HIV Outbreak Response and Case Counts

Minnesota has seen an increase of HIV in Hennepin and Ramsey Counties as well as the Duluth area. An outbreak was declared in Hennepin and Ramsey counties in 2020 with cases dating back to 2018, and the Duluth area declared an outbreak in 2021 with cases dating back to 2019. Minnesota's outbreak-associated cases have risk factors consistent with the national outbreaks. Outbreak cases do not account for all cases of HIV in Minnesota. In 2019, 276 people were diagnosed with HIV and in 2020, 226 people were diagnosed with HIV. There are more than 9,400 people living with HIV in Minnesota.

People at high risk in the current outbreaks include:

• People who use injection drugs or share needles/works.
• People experiencing homelessness or unstable housing.
• Men who have sex with men (MSM)
• People who exchange sex for income and other items they need.

Outbreak terms and definitions:

• Outbreak: an increase in newly diagnosed cases, often sudden, above what is normally expected in a population or area.
• Transmission Cluster: a way the health department groups people living with HIV (diagnosed or undiagnosed) based on how HIV is spreading.
  • Can represent recent and ongoing HIV spread.
  • Identified with methods such as time-space and/or molecular analysis.
• Risk Network: group of people with shared behaviors that are linked to previous HIV spread and where HIV could now be occurring.
  • Includes people who do not have HIV but are at risk for HIV.
  • Includes people living with HIV from the transmission cluster.

In recent years, CDC has required HIV molecular data in surveillance practices. State health departments are now required to collect HIV genetic sequences, analyze them to identify transmission clusters, and respond to prevent new infections. Molecular data involves using genetic sequences of HIV viruses (not genetic sequences of people) to identify communities where HIV is spreading more quickly. For more information about HIV molecular data and CDC requirements, visit HIV/AIDS Statistics and scroll to the Molecular Data Presentation.

The table below has four columns representing the current year and three comparison years. The 2022 column shows new HIV diagnoses reported to MDH by the year to date (YTD) shown. The 2019, 2020, and 2021 columns show total diagnosed cases of HIV for each calendar year. 2021 data is available at HIV/AIDS Statistics.

As of May 31, 2022:

*2021 data is available at HIV/AIDS Statistics.

HIV Diagnosis = New cases of HIV diagnosis (both HIV (non-AIDS) and AIDS at first diagnosis) diagnosed within a given calendar year (year to date).

HIV (non-AIDS) = New cases of HIV diagnosis (excluding AIDS at first diagnosis).

Hennepin and Ramsey Counties are investigating an outbreak of HIV that began in December 2018. The outbreak is occurring among people who:

1. Inject drugs whose residence at diagnosis was (or was unstably housed or incarcerated) in Hennepin or Ramsey County.

Or


2. Regardless of transmission risk, has spent time* in a known encampment corridor in Minneapolis or St. Paul since Dec 2018.

Or


3. Regardless of transmission risk, is named as a drug injection needle/works or sex partner (self or provider report) OR is in the social network (self or provider report) of OR is molecularly linked (at less than 0.5%) to a person who meets criteria 1 or 2.
   
   *socialized, stayed, was known to buy, sell or use drugs, or has engaged in sex

As of July 26, 2022
Data are preliminary and may change as reports are received.

07/26: Thirty people were added to the total outbreak case count because of newly available data. Of these 30 cases, 24 are included because of HIV molecular lab data, and 6 have recently been identified through interviews about social links to the outbreak. The 24 molecularly linked cases are being added to the outbreak due to receiving a backlog of several years of data at one time. While all 24 were diagnosed after the start of the outbreak in 2019, only two of these people were diagnosed in 2022. HIV molecular data does not indicate direct transmission between cases.

The outbreak near Duluth was declared among newly diagnosed cases of HIV in people after September 1, 2019 residing in the Duluth area* at the time of diagnosis** or reported cases of HIV that are linked to cases that are part of the outbreak as a sex partner, drug user sharing partner, person in their social network or molecular linkage.

Review the Health Advisory: HIV Outbreak and Syphilis Concern in Duluth Area for more information.

*Duluth area is the 30-mile radius around the city of Duluth.

**Including people who are unhoused, known to be in the area or people who are incarcerated or in chemical dependency treatment centers where their regular address is in the outbreak area.

As of July 26, 2022
Data are preliminary and may change as reports are received.

Action steps for providers include:

• People who are at high risk of HIV should be tested when requested, or at least annually. Visit HIV Prevention and Care for more information.
• Prescribe Pre-exposure Prophylaxis (PrEP), the daily pill to prevent HIV.
• Refer people who inject drugs to MDH's Syringe Services Programs.
• Ensure all new HIV testers have been trained. One training option is MDH's HIV Testing Trainings.
• Report all cases of HIV using the information found on Reporting HIV including AIDS.
• Get help with partner notification and connecting patients to care by using the STD/HIV Partner Services Program.
• Spread information about getting viral loads to undetectable levels and Undetectable=Untransmittable.

For more information about HIV prevention and education:

• Review resources about testing, transmission, PrEP, and more at HIV Prevention and Care.
• Find a PrEP provider near you, even for those without insurance. NPIN: PrEP Locator.
• Educate yourself about the science behind Undetectable=Untransmittable at Prevention Access: U=U.
• Review the Minnesota HIV Cluster and Outreach Detection and Response (CODR) Plan that lays out a Minnesota-specific plan to detect HIV clusters and outbreaks as well as carry out response activities. This plan is required by the Centers for Disease Control and Prevention (CDC) and will be regularly reviewed and updated.