Companion Text for the Slide Set:
Minnesota HIV/AIDS Prevalence & Mortality Report, 2004
Minnesota HIV/AIDS Prevalence & Mortality Report, 2004
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Introduction
Data Source
Data Limitations
Persons Living with HIV/AIDS in the United States
Persons Living with HIV/AIDS in Minnesota
Overview of HIV/AIDS in Minnesota, 1990-2004
Living HIV/AIDS Cases, 2004
Gender and Race/Ethnicity
Age
Mode of Exposure
Emerging Trend
HIV/AIDS Mortality in Minnesota
The Minnesota HIV/AIDS Prevalence & Mortality Report, 2004 contains estimates of HIV/AIDS prevalence (the number of persons living with HIV or AIDS) and mortality in Minnesota. These estimates can be used to help educate, plan for HIV/AIDS services and develop policy.
Data Source
The data in this report are based on confidential case reports collected
through the Minnesota Department of Health (MDH) HIV/AIDS Surveillance
System. In Minnesota, laboratory-confirmed infections of human immunodeficiency
virus (HIV) are monitored by the MDH through this active and passive surveillance
system. State law (Minnesota Rule 4605.7040) requires both physicians
and laboratories to report all cases of HIV infection (HIV or AIDS) directly
to the MDH (passive surveillance). Additionally, regular contact is maintained
with several clinical sites to ensure completeness of reporting (active
surveillance).
Data Limitations
The prevalence estimate is calculated by totaling the number of HIV and
AIDS cases diagnosed through December 31, 2004 who are not known to be
deceased and whose most recently reported state of residence was Minnesota.
It bears noting that persons who are HIV-infected but not yet tested are
not included in this prevalence estimate. Migration (known HIV-infected
persons moving in or out of the state) also affects the estimate. Refer
to the HIV/AIDS Prevalence & Mortality Technical Notes for a more
detailed description of data inclusions and exclusions.
Factors that impact the completeness and accuracy of the available surveillance
data on HIV/AIDS include the level of screening and compliance with case
reporting. Thus, any changes in numbers of infections may be due to one
of these factors, or due to actual changes in HIV/AIDS occurrence.
PERSONS LIVING WITH HIV/AIDS IN THE UNITED
STATES
The Centers for Disease Control & Prevention (CDC) estimates that
there are 800,000 to 900,000 people currently living with HIV/AIDS in
the United States. The number of people specifically living with AIDS
in the United States has been increasing in recent years: from approximately
290,400 in 1998 to approximately 406,000 in 2003. (1)
PERSONS LIVING WITH HIV/AIDS IN MINNESOTA
Overview of HIV/AIDS in Minnesota, 1990-2004
The number of persons assumed to be living with HIV/AIDS in Minnesota
has been steadily increasing over time. As of December 31, 2004, 5,002
persons known to be living with HIV/AIDS resided in Minnesota, a 2.2%
increase from 2003. While the number of HIV (non-AIDS) diagnoses has remained
steady since the mid-1990s at just under 200 cases per year, both the
number of newly diagnosed AIDS cases and the number of deaths among AIDS
cases have been declining since 1996. The decreases are primarily due
to the success of new treatments introduced in 1995 (protease inhibitors)
and 1996 (highly active antiretroviral therapy or HAART). These treatments
do not cure, but can delay progression to AIDS among persons with HIV
(non-AIDS) infection and improve survival among those with AIDS. Thus,
the declines slowed during the late 1990s and since 2001 the numbers of
AIDS cases have been slowly increasing.
Living HIV/AIDS Cases, 2004
Among the estimated 5,002 prevalent cases in Minnesota, 2,835 are diagnosed
with HIV (non-AIDS) and 2,167 are diagnosed with AIDS. The majority (87%)
of prevalent cases reside in the seven-county metropolitan area surrounding
the Twin Cities of Minneapolis and St. Paul (Hennepin, Ramsey, Anoka,
Dakota, Scott, and Washington counties). Although HIV infection is more
common in communities with higher population densities and greater poverty,
there are people living with HIV or AIDS in over 85% of counties in Minnesota.
Gender & Race/Ethnicity
Seventy-eight percent (78%) of prevalent HIV/AIDS cases are males. Broken
down by race/ethnicity, 64% of male cases are White, 19% African American,
7% Hispanic, 6% African-born, 1% American Indian, and 1% Asian/Pacific
Islander. In total, 36% of males living with HIV/AIDS are non-White whereas
only 12% of the general male population is Non-White. Among female cases,
the distribution is even more skewed toward women of color: 30% White,
33% African American, 25% African-born, 6% Hispanic, 4% American Indian,
and 2% Asian/Pacific Islander. Thus, 70% of prevalent female HIV/AIDS
cases are non-White whereas only 11% of the general female population
in Minnesota is non-White.
