Oh Tiny America, your slip is showing! Of course the medicine prevents transmission of HIV and should be taken.
But for Tiny America to assume that gay sex is risky sex, or that gay people ipso facto always engage in high-risk activity is to reveal your stunning lack of understanding of sexuality, medicine, and science, but above all, reveals Tiny America's unending fear and black hatred of the Other. Be it a gay, or one who is trans, or an immigrant. The Other.
Oh Tiny America, with such a big military able to shake the planet with its fury. And yet, still, nothing can protect you from your tiny ignorance. Small country. Hateful country. Little country.
11
NYT-- Didn't you just have an article regarding open relationships? Dr Cheng isn't taking Truvada because he is an "unattached gay man." He's taking it because he's not in an exclusive relationship.
2
It’s dismaying to see the level of ignorance displayed in the responses here. Even if he is engaged in risky behavior, so what? A prophylaxis that results in a zero infection rate is an outstanding outcome. Did any of you read the article or are you just upset that there are still gay people in a world you imagine to be only heterosexual?
6
How is this different from limiting disability lifetime payments to the morbidly obese? Lifestyle choices have risks. Insurance companies respond accordingly.
9
IMO, any gay man who is sexually active, regardless of ‘reckless’ or ‘responsible’ behavior, should take PrEP. The fact is that infection rates are disproportionately higher in gay men; anal sex carries the greatest risk of sexual transmission. Even if you ‘protect’ yourself, condoms fail. Monogamous partners cheat. Same thing with straight couples.
Without PrEP, stigma about HIV men will return, and negative men wouldn’t touch them with a ten foot pole. (If your partner is HIV , even if you always use a condom, and even if medication has reduced his viral load to undetectable levels, the “okay, but what IF...?” concern is really powerful. PrEP virtually eliminates it.) This leads some positive men to lie and others to avoid getting tested.
I’ve seen enough of these articles to know a lot of commenters get frustrated by a problem they perceive to be entirely avoidable. It’s true: if every sexually active gay man practiced ‘responsible’ sex, HIV rates would surely decrease and PrEP wouldn’t be as important. But that’s obviously an impossible standard. It’s why the seatbelt metaphor is apt. You drive responsibly. You expect other people to drive responsibly. Nevertheless, traffic accidents still happen, and you’ll be much safer if you’re wearing a seatbelt.
The young man is right. Until they develop a vaccine—and believe me, they’re trying—PrEP is the best thing we have.
24
why don't we get rid of health insurance in favor of universal coverage? and why don't we mandate liability insurance for gun owners? they should be covered if they hurt somebody.
What a silly country!
19
Any insurance stock holder should be denied access to medicine.
Seems only logical according to their logic.
12
I'm surprised people assume that Truvada is (or should be) available on demand, like asking for an extra condom.
The more Truvada is generalized, the more likely and the sooner that an HIV strain will be resistant to Truvada, thus defeating the whole prophylactic aim of Truvada to begin with.
Truvada should be treated like antibiotics, over prescribe it, or misuse it, and soon a super resistant bug comes along.
10
Insurance companies don't make money by paying claims.
5
Unfortunately, this is just another instance of discrimination. This man is well versed on how to be responsible and take care of himself and yet here is another way for an insurance company to deny coverage. Too bad insurance is something responsible people need to care of themselves should something unfortunate arise. Too bad insurance companies are greedy extortionists pretending to care and looking for ways not to pay claims.
6
I know a straight white female who was turned down by one company for a long term disability policy and then accepted by another, all based on the exact same data and medical profile. If you have a good insurance broker advocating for you, it's worth trying different companies until a good one says yes. Who's to say why.
7
Not surprised. I'm an insurance agent and have seen this time and time again. Yes, a gay client, super healthy, no meds other than being on PrEP, rejected for Disability. We barely got him approved for Life insurance. Multiple clients, rejected for life insurance for being on anti-anxiety meds, which in CA are like vitamins. The stigma of these meds needs to be addressed. People are taking these drugs to help them lead normal, healthy lives, ultimately leading to longevity. Underwriting at these old school carriers needs to be modernized. If not, there are disrupters waiting right around the corner.
