HIV Infection and AIDS, 2017

HIV/AIDS incidence in Minnesota remains moderately low. In 2016, state-specific HIV infection rates ranged from 1.5 per 100,000 population in Vermont to 31.8 per 100,000 in Georgia.  Minnesota had the 14th lowest rate (6.2 cases per 100,000 population). In 2016, state-specific AIDS diagnosis rates ranged from 1.2 per 100,000 persons in Montana to 12.0 per 100,000 population in Louisiana. Minnesota had the 15th lowest rate (2.4 cases per 100,000 population).

As of December 31, 2017, a cumulative total of 11,598 cases of HIV infection (2,217 AIDS at first diagnosis, and 9,381 HIV [non-AIDS] cases) were reported among Minnesota residents. By the end of 2017, an estimated 8,789 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 2017, 144 new AIDS cases (Figure 4) and 75 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 279 newly diagnosed HIV (non-AIDS) cases in 2009, and a low of 217 new HIV (non-AIDS) cases reported in 2017.
In 2017, 81% (229/284) of new HIV diagnoses (both HIV [non-AIDS] and AIDS at first diagnosis) occurred in the metropolitan area. In Greater Minnesota there were 55 cases in 29 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 2017, there were 83 new infections among white males, which is more than one third of new HIV infections among males (39%). Among black African American males, there were 58 new HIV diagnoses in 2017, which is more than a quarter of new HIV infections among males (28%). Among Hispanic males of any race and black African- born males, there were 29 and 25 new HIV infections in 2017 respectively.

Females account for an increasing percentage of new HIV infections, from 11% of new infections in 1990 to 26% in 2017. 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 2017, women of color accounted for 80% of new HIV infections among females in Minnesota. The number of diagnoses among African-born women has been increasing over the past decade. In 2017, the number of new cases among African-born women was 35, accounting for 47% of all new diagnoses among women. In 2017, there were 18 cases (24%) diagnosed among African American women.

Despite relatively small numbers of cases, HIV/AIDS affects persons of color disproportionately in Minnesota. In 2017, men of color comprised approximately 17% of the male population in Minnesota and 61% of new HIV diagnoses among men. Similarly, persons of color comprised approximately 13% of the female population in Minnesota and 80% 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, but race is not considered a biological cause of disparities in the occurrence of HIV.

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 47 cases reported in 2017. The number of new HIV infections among adolescent females has remained relatively consistent over time; in 2017 there were 8 cases. From 2015 to 2017, the majority (65%) of new infections among male adolescents and young adults were among youth of color (99/154), with young black African American males accounting for 39% of cases among young males of color. During the same period, young women of color accounted for 80% (28/35) of the cases diagnosed, with young black African-born women accounting for 37% of cases among young women of color. Between 2015 to 2017 after re-distributing those with unspecified risk, 86% of new cases among young males were attributed to male-to- male sex.  Among young females, 87% of new cases were attributed to heterosexual sex.

Since the beginning of the epidemic, male-to-male sex (MSM) has been the predominant mode of exposure to HIV reported in Minnesota. In 2017, MSM (including MSM who also inject drugs) accounted for 67% 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. In 2017, 84% of 74 new HIV diagnoses among women was attributed to heterosexual exposure. The number of cases among injection drug users (IDUs) (MSM/IDU and IDU) has remained similar over the past 3 years with 26 cases in 2017 compared to 27 cases
in 2016, which indicates a continued pattern of increased HIV infection among IDUs 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 2017, there were 60 new HIV infections reported among black Africans.

While black African-born persons comprise less than 1% of the state’s population, they accounted for 21% of all HIV infections diagnosed in Minnesota in 2017.

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 2017, the rate of perinatal transmission decreased 11-fold, from 15% in 1994-1996 to 1.8% over the last 3 years (2015-2017) 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, 2017