The following information was written by and is provided through a partnership with the Tennessee Department of Health:

On November 27, 2019, Tennessee Department of Health became one of the first state health departments in the Southern U.S. to join the “Undetectable Equals Untransmittable” (or “U=U”) campaign. The U=U campaign raises awareness about the fact that people living with HIV who stay on treatment and maintain an undetectable viral load cannot transmit the virus through sex and are much less likely to transmit it through needle-sharing. 

For a person living with HIV, being undetectable means that the amount of HIV virus in their blood is so small that it is “undetectable” to HIV viral load tests. When this happens, the person is incapable of transmitting HIV via sex. This has enormous health benefits for the individual as well. Staying undetectable can help a person living with HIV avoid the health complications from the virus and live a longer, healthier life.

Getting to undetectable status is a health goal for people living with HIV. To achieve and maintain an undetectable viral load, people need consistent access to treatment without fear. The fear that stigma creates can build barriers between medical providers and their clients.

The Centers for Disease Control and Prevention define stigma as “discrimination against an identifiable group of people, a place, or a nation.” This identifiable group of people can be a group of people who all share the experience of living with a health condition. For people living with HIV, stigmatization is a shared fear and, unfortunately, one grounded in reality.

According to Needs Assessment 2020 Special Study conducted by the Tennessee Community HIV/AIDS Partnership, one out of every three people living with HIV in Tennessee lives with the fear that their HIV status may be discovered by someone living in their community (Tennessee Community HIV/AIDS Partnership. "Needs Assessment Special Study). One in five experienced stigma related to their HIV status while receiving medical services. 

In deep dive interviews, people living with HIV in Tennessee reported choosing and staying with one provider and/or avoiding medical treatment altogether to avoid potential HIV stigma. Stories about stigma demonstrated that people living with HIV might be stigmatized because of their HIV status and because of their race, gender, and sexual orientation. 

One important dimension of stigma is that it provokes a fear response where fear is not needed or helpful. Study respondents described fear from people who lived in their community and from medical professionals in situations where HIV transmission was not possible. This fear made them more likely to limit their own options for treatment and in some cases served as a barrier to treatment itself. 

In 2021, we understand that treatment is a key cornerstone of prevention. Our state is healthier when everyone living with HIV has easy, uninterrupted access to treatment. Over the years, many barriers to such access have been dismantled in Tennessee; people living with HIV can get treatment even if they are uninsured and cannot afford it through the Ryan White HIV/AIDS Program. To help people get access to HIV treatment early and stay in care, services like transportation, housing, and psychosocial support are in place. Expert case managers are available to help people new to this network of support navigate to the services they need. But even with all of those resources, stigma can make a person living with HIV think twice about taking advantage of them. 

Ensuring that all Tennesseans, not just people living with HIV, understand that HIV treatment substantially reduces the risk of transmission fights stigma. When people living with HIV take their medications as prescribed and maintain an undetectable viral load, their efforts benefit their personal health and protect their community. 

All of us, whether we live with HIV or not, can play a role in dismantling stigma. If you or someone you love is living with HIV, here are some resources you can use to help a person achieve undetectable and untransmittable status:

• Get into care (if you aren’t in care already) by connecting with a Ryan White Medical Case Manager. A case manager can tell you whether or not you qualify for Ryan White services and can answer any questions you have about your diagnosis and your options. Click here to find a case manager near you.

• Get back into care after a lapse, a move, or any other type of care interruption with the help of an Early Intervention Services (EIS) specialist or a Re-engagement specialist. Click here to read more about EIS services in Tennessee or here to connect with a Re-engagement specialist.

• Identify and overcome your barriers to daily medication. Maintaining an undetectable viral load requires people living with HIV to stay on a daily medication regimen. If that is something you haven’t had to do before, it can be challenging. Identify what makes it hard to take your medication daily and share your concerns with your case manager and/or medical provider. Click here to learn more about all of the supportive services Ryan White offers to help people maintain stable access to care. 

• Set up a system of social support. Living with HIV can be challenging, especially if you are living in fear that people will discover your health status. One way to fight this fear is by telling the people in your life about your health. Planning a disclosure can be difficult, but there are lots of professionals and peers in Tennessee that can help. Your Ryan White medical case manager can support you in planning a disclosure. For people new to living with HIV, Anti-Retroviral Treatment and Access to Services (ARTAS) linkage coordinators can help you get into care and plan a first disclosure. Healthy Relationships is a series of workshops for people new to living with HIV that uses a peer model to help people get comfortable and good at talking about their HIV status. Click here for more information about ARTAS and Healthy Relationships.

HIV stigma has its roots in a time when we didn’t know what HIV was, how it spread, or how to treat it. Stigma alienates people living with HIV and is often part of a person’s thought process when considering care. No one should be afraid to do something good for their health, especially when it will also benefit their community. We all have a role to play in eliminating HIV stigma in our communities. Spread the word about U=U, bring up HIV and educate your friends and family, and spread the word about all of the resources people living with HIV in Tennessee have to maintain their health.

Three dangerous anti-trans bills are headed to Governor Lee. Contact him at 615-741-2001 and make your voices heard.

HB1233 is an anti-transgender student bathroom bill that offers trans students separate and unequal accommodations in our public schools. Tennessee could be the only state this year to enact a bathroom bill if the Governor signs it. 

HB1182 is the anti-transgender bathroom sign mandate bill that applies to businesses and organizations that have a trans-inclusive policy for multi-person restrooms. The bill requires them to put up a demeaning sign about biological sex. It could lead to increased policing of trans people in restrooms and aggression towards trans-inclusive businesses. 

