19 Jan A Statement from Margaret Hoffman-Terry, MD, FACP, AAHIVS
On behalf of its membership of HIV-specializing care providers, the American Academy of HIV Medicine (AAHIVM) finds the newly-created “Conscience and Religious Freedom” Division in the U.S. Department of Health and Human Services deeply concerning. AAHIVM members and credentialees are physicians, pharmacists, nurse practitioners, physician assistants, and other healthcare providers who, collectively, treat the majority of all HIV patients in the US.
The Academy believes that access to quality healthcare should never be based on gender, sexual preference or gender identity – any more than it should be based on race, ethnicity or level of physical or mental ability. It upholds the universal right to “medical care and necessary social services,” as specified by the United Nations Declaration of Human Rights (Article 25).
In creating this new DHHS Division, the Trump Administration appears to be supporting the dangerous notion that it is ethical for health professionals to pick and choose who they will treat, guided solely by their individual conscience. This sets an extremely alarming precedent and opens a pathway to systematized and normalized bigotry within the healthcare system. We are particularly concerned about how this could affect people living with HIV in this country. These individuals already face multiple challenges, often including inadequate access to care (especially in poorer, rural and southern parts of the country) and stigma in a wide range of forms. If we continue to go down this slippery slope, it is conceivable that people living with HIV could be legally denied care simply because a provider objects to their gender identity, personal characteristics or life choices.
This kind of discrimination not only harms individuals but is also counterproductive to the country’s ability to address and correct health care disparities nationwide. The DHHS “Disparities Action Plan” lists as one of its five goals to “advance the health, safety and well-being of the American people.” No qualification is added noting that the goal applies only to people who meet with their medical provider’s approval.
Finally, we are concerned about the effect of this Division on the goal of ending AIDS in the US. At present, 1.2 million people are living with HIV in the US and about 40,000 new infections are occurring annually. Only about half (49%) of this 1.2 million are receiving medical care consistently enough to be virally suppressed and, therefore, unable to transmit the virus. (https://www.cdc.gov/nchhstp/newsroom/2017/HIV-Continuum-of-Care.html). The CDC identifies stigma as a major causal factor that keeps many people living with HIV from accessing care regularly. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf0
The creation of a “Conscience and Religious Freedom” Division of DHHS allows medical providers to decide, on the basis of their personal beliefs, whom they will and will not treat. It validates discriminatory behavior and in doing so, fosters the stigmatization that drives people away from medical care and undermines efforts to reduce HIV transmission. This is contrary to medical ethics and to the AAHIVM organizational mission.