New HIV infections in Shelby County jumped 18% during the first three years of the 5-year-old End HIV 901 campaign. Yet the county has also seen increases in the tally of people with HIV getting their prescribed medical care and in those taking medication to curb their risk for contracting the disease.
Leaders of the campaign — whose tools include free HIV tests ordered online and free condoms — concede that it’s a long way from meeting a federally established goal of cutting new infections in the Memphis area by 90% in 2030. The effort also missed a federal benchmark for cutting new infections by 75% this year, with Shelby County Health Department officials citing preliminary data suggesting HIV infections rose 50% among those aged 15 to 24.
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“There have been wins and there have been places where we wish we could have done more,” said Dr. Aditya Gaur, St. Jude Children’s Research Hospital’s director of clinical research in infectious disease.
Still, the efforts of the 25 organizations comprising the St. Jude-led campaign are ongoing, Gaur added. The specialist in pediatric HIV and others are measuring End HIV 901’s incremental progress and plans:
St. Jude is preparing to enroll 16- to 24-year-old volunteers in global research on longer-acting PrEP, or pre-exposure prophylaxis, medicine taken to prevent HIV in those at risk of being infected through sex or injecting illicit drugs. (Young volunteers from St. Jude have previously participated in research resulting in the U.S. Food and Drug Administration’s June 2025 approval of PrEP that’s injected twice yearly, an alternative to the more-often prescribed daily pill.
Le Bonheur Children’s Hospital clinicians are discussing the possibility of reviving routine HIV testing of anyone 13 or older who shows up in its emergency department for any kind of medical treatment. Le Bonheur had done such testing for a year ending in 2009 as part of a Centers for Disease Control and Prevention demonstration project.
A county health department pilot project has mailed 1,391 free in-home HIV tests to persons who requested them online. Since May, the six-month experiment has also given out 168 tests at community events.
The department’s condom giveaways are paid for with funding from the Ryan White CARE Act, one of the HIV-prevention programs the Trump administration has retained. While Trump’s fiscal year 2026 budget leaves intact Ending the HIV Epidemic, the initiative his previous administration launched in 2019 in Memphis and 56 other locales, it guts a CDC team that was winding down a detailed, national analysis of HIV. Some observers have said the analysis is integral to efforts aimed at stemming HIV.
Male-to-male sex, Black people accounted for most Memphis-area HIV infections
Black people accounted for 50.9% of those newly infected with HIV in 2021 in Shelby County, where 69% of residents are Memphians. According to that same May 2023 Shelby County Health Department report, with the latest available data, 17.5% of those newly infected were Hispanic, 7.8% were non-Hispanic whites, and the remaining 16.7% were some other race.
Of those newly infected, 41% contracted the virus through male-to-male sex; 3% contracted it through heterosexual contact; and 2% through injected drug use. In the remaining 52% of new cases, how people became infected was not reported or identified.
In Memphis, a relatively new End HIV 901 initiative is urging pediatricians, gynecologists and other primary care doctors to routinely discuss HIV with every patient and to test for it. Just a handful in Memphis do that already, said Karrie Reed, End HIV 901’s community engagement manager.
“I am going out visiting, starting with pediatricians and then, I will transition to OB-GYNs in the area,” said Reed, a St. Jude staffer. “I am having conversations with them … to encourage those sexual health conversations that most providers are uncomfortable having with patients. We want to change that narrative here.”
Known as academic detailing, or promoting medical practices with proven outcomes, the initiative was created for good reasons, Reed said. She, her colleagues at St. Jude and other HIV advocates said they’ve heard patients complain of doctors shooting down their requests to, for example, be prescribed PrEP.
The outreach to physicians is sobering and fueled by a hard reality, said Gaur, a founder of Connect to Protect Memphis, formed in 2018 as the precursor to End HIV 901. “When you look at the HIV incidence data in 2018, and you look at the last one in the public domain, which is 2022, there is not a decrease” in HIV infection.
‘Courageous conversations’ to fight infections, stigma
The ongoing uptick of infections in Memphis alarms former health department director Dr. Michelle Taylor, who led the implementation of the department’s pilot project and overall HIV awareness campaign.
“Our rates of [sexually transmitted infections] and, in particular, HIV show us in real time that people are not having hard conversations, especially not with young people,” said Taylor, a Memphis native and now Baltimore’s health commissioner.
In Shelby County, whose residents are mainly in Memphis, teens and young adults have the highest infection rates. The number of people living with HIV is the highest for any Tennessee county.
The hoped-for reductions would equal 250,000 fewer HIV infections, project directors have estimated.
It‘s gravely concerning that 15- to 19-year-olds and 20- to 24-year-olds have accounted for three times more new infections in Memphis than in several other cities, said Rev. Dr. J. Lawrence Turner, president of the Black Clergy Collaborative of Memphis.
“Our children … are getting a sex education that is not being guided and shaped by the communities that love them and care for them,” said Turner, pastor of Mississippi Boulevard Christian Church and a father of two. “It’s of utmost importance that the church take the stigma off of HIV and AIDS and have some honest, courageous conversations that help our community take some proactive steps.”
Taylor, a Mississippi Boulevard member, has discussed HIV with that congregation. She enlisted Turner to record a YouTube video on the need for straight talk about HIV’s threat and how preaching sexual abstinence — from the pulpit or in classrooms that, following state law, mainly tell kids to abstain — isn’t a sure fix.
