Chattanooga nonprofit organizations that provide HIV services are scrambling to figure out how to keep those programs as Tennessee plans to forfeit millions in federal dollars used to support their work.
Cempa Community Care is one of several Chattanooga-area providers that was notified this week the Tennessee Department of Health would no longer accept two grants from the U.S. Centers for Disease Control and Prevention used to fund HIV surveillance, testing and prevention services through community partners around the state.
One of those grants allocates between $5.9 million and $6.5 million annually to Tennessee and was distributed to organizations such as Cempa, according to a CDC outline of grant recipients. The other was launched under the Trump administration and allocated roughly $2.1 million annually to Shelby County, a hot spot for new HIV infections.
Shannon Stephenson, CEO of Cempa Community Care, said in a phone interview Friday several of Cempa's key services and 14 staff positions are dependent on the CDC funds. Her initial estimate is Cempa will lose around $754,000 per year without the grant.
At-risk services include Cempa's distribution of medication to treat hepatitis C and a drug called PrEP that prevents the spread of HIV to those who are not infected. Cempa also has a clinic in Johnson City, based at East Tennessee State University, and a syringe exchange program that covers much of East Tennessee funded by the grant.
"We just want to focus on the fact that we have prevented the spread of infectious disease. We were on the frontlines of the COVID pandemic," Stephenson said. "Here we are, just kind of getting our wits about us and getting grounded again after working so hard on COVID, and then now you're gonna take away our ability to do (HIV) prevention and testing and education. It's not good."
There are more than 20,000 people living with HIV in the state, and 14% of Tennesseans with HIV are unaware of their status, according to the CDC.
Bill Christian, a spokesman for the Tennessee Department of Health, declined to comment but provided a letter sent to partner agencies saying the state is no longer going to accept the CDC funds -- and pass them along to local agencies -- in an effort to reduce the state's overall reliance on federal funding.
HIV prevention and surveillance efforts will be shifted to the metro health departments in Davidson, Hamilton, Knox, Madison, Shelby and Sullivan counties by June 1, the letter states.
Joeli Poole, a spokeswoman for the Hamilton County Health Department, said via email Friday the department was "recently notified that TDH will be making transitions in both funding and program activities in the HIV program. We do not have any specifics on what that means for ourselves or our community partners and await further information from TDH."
During his walkthrough for his second term inauguration outside the Capitol on Friday, Tennessee Gov. Bill Lee was asked about the decision to forgo CDC funds for HIV.
"We think we can do that better than the strings attached with the federal dollars," he said.
He did not say where the resources for the state to take over the services would come from.
"The purpose of this is to make sure that we spend the dollars in a way that best serves Tennesseans and that best mitigates and prevents HIV spread in the community, particularly focusing on human trafficking victims, the transmission to first responders, on the transmission from mothers to their babies," Lee said. "Those are populations that we want to focus on."
Most new HIV cases in Tennessee are among young, Black men who have sex with men, but the CDC states many counties in Tennessee are also experiencing or at risk of an HIV outbreak or significant increase in hepatitis infections due to injection drug use fueled by the opioid epidemic.
A document from the CDC states preventing new HIV transmission is best achieved by using proven interventions, including PrEP and syringe exchange programs -- a form of harm-reduction that provides sterile needles and syringes to people who inject drugs to prevent the spread of blood-borne viruses such as HIV and hepatitis C.
Syringe exchanges are also a primary entry points for HIV testing and are used to educate and funnel people with substance use disorders into treatment.
State and county health departments won't be able to offer syringe programs, Stephenson said, because federal law prevents taxpayer funds from going directly toward "drug paraphernalia."
As it stands now, the CDC grant funds the salaries and some aspects of Cempa's syringe program, and then Cempa fundraises and seeks other grants to supplement the aspects that can't be taxpayer-funded.
"Health departments aren't going to be able to get outside private funding to fund things like that, and the biggest impact of that is that we're in the heart of Appalachia," Stephenson said. "We're the next projected outbreak area. In fact, we had a new HIV positive come through our syringe exchange program just this week.
"I don't think that the opioid crisis was weighed into this decision," she said.
Choice Health Network is another provider with a Chattanooga-based clinic impacted by the state's decision to end CDC funding.
CEO Steve Jenkins said in a media statement Thursday the cut "threatens to reverse the significant progress made in the fight against HIV and AIDS."
"The decision announced by the state to cut funding for HIV prevention, detection and treatment programs that are not affiliated with metro health departments will be devastating for the people across the state served by Choice Health Network, especially those in rural areas of Tennessee," Jenkins said. "We rely on state funding to provide care for people across Tennessee, many of whom have no access to metro health departments."
Staff writer Andy Sher contributed to this report.