Minnesota Department of Health
STD and HIV Section
HIV/AIDS Community Prevention Planning
COMMUNITY COOPERATIVE COUNCIL ON HIV/AIDS PREVENTION
Minneapolis Urban League
9:00 a.m. - 5:00 p.m.
Thursday, May 20, 2004
Present
TASK FORCE MEMBERS
COMMUNITY MEMBERS
MDH STAFF
Gerry Anderson
Lucy Slater for Kip Beardsley
Lois Crenshaw
Kathy Brothen
Donna Clark
Kirk Fiereck
Rhys Fulenwider
Kelly Hansen - Parliamentarian
Doris Johnson
Nick Metcalf
Amy Moser
Rosemary Thomas
William Grier
Kevin Sitter
Drew Parks
Traci Capesius
Bankole Olatosi
Cliff Noltee
Wynfred Russell
Charlie Tamble
Gary Remafedi
Alissa Fountain
Jerry Moss
Fred McCormick
Adam Wennersten
Jared Erdmann
Lolita Davis Carter
Dr. Gizaw Tsehai
Luz Sánchez
Erick McCoy
Ruth Dauffenbach-Kotrba
Julie Hanson Pérez
Japhet Nyakundi
Georgia Harris
Absent:
Roxanne Anderson
Phillip Brown
Steve Moore
Becky Clark
Muhidin Warfa
INTRODUCTIONS
Introductions were made. Jerry Moss lit the candle. Rhys Fulenwider read the three goals of
community planning; Lois Crenshaw read the ground rules. The day’s expected outcomes were
reviewed. The April minutes were reviewed and approved. The April meeting evaluation
compilation was reviewed by Julie Hanson Pérez. The announcement sheets were passed
around.
Community Cooperative Council on HIV/AIDS Prevention Minutes 05/20/04 Page 1
MDH REPORT
Georgia Harris provided instructions for completing the reimbursement forms for CCCHAP
members. Lucy Slater announced that the state budget was given a 3% cut across the board.
MDH is not sure yet how this will impact the STD and HIV Section’s HIV prevention activities.
The HIV Prevention Leadership Summit (HPLS) will be held in Atlanta June 16-19, 2004.
There will be good representation from Minnesota at the conference. MDH is paying for Julie,
Gerry Anderson and Kip Beardsley to attend. NASTAD is sending Lucy, and the CDC is
sending Rosemary Thomas. Kelly Hansen and Wynfred Russell will also attend. They will
coordinate as possible in Atlanta in order to make the best use of their time in attending sessions.
Julie announced that this would be Kirk Fierek’s last meeting as he is moving to Baltimore to
enter a public health program at Johns Hopkins. Today is also Nick Metcalf’s last meeting.
They thanked Nick for his contributions to the CCCHAP over the last four years, and presented
him with a gift of appreciation.
Statewide Planning Update
Julie reviewed progress that has been made to date in terms of plans to move forward with
statewide planning efforts in collaboration with the Minnesota HIV Services Planning Council
(Planning Council).
Regions: Greater Minnesota has been divided into four regions based on existing Community
Health Services (CHS) regions. One of these four regions combines two CHS regions into one.
The metropolitan area will be defined as the 13 county eligible metropolitan area (EMA) so as to
be in line with the Planning Council. There are four counties that need to be placed with a region in
Greater Minnesota. Julie and Lucy will be meeting with staff from CHS for their suggestions as
how to group those counties based on actual working relationships with other Greater Minnesota
counties.
Annual Joint Statewide Meeting: The CCCHAP and the Planning Council will hold annual joint
statewide meetings, which will have a varying theme each year depending on where the two
planning bodies are in their planning processes. The first one will be in the fall of 2004 and will
be focused on prevention prioritization. In 2005, the focus will be training, informational
updates, and gap analysis. In 2006 the theme will be prioritization for care services.
Prioritization: Regional planning related to prevention will not be implemented as MDH does not
have the resources to support ongoing regional planning groups. Instead, participants will break
into groups by region at the annual statewide meetings and do regional prioritization. They will
follow the major population categories identified by CCCHAP. The Planning Council will do
regional planning for care services. It has not yet been determined whether the regions will set
their own priorities or develop a list of what they think is important that will then feed into the
Planning Council’s overall prioritization process. Services that are delivered on a statewide basis
(drugs, insurance, etc.) would not be identified as regional services.
