August 2002

AIDS Care in Minnesota

When the NEAC board met in Minneapolis in April, its members were guests of the Minnesota AIDS Project (MAP), the state’s oldest and largest AIDS service organization. Jim Huber, director of behavioral health in the State of Minnesota Department of Human Services, gave an overview of the situation in the state, which is somewhat atypical (Jim also oversees AIDS services for the department). For instance, infection among injection drug users (IDU) is almost nil, because it’s relatively easy to get clean needles. On the other hand, there are a disproportionately large number of native American female IDUs who are infected because for some time, the clean-needle law had been “at the discretion of” pharmacists, and people on reservations found it harder to get them.

The epidemic, Jim said, is disproportionately affecting gay men, especially African Americans, but there is also an emerging group of African-born people, especially Somali and Ethiopian. HIV-positive refugees are resettled in six cities; one is Minneapolis. And about 10% of Minnesotans who are HIV-infected live in rural areas, where it’s hard to find comprehensive services.

Management of Ryan White Title II is in the Human Services Department rather than the Health Department because it has a better state-wide structure, operating on a concierge model where the case manager is service coordinator.

Jim sees a particular need to focus prevention education on people who are already infected. However, health education is handled by a different department.

MAP Executive Director Lorraine Teel explained how the agency operates. It’s a professional and peer-based system, with nearly 70 paid staff members and 1,200 volunteers plus 3,000 advocates statewide who respond to calls for lobbying help and work within their communities. It provides full case management, from legal services to life enhancement, and offers a huge variety of educational programs.

MAP is constantly trying to get more information; it added some questions to a toothpaste survey in 2001 and discovered that 50% of those who responded are still not sure how HIV is transmitted. As Lorraine said, “The public remains uncertain about HIV. Uncertain about how it is and isn’t transmitted. Unsure about whether condoms even protect against HIV. And sadly, uncertain how to talk about HIV. It’s time to rededicate ourselves to providing basic HIV 101.”

MAP is certainly leading the way. It has a terrific workplace education program, because“people trust the health information they get from their employers.” MAP sees its role as making sure employers have the right information to share. It’s also teaming up with the Jaycees Family AIDS Network and the CDC Business and Labor Respond to AIDS Program to deliver the service.

One unusual and copyable initiative is the Lunch Out Loud program, MAP’s World AIDS Day commemoration event. On November 30, 2001, people living with HIV in 11 communities (including Minneapolis) got together with their lawmakers over lunch for conversations about living with AIDS. It’s a great way to let state legislators and local elected officials know that HIV is not just a “big city” problem. “Once people started talking and asking questions, we couldn’t get them to stop,” one local coordinator said. “I feel our legislators learned some first-hand information they did not know before.” Although some people were at first reluctant to tell their stories, “those that did left feeling that it was a valuable experience.”

MAP sees a special need to find ways to improve HIV services for gay/bi men of color. “The essential reality for men who come from African American, Asian American, Latino American and Native American cultural traditions is that those traditions often come in conflict with gay/bi sexual identity….MSM of color probably have some amount of identity crisis and do not want to be openly and politically associated with what is considered ‘gay.’” The MAP solution is PrideAlive, an approach to younger gay men that starts education with a series of diverse topics in which sexuality is part of, but not the sole, focus. It provides the starting point for MSM of color to be drawn in an indirect manner to deal with their sexual identity, at their own pace, in an environment free of a gay stigma.