Dear Tennessee

N.M.A.C. leads with race
Dear Tennessee Colleagues,

Friday is our last call. At the beginning of the year, none of us knew we were about to become best friends. While NMAC had concerns about Texas, Tennessee was not on our map. Your governor brought us together in what might be called a shot gun marriage. This was an important test for our movement. Could local, national, and federal agencies work together to figure out real solutions? This was the first time a state had turned back their core prevention funds, so there was no precedent. However, there was lots of fear. Would other states follow Tennessee? Given the numbers, NMAC was particularly concerned about Florida and Texas. And we still are concerned.It started with an email from Wayne Smith:

“Hello Paul. This is Wayne Smith from Knoxville, Tennessee and Samaritan Ministry reaching out about some issues with HIV prevention in Tennessee. I don’t know if you have heard, but our governor is pulling all CDC funding for prevention from our state. I think he is attempting to replace CDC funding with state funding so that he can control who gets prevention messaging and care. This looks to me like it is an effort to politicize HIV prevention and exclude people that he doesn’t think deserve this kind of service, especially the LGBTQ community. I wonder if this would be something that might be an agenda for other red states that want to control to whom services are provided. If you would like to discuss this with me to see how NMAC might be involved, please call.”

I’ve known Wayne for years; he is part of Samaritan Ministry. His email promoted a phone call where together we decided to hold a zoom with community-based organizations in Tennessee. He invited local colleagues, and I invited the Partnership to End the Epidemics (AIDS United, NASTAD, NCSD, NMAC, and the AIDS Institute) as well as Lambda, Funders Concerned About AIDS, and the Southern AIDS Coalition. For the next four  months we would meet on a weekly zoom to share information, concerns, and support.

On top of the loss of federal HIV prevention funds, there was also a 340B impact that was not as obvious. HIV PrEP uses FDA approved medications. Community organizations depend on 340B revenue to run their agencies. Given the state’s rejection of core HIV funds, would CBOs also lose their 340B funding? There are more 340B dollars then core federal HIV prevention support in Tennessee. Solutions needed to also address this important source of revenue.

The first calls were about setting ground rules and building trust. The Tennessee community needed the nationals to understand that what worked in deep red states is different and we needed to follow their lead. Like we’ve learned over the years with HIV prevention, there is not a one size fits all solution. The Tennessee strategy had to work in an environment where the state legislature had a super majority of Republicans who were also going after the transgender community, drag queens, and other legislators. HIV was just another in a long list of ways to remake their state. Tennessee became a flash point for the culture wars in America.

Building trust was difficult, especially when leaders don’t get along. The divisions were particularly challenging between local jurisdictions. Unfortunately, Tennessee like so many other states, created an environment of mistrust due to the competition for money and resources. This happens all too often, especially when there is not regular communication and partnership building between agencies. NMAC hopes this was not a one-off experience. Please consider a statewide coalition that can increase trust and support through regular communications.

Folks quickly realized there would not be a state legislative solution, so the group turned to the White House and the Centers for Disease Control and Prevention. This is where the nationals played a key role. It’s taken decades for our movement to build relationships with key federal agencies and every four years this could change. Back in the Reagan administration, much of our support came from closeted officials who were always looking over their shoulders. Now we get invited to the White House without having to hide. For Tennessee, the White House stayed out of the discussions because they understood the President could be a lightning rod. Our coalition worked primarily with the CDC while keeping the White House informed.

The biggest challenge in working with the CDC was the lack of time. I got Wayne’s email on January 192023, and the state was turning back funding as of May 31, 2023. Moving government bureaucracies takes time, especially one as large as the CDC. Could we get them to move in a timely fashion and what was the direction they needed to move?

None of this would have happened without CDC’s cooperation and leadership. The nationals became that annoying pest that kept bugging them into action. It started with having the CDC join our weekly calls to hear directly from community about the impact of the governor’s decision. You were able to paint a picture that only people working on the frontlines can share. CDC saw you as the heroes.

I don’t know what happened internally at CDC, but they were able to move in a timely fashion and follow our recommendation to fund the United Way as a neutral third party. While it may have seemed effortless from the outside, I know this was not as easy lift. As I was told, there was lots of support to do the right thing, but there were systems and approvals that need to be followed. Nimble is not a word that is usually associated with a government bureaucracy. What makes CDC’s solution so important is that it built the playbook for what to do if other states take similar actions.

Friday is our last call and I want to say “thank you.” You are heroes in the fight to end the HIV epidemic in America. It’s been my honor to work and get to know you. Together we showed our movement that local, national, and federal leaders can not only work together, but also accomplish the impossible. I hope not to see you again, especially for the joyous celebration when we end the epidemics.

Yours in the Struggle,

Paul Kawata

Paul Kawata