Distribution Process: Whether prevention and care funds are distributed jointly will depend to
some extent on the target populations identified for prevention. It may not make sense to jointly
distribute funds if the populations are very different. The grantees for prevention and care
funding (MDH, Minnesota Department of Human Services, and Hennepin County Human
Services Department) discussed piloting a joint Request for Proposals (RFP) around a specific
service area, such as outreach, in the metro area before implementing it in Greater Minnesota.
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Grantees also discussed developing a common grant application form that would contain basic
questions to be answered by both prevention and care applicants. There would be additional
specific questions to be answered by organizations applying for prevention funds and for those
applying for care funds.
Allocations: Regional prioritization for prevention will be dependent on whether the CCCHAP
decides to set aside funds for Greater Minnesota. Greater Minnesota was identified as a
subpopulation at the April 2004 CCCHAP meeting, but it hasn’t been determined whether there
will be a set aside of funds. This will be discussed at the August CCCHAP meeting. The
Planning Council already has a Greater Minnesota set aside. This funding would be divided up
by region under the statewide process. For both prevention and care, a formula will need to be
developed for regional allocation of funds. Each region would receive a base amount, and the
formula would be based in part on epi data. Other factors to be considered in the formula are
still to be determined.
CONSENSUS 101
Kelly reviewed the consensus process, which is the process the CCCHAP primarily uses to make
decisions.
Gary Remafedi noted that during the recent restructuring process, it was decided that the
CCCHAP would serve as an advisory body to MDH and would contribute to the development of
the comprehensive HIV prevention plan. He stated that the discussion related to consensus
makes it sound as though the CCCHAP still has decision making power, which he doesn’t see as
fitting with the advisory role. He asked for clarification so that he can know how best to serve in
his role as member of the CCCHAP.
Julie responded that although in the past the Bylaws stated that the CCCHAP had responsibility
for developing the HIV prevention plan, she doesn’t really see any difference in the CCCHAP’s
role now that the Bylaws say that the CCCHAP will contribute to the development of the plan.
She pointed out that the CCCHAP has never technically written the document, although they do
review it and provide recommendations. The major decisions made by the CCCHAP related to
prioritization of target populations and identification of interventions (or the identification of
priority co-factors in the future) are what MDH uses to develop the prevention plan. It is then
MDH’s responsibility to decide how the plan is implemented.
Kevin Sitter responded to Gary that the CCCHAP makes recommendations to MDH and he is
hearing from Julie that the advice is germane and important. Gary replied that there are different
opinions of what the role of the CCCHAP is and asked that it be clarified. Rhys added that it
seems as though confusion about the role of the group is based on the fact that the bylaws now
state that the group acts in an advisory capacity. The CCCHAP is relying on the good will of
MDH to follow their recommendations. This may have been the case in the past as well, but it
wasn’t how the roles and responsibilities were described in writing. There is a disconnect
between the perception of what the CCCHAP used to do and what they perceive the CCCHAP is
supposed to do now.
Jared Erdmann stated that no matter the role of the CCCHAP, the decision making process is still
important. Whatever that looks like, there needs to be a decision making process in place in
order to be able to say the group has come to a decision. Amy Moser added that the CCCHAP
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needs to decide as a body what they are going to put forth as advice to MDH, and they do have
one big decision each year, which is whether or not they concur on the plan.
Lucy said this is a group represented by both the community and MDH. We work together to
develop the CCCHAP’s recommendations. The responsibility of developing the prevention plan
is a joint responsibility, so we are advising ourselves. That is why consensus is an appropriate
method for making decisions as it is a joint effort instead of being adversarial. Members are
expected to be accountable to the community for their decisions.
Charlie Tamble said the spirit of collaboration is the goal, but he feels that in the end, MDH
makes the final decisions, especially when it comes to community assessment, available
positions, and funding or unfunding programs. Since MDH is making those decisions, it is out of
respect that we clarify what the CCCHAP’s role is. Lucy replied that MDH has always been
clear that the role of CCCHAP is to make planning decisions. Implementation of that plan in
terms of who gets funded is entirely the responsibility of MDH, and always has been.
Charlie asked whether being accountable means that CCCHAP members have to be accountable
for what happens in these meetings or be accountable for what MDH implements as a result of
those decisions. Lucy replied that the accountability is related to the role CCCHAP has in terms
of identifying target populations and interventions [note: in future the CCCHAP will identify
priority co-factors instead of interventions].
Lucy noted that this is an ongoing conversation that is appropriate to raise whenever people have
questions or concerns about the role of the CCCHAP. Amy encouraged people to bring their
concerns to the Process and Procedures Committee, as they are responsible for discussing and
recommending changes to the Bylaws.
