In 11 US States, Doctors Can Legally Refuse to Treat LGBTQ+ Patients — and It's Driving Down HIV Testing
New research shows that religious exemption laws targeting LGBTQ+ people are linked to a 28% drop in first-time HIV testing. The health consequences of legal discrimination are becoming measurable.
There’s an assumption embedded in every debate about anti-LGBTQ+ legislation: that the damage is primarily symbolic or psychological. That these laws send a message, create a hostile atmosphere, make people feel unwelcome. All of that is true. But a growing body of research is showing that the damage is also physical, clinical, and measurable in lives lost.
A study published in April 2026, covered extensively by The Conversation and NBC News, examined the impact of “conscientious objection” laws — statutes that allow healthcare providers to refuse treatment to patients on religious or moral grounds. As of this month, 11 U.S. states have enacted such laws with provisions that specifically affect LGBTQ+ patients. The states include South Carolina, Mississippi, Alabama, Arkansas, Tennessee, Ohio, and Illinois, among others.
The headline finding: LGBTQ+ adults living in states that passed these laws were 28% less likely to receive a first-time HIV test compared to their peers in states without them.
How refusal becomes avoidance
The mechanism isn’t always direct refusal at the point of care — though that happens too. More often, the laws create an atmosphere of uncertainty and fear that discourages LGBTQ+ people from seeking care in the first place. If you know your doctor can legally turn you away, you’re less likely to walk through the door.
The research found that conscientious objection laws had no measurable effect on HIV testing rates for heterosexual adults. The impact was specific to LGBTQ+ populations, confirming that these laws function as targeted discrimination with targeted health consequences.
Beyond HIV testing, the study found that LGBTQ+ adults in states with conscientious objection laws were 71% more likely to report being in “fair or poor” health after the laws were enacted. That’s not a subtle signal — it’s a dramatic deterioration in self-reported health status that correlates directly with the legal environment.
The scale of the problem
Roughly one in five LGBTQ+ Americans now lives in a state where a healthcare provider can legally refuse them care based on religious or moral objections. The laws vary in scope — some apply only to specific procedures like gender-affirming care, while others are broad enough to cover any healthcare service.
The practical effect is that LGBTQ+ patients in these states face a lottery every time they seek medical attention. Will this provider treat me? Will I be turned away? Will I have to explain my identity to get basic care? For many, the answer is to simply avoid the healthcare system altogether.
This has particularly severe implications for HIV prevention and treatment. Early testing is one of the most effective tools for reducing HIV transmission, and the communities most affected by HIV — including gay and bisexual men and transgender women — are precisely the populations targeted by these laws.
The federal backdrop
These state-level laws exist against an increasingly hostile federal landscape. The Trump administration has rolled back protections for LGBTQ+ patients in healthcare settings, rescinding Obama-era interpretations of the Affordable Care Act that prohibited discrimination based on gender identity. The Department of Health and Human Services has expanded its Office for Civil Rights division focused on religious freedom, effectively prioritizing provider conscience over patient access.
The result is a two-front assault: states passing laws that allow refusal, and a federal government that declines to intervene — or actively encourages it.
What the data demands
Public health researchers have been warning about these consequences for years. The new data validates those warnings with hard numbers. A 28% drop in HIV testing isn’t an abstraction — it translates to missed diagnoses, delayed treatment, and preventable transmissions. In a country that still sees approximately 30,000 new HIV infections per year, that’s not a rounding error.
The researchers are calling for federal non-discrimination protections that would override state conscientious objection laws in healthcare settings. Given the current political environment, that’s unlikely to happen soon. But the evidence is now clear: these laws don’t just offend principles of equality. They make people sick.
For LGBTQ+ people living in affected states, the practical advice from advocacy organizations remains the same: seek out LGBTQ+-affirming providers, use resources like the Healthcare Equality Index to find inclusive facilities, and don’t delay testing or preventive care. The laws are unjust, but your health can’t wait for justice.
