An overlooked public health problem in the United States is the misuse of “religious freedom” to encroach on individuals’ rights to access essential medication, including pre-exposure prophylaxis (PrEP), a medicine often utilized as the first line of defense against HIV infection.
In cases like Kelley v. Becerra, which was filed in my home state of Texas, employers are objecting to a provision of the Affordable Care Act that requires the insurance coverage of many essential services for ailments that include depression, hepatitis, HIV and some forms of cancer. Specifically, in Kelley, the employers rely on their Christian beliefs to support their unwillingness to provide health insurance that subsidizes PrEP medication, due to its alleged promotion of “homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” They claim that by requiring coverage of this medication, the government is burdening their exercise of religion.
PrEP, however, is a crucial medication that serves myriad communities and has helped curb one of the deadliest epidemics in United States history. Every person, regardless of their employer, deserves access to this critical treatment to protect themselves and others.
In the 1970s and ’80s, HIV/AIDS terrorized many communities, from gay men to immigrants and racial minorities. Given the demographics affected and the pervasive stigma surrounding the condition, suffering communities were neglected through the advancement of infection rates – resulting in nearly 700,000 dead. As the spread caused extensive distress, panic, and pain within these communities, many artists – including Felix Gonzalez-Torres, Larry Kramer and Keith Haring – captured the troubling zeitgeist of the HIV/AIDS epidemic.
Specifically, Gonzalez-Torres was able to capture much of the true anguish facing the communities at the time, particularly following the loss of his partner, Ross Laycock, from AIDS. Gonzalez-Torres, who himself later died due to complications arising from AIDS, synthesized heart-wrenching pieces ranging in subject matter from the gradual, yet evident, dissolution of a loved one to reflections on the time Gonzalez-Torres lost with his partner due to his untimely death.
These contemplations can best be seen in works such as “Untitled” (Perfect Lovers), a display of two clocks that begin at the same time, portrays the course of a relationship – presumably, the one between Gonzalez-Torres and Laycock. When the two clocks fall out of sync, audiences begin to observe the dissolution of one of the lovers’ health and themselves can, in some way, experience the desperation and grief that creeps in during the clock’s slowing. Eventually, this clock stops ticking completely, signifying the death of the partner. Meant to convey a simple fraction of the grief experienced by one individual within the much larger community experiencing this tragedy, “Untitled” (Perfect Lovers) serves as an emotional time capsule of the circumstances faced by so many in the 1970s and ’80s.
Thankfully, in the late 1980s, scientists were able to contain the spread through the development of symptom-managing and contagion-preventing treatments for infected individuals, as well as pre-emptive medication for others. The swift synthesis of these highly effective treatments, including antiretroviral therapy and PrEP, have made today’s infections effectively negligible as consistent consumption of medication suppresses symptoms and presence of the infection within an individual to nearly undetectable traces. When coupled with the sustained consumption of PrEP by community members, the HIV/AIDS epidemic has been nearly completely controlled.
However, in spite of these miraculous scientific developments, the inability to access these medications could quite seriously jeopardize the progress that has been made. This threat is currently being posed at the governmental level by religious extremists and their refusal to provide essential medical coverage for all of their employees.
In Kelley v. Becerra and similar cases, employers are misusing the Religious Freedom Restoration Act (RFRA) to justify the encroachment of their religious beliefs onto others and, in many ways, harming others. RFRA is a federal law intended to protect the religious freedom of religious minorities, not to override antidiscrimination protections and deny employees access to imperative healthcare. This exploitation of religious freedom has very serious externalities that can critically affect the health of so many communities.
Many representatives in Congress have shown interest in ending this kind of misuse of RFRA, as seen in the Do No Harm Act, as well as in the Repeal HIV Discrimination Act of 2021. It is important to support bills like this to protect our communities from a fully preventable, deadly public health crisis and to continue to prevent an epidemic of this kind again.