17
Underwriting criteria for disability insurance are opaque and, as the article states, propriety. Given the facts as presented, it does appear the first insurer's decision was questionable. The second insurer presumably insured because Dr. Cheng was not taking Truvada at the time. Is there discrimination because he is gay, legitimate or illegitimate concern about the side effects of Truada, an assumption that taking Truvada is correlated with increased unsafe sex--thus an increased risk of any STD? Will never know.
Long term care insurance is equally opaque. The article states that persons in sobriety may obtain long term care insurance as long as they are in self help groups etc. That is not necessarily true. I was offered the option of long term care insurance through my employer: at that point, I had been sober for several years but was taking medication proven to be effective against cravings. Little did it matter that I had years of sobriety, the fact that I was taking the meds indicated to the insurer that I really was not sober, else why take it? But an active alcoholic might be insured. Later, I was offered the option for LTC insurance through my employer again but the underwriter was different. Still taking the same med for the same reason & my application was approved under an expedited process. But the premium is higher because I was not initially insured at a younger age. Being cautious and taking the med penalized me, like taking Truvada penalized Cheng.
9
Insurance companies have no obligation to offer life insurance to anyone they deem high risk. I doubt it's anything personal against Dr. Cheng, but business is business.
5
This won't be a popular comment. Many commenters here suggest that men who have sex with men use Truvada solely to avoid using condoms rather than as a second layer of protection. Let's assume for the sake of argument that this is the case for some but not all. These commenters explicitly or implicitly argue that this particular use of PrEP is immoral, irresponsible, or somehow fraudulent.
Yet people who have spent decades deprived of the everyday intimacy, pleasure, liberation and guilt-free sex available to the rest of the population surely cannot be criticized for wanting condomless sex now that it's available. To find fault with men who take PrEP only to avoid condom use is logically to find fault with those who wear helmets only so they can avoid training wheels. Those who can't see that logic are exhibiting a conscious or subconscious negativity about gay sex and probably about gay people.
10
Disability insurance is besed on risk factors -- sounds to me as if this is more a situation of ignornace vs actual risk ratios form past policy holders. People with serous conditions can get insurnace -- but it will be expensive and only given for a short period of time in order to limit risk.
I'm not seeing direct discrimination here --- IE we don't like to insure gay men. They are viewing the taking of the medication as a willingness to be risky ... is there any studies to indicate that people on the drug do engage in risky behavior and depend on the drug to safeguard?
I can't get insurance w/o surcharges for a whole litany of activities -- scuba diving // private pilot //
1
"Moreover, advocates argue, the practice singles out gay men for discriminatory treatment. Women, for instance, are not denied coverage if they use birth control pills or get the vaccine against human papillomavirus, which can cause cervical cancer. Yet like Truvada, use of these drugs suggests an active sex life, with the accompanying risks."
Whoa whoa whoa. I support the advocates' goal -- of not penalizing men who take Truvada -- but these are faulty comparisons. The vaccine against HPV is supposed to be administered to young women (and young men) BEFORE they become sexually active and regardless of their anticipated sexual behavior, precisely because HPV is so common. It's abstinence-only conservative types who've been arguing that the HPV vaccine will somehow encourage teenage girls to embark on an "active sex life."
And although women who are not sexually active are less likely to use oral contraceptives than those who are, many women use oral contraceptives or other hormone-based contraception for reasons that have nothing to do with sex -- for dysmenorrhea (painful periods), acne, and other reasons.
7
I put the Doctor into the category of the unfortunate people that have much to lose but do risky stuff anyway. I put folks like Elvis and John Belushi in there with him. Why do people like this take undue risks to their health and well being.
5
" Yet like Truvada, use of these drugs suggests an active sex life, with the accompanying risks." HPV vaccine recommendations call for vaccinating all pre-teen girls and boys at age 11-12. I hardly think that recommendation "suggest an active sex life". This careless statement will continue to create barriers to routine HPV vaccination and cervical cancer will continue to kill our daughters, sisters, mothers, aunts, etc. Please do your research and choose your words more carefully in the future.
7
Thank you, Dr. Cheng, for being out and open about your choice to take Truvada when it was indicated. When physicians see their patients in their peers, they become more accepting and open. And when patients see themselves in their provider, they feel less judged and may even be more compliant. Thanks for contributing to the public's health.
13
I took Truvada-it gave me Autonomic Neuropathy. I took the protease inhibitors and I developed a window maker in my heart. PreP does a great job of virtually eliminating transmission as well as reducing the community's viral burden-but it is not without side effects-I don't buy the Truvada is safe meme especially since the manufacturer came out with a "superior," replacement.
