The HIV Funding Boogeyman

Last week, Mayor Freddie O’Connell’s office filed legislation to accept a $696,500 grant from the Tennessee Department of Health to assist the Metro Board of Health in the prevention of HIV. The legislation comes alongside multiple initiatives passed this year, including support for a needle exchange program.

The mayor's newest resolution includes a state allocation that has recurred over the years. Tennessee has provided Metro with HIV prevention and surveillance funds, including the annual $696,500 that mostly goes to salaries and benefits, since 2023.

Before that, similar CDC grants passed through the state to local health departments. But in 2023, Tennessee withdrew from two CDC-funded HIV-prevention cooperative agreements, ending roughly $8 million in annual federal funding.

The state said the change was to reduce dependence on federal funding and take direct managerial control. But the timing made for political fodder.

Disputes over abortion and transgender-focused services led some to interpret the decision as a targeted attack on Planned Parenthood. And though the decision affected specific CDC prevention grants, not all federal HIV funding, Democratic state leaders and officials warned that the cuts would be devastating.

“With funding being eliminated and threatened, all these efforts will have to either stop in some program areas and end others, it'll be a challenge to have adequate funding to comprehensively address the HIV epidemic,” said Amna Osman, executive director of Nashville CARES, at the time. “Funding is seriously being threatened at all levels—at the federal level and at the state level.”

But after Tennessee turned down CDC money, the state legislature approved $9 million in state funds to replace it, and the CDC still sent about $4 million straight to nonprofits, so the state ended up with roughly $13 million. Over the years, HIV funding in Davidson County has held steady at roughly $8 million per year, even peaking at just over $9 million in 2024. But a significant change did occur this year.

The Metro Council dipped into its opioid settlement money to help fund a needle exchange program through the Nashville nonprofit, Street Works. In 2018, Street Works established the state’s first sanctioned needle-exchange program. The services are directly tied to HIV and other disease prevention.

Metro has funded Street Works before, but never directly for needle programs. The earlier contracts, most recently a $452,000 grant approved in August, passed federal money through the Health Department for HIV case management, emergency aid, and transportation. This appears to be the first time Metro has paid for needle exchange itself and used its own settlement money to do it.

Street Works isn’t the only needle exchange program in town. Nashville CARES, Meharry Medical College, and Vanderbilt’s Comprehensive Care Clinic also run state-sanctioned programs. At least one group, Mainline Harm Reduction, has operated without state approval.