COMMUNICATION PLAN
During the restructuring process there was concern voiced about how to maintain communication
now that the CCCHAP doesn’t meet as often. Julie suggested the idea of a bi-monthly
newsletter and asked for ideas of what information to include. The following were suggested:
Updates on what MDH is doing related to planning and implementation
Updates on committees: Membership & Training, Process & Procedures, Joint Co-chairs
Calendar
- Meetings
- Community forums
- Homework expectations in preparation for meetings
Recruitment efforts for new members
Updates on Statewide and Linkages efforts
Community input mechanism
Training opportunities
FACTORS FOR PRIORITIZATION
Review of Prioritization Process
Julie reviewed the decisions that were made at the April meeting regarding the prioritization
process (refer to April meeting minutes for details). Kevin asked whether it would be prudent to
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include MSM/IDU as a subpopulation under both the MSM and the IDU major population
categories, instead of just including it under IDU. His reasoning was that those providing
services to IDUs might not have as much cultural specificity and sensitivity in serving MSM, and
providers serving the MSM population may not be as skilled in serving IDUs. He is concerned
that placing MSM/IDU only in the IDU category would lead towards implementation of
programs only by agencies whose expertise is in serving IDUs. Julie responded that at the last
meeting, the CCCHAP identified core risk factors that every program will have to address. One
of them is sharing injection and other skin puncturing materials, so MSM programs will be
required to address the issue of IDU. Kevin asked for stronger assurance that MSM/IDU will be
appropriately served.
Lucy stated that since the CCCHAP is using epi data to identify target populations, duplicating
priority populations in two areas in order to assure implementation of programs doesn’t seem
true to the prioritization process. Kevin responded that the prioritization process will influence
the RFP process and implementation. He stated that he is raising the issue here because he
doesn’t have any control over the RFP process. Amy pointed out that the decisions about
subpopulations had been made at the last meeting. Kevin was willing to end the discussion, and
Lucy assured him that his comments would be reflected in the minutes.
Review of Factors
After discussion at the April meeting, a process was decided on for prioritizing target
populations that requires CCCHAP members to consider different factors, or pieces of
information. The type of worksheet that will be used to do the actual prioritization was agreed
upon also. The CCCHAP will be working on refining the components of the worksheets in
several steps. Today the group will identify which factors should be considered and what
information should be included under each of them. The development of the rating scales for
each factor will be done in August. The CCCHAP will then assign a weight on a scale of 1 to 5
to each of the factors in order to denote their relative importance. This will happen in February
or March 2005, just prior to doing the actual prioritization.
Julie briefly reviewed documents used at the last meeting during the discussion about
prioritization models. She asked that the group consider the nine factors presented in the
documents (HIV incidence, trends, HIV prevalence, population size, impact, risk behaviors, cofactors, barriers to prevention information/services, other resources) as a starting point for
today’s discussion. She explained that they would be breaking into small groups in order to
discuss the following questions:
1. Are there any factors that should be added? If so, why?
2. Are there any factors that should be deleted? If so, why?
3. What type of information should be included for each of the factors? Why?
She clarified that the term “factor” comes from the Academy of Educational Development
(AED), which developed the prioritization model the group decided to use. In the context of
prioritization, factors refer to pieces of information that are taken into consideration when
making decisions.
Gary asked how much leeway the small groups had in adding or deleting factors. Lucy
responded that they have quite a bit of leeway. There are no specific factors that MDH thinks
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absolutely need to be included. What should be taken into consideration is which pieces of
information are available and can actually be collected for all the populations, and to which it is
feasible to apply realistic rating scales and weighting. The other thing to think about is how
much information is needed to make good decisions.
Rhys said that the CCCHAP may want to consider the availability of information about specific
subpopulations; for example, there has been a lot of research and work done with gay white men,
whereas there has been a lot less done with African American men on the down low. This lack
of information would make it difficult to make scientifically justifiable decisions. Julie
responded that the information related to co-factors would be a combination of research, needs
assessment data, and information gleaned from community groups and community forums.
Lucy added that about half of the factors involve real or estimated numbers; the others are based
at least in part on community input and anecdotal information. She felt that the process should
include both types of information, but does not want to have factors that should be expressed as a
number but are not quantifiable. Rhys agreed, and stated his concern is marginalizing
populations that need prevention work but don’t have the research to substantiate that need.
Lucy suggested the possibility of adding the lack of information/research as another factor.
