Epidemiological Profile of HIV/AIDS in Minnesota

General Population Demographics

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Description of Minnesota (1)

(1) All data presented in this section are from the U.S. Census Bureau, unless otherwise noted.

Geography

Minnesota is a geographically diverse state. Its 84,363 square miles are comprised of farmlands, river valleys, forests, and lakes. Minnesota has one large urban center made up of Minneapolis and St. Paul (the Twin Cities) in Hennepin and Ramsey Counties, respectively. The Twin Cities are located on opposite banks of the Mississippi River in the southeastern area of the state. The majority (54%) of the state’s 5,303,925 residents live in the Twin Cities and the surrounding seven-county metropolitan region. Duluth (northeast), St. Cloud (central), Rochester (southeast), Mankato (south central), and Moorhead (northwest) are other moderately sized population centers. The rest of Minnesota’s population resides in smaller towns, many of which have populations of less than 2,000.

Three large interstate highways traverse the state, two of which pass through Minneapolis-St. Paul. I-35 runs north-south and I-94 runs northwest-southeast. I-90 parallels the southern border of Minnesota. A host of state and county roads connect the remaining regions of the state.

Age

Minnesota’s population is growing and, like the rest of the nation, getting older. The median age in Minnesota increased from 35.4 years in 2000 to 37.4 years in 2010 mainly due to the aging “baby boomer” population. Despite the rising median age, population growth was most apparent in younger age groups, particularly among 20 to 29 year olds whose number increased by 13% between 2000 and 2010. According to the 2010 Census, 3.18 million persons (60%) living in Minnesota were under the age of 45. There is little difference in the age distribution between the state and the TGA.

Age Distribution in Minnesota and in TGA

Age
Minnesota
(n = 5,303,925)
Minneapolis – St. Paul TGA
(n = 3,279,833)
< 13 17.3% 18.1%
13 – 19 9.6% 9.6%
20 – 24 6.7% 6.5%
25 – 29 7.0% 7.6%
30 – 34 6.5% 7.0%
35 – 39 6.2% 6.7%
40 – 44 6.7% 7.2%
45 – 49 7.7% 7.9%
50 – 54 7.6% 7.5%
55 – 59 6.6% 6.3%
60 + 18.2% 15.8%


Race/Ethnicity

While Minnesota is predominantly White (approximately 85%), there has been an increase in the number of Black, Hispanic, and Asian/Pacific Islander persons living in Minnesota since 2000. At that time, 89% of Minnesotans were White, 3.5 Black, 2.9% Hispanic, 1.1% Native American, and 2.9% Asian. However, excluding the 2.4% of the Minnesota population that indicated two or more races, Black, Hispanic, and Asian/Pacific Islander populations increased by about 60%, 75%, and 50% respectively. As of 2010, there were approximately 274,000 Black, 250,000 Hispanic, and 216,000 Asian/Pacific Islander persons living in Minnesota. Additionally, data from the 2011 –2013 American Community Survey (ACS) show that foreign-born individuals account for 7.4% and 9.7% of the state and TGA population, respectively, compared to 5% and 7% in 2000.

The table below shows the race/ethnicity distribution for Minnesota and the TGA. While the race distribution does not differ greatly by gender, it does vary by geography. A significantly smaller percent of both White males (78% vs. 83%) and females (79% vs. 83%) reside in the TGA compared to the state as a whole. Additionally, census data show differences in age for Whites versus other groups. Twenty-one percent of non-Hispanic Whites in Minnesota were under the age of 18 compared to 35.2% for African Americans, 31.5%  for Asians/Pacific Islanders, 40.5% for Hispanics 32.9% American Indians, and 56.3% of those identifying as multi-racial (two or more races).