SB126 is a bill that puts into the Tennessee Code standards for gender-affirming care for trans youth. Why is that a bad idea? It is discriminatory because we don’t normally put standards of care into the law and if the standard of care changes based on research, we shouldn’t have to amend the law. It could also invite more restrictive amendments in future legislative sessions.

Contact Governor Lee today at 615-741-2001 and let him know your views on anti-transgender legislation.

Email Option:  You can also send him an email through his contact form at https://www.tn.gov/governor/contact-us.html .

Make your voice heard on bills moving the week of May 3 as the Legislature prepares to adjourn.

May 3

*HB1027, the bill regulating gender-affirming care for transgender youth, is on the House floor Monday evening.

-Use this easy form to contact your member of the Tennessee House of Representatives.  If you have already sent your message, share the link with friends.

-If you want to compose a personal email or voice mail for your state representative, but don't know who that is, be in touch at [email protected] any time before Monday at 10 a.m. Central Time.  We will help you with your message and with the contact information.  Put your street address and Zip code in the email. 

Near Future

-Calls to the Governor:  Several bills are heading to the Governor or on his desk.  Call Governor Lee at 615-741-2001, leave a message asking him to veto SB1229/HB529 (parent opt-out bill), SB1367/HB1223 (anti-trans student bathroom bill), and SB1224/HB1182 (anti-trans bathroom sign mandate bill).

-Letters to the Editor:  If you want to write a letter to the editor of your local paper (especially outside Nashville), and you need some guidance, reach out any time at [email protected] and let us know the name of your newspaper. We could use some letters urging the Governor to veto these bills. This weekend is a great time to start.

Discriminatory bills continue to advance. Take action and fight back with the steps below.

*If you want to have a phone meeting with your state senator and/or your state representative the week of April 26, contact us at [email protected] and we will help you get it set up and prepare you with an issue brief.

April 26

EVENT:  Quick Zoom Phone Bank on the Bad Bills

April 26 or April 27

*HB1027, the bill regulating gender-affirming care for trans youth, is up for a vote in House Government Operations Committee. Note: The information on the bill's page on the Legislature's web site says that it is up for a vote on April 27, but the House Government Operations Committee meeting is listed for April 26.  UPDATE:  The Government Operations Committee did approve the bill on April 26 and it is headed to the House floor soon.

-Use this easy form to contact your member of the Tennessee House of Representatives.

Indefinite Date

*SB1224, the anti-transgender sign mandate bill, will be on the Senate floor soon.

 -Use this easy form to send an email to your state senator and urge them to vote NO.

Note: There are additional bills that could be added to the calendar. If they are put on the calendar, we will add more campaigns.

More damaging bills are getting closer to passing. Take action on these bills moving the week of April 19.

Remember that the parent opt-out bill is heading to the Governor for his signature, so call him. Tell Governor Lee Veto SB1229/HB529 Parent Opt-out bill for LGBTQ curriculum at 615-741-2001.

Monday, April 19

Event:  Zoom phone bank against discriminatory bills at 6 p.m. Central Time.

*SB1367/HB1233, the anti-transgender student bathroom 2.0 bill, is up for floor votes in the Senate and House.

-Use this easy form to send an email to your own state senator and state representative. Feel free to add your own message.

Tuesday, April 20 (possibly Wednesday, April 21)

*SB1224, the anti-transgender bathroom sign mandate, is back in Senate Judiciary Committee.

-Use this easy form to send an email to all the committee members. Feel free to add your own message.

-Leave phone messages with the members of the committee using the scripts and office numbers at this link.

Indefinite Date

*HB1027, the caption bill amended to regulate gender-affirming care for trans youth, will be up for a vote in the House Government Operations Committee soon.

-Leave phone messages with the members of the committee using the scripts and office numbers at this link.

Note:  If you clicked on this link from the Times News Editorial, go to the new campaigns for the week of April 19 at https://www.tnep.org/take_action_on_dangerous_bills_moving_the_week_of_april_19 .  You can call Governor Lee and urge him to veto SB1229/HB529 by calling him at 615-741-2001 .

2021 has been the toughest legislative session in years. The week of April 12 is no departure as discriminatory bills continue their advance. Take action and fight back using the campaigns and events below.

If you are available to meet by phone or Zoom with your state senator and/or state representative in the next two weeks, be in touch at [email protected] and we will get you information to prepare you.

Monday, April 12

*EVENT: GLSEN TN phone bank

Tuesday, April 13

*SB1224, the anti-transgender bathroom sign mandate bill, is up in Senate Judiciary Committee.

-Leave phone messages with the members of the committee using the numbers and script at the link.

-Use this easy form to send a message to the committee and consider including your own message.

*HB1233, anti-transgender student bathroom bill 2.0, is up in House Finance Committee. The Senate companion bill has been delayed on the Senate floor and has been reset for April 19.

Wednesday, April 14

*EVENT: GLSEN TN's "Show Up for Trans Youth at Cordell Hull"

*HB578 and HB1027, bills attacking gender-affirming care for trans youth, are up in the House Health Committee.

-Leave phone messages with the members of the committee using the numbers and script at the link.

-Use this easy form to send a message to the committee and consider including your own message.

*HB529, the parent opt-out bill for sexual orientation/gender identity curriculum, is on the House floor.

-Use this easy form to send a message to your member of the Tennessee House of Representatives.

More discriminatory bills are getting dangerously close to passing. Take action on these bills moving the week of April 5.

Monday, April 5

*SB1229, the sexual orientation/gender identity curriculum opt-out bill, and SB1367, the anti-transgender school bathroom bill 2.0, are on the Senate floor.

-Use this easy form to contact your state senator. Consider including a short video message.

