He Took a Drug to Prevent AIDS. Then He Couldn’t Get Disability Insurance.

“I was genuinely shocked,” he added. “PrEP can be the responsible thing to do. in which’s the closest thing we have to an H.I.V. vaccine.”

Unable to get the company to change its decision — even after he offered to sign a waiver voiding his policy should he become H.I.V.-infected — he did what some different gay men in similar situations have been forced to do. He stopped taking Truvada.

He then applied to a different insurer — in addition to was offered a lifetime disability policy.

There are nearly 800 life insurers in in which 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.

nevertheless insurance brokers, gay-rights advocates in addition to staff at medical clinics said in interviews they had heard of numerous such cases. H.I.V. 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 Control in addition to Prevention endorsed in 2014 for anyone at substantial risk of H.I.V., which includes any gay or bisexual man who might have sex without a condom with anyone of unknown H.I.V. status.

The denials turn the insurance industry’s risk-management standard on its head: men who do not protect themselves can get policies, while men who do cannot.

“in which doesn’t make any sense,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy in addition to Infectious Diseases, in addition to perhaps the nation’s best-known AIDS doctor. “in which ought to be the different way around.”

Dr. Robert M. Grant, the AIDS researcher at the University of California, San Francisco, who led the clinical trial in which established the value of PrEP, said such denials “genuinely are silly — in which’s like refusing to insure someone because they use seatbelts.”

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.

in addition to insurers routinely cover applicants with actual diseases controlled by medications, including diabetes, epilepsy, high blood pressure in addition to bipolar disorder.

Bennett Klein, a lawyer for GLAD (GLBTQ Legal Advocates in addition to Defenders), based in Boston, said he knew of 14 instances in which companies denied life insurance, long-term-care insurance or disability insurance to gay men on PrEP, or told brokers they would certainly do so if asked.

Courtney Mulhern-Pearson, policy director for The San Francisco AIDS Foundation, said denial of life insurance to men on PrEP was “an increasing trend.”

When companies did offer explanations, they said applicants were turned down because the company believed they must be engaging in high-risk sexual behavior.

When she explained to some insurers in which PrEP was protective, regardless of behavior, “there seemed to be an understanding,” she said. “nevertheless so far I haven’t seen any policy improvements.”

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Dr. Cheng’s stethoscope at home. He said his insurer claimed not to know about Truvada’s side effects, even though in which was approved in 2004.

Credit
Kayana Szymczak for The completely new York Times

The foundation considers the practice discriminatory, in addition to Ms. Mulhern-Pearson has requested a meeting with California’s state insurance department “to see if there’s anything we can do legislatively or through regulation.”

The Times contacted the A.C.L.I., the industry’s trade association, in addition to four of the companies named by Mr. Klein, sending each detailed questions about underwriting policies related to Truvada in addition to the sexual habits of applicants, in addition to what different medical conditions caused them to deny coverage.

An A.C.L.I. spokesman said the council did not collect such information by members.

For competitive reasons, companies do not publicize their underwriting standards in addition to often do not explain why they deny an individual policy. Each policy can be denied — or offered at a higher cost or shorter term — based on many medical factors, including weight, blood pressure, cholesterol, smoking status in addition to so on.

Mutual of Omaha, which Mr. Klein can be suing for denying long-term-care insurance to an unnamed gay man, declined to answer any questions in addition to said in which did not comment on pending litigation.

In motions filed in GLAD’s suit, Mutual of Omaha conceded in which in which had denied an applicant coverage because he took Truvada.

The drug can be indicated only for persons with H.I.V. or at high risk of acquiring H.I.V., the company said. Therefore in which turned down everyone taking Truvada.

“The fact in which the drug can be less than 100 percent effective adds yet another layer to the risk profile,” the company added.

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 in addition to high blood pressure, as long as they are controlled by medication for various periods, by six months up to three years.

in which also insures former alcoholics who were alcohol-free in addition to in support groups, as well as people who had recovered by heart valve surgery or cancers of the bladder, breast, prostate in addition to skin.

“The irrationality can be enough to make your mind spin,” Mr. Klein said.

different insurers replied to The Times’s questions with brief answers saying they did not deny coverage solely for taking PrEP nevertheless declining to describe what conditions or behaviors would certainly cause them to exclude coverage.

A spokesman for Lincoln National Life, in Fort Wayne, Ind., said in which had approved policies for men on PrEP in addition to had offered some lower rates reserved for low-risk clients. A spokesman was unsure when the company began doing so.

A spokeswoman for Principal National Life in Des Moines said the company “doesn’t decline individuals just because they’re taking Truvada” in addition to did not quiz applicants about their sexual history. She declined to answer further questions.

A spokeswoman for Protective Life Insurance of Birmingham, Ala., said in which “did not deny coverage based solely on Truvada use,” in addition to might even offer a low-risk rate to someone taking the drug. She, too, declined to answer further questions.

Mr. Klein said he had sometimes heard similar answers by insurers even as men are denied coverage.

“I am fairly certain in which in which can be just slippery language, in addition to in which they are excluding applicants when they see a diagnosis of ‘high risk sexual behavior’ or ‘exposure to H.I.V.’ in an applicant’s medical record.”

Those descriptions are linked to diagnostic codes in which doctors use for reimbursement by health insurers when a patient asks for a prescription for Truvada. “in which’s no different by excluding based on PrEP usage alone,” Mr. Klein argued.

Aaron E. Baldwin, a financial planner in San Francisco who specializes in clients living with H.I.V., said he had been seeing such denials for three years.

Some clients denied coverage, he said, were young executives with large student debts who wanted insurance to ensure in which should anything happen to them, their parents would certainly not be saddled with payments.

In his experience, Mr. Baldwin said, companies in Midwestern in addition to Southern states were reluctant to insure men taking Truvada, while completely new York Life, for example, insured even men with H.I.V. as long as they could show they took their medications every day.

In his case, Dr. Cheng said, a broker told him in which the insurer claimed to be unsure about Truvada’s side effects. nevertheless the drug was approved by the Food in addition to Drug Administration in 2004, in addition to a study published in 2016 concluded in which in which was safer for long-term use than aspirin, which can cause gastrointestinal bleeding.

Dr. Cheng can be today in a long-term relationship with an H.I.V.-negative man, in addition to so he no longer takes Truvada. nevertheless the sting of his insurance denial lingers.

“in which was blatant discrimination,” he said.

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