Race and Ethnicity Distribution by Gender in Minnesota and TGA

 

Minnesota

Minneapolis-St. Paul TGA

 
(n=2,632,132)
(n=2,671,793)
(n=1,618,907)
(n=1,660,926)
Race / Gender
Male
Female
Male
Female
White (non-Hispanic)
82.7%
83.4%
78.3%
78.9%
Black /
African American
5.3%
5.0%
7.5%
78.3%
American Indian
1.1%
1.1%
0.7%
0.7%
Asian /
Pacific Islander
4.0%
4.2%
5.6%
5.9%
Other race
2.1%
1.8%
2.5%
2.2%
Two or more races
2.4%
2.4%
2.8%
2.8%
Hispanic / Latino*
5.0%
4.4%
5.7%
5.0%

*Includes all races

Of note is the growing number of African immigrants in Minnesota. The Minnesota State Demographer’s office estimates there are 72,930 (2) African-born persons living in Minnesota in 2011. However, many believe this to be an underestimate of the true African population in Minnesota, with some community members estimating that number at close to 100,000 (3).  Somalia, Ethiopia, and Liberia are the most common countries of origin although nearly every country in Africa is represented in Minnesota. Data from the MDH Refugee Health Program indicate that the number of sub-Saharan African primary refugees arriving in Minnesota has declined dramatically between 2006 and 2013 (from 4,764 cases in 2006 to 953 cases in 2013 – a decrease of 80%).


(2) Based on U.S. Census 2010 data, the Minnesota State Demographic Center estimates that there are 380,764 foreign-born persons, including 72,930 African-born persons are living in Minnesota out of a total population of 5,303,925.

(3) The American Community Survey is conducted by the U.S. Census Bureau for the years in between the decennial census. Because there are many reasons African-born persons may not be included in the census count (e.g. difficulties with verbal or written English), even 50,000 is likely an underestimate of the actual size of the African-born population living in Minnesota. Anecdotal estimates from African community members in Minnesota are as high as 100,000.

Additionally, in 2000 Minnesota became one of six initial sites in the United States to receive HIV-infected refugees. Prior to November 2009, immigrants, including refugees, were not permitted entry into the U.S. if they tested positive for HIV during their overseas physical exam unless they obtained a waiver. Agencies with local offices in the Twin Cities coordinated the arrival and resettled 200 HIV-infected refugees to Minnesota from August 2000 through December 2010, of which the majority were from African countries. However, beginning in 2010, the Federal Government reversed the statute barring entry for HIV positive immigrants. Consequently, HIV infection is no longer a barrier for entering the United States. Therefore, Minnesota added routine HIV screening to the refugee screening protocol in 2010.

Socioeconomic Status

Poverty and Income

Minnesota overall has fared somewhat better than the nation as a whole in regards to poverty and income. According to the 2011-2013 ACS, an estimated 11.6% of Minnesotans were living below the Federal Poverty Level compared to 15.9% nationally. Likewise, the per capita income from 2011-2013 for the United States was $27,884 and $30,902 in Minnesota. While these aggregate numbers are favorable, they misrepresent the disproportionate impact poverty has on persons of color. The 2011-2013 ACS estimates that 12% of all Minnesotans were living at or below the poverty level, however, this percent varied greatly by race, with 8% of Whites at or below the poverty level compared to 36%, 35%, 17%, and 24% of Blacks, American Indians, Asians/Pacific Islanders, and Hispanics, respectively.

Employment

According to Minnesota Department of Employment and Economic Development, Minnesota’s unemployment rate decreased from 5.6% in 2012 to 4.1% in 2014. This is the lowest rate of unemployment since 2006 and the 2014 unemployment rate in Minnesota is substantially lower than the 2014 national unemployment rate average of 6.2%.  However, the overall unemployment rates disguise staggering racial disparities. The 2011-2013 ACS indicated an unemployment rate of 17.3%, 10.1% and 18.3% for Blacks, Hispanics and American Indians, respectively in Minnesota compared to 5.4% among white (non-Hispanics).

Education

Minnesota’s emphasis on education is reflected in the low statewide percentage (7.7%) of people aged 25 years or older who have less than a high school education; the national average is 14.4%. However, the percentage of persons with less than a high school education is greater for persons of color in Minnesota. According to the 2011-2013 ACS, 17% of Black men and 22% of Black women are estimated to have less than a high school education compared to 6% and 5% of White men and women, respectively. High school graduation rates are even lower among Hispanics/Latinos, with 38% and 33% of Hispanic males and females not having a high school diploma, respectively.

Access to Health Care

Health Insurance

Overall, Minnesota has one of the lowest rates of uninsured residents in the nation. According to data released from the 2013 Minnesota Health Access Survey, 8.2% of Minnesotans were not covered by health insurance at the time of the survey compared to 9.0% in 2011, 9.0% in 2009, 7.2 in 2007 and 7.7% in the 2004 survey. However, the findings in this study suggest that significant differences continue to exist according to race/ethnicity, age, and country of birth.