-EVENT: Call Out Discrimination Zoom phone bank at 6:00 p.m. Central Time.

Tuesday, April 6

*HB1027, the caption bill regulating gender-affirming care for trans youth, is back in the House Health Subcommittee.

-Make calls to the members of the subcommittee using the numbers and script at the link.

-Use the new email campaign under HB578 with Wednesday's action steps. It is a combined campaign that includes HB1027.

*SB1224, the anti-transgender bathroom sign mandate, is up in Senate Judiciary.

-Make calls to the members of the committee using the numbers and script at the link.

-Take action with this easy email campaign. Add your own written or video message.

Wednesday, April 7

*HB578, the bill attacking gender-affirming care for trans youth, is up in the House Health Committee.

-Make calls to the members of the committee using the numbers and script at the link.

-Take action with this easy email campaign. Add your own written or video message.

*HB800, the bill banning LGBTQ content in school textbooks and instructional materials, is up in House Education Instruction Committee.

-Use this easy email campaign for HB800 and the two bills below. It will go to members of Senate Education Committee and House Education Instruction Committee. Add your own written or video message.

*SB659/HB1535, a bill that would ban supplemental curriculum materials not approved by the state, is up in Senate Education and House Education Instruction Committees.

-Make calls to the members of the House Education Instruction Committee on HB800 and HB1535 using the numbers and script at the link.

-Make calls to the members of the Senate Education Committee on SB659 using the numbers and script at the link.

-See the email campaign above for HB800.

Thursday, April 8

*SB126, another anti-trans youth health care bill, is on the Senate floor.

-Take action with this new, easy campaign to contact your own state senator.

Many dangerous bills are still moving through the Legislature during the week of March 29. Here are some ways you can take action.

Monday, March 29

*HB1182, the anti-transgender bathroom sign mandate, is on the House floor.

-Take action by using this form to send a message to your member of the TN House. You can add a video message.

*EVENT:  Kill the killer bills phone bank at 6:30 p.m. Central Time with GLSEN TN.

Tuesday, March 30

*HB800, the bill banning LGBTQ content in school textbooks and instructional materials, is up for a vote in the House Education Instruction Subcommittee.

-Email the members of the Education Instruction Committee about this bill and HB529 using the easy form.

-Call the members of the subcommittee and urge them to vote NO with the scripts and numbers at this link.

*HB1027, the caption bill that could be amended to regulate gender-affirming care for trans youth, is up in the House Health Subcommittee.

-Make calls to the members of the House Health Subcommittee on the bill with the script and numbers.

-Use this easy form to send an email to the members of the House Health Subcommittee and the Senate Health and Welfare Committee.

*EVENT:  TEP Rutherford County Zoom meeting at 6:30 p.m. Central Time.

Wednesday, March 31

*HB529, the sexual orientation/gender identity curriculum opt out bill, is up for a vote in the House Education Instruction Committee.

-Call the members of the committee using the scripts and numbers at the link.

-See the email form under HB800 on March 30 for the email campaign on this bill. It is a combined campaign.

*SB126, the caption bill that could be amended to regulate gender-affirming care for trans youth, is up in the Senate Health and Welfare Committee.

-Make calls to the members of the Senate Health and Welfare Committee using the numbers and scripts.

-See above under March 30 for the email campaign that sends an email to the House and Senate committees on the bill.

A record for discriminatory bills moving the week of March 22! Here are ways you can take action.

MARCH 22

*SB228/HB3, the anti-transgender student athlete bill, is up for a vote on the House floor.

-Use this form to send a message to your member of the Tennessee House about the bill.

-Online Event:  Call Out Discrimination Zoom Phone Bank at 6:00 p.m. Central Time.

MARCH 23

*HB1027 is a caption bill that would likely carry language regulating gender-affirming care for transgender youth. It is on notice in the House Health Subcommittee.

-Make calls on HB1027 with the scripts and phones numbers at this link.

-Use this easy form to email the House Health Subcommittee and the Senate Health and Welfare Committee.

*HB1182, the anti-transgender bathroom sign mandate, is BACK ON NOTICE after being taken off notice. It is up for a vote in the House State Government Committee.

-Use the email campaign at this link if you have not already done so.

-If you would like to leave messages for the members of the State Government Committee, find the script with phone numbers here.

*HB800 would ban LGBTQ content from the public school curriculum.  HB529 would require schools to let parents opt their students out of sexual orientation/gender identity curricula in public schools. Both bills are up for consideration in the House Education Instruction Subcommittee.

-Make calls on HB800 and a related bill, HB529, with the script and phone numbers at this link.

-Use this easy form to send emails to the subcommittee. Feel free to add your own message in the blank space.

-Online Event:  People's Preview of the State presented by Tennessee Advocates for Planned Parenthood. 6:00 p.m. Central Time.

MARCH 24

*HB578, the bill attacking gender-affirming care is up for a vote in the House Criminal Justice Committee.

-If you would like to leave phone messages with the members of the committee, find the scripts and phone numbers here.

-Email the members of the committee using the easy form at this link.

*SB126 is a caption bill that would likely carry language regulating gender-affirming care for transgender youth, is on notice in the Senate Health and Welfare Committee.

-Make calls to the members of the committee using the phone numbers and scripts at the link.

-The email campaign for this bill is combined with the March 23 campaign on the companion bill up in the House Health Subcommittee. See above.

*SB1229, the bill that would let parents opt their students out of sexual orientation/gender identity curricula in public schools, is up for a vote in the Senate Education Committee.  SB1367, which is an anti-transgender student bathroom bill 2.0 is up in the same committee on the same date.

