As goes the South, so goes the nation: Tennessee’s HIV cuts are a warning for marginalized populations

When Tennessee Gov. Bill Lee decided to reject millions of dollars of federal funding for HIV prevention and treatment earlier this year, he made history in the worst way. No other state has ever turned back this type of funding, and Lee’s move had the potential to spark a public health crisis that would start in Tennessee — but would not end there. 

That’s why the CDC’s announcement that it will bypass Lee and provide $4 million in direct federal funding to the United Way of Greater Nashville to pay for HIV-related services in Tennessee is so important. The move will save lives throughout the state — Shelby County, the home of Memphis, has some of the highest HIV and AIDS rates in the U.S. — and shows how far the Biden administration will have to go to protect vulnerable communities from attacks on their safety and dignity.

But let’s be clear: the CDC’s intervention may not be enough to prevent elected leaders in other red states who share Lee’s animus toward the communities hit hardest by HIV from adopting copycat legislation and policies. The near-unilateral decision by Lee’s administration provides a roadmap for other governors looking to muscle through similar moves of their own.

This unprecedented change had nothing to do with advancing public health or even fiscal responsibility. The state had long worked with the United Way of Greater Nashville to distribute CDC funding to other non-profit organizations that provide HIV services. But instead of working with the United Way to address any perceived concerns about how the money was allocated, the Tennessee Department of Health abruptly announced in January that it would reject the federal money. Several smaller nonprofits quickly said they’d have to reduce or eliminate vital HIV prevention services if the cuts went through. 

The rationalization for rejecting the $8.8 million in federal HIV funding is based on the pretext that using state dollars would allow for more efficient and effective distribution of aid to vulnerable populations. The “vulnerable populations” that the governor’s office alluded to — mothers, children, first responders and victims of human trafficking — represent a very small fraction of new HIV cases in the state. Cisgender women, for instance, account for fewer than 18 percent of Tennessee’s cases. 

In reality, the funding will be directed away from sexually active gay men, the transgender community and people who inject drugs — marginalized populations in Tennessee that also happen to be disproportionately Black. As a Black trans woman, this issue is deeply personal for me.

Lee’s action would also exacerbate an already-overlooked crisis in the South, which the CDC has described as the epicenter of the nation’s HIV epidemic. Despite only representing 38 percent of the total U.S. population, more than half of new HIV cases in the U.S. occur in 16 Southern states and the District of Columbia. 

That’s why we need to be clear about the fact that the CDC has made this move to save lives, not to score political points. It’s Lee, not the CDC, that has politicized the fight against HIV, which has long been a bipartisan effort. 

In 2003, President George Bush launched the United States President's Emergency Plan For AIDS Relief (PEPFAR) initiative, which has invested more than $100 billion in global HIV prevention, treatment and research efforts around the world and saved countless lives. 

In 2019, President Donald Trump announced an ambitious plan to end the HIV epidemic by 2030, in part by steering new funding to localized treatment and prevention efforts. 

Just last year, meanwhile, Sens. Ben Ray Luján (D-N.M.) and Rick Scott (R-Fla.), who are about as diametrically opposed on politics as two sitting U.S. senators can be, introduced legislation to increase flexibility for clinics to cover HIV prevention medication. 

That bipartisanship has seemingly disappeared as Republican governors and legislatures around the country escalate their growing, all-out assault on LGBTQ+ communities in their states.

Whether they’re banning public school teachers from educating students about sexual orientation and gender identity or banning safe, commonly administered gender-affirming care for minors, Republican-led state governments are advancing legislation to demonize and directly target LGBTQ+ communities across the country at breakneck speeds. Many of those communities have also been hit disproportionately hard by the HIV epidemic 

That means Lee’s move has the potential to inflict lasting damage in Tennessee, which is ranked 44th in public health nationally. Even worse, it could create a ripple effect of outbreaks throughout the other 15 states at the center of the HIV crisis.

Thanks to the courageous leadership of the CDC, the Biden administration found a creative way to avert an unnecessary public health crisis in Tennessee. But if other Republican governors follow in Lee's footsteps and reject federal HIV funding, the White House will have to move just as quickly — and just as aggressively — to prevent them from undoing decades of progress in the fight against this deadly disease.

Toni Newman, a policy expert and longtime advocate for LGBTQ+ equality, is the director of NMAC’s Coalition for Justice and Equality Across Movements. Previously the executive director of the Black AIDS Institute, Newman has spent decades working to improve HIV prevention and treatment efforts, especially for the trans community.