaintiffs’] religious beliefs by making them complicit in facilitating homosexual behaviors, drugs use, and sexual activity outside of marriage between one man and one woman,” O’Connor wrote. 

A tool in the fight against HIV 

The medication, which stands for Pre-exposure Prophylaxis, is a once-daily pill taken to reduce a patient’s likelihood of developing HIV from sex or injection drug use. PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed, according to the CDC

There are two pills available for use as PrEP: Truvada and Descovy. Truvada is for patients at risk through sex or injection drug use, while Descovy is for patients only at risk through sex. PrEP can also be taken through a shot known as Apretude.

Nearly 9,000 Ohioans are taking a form of PrEP while more than 27,000 Ohioans are living with HIV, according to data from AIDSVu and the Ohio Department of Health. Data shows the number of PrEP prescriptions in Ohio has been steadily increasing while the rate of transmission has been slowly decreasing over the past decade.

Rhea Debussy, director of external affairs at Equitas Health, said O’Connor’s ruling perpetuates the stigma surrounding HIV transmission by insinuating the virus is only spread between members of the LGBTQ+ community. While male-to-male sexual contact makes up 59% of transmission in Ohio men, heterosexual contact makes up 69% of transmission in women. 

“Presuming that prescribing PrEP makes you ‘complicit in queerness’ very much harkens back to misnomers about HIV,” Debussy said. “HIV is something that everyone needs to care about. It is a public health epidemic and we need to all contribute to the fight against HIV.” 

In response to O’Connor’s ruling, the Justice Department is requesting a court order to halt the decision while the case is appealed. In the interim, insurers and employers are able to decide whether to continue covering preventative healthcare. If upheld by a higher court, Debussy said the ruling will undoubtedly harm access to preventative care. 

“We’re going to see a situation where we lose a really amazing tool in the fight against HIV, a tool that has effectiveness up to 99%,” Debussy said. “Losing that tool is ultimately going to lead to more new HIV infections.” 

Anti-LGBTQ+ Rhetoric 

The ruling reflects a wave of anti-LGBTQ rhetoric spreading across the U.S., Debussy said. In Ohio, lawmakers are among a string of state legislators nationwide proposing anti-LGBTQ+ laws in 2023, breaking the record for the most bills introduced in a single year impacting the minority community.

Rep. Jena Powell (R-Arcanum) and 30 Republican co-sponsors have reintroduced the “Save Women’s Sports Act” in Ohio, banning transgender girls from participating in female sports. The act requires schools and universities to “designate separate single-sex teams and sports for each sex” and prohibits anyone “of the male sex” to participate in any women’s school sports. 

In addition, Rep. Gary Click (R-Vickery) has reintroduced the “Saving Adolescents from Experimentation Act,” barring healthcare professionals from providing gender-affirming treatment, like hormone replacement therapy and reconstructive surgery, to trans and gender non-conforming kids in Ohio. 

The hundreds of bills nationwide could be emboldening groups targeting LGBTQ+ people as anti-LGBTQ+ incidents — demonstrations, political violence, and offline propaganda activity —  are increasing rapidly. 

“This type of rhetoric is more than words, we know that it causes real harm,” Debussy said. “We also know that this type of rhetoric contributes to the rising rates of hate crimes and violence against the LGBTQ+ community.” 

Still, programs have been established that provide PrEP for free or at a reduced cost. Learn more here.