HIV Infection and AIDS, 2013

The incidence of HIV/AIDS in Minnesota remains moderately low. In 2011, state-specific HIV infection diagnosis rates ranged from 2.3 per 100,000 population in Vermont to 36.6 per 100,000 in Louisiana. Minnesota had the 17th lowest HIV infection rate (7.2 cases per 100,000 population). State-specific AIDS diagnosis rates ranged from 0.5 per 100,000 persons in Vermont to 22.8 per 100,000 population in Georgia. Minnesota had the 15th lowest AIDS rate (4.0 AIDS cases reported per 100,000 population).

As of December 31, 2013, a cumulative total of 10,409 cases of HIV infection (6,316 AIDS cases and 4,093 HIV [non-AIDS] cases) had been reported among Minnesota residents. Of the 10,409 HIV/ AIDS cases, 3,558 (3%) 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 2013, 154 new AIDS cases (Figure 4) and 71 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 2004 through 2013, at approximately 230 cases per year. With a peak of 281 newly diagnosed HIV (non-AIDS) cases in 2009, 224 new HIV (non-AIDS) cases were reported in 2013 (decrease of 5% from 235 in 2012). By the end of 2013, an estimated 7,723 persons with HIV/AIDS were assumed to be living in Minnesota.

Historically, and in 2013, over 80% (247/301) of new HIV diagnoses (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 number of new HIV infections among males, but the proportion of cases that white males account for is decreasing. In 2013 there were 126 new infections among white males. The annual number of cases among African American males peaked in 1992 at 78 and gradually decreased to 33 new infections in 2003. During the past several years the number of cases in this group has trended upwards, with a peak of 64 cases diagnosed in 2009, and 56 new HIV diagnoses in 2013. The number of HIV infections diagnosed among Hispanic males decreased in 2013 to 24 from 35 in 2012. The number of new infections among African-born males decreased in 2013 to 9 from 19 in 2012.

Females account for an increasing proportion of new HIV infections, from 11% of new infections in 1990 to 24% in 2013. 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. Since 2004, the annual number of new infections diagnosed among African American females has decreased slightly overall, although without a clear pattern from year to year. In 2013, 15 cases were reported among African American women, compared to 17 in 2012. In 2013, the number of new cases among African-born women was 33, accounting for 45% of all new diagnoses among women; this accounted for a 50% increase among African-born women from 2012. 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 2013, non-white men comprised approximately 17% of the male population in Minnesota and 42% of new HIV diagnoses among men. Similarly, persons of color comprised approximately 13% of the female population and 73% of new HIV infections among women. Race is viewed 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 (13-24 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, Minnesota has seen a steady increase in new cases among males in this age group, with 41 cases reported in 2013. Since 2004, the number of cases among young males has increased by about 78%. The number of new HIV infections among females in this age group has remained relatively consistent over time. In 2013 there were 11 cases diagnosed among young women. From 2011 to 2013, the majority (57%) of new infections among male adolescents and young adults were among youth of color (81/141), with young African American males accounting for 69% of the cases among young males of color. During the same time period, young women of color accounted for 60% (14/23) of the cases diagnosed, with young African American women accounting for 42% of cases among young women of color. Between 2011 and 2013 after redistributing those with unspecified risk, 94% (133/141) of new cases among young males were attributed to male-to-male sex. Among young females, 94% (22/23) of 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 diagnoses were attributed to MSM (or MSM who also inject drugs); in 2013, this group accounted for 50% of new diagnoses (151/301).

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 2% (5/301) in 2013. 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. Ninety-three percent of 212 new HIV diagnoses among women between 2011 and 2013 is attributed to heterosexual exposure after redistributing cases with unspecified risk.

Historically, race/ethnicity data for HIV/ AIDS in Minnesota have grouped non-African 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 African-born persons was observed. In 2013, there were 42 new HIV infections reported among Africans. While African-born persons comprise less than 1% of the state’s population, they accounted for 14% of all HIV infections diagnosed in Minnesota in 2013.

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 2012, 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 2011 to 2013 was 0.5% with no HIV-positive births from an HIV-infected mother in Minnesota in 2013.

• For up to date information see>> HIV (HIV/AIDS)
  
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2013