Ryan White Services and Unmet Need
Ryan White Services in Minnesota
This section of the profile provides a description of people who use the Ryan White HIV/AIDS
Program services in Minnesota, both within the TGA (Part A and Part B) and Greater Minnesota
(Part B), and quantifies the unmet need for primary medical care.
DATA SOURCES
The data presented in this section comes primarily from two sources, the enhanced HIV/AIDS
Reporting System (eHARS) and the Minnesota CAREWare system used by all agencies providing
Part A, Part B, ADAP and state-funded HIV services.
Since almost all Ryan White services are dependent on financial eligibility, it should not be
expected that everyone living with HIV/AIDS in Minnesota would be eligible and/or receiving
Ryan White services. Therefore, surveillance data should not be used as the standard by which
services are measured, but as an additional piece of the puzzle in describing HIV/AIDS care in
Minnesota.
OVERVIEW OF RYAN WHITE IN MINNESOTA
COMPARISON OF EPI AND UTILIZATION DATA
The number of clients utilizing Ryan White services has steadily grown from 1,771 in 1996 to
4,117 in 2014. This is compared to 7,988 people assumed to be living with HIV in Minnesota that
are in surveillance. Over the past three years, several of the funded services have seen increases
in the number of people being served.
GENDER
Males comprise the majority of those living with HIV/AIDS in Minnesota, accounting for 76% of
all cases. A similar distribution is seen among those receiving services, with males accounting for
70% of clients and females accounting for 29%. Transgender persons make up about 1% of those
receiving services and 0.5% of all cases in surveillance.
Minnesota HIV/AIDS Epidemiologic Profile—Ryan White Services and Unmet Need
December 2015
AGE
Persons ages 40-55 account for the most (47%) of the people receiving Ryan White services in
2014. Adolescents and young adults (ages 13–24) account for 5% of those receiving services. The
age distribution of those receiving services is similar to those living with HIV/AIDS according to
surveillance. People ages 40-55 account for 50% of those living with HIV/AIDS and adolescents
and young adults account for 4% (data not shown).
MODE OF EXPOSURE
People Living with HIV/AIDS By Mode of Exposure in
Minnesota, Ryan White Clients and Surveillance, 2014
There are substantial
Surveillance
differences in the mode of
Ryan White Clients
n=7,988
n=4,117
exposure distribution
Unspecified
Unspecified
between people receiving
15%
Other 7%
Other
3%
Ryan White Services and the
MSM
2%
44%
mode of exposure
distribution of everyone living
with HIV in Minnesota who
Hetero
are in surveillance. While
38%
Hetero
MSM account for 51% of
22%
those living with HIV/AIDS in
IDU
MSM/IDU
MSM/IDU
surveillance, they only
IDU
5%
5%
3%
5%
account for 44% in Ryan
n = Number of persons MSM = Men who have sex with men
IDU = Injecting drug use
Heterosexual contact with someone with or at risk for HIV
White clients. People with a
Other = Hemophilia, transplant, transfusion, mother w/ HIV or HIV risk
risk of heterosexual contact
make up a greater proportion of Ryan White clients than in surveillance, accounting for 38% of
Ryan White clients and 22% of people in surveillance.
RACE/ETHNICITY
There are differences in the racial/ethnic distribution between people receiving Ryan White
Services and everyone living with HIV in Minnesota who is in surveillance. While white people
account for half of the people living with HIV/AIDS in Minnesota, they account for 40% of the
people receiving Ryan White services. People of color account for the other half of the people
living with HIV/AIDS in Minnesota, and 60% of those receiving Ryan White Services.
Minnesota HIV/AIDS Epidemiologic Profile—Ryan White Services and Unmet Need
December 2015
MSM
51%
People Living with HIV/AIDS By Race/Ethnicity in Minnesota,
Ryan White Clients and Surveillance, 2014
Ryan White Clients
(n=4,117) Native
Other
4%
Asian/Pacific
Islander
2%
Hispanic
11%
Surveillance
(n=7,988)
American
2%
White
50%
White
40%
Other
3%
Black**
41%
Black**
35%
Hispanic
9%
Native
American
1%
Asian/PI
2%
*Includes 2 cases from Pierce and St. Croix Counties in WI.
