July 17, 2019 at 5:27 pm EDT | by Chris Johnson
HHS says ‘conscience rule’ won’t impair HIV work — but others disagree
PrEP, Truvada, Gilead, gay news, Washington Blade, drug resistance
A health official says a “conscience rule” won’t impair HIV work, but others say no. (Photo courtesy of Gilead)

A top health official within the Department of Health & Human Services insists a “conscience rule” recently instituted by the Trump administration will have no impact on its HIV work, although LGBT groups are disputing that assessment.

Assistant Secretary of Health Adm. Brett Giroir made the remarks in testimony on July 8 before the Presidential Advisory Council on HIV/AIDS, which was restaffed this year by President Trump. A transcript of the testimony was obtained Wednesday by the Washington Blade.

“HHS is committed to ensuring that persons with HIV/AIDS or at risk for HIV/AIDS are afforded equal access to health care – consistent with the law,” Giroir said.

Giroir added the conscience rule — as well as a proposal seeking to exclude transgender people from protections under Section 1557 of Obamacare — “will not affect” his department’s commitment to ensuring access for HIV treatment.

“I want to take this opportunity to be very clear: The Department of Health & Human Services is fully committed to enforcing all anti-discrimination laws Congress has applied to our programs, including civil rights laws and federal conscience protections,” Giroir said.

Invoking prior words from HHS leadership, Giroir said “every person must be treated with dignity and respect, and given every protection afforded by the Constitution and the laws passed by Congress.”

The HHS Office for Civil Rights, Giroir said, will address any remaining concerns about the conscience rule with PACHA members. The comment period for the Section 1557 change is still open.

Carl Schmid, a co-chair of PACHA and deputy executive director of the AIDS Institute, said Giroir’s testimony moved the ball forward in addressing “serious concerns” raised by the council about the regulatory changes.

“Assistant Secretary Giroir heard us and we are pleased with his initial response and his willingness to ensure that the director of the Office of Civil Rights directly hears our strong opposition to the rules,” Schimd said. “We look forward to having that meeting soon.”

Notably, Giroir said individuals will be given access to care “consistent with the law.” The Trump administration has denied civil rights law barring discrimination on the basis of sex applies to cases of anti-LGBT discrimination, and refused to enforce the law in that manner. (The U.S. Supreme Court has taken up cases that will soon resolve whether anti-LGBT discrimination is a form of sex discrimination under federal law.)

Gillian Branstetter, a spokesperson for the National Center for Transgender Equality, said Giroir’s assertion the new regulations won’t impact HIV work is “absolutely false” in terms of health care for transgender people.

“HIV remains at crisis levels for many in the transgender community, especially transgender people of color, and HHS is actively harming their access to health care free from stigma and fear,” Branstetter said. “Prejudice and ignorance routinely keep transgender people from accessing preventative HIV care and ongoing treatment for HIV, sustaining the dramatic levels and risks in communities around the country. Despite this, OCR and HHS have proven their commitment to debilitating the very guidance meant to protect the health care of vulnerable people across the country.”

In essence, Giroir addressed multiple initiatives within the Trump administrative that appear to pull in opposite directions: One is an initiative to beat the domestic HIV/AIDS epidemic by 2030, the others are new regulations seen as an attempt to enable anti-LGBT discrimination in health care.

In January, President Trump announced his administration’s initiative to end the HIV/AIDS epidemic within 10 years. As laid out by HHS officials, the plan consists of targeting places with high rates of new infection — 48 counties in the United States, D.C., San Juan and seven states where the epidemic is mostly in rural areas — with an aggressive HIV prevention and treatment campaign.

In a follow up to that announcement, Secretary of Health & Human Services Alex Azar in May announced a donation of 200,000 courses of PrEP per year for the next 11 years for HIV prevention.

(In a Cabinet meeting this week, Trump asked Azar to name PrEP manufacturer Gilead as the donor. The two affirmed the value of the donation is billions of dollars and Trump said the contribution is “really something.”)

Meanwhile, the Trump administration went in the opposite way in May and instituted a “conscience rule” allowing health care providers to opt out of services to which they have religious objections. Critics say it would enable medical practitioners to refuse to perform abortions, gender reassignment surgery for transgender people and treatment for people with HIV/AIDS — potentially leaving individuals without care.

On top of that, the Trump administration has proposed a rollback of an Obama-era regulation interpreting Section 1557 of the Affordable Care Act, which bars discrimination on the basis of sex in health care, to apply to cases of discrimination against women who have had abortions and transgender people. 

The move would essentially leave transgender people without any protections under federal law against discrimination in health care. As Giroir pointed out, the comment period for that proposed rollback is currently open.

Giroir’s comments stand in contrast to comments made by Centers for Disease Control Director Robert Redfield, who said stigma is “not in the interest of public health” when last year asked about a leaked memo from HHS that would exclude transgender people from laws against sex discrimination. In an interview with the Washington Blade, Redfield said combatting homophobia and transphobia in health care is a “critical, critical point.”

A coalition of HIV/AIDS groups — AIDS United, the National Alliance of State & Territorial AIDS Directors, the National Coalition of STD Directors, National Minority AIDS Coalition and the AIDS Institute — has already issued a statement condemning the rule change to Section 1557, asserting it “poses a direct threat to the health of millions of Americans and undermines the administration’s own goal of ending the HIV epidemic in the U.S. by 2030.”

David Stacy, government affairs director for the Human Rights Campaign, said in response to Giroir’s comments the Trump administration’s conscience rule “absolutely puts patients with HIV and AIDS at risk of being denied care or having their treatment impaired.”

“It also threatens to undermine access to PrEP and other scientifically proven interventions,” Stacy said. “This regulation, paired with the proposed exclusion of protections for transgender people under the Section 1557 implementing regulations, will undoubtedly put LGBTQ patients at an increased risk for discrimination and denial of care.”

The Trump administration, Stacy said, has “a responsibility to ensure equal access to medical care for all people, regardless of background.”

“It is disturbing that Assistant Secretary Giroir appears to not understand this,” Stacy concluded.

Chris Johnson is Chief Political & White House Reporter for the Washington Blade. Johnson attends the daily White House press briefings and is a member of the White House Correspondents' Association. Follow Chris

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