7
If it’s patent foramen ovale you mean by “window maker in my heart,” it’s not very likely Truvada could cause that. Patent foramen ovale is a birth defect where the fetal shunt between the atria of the heart fails to close after a baby is born and begins to breath. It’s a developmental problem that occurs in the first year of life.
Perhaps there’s some autocorrect error in your post, because that part makes no sense. But unfortunately, any particular drug may not work well for any particular patient, and side effects can be trivial or severe. Best of luck with your life.
2
No one will come out and say it so I will. It's just discrimination against a gay client. Partly motivated by the AIDS disaster, and covered over with a whole bunch of rationalization. It might not even be based on antique death rates, it might simply be prejudice.
Obviously whoever makes these decisions has not bothered to look into the real situation. They just don't want to insure gay men, period, but they can't get away with just saying that.
It's all very well to call on the free market, which straight white men are prone to do, since they are never on the wrong end of this kind of behavior.
38
One tries to look beyond the HIV/gay paradigm and think, wow, this is what health insurance is turning into. Profits based on risk management are everything and human suffering that may otherwise be alleviated is subordinate to their quarterly profit-and-loss data.
14
If profit and loss didn't matter, people would use their money in other ways that mattered.
Daryl
Daryl's Roadside Honor System Vegetable Stand and Dairy Produce
1
Reading these comments it almost seems as if some people resent the fact that there is now an extremely safe and effective way to block the transmission of the HIV virus.
Why would this be?
23
What's far more common than being outright denied life or disability insurance is being offered coverage at a policy rate so astronomical as to make the policy effectively out of reach for the consumer.
"According to internal underwriting guidelines obtained by Mr. Klein, Mutual of Omaha sells long-term-care policies to people with Addison’s disease, bipolar disorder, depression, mild coronary artery disease, diabetes, epilepsy and high blood pressure, as long as they are controlled by medication for various periods, from six months up to three years."
Several years ago, while still young and in good health, I sought to obtain standard term-life insurance coverage through Mutual of Omaha. I was offered Tier 4 coverage at a monthly premium worth more than my mortgage payment. The reason? 10 years previously I had been successfully treated for a single episode of depression. I had no history of suicidal ideation, was not hospitalized or treated through an inpatient program of any kind, and never had another episode in the years since. However that single episode flagged me as a high-risk individual in the insurance pool. This is why so many folks are hesitant to seek treatment for mental health disorders, and continues to serve as a serious deterrant to people receiving the care they need. The worst part? My broker said if my medical records had disclosed a history of smoking or high cholesterol, diabetes or hypertension, I would have been offered a better rate.
18
Life and Disability insurance companies also place clauses which limit the duration of benefit payments to those with mental illness. I experienced an episode of depression that limited my ability to continue full time employment. After 24 months of partial long term disability due to depression, my benefits were discontinued. My insurance broker did not discuss this when I purchased a long term disability policy. The policy outlined did not list this limitation choosing to hide it in the policy contract. At the time the explanation was that this is an “industry standard “. It seems that these companies discriminate against stigmatized individuals. They continue to deny policies, limit coverage duration, or outright deny benefits based upon arbitrary criteria that ignores medical facts.
6
What information should be available to whom? If you knew for sure a misfortune would not befall you, then you would not insure against it. If you knew for sure that a misfortune would befall you, then you would have an obligation to tell the insurance company, which would certainly not insure you. End result would the end of the insurance business.
Insurance only works when individuals and their insurers are not certain what will happen. Insurers make a best guess. Different insurers will guess differently.
I could never obtain disability insurance for hang gliding at any price, so I just chanced it. £5 million third party insurance though.
Assurance on the other hand, to pay out to your dependents when you die, will always be in business because it is 100% certain you will die.
2
Only yesterday it was reported that a medical director at AETNA didn't even read patients' health records before rejecting claims. Surely there are more qualified people looking for employment.
14
“The fact that the drug is less than 100 percent effective adds yet another layer to the risk profile,” the company added.
Hate to burst his bubble, but no method is 100%, except abstinence and we know that isn't realistic.
