During a public health crisis, the public is thinking about their health and the safety of their loved ones. However, while society is focused on protecting people from COVID-19, the sexual health and wellbeing of individuals is under major threat. This forum discusses three major concerns about the current state of sexual and reproductive health: (1) the impact the COVID-19 pandemic may have on people with human immunodeficiency virus (HIV); (2) how state executive orders are preventing access to abortions; and (3) how the closures of doctor’s offices, Planned Parenthood health clinics, and non-essential stores pose a major threat to access to contraception and sexually transmitted infection (STI) healthcare.
If we do not make sexual healthcare a priority during the pandemic, we are putting people at risk of suffering serious negative health consequences. It is important to recognize that COVID-19 is having a disproportionate impact on some communities due to systemic oppression. Sexual health risks also disproportionately affect vulnerable populations, with communities of color, communities of lower socioeconomic status, and the LGBTQ+ community being at higher risk for STI’s. Systemic inequalities limit the access and the quality of healthcare available to vulnerable populations. Additionally, racial, class, and educational disparities prevent people from accessing family planning healthcare, including contraception and STI prevention.
COVID-19 is posing a major threat to sexual health, and systemic oppression is heightening the risk of negative impacts for people who are already suffering at the hands of institutional racism, homophobia, transphobia, classism, and sexism. It is crucial that the next steps taken to fight against these sexual health threats are done with an intersectional perspective in order to address these disparities.
I. COVID-19 presents severe health risks to people with HIV
People with HIV are at a heightened risk for suffering from severe illness due to a COVID-19 infection. Old age, an underlying medical condition, and a compromised immune system significantly increase the risk COVID-19 will cause severe illness or death. This puts individuals with HIV at a higher risk for suffering from a severe COVID-19 because almost 50% of the people diagnosed with HIV in the United States are 50 years old or older, and they are more likely to suffer from additional underlying medical conditions.
HIV-positive individuals who are the most at risk are those with a low CD4 cell count and those not currently on an antiretroviral therapy (ART) treatment course. This is because poorly controlled HIV or AIDS causes a person to be immunocompromised. ART works by reducing the amount of the viral load in a person’s blood and bodily fluids, which helps keep the individual’s immune system strong and able to fight off other infections. However, ART needs to be taken daily in order to function properly, so if a person has access issues or cannot take ART consistently, HIV can multiply rapidly and weaken the immune system.
During the pandemic and stay-at-home orders, the CDC recommended that individuals with HIV have a 30-day supply of ART to ensure that they can stay on a daily treatment plan, and that they establish a stay-at-home clinical care plan with their HIV care provider. Although the cost of ART varies based on what combination of medications were prescribed, in 2018, the lowest average wholesale price for an initial ART regimen for a person with HIV was $36,080. Therefore, the CDC’s advice can only be followed by those with health insurance or the uninsured who can afford treatment.
The Kaiser Family Foundation found that, as of May 2nd, roughly 27 million people in the United States will lose their health insurance during the COVID-19 pandemic, in large part because 61% of individuals affected by job loss relied on employer-sponsored insurance (ESI) for healthcare coverage. If people with HIV have lost their insurance during the pandemic, then they have lost access to the care that they need to ensure they do not become immunocompromised. Although the CDC does not foresee any drug shortages that would prevent people from accessing ART, the loss of health insurance and jobs can be a significant barrier to consistent healthcare needed to ensure people with HIV survive the pandemic.
II. Stay-at-home orders have become a significant barrier to abortion care
Another crucial aspect of sexual healthcare is abortion access, but when the pandemic started and stay-at-home orders were put into place, some states used this as an opportunity to limit abortion access. Certain states issued stay-at-home orders that suspended all medical procedures deemed not “immediately necessary” in order to preserve personal protective equipment and other healthcare resources. These orders have been used to prevent people from accessing abortion care by categorizing abortions as procedures that are not immediately necessary. Many states restricting abortion access also have time limitations on when, during a pregnancy, a person can access an abortion.
