BEMIDJI, Minn. -- With the coronavirus pandemic in play throughout 2020, numbers related to other illnesses have been askew.
According to a July report from the Minnesota Department of Health, this includes sexually transmitted diseases. In its release of annual data, MDH found that because of uncertainty surrounding the pandemic-driven reduction in services and testing, some STD rates decreased slightly.
Notably, STDs, and the human immunodeficiency virus declined 2%. The total number of chlamydia cases, for example, was recorded at 21,942, an 11% decrease from the 24,453 reported in 2019.
Syphilis cases, meanwhile, declined by 3% in 2020. The number of new HIV cases also decreased, with 226 cases in 2020, compared to 276 in 2019.
MDH also estimates that 9,422 Minnesotans live with either HIV or acquired immunodeficiency syndrome. Of that number 5,247 are estimated to live with HIV while 4,175 have AIDS.
"We've noticed things impacting the numbers," said Christine Jones, who works for MDH as an STD/HIV/TB section manager. "One was many clinics only were doing STD testing for symptomatic individuals and not everyone had symptoms. Also, because of the stay-at-home order, people weren't seeking as much STD and HIV testing, so we definitely noticed a decrease of people accessing services."
One STD that remained on the rise, though, was gonorrhea, as MDH reported 10,217 cases in 2020, up 27% from the 8,063 in 2019.
Before 2020, the number of both chlamydia and gonorrhea had been climbing at the state and county levels.
- In 2017, Minnesota had 23,528 cases of chlamydia and 6,519 for gonorrhea.
- For 2018, MDH recorded 23,564 cases of chlamydia and 7,542 gonorrhea cases.
"Over the past two years, we've continued to see STDs increasing across the state, and that's been similar nationwide," Jones said.
In Beltrami County, for example, the main STD of concern has been syphilis.
"Pre-COVID, we were ramping up our work on syphilis because the numbers had really increased in our county," said Megan Heuer, Beltrami County Public Health director. "We were working with MDH to do a big push for education around syphilis."
In Beltrami County, there were 92 new syphilis cases in 2019, and 90 in 2020. So far in 2021, Heuer said there have been 40 reported cases.
"We know syphilis is highest in some of our individuals who also struggle with substance abuse, so we've seen it tied to those numbers," Heuer said. "It's not just syphilis with that either, but much of our STD numbers."
Heuer says the county's response is focused on preventative care and outreach.
"We want to encourage safe practices, take the time to ask some deeper questions and build relationships where people can be honest," Heuer said. "A lot of it is making partnerships and working with providers to do a lot of that screening. From our standpoint, it will be encouraging preventative appointments, teaching the risks and sometimes just getting the numbers out there to help people realize that it does exist. We also want to take the stigma away from it. These are treatable diseases and HIV is manageable."
In its July report, MDH highlighted an HIV outbreak in the Twin Cities metro area and Duluth. In the latter, the greater Duluth area has reported 17 cases.
"This is concerning, especially as MDH and other organizations respond to two HIV outbreaks in the state," Jones said in a release about the outbreak. "It's incredibly important that people seek preventative care and testing now in 2021. The HIV outbreaks in the Twin Cities and Duluth highlight a rise in overlapping issues among people who inject drugs and people who are unhoused."
MDH data shows people assigned male sex at birth account for the majority of HIV cases statewide at 84%. MDH statistics also show more than two-thirds of the state's new HIV cases disproportionately affect communities of color.
"The ways to prevent HIV include consistent condom use and the daily pill to prevent HIV," said Dr. Ruth Lynfield, MDH medical director and epidemiologist. "It is also really important to get tested regularly for HIV and STDs, and if you are diagnosed with HIV, to take and stay on treatment to make the levels of the virus undetectable. This is so essential because people living with HIV who are taking their medications and have an undetectable viral load do not pass HIV through sex."
Before 2020, the number of new HIV cases was around 280 on an annual basis.
- MDH recorded 280 new HIV cases in 2017, with 65 AIDS diagnoses and 215 non-AIDS cases.
- The state recorded 286 HIV cases in 2018, with 58 new AIDS diagnoses 228 non-AIDS cases.
- In 2019, 275 new HIV cases were reported, with 219 non-AIDS cases and 576 new AIDS diagnoses.
- Of the 226 new HIV cases reported in 2020, 183 were non-AIDS and 43 were new AIDS diagnoses.
Resources for help
In counties like Beltrami and others like it in Greater Minnesota, one option for those living with HIV is the Rural AIDS Action Network. The organization was established more than 25 years ago in northern Minnesota and works with nearly 500 people per month.
According to RAAN Executive Director Mary McCarthy, there are an estimated 1,500 Minnesotans living in Greater Minnesota with HIV. For northern Minnesota, RAAN has offices in Duluth, Grand Rapids and Moorhead.
"Over the last decade, we've really incorporated a lot more harm reduction techniques, including a syringe exchange program and Narcan for overdose prevention," McCarthy said. "The syringe exchange program, like other harm reduction activities, is really helpful in reducing transmission of all infectious diseases, HIV is just one of them."
Regarding the recent outbreaks in Duluth and the Twin Cities, McCarthy said both areas also were noticeable for having overdoses. With that in mind, McCarthy said there's a possibility that numbers may increase in Bemidji, which also experienced a rise in overdoses recently.
"One of my concerns is that the Bemidji area experienced a significant amount of overdoses," McCarthy said. "My worry is the transmission pattern might follow that pattern. So Bemidji may be the next place where we see those increases."
At MDH, the strategy to assist rural areas where resources may be lacking is working with partners in the areas. One of the state's partners is Planned Parenthood. Jones said MDH provides grants to Planned Parenthood to provide HIV testing, STD screenings and risk assessments.