A federal judge in Texas ruled that the requirement to cover HIV prevention drug PrEP “violates” the religious rights of individuals and employers.

District Court Judge Reed O’Connor, who was an appointee of President George W. Bush to the US District Court for the Northern District of Texas, has also thrown the requirement for insurance providers to cover a range of other preventative services, such as mammograms and colonoscopies, under the Affordable Care Act into doubt.

The ruling has the potential to affect the nearly 168 million people on employer health insurance and on Obamacare’s individual market.

The judge sided with conservative employers and individuals in Texas who argued that requirements set by the US Preventive Services Task Force were unconstitutional, with the ruling blocking enforcement of its rules nationwide.

READ MORE: PrEP: 5 questions about the HIV prevention drug answered

When taken correctly, PrEP (pre-exposure prophylaxis) reduces the risk of getting HIV from sex by 99 per cent.

It has been hailed by sexual health experts, clinics and organisations as one of the main reasons for countries like the US and UK seeing steady decreases in new HIV cases.

“Providing coverage of PrEP drugs’ facilitates and encourages homosexual behavior”

In his 28-page opinion of Braidwood Management, Inc. v. Xavier Becerra et al., however, O’Connor wrote that employers and individuals had reason to sue over providing it because “compulsory coverage for those services violates their religious beliefs by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.”

The judge continued: “And like the owner of Braidwood, these Plaintiffs object to purchasing or providing coverage for PrEP drugs because they believe that (1) the Bible is ‘the authoritative and inerrant word of God,’ (2) the ‘Bible condemns sexual activity outside marriage between one man and one woman, including homosexual conduct,’ (3) providing coverage of PrEP drugs’ facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman,’ and (4) purchasing coverage of PrEP drugs by purchasing such coverage for personal or business use makes them complicit in those behaviors.”

READ MORE: ‘I was diagnosed with HIV after being refused PrEP – now I want to raise awareness’

There are 15 states which currently require insurance companies to cover the preventive services in question regardless of federal law, but those rules do not apply to self-insured employer plans which cover most of the people with private insurance.

Health insurance experts noted that the ruling is unlikely to have an immediate effect, though has the potential to deter people from seeking out services in fear of receiving a medical bill for accessing them.

White House press secretary Karine Jean-Pierre said the ruling is “yet another attack on the Affordable Care Act” and shared that the Justice and Health Departments are reviewing it.