Factors for Prioritization
After the small groups reconvened, Julie asked for their suggestions for additional factors:
1. Incidence Rate
2. Change “Impact” to a “Disparity,” which would be described as a ratio
3. Add each of the Core Risk Behaviors (CRB) identified at the April meeting as an individual
factor. Add one additional CRB: HIV negative person having unprotected sex or risk with a
known HIV positive person.
4. Marginalized populations
5. Co-morbidities (STDs, unintended pregnancy, IDU/chemical dependency, mental health)
6. Change “Impact” to “Community Impact”
a. YPLL (years of potential life lost)
b. Medical expenses associated with not preventing HIV infection
c. Socioeconomic costs associated with not preventing HIV infection
7. Community readiness, or the extent a community is ready to use prevention services
8. Historical weight (history of marginalization, what has been done within this community in
the past)
9. Current resources by population (equity in terms of FTEs available to serve population)
10. How much published information available for each population
11. Accessibility of services and accessibility of population (how easy it is to reach a population)
12. Change “Other Resources” to “Other Resources Available”
Suggestions for factors to remove:
1. Risk behaviors – every population engages in risk behavior
2. Other Resources – availability of services does not equal utilization
3. Prevalence
4. Impact - the information contained here is misleading
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Discussion
Several members spoke in favor of adding incidence rate as a factor. The rate offers a way to
compare populations that are fairly diverse, particularly in populations where there hasn’t been a
lot of research done. Raw numbers, such as the number of new cases in a population, don’t really
allow for comparison.
Peter Carr, epidemiologist at MDH, explained some of the epidemiological terms being
discussed. Prevalence refers to the number of living HIV/AIDS cases at a certain point in time,
such as at the end of 2003. Incidence refers to the number of new HIV cases diagnosed within a
certain time period, such as during 2003. Incidence and prevalence may be reported as a number
or a percentage. For example, MSM accounted for 116 newly reported infections in 2003, or
44% of all new infections in that year.
Incidence rate is the number of new infections by population, which can be broken down by age
group, race/ethnicity, gender, etc. Prevalence rate is the number of living HIV/AIDS cases by
population. The rate allows us to compare the impact of the disease in different populations,
taking into account the population size. For example, in a population of 30,000 people that has
100 new infections, the incidence rate would be relatively high (333 per 100,000). In a
population of 3,000,000 people with 300 new infections, the incidence rate would be low (10 per
100,000), even though the actual number of cases is higher in the second population. Rate is
calculated by dividing the number of infections by the size of the population (100/30,000 =
.003333) and multiplying by 100,000. Rate accounts for the impact of disease relative to the size
of the population.
Peter went on to state that one of the reasons for using prevalence data in the prioritization
process is that it gives us an estimate of the size of the pool of infection. If there are only 10
people in a group who are infected, there is a smaller chance of being exposed to an infected
person because that number is so small. If there are 1,000 people who are infected in a group,
there is greater opportunity to come into contact with someone with the disease.
Amy suggested maintaining incidence and prevalence as factors, and adding both incidence and
prevalence rates. She asked if population size would need to be maintained as a factor since it is
used to calculate the rate. Julie replied that although the size of the population is used to
calculate the rate, the resulting rate is expressed as a number and you won’t know what the
population size was. If there is a high incidence rate in a small population and the same high
incidence rate in a larger population, the information regarding population size can help inform
prioritization decisions.
The group then discussed whether to add incidence rates and prevalence rates as separate factors,
or to include them as pieces of information under the incidence and prevalence factors
respectively. The group agreed that it is important to have them as four separate factors
(incidence, incidence rate, prevalence, and prevalence rate) in order to allow for rating and
weighting each of them individually.
Consensus: The CCCHAP agreed to add incidence rate and prevalence rates as factors.
It was decided that the remainder of this discussion would be postponed until the next day to
allow the co-chairs and staff time to determine an effective process.
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CALCULATION OF POPULATION SIZE
Methodology
Peter explained how population size estimates were developed for the various subpopulations
included under the major target populations of HIV Positive Individuals (HIV+), Men Who Have
Sex with Men (MSM), High Risk Heterosexuals (HRH), Injection Drug Users (IDU), and
Greater Minnesota (GM). The purpose of this conversation is to have the CCCHAP come to
consensus about how population size is defined for the various subpopulations. These
population sizes will be used to calculate incidence and prevalence rates, which as decided
earlier, will be two of the factors taken into consideration during prioritization. Two basic
sources of information were used in the population size calculations, the 2000 U.S. Census data
and the HIV/AIDS surveillance data collected at MDH.