4
Tenofovir disoproxil does indeed have long term side effects most worrisome being its effects on bone mineral density and renal function. It is certainly effective as prophylaxis in PrEP, but I would not minimize the chance that it may cause serious health problems after many years of use. I agree that insurers should probably look favorably on PrEP as a health and life sustaining practice as the evidence currently shows. I would also point out that disability insurance for physicians is quite expensive and a luxury, not a right; the insurance company, rather than deny the coverage, should probably have priced it quite high, if they had legitimate concerns about the long term safety of the medication.
3
The US Coast Guard also discriminates against those taking Truvada as PrEP. At my recent renewal of my USCG licensing credential, the USCG would not renew until after my physician submitted a letter. When pushed, I asked if it was because I was taking Truvada, and the Coast Guard confirmed it was. I posed the same question, should I stop taking Truvada in order to work? Luckily the USCG eventually renewed my license.
8
I'm not at all surprised. Insurance companies are in the business of making money. They are not in the business of preventing disease, doing what's best for patients, giving people more choices, or making anything regarding health care easier. They excel at putting barriers up, denying claims, and finding reasons to refuse coverage unless otherwise directed. Why should taking Truvada to prevent getting HIV through sex be any different?
Health insurance companies are not doing anything to improve health care in America. They are restricting people's choices when it comes to doctors, hospitals, pharmacies, and even medication. They allow appeals but most fall out in their favor, not the patient's. Health insurance in America is a scam and being covered doesn't mean it's affordable. In fact the people who need care the most are the ones who suffer the most from the industry's bottom line mentality.
27
Sounds to me like free enterprise is alive and well in the USA. One insurance company refuse to insure a person for whatever reason and another does insure. One foregoes a risk however small and the other makes a profit if their risk assessment is accurate. Of course if the risk assessment is wrong they will have a high cost to pay.
The problem would be if we had just one insurance company and it made all the risk assessments. Ie a nationalized disability insurance monopoly run by the government. Then if the coverage was denied by the state monopoly company, Dr Cheng would have no options.
1
I bought that arguement too, and kept my PPO, shelling out big bucks for "options." Then I went to Kaiser when it became too expensive, and the quality of care, convenience, and money saved has made me a convert. Options sound great, until you find out that the entity who controls costs, promotes pro-active health care, and has a centralized management is more effecient and can afford to provide better care.
10
Ignoring the obvious paradox of including the two expressions of 'health insurance' and 'free enterprise' in the one sentence, you misunderstand the concept of universal health coverage run in countries like Australia and the United Kingdom. If you are a citizen, and for most permanent residents, you do not have to acquire health insurance, you are fully covered for healthcare in a public hospital, if you go to your local doctor or specialist you are entitled to the Medicare rebate, if you fill a prescription for most drugs, you will pay a maximum fee of $39.50. The option of being refused healthcare or insurance because of an pre-existing condition (apart from pregnancy) never arises.
5
There are other examples of senseless denials in the health insurance industry. When I wanted to change my Medigap insurance, I made the error of first cancelling my old policy, then applying for a new one. It turns out that while the ACA prevents denial for pre-existing conditions in regular health insurance, it does not do so in Medigap policies.
I have hairy cell leukemia, an extremely slow acting form of leukemia. Most people who had it in the past died from something else. Then what is essentially a cure was discovered. This cure works in over 90% of the cases.
In my case I have been in remission since about 2000. In fact, my white blood cell count has increased so it is back in the normal range.
But I have been unable to get a Medigap policy.
11
The title of the article is misleading. He's taking the drug to prevent HIV infection, not AIDS. If someone does become HIV positive, it doesn't mean it will progress into AIDS.
46
It's simple: Any Insurer who denies coverage should lose their license to practice business. Friends?
13
Taking Truvada may not mean multiple partners. What abut discordant couples where one of the people has HIV and one doesn't Clearly the insurance companies are making assumptions that may not be valid.
19
Doesn't even mean someone is sexually active! I take birth control pills but haven't ... needed ... them in a while. But I want to keep myself protected and prepared.
Sure seems like this is insurance companies discriminating against gay men specifically. Since they'll give long-term disability insurance to people who already have conditions, like diabetes, which are nearly certain to cause disability at some point, the only reason to deny insurance to people who are avoiding a cause of disability would be discrimination.
Of course since it's the Trump years, nothing will be done about this. But hopefully once we have a sane federal government again, this practice, like real estate red-lining, will be terminated.
