HIV Infection and AIDS, 2015
HIV Infection and AIDS The incidence of HIV/AIDS in Minnesota remains moderately low. In 2014, state-specific HIV infection diagnosis rates ranged from 1.9 per 100,000 population in Montana to 36.6 per 100,000 in Louisiana. Minnesota had the 16th lowest HIV infection rate at 7.0 cases per 100,000 population. In 2014, state-specific AIDS diagnosis rates ranged from 0.7 per 100,000 persons in Montana and Wyoming to 13.7 per 100,000 population in Louisiana. Minnesota had the12th lowest AIDS rate at 3.0 AIDS cases reported per 100,000 population.
As of December 31, 2015, a cumulative total of 11,007 cases of HIV infection (6,499 AIDS cases and 4,508 HIV [non- AIDS] cases) had been reported among Minnesota residents. Of the 11,007 cases, 3,737 (34%) are known to have died. By the end of 2015, an estimated 8,215 persons with HIV/AIDS were assumed to be living in Minnesota.
The annual number of AIDS cases reported in Minnesota increased steadily from 1982 through the early 1990s, reaching a peak of 361 cases in 1992. Beginning in 1996, the annual number of new AIDS diagnoses and deaths declined sharply, primarily due to better antiretroviral therapies. In 2015, 141 new AIDS cases (Figure 4), and 89 deaths among persons living with HIV infection, were reported.
The number of HIV (non-AIDS) diagnoses has remained fairly constant over the past decade from 2005 through 2015, at approximately 247 cases per year. With a peak of 282 newly diagnosed HIV (non-AIDS) cases in 2009, 228 new HIV (non-AIDS) cases were reported in 2015 (a decrease of 4% from 2014).
Historically, and in 2015, over 80% (255/294) of new HIV diagnoses (both HIV [non-AIDS] and AIDS at first diagnosis) occurred in the metropolitan area. However, HIV or AIDS cases have been diagnosed in residents of 86 counties statewide. HIV infection is most common in areas with higher population densities and greater poverty.
The majority of new HIV infections in Minnesota occur among males. Trends in the annual number of new HIV infections diagnosed among males differ by race/ethnicity. New infections occurred primarily among white males in the 1980s and early 1990s. Whites still comprise the largest number of new HIV infections among males, but the proportion of cases that white males account for is decreasing. In 2015, there were 109 new infections among white males. During the past decade, the number of cases among black males has fluctuated from year to year, with 57 new HIV diagnoses in 2015. This represents a 27% increase among black males from 2014 to 2015. The number of HIV infections diagnosed among Hispanic males decreased from 28 in 2014 to 21 in 2015. The number of new infections among black Africanborn males has fluctuated greatly from year to year and in 2015 the number of cases increased to 23 compared to 20 in 2014, representing a 15% increase.
Females account for an increasing percentage of new HIV infections, from 11% of new infections in 1990 to 23% in 2015. Trends in HIV infections diagnosed annually among females also differ by race/ethnicity. Early in the epidemic, whites accounted for the majority of newly diagnosed infections. Since 1991, the number of new infections among women of color has exceeded that of white women. Since 2005, the annual number of new infections diagnosed among black females has decreased slightly overall, although without a clear pattern from year to year. In 2015, there were 15 cases diagnosed among black women, compared to 16 in 2014. In 2015, the number of new cases among black African-born women was 36, accounting for 52% of all new diagnoses among women; this accounted for an increase of 13% among black African-born women compared to 2014.The annual number of new infections diagnosed among Hispanic, American Indian, and Asian females is small, with 10 or fewer cases annually in each group.
Despite relatively small numbers of cases, persons of color are disproportionately affected by HIV/ AIDS in Minnesota. In 2015, men of color comprised approximately 17% of the male population in Minnesota and 49% of new HIV diagnoses among men. Similarly, women of color comprised approximately 13% of the female population and 81% of new HIV infections among women. It bears noting that race is not considered a biological cause of disparities in the occurrence of HIV, but instead race can be used as a proxy for other risk factors, including lower socioeconomic status and education.
A population of concern for HIV infection is adolescents and young adults (13 to 24 years of age). The number of new HIV infections among males in this age group has remained higher than new diagnoses among females since 1999. Since 2001, a steady increase in new cases among males in this age group has occurred, with 53 cases reported in 2015. Since 2005, the number of cases among young males has increased by about 77%. The number of new HIV infections among females in this age group has remained relatively consistent over time. In 2015 there were 12 cases diagnosed among young women. From 2013 to 2015, the majority (58%) of new infections among male adolescents and young adults were among youth of color (84/144), with young black males accounting for 61% of cases among young males of color. During the same time period, young women of color accounted for 72% (16/22) of the cases diagnosed, with young black African-born women accounting for 75% of cases among young women of color. Between 2013 and 2015 after redistributing those with unspecified risk, 97% (140/144) of new cases among young males were attributed to male-to-male sex. Among young females, 91% (29/32) of new cases were attributed to heterosexual sex.
Since the beginning of the epidemic, male-to-male sex has been the predominant mode of exposure to HIV reported in Minnesota, although the number and proportion of new HIV infections attributed to men who have sex with men (MSM) has declined since 1991. In 1991, 70% (318/455) of new HIV diagnoses were attributed to MSM (or MSM who also inject drugs); in 2015, this group accounted for 53% of new diagnoses (156/294).
The number and percentage of HIV infections in Minnesota that are attributed to injection drug use has declined over the past decade for men and women, falling from 12% (54/455) of cases in 1991 to 9% (26/294) in 2015. Though, in 2015 there was an 86% increase of HIV infections attributed to injection drug use as compared to 2014 (14/307). Heterosexual contact with a partner who has or is at increased risk of HIV infection is the predominant mode of exposure to HIV for women. Seventyfive percent of 68 new HIV diagnoses among women in 2015 is attributed to heterosexual exposure.
Historically, race/ethnicity data for HIV/ AIDS in Minnesota have grouped non-African born blacks and black African-born persons together as “black.” In 2001, we began analyzing these groups separately, and a marked trend of increasing numbers of new HIV infections among black African-born persons was observed. In 2015, there were 59 new HIV infections reported among black Africans. While black African-born persons comprise less than 1% of the state’s population, they accounted for 20% of all HIV infections diagnosed in Minnesota in 2015.
HIV perinatal transmission in the United States decreased 90% since the early 1990s with increased testing and antiretroviral therapy. The trend in Minnesota has been similar, but on a much smaller scale. While the number of births to HIV-infected women increased nearly 7-fold between 1990 and 2012, the rate of perinatal transmission decreased 6-fold, from 18% in 1990 to 3% in 1995. The overall rate of perinatal transmission for 2013‑15 was 1.6% with 2 HIV-positive births from HIV-infected mothers in Minnesota in 2015.
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