Highlights from the MN HIV Surveillance Report, 2011 Minnesota Department of Health HIV/AIDS Surveillance System HIV/AIDS in Minnesota: New HIV Infection, HIV (non-AIDS) and AIDS Cases by Year, 1996-2011 *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. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Estimated Number of Persons Living with HIV/AIDS in Minnesota As of December 31, 2011, 7,136* persons are assumed alive and living in Minnesota with HIV/AIDS 3,775 living with HIV infection (non-AIDS) 3,361 living with AIDS * 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. 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, 1996-2011 *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. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Kittson HIV Infections† by County of Residence at Diagnosis, 2011 Roseau Lake of the Woods Marshall Koochiching Pennington Beltrami Norman Clearwater Polk Cook Mahnomen Itasca Lake St. Louis * Red Lake None 1-2 3-6 Hubbard Becker Clay Number of Infections 7 - 15 Cass 16 - 54 Crow Wing Otter Tail Kanabec Isanti Sherburne Hennepin McLeod Renville Carver Scott Dakota Sibley Redwood Nicollet Le Sueur Rice * Lyon Rock Nobles Cottonwood Jackson Blue Earth Watonwan Martin Faribault Waseca Steele Freeborn Data Source: Minnesota HIV/AIDS Surveillance System *Counties in which a state correctional facility is located # 7-county metro area, excluding the cities of Minneapolis and St. Paul Goodhue Wabasha Brown Pipestone Murray Total number = 292 * Lincoln Ramsey Wright Kandiyohi Meeker * Yellow Medicine Anoka * Lac qui Parle Chippewa * Swift Chisago Benton Stearns Big Stone City of Minneapolis – 101 City of St. Paul – 43 Suburban# – 107 Greater Minnesota - 41 Washington Pope Mille Lacs Stevens Morrison * Traverse Douglas 55 - 175 Pine Todd Grant Carlton * Wilkin Aitkin * Wadena Dodge Mower Olmsted Winona Fillmore †HIV or AIDS at first diagnosis Houston HIV/AIDS in Minnesota: Annual Review Map of Metro Area: HIV Infections† by County of Residence at Diagnosis, 2011 Number of Infections Anoka * None Washington 1-2 3-6 * Hennepin 7 - 15 16 - 54 Ramsey 55 - 175 City of Minneapolis – 101 City of St. Paul – 43 Suburban# – 107 Carver Total number (Metro only) = 251 Scott * Dakota * Counties in which a state correctional facility is located 7-county metro area, excluding the cities of Minneapolis and St. Paul # Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* in Minnesota by Residence at Diagnosis, 2011 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 or AIDS at first diagnosis Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Gender and Race/Ethnicity HIV/AIDS in Minnesota: Annual Review HIV Infections* by Gender and Year of Diagnosis, 1996 - 2011 * HIV or AIDS at first diagnosis Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Diagnosed in Year 2011 and General Population in Minnesota by Race/Ethnicity * HIV or AIDS at first diagnosis † Population estimates based on 2010 U.S. Census data. Data Source: Minnesota HIV/AIDS Surveillance System n = Number of persons Amer Ind = American Indian Afr Amer = African American (Black, not African-born persons) Afr born = African-born (Black, African-born persons) HIV/AIDS in Minnesota: Annual Review HIV Infections* Diagnosed in Year 2011 by Gender and Race/Ethnicity Males (n = 218) * HIV or AIDS at first diagnosis Data Source: Minnesota HIV/AIDS Surveillance System Females (n = 74) 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 HIV/AIDS in Minnesota: Annual Review Number of Cases and Rates (per 100,000 persons) of HIV Infection* by Race/Ethnicity† – Minnesota, 2011 Race/Ethnicity Cases % Rate 143 49% 3.2 Black, African-American 64 22% 32.6 Black, African-born 44 15% 60.3 Hispanic 24 8% 9.6 American Indian 4 1% 7.2 Asian/Pacific Islander 8 3% 3.7 Other^ 5 2% x 292 100% White, non-Hispanic Total * HIV or AIDS at first diagnosis; 2010 U.S. 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. † Estimate of 72,930 Source: Retrieved from MNCompass.org on 3/22/12. Additional calculations by the State Demographic Center. ^ Other = Multi-racial persons or persons with unknown race †† Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Mode of Exposure HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Males by Mode of Exposure and Year of Diagnosis, 1996 - 2011 MSM = Men who have sex with men * HIV or AIDS at first diagnosis IDU = Injecting drug use Heterosexual = Heterosexual contact Unspecified = No mode of exposure ascertained Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Females by Mode of Exposure and Year of Diagnosis, 1996 - 2011 IDU = Injecting drug use Heterosexual = Heterosexual contact with HIV+ , with IDU, with partner with unknown risk Unspecified = No mode of exposure ascertained * HIV or AIDS at first diagnosis 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 - 2011 * HIV or AIDS at first diagnosis for a child exposed to HIV during mother’s pregnancy, at birth, and/or during breastfeeding. Note: an additional 2 children under the age of 13 years were diagnosed in Minnesota in 2011. Neither were born in the United States. