The South Leads the U.S. in HIV Infections. Tennessee Is About to Make It a Lot Worse

HIV testing and prevention in Tennessee may be more difficult to attain come this spring. Dozens of organizations across the state are bracing for the loss of significant federal funding for HIV prevention after the state declined nearly $9 million in government funds from the CDC. It’s a move that could result in a spike of new infections and be a bellwether for the rest of the nation — especially in red states. 

In the capital of Nashville, organizations like Nashville Cares, which has spent nearly 40 years building a network for testing, prevention, and resources for HIV care and treatment, will see a chunk of their testing and prevention funding imperiled. That puts some of the key tools in the fight against HIV in jeopardy: early detection, as well as access to PrEP, or pre-exposure prophylaxis. 

Naturally, those on the front lines combating HIV are livid, with some drawing connections between a new anti-abortion health commissioner installed by the state’s Republican governor, Bill Lee, and efforts to defund Planned Parenthood, which provides HIV testing and condoms, along with access to abortion services. 

“It’s an incredibly reckless disregard for welfare and life because of politics and power,” Molly Rose Quinn, executive director for Out Memphis, tells Rolling Stone. “It’s very clear from the statements that have been made by Governor Lee and the state’s health commissioner that the decision was motivated by the state’s relationship to the federal government.”

In Memphis, leaders are particularly concerned about what the funding cuts may mean because of the heightened risk factors in Shelby County. As recently as 2021, the Memphis area ranked third in the country for new HIV infections and first for new AIDS cases. It also had the fourth highest rate of poverty in U.S. cities larger than 500,000 people. 

“It just makes no sense,” Diane Duke, executive director of the Friends for Life in Memphis, says. “In one of the poorest states in the nation with great health disparities, huge transmission rates for HIV, why would you give that money back?” 

The Tennessee Department of Health, now led by Dr. Ralph Alvarado, made the announcement affecting the funds in January, as first reported by the Commercial Appeal. The decision is set to go into effect after May 31.

In a letter obtained by Knoxville outlet WBIR, the Tennessee Department of Health informed United Way of Greater Nashville — which administers the funds — of a plan for the state to take over the management of the services:

“These arrangements were made under prior administrations, and this administration is examining areas where it can decrease its reliance on federal funding and assume increased independence,” it read. “The State has determined it is in the best interest of Tennesseans for the State to assume direct financial and managerial responsibility for these services.”

Right now, Tennessee’s plan for how to manage HIV services internally is vague at best. State officials have said testing and prevention would continue, but the focus would be on first responders, trafficking victims, and mothers and children — none of which are the biggest at-risk groups for HIV transmission. 

The decision to decline the funding is a head-scratcher, even in a politically combative climate. HIV testing and treatment has generally had bipartisan support over the years, including from former President Donald Trump, who in 2019 signaled his intention to help end new cases by 2030.

But advocates say that goal can only be met through detection and fast treatment. (Individuals who test positive are usually able to get linked to care within 72 hours.)

“Ensuring that people know their HIV status is really critical,” Amna Osman, CEO of Nashville Cares, tells Rolling Stone. “It’s really important for individuals to get medical care immediately.” 

To that end, Nashville Cares provides testing for emergency room settings in order to make the process more routine, an approach that is able to catch cases that might not have been tested through the usual channels, whether because of stigma or other reasons. The state’s refusal of the federal funds will affect the organization’s ability to continue the program.

“We’ve found individuals who wouldn’t necessarily have known their status if we weren’t in the emergency department,” Osman says.

Across the state in Memphis, Duke’s organization Friends for Life stands to lose more than $1.5 million in funding, which is distributed directly between their testing and treatment offerings, along with PrEP and PEP (post-exposure prophylaxis) access, and indirectly through pharmacy rebates for HIV meds. Even the nonprofit St. Jude Children’s Research Hospital, which treats and researches HIV in addition to its cancer efforts, could lose funding.

The problem is not just one of front-end testing and prevention, either. Organizations like Nashville Cares, Out Memphis, and Friends for Life have spent years building trust in their communities, working on reducing the stigma around HIV, making testing accessible, and securing care for individuals in need. All of these services are linked, so it’s impossible to change one without affecting another.

“There’s so much inter-agency collaboration,” Quinn says. “You can get your tests at one non-profit, you can get your rental assistance at another, you can get your meds at another. We all know each other, we all work together.”

“This is going to threaten systems that have been created to really support communities and clients. It’s affecting the most vulnerable of our community,” Osman adds. “We can say ‘cut funds’ but we’re shaking a system and we’re creating some serious problems that we may not see right away.”

Quinn stresses the lack of funding will disproportionately impact people of color. “Early detection is particularly essential if you have any other social determinants of negative health outcomes – like living in poverty, living in housing instability, living in a homophobic environment, living in a transphobic environment,” she says. “The vast majority of people living with HIV come from marginalized communities.”

Those communities can also benefit the most from the healthcare services provided by Planned Parenthood. But according to a report by the AP, efforts to block federal funds from Planned Parenthood — which has been targeted for providing women access to abortions — have been underway in Tennessee as far back as 2015. Despite the Supreme Court overturning Roe v. Wade in June 2022, the undermining of Planned Parenthood continues.

Now some worry that the elimination of the federal funds will result in a perfect storm of new HIV cases with less options to treat and detect. There’s a historical precedent for the concern. In the years 2015 through 2017, Florida — then led by Republican governor Rick Scott — deliberately failed to secure millions in CDC funding for HIV testing and also blocked CDC grant applications, which was followed by Florida leading the nation in new HIV transmissions.

“[With] the tools and the medications and the science and advancements we’ve got in the last 40 years, this is really regressing us back,” Osman of Nashville Cares says. “When we have an outbreak in certain areas, if we don’t have a strong surveillance system, how are we going to respond in a timely manner?”