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The Potential Domino Effect of Tennessee’s HIV Federal Funding Cuts

Publisher’s Note: Since we first published this piece by Jennifer Lockwood of Ravin Consultants, there has been an important development that is addressed at the end of the story. We thank Jennifer and her team for alerting us and recommending that we republish the article with their update.


On January 17th 2023, a letter was sent from the Tennessee Department of Health (DOH) to Tennesseans serving “as notification of changes in the HIV Program.”  The letter informed federal grantees that they will no longer receive CDC funded HIV ‘in-kind support and services’ and will need to find their own financial means by June 1, 2023.

This means cash-strapped safety net providers treating HIV and STD patients will no longer receive federal funding for such essential items as condoms, lubrication, HIV and/or Hepatitis testing kits, prevention materials, or any other support services.

Let the dominoes begin to fall: Tennessee 340B ineligibility due to funding loss

Organizations that are currently qualified under Tennessee’s STD 340B Program, which has become the most important financial lifeline for many non-profit organizations, may no longer be eligible to participate because of the lost funding.  As a result, thousands of patients are in danger of losing their access to life-saving medications. There are at a minimum 14 non-profit organizations located in the state with ‘in-kind products or services’ that now need to scramble for HIV grants and 340B eligible grants to continue their revenue streams. Other Tennessean organizations, with direct funding through the state, and not CDC, will also need to search elsewhere. 

According to Glen Pietrandoni, Chief Advocacy Officer of Avita Care Solutions, “Rejecting federal funding for HIV prevention, testing, and treatment programs that benefit Tennesseans is short-sighted. Community health organizations and the tens of thousands of individuals living with HIV in the state who seek inclusive, affordable, and comprehensive health care will be critically impacted. Worse, we’re undermining years of progress in building trust among the underserved populations who benefit from these life-saving services, including women and the Black, Brown, and LGBTQ+ communities. Covered entities are trusted for their patient-centered care, including HIV prevention, testing, and treatment. If there’s no federal funding or state-funded initiatives to support this care, it’s not political agendas but people that suffer.”

Smoke and mirrors

Tennessee Governor Bill Lee (R) stated that, “We think that we can do better than the strings attached with the federal dollars that came our way…” and he would, “Continue supporting HIV testing and prevention, but the focus would be first responders, victims of human trafficking, and mothers & children.” While we can all agree that these groups are a very important part of our population, the notion of prioritizing one target population over another does not hold up well when there are free federal funds available to take care of ALL populations.

By failing to prepare, you are preparing to fail

Health Commissioner Dr. Ralph Alvarado articulated to the Tennessee Senate’s Health and Welfare Committee, “Right now, it’s in the best interest of Tennesseans to assume direct financial and managerial responsibility for these services.” Yet that price tag is nearly $10 million annually, with no known plan for how this will be replenished, and no option to submit questions until March 15. The state hopes to have a new contract implemented by June 1. This timeline (although admirable) is extremely ambitious, to say the least.

Hammer and anvil?

It is believed by many health care advocates and other experts that Tennessee is attempting to further disrupt Planned Parenthood, which also conducts HIV/STD testing. Roe v. Wade was overturned by the U.S. Supreme Court in June 2022; by August 2022, abortion became illegal in the state. As of early January, there are 14 states that have similar near-total abortion bans in effect. There are at least 570 non-profit organizations within these 14 states that are funded from the state. The fear is that these states could be next to reject CDC HIV funding.

Cutting off one’s nose to spite one’s face

Let’s think hypothetically over a larger scale. There are 24 “red states” that have banned abortion in some capacity. Take Florida, for example, which has the third highest number of HIV positive patients per capita, behind California and New York. It is a well-known fact in healthcare that preventive care is significantly less expensive than actual treatment itself, especially in the case of HIV. At a minimum, there are 1,228 STD organizations servicing HIV patients within these 24 states and they should all be paying very close attention to what’s happening in Tennessee right now.

The domino effect may be catastrophic

Should we question the potential of the mindset of the Tennessee government to spread across the US? While we don’t know the answer, we know that if this did occur, there would be at least 2,407 STD organizations in the US currently receiving HIV CDC pass-through funding that could be severely affected. Approximately 1.2 million people in the United States have HIV, 13% of which don’t even know they have it and need HIV-testing. Now is not the time to decrease funding, especially after the COVID-19 pandemic where many did not routinely test due to quarantines and restrictions. Losing free federal funding and thus losing 340B unrestricted revenue, would not only be catastrophic for non-profit organizations, but would undoubtedly reverse the recent gains in HIV prevention and treatment programs.

The final domino laid to rest: this will impact ALL populations

Planned Parenthood represents less than 10% of all non-profit organizations providing HIV services, prevention, and treatment. Americans need to realize the bigger picture here with HIV. You may be reading this and think that this article only represents the LGBT arena; however, heterosexual contact accounted for 22% of all HIV diagnoses in 2020, and an additional 7% from injection drug use.

So, we ALL need to speak up and nip this in the bud

Even if your organization does not reside in Tennessee, or a “red state”, does not receive CDC pass-through funding, is not an STD Clinic, or does not serve the HIV population; this is something we all need to rally around to continue the fight against HIV and other sexually transmitted infections. The communities most at-risk of HIV cannot afford to lose access to critical preventive services, and we certainly cannot unravel 20+ years of trying to end the HIV epidemic.

If you believe your organization may be affected by this decision, please contact Ravin Consultants to discuss contingency plans.

Update: May 30, 2023

The CDC has annually provided millions of dollars ($6.2 million in 2022) to the State of Tennessee to be used towards the prevention of HIV transition in the state. The Department of Health then awarded approximately $4 million to the United Way of Greater Nashville, which in turn distributed the funds to other community-based organizations. The remainder of the $6.2 million from the CDC was typically allotted to support HIV surveillance in the state.  

After the Lee administration in Tennessee announced that they would be declining the federal funding this year, many of the stakeholder organizations at risk of losing funds appealed to the CDC to circumvent the state. The CDC agreed and announced that instead of awarding federal dollars to combat HIV transmission to the state of Tennessee Department of Health, it would provide the funding directly to the United Way and other nonprofit organizations that would have normally received allotments. This development has restored hope to the many organizations in Tennessee that are fighting to keep new HIV infections down. 

Jennifer Lockwood, CEO

Jennifer Lockwood, MBA, ACHE, is Chief Executive Officer at Ravin Consultants. To learn more about Jennifer, please read her 340B Report Industry Leader Spotlight.

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