By: Ranier Simons, ADAP Blog Guest Contributor
In the current political climate, given the government’s health policy landscape, many stakeholders are concerned about the stability of public health. This is undeniably true in the HIV space. Republicans seek deep cuts to HIV prevention and treatment funding, which would destabilize the already tenuous nature of care for people living with HIV/AIDS (PLWHA), especially those in vulnerable populations. Hindering effective HIV response is disconcerting, with trends such as HIV clusters appearing. In recent times, HIV cluster outbreaks have been identified. Fruitful public health support of PLWHA requires an increase in resources, not a reduction.
![]() |
Photo Source: Maine.gov |
One such cluster of increased HIV transmission is in Penobscot County, Maine, where Bangor is located. A cluster outbreak was first identified there in late 2023 (Budlon, 2025). A cluster is a group of people with related HIV infections. As of September 2025, the number of cases in this cluster has reached 29 (main DHHS). This area of Maine typically sees only two instances of transmission per year (Budlon, 2025). The majority of those involved in this cluster have been experiencing homelessness, injection drug use, or both in the 12 months before their diagnosis (Tusinksi, 2025). These conditions do not cause HIV; however, they do increase the risk of transmission. Housing instability hinders treatment adherence and consistent access to HIV care. Injection drug use can lead to behavior with increased risk, including sharing needles (Arum et al., 2021). Public health officials infer that the number of transmissions is likely higher than 29, given that many have not been tested.
Another cluster seeing a notable increase is in New York. The increase in infections in a reported cluster in Broome County, New York, in early August is higher than the number seen annually over the past four years. Most of those in the cluster are unhoused, have used intravenous drugs, are Caucasian, and between the ages of 30 and 45 (McCarthy, 2025). In addition to those identified in the clusters, the Broome County Health Department estimates there are a couple of dozen more people who have been exposed to HIV that they are not aware of (McCarthy, 2025). Additionally, as of 2023, Broome County has the third-highest rate of new Hepatitis C mortality in New York state (McCarthy, 2025). Hepatitis C, tuberculosis, Hepatitis B, and syphilis are often comorbid with HIV (McCarthy, 2025). HIV transmission has historically been overrepresented in the South; thus, this Northeastern trend is concerning.
Actions by the current administration are in direct opposition to supporting the reversal of these transmission trends. Reductions in HIV-related funding are harmful on many levels. In a July 2025 Executive Order (EO), the President implies defunding harm reduction. Harm reduction includes syringe service programs (SSP) in which evidence-based data shows that they are one of the best ways to prevent HIV and Hepatitis spread among those who inject drugs. Unlike the EO states, SSPs or safe consumption sites do not facilitate or worsen drug use. Two prominent SSPs in Maine have already shut down. The Maine Center for Disease Control and Prevention revoked the Health Equity Alliance’s (HEAL) syringe exchange certification in January 2025 (Bush, 2025). Additionally, due to a zoning issue, SSP Needlepoint Sanctuary was forced to close in July 2025 (Rupertus, 2025).
The language of the EO also paints the unhoused as a criminal group riddled with drug addiction and mental health disease, deserving of involuntary commitment to facilities to restore public safety. The President’s prescription of rounding up people experiencing homelessness and destroying encampments is the same sentiment that resulted in Camp Hope being closed in February of this year. It was the largest homeless encampment in Bangor, Maine (Peters, 2025). Many of those pushed out of the encampment have not been connected to residential situations and remain unhoused. The encampment served as a means for public health providers to reach unhoused PLWHA for treatment and tracing. However, with the residents of the encampments now scattered, any linkage to care that had occurred is destroyed. That is detrimental to PLWHA and the public since HIV prevention is a public issue.
![]() |
Photo Source: CNN |
The House Republican budget proposal slashes federal HIV prevention and treatment funding, seeking almost $2 billion in HIV-related cuts (Ryan, 2025). This is coupled with the large number of HIV related NIH grants that have already been defunded. In a speech, NIH Director Dr. Jay Bhattacharya stated, “We have now in our capacity the ability to actually end the HIV epidemic by 2030, to reduce HIV transmission to very, very low levels. And we just need to figure out how to do it” (Ryan, 2025). It is unclear how this goal can be achieved, given the massive amount of HIV treatment and prevention defunding that the Trump Administration and House Republicans wish to achieve.
