NASHVILLE — After providing free H.I.V. testing at a drive-through occasion final 12 months, employees members at Nashville CARES, a nonprofit sexual well being clinic, made an alarming discovery: a cluster of constructive exams from a single neighborhood.

“There was one one who had unknowingly handed it to a number of companions, and we had been in a position to intervene shortly earlier than it turned a full-blown outbreak,” mentioned Lisa Binkley, who leads the clinic’s H.I.V. prevention crew.

For this work and different efforts to attempt to curb the unfold of H.I.V. within the Nashville area, Ms. Binkley and her colleagues have relied closely on federal grant cash. In order that they had been surprised when Tennessee’s well being commissioner introduced earlier this 12 months that the state would not settle for $8.8 million in federal grant cash, which for greater than a decade has been distributed amongst nonprofit teams, county well being departments and well being care organizations.

Tennessee is the one state to have rejected the funding; Gov. Invoice Lee, a Republican, as a substitute plans to allocate $9 million in new state funding for H.I.V. prevention and monitoring in July. The governor mentioned the transfer would supply the state better independence in its decision-making. However some organizations say they’re involved that the state is not going to supply them funding if they don’t align with the governor’s conservative positions on points like transgender rights, and his opposition to abortion entry.

“You’ll be able to’t politicize public well being,” mentioned Mia Cotton, the chief packages officer of Buddies for Life, a Memphis nonprofit that has acquired the federal funding.

The state has not introduced which teams will obtain the funds, or the foundations on how they can be utilized, however the governor’s workplace has indicated that its priorities embody “susceptible populations, equivalent to victims of human trafficking, moms and kids, and first responders.”

Public well being consultants say Mr. Lee’s listed examples are at odds with the fact on the bottom, as these teams signify solely a tiny fraction of recent H.I.V. circumstances in Tennessee, in response to a latest report from the AIDS charity amfAR. Among the highest-risk teams within the state are sexually lively homosexual males, transgender ladies and those that inject medicine, in response to Greg Millett, the director of amfAR and an epidemiologist.

In a letter final month to the Facilities for Illness Management and Prevention, which provides out the grants, the state well being commissioner, Dr. Ralph Alvarado, cited Governor Lee’s need to cut back the state’s “reliance on federal funding” and “assume elevated independence.”

Jade Byers, a spokeswoman for Mr. Lee, mentioned the brand new method would even be extra environment friendly than the “cumbersome” strategy of receiving C.D.C. grant {dollars}, which requires organizations to spend their very own cash after which search reimbursement from the federal authorities.

Tennessee at present depends on the nonprofit United Approach of Higher Nashville to pick out the recipients and distribute the federal grant cash. No different states have refused C.D.C. funding for H.I.V. prevention and monitoring, in response to a federal well being official.

The C.D.C. requires that recipients of its H.I.V. prevention and monitoring grants give attention to teams which can be most susceptible to H.I.V., utilizing federal information to determine essentially the most susceptible populations in a selected space. Among the many teams recognized by the C.D.C. as high-risk are males who’ve intercourse with males, transgender individuals, and Black and Hispanic individuals. The C.D.C. declined to touch upon Mr. Lee’s choice.

At State Senate committee listening to final week, Senator Jeff Yarbro, a Democrat, requested Dr. Alvarado if the brand new funding method would permit Tennessee to “proceed focusing the majority of those efforts the place the majority of the danger is.”

Dr. Alvarado mentioned he “would think about the identical populations” that at present profit from the C.D.C. funds “will proceed to obtain advantages.” However he didn’t say whether or not organizations and packages that target L.G.B.T.Q. populations can be affected by the funding change, nor did the governor’s workplace when contacted for clarification.

Governor Lee, whose signing of a complete abortion ban and proposed tax cuts have been broadly applauded by Tennessee Republicans, has confronted questions from inside his social gathering of the H.I.V. funding choice.

State Senator Becky Massey, a Republican, requested Dr. Alvarado on the listening to final week if the state deliberate to proceed funding native nonprofits which have been efficient at H.I.V. outreach in rural areas.

Dr. Alvarado mentioned he couldn’t reply her query on the report.

Amongst those that worry that the state will politicize its funding selections is Ray Holloman, who leads the Tennessee Transgender Process Power, a volunteer group that the state well being division established in 2018, through the earlier administration. The crew acquired an annual finances of $10,000, with the purpose of connecting transgender residents to H.I.V. prevention assets; the cash got here from the C.D.C. grants.

