Policy, prevention clash over anti-hiv drug
Three years ago, Dr. Philip Cheng, a urology resident at Harvard’s Brigham and Women’s Hospital, nicked himself while preparing an Hiv-positive patient for surgery.
Following hospital protocol, he took a one-month course of Truvada, a cocktail of two antihiv drugs, to prevent infection.
Later, because he was an unattached gay man, he decided to keep taking Truvada to protect himself from getting HIV through sex. The practice — called PREP, short for pre-exposure prophylaxis — is safe and highly effective. Several studies have shown that users who take the drug daily are at nearly zero risk of HIV infection.
But when Cheng applied for disability insurance — which many young doctors do to protect a lifetime’s worth of income should they be hurt — he was told that, because he was taking Truvada, he could have only a fiveyear policy.
Cheng is healthy, has never had surgery or been hospitalized, and takes no other medication. “And I never engaged in sexually irresponsible behavior,” he said. “I’ve always been in longer-term monogamous relationships.”
“I was really shocked,” he added. “PREP is the responsible thing to do. It’s the closest thing we have to an HIV vaccine.”
Unable to get the company to change its decision — even after he offered to sign a waiver voiding his policy should he become Hiv-infected — he did what some other gay men in similar situations have been forced to do. He stopped taking Truvada.
He then applied to a different insurer — and was offered a lifetime disability policy.
There are nearly 800 life insurers in this country, according to the American Council of Life Insurers. There are no national figures on how many of them have denied coverage to men because they take PREP.
But insurance brokers, gayrights advocates and staff at medical clinics said in interviews they had heard of numerous such cases. HIV specialists say the denials endanger men’s lives by encouraging them to drop PREP if they need life, disability or long-term-care insurance.
By contrast, health insurance companies usually cover PREP, which the Centers for Disease