-Make calls to the members of the committee using the phone numbers and scripts at this link.

-Use this easy form to email the Senate Education Committee on both bills. Add your own message in the blank space.

-Online Event:  TEP Knox, Anderson, and Blount Counties virtual meeting at 6:00 p.m. Eastern Time.

-Online Event:  TEP Shelby County virtual meeting at 6:30 p.m. Central Time.

MARCH 25

-Virtual Event:  TEP Tri-Cities virtual meeting at 6:30 p.m. Eastern Time.

More anti-LGBTQ bills are moving the week of March 15. We urge you to take action by participating in the March 15 phone bank and using the email campaigns listed below. Be sure to use the blank space in each email campaign to add your own personalized short message. 

Monday, March 15

*Zoom phonebanking event against the bills below at 6:30 p.m. Central Time:  https://www.facebook.com/events/160316425916433/ 

Tuesday, March 16

*SB1124/HB1182, bathroom sign mandate, up in House State Government Committee. GOOD NEWS! The bill was taken OFF NOTICE on March 16.

Wednesday, March 17

*SB657/HB578, attacking gender-affirming care for trans youth, up in House Criminal Justice Subcommittee. The bill passed the subcommittee. There will be an amendment removing criminal penalties in the full committee, but no version of this bill is acceptable.

*SB193/HB372, diversity training opt out bill, in House Public Service Subcommittee. Taken off notice on March 17.

*SB1367/HB1233, Bathroom Bill 2.0, up in House Education Administration Committee

-Email campaign:  https://ujoin.co/campaigns/1205/actions/public/1615525540?action_id=1274  

-If you want to leave phone messages for the members of the committee, find the scripts and phone numbers at this link.

Thursday, March 18

*SB228/HB3, anti-trans student athlete bill, on the House floor.

-Email campaign on the bill:  https://ujoin.co/campaigns/1209/actions/public/1615478903?action_id=1251 

Discriminatory legislation is moving fast the week of March 8. We have listed each bill below and what you can do. But before we list the specific tasks for each bill, here are a couple of extraordinary steps you can take:

1. Do you want to have a virtual meeting with your legislators to discuss these bills? Here's how to set one up. If you give us a day's notice before your meeting, we may be able to help brief you. Email us at [email protected] for more details.

2. Do you want to help with media calls this week? Reporters around the state may contact us for comment on different bills. Particularly if you are trans or nonbinary and want to talk to the media about these bills, let us know at [email protected]  Include your city of residence when you send your email. Note: If you volunteer for this responsibility, you should be prepared to respond to media calls the same day you get the request.

The bills moving this week and action campaigns:

*SB228/HB3, the anti-transgender student athlete bill, has passed the Senate and could  be up for a floor vote at any time. Use this easy form to contact your member of the Tennessee House and add your own message in the blank space.

*SB1367/HB1233, which is a bill that requires schools to make accommodations for students who don't want to share restroom/locker room space with transgender students, is up for a subcommittee vote on March 9. Email the subcommittee with this link and add your own message in the blank space. Make calls or leave messages for some of the members of the subcommittee using the script and numbers at this link.

*SB657/HB578 attacks gender-affirming care for transgender youth and is up for a vote on March 10. Email the subcommittee at this link if you have not already done so. Make calls or leave messages with the script and phone numbers at this link.

*SB1224/HB1182 is a bill that requires businesses and public buildings with transgender-inclusive restrooms to post signs that say: "THIS FACILITY MAINTAINS A POLICY OF ALLOWING THE USE OF RESTROOMS BY EITHER BIOLOGICAL SEX, REGARDLESS OF THE DESIGNATION ON THE RESTROOM." These signs will endanger transgender people and could lead to aggression against trans-inclusive businesses.  Call or leave messages with the subcommittee using the script and phone numbers at this link.  Email the subcommittee members with this easy form and add your own message in the blank space.

We are pleased to announce that Boro Pride returns on August 21 this year.  Please, find the various sponsorship and vendor levels and benefits in the graphic below. When you have selected your level, use the form at the left to make your payment.

Vendors and attendees must adhere to CDC COVID-19 guidelines. By making your payment, you agree to follow the guidelines that will be provided to you prior to the event. Vendors will be notified of the guidelines in follow-up communication.

If you wish to pay by check, you may do so by making the check payable to "TEP Foundation" and putting "Boro Pride" in the memo line. Mail checks to P.O. Box 330895 Nashville, TN 37203. Please, let us know that you are sending a check by emailing us at [email protected] so that we can reserve your spot.  Note: The word "donation" may appear on this page or in your receipt. It refers to your payment for your sponsorship or vendor space. 

This is the current shape of the #SlateOfHate in Tennessee.

SB228/HB3 by Sen. Hensley and Rep. Cepicky: This bill repeats the effort to prevent transgender students from participating in high school and middle school sports. It ties a student's gender to the original birth certificate.  The "whereas" clauses attempt to pit transgender people against women's sports.  Governor Lee signed the bill after it passed both legislative chambers.

SB562/HB233 by Sen. Bowling and Rep. Leatherwood: This bill appears to be a caption bill that would eventually carry explicitly anti-marriage equality language. It pertains to marriage licensing and definitions.  The bill has not moved this session.

SB193/HB372 by Sen. Bowling and Rep. Casada:  This bill allows employees of state or local government (which also includes public universities and colleges) to skip trainings or seminars that conflict with their values or religious beliefs.  We believe that the bill provides a way of undermining LGBTQ-inclusive training sessions and seminars offered by government entities. Taken off notice on March 17.