Mr. Holloman mentioned he and his colleagues tried to be discreet about their ties to the state well being division.

“We knew from the beginning, if we obtained any type of visibility, they had been going to take our funding away from us,” he mentioned.

His fears gave the impression to be confirmed final fall, when The Each day Wire, a right-wing media outlet, revealed an article accusing the state activity drive of shifting past its unique mission of H.I.V. prevention to “promote transgender surgical procedures and abortion.” A spokeswoman for the governor advised the outlet that he didn’t help the duty drive.

Mr. Holloman mentioned the allegations had been baseless, however, within the weeks that adopted, he noticed his work unravel. The Tennessee Well being Division faraway from its web site details about the duty drive and different well being assets for trans individuals, in addition to details about the state’s H.I.V. prevention packages. Then, Mr. Holloman discovered that the funding for the duty drive would finish on Dec. 31, 2022.  

The duty drive is at present fund-raising to exchange the cash beforehand supplied via the C.D.C. grant, and is hoping to proceed providing H.I.V. prevention training with nonprofit companions.

Deliberate Parenthood of Tennessee and North Mississippi, one other recipient of the federal H.I.V. funding, was additionally notified final fall that the Lee administration deliberate to chop off its entry to the C.D.C. grant. In an announcement launched in January, Deliberate Parenthood mentioned that it had “tried to work with the governor’s workplace following this newest effort, however the state abruptly introduced their withdrawal from the federal program altogether.”

For Mr. Holloman and different L.G.B.T.Q. individuals in Tennessee, the transfer to remove funding to the Tennessee Transgender Process Power is seen as a part of a broader assault on trans rights. Governor Lee has authorized laws that bans all gender-affirming therapy, hormone therapies and referrals for transgender youngsters to obtain medical care within the state. He additionally referred to as for an investigation of the Clinic for Transgender Well being on the Vanderbilt College Medical Heart.

Tennessee lawmakers have additionally superior laws that will block trans individuals from altering the gender listed on their drivers’ licenses.

Over the previous decade, the South has emerged because the epicenter of the nation’s H.I.V. epidemic. Folks in Southern states account for over half of recent H.I.V. circumstances every year, though simply 38 p.c of the U.S. inhabitants lives within the area. Shelby County, which incorporates Memphis, has certainly one of one of many highest charges of recent H.I.V. infections nationwide.

Ms. Cotton, of Buddies for Life, mentioned there was an additional, hidden value to Tennessee’s choice to refuse the federal funding. Buddies for Life receives roughly $500,000 per 12 months from the C.D.C. grants, and the group’s standing as a federal grant recipient makes it eligible to purchase medicine from producers at a steep low cost, as a part of a program that started within the Nineties to assist enhance public well being in low-income communities.

With out the grant cash and the drug reductions, Ms. Cotton mentioned, the Buddies for Life clinic would almost certainly have to shut down. Ms. Cotton and different H.I.V. prevention consultants throughout the state have been scrambling to seek out different sources of funding since Dr. Alvarado advised the C.D.C. that the state not needed the grant cash.

“It’s been scary, since you need to give individuals constant well being assets, and we simply don’t know what’s going to occur come June with out the federal cash in place,” mentioned Amna Osman, the chief govt of Nashville CARES, referring to the top of the federal grand contract. The group serves 50,000 individuals throughout 17 counties.

Ms. Osman mentioned she and her colleagues had been fearful about what may occur if they may not afford to supply H.I.V. testing; the group at present receives greater than 40 p.c of its finances for H.I.V. prevention and training, or $315,000 a 12 months, from the C.D.C. grants.

Final month, Ms. Binkley, Ms. Osman and different CARES employees members introduced a cell clinic to a homeless encampment alongside the Cumberland River in downtown Nashville, providing free H.I.V. and hepatitis C testing, whereas additionally distributing check strips that detect fentanyl in road medicine and handing out Narcan, a medication that may quickly reverse an opioid overdose.

Minutes after they pulled into an empty lot on the middle of the encampments, they arrange three folding tables stacked with medical historical past varieties, testing provides, sandwiches and bottled water.

“Doesn’t matter the place we’re, everyone at all times says, ‘Oh, don’t fear, I obtained examined final week,’” Ms. Binkley mentioned. “Folks simply don’t need to know, loads of the time. It’s scary to know in case you’re constructive, however we’re good at setting individuals comfortable.”