Every year in Minnesota, 300 people are diagnosed with HIV infection.
Under an ambitious new HIV reduction plan announced Wednesday, the state hopes to cut that to no more than 75 people by the year 2035. The plan sets out a series of goals, including increasing the number of people getting tested, getting HIV-positive people into medical treatment and keeping them under medical care.
However, the plan has no new state or federal money at this time, and state health officials acknowledge that they will need more resources to tackle some of the problems that have so far impeded progress in HIV prevention and reduction.
"We know that ending HIV is possible," Minnesota Health Commissioner Jan Malcolm said during a briefing Wednesday. "There have been tremendous developments in HIV prevention and treatment that make it possible to stop the spread of this disease."
Under those advances, HIV-infected people are living longer, and the virus can be suppressed, meaning that it won't be passed on to others.
In 2017, Minnesota had about 8,600 people with an HIV diagnosis. Although many of them get some medical treatment within three months of diagnosis, overall just 73% of them were considered to be receiving ongoing HIV care. And just six out of 10 had the virus under control.
Keeping people who are HIV-positive connected to medical care is one core part of the new plan. Some patients lose contact with the system, especially if they become homeless. The plan acknowledges that HIV reduction will require more than just access to health care clinics. It will also involve social support.
"Housing is health care," said Chryssie Jones, manager of the STD/HIV/TB section at the Health Department. "We know that it is a factor [that contributes to] people staying in care."
In addition, the state estimates that there are about 1,000 people in Minnesota who are infected with HIV but don't know it. HIV symptoms can take six months to develop but sometimes take even longer.
State officials want to encourage more HIV testing so these cases can be caught earlier, reducing the chances of spreading the infection to others.
Testing has been a longtime goal in HIV prevention, but many people shy away from it, and doctors often don't encourage it because of the stigma associated with the illness.
The state's plan calls on medical organizations, AIDS advocacy groups and other community groups to continue the education effort to help erase the stigma.
"Community will play a key role in implementing this plan," said Claire Wilson, deputy commissioner at the Minnesota Department of Human Services. "If we don't center the community in this work we will fail again."
Wilson said a regional telemedicine model will help disseminate information about HIV testing and treatment to providers who may not have much firsthand knowledge about the disease.
That model has so far proven successful in the opioid epidemic, where doctors, nurse practitioners and other caregivers are learning from peers and other experts about appropriate prescribing techniques and medication-assisted treatment.
Finally, the state wants to expand access to a drug known as pre-exposure prophylaxis, or PrEP, a daily pill for people who are HIV negative that can reduce the chance that they will become infected by sexual transmission of the virus by 90%.
"We would like to see more HIV negative people on PrEP," Jones said. But it is also important to educate more doctors about the medication because many are unfamiliar with it, she added.