SB1229/HB529 by Sen. Rose and Rep. Moody:  This bill would require public schools to notify parents before offering any curriculum about sexual orientation and gender identity. The bill allows parents to opt their children out of such instruction. The bill has passed the Senate and is headed to the House floor.

SB657/HB578 by Sen. Bowling and Rep. Ragan: This bill criminalizes gender-affirming care for transgender youth. Passed House Criminal Justice Subcommittee on March 17. It will be amended in the full committee to remove the criminal penalties, but no version of this bill is acceptable. Moving in House committees. The bill has not moved in the Senate and will be up in the House Health Committee on April 14.

SB1216/HB800 by Sen. Niceley and Rep. Griffey: This bill censors LGBTQ content in public school textbooks and instructional materials. It's an updated version of the old "Don't Say Gay" bill. The bill passed the House Education Instruction Committee on April 7 and is headed to House Finance. It is said that it will not move in the Senate this year. 

SB1238/HB1177 by Sen. Pody and Rep. Jerry Sexton: This legislation is an anti-transgender "bathroom" bill. The bill has not moved this year.

SB1367/HB1233 by Sen. Bell and Rep. Zachary:  Anti-transgender student bathroom bill 2.0.  The bill is up in House Finance subcommittee on April 13 and before the full Senate on April 19.

SB1224/HB1182 by Sen. Rose and Rep. Rudd: This will requires businesses that have transgender-inclusive restrooms to post signs saying, "THIS FACILITY MAINTAINS A POLICY OF ALLOWING THE USE OF RESTROOMS BY EITHER BIOLOGICAL SEX, REGARDLESS OF THE DESIGNATION ON THE RESTROOM." That will make restrooms less safe for transgender people and it will lead to aggression against inclusive businesses.  Passed House State Government Committee with some minor amendments on March 23. The bill has passed the House and is set for the Senate Judiciary Committee on April 13.

SB126/HB1027 by Sen. Haile and Rep. Kumar:  This is a caption bill that will likely carry language regulating gender-affirming care for transgender youth. Moving in Senate and House committees.  The bill is on the Senate floor on April 8 and is set for the House Health Committee on April 14.

SB659/HB1535 by Sen. Bowling and Rep. Weaver:  This bill is a wide-ranging effort to prevent supplemental materials from being used in public school curricula. One effect would be to inhibit LGBTQ-inclusive materials.  The bill is heading to the House floor, but it won't be heard in the Senate Education Committee until next year.

SB1208 by Sen. Pody:  "As introduced, prohibits this state and any political subdivision of this state, or any official of this state or a political subdivision, from creating, enforcing, or endorsing policies that respect or promote non-secular self-asserted sex-based identity narratives, sexual orientation orthodoxy, or non-secular marriage doctrine because the policies fail the Lemon test, as established by the United States Supreme Court in Lemon v. Kurtzman, 403 U.S. 602 (1971)." Note: There is no House sponsor at this time.

If you would like to support our work of tracking legislation affecting the LGBTQ community, you can make a contribution at this link.

The following information was written by and is presented in partnership with the Tennessee Department of Health:

World AIDS Day was Dec 1, a day when we remember lives lost to this global pandemic and acknowledge the many lives which continue to be affected by HIV.  Thankfully, in recent years we have much to be grateful for when considering options for HIV prevention.  In addition to external and internal condoms (www.freecondomstn.org), we now have biomedical HIV prevention options which include PrEP, an antiretroviral medication which reduces the chance of contracting HIV by 99% when taken as prescribed, and PEP, a 28-day antiretroviral treatment for people who may have been exposed to HIV within the previous 72 hours.  Below you will find the answers to several important questions about these HIV prevention options.

PrEP (pre-exposure prophylaxis)

Who could benefit from taking PrEP?  Anyone who does not have HIV and who may be likely to encounter HIV.  This could be someone who is sexually active and doesn’t use condoms consistently or is not in a mutually monogamous relationship (i.e. both partners only have sex with each other, and no one else), someone whose partner is living with HIV, or someone who shares injection equipment with other people when using drugs or silicone, as well as anyone who feels that PrEP will allow them to take more control of their sexual health and reduce their anxiety about HIV.

How does PrEP work? When HIV enters the body, it attacks our immune system through our CD4 T cells, using those cells to make more copies of the virus.  PrEP stops the virus from making copies of itself inside the CD4 T cells, preventing HIV from taking hold and stopping it from reproducing.  

How do I take PrEP? PrEP is currently approved by the FDA as a once-daily pill.  It should be taken about the same time of day, every day, and can be taken with or without food.

Is PrEP safe?  Yes! The medications used for PrEP have been around for 20 years as antiretrovirals used to treat people living with HIV, so we have many years of data to tell us about how PrEP affects our bodies.  A very small fraction of patients may have a decrease in kidney function or an increase in bone density loss, but both side effects are reversible when PrEP is stopped.  Your doctor will monitor kidney function through labs and determine if monitoring is needed for bone density, as well.

Which medicines can be used for PrEP?  The first PrEP regimen approved by the FDA was Truvada, in 2012, followed by Descovy, in 2019.  While both daily medications work extremely well, there are some differences between the two.  First, Truvada is approved for use in cisgender and transgender individuals of all genders, while Descovy is currently only approved for use as PrEP in people assigned male at birth.  (Studies are under way to expand approval to include people having receptive vaginal sex.)  Second, while Truvada should only be used by people with normal kidney function, Descovy may be used by some people with decreased kidney function.  Additionally, as of this fall, a generic version of Truvada is also available.  Finally, recent studies have shown a long-acting injectable medication, Cabotegravir, to be another highly effective option which may soon be available for use as PrEP.