The suspension and postponement can systematically prevent many from ever accessing an abortion, if the stay-at-home orders extend past the legal window for abortion access. In response to these stay-at-home orders, organizations, including ACLU and Planned Parenthood, have sued to combat the potential ban on abortion access. Abortion providers and reproductive justice groups have asserted that these orders violate the 14th amendment.
As these orders are currently being fought, there have been some victories and some losses, resulting in limited access to abortion. Arkansas’s ban is still in effect and is currently being challenged by the ACLU. Alaska, Iowa, Kentucky, West Virginia, Louisiana, Mississippi, and Texas had bans, but they are no longer in effect, as most have expired and were not reinstated.
Prior to the expiration of the executive order in Texas, there was a legal battle over whether the Governor’s executive order, which postponed all not immediately medically necessary surgeries and procedures, included abortions. The United States District Court for the Western District of Texas issued a temporary restraining order to exempt abortions from the executive order. However, the United States Court of Appeals for the Fifth Circuit ordered the District Court to vacate the decision, as they held that the executive order was not a complete ban on abortions.
The Alabama, Ohio, Oklahoma, and Tennessee bans are currently blocked by court orders. In Alabama, the district court enjoined the stay-at-home order from being enforced and held that the “mandatory postponement until April 30 would operate as a prohibition of abortion, entirely nullifying their right to terminate their pregnancies, or would impose a substantial burden on their ability to access an abortion.” These legal fights around abortion access are ongoing, but it is clear that stay-at-home orders have become a significant barrier in people accessing abortions.
III. The pandemic has caused significant limitations to accessing preventative sexual healthcare, including contraception and STI testing
Finally, the loss of health insurance and the bans on non-essential medical care have also limited access to preventative sexual healthcare. Across the country, some Planned Parenthood health centers have temporarily closed or significantly reduced their hours of operation and stopped accepting walk-in appointments. The limitations on access to Planned Parenthood and other sexual health clinics can result in a large number of people not being able to access necessary healthcare.
As of December 2019, Planned Parenthood has provided sexual and reproductive healthcare and education to 5,400,000 people each year. This care includes abortion services and referrals, birth control and emergency contraception, HIV services, LGBTQ+ services (including hormone therapy), STI testing, treatment, and vaccine services, cancer screenings, and pregnancy testing and services. Although Planned Parenthood is providing telehealth, there is only so much that can be done remotely.
Planned Parenthood is encouraging people to use condoms and other barrier methods of contraception that can be purchased at local pharmacies if they cannot access their normal form of contraception due to COVID-19-related shutdowns. Additionally, websites like NURX can provide online sexual healthcare by putting patients in contact with a medical team that can provide personalized online healthcare. This can include online birth control prescriptions, emergency contraception, mail-in STI testing kits, pre-exposure prophylaxis (PrEP) prescriptions, Human Papilloma Virus (HPV) screening tests, and even some STI treatments.
Although companies like NURX are helping provide sexual healthcare during a pandemic, this care is not assessible for people who lack health insurance. As millions lose their health insurance, there is a significant barrier to access they must now overcome. Planned Parenthood attempts to overcome this barrier through providing reduced or no-cost options, but as Planned Parenthood has had to limit their services, once-accessible healthcare is once again out of reach for many people in need. If people do not have access to sexual health resources, then they cannot take preventative measures to protect themselves from unplanned pregnancies and sexually transmitted infections. Loss of health insurance, state limitations on in-person access, and inaccessible telemedicine may result in a severe increase in negative sexual health outcomes.
There are many threats to public health and well-being during the COVID-19 pandemic, and it seems that sexual health concerns have been put on the back burner. However, sexual healthcare is too important to ignore. Access to HIV healthcare, preventative care, and abortion care must be prioritized to ensure that the sexual health of all individuals is protected.
Mackenzie Darling is a second-year student at Northeastern University School of Law. Prior to law school, she graduated with a Bachelor of Science in Public Health and a Bachelor of Arts in Philosophy from the University at Albany. She is the current Vice Chair for the Women’s Law Caucus and an Associate Editor of the Northeastern University Law Review. She is interested in reproductive justice, health law, and intersectional feminism.