Author Archives: Alexander Naum

A License to Discriminate in Health Settings

In a recent federal court case, Religious Sisters of Mercy v. Azar (2021), a coalition of healthcare entities affiliated with the Catholic Church attacked a nondiscrimination provision under Section 1557 of the Patient Protection and Affordable Care Act (PPACA). The U.S. District Court in North Dakota granted a permanent injunction that enjoins the US Department of Health and Human Services (HHS) from enforcing Section 1557 of the PPACA. This injunction also prevents the HHS from withholding federal funding to religiously affiliated providers and insurers who deny transition services. The Plaintiff in this case originally sought an exemption from the anti-discriminatory laws that compelled them to perform and provide coverage for gender transitions and abortions. The Court, however, chose not to rule on the abortion claims. Although this ruling granted protection of religious freedoms under the First Amendment, it also allows healthcare providers impose their religious beliefs onto others and deny essential transgender health services. The implications of this ruling could lead to a broader chipping away of protections for healthcare services that are perceived as “unconscionable” by religiously-affiliated providers and insurers.

Section 1557 of the Patient Protection and Affordable Care Act states that patients shall not, “be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance.” The congressional intent of this provision was to create an all-encompassing healthcare antidiscrimination statute. This was demonstrated through the expansion of existing civil rights laws, specifically the expansion of Title IX, which had only prohibited sex discrimination in federally-funded school activities. Other important civil rights laws that the provision expanded include Title VI (preventing race, color and national origin discrimination), Section 504 (preventing disability discrimination) and the Age Discrimination in Employment Act (preventing age discrimination).

Religiously-affiliated hospitals make up a large portion of the of the hospital’s patients have access to in the United States. In 2016, MergerWatch and Maidson Healthcare Advisors released a report showing that 14.5% of all acute care hospital in the U.S. were Catholic affiliated. The report also found that 46 of these Catholic affiliated hospitals are the sole short-term, acute health care resource for many patients living in specific geographical regions. As a result of this ruling, patients living in these regions who lack access to adequate transportation, have now lost access to transition services.

Should religious protections under the First Amendment extend to health programs at the expense of equitable health care access? While some could argue that those in need of transgender health services can just go to a non-religiously-affiliated hospital, many of these individuals are limited to the hospitals within their geographical region. As other First Amendment lawsuits similar to Religious Sisters v. Mercy are filed, courts will have to determine if granting relief  to religiously-affiliated health entities limits the protections of Section 1557 under the guise of religious freedom.           

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A Summer without Pride: Public Health Efforts to Reduce the Spread of HIV During COVID-19

Across the United States, Pride festivals provide opportunities for members of the LGBTQ community to celebrate their identities, receive free HIV testing, and other HIV prevention resources. This past summer, the COVID-19 pandemic had forced many cities in the United States to cancel their pride celebrations to reduce the spread of the coronavirus. While these state and municipal stay-at-home orders were needed to protect the public from COVID-19, the resulting loss of Pride events that provide the public with free HIV testing and PrEP advocacy may contribute to a potential increase in HIV cases.

HIV disproportionally affects members of the LGBTQ community in the United States, especially Black and Latinx members. According to the Centers for Disease Control and Prevention (CDC), one in six of all gay or bisexual men in the United States will contract HIV in their lifetime. When looking at the health risks by race, the CDC estimates that 1 in 2 Black men, one in four Latinx men, and one in eleven white men who identify as gay or bisexual will contract HIV in their lifetime. For transgender women,  the CDC estimates that 14% of all transgender women in the United States live with HIV. When analyzing the data by race, the CDC approximates that 44% of Black transgender women, 26% of Latinx transgender women, and 7% of white transgender women live with HIV.

Free HIV testing at Pride events have been shown to be an important strategy to promote HIV prevention in LGBTQ community, especially for those who lack access to healthcare. A study conducted by the CDC surveyed participants who were getting tested for HIV at Pride events held in thirteen separate cities in the United States. Among the participants tested at the Pride events, 11.9% had never been tested for HIV and 21.7% had not been tested for HIV for more than twelve months prior to the event. When analyzing the participants who tested positive for HIV, 84.4% stated that they were unaware of their HIV infection. Overall, the study found that free HIV testing in nonclinical settings like Pride events are an extremely useful strategy to promote HIV prevention among groups who lack access to healthcare and/ or fear societal stigma.

Some public health organizations have emphasized the importance of at-home HIV testing and prevention during the COVID-19 pandemic. For example, the non-profit organization Greater Than AIDS created an online platform to link people with participating local health agencies and community-based organizations in order to obtain free or reduced cost at-home HIV tests. Other efforts include the U.S. Department of Health and Human Service’s (HHS) Ready Set PrEP program. Pre-Exposure Prophylaxis (PrEP) is a daily pill that studies have shown to reduce the risk of contracting HIV by more than 90%. The Ready Set PrEP program works to provide free PrEP medication from participating pharmacies or by mail to individuals without insurance.

COVID-19 is a pressing public health issue in the United states. The total reported COVID-19 cases in the United States have reached the millions and the total reported COVID-19 related deaths are nearing 250,000. Yet, COVID-19 is not the only public health crisis that the United States faces. In 2018, an estimated 36,400 new HIV infections occurred in the United States. Currently, 1.2 million Americans live with HIV and about 14% of those people do not know they have the virus and need testing. While HIV prevention outreach like Pride events have been limited during the COVID-19 pandemic, public health organizations are trying to work around this obstacle. By expanding access to free at-home HIV testing and distribution of PrEP, public health officials may continue to be effective at reducing the spread of HIV.

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