Bangor officials and community organizations are scrambling to find ways to fill a gap in HIV care weeks after a critical program suddenly ended.
Clients who had been working with case managers under the Northern Maine HIV program, which was most recently run through the Regional Medical Center at Lubec, are in limbo without the vital support channel that shuttered last month.
In response, Community Health and Counseling Services, a nonprofit that primarily offers mental health care services, is actively hiring for new HIV case manager positions. Bangor’s Opioid Settlement Funds Advisory Committee is also considering using some of its funds to hire HIV case managers who would be employed through the city.
HIV case management is an essential service that helps people with the disease navigate an often confusing landscape of resources. The loss of these services in northern Maine has raised alarm — especially given the ongoing HIV outbreak in Penobscot County, which has seen 26 new cases reported since October 2023.
Providers, public health officials and clients all emphasized the urgent need for case management for both people diagnosed as part of the outbreak as well as longer-term clients who lost services.
The support and stability provided by HIV medical case management helps people lower their viral load, which then lowers the risk of further transmission, according to Jennifer Gunderman, the city’s public health and community services director.
“I cannot begin to describe to you what a significant blow this is to our community,” Gunderman said of the loss of case management services at a City Council workshop meeting on Monday. The public health department and its community partners are already stretched thin trying to address the outbreak, she said.
It was a natural fit for Community Health and Counseling Services to fold HIV case management under its existing behavioral health clinic, according to Brian Moynihan, the organization’s manager of specialized community services.
The nonprofit had already been working with homeless people, who make up nearly all of the cases reported in the outbreak, to provide services such as medical outreach, overdose prevention and HIV testing, Moynihan said.
In some cases, these relationships effectively became “ad hoc case management support,” Executive Director Dale Hamilton said.
The organization saw an opportunity to expand and formalize that support after the Regional Medical Center at Lubec ended its medical case management services. It is now recruiting for two case manager positions, Hamilton said.
New programs are urgently needed for the nearly 150 people who just found out their case management services were terminated, according to former client Kris Daignault.
Daignault, who lives in Bangor, said he’s been living with HIV for 35 years and received services through the Northern Maine HIV Program since moving to the area from Vermont about a year ago.
He only received the letter telling him the program had ended last week — after the services had already been terminated. “Now we’re all scrambling,” he said.
Gunderman also stressed how hard it has been on clients to have these services ended so abruptly.
“When we are dealing with a disease that carries so much stigma with it, HIV medical case management also provides a service to remind people that they are cared about, that they are important, that they matter,” she said. “And to have that so quickly taken away has ripple effects in many different ways for an individual.”
HIV case managers coordinate with their clients to find medical providers and help with other challenges they face related to their diagnosis. Having that consistent relationship with someone who understood his needs and had contacts with a wide range of resources was essential, Daignault said.
Part of his case management included a connection to therapy services, he said. But when the program was terminated, his therapist told him she wouldn’t be able to continue with his care unless he transitioned to telehealth, which he wasn’t comfortable doing.
Now he’s on his own to find a new therapist and get the paperwork done for other medical providers like dentists and eye doctors — all things his case manager used to help him with.
“I just don’t know how it’s going to work or if I should cancel my next appointments with [my providers] until I can get this figured out,” he said. “So there’s going to be a lapse in care.”
“Fortunately I can be my own advocate,” Daignault said, but he added these challenges would be even more difficult for clients who don’t have stable housing.
Community Health and Counseling Services leaders hope to get HIV case management running soon.
The city’s public health department is also working with Penobscot Community Health Care to provide some case management-related services, according to Gunderman.
She is confident the county will see more HIV cases reported as more people get tested and there continues to be a risk of transmission.
The public health department recently hired an infectious disease specialist who will start work in mid-August, Gunderman told city councilors on Monday. She also said her team is exploring the possibility of regularly providing PrEP — a medication that lowers the risk of HIV transmission for people at high risk of being exposed to the disease — at its clinic.
The public health team already offers free HIV testing for anyone at moderate or high risk of transmission and has been distributing free self-tests to people who are hesitant to engage with formal health care providers, she said.
Bangor’s Opioid Settlement Funds Advisory Committee is also exploring ways to fill the gap in HIV services.
In a meeting last week, committee member Jayson Hunt raised the idea of using some of Bangor’s opioid settlement money to hire case managers through the city for homeless people with HIV or substance use disorder. Bangor has already received about $1 million of these funds and will eventually get more than $3 million.
Committee members expressed support for the idea and planned to discuss it further at their July 23 meeting.