Notable differences continue to exist among the different race/ethnic groups. While only 6.0% of Whites were uninsured in 2013, the percentages among Hispanics (34.8%), American Indians (18.0%), Blacks (14.7%), and Asians (13.2%) were considerably higher.

In 2013, persons aged 18-24 and 25-34 experienced uninsurance rates significantly above the statewide rate (13.6% and 17.1% for 18-24 and 25-34 year olds, respectively, compared to 8.2% statewide). Persons aged 0-17 and over 65 had uninsurance rates significantly below the statewide rate 6.2% and 0.4%, respectively).

Country of birth is a significant factor in uninsurance rates in Minnesota. In 2013, people born in the United States had significantly lower uninsurance rate than the statewide rate of 6.6% while those not born in the United States had a significantly higher uninsurance rate of 26.4%.

Prenatal Care

Minnesota is known for its caliber of health care. Unfortunately, when it comes to prenatal care, women do not access health services equally. According to unpublished data from the Minnesota Pregnancy Risk Assessment Monitoring System, 85.3% of Minnesota mothers giving birth in 2011 began prenatal care in the first trimester. However, while 90.3% of White women began prenatal care in the first trimester, only 69.8% of Black, 66.0% of American Indian, and 68.1% of Hispanic women did. Additionally, 87.5% of US-born mothers began prenatal care in the first trimester compared to 72.9% of foreign-born mothers.

Gay, Lesbian, Bisexual and Transgender (GLBT) Persons in Minnesota

Accurate estimates of the GLBT (4) population in Minnesota are unavailable. However, the 2010 Census provides some data related to GLBT persons in Minnesota. Although not a valid measure of the extent of same sex relationships in Minnesota, unmarried partners of the same sex made up an estimated 13,718 households in Minnesota in the year 2010, with approximately 70% of those households located in the TGA.

There have been some national studies that have attempted to estimate the prevalence of same sex behavior, which is different than estimating the number of GLBT persons since some people may engage in same sex behavior but not identify as GLBT. In early work by Kinsey and colleagues in the 1940s and 1950s, 8% of men (5) and 4% of women (6) reported exclusively same gender sex for at least 3 years during adulthood. Generalizing these findings to the general population is very questionable because these data were based on convenience samples.

Subsequent to this work, studies more representative of the general U.S. population have been undertaken. Comparing national surveys from 1970 and 1991, Seidman and Rieder estimated that from 1% to 6% of men had sex with another man in the preceding year (7). Another population-based study estimated the incidence of same sex behavior in the preceding five years at 6% for males and 4% for females (8). Estimates vary for a number of reasons, including varying definitions of homosexuality and/or methods of data collection. Approximately 77,000 men and 50,000 women in Minnesota would be predicted to engage in same sex behavior using the methodology from the Sell study. The accuracy of these numbers is difficult to gauge, at best.

More recently, the SHAPE 2010 study conducted in Hennepin County found that 9.2% of adult males and 4.7% of adult females in Hennepin County identified as GLBT (9). Applying these percentages to the entire state adult population, we would estimate that approximately 182,000 men and 96,000 women identify as GLBT.

Also relevant to the context of GLBT life in Minnesota is the fact that Minnesota and the Twin Cities, in particular, attract individuals with a variety of sexual orientations. A strong gay community exists in the Minneapolis-St. Paul area. Additionally, Minnesota is one of sixteen states and the District of Columbia that has laws banning discrimination based on sexual orientation and gender identity.

A nationally renowned center for individuals seeking transgender support and services is located in Minneapolis. Although transgender people identify as heterosexual, bisexual, gay, and lesbian, variances in gender identity complicate the categorization. Some male to female transgender individuals identify as lesbian, some as heterosexual, and others as bisexual. Similarly, some female to male individuals identify as gay, some are heterosexual, and others are bisexual. Politically, and sometimes for access to services, many transgender individuals find alliances within the gay and lesbian community.

All of these factors may contribute to a larger GLBT population in Minnesota than would be predicted based upon national averages. Any estimates for the GLBT population must be used with caution.

