The HIV cluster in Penobscot County spreading among people who inject drugs and may be homeless can spread beyond those communities if those at risk never get tested, an infectious disease physician warned.
“Those who are currently homeless may not always be, and substance use behavior can change over time, including when people seek treatment,” John Chiosi, an infectious disease physician at Massachusetts General Hospital, said. “It’s possible that someone who acquired HIV by injecting drugs can still give it to others even if they are not currently injecting drugs or are homeless anymore.”
When someone contracts HIV, the virus usually presents flu-like symptoms that pass, leading the infected person to assume they recovered from a brief illness, Chiosi said. The person may have no symptoms for years, but they can still give HIV to others during that time, either through sharing needles or through unprotected sex.
“It’s critical to test people who are at risk so we can identify if they have HIV and get them into treatment,” said Chiosi, who has researched ways to treat and prevent infections related to drug use, including HIV and hepatitis C. “HIV is entirely preventable and treatable.”
Chiosi’s expertise highlights both the risk an HIV cluster poses to a community and the importance of local providers continuing to provide necessary testing, prevention methods and treatment to those at risk of contracting the virus. In Penobscot County, that work is being done by the Bangor Public Health Department, Penobscot Community Health Care, Maine Family Planning, Wabanaki Public Health and Wellness, St. Joseph Hospital, and Community Health and Counseling Service.
Since October 2023, 21 people in Penobscot County have tested positive for HIV, all of whom reported injecting drugs within a year of their diagnosis, according to the Maine Center for Disease Control and Prevention. All but one of the 21 people also tested positive for hepatitis C, and 19 people reported being homeless within a year of testing positive.
HIV is a virus that attacks a person’s immune system, destroying cells that fight infection and disease, according to the CDC. With proper and consistent medical treatment, it can be virally suppressed to undetectable levels and a person can’t transmit it to others, but there is no cure.
If left untreated, HIV will weaken a person’s immune system and eventually develop into AIDS. Without treatment, people with AIDS typically survive about three years, according to the CDC.
Massachusetts saw the virus spread to multiple communities when an HIV outbreak occurred in the cities of Lawrence and Lowell from 2016 to 2018. More than 120 cases of HIV were linked to that cluster, according to the Massachusetts Department of Public Health.
In November 2018, a separate cluster of HIV infections was identified among people who inject drugs in the Boston region. While the cluster is concentrated in Boston, new HIV diagnoses among people who inject drugs have occurred state-wide, Massachusetts Public Health Department reported.
More than 200 people connected to the Boston cluster had tested positive for HIV as of May 31, 2024, according to Massachusetts Department of Public Health and the Boston Public Health Commission.
Boston, Lawrence and Lowell were able to end those HIV clusters by what several providers in Penobscot County are doing now: testing people for HIV, treating those who test positive, and providing harm reduction materials to at-risk individuals.
“All of those together can help address this cluster,” Chiosi said.
The challenge, Chiosi said, is fighting the stigma around HIV, substance use and homelessness. Additionally, those who are most at risk may not be connected to health care or willing to trust providers immediately.
Amy West, a family nurse practitioner and associate medical director of substance use disorder services at Penobscot Community Health Care, has been working to address HIV in the community by offering “street medicine” to those most at risk.
In addition to providing medical care within the Hope House Health and Living Center, West travels to people who are living outside or spending a significant amount of time in warming centers or the Bangor Public Library and brings medical care to them.
While West can help people with everyday illnesses such as the flu, she now spends much of her time testing people for HIV and ensuring the people who test positive get the medication they need to treat the virus.
“Any time you see patients that you care deeply for struggling with an emotionally life-changing diagnosis is hard,” West said. “But, it’s fulfilling and empowering to be able to connect people to treatment that helps them overcome something that can feel overwhelming.”
West also helps people at-risk of HIV connect them with the harm reduction supplies that can keep them healthy, such as sterile needles, condoms and PrEP, a medicine people at risk for HIV can take to prevent getting the virus from sex or injection drug use.
While the recent uptick in HIV cases locally can seem discouraging, West said it’s a sign that local organizations are working together to get more people tested.
“That’s something I didn’t anticipate that has been a wonderful thing around something that’s really sad and devastating from a community perspective,” West said. “It has been a beautiful thing to be part of a team that cares deeply for its community.”
