Aneri Pattani
Penobscot County, Maine, is grappling with the biggest HIV outbreak within the state’s historical past. Home to Bangor, a metropolis of roughly 32,000, the county has recognized 28 new cases over almost two years. That’s seven instances the everyday quantity for that size of time. Nearly all circumstances are amongst individuals who use medication and are homeless.
Public well being consultants and native advocates say the outbreak is fueled by a confluence of on-the-ground elements: the sidelining and shutting of packages that distributed sterile syringes to individuals who use medication, a scarcity of medical suppliers centered on HIV, and the clearing of town’s largest homeless encampment, which upended take care of newly recognized individuals dwelling there.
But these points could not stay native for lengthy.
The Trump administration is pushing related techniques nationwide. In a recent executive order, Trump referred to as for defunding packages that interact in hurt discount — a broad time period that encompasses many public well being interventions, together with syringe providers, aimed toward holding individuals who use medication alive. Such efforts are generally controversial, with critics saying they permit criminality. The govt order additionally helps forcing homeless individuals off the road and into remedy. This comes after the administration reduce or delayed funding for numerous addiction and HIV-related packages and hollowed out federal companies focused on these topics.
The administration says its method will enhance public security, however decades of research counsel in any other case. Many advocates and researchers warn these efforts might spark extra outbreaks just like the one in Bangor.
“That feels inevitable,” mentioned Laura Pegram, director of Drug User Health for NASTAD, an affiliation of public well being officers who administer HIV and hepatitis packages.
She mentioned individuals who use medication face a trifecta of dangers: HIV, hepatitis C, and overdose. “Across the country, I think we’ll start to see those three things starting to be on the rise again.”
“That will be incredibly costly,” she added — in {dollars} and “in a real human way.”
Outbreaks that begin amongst individuals who use medication can simply unfold to those that don’t.
An HIV Outbreak
The first HIV case in Bangor’s present outbreak appeared in October 2023, effectively earlier than Trump’s return to the presidency.
Puthiery Va, director of Maine’s public health department, attributed the emergence to the opioid epidemic, housing shortages, and the higher Bangor space’s sparse well being care providers.
Local advocates highlighted an extra, acute issue: provide shortages on the area’s largest syringe providers program and its subsequent closure.
A nonprofit that supplied well being care and social providers to individuals who use medication, Health Equity Alliance, or HEAL, distributed more than half a million sterile needles yearly.
Like different such packages nationwide, its objective was to stop the unfold of infectious illness that may happen if individuals share needles to inject medication.
However, monetary struggles and mismanagement led to extreme shortages lately. Former HEAL govt director Josh D’Alessio acknowledged such points, telling KFF Health News, “We did run out of syringes” at instances or restrict what number of contributors might take. Several of those shortages struck within the fall of 2023, main HEAL staffers to counsel a hyperlink to the primary HIV case.
The Future of Harm Reduction
Research suggests a robust connection between previous HIV outbreaks amongst individuals who use medication and lack of entry to sterile needles, mentioned Thomas Stopka, an epidemiologist at Tufts University School of Medicine.
A 2015 outbreak in Scott County, Indiana, and one within the Merrimack Valley of Massachusetts a couple of years later have been curbed solely after syringe services programs ramped up, he mentioned. If such packages had existed sooner in Scott County, greater than 100 infections might have been prevented, one study suggested.
Va, who leads the Maine Center for Disease Control and Prevention, mentioned she considers the scarcity of syringe providers within the Bangor space to be an element within the outbreak however not the first trigger.
Stopka mentioned the very best observe throughout an outbreak “is to amplify access to sterile syringes.”
But Trump’s latest govt order hyperlinks harm-reduction packages to crime, saying such efforts “only facilitate illegal drug use and its attendant harm.” The order doesn’t identify syringe providers packages — which have been supported by each Democrats and Republicans up to now — nevertheless it targets “safe consumption” websites, the place individuals can use medication below supervision. Many advocates worry the assaults will likely be broader.
A letter from the nation’s main dependancy company increasing on Trump’s govt order mentioned federal funds cannot be used to purchase syringes or drug pipes. However, that has been true for a lot of the previous few many years. The letter didn’t handle supporting basic working prices for syringe providers packages.
Department of Health and Human Services spokesperson Andrew Nixon advised KFF Health News that the administration is dedicated to “addressing the addiction and overdose crisis impacting communities across our nation.” But he and spokespeople for the White House didn’t reply to particular questions in regards to the administration’s stance towards syringe providers.
In Bangor, some locals have raised issues about hurt discount that echo the president’s. At a March 2024 City Council meeting — shortly after a syringe providers program was newly licensed by the state to function domestically — residents and enterprise house owners mentioned they felt unsafe with the rising inhabitants of people that have been homeless and utilizing medication. They nervous syringe packages have been fueling the habits.
