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 December 2018, and the Duluth area declared an outbreak in 2021 with cases dating back to September 2019.

Recent epidemiology and HIV molecular analyses support two distinct outbreaks occurring concurrently within the Hennepin County and Ramsey County areas.

1. HIV transmission among persons who inject drugs (PWID) who live or have spent time in a known encampment corridor in Minneapolis or St. Paul.
2. HIV transmission among PWID, including men who have sex with men and inject drugs (MSM/IDU), and are not known to have spent time in a known encampment corridor in Minneapolis or St. Paul.

MDH’s case definitions for these two outbreaks are located below under “Hennepin and Ramsey County HIV Outbreak Data.”

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 2021, 298 people were diagnosed with HIV. There are more than 9,600 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 Sept. 30, 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).

Analysis of molecular and epidemiological data has resulted in MDH identifying two distinct outbreaks occurring concurrently within Hennepin and Ramsey counties.

HIV molecular data analysis involves using genetic sequences of HIV viruses to identify clusters and communities where HIV is spreading more quickly.

Based on newly available molecular HIV lab data recently reported to MDH from a several year backlog, many additional cases have been identified as linked to existing HIV outbreaks. Several molecular clusters were identified that show groups of people with closely related strains of HIV within a short time period indicating that transmission is happening quickly within the clusters.

Please note: HIV molecular data does not indicate direct transmission between cases.

Encampment-related Case Definition:
HIV diagnosis on or after December 1, 2018, in a person who:

1. Injects drugs and has spent time in a known encampment corridor prior to or at HIV diagnosis, and whose residence at diagnosis was (or were unstably housed or incarcerated) in Hennepin or Ramsey County
   
   Or
    
2. regardless of transmission risk, named drug injection (needle/works) or sex partner or part of the social network*(self or provider report)
   
   Or
    
3. is molecularly linked (at <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 in an encampment

Men who have Sex with Men (MSM)/IDU & IDU-related Case Definition (Non-encampment):
HIV diagnosis on or after December 1, 2018, in a person who:

1. Injects drugs (IDU) or who injects drugs and was assigned male at birth and has sex with people who are assigned male at birth (MSM/IDU) whose residence at diagnosis was (or were unstably housed or incarcerated) in Hennepin or Ramsey County and who is NOT known to have spent time in a known encampment corridor in Minneapolis or St. Paul prior to HIV diagnosis
   
   Or
    
2. regardless of transmission risk, is a named 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 <0.5%) to a person who meets criterion 1.

As of Nov. 22, 2022
Data are preliminary and may change as reports are received.

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 Nov. 22, 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.