Tennessee Government’s Decision to Return Federal HIV Prevention Funds puts Progress Towards Ending the Epidemic in the State at Risk
The State of Tennessee has notified the U.S. Centers for Disease Control and Prevention (CDC) that it intends to return federal funding for HIV prevention programs, including core surveillance and prevention program (PS18-1802) and Ending the HIV Epidemic (PS20-2010) funds beginning May 31, 2023.1 These funds have allowed the Tennessee Department of Health (TDH) to build a robust and effective HIV prevention program that has made remarkable progress in reducing new HIV diagnoses in Tennessee.
Between 2008 and 2019, there has been a 22.5% decrease in new HIV diagnoses in Tennessee, from 998 in 2008 to 773 in 2019. The number of pre-exposure prophylaxis (PrEP) users in the state has increased drastically, from 93 individuals in 2012 to 6,909 in 2021. The percentage of people living with HIV who are virally suppressed in Tennessee exceeds the national average.2
Tennessee has been able to achieve this progress thanks to CDC funding from PS18-1802 and PS20-2010 that has helped build up the state health department and support a network of community-based organizations (CBOs) and other HIV prevention service providers that rely heavily on these federal awards. These organizations work diligently to provide accessible, affordable, and culturally competent HIV services and resources to people vulnerable to HIV; they understand and often represent individuals in the communities served.
Additionally, many of these programs have been able to secure discounted-cost medications, including PrEP and post-exposure prophylaxis, and generate significant savings as CDC-funded covered entities participating in the 340B Drug Pricing Program. There is no clear path for these programs, many of which are dependent on 340B savings to fund comprehensive medical and supportive care for people vulnerable to HIV, to remain 340B covered entities with the rescinding of these federal funds.
CBOs increase the reach of HIV services via federal funds awarded by health departments to programs and providers in local communities, as well as through 340B program savings. A gap in access will significantly impact the individuals in Tennessee who rely on these services.
An interruption in funding couldn’t come at a worse time for Tennessee. HIV organizations in the state were already struggling with a loss of program savings from the 340B program and were reallocating Ryan White funds. Despite this, Tennessee has been seen as a model of Ending the HIV Epidemic Initiative (EHE) efforts – although the progress the state has made in reducing HIV incidence is now seriously at risk. The southern United States has the greatest burden of HIV in the country – it is essential to invest in and support programs that provide HIV testing, surveillance, and linkage to care and treatment.
1Federal funds for Tennessee’s Ryan White HIV/AIDS Program Part B and ADAP will not be affected. Additionally, federal funds being allocated to counties in the state (e.g., Shelby County) to support HIV care services will not be impacted.
2All data comes from AIDSvu’s local data report on Tennessee