How is Shelby County dealing with the state’s rejection of HIV funds?
Two months after Tennessee confirmed it would no longer be accepting millions of federal dollars for Hiv-related programming, Shelby County is still trying to figure out how testing and prevention services will be adequately delivered for residents of the county with the highest HIV burden in the state.
More than 19,000 Tennesseans live with HIV and Shelby County has the third highest incidence rate of new HIV infections in the country, according to the Centers for Disease Control and Prevention. Tens of thousands — especially in minority communities, which are disproportionately affected by the virus — could be greatly impacted if HIV prevention and testing services are not appropriately funded.
County officials on Wednesday announced the formation of the HIV Equity Coalition, which will attempt to dig into the ripple effects of the state’s decision and identify solutions. During a Zoom call, members of the group — also called the HIVE Coalition — outlined what the funding loss could mean for them and what strategies are being explored to plug those holes.
Advocates said everything from community outreach to the availability of PREP (pre-exposure prophylaxis) could be impacted and local organizations could have to cut staff or services. And all of those have a tangible impact on real people in Shelby County.
“We have babies that are not living with HIV because of prevention efforts in our community and so the prevention funding is so important for everyone in our community,” said Melissa Farrar, chief operating officer of Hope
House Memphis. “It’s so important that everyone has equitable access to prevention services.”
Farrar said nonprofits already have limited staff and can only do so much. Funding cuts will limit the ability to get out into the community and provide vital resources like HIV tests.
Community-based organizations across Tennessee were notified in mid-january the state was ending its participation in two CDC programs that provide more than $9 million annually across the state for Hivrelated programming. One of those funding sources went solely to Shelby County because of the high HIV transmission rate in the county.
According to the state health department, those grants have in the past funded “HIV counseling, testing and referral, HIV partner counseling and referral services, HIV health education and risk reduction programs, HIV prevention for positive individuals, public information programs, a tollfree HIV/STD hotline, capacity building programs, and a quality assurance and evaluation component.”
Shelby County Mayor Lee Harris called the state’s decision “a disastrous move” when tools are available to stop the spread of HIV. Gov. Bill Lee has said he believes the state can better administer these programs “better than the strings attached with the federal dollars.”
“The funding for this HIV prevention program is very important and it’s important that it is spent effectively and efficiently in the ways that best serve Tennessee,” he said earlier this year.
The state also said priorities in Hiv-prevention funding would be shifted to focus on first responders, victims of human trafficking and pregnant women, groups that statistically are not at high risk.
However, more than two months after the state’s decision to reject federal funds became public, officials in Nashville still have not expressly spelled out how Hiv-related programming in Tennessee will be funded moving forward.
How we got here
Organizations that have received the CDC
funds through the state of Tennessee — administered by United Way of Nashville — were notified in January funding would end as of May 31.
The ramifications could be massive, advocates have said.
The South has the highest HIV transmission rate of any region in the country and Shelby County has a transmission rate high enough to qualify it for extra federal funding for HIV testing and surveillance totaling about $2.1 million. Without that money, advocates and nonprofits say the state’s surveillance network could fall apart and HIV could spread relatively unchecked.
Preliminary data from the CDC showed 831 new cases of HIV in Tennessee in 2021 and 575 new cases were identified in the first nine months of 2022. AHEAD, which solely tracks Hiv-related data, recorded 232 new HIV diagnoses in Shelby County in 2022.
Harris last month sent a letter to Lee and TDH Commissioner Ralph Alvarado, asking them to reverse the decision to decline federal funding and this month launched the HIVE Coalition.
“This is the start of our efforts which we are committed to sustaining until our vulnerable HIV population has the level of healthcare access that we know is needed,” he said Wednesday.
U.S. Rep. Steve Cohen earlier this year sent a letter to Xavier Becerra, secretary of the U.S. Department of Health and Human Services, asking for the federal government to circumvent the state and send Hiv-related funding to local health departments and nonprofits.
“Governor Lee’s decision to end participation in the CDC Prevention and EHE program will limit Tennesseans’ access to lifesaving health care, which is already hampered by the state’s repeated refusal to expand Medicaid under the Affordable Care Act,” Cohen
wrote in the letter, which was posted online and shared with reporters.
What happens next
On Wednesday, Mia Cotton, chief programs officer at Friends For Life, a Memphis nonprofit that focuses on serving people living with HIV/AIDS and reducing the spread of HIV, said there were a variety of options being considered for how to move forward.
She said a group of impacted nonprofits has put together a letter to send to the CDC asking the federal agency to give the Hiv-related funding directly to United Way of Nashville for it to distribute to organizations across Tennessee, rather than the funding first being sent to TDH.
Cotton said organizations have also talked with the Shelby County Health Department about whether it can receive the funds from CDC and then disseminate them to community groups, either for just Shelby County or for all of Tennessee.
Direct funding from the federal government to community organizations is also something being explored, she said. Some organizations already receive direct federal funding for other programs, possibly paving the way.
However, while many options are on the table, no solution has been landed on.
“We really don’t know, it’s all up in the air,” Cotton said. “The CDC has not been able to communicate the way they would like to only because there has been limited notification from the state.”
Corinne S Kennedy covers healthcare, economic development and real estate for The Commercial Appeal. She can be reached via email at Corinne.kennedy@commercialappeal.com