Said Turner, whose kids are 12 and 10: “It’s okay to hold the Bible and reality together. If we give young people an ethic that does not prepare them to deal with reality, in that darkness, we perpetuate the spread of the virus.”
Getting closer to the affected communities
The number of Tennesseans with HIV rose annually from 2017 through 2021, the last year the Tennessee Health Department issued an HIV surveillance report. In 2021, .75% of Shelby County residents, or 6,954 people, were known to be living with HIV. That was up from 6,349 people with HIV in 2017. Second to Shelby was Davidson County, where Nashville is the county seat. There, .58% of residents, or 4,096 people, were living with HIV. That was up from 3,789 people with HIV in 2017.
In 2023, newly diagnosed HIV infections numbered 352 in Shelby County, up from 338 in 2022, according to the latest available federal data. The respective numbers were 302 in 2021 and 258 in 2017.
DeWayne Murrell, executive director of The Project for Advancement in Gays’ Efforts, an LGBTQ youth advocacy organization, is among those who question the accuracy of the Shelby County tally and whether the 2025 goal will be met.
For one, End HIV 901 has hit some bumps. Last year, county and state health officials alternately blamed bureaucratic red tape at the federal level and a shortage of local health department sexual-disease investigators for Shelby County’s loss of $3 million in federal funds to fight HIV and enroll more people in HIV care.
It was part of an $8.6 million allocation earmarked in 2019 after federal officials named Memphis, home to 69% of county residents, among 48 HIV hot spots nationwide. Forty-nine percent of the nation’s estimated 31,800 new HIV infections were in the South, home to 39% of the U.S. population, according to a 2024 Centers for Disease Control and Prevention report.
Murrell is among those charging that End HIV’s key leaders haven’t done enough to make sure more federal funds trickle down to the grassroots, where activists are closer to some of the communities and individuals most at risk for being infected. The forfeited millions reflect that failing, critics argue.
Murrell lauds, for example, HIV-focused work at Shelby County health clinics and the health department’s anti-HIV campaigning at assorted health fairs and other community events.
“But those are not the places where people who are LGBTQ most likely are going to go to get any counseling, testing, education, anything like that,” said Murrell, who has spent two decades in HIV prevention.
Who, he asks, is spreading the word about HIV throughout an LGBTQ network of after-hours clubs, at house parties that LGBTQ youth and young adults refer to as kickbacks?
“The health department is a government agency with traditional hours,” Murrell said. “They don’t really have anyone doing outreach for these people who are high-risk, with all these negative markers. That has always been the case.
“There is not much of a connection at all to the underground LGBTQ community.”
Funding, including that dispensed through Shelby County, to grassroots groups like his often is an afterthought, he said.
Changing habits, changing attitudes
The latest available data show that 64.5% of Shelby County residents aged 13 and older who were newly diagnosed in 2022 got medical treatment within a month of their diagnosis.
Of those 13 or older who were living with HIV, 64.7% had viral loads that were undetectable or low enough to lower their risks of infecting someone else.
Of those 16 and older, 18.1% had been prescribed PrEP as a daily pill. The goal is to reach 50% in 2025.
The assorted HIV-themed community events, billboards and free tests aim to change attitudes about HIV and understanding of what drives the numbers up and down.
It’s a good thing that teens who are at least 14 can be tested for HIV or other sexually transmitted diseases at the health department without parental consent, said Misty Hayes-Winton, the department’s sexual health manager. Many youth don’t have parents who invite and offer straight talk about sex and sexual health.
The county’s HIV efforts are steadily improving, Hayes-Winton added, even as she wishes for a mobile unit dedicated to outreach. “In a perfect world, we’d have a mobile going out into the communities and those ZIP codes that are marginalized or face health disparities,” she said. “We’d have clinics in the schools, where they offer STI and HIV testing as well as condoms and education — as far as abstinence — about safer sex practices and also PrEP.”
It would be great, Taylor said, if the law didn’t allow for teachers to be fined for giving students full knowledge of their sexual selves and the risks of certain sexual behaviors.
Before heading to medical school, while she taught at Fairleigh High School, she’d been tasked with organizing a schoolwide blood drive in the late 1990s. “I will never forget, one of the other teachers came to me and said, ‘Well, you know why people don’t want to do the blood drive?’” Taylor, a pediatrician, recalled. “Because the last time we did a blood drive, several of the students here tested positive for HIV.”
Would other students also be infected and want to know? Would they want others to know?
The stigma of HIV has dissipated, Tayior said, but it lingers.
“We actually need to be able to say that word, which is not a curse word,” she said. “So that we can protect our young people, so that we can help them make choices, whether it be abstinence or safer sex practices, right?”
Despite the current infection rates in Memphis, St. Jude’s Reed said she’s optimistic that change will come. “We have PrEP. We’ve got ‘U=U,’” she said, giving the abbreviation for “undetectable equals untransmittable,” and medicines that keep down HIV viral loads.
“We may have missed the mark for 2025,” she said, “but I think it’s very much attainable for 2030.”
Health and criminal justice journalist Katti Gray’s news coverage has appeared on ABC.com, CBS.com, and in The Guardian US, the Los Angeles Times, Newsday, Reuters, The Washington Post and other publications.
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