But analysis suggests syringe providers packages reduce discarded needles in the neighborhood and do not increase crime. They can halve new HIV and hepatitis C circumstances, increase entry into dependancy remedy fivefold, and save taxpayer money. They are additionally leading distributors of overdose reversal medicines, using which many communities — and the Trump administration — have mentioned they help.
The metropolis in the end determined the newly licensed program, Needlepoint Sanctuary, couldn’t function in distinguished public parks or squares.
In the next months, Needlepoint ran its syringe providers solely on the metropolis’s largest homeless encampment, the place a number of individuals had examined optimistic for HIV, mentioned the group’s govt director, William “Willie” Hurley. That led to February when town cleared the encampment.
This summer season, Needlepoint secured a personal location for its syringe providers however shut it down 5 days later when metropolis officers raised zoning concerns.
Jennifer Gunderman, director of Bangor’s well being division, mentioned town is attempting to strike a stability between “making services available and what the community wants.”
“Getting the buy-in of most of the community” is “critical to the future of harm reduction,” she mentioned.
Other cities in Maine and beyond have seen backlash end in new legal guidelines that prohibit how syringe providers packages function or shutter them.
Gunderman mentioned she is hoping to keep away from that in Bangor.
Clearing Encampments
Trump’s latest govt order additionally requires clearing homeless individuals off the road and involuntarily committing them to remedy services.
The administration is enacting this coverage in Washington, D.C., the place it has bulldozed tents and threatened homeless individuals with fines and jail time in the event that they don’t go away the streets.
White House spokesperson Abigail Jackson mentioned individuals have the choice to be taken to a shelter or obtain dependancy and psychological well being providers.
Similar insurance policies have taken maintain nationwide lately, even in liberal hubs like New York and California.
Last 12 months in Bangor, as a homeless encampment that had existed for several years grew to almost 100 residents, enterprise house owners and locals referred to as for its clearing.
Some advocates and social service suppliers warned that doing so might exacerbate the HIV outbreak and overdose disaster. At two City Council conferences in November, they explained that it might be troublesome to search out individuals they served after a clearing and that scattering newly recognized individuals could spark HIV clusters elsewhere.
“Plenty of people said you’re going to lose track of these people,” Amy Clark, a board member for the Bangor Area Recovery Network, advised KFF Health News. “They did it anyway.”
‘I’m Still Alive’
Two months after clearing the encampment, the city reported not figuring out the situation of greater than a 3rd of the individuals who had lived there.
Clark mentioned it’s not stunning that town couldn’t join everybody to housing or remedy. Many individuals mistrust these providers, shelters are ceaselessly full, and remedy providers are scarce. “Where exactly are these people supposed to go?” she mentioned.
City officers burdened in Council conferences and studies that they have been taking a humane method. They ramped up social providers for months main as much as the clearing, connecting individuals to every part from housing to storage services and laundry.
Gunderman, town well being director, mentioned she is aware of the sweep wasn’t ultimate however that neither was crowding of us in an unsanitary encampment. “It was a situation where there weren’t a lot of great answers,” she mentioned.
To assist observe of us from the encampment and maintain them engaged in HIV remedy, town is now utilizing about $550,000 in opioid settlement funds to rent two case managers. (The solely different native HIV medical case administration program shuttered over the summer.)
“What we know from outreach we’ve been doing already is that we spend a lot of time looking for people,” Gunderman mentioned.
Jason, who has been homeless for a lot of the previous decade and examined optimistic for HIV this 12 months, has seen that in motion.
Members of what he calls his medical group have scoured the streets for hours to search out his tent and remind him to take his HIV remedy pictures, he mentioned. Some picked up prescriptions and delivered them to him.
“They’ve made sure I’m taken care of,” Jason mentioned. (KFF Health News agreed to make use of solely his first identify to guard his privateness.)
Jason believes he acquired the virus final 12 months on the homeless encampment whereas utilizing medication that another person ready. He had tried to keep away from the encampment for months. But every time he arrange his tent elsewhere, he mentioned, cops advised him to maneuver.
When he acquired the analysis, he considered his uncle, who died of AIDS within the Nineteen Eighties.
“It hurts to talk about,” Jason mentioned, “but I’m still alive.”
After months of remedy, his viral load is now undetectable. Over the summer season, his group helped him discover housing.
But Jason remains to be struggling to search out sterile needles frequently. He worries about others dealing with a scarcity.
“That’s how this outbreak has been spreading more and more,” Jason mentioned. “Every time we turn around there’s another case.”
