He Took a Drug to Prevent AIDS. Then He Couldn’t Get Disability Insurance.

“I was unequivocally shocked,” he added. “PrEP is a obliged thing to do. It’s a closest thing we have to an H.I.V. vaccine.”

Unable to get a organisation to change a preference — even after he offering to pointer a waiver voiding his process should he spin H.I.V.-infected — he did what some other happy group in identical situations have been forced to do. He stopped holding Truvada.

He afterwards practical to a opposite insurer — and was offering a lifetime incapacity policy.

There are scarcely 800 life insurers in this country, according to a American Council of Life Insurers. There are no inhabitant total on how many of them have denied coverage to group since they take PrEP.

But word brokers, gay-rights advocates and staff during medical clinics pronounced in interviews they had listened of countless such cases. H.I.V. specialists contend a denials discredit men’s lives by enlivening them to dump PrEP if they need life, incapacity or long-term-care insurance.

By contrast, health word companies customarily cover PrEP, that the Centers for Disease Control and Prevention permitted in 2014 for anyone during estimable risk of H.I.V., that includes any happy or bisexual male who competence have sex though a condom with anyone of opposite H.I.V. status.

The denials spin a word industry’s risk-management customary on a head: group who do not strengthen themselves can get policies, while group who do cannot.

“It doesn’t make any sense,” pronounced Dr. Anthony S. Fauci, executive of a National Institute of Allergy and Infectious Diseases, and maybe a nation’s best-known AIDS doctor. “It ought to be a other approach around.”

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Dr. Robert M. Grant, a AIDS researcher during a University of California, San Francisco, who led the clinical trial that determined a value of PrEP, pronounced such denials “really are stupid — it’s like refusing to protection someone since they use seatbelts.”

Moreover, advocates argue, a use singles out happy group for discriminatory treatment. Women, for instance, are not denied coverage if they use birth control pills or get a vaccine opposite tellurian papillomavirus, that can means cervical cancer. Yet like Truvada, use of these drugs suggests an active sex life, with a concomitant risks.

And insurers customarily cover field with tangible diseases tranquil by medications, including diabetes, epilepsy, high blood vigour and bipolar disorder.

Bennett Klein, a counsel for GLAD (GLBTQ Legal Advocates and Defenders), formed in Boston, pronounced he knew of 14 instances in that companies denied life insurance, long-term-care word or incapacity word to happy group on PrEP, or told brokers they would do so if asked.

Courtney Mulhern-Pearson, process executive for The San Francisco AIDS Foundation, pronounced rejection of life word to group on PrEP was “an augmenting trend.”

When companies did offer explanations, they pronounced field were incited down since a organisation believed they contingency be enchanting in high-risk passionate behavior.

When she explained to some insurers that PrEP was protective, regardless of behavior, “there seemed to be an understanding,” she said. “But so distant we haven’t seen any process changes.”

Photo

Dr. Cheng’s stethoscope during home. He pronounced his insurer claimed not to know about Truvada’s side effects, even nonetheless it was authorized in 2004.

Credit
Kayana Szymczak for The New York Times

The substructure considers a use discriminatory, and Ms. Mulhern-Pearson has requested a assembly with California’s state word department “to see if there’s anything we can do legislatively or by regulation.”

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The Times contacted a A.C.L.I., a industry’s trade association, and 4 of a companies named by Mr. Klein, promulgation any minute questions about underwriting policies associated to Truvada and a passionate habits of applicants, and what other medical conditions caused them to repudiate coverage.

An A.C.L.I. orator pronounced a legislature did not collect such information from members.

For rival reasons, companies do not ventilate their underwriting standards and mostly do not explain since they repudiate an particular policy. Each process is denied — or offering during a aloft cost or shorter tenure — formed on many medical factors, including weight, blood pressure, cholesterol, smoking standing and so on.

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Mutual of Omaha, that Mr. Klein is suing for denying long-term-care word to an unnamed happy man, declined to answer any questions and pronounced it did not criticism on tentative litigation.

In motions filed in GLAD’s suit, Mutual of Omaha conceded that it had denied an applicant coverage since he took Truvada.

The drug is indicated usually for persons with H.I.V. or during high risk of appropriation H.I.V., a organisation said. Therefore it incited down everybody holding Truvada.

“The fact that a drug is reduction than 100 percent effective adds nonetheless another covering to a risk profile,” a organisation added.

According to inner underwriting discipline performed by Mr. Klein, Mutual of Omaha sells long-term-care policies to people with Addison’s disease, bipolar disorder, depression, amiable coronary artery disease, diabetes, epilepsy and high blood pressure, as prolonged as they are tranquil by remedy for several periods, from 6 months adult to 3 years.

It also insures former alcoholics who were alcohol-free and in support groups, as good as people who had recovered from heart valve medicine or cancers of a bladder, breast, prostate and skin.

“The madness is adequate to make your mind spin,” Mr. Klein said.

Other insurers replied to The Times’s questions with brief answers observant they did not repudiate coverage only for holding PrEP though disappearing to report what conditions or behaviors would means them to bar coverage.

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A orator for Lincoln National Life, in Fort Wayne, Ind., pronounced it had authorized policies for group on PrEP and had offering some reduce rates indifferent for low-risk clients. A orator was uncertain when a organisation began doing so.

A mouthpiece for Principal National Life in Des Moines pronounced a organisation “doesn’t decrease people only since they’re holding Truvada” and did not ask field about their passionate history. She declined to answer serve questions.

A mouthpiece for Protective Life Insurance of Birmingham, Ala., pronounced it “did not repudiate coverage formed only on Truvada use,” and competence even offer a low-risk rate to someone holding a drug. She, too, declined to answer serve questions.

Mr. Klein pronounced he had infrequently listened identical answers from insurers even as group are denied coverage.

“I am sincerely certain that this is only sleazy language, and that they are incompatible field when they see a diagnosis of ‘high risk passionate behavior’ or ‘exposure to H.I.V.’ in an applicant’s medical record.”

Those descriptions are related to evidence codes that doctors use for payment from health insurers when a studious asks for a medication for Truvada. “That’s no opposite from incompatible formed on PrEP use alone,” Mr. Klein argued.

Aaron E. Baldwin, a financial planner in San Francisco who specializes in clients vital with H.I.V., pronounced he had been saying such denials for 3 years.

Some clients denied coverage, he said, were immature executives with vast tyro debts who wanted word so that should anything occur to them, their relatives would not be saddled with payments.

In his experience, Mr. Baldwin said, companies in Midwestern and Southern states were demure to protection group holding Truvada, while Prudential, for example, insured even group with H.I.V. as prolonged as they could uncover they took their drugs each day.

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In his case, Dr. Cheng said, a attorney told him that a insurer claimed to be uncertain about Truvada’s side effects. But a drug was authorized by a Food and Drug Administration in 2004, and a investigate published in 2016 resolved that it was safer for long-term use than aspirin, that can means gastrointestinal bleeding.

Dr. Cheng is now in a long-term attribute with an H.I.V.-negative man, and so he no longer takes Truvada. But a prick of his word rejection lingers.

“It was blatant discrimination,” he said.

Correction: Feb 12, 2018

An progressing chronicle of this essay misstated a name of a organisation that provides word to group with H.I.V. It was Prudential, not New York Life.


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