HIV Positive Individuals
HIV/AIDS surveillance data were used to determine population size for the HIV +
subpopulations (MSM, HRH, IDU, Youth ages 13 - 24). One limitation of the surveillance data
is that there are a number of cases that have no known risk identified. A method developed by
CDC was used to redistribute risk in order to assign a transmission risk category to all cases
included in the surveillance data. This method was presented and discussed at the April
CCCHAP meeting.
Men Who Have Sex with Men
Census data were used as the starting point to estimate the size of MSM subpopulations (MSM
of All Races, MSM of Color, Young MSM ages 13 – 24). Census data were used to calculate the
number of males by race and age group. Based on a 1996 national study conducted by Wells,
which looked at sexual behavior (not sexual orientation), the figure of 6% was used to estimate
the number of males in each of the subpopulations who have sex with men.
There was some discussion about whether there was any newer research that could be used.
Amy stated that she did not feel many studies had been done in communities of color at that
time. Peter was not aware of any newer studies but would welcome any information. A study
referenced in the prevention plan was done in Hennepin County in 2002 and found that 4%
males and 2% females identified as GLBT. The Census data include information about
unmarried households made up people of the same gender, which was 4.9% of the state. These
data do not take single households into consideration. Gary referenced an earlier study done of
37,000 youth, which estimates that about 2% were MSM. Peter stated that it is important to note
what is being measured; for example, asking participants if they are gay versus if they have had
sex with a man in the last 12 months. It is important to use data that look at behavior. Peter
agreed to look into whether there are any newer studies and use an updated estimate for MSM, if
available. The group agreed that the estimate for Young MSM should also be based on the most
recent study that can be found.
High Risk Heterosexuals
Census data were used to determine the size of the HRH subpopulations (African Men and
Women, African American Men and Women, Asian Pacific Islander Men and Women, Latino
Men and Women, Native American Men and Women, White Men and Women, and Young Men
and Women ages 13 – 24). From those estimates, and again based on the Wells study, an
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estimated percentage of men (0.8%) and women (0.3%) who only have sex with the same gender
was subtracted, meaning that bisexual men and women are included in the HRH subpopulations.
In regards to the calculation of the African-born heterosexual population, the Census estimate of
35,188 was used and divided evenly by gender. The number of African Americans was
calculated by taking the total number of people who identified as Black and subtracting the
number of African-born from each gender. Wynfred Russell felt that the numbers for Africans
were an underestimate and suggested using information from the INS or international
government organizations. Peter suggested adding a footnote stating that the estimate is based
on census data but it is widely considered to be an underestimate. Jared suggested also adding a
similar footnote for the Latino population, since the Census data do not necessarily include
undocumented immigrants. He said it is estimated that there are 18,000 – 35,000 undocumented
Latino immigrants in Minnesota. Wynfred cautioned that any footnotes that are included should
be specific to each population as necessary.
Donna Clark asked if the Census data for Native American men and women included people
living on the reservations. Peter thought that it did. Rhys asked whether the numbers include
people who identify as being of multiple races. Peter did not think so, but said he would have to
check. The group was concerned that a lot of people would be left out if multiple races were not
considered. Peter said the easiest way to take multiple race into consideration using the Census
data is to use any mention, which means that anyone who mentions Native American gets
counted as Native American and if they also identify as White, they would be counted as White,
as well. This results in the population numbers adding up to more than the total number of
people in the state, but accounts for multiple racial identities. Peter suggested that he go back and
look at the data, and if it seems reasonable he will recalculate using the any mention count.
Peter mentioned another method that has been developed which converts multiple races to one
race. This has been done by looking at people who identify as having two races, such as White
and African American. They were asked to choose one race. Percentages were developed by
looking at the number of people who identified primarily as White and those that identified
primarily as African American. If, for example, 70% primarily identified as African American,
then 70% of people in the Census data who identified as both African American and White
would be placed in the African American population and the remaining 30% would be
considered White.
Rhys noted that increasing the numbers of people included in a population is not always
advantageous. If the size of a specific population is increased by including people who identify
as multiracial, the increased population estimate is then used when calculating HIV prevalence or
incidence rates. This then dilutes the rate. He suggested only using the numbers for people who
identify a single race and footnoting the underestimates as appropriate. Peter said he would
clarify what numbers are being used, and would calculate the size of the populations based on
the model that converts multiple races into one race so that the CCCHAP can compare the results
to the estimates based on single race categories.