**Black – includes both African Americans and Black, African-born persons.
***Other – Multi-racial persons or persons with unknown race
GEOGRAPHY
The table below shows that the proportion of HIV positive people receiving services is greater
the TGA than in Greater Minnesota. Additionally, based on the number of people served by Ryan
White, the majority of people accessing Ryan White services live in the TGA (86%) compared to
13% in Greater Minnesota. In addition, 1% of people receiving services have unknown counties
of residence, and less than 1% reside in other states.
Number of People Receiving Ryan White Services and Living Cases of HIV/AIDS, Minnesota 2014
Greater MN
13-County TGA
Number Receiving
Services*
Number in Surveillance Ŧ
Percentage Receiving
Services
541
1,128
48%
3,529
6,832
52%
* Includes 10 cases from Pierce and St. Croix counties, does not include 43 cases with unknown residence.
Ŧ
Does not include 38 cases with unknown residence.
Minnesota HIV/AIDS Epidemiologic Profile—Ryan White Services and Unmet Need
December 2015
SERVICES RECEIVED IN 2014
Number of Clients Served
In 2014, Medical Case
Most Utilized Ryan White Care Services, Minnesota
Management was the
2012-2014
most utilized service,
with 2,960 clients (72%
2012
2013
2014
of clients) accessing
3500
case
management
3067
2968 2960
3000
services.
Medical
Transportation Services
2500
was the next most
utilized service with
2000
1,517 clients (37% of
1610 1584 1571
1479 1510
1460
1444 1429 1442
1500
clients), followed by the
1311
1091
1086 1132 1044
Meal Services with
1000
773
1,442 clients served
(35% of clients), AIDS
500
Pharmaceutical
0
Assistance
Program
MCM
ADAP
Outpt./Amb. Med.
Emergency
Transportation
Meal Services
(ADAP) with 1,311
Care
Financial
Assistance
clients (32% of clients),
and emergency financial
assistance with 1,044 clients (25% of clients). The next most used services were Case
Management (non-medical), Outpatient/Ambulatory Care, and Oral Health Care with 871, 773,
and 622 clients, respectively.
Characterizing Unmet Need for Primary Care among HIV Positive People
The definition of unmet need for primary medical care is: “An individual with HIV or AIDS is
considered to have an unmet need for care (or to be out of care) when there is no evidence that
s/he has received any of the following three components of HIV primary medical care during a
defined 12-month time frame: (1) viral load testing, (2) CD4 count, or (3) provision of antiretroviral therapy (ART).” 1
MDH calculated an estimate of unmet need using data in eHARS to determine the number of
people living with HIV/AIDS as of December 31, 2014 and how many of those individuals had
received a CD4 or viral load test in 2014.
As of December 31, 2014 there were 7,988 persons living with HIV/AIDS in Minnesota. Using the
methodology described above, we are able to estimate that of those, the number not receiving
primary medical care for their HIV is 2,149 or 27% of people living with HIV/AIDS in Minnesota.
1
HRSA/HAB definition of unmet need
Minnesota HIV/AIDS Epidemiologic Profile—Ryan White Services and Unmet Need
December 2015
The table below shows the number of people living with HIV/AIDS who are in and out of care by
race, gender and mode of exposure.
Demographic Characteristics of Out of Care PLWHA in Minnesota, 2014
Number
Number
Number
In Surveillance
In Care
Out of Care
Race*
White, not Hispanic
3,977
3,065
912
Black, not Hispanic
2,819
1,948
871
African American
1,719
1,177
542
African-born
1,100
771
329
Hispanic
716
459
257
American Indian
121
96
25
Asian/Pacific Islander
153
117
36
Multiple Races
180
147
33
Sex at Birth
Male
6,108
4,443
1,665
Female
1,880
1,396
484
Mode of Exposure
MSM
4,046
3,012
1,034
IDU
429
283
146
MSM/IDU
405
307
98
Heterosexual contact
1,775
1,316
459
Mother with HIV
103
90
13
Other/hemophilia/blood transfusion
34
27
7
Unspecified risk
1,196
804
392
Total
7,988
5,839
2,149
Percent
Out of Care
23%
31%
32%
30%
36%
21%
24%
18%
27%
26%
26%
34%
24%
26%
13%
21%
33%
27%
*Excludes individuals of unknown race
Minnesota HIV/AIDS Epidemiologic Profile—Ryan White Services and Unmet Need
December 2015