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:
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@example.com. 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.
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
TN Senate District 10-Bradley and Hamilton Counties
TN Senate District 14-Bedford, Lincoln, Marshall, Moore, and Rutherford Counties
TN Senate District 22-Houston, Montgomery, and Stewart Counties
TN House District 4-Unicoi and Carter Counties
TN House District 6-Washington County
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
TN House District 37-Rutherford County
TN House District 38-Clay, Fentress, Macon, Pickett, and Scott Counties
TN House District 40-DeKalb, Smith, Sumner, and Trousdale Counties
TN House District 48-Rutherford County
TN House District 49-Rutherford County
Brandon Thomas-LGBTQ candidate
TN House District 56-Davidson County
TN House District 63-Williamson County
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
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
TN House District 97-Shelby County
CITY GOVERNMENT ENDORSEMENTS
City Council Ward 4
Margaret Thompson-LGBTQ candidate
City Council Ward 5
City Council Ward 9
City Council Ward 11
Ashlee Evans-LGBTQ candidate
City Council Ward 12
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.
Kyle Beagle-LGBTQ candidate
Jeffrey Clark-LGBTQ candidate
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 firstname.lastname@example.org and we will consider your request.
Below are the responses for those candidates who completed surveys by the September 28 deadline:
Voters cast their ballots for alderman by district and may select one candidate in their district.
*Alderman Position 6
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.
There are eight candidates for city commission; voters may select up to three.
There are four candidates for city council; voters may select up to two.
There are eight candidates for alderman; voters may select up to four.
The following state legislative candidates (TN Senate and TN House) turned in surveys to Tennessee Equality Project by the September 17 deadline. TEP did not survey in all legislative races. For example, there is only one candidate in many races where an incumbent is seeking reelection. In some races in which we sent out surveys, no candidate responded.
Candidates are listed within their district in the order in which they responded to the survey.
District 2-Blount and Sevier Counties
District 6-Knox County
District 10--Bradley and Hamilton Counties
District 14-Bedford, Lincoln, Marshall, Moore, and Rutherford Counties
District 20-Davidson County
District 22-Houston, Montgomery, and Stewart Counties
STATE HOUSE OF REPRESENTATIVES
District 4-Unicoi and Carter Counties
District 6-Washington County
District 13-Knox County
District 18-Knox County
District 25-Cumberland, Putnam, and Van Buren Counties
Robyn Deck-Democrat (received after deadline)
District 37-Rutherford County
District 38--Clay, Fentress, Macon, Pickett, and Scott Counties
District 40-DeKalb, Smith, Sumner, and Trousdale Counties
District 48-Rutherford County
District 49-Rutherford County
District 56-Davidson County
District 63-Williamson County
District 82-Crockett, Haywood, and Lauderdale Counties
District 83-Shelby County
District 89-Knox County
District 90-Shelby County
District 96-Shelby County
District 97-Shelby County
The following information is written by and provided in partnership with the Tennessee Department of Health:
2020 has been a difficult year for all of us. This Spring and Summer have made us all think more about our health, and how important it is that we take care of ourselves today to prepare for the problem that could be just over the horizon.
This year has also put into sharp focus all the reasons we have for not being proactive about our health. Health care is expensive and, for many of us, challenging to access. Health information is hard to understand and is changing every day. The evolution around HIV is a perfect example of this. HIV treatment gets easier to access for Tennesseans every year, and in the last decade has gone from a process which a person might delay to one where getting into treatment as soon as possible changes how a person lives with the disease. On top of that, HIV prevention tools now include PrEP, a daily pill.
The realities around prevention and treatment for hepatitis C have gone through a similar evolution. The term hepatitis refers to inflammation of the liver, and can be caused by many different things. These causes include fatty liver disease, over-consumption of alcohol, exposure to toxins and chemicals, some drugs and medications, and infections. In Tennessee, one of the main causes of hepatitis is the hepatitis C virus.
Hepatitis C virus is ten times more infectious than HIV, and one in four people with HIV will experience hepatitis C co-infection. As the use of injection drugs continues to rise statewide, so too does hepatitis C; approximately 53% of people who inject drugs have hepatitis C (source).
