A population of Minnesotans the size of Orono — 7,723 people — now lives with HIV, but fewer are dying each year from the sexually transmitted infection or from AIDS, the immune system disease that can result.
Minnesota recorded 301 new HIV infections last year, according to an annual report released Wednesday by the state Department of Health, but only 71 deaths of people with AIDS and/or HIV. That is the lowest annual total since 2004, the earliest year for which the state published combined HIV/AIDS death figures.
Health officials said the report reveals no clear trends for the disease. The number of newly diagnosed infections last year was 4 percent lower than the 314 cases in 2012, but about average for the past decade. Last year's death total also wasn't much lower than the 76 deaths recorded in 2012. (Deaths include people with HIV or AIDS who died of other causes.)
However, the death total was well below the average of 87 per year for the past decade. And 22 percent of Minnesotans with HIV or AIDS are now older than 55. Ten years ago, that figure was just 6 percent.
"Patients today expect to live a much longer life — a much longer, healthier life" even though AIDS remains incurable, said Dr. Tim Schacker, director of the HIV program at the University of Minnesota Medical Center.
Advances in anti-retroviral medications over the past two decades have slowed the ability of HIV to replicate itself — in some cases to the point where patients have undetectable levels of the virus in their blood.
A lower mortality rate isn't the only change over time in the course of HIV and AIDS in Minnesota. HIV was once a disease diagnosed primarily among men who had sex with other men, but they represented a minority of new cases last year. While 75 percent of newly diagnosed HIV infections were in men of all sexual orientations last year, the number of cases in males actually declined 11 percent from 2012, while increasing 22 percent among females.
"For so many years, people have associated HIV with male-to-male transmission," said Krissie Guerard, HIV section manager for the Minnesota Department of Health. "That obviously isn't the case. Women can also get the disease."
HIV rates remain higher among minorities and in lower-income communities, but the risk long ago spread beyond the urban cores of the state. Last year 115 new HIV cases were diagnosed among suburban Minnesotans, a 22 percent increase from 2012.
For public health advocates, the data present a number of challenges. The state didn't know the method of HIV transmission for a quarter of the new cases in 2013, suggesting that the disease retains a stigma and that patients aren't willing to disclose that information even to health professionals, said Bill Tiedemann, executive director of the Minnesota AIDS Project.
While the decline in deaths is "incredibly" positive, the resulting message that AIDS is now a chronic disease rather than a terminal one might lead to apathy among people who need regular testing or treatment, Tiedemann added. Nearly three in 10 of new diagnoses last year were made late in the course of infections, meaning that people were carrying their infections for months or years without getting tested.
"The data says to me that people don't think they are at risk," he said, "and if they are at risk, they're not taking the proper precautions."
The state recommends HIV screening for all people aged 13 to 64, and annual screening for anyone who has had unprotected sex or a new sexual partner, or has shared needles to inject drugs.
The larger population of infected Minnesotans creates some risk that HIV will spread more broadly, but health officials said that's unlikely as long as people maintain regular treatment that reduces the virus in their bodies and minimizes the risk of transmission.
The AIDS Project provides case management to 400 people who are HIV-positive, and makes sure they follow medication regimens. Tiedemann said more than half of the patients in that program have viral levels that are undetectable and that the risk of them transmitting HIV to sexual partners is low.
"You've got to make sure you are engaged with your HIV-positive population," he said, "so you make sure they stay in care and are adherent to their medications."