The Bangor City Council approved spending $550,000 in opioid settlement funds Monday to create an intensive case management program for people who have contracted HIV during the ongoing outbreak in Penobscot County.
That amount is about half of the funds Bangor has received so far from national settlements with companies accused of contributing to the opioid crisis.
Members of the city’s opioid settlement funds advisory committee hope the program will fill an urgent need as new HIV cases continue to be diagnosed in the area. The 28th case in the HIV outbreak, which started in October 2023, was reported last week.
The need for specialized care for people affected by the outbreak, nearly all of whom reported injecting drugs and being homeless in the year before their diagnosis, has only grown since the Regional Medical Center at Lubec suddenly ended its HIV case management program at the end of June.
“This is a substantial amount of money,” Councilor Dan Tremble said, but “to not do this would be an abdication of our responsibility. I mean, it is a direct result of the opiate problem.”
The approximately $550,000 budget for the program, drafted by the city’s public health department at the committee’s request, would pay for two intensive case managers who would work with clients diagnosed as part of the HIV outbreak to do paperwork, connect them to medical care and other services, and check in on them multiple times per week to make sure they’re getting the care they need.
That money would fund the program for two years, after which the case managers could switch to a reimbursement model, the proposal states.
The budget provides funding for office space, equipment and administrative time. It also pays for transportation for the case managers to meet clients in the field and for clients to get to their appointments. The program will aim to reduce the viral loads of people in the outbreak and keep them as healthy as possible while also reducing the spread of HIV, according to the proposal.
The people diagnosed during the outbreak tend to face a variety of extra challenges and require a greater degree of support, as most of them have injected drugs and been homeless in the year leading up to their diagnosis.
For example, homeless people are likely to have more trouble staying on track with their medications and appointments, committee member Jayson Hunt said in a July 23 meeting. Hunt works for Wabanaki Public Health and Wellness and drafted the proposal after initially bringing the idea to the group earlier in July.
Especially following the closure of the homeless encampment behind Hope House in February, it’s been difficult for providers to find and care for the people affected by the outbreak, he said.
“Treating HIV is really not that hard,” said Scott Melton, the second chief for infectious diseases at Eastern Maine Medical Center, during public comment at Monday’s council meeting. “The problem is keeping patients [in] care, and it’s doubly so with the homeless population, trying to track them down,” he said. “Qualified case management makes all the difference.”
People with HIV will receive case management through the city’s program until they reach certain benchmarks with their health and living situations, according to Hunt. After that, they could be referred to a different, lower-intensity case management program, making room for new people to cycle in, he said in the July 23 committee meeting.
Community Health and Counseling Services in Bangor added HIV case management to its behavioral health clinic services last month, but committee members agreed that this program will not be able to mitigate the ongoing outbreak on its own.
The two programs will complement each other as they have different strengths and limitations, according to Community Health and Counseling Services executive director Dale Hamilton.
While the proposal for the city-run program is primarily focused on the outbreak that has emerged in the last two years, there are also many others in the region living with HIV, including 140 people who lost case management services when the Regional Medical Center at Lubec ended its program — so there is a huge gap in care, Hamilton said.
“We’re not, as an organization, going to be able to develop enough resources to meet that need in a short amount of time,” he said at Monday’s meeting, saying he thought both programs were needed. He said his nonprofit would work closely with the city to make sure people’s needs are met and that neither program is duplicating work the other is doing.
Hamilton and Melton spoke in favor of the proposal at Monday’s meeting, while Amy Clark, a board member for the Bangor Area Recovery Network, spoke against it.
The opioid settlement committee voted unanimously on July 23 to send the proposal to the council. This is the first proposal to come out of the committee, which started meeting at the end of June, about three years after the city began receiving settlement money.
Before establishing the committee this spring, Bangor had only spent about $20,000 of the funds, which it used for a syringe cleanup contract. Recovery advocates have criticized the city for the years-long delay in spending the money.
The city will continue to receive payments each year until 2038 and is expected to get at least $3.4 million total.