Does PrEP have side effects?  As with any medication, some people experience mild side effects when they first start taking PrEP, often called “start-up syndrome.”  These can include nausea, dizziness, lack of appetite and headache.  Only about 20% of patients will have any side effects, and they usually stop within two weeks to a month after beginning PrEP.  

Is PrEP safe to use with gender-affirming hormones?  Yes!  Although there is limited research on trans folks who use PrEP and gender-affirming hormones, what data that does exist indicates that PrEP does not affect hormones for either trans men or trans women, and hormones do not significantly affect PrEP, either.

What do I have to do to get PrEP?  In order to get PrEP, you’ll need to see a provider, either in person or virtually, for an initial visit and follow-up appointments every 3 months.  At those appointments you’ll also do important lab work, including HIV and STI (sexually transmitted infections), kidney function (creatinine), pregnancy (if applicable), and every six months to one year, Hepatitis B and C testing (depending on need).

Once I start PrEP, do I have to stay on it forever? No way!  PrEP is a medication intended to be used when you need it and stopped when you don’t.  We like to think about “seasons of pleasure,” when you may have more sexual or drug use encounters in which you could be exposed to HIV.  During these times you may choose to use PrEP to protect yourself from HIV.  If your likelihood of being exposed to HIV changes, you may choose to stop using PrEP.  However, it is important to remember to discuss stopping PrEP with your provider and before starting it again, even if you already have your prescription filled.  This is because you’ll need new labs drawn to be sure it’s still safe for you to take PrEP.  

Also, keep in mind that it takes 7 days for PrEP to reach maximum efficacy for anal sex and 21 days to reach maximum efficacy for vaginal sex or blood exchange, so if you have a short window of time when you think you don’t need PrEP, consider continuing to use it so that you’re protected when you need it down the road!

PEP (post-exposure prophylaxis)

When should I seek PEP (post-exposure prophylaxis)? PEP should be used in cases when there is a strong likelihood that someone who does not have HIV has been exposed to HIV within the last 72 hours, which could include not knowing the HIV status of a sex partner with whom you had condomless sex (anal or penile-vaginal), having condomless sex with someone who is living with HIV and who is not virally suppressed (undetectable), or sharing syringes or other works with someone with whom you used drugs or injected silicone, and whose HIV status you do not know, or who is living with HIV.  PEP is for emergency situations and not a substitute for regular use of HIV prevention methods such as using condoms, taking PrEP or not sharing needles or works.  

How do I take PEP? PEP is usually prescribed as a combination of three antiretroviral medications, taken once or twice daily for 28 days.  There are several different combinations of medications which can be used for PEP, depending on the patient’s needs.

How does PEP work? PEP works by preventing HIV from replicating in the body after a recent exposure. 

Is PEP safe? Yes! PEP regimens consist of several anti-retroviral medications which have been used to treat people living with HIV for many years, so we have a lot of data on how these medicines affect the body.  There is more than one PEP regimen, so your doctor will have options to consider if you have a specific medical concern.

Does PEP have side effects? Some people experience side effects such as fatigue, dizziness, nausea, flatulence, and headache, although most side effects go away or become manageable within a few days or weeks.  Some of these side effects can be managed with over the counter or prescription medications, as well.  

PrEP and PEP Access

How do I get PrEP or PEP in Tennessee? Many, but not all healthcare providers in Tennessee will prescribe PrEP and PEP.  First go to www.GetPrEPTN.com to learn more about PrEP and PEP, then find a navigator to help you walk through the process and to find a doctor to prescribe the medication.  This website is available in Spanish, as well.

How much do PrEP and PEP cost? You may have heard that PrEP and PEP are expensive.  Thankfully there are a number of programs that can help to pay for prescriptions or prescription copays, and some even cover labs and appointment fees.  Don’t know where to start?  Don’t worry!  Our navigators are trained to help you find the right program, fill out the paperwork, and make sure that PrEP or PEP is accessible to anyone who needs it!  You can find a navigator here: https://getpreptn.com/get-prep/.  Even if you don’t live nearby, navigators can help you remotely via phone, text, or video chat- whatever works for you!

For more information about PrEP and PEP, check out the following resources:

www.getpreptn.com 

https://www.cdc.gov/hiv/basics/prep.html

https://www.cdc.gov/hiv/basics/pep.html

www.whatisprep.org 

We are pleased to release the application for the Marisa Richmond Public Policy Fellowship at this link.

The Marisa Richmond Public Policy Fellowship is a program for Black transgender, gender non-conforming, and non-binary undergraduate students enrolled in an accredited Tennessee college or university who are interested in public policy advocacy. The fellowship honors the federal, state, and local advocacy of Dr. Marisa Richmond in the areas of racial justice and LGBTQ rights.

Three applicants will be selected for the Spring 2021 fellowship, ideally one from East Tennessee, one from West Tennessee, and one from Middle Tennessee depending on the geographic diversity of the application pool.

Fellowship recipients will receive a $1000 stipend and participate in Zoom/conference call discussions with leading advocates to explore key issues in public policy and build their network. The program will go from mid-January through March to coincide with the state legislative session. There are no project or work requirements so that students can focus on their academic requirements and self-care.

APPLICATIONS ARE DUE ON DECEMBER 11 BY 8:00 P.M. EASTERN TIME/7:00 P.M. CENTRAL TIME. Submit your answers through this Google form. Questions should be directed to [email protected]. The fellowship is a program of the Tennessee Equality Project Foundation.

The Tennessee Equality Project rescinds our endorsement of Sen. Steven Dickerson in the Tennessee Senate District 20 race.

Although he has an exemplary record on LGBTQ rights in the Legislature, elected officials are called to speak out against racism in politics.

