US federal court ruling could result in 2,000 new HIV infections among MSM each year

March 25, 2023

2 min read

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Disclosures:
The authors report no relevant financial disclosures.

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Key Takeaways:

• A US federal court recently ruled against requiring health insurers to cover PrEP under the Affordable Care Act.
• This could result in an estimated 2,000 new HIV infections among MSM in the coming year.

The federal court ruling against requiring health care insurers to cover PrEP could result in more than 2,000 new and preventable HIV infections among at-risk populations within 12 months of the ruling.

“A federal court recently ruled it unconstitutional to mandate employer-sponsored insurance coverage of HIV prevention with PrEP,” A David Paltiel, Ph.D, professor at the Yale School of Public Health, told Healio.

Paltiel AD, et al. Open Forum InfectDis. 2023;doi:10.1093/ofid/ofad139.

“PrEP is scientifically proven, cost-effective, and a cornerstone of the federal government’s approach to ending the HIV epidemic. We wondered how many new HIV infections would result from the court’s decision,” he said.

Using data gathered from the CDC and advised by the HIV Prevention Trials Network, as well as previous studies, Paltiel and colleagues compared new HIV transmissions under several PrEP coverage estimates.

According to the study, they determined HIV incidence over a single year among PrEP-indicated men who have sex with men (MSM). The researchers noted that they purposefully “tipped the scales” to “understate the potential consequences of the Braidwood ruling,” and considered only primary HIV transmission effects in the year after the ruling took effect while ignoring both infections occurring beyond 1 year and secondary transmissions.

Overall, the estimates showed that for every 10% decrease in PrEP coverage resulting from this ruling, an additional 1,140 HIV infections would be reported among MSM in the following year.

Additional estimates showed that — under current Affordable Care Act (ACA) provisions and 28% PrEP coverage of indicated MSM — 21,867 new HIV infections would occur among MSM in the US annually, whereas another shows that if suspension of ACA provisions lowers PrEP coverage to 10 %, an additional 2,057 HIV infections could be reported in MSM.

An estimate created using a 1% decrease in the number of indicated MSM receiving PrEP treatment showed 114 new HIV infections in the following year.

The researchers also created estimates under the assumption that PrEP is more effective among MSM than assumed — 90% instead of 75% — a 1% decrease in the number of indicated MSM receiving PrEP treatment would result in even more new infections — 137 vs. 114 — in the following year.

“By removing the requirement of insurers to cover PrEP, the court’s ruling will have dramatic and injurious consequences for both individuals and public health, undermining years of effort and investment to end the HIV epidemic in the US,” Paltiel said.

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