Minnesota Supplement to HIV Surveillance (SHAS) Project Summary
The Supplement to HIV/AIDS Surveillance (SHAS) was a CDC-funded project designed to provide an in-depth description of people diagnosed with HIV/AIDS in Minnesota, including information about the care and treatment they were receiving. The purpose of this information was to provide planning groups, providers, and health agencies with data that could be used to develop strategies and interventions to prevent HIV infection and improve care. CDC provided a questionnaire for the project that consisted of six modules or groups of questions: Demographic/Socioeconomic, Drug Use (illicit), Sexual Behavior/STD History, Reproductive History, HIV Testing and Medical Therapy, and Health and Social Services. Participation was voluntary and respondents received a nominal stipend and gift certificate for their involvement.
SHAS Study Population
In Minnesota all HIV-infected persons reported to the Minnesota Department of Health (MDH) who were diagnosed with HIV or AIDS in the previous three years and living in the 11 Minnesota counties of the Minneapolis/St. Paul Eligible Metropolitan Area (EMA) were eligible to participate in SHAS. In 1999-2003 an average of 335 new cases of HIV infection or AIDS have been reported annually in Minnesota (includes new AIDS cases in persons previously diagnosed with HIV infection in previous years), with 90% of the cases residing in the EMA. During the project period of August 2000-December 2003, 215 interviews were completed. SHAS participants were interviewed by persons specifically trained to give the SHAS interview and who had many years of experience interviewing HIV and STD cases.
In Minnesota all newly reported cases of HIV infection are assigned to the MDH Disease Intervention Unit (DIU) for voluntary counseling and referral, interviewing, and to offer partner notification services. On August 1, 2000, Disease Intervention Specialists in that unit began inviting persons they contacted to participate in the SHAS Project. Participants were also recruited through advertisements at clinics and AIDS organizations.
Although a great deal of information was gained through this project, the data do have some limitations. The persons with HIV infection interviewed for this project were not randomly chosen. As a result SHAS participants may not be representative of the entire metropolitan population diagnosed with HIV. Ideally, the distribution of SHAS participants by AIDS status, age, gender, race, and transmission risk would be similar to all metropolitan HIV/AIDS cases reported to MDH during the project period. However, SHAS cases were more likely to be Black and to identify IDU as a transmission risk factor. Also, White males without an AIDS diagnosis were slightly under represented among SHAS participants. The percentage of White female cases without an AIDS diagnosis and White AIDS cases for both genders were similar to all metropolitan cases. The percentage of cases with unspecified or “other” risk was lower in SHAS. The data sets had similar percentages of MSM.
Additionally, these are self-reported data and are therefore subject
to recall and social desirability biases.
Although the total sample included 215 persons, a larger sample would have allowed more sub-group analyses. And finally, the sample did not include Greater Minnesota HIV/AIDS cases, so the data are not representative of that population.
Uses of SHAS Data/Results
Perhaps the most interesting data to come from SHAS was the strong association of non-intravenous drug use and HIV infection. 64% of persons interviewed had used non-intravenous drugs (excluding marijuana and nitrites). Risky sex (defined as sex without a condom or unsure and the partners HIV status was negative or unknown to the person interviewed) ranged from 5% to 24% depending on gender and type of sexual act. Considering we only asked about the last time interviewees had sex with either a steady or non-steady partner in the last year (we combined data for these two groups for analyses) and we relied on interviewees for information, these percentages are alarming. Some risky sex was reported even after HIV diagnosis. Virtually all (99%) had received some HIV care in the last year. However, even though the majority (79%) were screened for TB just prior to or after HIV diagnosis, the percentage should have been higher. More disconcerting was the fact that of those who never had Hepatitis B, 70-77% (13 persons were unsure) reported they had never been vaccinated. We will be investigating these findings further.
SHAS data have been presented to the Minnesota Department of Health STD, HIV and TB Section, the Minnesota HIV/AIDS prevention and services community
planning groups, and the African American AIDS Task Force.
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