19
Dr. Cheng's experience does not surprise me. These insurance companies are loathe to take on anyone who may be a bad bet as they are committing themselves to at least partial replacement of a significant income. The key to disability insurance is that it must be purchased when one is very young before any conditions may occur. I know of two physicians, one had a very curable form of cancer and the other had a vestibular condition for which she experienced occasional bouts of vertigo but was well-controlled on medication, and both of them were denied disability insurance. Neither of them were surgeons and both worked primarily desk jobs. Anyone pursuing a career as a physician should buy disability insurance upon the commencement of medical school.
6
Its at least as bad as someone who asks their insurance to pay for Chantix. The insurer nw knows that the insured is a smoker. YUUUGE increase in likelihood of costly medical treatment down the road. This risk gets passed on to the consumer in the form of much higher premiums. I can imagine Truveda would cause the same reaction among those doing a cost benefit analysis on insuring this patient.
3
It’s not equivalent at all. An ex-smoker has already caused themselves harm by smoking and it can’t be argued that they haven’t, or they wouldn’t need chantix. This is not the case for a person who starts taking Truvada for PrEP. It won’t b prescribed for this purpose unless the person tests negative for HIV
4
Insurance would already know they are a smoker from their medical records. In fact, insurers happily pay for Chantix because it means their risk profile is going down.
1
Two logical fallacies here. First, many health insurers do indeed cover PrEP, just as they cover Chantix (or so I gather from your post). So insurers clearly recognize that PrEP's effective in preventing HIV infection and saves money for the insurer and ultimately consumers. Not the other way around as you suggest. Otherwise, they couldn't cover it.
Second, you're talking about health insurance coverage for medication. That's not what this article is about. It's about life insurance and long-term care insurance covering death and long-term nursing care, respectively. The point the article makes is that these sorts of insurance typically exclude only people with grave conditions (e.g., Alzheimers patients) or live lives that make them likely to get those conditions (e.g., smokers). Those who take PReP are just the opposite--HIV-negative people at minimal risk for HIV. They should be an insurer's dream.
1
As we all lose more and more of our privacy, things will only get worse.
4
Effective at stopping the spread of HIV I have no doubt. But safe?
An asprin a day is considered safe. Has NIH or CDC or anyone els made a definitive statement that taking these strong HIV drugs daily is safe?
I understand it may be safer than getting HIV. But is it safe in and of itself?
1
Yes, there have been some large scale and long-term studies. There have been mixed findings regarding renal toxicity and osteoporotic risk, but it's generally been found to be safe when taken for 1-2 years.
Compare that to birth control pills, which triple a woman's rate of having a pulmonary embolism -- a condition that can be rapidly fatal. Yet disability insurance companies don't discriminate against women who are taking the pill, do they?
5
I think the article answered your question in its third from the last paragraph. It cited (with a link) to a study published in January 2016 in the Open Forum Infectious Diseases, Volume 3, Issue 1. I only briefly scanned the study's abstract, and didn't see where it claimed that PrEP is safer for long-term use than aspirin, although that may be stated elsewhere in the full study. But relying on your assertion that "[a]n aspirin a day is considered safe" as the comparative baseline, the abstract did state that PrEP "favorably compares with aspirin in terms of user safety" with respect to short-term and medium-term usage.* If the aspirin baseline is your definition of "safe in and of itself," then I'd say that the study definitively answered your query in the affirmative.
*The study acknowledged that due to PrEP's relative recency, more research was needed in order to assess its long-term safety.
2
There have been studies on this, in fact.
"We conclude that FTC-TDF for PrEP for HIV infection favorably compares with aspirin in terms of user safety. Although long-term studies are needed, providers should feel reassured about the safety of short- and medium-term PrEP for HIV infection with FTC-TDF." [from 2012 UCLA study]
https://www.hivplusmag.com/prevention/2016/1/06/new-study-shows-prep-saf...
http://men.prepfacts.org/the-basics/
2
I'm surprised by how many people are asking "Well, if he wasn't doing anything 'risky' then why was he even on Truvada?". Sometimes, you don't know what risks you are taking, this is true for anyone who's sexually active, even those in monogamous long-term relationships. We wouldn't be asking why a heterosexual couple uses the pill and a condom because it is understood that they're just taking precautions, just in case. Why is safe/responsible sexual activity for gay men still considered "sketchier" or more "irresponsible" than heterosexual people who don't take enough precautions?
