PrEP under threat in the US

The decision to challenge the avaiblity PrEP in the USA marks the latest chapter in the ongoing legal battles surrounding LGBTIQ+ rights in the USA.

The case stems from a lawsuit filed by conservative Texas employers who argue that the requirement to cover certain preventive services violates their religious freedoms, saying that providing coverage for PrEP 'facilitates and encourages homosexual behaviour, prostitution, sexual promiscuity and intravenous drug use".

At the heart of the legal challenge is the constitutionality of the U.S. Preventive Services Task Force (USPSTF), which determines which treatments must be covered at no cost to patients. Lower courts, including the 5th U.S. Circuit Court of Appeals, have ruled that the USPSTF is unconstitutional because its members are not appointed by the president nor confirmed by the Senate.

The Biden administration has argued that the preventive care mandate saves lives. However, with a change of government happening this year, things are guaranteed to change.

If the US Supreme Court sides with the challengers, it could have far-reaching consequences for millions of Americans. The ruling could potentially eliminate the requirement for insurers to cover a wide range of preventive services without cost-sharing, including:

• HIV prevention medication (PrEP)
• STI and BBV medications
• Transgender healthcare
• Contraceptives

Health policy experts warn that removing these coverage requirements could lead to significant public health impacts. A study by researchers at the Yale School of Public Health estimates that the loss of no-cost PrEP coverage alone could result in more than 2,000 preventable HIV infections in the coming year.

The Supreme Court is expected to hear the case within the next few months, with a decision likely to be handed down in 2026. This case represents the fourth major challenge to the Affordable Care Act to reach the Supreme Court since its enactment in 2010.

As the legal battle unfolds, millions of Americans who rely on these preventive services will be watching closely, aware that the outcome could reshape the landscape of healthcare coverage in the United States.