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Once a death sentence, Minnesota officials now have a plan to ‘effectively end’ HIV epidemic in the state

New drugs can make the disease untransmittable — but not everyone can afford them.

PrEP is generally covered by health insurance programs. But out-of-pocket, its costs can run $2,000 a month, putting it out of reach for people without health insurance.

It’s been 37 years since the first case of AIDS was confirmed in Minnesota.

Its first documented victim was Bruce Brockway, the publisher of the Twin Cities’ first gay newspaper. He died in the 1984 from complications of the disease, but not before co-founding the Minnesota AIDS Project, an organization that helped people in Minnesota with HIV/AIDS.

In the following years, thousands more Minnesotans contracted HIV — almost always a death sentence in those early years, before the virus was well-understood and new medications made it untransmissible and more manageable to live with.

Despite those innovations, Minnesotans are still contracting HIV: 286 new cases were confirmed in Minnesota in 2018, according to data from the Minnesota Department of Health.

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The state of Minnesota wants to bring those numbers down. Last week, the state announced a plan to reduce diagnoses of HIV by at least 25 percent by 2025 and at least 75 percent by 2035.

Jan Malcolm
MinnPost photo by Greta Kaul
Health Commissioner Jan Malcolm
“For the first time, we have the knowledge and the tools to effectively end this epidemic in our state,” said Health Commissioner Jan Malcolm — a statement she said she couldn’t have imagined making when when the virus was first identified.

A brief history of HIV in Minnesota

Little was understood about HIV, the virus that causes AIDS, in 1981, when men in coastal cities began to get sick.

In those early days, public health officials didn’t know what caused the illness or how it was transmitted, leading to widespread fear and stigma. In headlines, it was called the gay plague because most documented HIV victims were gay men.

At first, the number of confirmed cases in Minnesota were relatively small: five in 1982, and 10 in 1983. But the next year, the number quintupled, and the following year, it ballooned nearly eightfold.

New HIV diagnoses by year in Minnesota
Source: Minnesota Department of Health

“Those early years were really characterized by trying to figure out what this disease was and how it was communicated and how it was stopped,” said Paul Skrbec, the manager of public relations and marketing communications at JustUs Health, an organization that provides health resources to the LGBTQ community.

Through the ’80s and up until recently, the focus of prevention efforts was making sure people from at-risk populations got tested, treatment and promoting safe sex, Skrbec said.

In 1990, the federal government passed the Ryan White Act, which provided treatment and care for low-income and underserved people with HIV. Minnesota started to see declines in cases in the mid-’90s, as the first anti-retrovirals, drugs that stopped the virus from replicating, became available.

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The first drugs for managing HIV were harsh. They could cause nausea, diarrhea, loss of taste and nerve injury.

The goal of anti-retrovirals is to make levels of HIV undetectable in people who have tested positive for the virus, making it effectively impossible for them to transmit it to a partner. Minnesota and other states have signed onto a campaign that use the slogan U=U, or undetectable = untransmittable.

Better drugs, with less harsh side effects, have made living with HIV more manageable. For people like Skrbec, who was diagnosed with HIV in 2003, it’s now easier to manage HIV than other medical conditions.

“People like myself are able to tolerate their regimens very well,” he said.

In the last several years, the fight against HIV has changed dramatically with the introduction of pre-exposure prophylaxis, or PrEP. People who have not tested positive for HIV but are at risk of contracting the virus can take the drug Truvada, in the form of a once-daily pill, to prevent themselves from infection.

In Minnesota, an estimated 1,600 people were using PrEP in 2017, according to AIDSVu, an organization that maps HIV.

Despite the advent of PrEP, the number of new cases in Minnesota has hovered around 300 per year for several years. Sex between men remains the primary method of transmission.

Cause of transmission of HIV in Minnesota, 2017
Source: Centers for Disease Control


As some Minnesotans have gained access to resources to help prevent HIV, others have been left behind.

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Minnesotans more at risk of getting HIV include gay, bisexual and other men who have sex with men, IV drug users, yes. But also at increased risk are people of color, American Indians and transgender people, according to the Minnesota Department of Health.

In 2017, CDC data show the rate of new HIV diagnoses in African American Minnesotans was 51 per 100,000 people, compared to 15 for Hispanic or Latino Minnesotans, 4 for Native American Minnesotans (in other recent yer and 3 for Asian Minnesotans and white Minnesotans.

These disparate rates are largely driven by underlying disparities in things like education, homelessness and access to health care in Minnesota, public health officials say.

PrEP, for instance, is generally covered by health insurance programs. But out-of-pocket, its costs can run $2,000 a month, putting it out of reach for many.

Part of the state’s plan to reduce new cases of HIV is aimed at reducing those disparities by attacking their underlying causes.

The five overarching goals in the state’s new plan, called END HIV MN, include preventing new infections, reducing health disparities related to HIV, increasing the level of care for people who are HIV-positive, making sure people living with HIV or at high risk of getting it have stable housing and better coordinating HIV prevention and treatment efforts across government and health care organizations.

As far as goals go, in addition to reducing transmission, ultimately by 75 percent in the next decade and a half,  the plan seeks to, in six years, make sure 90 percent of Minnesotans who have tested positive for HIV know their status; increase the share of HIV-positive Minnesotans with consistent care to 90 percent; and increase the share who have tested positive have undetectable levels of the virus to 90.

Christine Jones
MinnPost photo by Greta Kaul
Christine Jones
The goals were developed after years of focus groups and surveys in affected communities.

Christine Jones, MDH’s STD, HIV and TB section manager, said she’s fielded questions about how different the new plan is from what the state’s already doing.

The difference, she said is in building more infrastructure and filling in the gaps, “looking at what resources we do have in place, where the gaps are and how are we going to fill those gaps,” she said.

Not everyone thinks it’s ambitious enough to truly end HIV in Minnesota, though.

Skrbec pointed to San Francisco’s plan, adopted in 2014, to get to nearly zero new cases by 2020 with major efforts to diagnose people early and connect them to care.

“There’s not a lot of innovation, not a lot of new thought in it,” Skrbec said. “That is something that as a Minnesotan, I certainly expect more. I’ve lived in the Deep South, and I know the challenges that other areas of the country have, and it’s one of the things I pride myself on, being born and raised in Minnesota, we often are very bold in finding solutions to social issues.”