Injection Drug Users
A study done by the Institute for AIDS research estimated that there were 8,081 IDUs in the 11
county eligible metropolitan area (EMA) in Minnesota. This number was used to calculate the
percentage of IDUs in the EMA, which was 0.27%. This percentage was then applied to the
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entire population of the state to arrive at an estimate for the subpopulation of IDU All Gender All
Races. To calculate the population size for the subpopulation of MSM/IDU, the estimate of all
IDUs was divided in half to arrive at an estimate of male IDUs, and that number was multiplied
by 6%.
Peter noted he thought this method led to an overestimation of the population size of IDU in
Greater Minnesota. Alissa Fountain and Kirk disagreed, saying that they thought that injection
drug use in Greater Minnesota is probably higher than in the metro area. It was also suggested
that the percentage for MSM/IDU is probably higher than the 6% estimate used for MSM. Rhys
recommended including sex workers because there are a number of men who are able to get their
fix because they become sex workers.
Greater Minnesota
The calculation of population size for the GM subpopulations (HIV+, MSM, HRH, IDU, Youth)
varied somewhat according to the population. For HIV+, surveillance data were used to identify
the number of people living with HIV/AIDS outside of the eleven county metropolitan area. For
MSM, the number of males living in the GM counties was multiplied by 6%. HRH was
calculated by totaling the number of men and women living in GM counties, and then subtracting
the estimated percentage of men (0.8%) and women (0.3%) who only have sex with the same
gender. The estimate of IDU was calculated by multiplying the population outside of the metro
area by 0.27%. Census data were used to identify the number of youth living in GM ages 13 to
24. Kirk asked if there were studies that estimate the size of MSM populations in rural areas. He
felt that it is probably lower than 6% in GM.
Definition of Target Populations
Jared asked how the category of high risk heterosexuals is being defined. Peter replied that
according to these population estimates, they are defined as everyone but the 0.8% of men and
0.3% of women who identify as having sex only with the same gender, based on the 1996 Wells
study. Jared was concerned about considering HRH as a target population without really having
a clear notion of how “high risk” is being defined or what level of risk exists within the
population.
Rhys asked if there was any research that would help define high risk heterosexuals. Peter is
aware of a risk factor surveillance system that asks a few questions about sex, and he would be
willing to explore that data to come up with a more accurate estimate. Rosemary said she did a
grant review for Michigan last year and they defined HRH very clearly in the RFP process. The
definition was someone who has sex with someone who is HIV+, someone who had sex with an
IDU, and/or someone who is a prostitute.
Julie noted that the size of the population at high risk is not being calculated for any of the target
populations. For example, the size of the MSM population is an estimate of how many men have
sex with men; we are not identifying how many MSM are engaging in high risk behaviors. She
suggested for consistency’s sake, that the group either: 1) try to come up with population size
estimates of how many members of each target population are actually at risk, which could be
quite difficult to do, or 2) change the name of the high risk heterosexual population to just
heterosexual, and continue to estimate all population sizes as previously described.
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Gary liked the idea of identifying what percentage of people are at high risk because programs
that are working with heterosexual people at risk are looking at a small percentage of the
heterosexual population, which is difficult to find and tough to work with. Jared noted that we
tend to categorize people but don’t bring out the complexities within the groups very much. He
wondered if this is something that can be noted for future development.
Kirk said that he thinks it would be better statistically to find a more manageable and true
number for HRH than it would be to find the real number of high risk MSM. The MSM
population is small compared to the total population, and the chance of a low risk MSM having
sex with a high risk MSM is much greater than that of a low risk heterosexual having sex with a
high risk heterosexual. Amy felt that it would be dangerous to say that a person is at risk just
because he is an MSM.
Consensus: The CCCHAP agreed to define all of the populations as being high risk, and that the
population size estimates would be defined as the number of people within each of the
populations that are at high risk.
ANNOUNCEMENTS
Kevin announced that Dr. Tony Mills will be in town on June 10 and 11, 2004, and will be
meeting with consumers and providers to talk about HIV, barebacking, syphilis, and medication
interactions among MSM.
Amy announced that the HIV/AIDS Division at DHS has had to make big changes to the drug
and insurance program. A document with summary information was available on the back table,
and she will be available to answer questions tomorrow morning.
Lolita Davis Carter announced that the Minneapolis Urban League will be having a Juneteenth
kickoff celebration. The phone number fore more information is 612-302-3145.
ADJOURNMENT
The meeting was adjourned at 5:00 p.m.
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