Ryan White Part B Supplemental - The State of Maine faces unique service delivery challenges due to its large, sparsely populated geographic area. Maine is the largest state in New England, with its largest population centers in Portland (69,104); Lewiston (38,404), and Bangor (31,628). Maine has also seen a significant increase in homelessness in the past ten years. In 2015, Maine had a total of 1,134 people experiencing homelessness. In 2024, this number increased to 2,695 individuals. Many of these individuals are chronically unhoused, with one or more mental disorders. More than half of the adults screened had substance use disorder. In the State of Maine, about 1,760 people are living with diagnosed HIV, 60 percent of whom are enrolled in Ryan White Part B services. According to Maine’s 2023 Continuum of Care, 76 percent of all people living with diagnosed HIV were virally suppressed, compared to 86 percent of state’s Ryan White Part B enrollees. These data show that individuals enrolled in the Ryan White Part B Program have a higher probability of maintaining viral suppression and therefore retaining their linkage to care. Penobscot County, Maine, has been experiencing an HIV outbreak since October 2023. This outbreak has now (as of March 8, 2025) increased to 21 case patients newly diagnosed with HIV. All 21 new diagnoses were linked to injection drug use (IDU). Nineteen of these individuals reported being unhoused in the past year and 20 were coinfected with Hepatitis C Virus. Only 62 percent of these clients were linked to care, and of those, only 30 percent have retained viral suppression as of February 28, 2025. We have observed more than 800 percent increase in HIV diagnoses in Penobscot County to date. In the five years before the current HIV outbreak, there were an average of two new HIV diagnoses per year in Penobscot County. In 2024, there were a total of 17 new HIV diagnoses in Penobscot County. In 2024, there were a total of 66 new HIV diagnoses reported in Maine. In the previous five years (2019-2023), there were an average of 31 new HIV diagnoses each year in Maine. Despite collaborations between a Ryan White Part C Recipient, the City Health Department, Maine CDC, Syringe Service Programs, and Federally Qualified Health Centers (FQHCs), viral suppression and retention in care have been difficult to achieve and maintain for this population. Ryan White HIV/AIDS Program Part B States/Territories Supplemental Grant Program would allow Maine’s Ryan White Part B Program to provide this community with one full-time Street Medicine Case Manager. This case manager would not follow the traditional brick-and-mortar model of care. Instead, this case manager will take on the street medicine model, meaning “meeting would-be patients exactly where they are: on the street.” This “flips the power dynamic in favor of unstably housed individuals, in a world where the power dynamic is often skewed against them.”
