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Lawsuit Challenges Denial of Insurance to Gay Man Using PrEP as HIV Prevention

September 21, 2015

In the first lawsuit of its kind in the United States, last week Gay & Lesbian Advocates & Defenders (GLAD) filed a claim with the Massachusetts Commission Against Discrimination (MCAD), charging Mutual of Omaha Insurance Company with discrimination for denying a gay man long-term care insurance because he is taking Truvada (tenofovir/FTC) as pre-exposure prophylaxis (PrEP).

Truvada is a prescription combination of two antiretroviral drugs, emtricitabine and tenofovir, and is manufactured by Gilead. The U.S. Food and Drug Administration (FDA) approved it in 2004 to treat HIV-infected patients. When used with other HIV medicines, Truvada can lower an HIV-infected patient's viral load by keeping HIV from replicating.

In 2012, the FDA approved Truvada as a method of preventing HIV infection by halting the replication of the HIV virus in an uninfected person upon exposure. Studies have increasingly shown that use of Truvada as PrEP has high rates of effectiveness when adherence levels are also high. The recent PROUD study showed an 86% effectiveness rate of Truvada as PrEP among a group of 544 men who have sex with men (MSM) and transgender women, who are among those highest at risk for contracting HIV through sexual contact.

The plaintiff of the GLAD lawsuit, identified as John Doe, believes that taking daily medication to prevent HIV infection is the responsible thing to do.

"Insurance companies should be begging everyone to take Truvada -- not discouraging them," Doe said in a statement issued by GLAD. "As someone who lived through the worst of the epidemic and saw dozens of my friends die, I want to do everything I can to stop it."

Doe, a 61-year-old man from Boston, applied for long-term care insurance with Mutual of Omaha in November 2014. Long-term care insurance is used to pay for some or all end-of-life costs, such as for nursing homes, assisted living facilities and home health care. In February of this year, Mutual of Omaha sent Doe a letter explaining that he was being denied long-term care insurance on the grounds that he was taking Truvada as PrEP. Mr. Doe appealed the denial; his appeal was rejected this past April.

"We should be well beyond the days when insurers make decisions based on fear and stereotypes about HIV," said Bennett Klein, senior attorney and AIDS Law Project director at GLAD. "The assumption is that gay male sexuality is inherently risky and unhealthy, and that's just wrong," he added.

GLAD's suit asserts that Mutual of Omaha "illegally denied Mr. Doe access to a place of public accommodation based on sexual orientation and on disability." GLAD notes that disability anti-discrimination laws "protect those who are treated adversely based on false beliefs about a health condition."

"This is new terrain," said Damon L. Jacobs, a licensed marriage and family therapist and PrEP advocate from New York City. "We've never had a method like [Truvada] to prevent HIV before. Hopefully this lawsuit will force the powers that be to reevaluate the system of how they deny coverage and will help to educate more people about PrEP."

Jennifer Johnson Avril is a communications professional and HIV/AIDS activist based in New York City. She is a master's candidate in media studies for social change.

Copyright © 2015 Remedy Health Media, LLC. All rights reserved.

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This article was provided by TheBody.


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