Regardless of the current destabilization in the HIV-related public health space, monitoring for transmission trends and cluster outbreaks is imperative. A challenging aspect of monitoring is HIV molecular surveillance. HIV molecular surveillance involves the collection and tracking of virus sequences from specific genetic strains of HIV. HIV transmission reporting is required by law for public health purposes. When a person tests positive for HIV, additional genetic bloodwork is done to determine the specific strain of HIV for epidemiological and cluster tracking purposes.
In theory, meaningful data analysis is achieved by collecting this information. However, there are no proper safeguards in place to ensure the privacy of the PLWHA from whom this data is collected. Privacy breaches could result in harm, including economic and physical safety concerns. There are safer means of acquiring tracking data, such as tracking HIV through comprehensive case surveillance, behavioral and clinical monitoring, and analysis of pharmaceutical data (CDC, 2025). ADAP Advocacy is strongly opposed to HIV molecular surveillance being used to combat HIV clusters and has routinely supported the Center for HIV Law and Policy in its advocacy in this space.
![]() |
Photo Source: Center for HIV Law & Policy |
Data shows that some HIV transmission statistics are trending in the wrong direction. Now is not the time to destabilize the fragile infrastructure that is the status quo. If massive defunding ultimately becomes a permanent reality, HIV clusters will increase, and many preventable transmissions will occur. That outcome will result in a significantly higher level of societal and governmental spending compared to the savings the administration professes to achieve from its proposed fiscal cuts.
[1] Arum, C., Fraser, H., Artenie, A. A., Bivegete, S., Trickey, A., Alary, M., Astemborski, J., Iversen, J., Lim, A. G., MacGregor, L., Morris, M., Ong, J. J., Platt, L., Sack-Davis, R., van Santen, D. K., Solomon, S. S., Sypsa, V., Valencia, J., Van Den Boom, W., Walker, J. G., … Homelessness, HIV, and HCV Review Collaborative Group (2021). Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. The Lancet. Public health, 6(5), e309–e323. https://doi.org/10.1016/S2468-2667(21)00013-X. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8097637
[2] Budlon, K. (2025, July 11). Penobscot County HIV outbreak continues to grow; providers say the rest of Maine is at risk. Retrieved from https://www.mainepublic.org/health/2025-07-11/penobscot-county-hiv-outbreak-continues-to-grow-providers-say-the-rest-of-maine-is-at-risk
[3] Bush, B. (2025, January). Maine CDC change to syringe-exchange program in Bangor displaces need for services. Retrieved from https://www.newscentermaine.com/article/news/health/health-equity-alliance-syringe-needle-exchange-program-revoked-maine-cdc/97-f5132e6d-2c9f-405c-b034-cae05cd6de1c
[4] Centers for Disease Control and Prevention. (2025, February 7).About HIV Surveillance and Monitoring. Retrieved from https://www.cdc.gov/hiv-data/about/index.html#:~:text=Medical%20Monitoring%20Project%20(MMP):,outlets%20in%20the%20United%20States.
[5] McCarthy, J. (2025, September 17). HIV cases have increased in Broome County cluster. Why there is still a 'big unknown'? Retrieved from https://www.pressconnects.com/story/news/public-safety/2025/09/17/hiv-cases-rise-in-ny-cluster-while-health-leaders-grapple-with-containment/86181140007/
[6] Peters, D. (2025, February 28). 'It's family here': Bangor officially closes city's largest homeless encampment. Retrieved from https://www.newscentermaine.com/article/news/local/bangor/bangor-closes-homeless-encampment-camp-hope-maine/97-00f3028d-4739-4ce9-b5fc-9287ab30e6ff#:~:text=Boyd%20Kronholm%2C%20executive%20director%20of%20the%20Bangor,approach%2D%2Drather%20than%20an%20immediate%20sweep%2D%2Dis%20more%20effective.
[7] Rupertus, A. (2025, July 28). Bangor syringe exchange service shuts down shortly after opening. Retrieved from https://www.bangordailynews.com/2025/07/28/bangor/bangor-health/needlepoint-sanctuary-shut-down-shortly-after-opening-n6hjn1me0n/
[8] Ryan, B. (2025, September 29). Republicans seek deep cuts to HIV prevention and treatment funding. Retrieved from https://www.msn.com/en-us/news/other/republicans-seek-deep-cuts-to-hiv-prevention-and-treatment-funding/ar-AA1NGD63?ocid=socialshare
[9] Tusinski, D. (2025, July 23). How a ‘cluster’ of HIV cases in Penobscot County became one of Maine’s largest outbreaks. Retrieved from https://www.pressherald.com/2025/07/23/how-a-cluster-of-hiv-cases-in-penobscot-county-became-one-of-maines-largest-outbreaks/
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.