93
Why? Because this type of sex has over a 70% transmittal rate for the HIV Virus--far above the HIV Transmittal rate for heterosexual couples. Why, because PReP only works 85% of the time--the other 15% result in the transmittal the HIV virus. You wouldn't extend Disability Insurance at the same rate for a 2 pack a day smoker? The insurer did the right thing and protected the other insureds from having to be responsible for when he engages in highly risky behavior.
2
This is not true. Reports on PReP's effectiveness vary from 86% to 98%, and infection with HIV does not result from every time that it is not effective. That would require everyone with whom the PReP user was having sex with to be HIV+ and not on treatment so as to be undetectable (which makes the virus un-transmittable), and that the PReP user was not using any other form of protection at the same time.
4
For people who take PrEP daily, their estimated level of protection is 99%.
3
in 1991 I applied for private disability insurance because I was planning on getting pregnant and as a geriatric pregnancy, I wanted to ensure I didn't end up homeless if I were put on bed rest. As part of the insurers setting up the policy they asked the doctor who had performed my last (negative) colonoscopy to send them my records. They turned me down for insurance, and when I enquired why they said it was because of my on going condition. What condition? I had NO condition. So I called the doctor who revealed they had sent the insurer the WRONG PATIENT RECORDS. For a completely different patient with me same name. But the insurer would not relent, so I did what Dr. Cheng did and went with a different insurer, and got the policy. The problem is that there is no appeal process for these arbitrary and unreasonable decisions made by insurers. And no state insurance board is interested in actually policing the insurers so they do as they please. This is not reserved for AIDS, or gay people, this is done in ways large and small to Everyone.
48
Of course they have. There's no money in sick people.
We should not blame the insurance company for this. We should blame the society which entrusts the health of its citizens to gamblers, and profiteers.
We have to blame ourselves, and then act to remove these gamblers from healthcare and relocate them to Las Vegas where they'll be happier, and America will be healthier.
5
What are you talking about? This article isn't about insuring sick people - it's about someone who is healthy and taking steps to remain that way who is being denied insurance.
For the professionals whom this applies: A) Get all applicable protection coverage in place. B) Go on Truvada. They can only underwrite you once.
4
This sounds like a car insurance company refusing coverage to a driver for choosing to wear a seat belt while driving. Absurd.
15
The way Truvada is prescribed and perceived encourages a lot of paradox, or exaggeration:
In order to convince your doctor to prescribe Truvada, you have to convince your doctor that you consistently engage in high risk behavior, but once on Truvada, in order to convince your doctor (or partner, or insurance company) that your are not irresponsible, you have to maintain that you never engage in unprotected sex, that you are monogamous.
I think Truvada is being used as Viagra is being used: as a recreational drug that people don't really need, but is nice to have around, just in case that occasion arises...
That's what insurance companies are calculating: real human behavior, not reported behavior.
3
Your analysis shows no insight, let alone compassion, for gay men trying to engage in responsible sexual behavior.
Might we take Dr. Cheng at his word - that he was only in monogamous long term relationships? Might it not occur to you that MANY people, including many men and women in heterosexual relationships, might also think they are only in long term monogamous relationships while in fact their partners are not practicing monogamy without the knowledge of the other? Might it occur to you that Dr. Cheng might have reached a point in his monogamous relationship where there was enough trust to no longer need to have Truvada as a fail safe against someone who might not be as committed as he is to monogamy?
All likely, but not in the mind of those like yourself who refuse to see beyond their biases against gay men as promiscuous and incapable of having responsible long term relationships.
Dr. Cheng was discriminated against by his life insurance company. What else can we call this?
This is another example of money being more important than people. And, in the extreme, the life of a gay doctor isn't worth much in the eyes of the insurance industry.
We must take care of and protect all people, and discriminate against none.
20
I am uncertain whether or not the decision by the 1st Insurance company to limit its exposure (risk-measurement) to 5 years was discrimination against gay men or just based on statistics.
Make no bones about it, both Insurance companies identified in the article are in it for a profit and a ROI on their shareholders. They are not there to make a social statement. As more data accumulates and the 1st Company discovers that this proactive medical treatment is beneficial and is no more risky than any other condition already insured, I am almost certain that this first Insurance company will offer lifetime disability.
