No. 1 AIDS hotspot in the US just suffered a big cut in HIV funding, and results could be devastating

Diane Duke spent six hours on a bus and hours more talking to Tennessee state legislators Wednesday about issues important to her community and her home city of Memphis. As the director of Friends for Life, a nonprofit organization focused on supporting people living with HIV, she was there to advocate for the LGBTQ+ community and for Memphis.

“It was good, but I’m exhausted,” she told Reckon over the phone Thursday.

While at the capitol, she took time to meet with state lawmakers who filed a bill that would secure HIV prevention funding for the organization, which could lose $1.2 million and threaten the operation of two of the organization’s sexual health clinics in Memphis when federal HIV prevention funding runs out May 31.

In January, the Tennessee Dept. of Health told Duke’s organization, Friends for Life, that the state had decided to stop taking HIV prevention funding from the CDC. Tennessee typically receives about $9 to $10 million in federal HIV prevention grants, which is then distributed to health centers eligible for the grant funding.

Duke said her organization usually receives about $500,000 from the CDC grant distributed by the state. The funding also qualifies FFL to receive funding from the 340B drug discount program, which allows the organization to provide PrEP and PEP for free or at a very low cost.

The loss of the CDC and 340B funding could mean Duke’s nonprofit could lose $1.2 million for HIV prevention—a cut that would threaten two of the organization’s sexual health clinics and the progress they’ve made toward preventing the spread of HIV in the city with the highest rate of new AIDS diagnoses nationwide, according to the CDC.

Memphis’s own Shelby County was one of 48 counties identified in the federal government’s “Ending the HIV Epidemic in the U.S.” initiative announced in 2019. These 48 counties and an additional seven states were chosen because at least 50 percent of all new HIV diagnoses occurred in these areas in 2016 and 2017.

Because of this designation, Shelby County clinics are eligible for HIV prevention and treatment funding through various federal funding initiatives, according to hiv.gov.

The EHE initiative aims to reduce the number of new HIV infections by 75% by 2025, and end the epidemic by 2030. A threat to this funding represents a threat to the effort to end HIV and could undo the progress toward that goal, Duke said.

This money is not the only source of funding for Friends for Life, but there are other clinics in Memphis that are much more dependent on the funding. The state has said it will fill the gap created by the rejected CDC funds, but details about how that will work or where that money will come from haven’t been shared with former grantee organizations, Duke said.

Planned Parenthood of Tennessee and North Mississippi—which serves the Memphis area—will lose about $235,000 from the CDC grant, which the organization uses to distribute condoms and train people how to test for HIV.

The organization saw more than 12,000 unique patients, distributed more than half a million condoms and provided nearly 17,000 HIV and other STI tests in 2022, according to the PPTNM’s 2022 annual report. More than half (51%) of the patients were black, the report said.

“Grant recipients are working with the CDC in hopes of United Way of Nashville receiving the grant dollars directly, free from state interference. In any case, Planned Parenthood is committed to non-judgmental, evidence-based HIV prevention programs,” said Ashley Coffield, CEO of Planned Parenthood of Tennessee and North Mississippi.

What communities are getting impacted the most?

More than 20,000 Tennessee residents are living with HIV and are receiving treatment, but the CDC estimates 14% of Tennesseans don’t know their HIV status so the number of people living with the condition could be higher. These people who don’t know their status are important, because the CDC estimates 80 percent of all new HIV infections are transmitted from people who don’t know their status or who aren’t receiving treatment.

The people who will feel the effect of this lost funding are people living in poverty, people without health insurance, people experiencing income inequality and people living in HIV hotspots, according to HIV risk factors identified by the EHE program.

But why is poverty a factor here? Simply, people who are worried about meeting simple needs like food and housing are less likely to seek out routine health screenings, Duke explained. The testing services her organization provides includes free testing at mobile clinics, local bars and other public events. Instead of requiring patients to seek out care, Friends for Life brings HIV care to them.

Memphis’s poverty rate, unemployment rate and percent of residents without health insurance (25%) were higher than the national averages when the EHE program was announced in 2019.

Memphis’s Black population is also disproportionately affected by HIV, with 82% of all new HIV infections in 2020 occurring in Black residents—who comprise just over half (51%) of the county population, according to AIDSvu data. The rate of people newly diagnosed with HIV in Shelby County was three times the national rate, according to AIDSvu.

Why is Tennessee rejecting this funding?

There’s been a lot of discussion about why state officials are rejecting the funding. The letter sent to grantees last month coincided with the installation of health department director Dr. Ralph Alvarado, the Tennessean reported.

An NBC report blamed conservative blogger Matt Walsh’s “investigation” of Vanderbilt’s gender-affirming care program with the state’s decision to cut funding. Other state officials have said the decision to cut the funding was made “under previous administrations,” and was part of a move for the state to be less reliant on federal funds.

“We see that the state is rapidly politicizing public health to make it conform to a far-right Christian version of sexual morality, and it’s dangerous. It’s affecting people from all walks of life, but consistently touches issues involving Planned Parenthood, so I’ve had a front row seat as Tennessee has become captive to extremists,” Coffield said.

For Duke, the reasons don’t matter—people’s lives matter.

“Why would a state that’s one of the poorest states in the nation give back $10 million?” Duke asked. “It doesn’t make sense to me. If it’s politically driven, then shame on them. It’s tragic. There are real people who can die because of this.”

HIV, while still a serious diagnosis, is no longer a death sentence—if you get treatment. Letting HIV go untreated can lead to the disease progressing into AIDS. This is where HIV becomes deadly.

Pushing back

Regardless of what additional money the state may (or may not) give to the clinics to replace the gap created by the rejected CDC funding, Duke said she is not giving up on the people who depend on them for HIV treatment and other health services.

“We’re going to continue to work to provide services and we’re going to do everything humanly possible to make sure our clients aren’t going to suffer. We’re not going to go down without a fight,” Duke said.

While it’s important to focus on the harm that could be caused by losing this funding, Duke said she thinks people concerned about the funding loss should contact their legislator and ask them to support House Bill 370 and Senate Bill 290, which would require the state to seek out any available federal grants the state is qualified to receive.

“All too often in situations like this, all the negative stuff overcomes the positive,” she said. “So, those thank-yous sent to the legislators really focusing on helping us are important.”