Related: TEP statement on the racist ad in the TN Senate District 20 race.

We have seen the disgusting, racist ad targeting Mayor Heidi Campbell and Gideon's Army that was created by a political action committee. We call for it to be taken down and we call on Sen. Steve Dickerson's campaign to denounce it and call for its removal.  Even those who are not responsible for creating a campaign ad must act responsibly when they become aware of it because racism is a deadly force in our state.

We are considering the future of our endorsement in the Senate District 20 race.

The following information was written by and is provided in partnership with the Tennessee Department of Health:

October is Health Literacy Month, and it could not come at a better time. We have been bombarded with health information because of the pandemic, and wading through it all can be difficult. Health literacy is the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions (source). 

Most of us experience greater health literacy in some instances and less in others. Those of us living with a chronic health condition find ourselves becoming expert in that condition and the resources around it. On the flip side, some parts of our health are less familiar to us. Sexual health usually falls on the less familiar side. 

Sexually transmitted infections (STIs) are a topic where health literacy is often low. While one in two sexually active people will get an STI by their 25th birthday, the common experience of having STIs has not been enough to build expertise and comfort with this facet of our health. 

There are as many reasons to change this as there are different types of STIs. All STIs are treatable, and most infections can be cured with oral or injectable antibiotics. For infections like HIV and genital herpes, early and consistent treatment can make a huge impact on how the disease affects a person’s life. Most STIs infect us without symptoms, so routine testing is the only way we have to know when treatment is needed. 

Nationally and in Tennessee, rates for almost every STI are rising. But not all STI testing is created equal, and research demonstrates that requesting the right type of STI testing is increasingly important. 

According to the Centers for Disease Control, 15–24 year olds make up a fourth of the nation’s population, but account for half of all new STIs (source). STI rates in Tennessee are also on the rise. From 2018 to 2019 all STI rates increased: Chlamydia by 8%, Gonorrhea by 9%, Syphilis (all stages) by 29% (source: Patient Reporting Investigation Surveillance Manager (PRISM), 2018–2019). Tennessee surpassed U.S. rates for both gonorrhea and chlamydia in 2018-2019 (source). 

Even with these rising STI rates, the numbers are still under-estimates because when people present to get STI testing, they are often not getting the most complete testing available. Testing for STIs like Gonorrhea and Chlamydia is recommended at all sites of exposure, including the throat and rectum, and oral and anal testing is referred to as extragenital testing. Those presenting for STI testing usually receive standard testing, which is done by collecting a urine and/or vaginal swab and for some STIs a blood sample; but standard testing only identifies penile and vaginal infections in some STIs, and does not identify extragenital infections. Standard testing is often focused on the least invasive and most comfortable option for the patient, and is what is routinely offered in health department clinics.  

When it comes to STIs, a little bit of additional discomfort during testing is worth it. Nationally, traditional urine testing for gonorrhea and chlamydia miss 70%–88% of infections that are found using extragenital testing with men who have sex with other men (source). In 2019, a Tennessee Department of Health study identified that standard testing alone would have missed up to 46% of infections in males, and 18% of infections in females (Source: Patient Tracking Billing Management Information System [PTBMIS], 2019).

STI tests now include a lot of new options, and one key characteristic of STI screening that can significantly impact its accuracy is the type of sample used to run the test. Unless you specifically request something different as the patient, you are likely to be provided with standard testing for STIs. 

In 2019, a Tennessee Department of Health study found that when extragenital testing was offered to all patients, testing increased significantly. Among males, rates of rectal testing increased by 200%, and oral testing increased by 78%; among females, oral testing increased 122%, and rectal testing increased 316% compared to 2018 testing data (Source: PTBMIS,2019). This suggests that patients and health care providers are not always talking about oral and anal sex. If health care providers use patient reporting alone, oral and rectal testing may not be completed or offered, even if warranted.  This is why it is so important to not only talk to your health care provider about all of your sexual practices, but also to request extragenital testing.

Extragenital testing is not new, but health literacy and personal advocacy are required to get access to it. Healthy literacy includes knowing that this type of testing is more accurate and where you can go to get it. In Tennessee, local health departments that provide STI testing have oral and rectal testing available. Personal advocacy involves asking for the version of the test during the appointment that fits your needs and answering the detailed questions about sex asked by a medical provider that will lead to knowledgeable, personalized care. Medical providers often assume that patients will be more comfortable giving a urine sample than they will be using an anal swab, so personal advocacy includes speaking up to let your provider know that you want to get more comfortable taking oral and rectal tests. 

Annual testing is recommended for all adults for all STIs, so every year you have a chance to use your increased health literacy and personal advocacy skills to get more effective testing. Asking for STI testing that includes oral and rectal swabs will not increase the cost you are asked to pay, and health departments all over Tennessee offer STI testing at little to no cost. HIV testing on its own is free, and the cost range for full STI testing is usually between $10–$20 in metro areas and is either free or calculated using a sliding scale based on income at regional Health Departments. When making an appointment, the clinic can provide information on cost. You will not be turned away due to an inability to pay the day of services.  Many clinics have same day or next day appointments and some clinics allow for same-day walk-ins. 

