HIV Infection and AIDS, 2011

The incidence of HIV/AIDS in Minnesota remains moderately low. In 2010, state-specific AIDS rates ranged from 0.5 per 100,000 population in Vermont to 22.1 per 100,000 in Maryland. Minnesota had the 14th lowest AIDS rate (4.0 cases per 100,000). Similar comparisons for HIV (non-AIDS) incidence rates are not possible because some states only began named HIV (non-AIDS) reporting recently.

As of December 31, 2011, a cumulative total of 9,785 cases of HIV infection (5,997 AIDS cases and 3,788 HIV [non- AIDS] cases) had been reported among Minnesota residents. Of the 9,785 HIV/ AIDS cases, 3,347 (34%) are known to have died.

The annual number of AIDS cases reported in Minnesota increased steadily from the beginning of the epidemic through the early 1990s, reaching a peak of 361 cases in 1992. Beginning in 1996, the annual number of new AIDS diagnoses and deaths among AIDS cases declined sharply, primarily due to better antiretroviral therapies. In 2011, 182 new AIDS cases (Figure 3) and 61 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 2002 through 2011, at approximately 230 cases per year. With a peak of 280 newly diagnosed HIV (non-AIDS) cases in 2009, the past 2 years have seen promising decreases with 248 in 2010 (a 13% decrease) and 219 in 2011 (a 12% decrease). By the end of 2011, an estimated 7,136 persons with HIV/ AIDS were assumed to be living in Minnesota.

Historically, and in 2011, over 80% (251/292) of new HIV infections (both HIV [non-AIDS] and AIDS at first diagnosis) reported in Minnesota occurred in the metropolitan area. However, HIV or AIDS cases have been diagnosed in residents of more than 90% of 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 proportion of new HIV infections among males, but new infections among white males decreased between 1991 and 2000, from 297 to 101. However, since then the trend has reversed, and in 2011 there were 129 new infections among white males (28% increase). The decline among U.S.-born black males has been more gradual, falling from a peak of 79 new infections in 1992 to a low of 33 new infections in 2003. Since 2004 the number of cases among African American males has been stable at around 40 cases per year. While during the past several years the number of cases in this group has trended upwards, with 58 cases diagnosed in 2010 and a peak of 64 in 2009, the number is back down in 2011 with 43 new HIV diagnoses. The number of HIV infections diagnosed among Hispanic males decreased in 2011 to 19 from 29 in 2010. The number of new infections among African-born males increased in 2011 to 17 from 13 in 2010. This represents a decrease of 34% among Hispanic males and an increase of 31% among African-born males from 2010 to 2011.

Females account for an increasing percentage of new HIV infections, from 11% of new infections in 1990 to 25% in 2011. 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 in women. Since 1991, the number of new infections among women of color has exceeded that of white women. The annual number of new HIV infections diagnosed among U.S.-born black females had remained stable at 22 or fewer cases during 2001 to 2004, but increased to 28 new cases in both 2005 and 2006. In 2011 there were 21 new infections diagnosed among U.S.-born black females. In contrast, the number of new infections among African-born females increased greatly from 4 cases in 1996 to 39 in 2002. However, since 2002 the number of new HIV infections in African-born females has decreased, with 17 new cases diagnosed in 2006. In 2011 the number of new cases among African-born women was 27, making up 36% of all new diagnoses among women. 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 2011, non-white men comprised approximately 17% of the male population in Minnesota and 41% of new HIV infections among men. Similarly, persons 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 infections among females since 1999. Since 2001, Minnesota has seen a steady increase in new cases among males in this age group, with 47 cases reported in 2011. Since 2001, the number of cases among young males has increased by over 250%. The number of new HIV infections among females in this age group increased slightly between 2007 and 2009, (from 13 cases to 18 cases), but decreased to 11 cases in 2010 and that trend continued 2011 with 8 cases. From 2009 to 2011, the majority (55%) of new infections among male adolescents and young adults were among youth of color (108/195), with young African American males accounting for 65% of the cases among young males of color. During the same time period, young women of color accounted for 63% (22/35) of the cases diagnosed, with young African American women accounting for 32% of cases among young women of color. Between 2009 and 2011 after redistributing those with unspecified risk, 96% (188/195) of new cases among young males were attributed to male-to-male sex. Among young females, all 35 new cases were attributed to heterosexual sex.

Since the beginning of the HIV 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 infections were attributed to MSM (or MSM who also inject drugs); in 2011, this group accounted for 53% of new infections (156/292).

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 1% (2/292) in 2011. 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. Ninetyfive percent of 205 new HIV diagnoses among women between 2009 and 2011 can be attributed to heterosexual exposure after re-distributing cases with unspecified risk. Historically, race/ethnicity data for HIV/ AIDS in Minnesota have grouped U.S.- born blacks and 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 Africanborn persons was observed. In 2011, there were 44 new HIV infections reported among Africans. While Africanborn persons comprise less than 1% of the state’s population, they accounted for 15% of all HIV infections diagnosed in Minnesota in 2011.

HIV perinatal transmission in the United States decreased 81% between 1995 and 1999. 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 2011, the rate of perinatal transmission decreased 6-fold, from 18% in 1990 to 1995 to 3% in 1996–2006. The overall rate of transmission for 2009 to 2011 was 1.0% with no HIV-positive births from HIV infected mothers in Minnesota in 2011.

• For up to date information see>> HIV (HIV/AIDS)
  
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2011