The city of Bangor is confronting the largest HIV outbreak in Maine’s history, a crisis that the region’s top public health official says was years in the making as homelessness, injection drug use, and a thinning safety net converged in one of the state’s most vulnerable populations.
At least 41 people have been diagnosed with HIV in Penobscot County since the first case in what would later be recognized as a cluster was identified in October 2023, according to Jennifer Gunderman, Bangor’s director of public health and community services. The count, current as of late April, already exceeds the fewer than 40 new HIV diagnoses Maine typically recorded statewide in an entire year over the past decade, she said. The true toll, Gunderman cautioned, is almost certainly larger.
“Epidemiologically speaking, where are we in the outbreak? We don’t know until it’s over,” Gunderman said in an interview with The Maine Monitor, which distributed the story through The Associated Press. “The numbers are likely much bigger than the state has been able to track.”
The vast majority of known cases involve people who inject drugs and are unhoused, she said, but there are likely additional infections among people who are housed and injecting drugs. Sex work — performed for money, support, or shelter — compounds the risk of transmission, Gunderman added.
The conditions that primed the county for an outbreak had been building for years. HIV had “dropped off the radar” in Maine because the state’s incidence was low, Gunderman said, but then a cascade of risk factors piled up: growing homelessness, pervasive drug use, disappearing syringe service providers and health care options, and fewer case management programs.
In response, the state increased HIV and hepatitis C testing among at-risk groups, expanded prevention and syringe services, and linked people diagnosed with HIV to medical care. The Bangor public health department broadened its own testing and distributed HIV self-tests. It also established a case management program that helps clients get rides to medical appointments and apply for health insurance. In early May, the Bangor City Council voted to allow the department to seek syringe service certification so it can distribute sterile syringes to clients with HIV.
“Now, it’s like how do we understand those ingredients and see where other parts of the state might have these ingredients?” Gunderman said. She said the department plans to use its experience to assist other Maine communities with fewer resources.
Gunderman, an epidemiologist who began her public health career at what is now the Maine CDC in the late 1990s, became Bangor’s public health director in April 2024. Since then, homelessness and drug use have drawn sharp scrutiny in the city, she said. The solutions, she added, will require coordinated action on multiple fronts — “movement on many levels, with both short- and long-term solutions.”
The public health department’s work goes beyond the outbreak. It runs maternal mental health support, lactation programming, the Women, Infants and Children (WIC) program, and a travel medicine clinic. It also recently received a $243,000 grant to launch a community paramedicine program.
“Oftentimes, people think a local health department is for the most vulnerable of our community. That’s an important part of our work, but our local health department is to serve everybody,” Gunderman said.