Here are some helpful steps to take as you get ready to get STI testing:

1. Identify your testing location and learn more about STI testing there. Click here for a list of health departments in Tennessee to quickly find one close to you. Once you’ve identified the place, go on their website or call to learn more about their scheduling procedures, what forms of identification you need to bring, and what your STI testing (and potential treatment) will cost.
2. If you are coming to a health department clinic after being tested at another location, bring your information with you. Bring any lab results and information from your last clinic appointment with you to your health department visit to save time and ensure you are getting the correct tests and treatment options. 
3. Be ready to answer questions about your sexual history. Be prepared for the questions they will ask you, and bring questions of your own. Write down 2 – 4 questions you have so that when you are face-to-face with your provider, you don’t forget what to ask. 
4. Write down any requests that are important to you. This includes requesting extragenital testing for STIs. It can also include requesting a walkthrough of the exam before you start. 
5. Learn more about STIs before you go. Doing your own research can both increase your knowledge and help you feel confident and comfortable during the process. The Centers for Disease Control and Prevention’s STI resource page is a great place to start. 
6. Choose a change to make in the next year. STI testing is annual, and it can be a great time to make a new resolution to improve your sexual health. Learn more about how to get free condoms, start on Pre-Exposure Prophylaxis (PrEP), and other ways you can improve your health on Tennessee Department of Health’s HIV Prevention page.

STIs are common, but STI testing is widely available in Tennessee. Start planning today, and don’t let discomfort or a lack of information stop you from getting the best testing and care possible. 

Tennessee Equality Project

State and Local Endorsements

Tennessee Equality Project lobbies the Tennessee General Assembly and local governments around the state on behalf of the LGBTQ community.  We are pleased to endorse a strong group of candidates for state and local government this year, including a number of LGBTQ candidates who can significantly change the conversation about our issues in Tennessee.  The Slate of Hate, which is a set of vicious anti-LGBTQ bills, looms as a threat when the Legislature reconvenes in January. On the other hand, we have important opportunities to advance equality in many of our cities.  The candidates we have endorsed can play a vital role in fighting discrimination and making life better for LGBTQ Tennesseans.  

TENNESSEE GENERAL ASSEMBLY ENDORSEMENTS

TN Senate District 6-Knox County

Jane George

TN Senate District 10-Bradley and Hamilton Counties

Glenn Scruggs

TN Senate District 14-Bedford, Lincoln, Marshall, Moore, and Rutherford Counties

Chase Clemmons

TN Senate District 22-Houston, Montgomery, and Stewart Counties

Ronnie Glynn

TN House District 4-Unicoi and Carter Counties

Bobby Harrell

TN House District 6-Washington County

Brad Batt

TN House District 13-Knox County

Rep. Gloria Johnson

TN House District 18-Knox County

Eddie Mannis-LGBTQ candidate

TN House District 25-Cumberland, Putnam, and Van Buren Counties

Robyn Deck

TN House District 37-Rutherford County

Mariah Phillips

TN House District 38-Clay, Fentress, Macon, Pickett, and Scott Counties

Carol Abney

TN House District 40-DeKalb, Smith, Sumner, and Trousdale Counties

Paddy Sizemore

TN House District 48-Rutherford County

Matt Ferry

TN House District 49-Rutherford County

Brandon Thomas-LGBTQ candidate

TN House District 56-Davidson County

Bob Freeman

TN House District 63-Williamson County

Elizabeth Madeira

Our endorsement goes to Elizabeth Madeira for her strong outreach to the LGBTQ community. We also wish to commend candidate Brad Fiscus for his clear expressions of support for our community.

TN House District 82-Crockett, Haywood, and Lauderdale Counties

Andrea Bond Johnson

TN House District 83-Shelby County

Jerri Green

TN House District 89-Knox County

Keri Keeling (Write-in candidate)

TN House District 90-Shelby County

Torrey Harris-LGBTQ candidate

TN House District 96-Shelby County

Dwayne Thompson

TN House District 97-Shelby County

Gabby Salinas

CITY GOVERNMENT ENDORSEMENTS

Clarksville 

City Council Ward 4

Margaret Thompson-LGBTQ candidate

City Council Ward 5

Melissa Eldridge

City Council Ward 9

Karen Reynolds

City Council Ward 11

Ashlee Evans-LGBTQ candidate

City Council Ward 12

Joe Shakeenab

Our endorsement goes to Joe Shakeenab for his demonstrated willingness to take action to address discrimination. We are also grateful to candidate Trisha Butler for her expressions of support for the LGBTQ community.

Johnson City

City Commission

Kyle Beagle-LGBTQ candidate

Jeffrey Clark-LGBTQ candidate

Debbie Harley-McClaskey

Maryville

City Council

Sarah Herron

Portland

Board of Aldermen

Lloyd Dunn-LGBTQ candidate

The Tennessee Equality Project surveyed candidates in these cities that are holding November 3 elections. All candidates for the city legislative body were surveyed. If you are a candidate and we didn't survey in your city and you would like us to do so, be in touch at [email protected] and we will consider your request.

Below are the responses for those candidates who completed surveys by the September 28 deadline:

BARTLETT

Voters cast their ballots for alderman by district and may select one candidate in their district.

*Alderman Position 6

Kevin Quinn

CLARKSVILLE

Voters cast their ballots for city council according to the ward in which they live. There are multiple candidates per ward in most races, but voters may only select one.

*Ward 4

Margaret Thompson-LGBTQ candidate

*Ward 5

Melissa Eldridge

*Ward 9

Karen Reynolds

*Ward 11

Ashlee Evans-LGBTQ candidate

*Ward 12

Trisha Butler

Joe Shakeenab

JOHNSON CITY

There are eight candidates for city commission; voters may select up to three.

Kyle Beagle-LGBTQ candidate

Jeffrey Clark-LGBTQ candidate

Debbie Harley-McClaskey

MARYVILLE

There are four candidates for city council; voters may select up to two.

Sarah Herron

PORTLAND

There are eight candidates for alderman; voters may select up to four.

Lloyd Dunn-LGBTQ candidate

If you would like to support the work of Tennessee Equality Project, you can contribute at this link.