NASHVILLE, Tenn. (AP) — Top Tennessee health officials attempted to oust Planned Parenthood from a program designed to prevent and treat HIV before eventually deciding to forgo federal funding for the program, despite warnings that doing so will have a devastating impact on marginalized communities, documents show.

The decision is the latest development in a ruby red state where abortion is already banned. Republicans leaders, however, have actively tried to cut off public ties with the organization for any other services, due to its long history of offering and defending abortion care.

According to a letter from Planned Parenthood, Tennessee’s Department of Health in November alerted the organization that it would no longer receive HIV prevention grants starting in 2023, as well as warn that the state was terminating its partnership with Planned Parenthood to provide HIV testing.

The letter, which was obtained by The Associated Press, was sent to the health agency’s general counsel, Mary Katherine Bratton, on Nov. 16.

The document states that United Way — which distributes the HIV federal funding grant on the health agency’s behalf — said the department wanted to sever ties with Planned Parenthood “for reasons wholly unrelated to the purpose of the program.”

“As United Way reported: ‘TDH said given the current political climate we are not moving forward with funding Planned Parenthood,’ and TDH ‘can no longer directly or indirectly fund (Planned Parenthood),'” wrote Planned Parenthood’s attorney Alan E. Schoenfeld.

Schoenfeld added that Planned Parenthood wanted to avoid litigation and requested a meeting later that month. The issue was eventually dropped until this week, when the Department of Health announced it was choosing to walk away from the federal HIV prevention, detection and treatment funding and instead would rely on state funding for such efforts starting June 1. The Commercial Appeal was the first to report the announcement.

The department’s move was a shock to many of the participating organizations tasked with providing vital HIV services across the state. Planned Parenthood, which has worked with the state to distribute free condoms for more than a decade, declared that Republican Gov. Bill Lee’s administration was choosing the “nuclear option” in order to avoid having to work with the organization.

“This is yet another public health crisis manufactured by Gov. Lee,” said Ashley Coffield, president and CEO of Planned Parenthood of Tennessee and North Mississippi. “They are using Planned Parenthood as the entry way to take down the whole sexual and reproductive health care system. We’re often the most public target, but this affects so many groups.”

A spokesperson for the Department of Health declined to directly answer questions about why they attempted to cut Planned Parenthood from the HIV program in November. Instead, they provided a Jan. 17 letter explaining that “prior administrations” had decided to accept the federal funding for HIV surveillance but the state has determined “it is in the best interest of Tennesseans for the State to assume direct financial and managerial responsibility for these services.”

“The funding for this HIV prevention program is very important and it’s important that it is spent effectively and efficiently in the ways that best serve Tennessee,” Lee told reporters Friday. “We think we can do that better than the strings attached with the federal dollars that came our way and that’s why we made that decision.”

Tennessee’s health agency’s website says the CDC grant helps fund: “HIV counseling, testing and referral, HIV partner counseling and referral services, HIV health education and risk reduction programs, HIV prevention for positive individuals, public information programs, a toll-free HIV/STD hotline, capacity building programs, and a quality assurance and evaluation component.”

The website goes on to say that state funding provides additional support for HIV testing, but it does not give an amount.

Separately, Lee appointed Ralph Alvarado as the new health commissioner in late November. Alvarado is a former Kentucky state senator who has publicly opposed most abortion access. Alvarado officially took over the role on Monday, just two days before the department announced it would cut off the HIV federal funding.

Planned Parenthood has since been removed from the health agency’s website that lists community organizations that distribute free condoms.

“There’s nothing pro-life about punishing people who are living with HIV and enabling this virus to spread undetected,” said Democratic state Sen. London Lamar of Memphis.

Lamar added that public health efforts have helped slow the spread of HIV in Tennessee and that cutting off federal funding “endangers the lives of Tennesseans.”

Planned Parenthood has partnered with Tennessee’s Department of Health to provide HIV testing since 2008, when Democratic Gov. Phil Bredesen was in office. Four years later, under then Republican Gov. Bill Haslam’s administration, the health agency attempted to remove Planned Parenthood from the program — a move that was ultimately challenged in court.

A district court later found that the department had targeted Planned Parenthood “based upon their First Amendment activity for advocating abortion” and issued a permanent injunction preventing the state from dissolving any partnership with the organization because of their abortion care advocacy. That injunction is still in place.

Meanwhile, Planned Parenthood has been forced to stop all abortion services ever since the U.S. Supreme Court overturned the constitutional right to abortion last year.

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Associated Press writer Jonathan Mattise contributed to this report.

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