Epidemiological Profile of HIV/AIDS in Minnesota
Jessica Brehmer, MPH – Surveillance Epidemiologist
Allison La Pointe, MPH—HIV Surveillance Coordinator
AIDS – Acquired Immune Deficiency Syndrome
CCCHAP – Community Cooperative Council on HIV/AIDS Prevention
DIS – Disease Intervention Specialist
HIV – Human Immunodeficiency Virus
IDU – Injection Drug Use(r)
MDH – Minnesota Department of Health
MSM – Men Who Have Sex with Men
STD – Sexually Transmitted Disease
STI – Sexually Transmitted Infection
TGA – Transitional Grant Area
The epidemiological (epi) profile presents data on the HIV epidemic in the state of Minnesota. The profile is intended to give the Community Cooperative Council on HIV/AIDS Prevention (CCCHAP) and the Minnesota HIV Services Planning Council (Planning Council) a thorough understanding of the epidemic in our state. By showing who is becoming infected and who is living with the disease, the epi profile helps identify the people who are in need of prevention and careservices, both those who are infected and those at risk. The epi profile serves as a starting point for the CCCHAP and the Planning Council in their consideration of which prevention and care services are needed.
The profile presents data for the state as a whole, the 7-county metropolitan area (1), and the Minneapolis-St. Paul Transitional Grant Area (2) (TGA), consisting of eleven Minnesota counties and two Wisconsin counties.
MDH has collected AIDS data since 1982 and HIV data since 1985. Data for the epi profile are mainly obtained through the HIV/AIDS surveillance system at the MDH. These data are mostly obtained through passive surveillance from providers and consist of reports of confirmed Western-blot tests, viral loads and CD4 counts, in addition to case reports and interview data that include information on risk factors and behavior. Data on risk factors and demographics rely heavily on patient and provider reporting. The data in this report are from both interviewed and non-interviewed cases (cases are interviewed by DIS when possible). Cases living with HIV/AIDS include persons currently living in Minnesota who were diagnosed outside of the state. However, cases involved in these analyses do not include persons diagnosed in Minnesota, but who are known to no longer reside in the state. Cases also do not include persons incarcerated at federal correctional facilities in Minnesota.
Additional data on STIs, viral hepatitis and TB were obtained from the MDH STD Surveillance System, MDH Viral Hepatitis Surveillance System, and MDH TB Surveillance System.
More people than ever are living with HIV/AIDS in Minnesota due to both the introduction of new therapies that have slowed the progression of disease for many and, unfortunately, a consistent number of new infections diagnosed each year.
The epidemic in Minnesota is driven by sexual exposure, primarily among MSM, who represent the largest percentage of living (51 percent) and new cases (53 percent in 2011). Among females, heterosexual contact accounts for the vast majority of living (72 percent) and new cases (85 percent in 2011). Injection drug use directly or indirectly accounts for 11 percent of living cases and 3 percent of new cases in 2011.
The HIV epidemic in Minnesota affects racial and ethnic minorities disproportionately, especially African Americans, who are over represented in every risk group. However, the emerging epidemic among African-born persons seems to be leveling off. Minnesota continues to see an increasing number of living cases among foreign-born persons, which has significant implications for both prevention and care activities.
While the number of births to HIV-positive women continues to increase, the rate of perinatal transmission has remained quite low (1 percent in 2009-2011). This is one of the success stories in HIV prevention.
Adolescents and young adults (ages 13-24) represent a small percentage of living cases (4 percent) however they have represented an increasing proportion of new cases from 11 percent in 2002 to 19 percent in 2011. Cases among adolescent and young-adult males have more than doubled between 2002 and 2011, from 19 to 47 new cases.
HIV/AIDS continues to be geographically centered in the Twin Cities metropolitan area, although injection drug users and heterosexual people living with HIV/AIDS appear to be more likely than other groups to live in Greater Minnesota than the TGA.
Over the past five years the HIV epidemic in Minnesota has changed in several ways, both when looking at new infections and persons living with HIV/AIDS. In this time period, Minnesota has seen a slow but steady overall increase in the number of people being newly diagnosed with HIV infections with a promising decrease in new diagnoses in 2010 and 2011 as well as an increase in the number of those living with HIV/AIDS in the state. The population living with HIV has become more racially, ethnically, culturally and linguistically diverse, which will pose additional challenges to both prevention and service providers. The success of antiretroviral medications has not only extended the life of those recently diagnosed, but also of those diagnosed long ago, which is reflected in the “aging” of those living with HIV/AIDS. Finally, females account for a growing percentage of both those living with HIV and new HIV infections.