BANGOR – There’s not much about grief that Denis Cranson hasn’t seen.

The director of the Eastern Maine AIDS Network started working with the HIV-AIDS community in 1991 when the disease was at its most devastating. New cases were emerging steadily. Every diagnosis was a virtual death sentence because there was no treatment that worked.

Cranson, 47, who will step down from his position in a month or so, was finishing a master’s degree in human development at the University of Maine when he signed up for a 15-week volunteer internship at the recently established EMAN.

He never left.

“It was all just so sad,” he recalled in a recent interview at the rambling Harlow Street offices that house EMAN now. “I could see the need was so great. I just stayed on.”

The shoestring operation was based then in a windowless, two-room space in the rear of a brick building that housed several medical practices and other professional offices. “It wasn’t inexpensive,” Cranson said. “It was just the only place that would rent to us.”

The workers consisted of the original director and a community educator. There was no support staff – no one who understood fund raising or filing or bookkeeping. The overworked staff had all it could do, day-to-day, to try to stem the sudden and inexorable tide of grief, pain and financial disaster that rose around the stigmatized victims of the poorly understood disease.

“At that time, if you had [human immunodeficiency virus] you would get [acquired immune deficiency syndrome],” Cranson said in a recent interview. “Everything was crisis-driven. Every day, someone was dying. People were terribly sick. They’d go to the hospital for help, and there would be horror stories about how they were treated. Whole families were in crisis, not only because of the disease, but at least sometimes, because they were just learning that a family member was gay.”

Postponing his plans to pursue a doctoral degree, Cranson continued his volunteer work for about a year. He took over as community educator when the position opened up, and in 1995 he was named director.

Cranson has guided the agency through a dramatic period of growth and turmoil. Treatment for HIV has improved markedly, and, though there is still no cure, someone with a new diagnosis can – with careful medical management and a network of social supports – expect to live a near-normal lifestyle for many years.

While the virus is still largely associated with the gay community, more and more of EMAN’s roughly 65 steady case management clients are heterosexual. Many are women. Some are teenagers and a few are children. Infection through intravenous drug use accounts for a significant percentage of the cases. Cranson said fully half of his clients have a triple diagnosis of HIV, substance abuse and mental illness.

These changes in the profile of HIV-AIDS have forced parallel changes within the agencies that serve the affected population. Under Cranson’s direction, EMAN has evolved from a reactive, crisis-driven, grass-roots program to a proactive, anticipatory agency with a professional staff and a focused mission.

It hasn’t been easy.

Cranson inherited an administrative snarl of bad bookkeeping and inconsistent records that reflected the chaotic, seat-of-the-pants early days of the program. Drawing on his two-year business degree from Beal College in Bangor, he worked with state regulators to repay more than $19,000 that had been misspent. Cranson attributes the misallocated dollars to “growing pains” in a new organization run by people with more compassion than business sense.

“There was no malfeasance,” he said. “Money might have been spent on buying medications for people who couldn’t afford it instead of on rent, for example.”

He launched a campaign to repair the tarnished public image of the organization, which he said had been cast as a “cash cow” when word of the funding problems had gotten around. He enlisted the support of the news media though coverage of public events, paid advertisements and public service announcements.

Professionalizing the image of the organization and going public with the changing nature of its mission helped it qualify as a recipient of United Way funds, as well as making a stronger case for state and federal dollars.

The frantic struggle to provide supportive end-of-life care to a marginalized and largely reviled population has been replaced now with a longer-term strategy aimed at preventing the spread of the virus and restoring the independent, productive lifestyles of its victims.

In addition to offering education, testing, counseling and support at the center, EMAN now takes its act on the road, providing services to jails and prisons, local high schools, the University of Maine, group homes, and the Penobscot Nation reservation in Old Town.

Cranson, whose undergraduate degree is in education, teaches a class about HIV-AIDS to aspiring social workers, teachers, nurses and others at the University of Maine.

EMAN manages a controversial needle exchange program, so drug users don’t have to share a needle; it also lessens the number of contaminated needles left in public places. Cranson said the needle exchange program is “daring” and reflects growing public acceptance of the disease and population it affects. “We would never have tried it in the mid-’90s,” he said.

