1. HIV Surveillance Report, 2010 Minnesota Department of Health HIV/AIDS Surveillance System Glenise Johnson, MPH HIV Surveillance Epidemiologist Minnesota Department of Health HIV/AIDS Surveillance System Glenise Johnson, MPH HIV Surveillance Epidemiologist

2. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review National Context

3. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review U.S. State-Specific AIDS Rates per 100,000 Population Year 2008

4. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Persons Living with HIV/AIDS in Minnesota Overview of HIV/AIDS in Minnesota

5. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Estimated Number of Persons Living with HIV/AIDS in Minnesota * This number includes persons who reported Minnesota as their current state of residence, regardless of residence at time of diagnosis. Includes state prisoners and refugees arriving through the HIV+ Refugee Resettlement Program, as well as HIV+ refugee/immigrants arriving through other programs.

6. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV/AIDS in Minnesota: Number of Prevalent Cases, and Deaths by Year, 1996-2010 *Deaths among MN AIDS cases, regardless of location of death and cause. ^Deaths in Minnesota among people with HIV/AIDS, regardless of location of diagnosis and cause.

7. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review

8. Persons Living with HIV/AIDS in Minnesota by Current Residence, 2010

9. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Persons Living with HIV/AIDS in Minnesota by Gender, 2010 5,243 (77%) 1,571 (23%)

10. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Persons Living with HIV/AIDS in Minnesota by Gender and Race/Ethnicity, 2010

11. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Number of Cases and Rates (per 100,000 persons) of Persons Living with HIV/AIDS by Race/Ethnicity – Minnesota, 2010 Accurate population estimates for African-born persons and MSM (any race) living in Minnesota are unavailable – anecdotal (50,000) and 2000 US Census data (35,188) ) were used to create the range of rates reported for African-born. ^ Other = Multi-racial persons or persons with unknown race Census Data used for rate calculations. African-born refers to Blacks who reported an African country of birth; African American refers to all other Blacks. Cases with unknown race are excluded.

12. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Persons Living with HIV/AIDS in Minnesota by Age and Gender, 2010

13. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Foreign-Born Persons Living with HIV/AIDS in Minnesota by Region of Birth, 1996-2010 Region of Birth Latin Amer/Car – Includes Mexico, Caribbean, and Central/South American countries

14. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review New HIV Infections, 2010

15. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV/AIDS in Minnesota: New HIV Infection, HIV (non-AIDS) and AIDS Cases by Year, 1996-2010 *Includes all new cases of HIV infection (both HIV (non-AIDS) and AIDS at first diagnosis) diagnosed within a given calendar year. ^Includes all new cases of AIDS diagnosed within a given calendar year, including AIDS at first diagnosis. This includes refugees in the HIV+ Resettlement Program, as well as, other refugee/immigrants diagnosed with AIDS subsequent to their arrival in the United States.

16. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review

17. Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (except Minneapolis), Ramsey (except St. Paul), Scott, and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area. HIV Infections* in Minnesota by Residence at Diagnosis, 2010 * HIV or AIDS at first diagnosis

18. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Gender and Race/Ethnicity

19. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Diagnosed in Year 2010 and General Population in Minnesota by Race/Ethnicity

20. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* by Gender and Year of Diagnosis, 1996 - 2010 * HIV or AIDS at first diagnosis

21. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Diagnosed in Year 2010 by Gender and Race/Ethnicity * HIV or AIDS at first diagnosis n = Number of persons Afr Amer = African American (Black, not African-born persons) Afr born = African-born (Black, African-born persons) Amer Ind = American Indian Other = Multi-racial persons or persons with unknown race

22. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Adolescents and Young Adults

23. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Adolescents and Young Adults by Gender and Year of Diagnosis, 1996 - 2010 * HIV or AIDS at first diagnosis Adolescents defined as 13-19 year-olds; Young Adults defined as 20-24 year-olds.

24. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Adolescents and Young Adults by Gender and Race/Ethnicity, 2008 - 2010 Combined

25. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Adolescents and Young Adults by Gender and Estimated Exposure Group #, 2008 - 2010 Combined

26. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Births to HIV-Infected Women and Number of Perinatally Acquired HIV Infections* by Year of Birth, 1996 - 2010 * HIV or AIDS at first diagnosis for a child exposed to HIV during mothers pregnancy, at birth, and/or during breastfeeding.

27. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV among Foreign-born Persons

28. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* among Foreign-Born Persons in Minnesota by Year of Diagnosis and Region of Birth, 1996 - 2010 Region of Birth # * HIV or AIDS at first diagnosis Excludes persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. # Latin America/Car includes Mexico and all Central, South American, and Caribbean countries.

29. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Foreign-Born Persons by Gender and Age, 2010

30. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Late Testing

31. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Time of Progression to AIDS for HIV Infections Diagnosed in Minnesota*, 2000 - 2010 *Numbers include AIDS at 1 st report but exclude persons arriving to Minnesota through the HIV+ Refugee Resettlement Program, as well as other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. ^ Percent of cases progressing to AIDS within one year of initial diagnosis with HIV Infection. Numbers/Percent for cases diagnosed in 2010 only represents cases progressing to AIDS through April 4, 2011.

32. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Summary The number of people living with HIV in 2010 has increased by 4% since 2009. The number of newly reported HIV infections in 2010 decreased by 11% compared to 2009, but is the second highest number of cases reported since 1995. Among new cases of HIV/AIDS, disparities still persist for adolescents and young adults (24% of cases), minorities (50% of cases) and MSM (54% of cases).

33. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Contact Information Glenise Johnson, MPH HIV Surveillance Epidemiologist, STD and HIV Section Telephone: 651-201-5624 E-mail: glenise.johnson@state.mn.usglenise.johnson@state.mn.us

34. Hepatitis A, B & C in Minnesota, 2010 Kristin Sweet, MPH Minnesota Department of Health Hepatitis Surveillance System Kristin Sweet, MPH Minnesota Department of Health Hepatitis Surveillance System

35. Basic Features of Hepatitis Viruses Virus A B C Incubation Period* 4 (2-6) 8-12 (6-24) 6-9 (2-24) Transmission fecal-oral parenteral * Weeks Chronic Infection No Yes

36. Chronic Viral Hepatitis Infection Hepatitis B 6-10% Hepatitis C85% Hepatitis A 0%

37. Communicable Disease Reporting – HIV & Hepatitis Hepatitis A, B, C, D and E, HIV and AIDS are all reportable by name to the Minnesota Department of Health (MDH). All reported cases may be contacted by the MDH Surveillance staff for epidemiological follow-up.

38. Minnesota Hepatitis Surveillance System Hepatitis B reportable since 1987 Hepatitis C reportable since 1998 Passive data collection

39. Data Source: Minnesota Viral Hepatitis Surveillance System Introduction Data in this presentation are current through 2010 Definitions: Acute case: Infected within the last six months Symptomatic Chronic case: Infected for over six months Asymptomatic or symptomatic Resolved cases: No evidence of current infection Evidence of past infection

40. Data Source: Minnesota Viral Hepatitis Surveillance System Data limitations The slides rely on data from HCV and HBV cases diagnosed through 2010 and reported to the Minnesota Department of Health (MDH) Hepatitis Surveillance System. Some limitations of surveillance data: Data do not include hepatitis-infected persons who have not been tested Data do not include persons whose positive test results have not been reported to the MDH Persons are assumed to be alive unless the MDH has knowledge of their death. Persons whose most recently reported state of residence was Minnesota are assumed to be currently residing in Minnesota unless the MDH has knowledge of their relocation.

