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New HIV-related moral panic

The Centers for Disease Control and Prevention announced some noteworthy information in May, just before Pride Month: The fewest new HIV diagnoses in decades occurred in 2021.

Thanks to effective preventative measures, such as PrEP, there were 12% fewer new HIV infections between 2017 and 2021.

Finally putting an end to the epidemic may be within our reach. Preventive measures now include the use of the drug PrEP (for pre-exposure prophylaxis), and adoption is at an all-time high.

But if lawmakers and judges capitalize on the political capital of a resurgent moral panic about HIV, they may undo this progress.

The case Braidwood Management Inc. v. Becerra, in which self-described Christian business owners contested their duty to offer health insurance covering PrEP and other preventative services, may be the source of the most well-known threat to HIV prevention.

Judge Reed O’Connor proved to be a friend to them; he agreed that covering PrEP compromises their right to practice their religion and further stated that this drug “facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage.”

This runs counter to a multitude of data demonstrating that a person’s decision to use PrEP has no bearing on their sexual orientation, marital status, or usage of injectable drugs.

O’Connor still ordered a national ban on cost-free preventative healthcare for all Americans as part of his Braidwood decision in April. In the midst of a public outcry and a forceful response from the Department of Justice, the decision is temporarily halted.

However, higher courts could uphold this precedent. If Judge O’Connor’s decision continues, we estimate that 2,000 completely avoidable new HIV infections will occur in the upcoming year as a result of his decision if even a tiny percentage of private insurers decide not to cover PrEP.

Less attention has been paid to other risks to HIV prevention. A legislative version of Braidwood was approved by the governor of Florida in May.

Healthcare professionals and insurance companies are protected under SB 1580 if they decline to give or cover treatment that goes against their “sincerely held religious, moral, or ethical beliefs.” Even if it isn’t mentioned, HIV prevention plainly depends on it.

Florida serves as a test example for a medical system that is ideologically motivated thanks to this overbroad and ruthlessly inclusive law.

People who fall along the fault lines of race, socioeconomic class, sexual orientation, and gender identity will be harmed if other states adopt it.

Tennessee startled the public health community once again this year when it rejected $9 million in federal funds intended for HIV testing, treatment, and prevention. Despite the fact that infections are more expensive to cure than they are to prevent, this action gives the state closer control over NGOs that provide care to people with increasingly politicized health needs, such as abortion and gender-affirming care.

A $255 million public budget will be needed, according to researchers, to treat hundreds of new HIV infections that could be prevented.

Because PrEP is 99 percent effective at preventing HIV, all of this is really concerning.PrEP works similarly to a vaccine in that it stops the virus from entering bodily cells.

Because it does not rely on condom use or partner disclosure to avoid infection, it is particularly helpful. It receives a Grade A recommendation from the United States Preventive Services Task Force, an impartial, voluntary panel of medical professionals.

Who needs PrEP the most and why should be made crystal apparent. Communities of color are prevented from accessing cutting-edge HIV treatment and prevention because of systemic racism. But PrEP is making a breakthrough, and its advantages are significant, thanks to cutting-edge community health practices.

The confidentiality of PrEP combats stigma and gives women more power in close relationships. Because more than one-third of parents with HIV fear holding or kissing their children, PrEP safeguards families.

PrEP also eliminates the intolerably high lifetime infection risks that Black and Hispanic males who have sex with men face, which exceed 50% in the absence of effective protection.

It makes sense to revive the moralism that turned HIV into a worldwide epidemic for those whose political futures depend on expensive victories in the current culture wars.

However, it is the job of our public officials to safeguard the community health networks and evidence-based tools that are bringing us there.

All forms of preventive healthcare, including PrEP, must have legal rights, according to the federal government.

States that can politically do so must follow suit as an additional measure of security. Furthermore, higher courts must reject morally dubious religious doctrines and create judicial precedents that safeguard public health.

Meredith McNamara is a co-founder of the Integrity Project, which encourages the use of empirical evidence in health, an assistant professor of pediatrics at Yale School of Medicine, and an expert in adolescent medicine.



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