Bangor health director says housing, drug use drove Maine’s HIV spike

As Maine grapples with its largest HIV outbreak, Bangor’s director of public health and community services, Jennifer Gunderman, said the rise was enabled by a cluster of risk factors that accumulated over time. In an interview, Gunderman described how HIV had “dropped off the radar” in Maine because the state historically saw low incidence of the disease—until homelessness, drug use, and gaps in services began to stack up.

Gunderman said the conditions made it more likely that an outbreak would “balloon,” pointing to increased homelessness and wide drug use alongside the disappearance of syringe service providers and fewer options for case management. She also said there are likely additional infections beyond the groups represented in confirmed cases, including among people who are housed and injecting drugs, and where sex work is occurring for money, support or housing.

The outbreak’s first identified case, Gunderman said, was in October 2023. Penobot County later had 21 confirmed cases about a year and a half after that initial identification, and the cumulative total of confirmed cases had grown to at least 41 as of April 24, according to her remarks. She said those numbers likely understate the scope of the outbreak because the state has limited ability to track every case as the investigation continues.

While Gunderman said most of the known cases have been among people who are injecting drugs and who are unhoused, she said the investigation has to account for the possibility of additional spread patterns as the outbreak evolves. She said Maine CDC is working with national experts to model the outbreak and estimate how far it may have progressed, and she called it difficult to know “where are we in the outbreak” until it is over.

Gunderman described the state’s response as expanding access to HIV and hepatitis C testing among those at risk, providing HIV and sexually transmitted infection prevention services, offering syringe services and other harm reduction services, and linking people diagnosed with HIV or hepatitis C to medical care and treatment. She said the number of confirmed cases has continued to grow even as the state increased services designed to reduce transmission.

She also emphasized the role of local public health capacity in dealing with an outbreak that is tied to housing instability and drug use. In Bangor, which has one of the state’s two city public health departments, Gunderman said the local department expanded testing for HIV and sexually transmitted infections, distributed HIV self tests, and helped get people into housing. The department also set up an HIV case management program to help people get rides to appointments and apply for health insurance.

Gunderman said the city has been working on harm reduction steps as well. She said Bangor’s city council this week voted to allow the public health department to apply for syringe service certification so it can give out sterile syringes to clients with HIV. Gunderman said Bangor plans to use its experience to help other communities in Maine that may have fewer resources but face similar conditions.

Looking beyond infection control, Gunderman said Bangor’s public health department provides services that include maternal mental health support, lactation programming and administration of the Women, Infants and Children program, as well as a travel medicine clinic that provides required immunizations for different countries. She also said the department recently received a $243,000 grant from the Peter and Carmen Lucia Buck Foundation to launch a community paramedicine program.

Gunderman, who joined the city in April 2024 after a prior career that included work with what is now the Maine CDC and experience establishing statewide infectious disease surveillance, said the challenges her department faces reflect broader needs that extend past any single local program. She said the solutions to homelessness are bigger than what the city can accomplish alone and will require movement on multiple levels, including both short- and long-term approaches.

“There’s a lot of tension and friction that happens around these conversations,” Gunderman said. “But what I’m learning is that we all do have the same goal here, (which is) being a healthy, happy community for everybody.”

And she said that while many people think local health departments focus only on the most vulnerable residents, her department sees its role as serving everyone, describing it as “to serve everybody.”