HIV Infection and AIDS, 2018

HIV/AIDS incidence in Minnesota remains moderately low. In 2017, state-specific HIV infection rates ranged from 2.1 per 100,000 population in Wyoming to 30.0 per 100,000 in Georgia. Minnesota had the 16th lowest rate (6.0 cases per 100,000 population). In 2017, state specific AIDS diagnosis rates ranged from 0.9 per 100,000 persons in New Hampshire to 12.5 per 100,000 population in Georgia. Minnesota had the 16th lowest rate (2.6 cases per 100,000 population).

As of December 31, 2018, a cumulative total of 11,852 cases of HIV infection (2,267 AIDS at first diagnosis, and 9,585 HIV [non-AIDS] cases) were reported among Minnesota residents. By the end of 2018, an estimated 8,981 persons with HIV/AIDS were 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 2018, 116 new AIDS cases (Figure 4) and 82 deaths among persons living with HIV infection in Minnesota were reported.

The number of HIV (non-AIDS) diagnoses has varied over the past decade. There was a peak of 278 newly diagnosed HIV (non-AIDS) cases in 2009, and a low of 215 new HIV (non-AIDS) cases reported in 2017, which is lower than 228 cases reported in 2018.

In 2018, 77% (221/286) of new HIV diagnoses (both HIV [non-AIDS] and AIDS at first diagnosis) occurred in the metropolitan area. In Greater Minnesota there were 65 cases in 35 counties. 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 HIV infections among males, but the proportion of cases that white males account for is decreasing. In 2018, there were 93 new infections among white males, which is slightly less than half of new HIV infections among males (43%). Among black African American males, there were 49 new HIV diagnoses in 2018, which is about a quarter of new HIV infections among males (23%). Among Hispanic males of any race and black African-born males, there were 34 and 23 new HIV infections in 2018 respectively.

Females account for an increasing percentage of new HIV infections, from 11% of new infections in 1990 to 24% in 2018. 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.

In 2018, women of color accounted for 69% of new HIV infections among females in Minnesota. The number of diagnoses among African-born women has been increasing over the past decade. In 2018, the number of new cases among African-born women was 25, accounting for 37% of all new diagnoses among women. In 2018, there were 13 cases (19%) diagnosed among African American women.

Despite relatively small numbers of cases, HIV/AIDS affects persons of color disproportionately in Minnesota. In 2018, men of color comprised approximately 17% of the male population in Minnesota and 57% of new HIV diagnoses among men.

Similarly, persons of color comprised approximately 13% of the female population in Minnesota and 69% of new HIV infections among women. It bears noting the use of race can be a proxy for other risk factors, including lower socioeconomic status and education, and race is not considered a biological cause of disparities in the occurrence of HIV.

In 2018, there were 103 diagnosed with HIV <30 years of age, accounting for 36% of all cases. Most of these cases were among young males; 83% of cases <30 years were male. The average age at diagnosis in 2018 was 34 years for males and 38 years for females. A population of concern for HIV infection is adolescents and young adults (13-24 years). The number of new HIV infections among males in this age group has remained higher than new diagnoses among females since 1999, with 33 cases reported in 2018, which is lower than 47 cases reported in 2017. The number of new HIV infections among adolescent females has remained relatively consistent over time; in 2018 there were 5 cases. From 2016 to 2018, the majority (66%) of new infections among male adolescents and young adults were among youth of color, with young black African American males accounting for 34% of cases among young males of color. During the same period, young women of color accounted for 75% of the cases diagnosed, with young black African American women accounting for 43% of cases among young women of color.

Since the beginning of the epidemic, male-to-male sex (men who have sex with men; MSM) has been the predominant mode of exposure to HIV reported in Minnesota. In 2018, MSM (including MSM who also inject drugs) accounted for 71% of new diagnoses among men. 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.

among women was attributed to heterosexual exposure. The number of cases among people who inject drugs (IDU and MSM/IDU mode of exposure) has increased slightly over the past 3 years with 32 cases in 2018 compared to 26 cases in 2017, which indicates a continued pattern of increased HIV infection among people who inject drugs in the state.

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, MDH began analyzing these groups separately, and a marked trend of increasing numbers of new HIV infections among black African-born persons was observed. In 2018, there were 48 new HIV infections reported among black Africans. While black African-born persons comprise less than 1% of the state’s population, they accounted for 17% of all HIV infections diagnosed in Minnesota in 2018.

HIV perinatal transmission in the United States decreased 90% since the early 1990s. The trend in Minnesota has been similar. While the number of births to HIV-infected women increased nearly 7-fold between 1990 and 2018, with 65 births to pregnant persons in 2018, the rate of perinatal transmission decreased, from 15% in 1994-1996 to 0.6% over the last 3 years (2016- 2018), with 1 HIV-positive birth in 2017.

• For up to date information see>> HIV (HIV/AIDS)
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2018