I am thankful that the Dr. was able to receive adequate insurance. He sounds like an extremely responsible individual.
2
The doctor never had a need to take Truvada. It's only for those who want to practice unsafe sex. To make this story out to be a dilemma for the doctor, there never was one. He did not engage "in sexually irresponsible behavior." That's a quote from him. So why take Truvada after the one-month precautionary use? Perhaps he isn't telling the whole story?
4
And you know this how?
3
he was exposed by a cut while treating an hiv + patient, mentioned early on in the article
7
This is totally false. Truvada is meant to be paired with safer sex practices, as another line of defense against HIV. Some people may use it and engage in unsafe sex, but it's utterly false to say "It's only for those who want to practice unsafe sex." That's like saying that you only need birth control if you're not using condoms.
14
Has there been a real, honest, study on the actual behavior of those who take Truvada? Do they actually engage in risky behavior? Do they engage in more risky behavior on Truvada? Do they take Truvada on the schedule as prescribed?
Because Dr. Cheng presents the typical self-reported user of Truvada, and the typical reported case sounds too good to be true: they are all responsible, they don't engage in unprotected sex, they are in monogamous relationships, they are taking Truvada "just in case" etc., etc.
Why then did Dr. Cheng asked to be put on Truvada as a regular regime?
If he never needed it, he shouldn't be on it anyway.
2
Do women who receive the HPV vaccine to prevent cervical cancer start having lots of unprotected sex? How about women on OCPs? Do people who get flu vaccines let others sneeze on them? When diabetic patients are prescribed insulin do they start eating more cupcakes? Do patients with coronary artery disease eat more bacon after they start taking aspirin? I hope these rhetorical questions help shed light on why your concern is silly. As to "never needing" Truvada prophylaxis, why wouldn't someone who wields a scalpel for a living want an extra layer of protection against a life altering illness, particularly given that Truvada is so inexpensive, effective, and safe? And even if someone weren't a doctor, anyone who has sex - period - (which I imagine is most adults in the USA, regardless of their sexual orientation) is at least some small risk for HIV infection, even if they are in a monogamous relationship (or think they are). I wish everyone were so responsible. Do you have doubts about the "actual" behavior of this population simply because they are gay men? Why should gay individuals need to provide a higher burden of proof regarding their behavior?
33
Truvada is fine. But the cultural side-effect can be frightening. I imagine that many insurance companies are actuarially aware that PrEP use leads many gay men to give up safe-sex practices altogether. The incidence of other STDs is increasing rapidly among gay men. It’s not uncommon to hear about gay men exposed to syphilis several times a year. And don’t forget about things such as drug-resistant gonorrhea. What I see in the gay community is a return to the behaviors of the late 70’s which allowed a little-known virus to gain a foothold and kill thousands upon thousands of gay men. I’m not speaking as a prude. I’m speaking as a gay man who came out in 1981, just in time to live a two-decades-long horror film. So before we condemn the insurance companies let’s be honest about how many gay men are behaving on PrEP. We’re preventing the last disease while perhaps inviting the next one.
16
Sir, your points might seem valid to you, but do insurance companies discriminate against promiscuous heterosexuals who take just as many risks? The answer is no, at least not visibly.
Your honesty is admirable, but you are unintentionally inviting discrimination and hate into your community. Obscenely wealthy insurance companies aren't God. They don't get to decide who is worthy of coverage, while excluding others they deem too risky.
They should cover all people, and discriminate against no one.
32
Pamela, the rate of transmission of the HIV virus is several times greater for gay men than it is for heterosexual couples. Heterosexual sex has a transmission rate of approximately 25%; the other rate is over 75%. Facts matter.
5
Why doesn't the article say which specific insurance company Dr Cheng was applying to? Is there any reason why the NYTimes should protect their identity? Why not expose them and let them feel a little heat from an angry public? Why should they be given anonymity?
11
I think that most of us can agree by now that health insurance companies are run by fools.
26
One more reason to hate insurance companies. Their bottom line, and the bottom line for consumers, is that they continue to operate in a world that existed 20 years prior to the issue being discussed. National health insurance, anyone?
46
this is disheartening. another example of the insurance industry's failure to recognize proactive health care.
48
Dr. Cheng, thank you for bravely coming forward with your story! I hope it leads to needed change. Best wishes to you.
88