41. Acute Viral Hepatitis Acute case: Infected within the last six months Symptomatic

42. Reported rate per 100,000 population of acute viral hepatitis United States, 1999-2008 Data Source: Surveillance for Acute Viral Hepatitis --- United States, 2007, May 22, 2009 / 58(SS03);1-27Surveillance for Acute Viral Hepatitis --- United States, 2007

43. Number of Acute Cases per year Minnesota, 1999-2010 Data Source: MN Viral Hepatitis Surveillance System

44. Chronic Viral Hepatitis

45. Overview of Chronic HBV in MN Chronic case: Infected for over six months Includes cases with no evidence of recent infection Asymptomatic or symptomatic

46. Reported Number of Persons with Chronic HBV in MN As of December 31, 2010, 19,420* persons are assumed alive and living in MN with chronic HBV *Includes persons with unknown city of residence Note: Includes all chronic, and probable chronic cases. Data Source: MN Viral Hepatitis Surveillance System

47. Persons Living with HBV in MN by Current Residence, 2010 Metro = Seven-county metro area including Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties. Greater MN = All other Minnesota counties, outside the seven-county metro area. Total number with residence information = 18,657 (763 missing residence information) Data Source: MN Viral Hepatitis Surveillance System

48. Persons with Chronic HBV in MN by Age, 2010 Median Age: 42 Data Source: MN Viral Hepatitis Surveillance System

49. Chronic HBV in MN by Gender, 2010 Data Source: MN Viral Hepatitis Surveillance System

50. Persons Living with Chronic HBV in Minnesota by Race, 2010 Persons with unknown race=2,460 Afr Amer = African American /Black Asian=Asian or Pacific Islander Amer Ind = American Indian Other = Multi-racial persons or persons with other race Data Source: MN Viral Hepatitis Surveillance System

51. Persons Living with Chronic HBV in Minnesota by Race rates (per 100,000 persons*), 2010 *Rates calculated using U.S. Census data Excludes 2524 cases with multiple races and unknown race Data Source: MN Viral Hepatitis Surveillance System

52. Overview of HCV in Minnesota A hepatitis C case is defined as current or past infection with hepatitis C and includes: Acute cases: Infected within the last six months Symptomatic Chronic cases: Infected for over six months Resolved cases: No evidence of current infection Evidence of past infection

53. Reported Number of Persons Living with HCV in MN As of December 31, 2010, 35,241 * persons are assumed alive and living in MN with HCV *Includes persons with unknown city of residence Note: Includes all acute, chronic, probable chronic, and resolved cases. Data Source: MN Viral Hepatitis Surveillance System

54. HCV Infected Persons Identified through Passive Surveillance in MN through 2010 **http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm *Includes all acute, chronic, probable chronic, and resolved cases. HCV infected persons* identified through passive surveillance Estimated unidentified HCV infected persons 35,241 49,622 N=84,862** Data Source: MN Viral Hepatitis Surveillance System

55. Persons Living with HCV in MN by Current Residence, 2010 Suburban = Seven-county metro area including Anoka, Carver, Dakota, Hennepin (except Minneapolis), Ramsey (except St. Paul), Scott, and Washington counties including those in Hennepin County or Ramsey County with unknown city. Greater MN = All other Minnesota counties, outside the seven-county metro area. Total number with residence information= 31,989 (1385 missing residence information) Data Source: MN Viral Hepatitis Surveillance System

56. Persons Living with HCV in MN by Age, 2010 Median Age: 54 Data Source: MN Viral Hepatitis Surveillance System

57. *Includes anonymous methadone patients Persons Living HCV in MN by Gender*, 2010 Data Source: MN Viral Hepatitis Surveillance System

58. Persons Living with Chronic HCV in Minnesota by Race, 2010 Afr Amer = African American /Black Asian=Asian or Pacific Islander Amer Ind = American Indian Other = Multi-racial persons or persons with other race

59. Persons Living with HCV in Minnesota rates (per 100,000 persons*), 2010 *Rates calculated using U.S. Census data Excludes 11,157 persons with multiple races or unknown race Data Source: MN Viral Hepatitis Surveillance System

60. Hepatitis C Update

61. National Context New York Hepatitis C cluster 20 cases Ages 19-29 (median:19) 19 PWID 19 attended two high schools in a single postal code Massachusetts Cases ages 15-25 2002: 15 per 100,000 2005: 32 per 100,000

62. Data Source: Minnesota Viral Hepatitis Surveillance System Dakota County Cluster 16 cases Age Range: 16-26 Median: 18 13 Male and 3 Female Injection drug use related

