When HIV Stigma and Conscientious Objection Collide

A quiet academic debate over a physician's right to refuse specific healthcare services on the basis of moral or ethical objections or religious beliefs is spilling over into thearena in some states, pitting some patients requesting preventive medication against legislators and lawyers.

Brummett speaks from personal experience. As a graduate student at Saint Louis University, he was denied a prescription for PrEP — first on the basis of his university's Catholic commitments and then because his physician was against"enabling immoral sexual behavior.

But conscience creep is showing itself to be formidable opponent, and numerous states have already adopted or are considering laws that appear to affect mostly underserved populations and LGBTQ people directly and negatively, raising questions about discriminatory care provision. that not only allows providers to refuse care but also protects them from all civil, criminal, or administrative liability.

Texas infectious disease specialists are understandably concerned. However, physicians and healthcare providers practicing in other states might wish to pay attention.

Findings from a study conducted among 820 primary care clinicians in the Southeast US suggested that overall, fewer than 40% discussed sexual health with their patients. The study was, only 16% ever prescribed PrEP. In their discussion, the authors wrote that although they did not directly examine stigma, the"existing literature indicates that HIV-related stigma could be negatively affecting HIV prevention and care during clinical encounters.

Sarah Hull, MD, MBE, a cardiologist and associate director of the Program for Biomedical Ethics at Yale School of Medicine in New Haven, Connecticut, is more emphatic in her viewpoint on conscientious objection in HIV.

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