In 2012 MDH began estimating the population of MSM in Minnesota. This estimate generates a denominator for the most commonly reported risk factor in Minnesota and allows for the calculation of a rate of infection and rate of prevalence among those in the risk group. It should be noted that this is an estimate of a risk behavior and not an estimate of GLBT identification. Estimation is done each year using the most recently available census data for men over the age of 13 and using the model by on Laumann et al where 9% of the urban population, 4% of the suburban population and 1% of the rural population are estimated to be MSM. Using 2010 census data, this methodology estimates that there are 92,788 MSM in Minnesota.

(4) The term “GLBT” (gay, lesbian, bisexual, or transgender) refers to sexual identity. “MSM” (men who have sex with men), another term used throughout this document, refers only to sexual behavior and is not synonymous with sexual identity.

(5) Kinsey AC, Pomeroy WB, Martin CE. Sexual Behavior in the Human Male. Philadelphia: WB Saunders, 1948

(6) Kinsey AC, Pomeroy WB, Martin CE. Sexual Behavior in the Human Female. Philadelphia: WB Saunders, 1953

(7) Seidman SN, Rieder RO. A review of sexual behavior in the United States. American Journal of Psychiatry, 151(3):330-341, 1994

(8) Sell RL, Wells JA, Wypij D. The prevalence of homosexual behavior and attraction in the United States, the United Kingdom, and France: results of national population-based samples. Archives of Sexual Behavior, 24:235-248, 1995

(9) Hennepin County Human Services and Public Health Department. SHAPE 2010 Adult Data Book, Survey of the Health of All the Population and the Environment, Minneapolis, Minnesota, March 2011

Transgender Persons

Minnesota appears to attract a relatively large number of individuals who describe themselves as transgender due to the available treatment programs and access to hormonal and surgical sex reassignment.

Studies show that transgender individuals have elevated rates of HIV, particularly among transgender sex workers. These studies focus primarily on male to female transgender individuals. Possible reasons for the higher rates among transgender sex workers are more frequent anal receptive sex, increased efficiency of HIV transmission by the neovagina, use of injectable hormones and sharing of needles, and a higher level of stigmatization, hopelessness, and social isolation.

Female to male transgender persons who identify as gay or bisexual may be having sexual intercourse with biological men who are gay or bisexual. Because the prevalence of HIV is higher among MSM, female to male transgender persons who identify as gay or bisexual are at greater risk for HIV than those who identify as heterosexual.

Studies by the University of Minnesota’s Program in Human Sexuality identified specific risk factors such as sexual identity conflict, shame and isolation, secrecy, search for affirmation, compulsive sexual behavior, prostitution, and found that transgender identity complicates talking about sex.(10) (11)

(10) Bockting WO, Robinson BE, Rosser BR. Transgender HIV prevention: a qualitative needs assessment. AIDS Care, 10(4):505-525, 1998

(11) Bockting WO, Robinson BE, Forberg J, Scheltema K. Evaluation of a sexual health approach to reducing HIV/STD risk in the transgender community. AIDS Care, 17(3):289-303, 2005

Sensory Disability

Written and/or verbal communication can be hindered for persons with a sensory disability(ies). Depending on the medium, general HIV awareness and prevention messages cannot be assumed to reach such populations. According to 2011 - 2013 ACS data, 3.6% of non-institutionalized Minnesotans are estimated to be living with hearing difficulty and 3.9% of non-institutionalized Minnesotans are estimated to be living with vision difficulty.

Homelessness

Homelessness is also seen as a social determinant of health. According to the 2012 Wilder Homelessness Survey, an estimated 10,214 people were homeless in Minnesota (12).This number has increased by 10% since 2009 with the largest reported increase among persons age 55 years and older (48% increase). Despite this increase of homelessness among older people, persons age 21 and under still account for the largest proportion of homelessness (46%). For persons who are HIV positive, homelessness can mean reduced access to treatment and lower survival rates, Also, persons who are homeless (particularly youth) may be at higher risk for having unprotected sex and using injection drugs.


(12) http://www.wilder.org/Wilder-Research/Research-Areas/Homelessness/Pages/Statewide-Homeless-Study-Most-Recent-Results.aspx

Updated Wednesday, December 30, 2015 at 03:36PM