63. Data Source: Minnesota Viral Hepatitis Surveillance System Carlton County Cluster 17 cases Age Range: 19-70 Median: 27 Cases under 30: 11 8 Male and 9 Female All reported the same city of residence Injection drug use related

64. Data Source: Minnesota Viral Hepatitis Surveillance System Mahnomen County Cluster 14 Cases Age Range: 18-63 Median: 27 6 Male and 8 Female 11 with the same reported city of residence Injection drug use related

65. Data Source: Minnesota Viral Hepatitis Surveillance System Newly confirmed HCV cases- age distribution by year

66. Contact Information Kristin Sweet, MPH Hepatitis Surveillance Epidemiologist, Immunization, Tuberculosis & International Health Section Telephone: 651-201-4888 E-mail: kristin.sweet@state.mn.uskristin.sweet@state.mn.us

67. Viral Hepatitis in Minnesota Cheri Booth, MPH Adult Viral Hepatitis Prevention Coordinator Cheri.booth@state.mn.us 651-201-4035

68. What you can do… Viral hepatitis is complex. Be informed, but know where to go for answers. Know your agencies risk populations and the behaviors of greatest concern Proactively screen for risk Resources are scarce. Adopt harm reduction as a strategy to reduce burden of illness. Be prepared with a referral plan.

69. Be Informed… Know where to go for easy-to-use and reliable information HCV advocate: www.hcvadvocate.orgwww.hcvadvocate.org Hepatitis B Foundation: www.hepb.orgwww.hepb.org Request training for your agency MDH provides free, on-site education for your staff tailored to your needs

70. 4 th Annual Hepatitis Symposium Aug 18, 2011 Presented by: Minnesota Department of Health and MATEC Purpose: provide a forum for discussing the viral hepatitis prevention, diagnosis, management, and treatment needs of Minnesotans. bring together clinical and community program partners to encourage and reinforce principles of integration and improvements in the continuum of care.

71. Screening: Sexual and Drug Use History Identifies those at highest risk for becoming infected or for spreading infection to others Overlaps with key questions for identifying HIV/ STD risk Prevents missed opportunities for prevention and Harm Reduction Counseling

72. Key Questions Injection drug use, even once? Unprotected oral, vaginal, or anal sex ? History of STD*, HIV, or Hepatitis infections? *STD or HIV infection causes changes in the bodys defense systems allowing the virus to transmit easier.

73. The Minnesota Department of Health (MDH) identified a need for the standardization of risk assessment questions and concepts to ensure better collection of information and in meeting the resulting needs. The purpose of this guide and accompanying tool is to: increase consistency and improve risk reduction messages, increase consistency and accuracy of client assessments, insure uniformity of referrals to appropriate resources, and improve quality control and standards. http://www.health.state.mn.us/divs/idepc/diseases/ hiv/riskassessment/index.html Integrated Viral Hepatitis, STD, and HIV Risk Assessment

74. Chronic Hepatitis C HCV leads to ~10,000 deaths per year from chronic liver disease. Vaccinate for HAV/HBV when appropriate. Encourage reduction or cessation of alcohol or drug use. Explore anti-viral treatment options. Remember, treatment is NOT FOR EVERYONE!

75. Referral Plan Advanced testing: Provide advanced testing or refer to clinics that can, ex: Red Door, Room 111, HCMC, etc Harm Reduction, SA services Social stability and mental health services are often necessary.

76. Contact Info Cheri Booth, MPH Adult Viral Hepatitis Prevention Coordinator Cheri.booth@state.mn.us 651-201-4035

77. Contact Information Glenise Johnson, MPH HIV Surveillance Epidemiologist, STD and HIV Section Telephone: 651-201-5624 E-mail: glenise.johnson@state.mn.usglenise.johnson@state.mn.us Kristin Sweet, MPH Hepatitis Surveillance Epidemiologist, Immunization, Tuberculosis & International Health Section Telephone: 651-201-4888 E-mail: kristin.sweet@state.mn.uskristin.sweet@state.mn.us Cheri Booth, MPH Adult Viral Hepatitis Prevention Coordinator, STD and HIV Section Telephone: 651-201-4035 E-mail: Cheri.booth@state.mn.usCheri.booth@state.mn.us