Cranson is especially proud of the small group of high school volunteers who take the message of testing, treatment and prevention into area schools. Because treatment has improved, “kids today don’t know what the face of AIDS looks like,” he said. “Most of the people with HIV on the street don’t look sick.” Without being confronted by the fearsome evidence of the disease, the case for prevention becomes less compelling, he said.

Ironically, as the horror and despair of the disease have receded from the public eye, stigma against its victims has re-emerged, Cranson said. Although the face of AIDS may be changing, for many the association with the gay community is indelible. And while acceptance of the gay lifestyle may seem to be expanding in some quarters, Cranson said, “there’s a tremendous backlash.”

“Many people are far more accepting than they were a year ago, but it’s a sharp line. There are plenty of people who would put everybody with AIDS on an island and burn it.”

Almost 20 years after Bangor resident Charlie Howard was thrown into Kenduskeag Stream to drown, Cranson said, antipathy toward homosexuals lives on. “People are more politically correct now. But in the privacy of the voting booth and in the privacy of the mind, there’s still a lot of feeling against homosexuals.

“We get quite a few calls from people who implore us to find God,” Cranson said, giving a small smile. “They don’t realize that quite a few of us here already have found God.”

Along with its outreach work in the community, EMAN manages a steady clientele of about 65 adults, teens and children from three counties. Cranson says that number reflects only the people who have no insurance and rely on his staff for case management and direct services. The number of area residents the organization reaches each year through talks and videotapes, through testing and other outreach efforts, he said, is in the thousands.

The organization employs seven full-time workers – three social workers, two educators, a front office staffer and Cranson. The $400,000 annual budget is built on a combination of state, federal, private foundation, and local fund raising. Cranson said state and federal contributions haven’t changed in over a decade, despite the agency’s client base nearly quadrupling and operational expenses increasing dramatically.

At the Harlow Street office, the agency boasts a fully stocked food pantry and the contracted services of a nutritionist who can help clients address their special dietary needs. There’s a massage therapist and other health care adjuncts, in addition to personal counseling, financial guidance and case management.

The goal , Cranson said, is to help his clients reclaim their lives. “For 90 percent of my clients, their HIV is manageable,” he said. “So now we’re addressing issues of chronic illness. We try to encourage people to do as much as they can.”

But that’s no simple thing. “Giving people back their lives comes with some problems,” he said. “If people give up responsibility for their lives, thinking they’re going to die, it’s very hard to have them take that responsibility back. The case management we do now means we’re no longer doing everything for a person; now we’re trying to get that person to resume his life activities.”

Taking his own advice, Cranson is letting go of the reins at EMAN and will return to UMaine in January to work on his long-deferred doctorate, with a focus on public administration. His goal is to parlay his formal education and life experience in business management, teaching, medical care, social work, and human sexuality and development into a high-level position where he can make a stronger contribution to the HIV-AIDS community.

Cranson said he has no regrets about having delayed his academic aspirations when he first came to EMAN. “I’ve gained much more than I’ve given,” he said. “But there comes a time when you have other goals. … I sat down and looked at my life and realized that if I’m ever going to do this, I’d better do it now. But I’m never going to disconnect from this issue.”

What will a new director need to bring to EMAN to maintain the organization’s professional status and carry on its lifesaving work in the community? Compassion, once the driving force behind AIDS activism, is no longer enough, Cranson said.

“In the beginning, having a huge heart was vital because you were dealing with people who had no other support,” he said. “Empathy is still important, but as HIV has evolved, there have been a lot of changes. You have to know a lot about the connected issues of substance abuse and mental illness. You need business savvy, too. No matter how big your heart is, if you give up the store and end up folding you won’t do anyone any good.”

In dealing with a chronic illness, he said, the ability to define the mission of the organization, establish boundaries and stick by administrative decisions is critical.

After a national search for Cranson’s successor, the board of directors at EMAN is narrowing in on a candidate to replace him before the end of the year. Cranson, who already is taking a couple of warm-up graduate classes, said he’ll work to bring his replacement up to speed, and expects to be a regular at the Harlow Street offices into the new year.