Leaders of local organizations that are addressing Penobscot County’s HIV outbreak have concerns about how two potential actions by state and local governments could worsen the disease’s spread in the region.
First, state lawmakers are considering a proposed bill, LD 219: An Act to Limit Hypodermic Apparatus Exchange Programs to a One-for-one Exchange. If approved, the bill would require Maine syringe providers to give clients one sterile needle for every used one that’s returned.
Additionally, President Donald Trump is considering shutting down the HIV prevention division of the U.S. Centers for Disease Control and Prevention, which provides funding to states for HIV response and prevention efforts, including syringe exchanges, testing and education, the New York Times reported.
Leaders of Penobscot County’s two state certified syringe service providers agreed both the bill and Trump’s potential cuts to the CDC would put the community — especially those who inject drugs — at risk. This would be especially harmful in the midst of Penobscot County’s HIV outbreak that has already accrued 22 new cases since October 2023. All of the 22 people who were diagnosed with HIV reported injecting drugs within a year of testing positive.
While it may seem counterintuitive, giving people who inject drugs clean equipment is intended to deter them from reusing or sharing needles, which can spread bloodborne illnesses, such as HIV.
State rules allow all syringe service providers to give a person up to 100 syringes at a time, regardless of how many used ones they have to give back. But, that allowance doesn’t mean distributors give each person 100 syringes every time.
Wabanaki Public Health and Wellness typically matches the number of used syringes a client returns, but caps distribution at 50, said Lisa Sockabasin, CEO of the organization. This means if someone gives 10 used needles, they’ll usually give that person 10 clean syringes in return.
However, the Bangor nonprofit feels the ability to give people the number of syringes they need rather than being restricted by how many contaminated needles a person gives back is essential to preventing the spread of bloodborne diseases, Sockabasin said.
“If people need more than one needle and they only have one needle to bring in, exchange programs need to be able to provide them with what they say they need to keep them safe,” Sockabasin said. “Allowing syringe exchange programs that flexibility is critical, particularly when we’re trying to address an HIV outbreak.”
Both local syringe service providers reported they typically collect more needles than they give out.
For example, Wabanaki Public Health and Wellness gave out 80 syringes but received 802 used ones between November 2022 and October 2023, according to the Maine CDC’s annual report of syringe providers for fiscal year 2023.
William Hurley, executive director of Needlepoint Sanctuary, said switching the state to a one-for-one syringe policy would “absolutely” worsen the county’s HIV outbreak.
“It would decrease access to sterile syringes, which makes it more likely that people would share syringes,” Hurley said. “Any time you restrict access to sterile supplies, you’re going to have that outcome.”
While one-for-one syringe exchange policies are common across the country, Hurley said it isn’t considered best practice to prevent the spread of HIV. Instead, the policy aims to increase the likelihood that used syringes will get disposed of and reduce needle waste.
However, the chances that needles will get thrown away depends heavily on whether the person using the needles is housed and the community’s support.
“The reality of syringe disposal is when you have a client who’s housed, you typically get back all of their used syringes and more,” Hurley said.
When it comes to the Trump Administration’s proposed cuts to federal HIV prevention work, local organization leaders agree it would be harmful to their efforts locally, but it’s unclear exactly how.
Jennifer Gunderman, director of the Bangor Public Health Department, said federal HIV prevention funds support efforts in Maine, including syringe service programs, HIV testing, education, treatment and other services.
“Reductions in those funds will jeopardize the ability to address the HIV outbreak,” Gunderman said.
Needlepoint Sanctuary receives free HIV testing kits from the federal government that could get cut if Trump follows through, Hurley said. Those kits would be very expensive if the organization had to begin purchasing them out of pocket.
Wabanaki Public Health and Wellness receives one federal grant that pays for HIV testing and the rest of the organization’s HIV prevention and response funding comes from the Maine CDC, Sockabasin said.
While it’s unclear exactly how cuts to the federal CDC’s HIV prevention funds would trickle down to Wabanaki Public Health and Wellness, Sockabasin said it would be the latest in a series of funding cuts for HIV work in rural areas.
“The decrease of HIV funding and the lack of attention in rural areas over the past decade or more is being seen in Bangor, Maine, right now,” Sockabasin said. “Any more restrictions on funding, HIV will then be in your backyard if it isn’t already.”