LGBTQ people are more likely to misuse substances, including both drugs and alcohol, than others. Discrimination and stigma can contribute to over-dependence on alcohol and drugs for LGBTQ people (source). LGB youth are 25% more likely to drink alcohol, twice as likely to use ecstasy and cocaine, and four times as likely to use heroin and meth (source). LGBTQ people are also less likely to have health insurance than others, particularly youth, seniors, and transgender persons, putting significant barriers between them and routine medical care (source, source, source). These realities mean that LGBTQ people are more likely than others to come into contact with HIV and hepatitis C, while also having unique barriers to health care.
In Tennessee, access to hepatitis C screening and treatment has increased dramatically in the last few years. This is huge for LGBTQ people who are at elevated risk for hepatitis C, because it can now be cured in most people while the consequences of lack of treatment compound significantly over time. Over 90% of people with hepatitis C can be cured with 8-12 weeks of oral medication (source). If left untreated, complications include chronic hepatitis C infection (75-85 out of every 100 people), chronic liver disease (60-70 out of a 100), cirrhosis (5-20 out of a 100), and death (1-5 out of 100) (source). Cirrhosis and liver cancer cause about 1 in 5 percent of hepatitis C-related deaths, as treatment options are limited for these conditions (source).
Hepatitis C is a health concern where knowledge about screening and treatment is critical, and can mean the difference between three months of treatment and years of chronic health issues. Hepatitis C screening is a two-step process that starts with an antibody test (which will always be positive for anyone who has ever been exposed to hepatitis C) and an RNA confirmatory test (which can tell you if you currently have hepatitis C). Antibodies to hepatitis C are not protective, and you can be re-infected even if you have successfully completed past hepatitis C treatment.
If you think you might have hepatitis C, your local health department can provide you with testing and treatment options. Here is a list of health departments in Tennessee that you can use to find the location most convenient for you.
If you have a positive hepatitis C test, or if you have had a positive test in the past but need support finding free or low cost treatment, Tennessee has Viral Hepatitis Case Navigators who provide resources to patients seeking hepatitis C treatment. To get started, contact your local health department and ask to be connected to a Viral Hepatitis Case Navigator.
If you want to get involved in the statewide effort to better coordinate work around HIV, sexually transmitted infections, hepatitis C, and substance misuse, click here to learn more about the End the Syndemic Tennessee initiative.
On July 3 Tennessee Governor Bill Lee granted county mayors the authority to issue mask/face covering mandates. Here is the status of mask mandates in Tennessee counties.
Bradley County: No mask mandate for now.
Cheatham County: "Hard no," according to a July 6 WSMV report.
Davidson/Nashville: Mask mandate is in place.
Dickson County: "Hard no," according to a July 6 WSMV report.
Franklin County: The Mayor says NO in this video.
Greene County: Mask mandate announced on July 13 to begin on July 15.
Hamblen County: Mask mandate issued on August 1.
Henry County: Mask mandate in place.
Jefferson County: Mayor announced no mask mandate on July 8.
Knox County: Mask mandate in place, but the County Mayor voted against it and the Sheriff has not indicated he will enforce it. This Facebook group discusses which Knoxville-area businesses are following the mask mandate.
Loudon County: County Mayor says no mask mandate at this time, according to WATE.
Madison County: Mask mandate is in place, but there has been a protest.
Montgomery County: Mask mandate announced on July 14.
Putnam County: No mask mandate announced on July 7.
Robertson County: Mask mandate announced on July 7.
Rutherford County: Mask mandate announced on July 20.
Sevier County: Mask mandate announced on July 7.
Shelby County: Mask mandate in place.
Sumner County: Sumner County's mandate was issued on July 6. Read the statement from Mayor Holt here. Thanks to everyone who contacted the County Mayor.
Sullivan County: Mask mandate announced on July 10.
Washington County: Mask mandate announced on July 13 to begin July 14.
Williamson County: Mask mandate in place as of July 6. Thanks to everyone who contacted the County Mayor.
Wilson County: Mask mandate announced on July 17.
*Send any updates to email@example.com .