Minnesota recorded 307 new HIV cases last year, bringing the number of residents living with the infection to nearly 8,000 and prompting advocates to call for more supportive housing, medication therapy and other services to stop the disease from spreading.
The 7,988 Minnesotans living with HIV is the largest total on record — a positive sign in that better medications have mostly converted the infection from a terminal diagnosis to a chronic illness.
But the total, released Thursday in the state Health Department’s annual HIV report, also raises the stakes for public health officials because it shows growth in the pool of people who could spread the infection.
The good news is that 63 percent of HIV-infected Minnesotans in 2014 were considered virally suppressed — meaning medication had diminished their infections to the point where they are unlikely to spread the virus through the common methods of unprotected sex or shared needle usage. And that number has increased 1 percentage point each year since 2012, when the state started tracking it.
Now health officials want to bring that total closer to 100 percent, which would halt HIV’s spread in Minnesota.
“We really want to look at getting people into care … and getting people back into care who have fallen out of care,” said Krissie Guerard, director of the Health Department’s STD and HIV section.
Since 2000, Minnesota has reported between 280 and 370 new HIV infections each year, and in 2013 it ranked 17th nationally for the rate of new cases.
An ‘impoverishing disease’
At Clare Housing, which provides permanent shelter to low-income Minnesotans with HIV, leaders say an increase in housing opportunities would be a key to containing HIV, because studies have shown that viral suppression is easier to achieve when infected people have stable housing. Ninety-one percent of people with HIV who live in Clare apartments or receive rent support from the organization are virally suppressed.
Housing assistance can be crucial because many people with HIV come from poverty or end up in poverty because the stigma associated with the infection disrupts their careers, said Chuck Peterson, Clare’s executive director.
“HIV can be an impoverishing disease,” Peterson said.
Joe, a 57-year-old who lives at Clare’s apartment complex in north Minneapolis, credits stable housing for his health. Addicted to heroin and homeless a few years ago, the U.S. Army veteran said he was scared to carry his HIV medication in his pocket — even though he needed to take it daily — while on the streets.
“I didn’t want anybody to see me using the drugs,” he said.
A first step before housing, though, is identifying everyone who carries the infection, said Matt Toburen of the Minnesota AIDS Project. The estimate in Thursday’s report excludes as many as 1,200 to 1,500 people who are infected but don’t know their status or are hiding it.
More than 50 HIV infections each year are already at the AIDS stage when diagnosed — meaning the virus has circulated long enough to destroy most of the body’s T cells that fight off infection.
Toburen said many at-risk individuals are homeless, so just getting them tested can be a challenge: “Convincing them that going to an HIV doctor is their highest priority is often difficult, because their highest priority is ‘Where am I going to sleep tonight?’ ”
State officials said they are discussing additional prevention services to target a somewhat definable population. Of the new infections last year, 62 percent involved men who have sex with other men. The trend in infections is younger, though, as 31 percent of the men whose infections were discovered last year were between ages 20 and 29. Black women accounted for most of the 73 infections discovered in females last year, a 7 percent increase from 2013. Most were African-born.
The report also concluded that HIV transmission occurred largely through sexual activity; the rate of infections involving contaminated drug needles is lower in Minnesota than the rest of the country.
The state’s total HIV population includes more than 300 refugees from HIV-ravaged countries who were infected before settling in Minnesota.
Guerard said one solution includes the expansion of PREP, short for pre-exposure prophylaxis, which gives high-risk individuals medication that can prevent HIV infection even when exposed to the virus. Many health plans already cover the cost of the medication, but the state is seeking ways to make it more widely available, she said.
One concern among prevention advocates is apathy — even among those at high risk — because the disease has become so treatable that it doesn’t strike fear as it did in the 1980s and ’90s.
Toburen warned that the disease still seems to age people by 15 years and leaves them vulnerable to other illnesses.
Calling 307 new cases “unacceptable,” he said, “there’s no reason in 2015 that we should continue to see this many people infected with HIV.”