Penobscot County is experiencing the largest HIV outbreak in Maine's history, with confirmed cases rising despite public health interventions. Jennifer Gunderman, Bangor’s director of public health and community services, said that HIV had largely been overlooked in the state due to historically low incidence, but a combination of factors—including rising homelessness, widespread drug use, and a reduction in syringe service providers and healthcare options—created the conditions for the outbreak.
The first case in what was later identified as a cluster was detected in October 2023. Eighteen months on, Penobscot County had 21 confirmed cases, but as of 24 April, the cumulative total had reached at least 41. Gunderman noted that the true number is likely higher than what the state has been able to track, given that Maine typically recorded fewer than 40 new HIV diagnoses annually over the past decade.
The majority of known cases involve people who inject drugs and are homeless, but Gunderman suspects additional cases among housed individuals who inject drugs. Sex work for money, support, or housing has also increased risk factors. The Maine Center for Disease Control and Prevention is collaborating with national experts to model the outbreak and estimate its true scale. “Epidemiologically speaking, where are we in the outbreak? We don’t know until it’s over,” Gunderman said.
In response, the state has expanded HIV and hepatitis C testing, prevention services, syringe access, and linkage to care. Bangor’s public health department has increased its own testing, distributed HIV self-tests, helped secure housing, and established an HIV case management programme to assist with appointments and health insurance. The Bangor City Council recently approved the department’s application for syringe service certification to provide sterile syringes to clients with HIV.
Gunderman, who began her role in April 2024, brings extensive experience from her career as an epidemiologist with the Maine CDC, including work on mumps, HIV, and sexually transmitted infections. She stressed the importance of local public health efforts and plans to use Bangor’s experience to help other communities with fewer resources that may face similar risks. “Now, it’s like how do we understand those ingredients and see where other parts of the state might have these ingredients?” she said, emphasising the need for increased testing, prevention messaging, and outbreak prevention.
