HIV Infection and AIDS, 2014

The incidence of HIV/AIDS in Minnesota remains moderately low. In 2013, state-specific HIV infection diagnosis rates ranged from 2.5 per 100,000 population in Vermont to 43.7 per 100,000 in Maryland. Minnesota had the 17th lowest reported HIV infection rate (7.0 cases per 100,000 population). In 2013, state-specific AIDS diagnosis rates ranged from 0.7 per 100,000 persons in Vermont to 21.7 per 100,000 population in Maryland. Minnesota had the 14th lowest AIDS rate (3.2 AIDS cases reported per 100,000 population).

As of December 31, 2014, a cumulative total of 10,718 cases of HIV infection (6,497 AIDS and 4,221 HIV [non-AIDS] cases) had been reported among Minnesota residents. Of the 10,718 HIV/AIDS cases, 3,638 (34%) are known to have died. By the end of 2014, an estimated 7,988 persons with HIV/AIDS were assumed to be living in Minnesota.

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 declined sharply, primarily due to better antiretroviral therapies. In 2014, 160 new AIDS cases (Figure 3) and 91 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 2014, at approximately 247 cases per year. With a peak of 282 newly diagnosed HIV (non-AIDS) cases in 2009, 235 new HIV (non-AIDS) cases were reported in 2014 (an increase of 9% from 216 in 2013).

Historically, and in 2014, over 80% (264/307) 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 occurred 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 2014 there were 122 new infections among white males. During the past decade, the number of cases among African-American males has fluctuated from year to year, with 45 new HIV diagnoses in 2014. This represents a 22% decrease among African-American males from 2013 to 2014. The number of HIV infections diagnosed among Hispanic males increased in 2014 to 28 from 23 in 2013, a 22% increase. The number of new infections among African-born males has fluctuated greatly from year to year and in 2014 the number of cases increased to 20 compared to 9 in 2013, a 122% increase.

Females account for an increasing percentage of new HIV infections, from 11% of new infections in 1990 to 24% in 2014. 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 2005, the annual number of new infections diagnosed among African American (black) females has decreased slightly overall, although without a clear pattern from year to year. In 2014 there were 16 cases diagnosed among African American women, compared to 13 in 2013. In 2014 the number of new cases among African-born women was 32, accounting for 44% 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 2014, men of color comprised approximately 17% of the male population in Minnesota and 44% of new HIV diagnoses among men. Similarly, persons of color comprised approximately 13% of the female population and 79% 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 (13-24 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 49 cases reported in 2014. Since 2005, the number of cases among young males has increased by 63%. The number of new HIV infections among females in this age group has remained relatively consistent over time. In 2014 there were 8 cases reported among young women. From 2012 to 2014, the majority (59%) of new infections among male adolescents and young adults were among youth of color (85/143), with young African American males accounting for 66% of the cases among young males of color. During the same time period, young women of color accounted for 64% (14/22) of the cases diagnosed, with young African-born women accounting for 50% of cases among young women of color. Between 2012 and 2014 after re-distributing those with unspecified risk, 94% (134/143) of new cases among young males were attributed to male-to-male sex. Among young females, 94% (20/22) 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 2014, this group accounted for 50% of new diagnoses (155/307).

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% (5/307) in 2014. 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. Seventy-three percent of 73 new HIV diagnoses among women in 2014 is attributed to heterosexual exposure.

Historically, race 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 2014, there were 52 new HIV infections reported among Africans. While African-born persons comprise less than 1% of the state’s population, they accounted for 17% of all HIV infections diagnosed in Minnesota in 2014.

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 3% in 1995. The overall rate of perinatal transmission for 2012 to 2014 was 1.1% with 1 HIV-positive birth from an HIV-infected mother in Minnesota in 2014.

• For up to date information see>> HIV (HIV/AIDS)
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2014