Please note that race is not considered a biological reason for disparities
related to HIV/AIDS experienced by persons of color. Race, however, can
be considered a marker for other personal and social characteristics that
put a person at greater risk for HIV exposure. These characteristics may
include, but are not limited to, lower socioeconomic status, less education,
and less access to health care.
Age
Seventy-eight percent (78%) of persons living with HIV/AIDS in 2004 are
currently 35 years of age or older. Broken down into five-year age groups,
40-44 year olds make up the largest group (24% of cases), followed by
35-39 year olds (18%) and 45-49 year olds (17%).
Mode of Exposure
In 2004, MDH used a risk re-distribution method to estimate the mode of
exposure among cases with unknown risk. For additional details on how
this was done please read the HIV Prevalence and Mortality Technical Notes.
All mode of exposure numbers referred to in the text are based on the
risk re-distribution.
The proportions of living cases attributable to particular modes of exposure
differ among gender and race groups. While male-to-male sex (MSM or MSM/IDU)
accounts for an estimated 93% of White male cases, it accounts for an
estimated 61% of non-White male cases. The estimated percent of male cases
that identified IDU or MSM/IDU as a risk factor was particularly high
for American Indians (34%), African Americans (30%) and Hispanics (17%).
These percentages among White, Asian, and African-born males were estimated
at 11%, 8%, and 0%, respectively. Similar to the MSM category, IDU may
be underreported due to social stigma.
Across all race/ethnicity groups, females most frequently report heterosexual
contact as their mode of HIV exposure. However, IDU also accounts for
a large percentage of female cases among most race/ethnicity groups. The
largest estimated percentage of IDU cases are among American Indians (62%)
followed by Whites, African Americans, and Hispanics with 25%, 24%, and
21%, respectively. There were no cases either among African-born females
or among Asian females. The number of prevalent HIV/AIDS cases among Asian
females was too small (n = 22) to make generalizations about risk.
While risk re-distribution was used to make better sense of mode of exposure
information there are differences by race and gender on how many cases
have unspecified risk. Among males 15% of prevalent cases have no risk
information, compared to 41% of females. Additionally, among males only
5% of White prevalent cases have unspecified risk, compared to 91% of
African-born, 36% of Asian, and over 15% for both African American and
Hispanic cases. Among women, the disparity between White females (24%
unspecified) and women of color is not as striking, except for African-born
(81% unspecified) and Asian (58%) females. See the HIV/AIDS Prevalence
& Mortality Technical Notes for a detailed discussion of mode of exposure
categories.
Emerging Trend
Between 1990 and 2004, the number of foreign-born persons living with
HIV/AIDS in Minnesota increased substantially, especially among the African-born
population. In 1990, 50 foreign-born persons were reported to be living
with HIV/AIDS in Minnesota, and by 2003 this number had increased twelve-fold
to 692 persons. In 2004, the total number of foreign-born persons living
with HIV/AIDS in Minnesota was 791, a 14% increase from 2003. This trend
illustrates the growing diversity of the infected population in Minnesota
and the need for culturally appropriate HIV care services and prevention
efforts.
The characteristics of foreign-born persons living with HIV/AIDS in Minnesota
differ from U.S.-born, especially in gender. While females account for
18% of cases among U.S.-born persons, they account for 42% of foreign-born
cases. This is especially noticeable among African-born cases, where women
account for 53% of those living with HIV/AIDS in Minnesota. Among Asian-born
cases, women account for 42% of cases. The gender distribution among cases
born in Latin America, the Caribbean and Europe is similar to that of
U.S.-born cases, where about 18% of prevalent cases are among women.
HIV/AIDS MORTALITY IN MINNESOTA
The number of deaths (2) among Minnesota AIDS cases decreased between 1995 and 1997 and remained relatively constant between 1997 and 2004. The largest declines in mortality were observed among White males in the mid 1990s. In recent years, the number of deaths among AIDS cases has been comparable between White and non-White males and between White and non-White females. In 2004, a total of 58 deaths were reported among AIDS cases. Of these deaths, six (6) were among women and 54 among men.
(Last Revised: 4/14/2005)
(1) Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2002:14. (return to text)
(2) Includes all deaths, regardless of cause. (return to text)