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Special Populations HIV/AIDS in Minnesota: Annual Review Adolescents & Young Adults (Ages 13-24)* * Case numbers are too small to present meaningful data separately for adolescents and young adults. HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Adolescents and Young Adults† by Gender and Year of Diagnosis, 1996 - 2011 * HIV or AIDS at first diagnosis † Adolescents defined as 13-19 year-olds; Young Adults defined as 20-24 year-olds. 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, 2009 - 2011 Combined Males (n = 195) * HIV or AIDS at first diagnosis † Adolescents defined as 13-19 year-olds; Young Adults defined as 20-24 year-olds. Data Source: Minnesota HIV/AIDS Surveillance System Females (n = 35) n = Number of persons Amer Ind = American Indian Afr Amer = African American (Black, not African-born persons) Afr born = African-born (Black, African-born persons) Other = Multi-racial persons or persons with unknown race HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Adolescents and Young Adults† by Gender and Estimated Exposure Group#, 2009 - 2011 Combined Males (n = 195) Females (n = 35) * HIV or AIDS at first diagnosis n = Number of persons MSM = Men who have sex with men † Adolescents defined as 13-19 year-olds; Young Adults defined as 20-24 year-olds. IDU = Injecting drug use Heterosex = Heterosexual contact # Mode of Exposure proportions have been estimated using cases for 2009-2011 with known risk. For more detail see the HIV Surveillance Technical notes. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV and Hepatitis B, C co-infection HIV and Hepatitis B and C As of December 31, 2011* , 7,136 persons are assumed alive and living in Minnesota with HIV/AIDS Of these 7,136 persons, 855 (12%) are co-infected with either Hepatitis B or C Of the 855, 288 (34%) are living with HIV and Hep B Of the 855, 523 (62%) are living with HIV and Hep C Of the 855, 44 (5%) are living with HIV, Hep B and Hep C * 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. Data Sources: Minnesota HIV/AIDS Surveillance System and Minnesota Hepatitis Surveillance System Foreign-born Cases HIV/AIDS in Minnesota: Annual Review HIV Infections* among Foreign-Born Persons† in Minnesota by Year of Diagnosis and Region of Birth, 1996 - 2011 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. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review # HIV Infections* Among Foreign-Born Persons† by Gender and Year of Diagnosis, 1996 – 2011 •HIV or AIDS at first diagnosis † Excludes persons arriving in Minnesota through the HIV+ Refugee Resettlement Program, as well as, other refugee/immigrants with an HIV diagnosis prior to arrival in Minnesota. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review HIV Infections* Among Foreign-Born Persons† by Gender and Age, 2011 * 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. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Countries of Birth Among Foreign-Born Persons† Diagnosed with HIV*, Minnesota, 2011 • Mexico (n=12) • Kenya (n=11) • Liberia (n=10) • Somalia (n=7) • Ethiopia (n=5) • Viet Nam (n=3) • Other^ (n=21) * 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. ^ Includes 18 additional countries. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Late Testers (AIDS Diagnosis within one year of initial HIV Infection Diagnosis) HIV/AIDS in Minnesota: Annual Review Time of Progression to AIDS for HIV Infections Diagnosed in Minnesota*, 2001 - 2011† 29.3%^ 33.7%^ 35.4%^ 41.2%^ 30.6%^ 29.8%^ 32.0%^ 33.2%^ 35.6%^ 30.9%^ 30.5%^ *Numbers include AIDS at 1st 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 2011 only represents cases progressing to AIDS through April 2, 2012. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Progression to AIDS within 1 year of initial HIV Infection* Diagnosis by Gender, 2001 - 2011† *Numbers include AIDS at 1st 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. † Numbers/Percent for cases diagnosed in 2011 only represents cases progressing to AIDS through April 2, 2012. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Progression to AIDS within 1 year of initial HIV Infection* Diagnosis by Race/Ethnicity^, 2001 - 2011† *Numbers include AIDS at 1st 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. † Numbers/Percent for cases diagnosed in 2011 only represents cases progressing to AIDS through April 2 2012. ^Percentage not calculated if less than 10 cases diagnosed per year Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Time of Progression to AIDS for HIV Infections* Diagnosed Among Foreign-Born Persons, Minnesota 2001 - 2011† 40.6%^ 41.4%^ 59.3%^ 44.0%^ 49.2%^ 47.4%^ 42.5%^ 42.7%^ 40.3%^ 43.6%^ 48.3%^ *Numbers include AIDS at 1st 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 2011 only represents cases progressing to AIDS through April 2, 2011. Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review Conclusions There were 292 new HIV infections reported in MN in 2011 A decrease of 12 percent from 2010 Great disparities in HIV infection persist among populations of color and American Indians living in Minnesota Male-to-male sex remains the leading risk factor for acquiring HIV/AIDS in MN New HIV infection remains concentrated in the Twin Cities seven-county metro area (86% of new infections in 2011) Foreign-born persons made up nearly 1 in 4 of new HIV infections in 2011, and progress from HIV to AIDS more quickly than U.S. born persons living with HIV in Minnesota Data Source: Minnesota HIV/AIDS Surveillance System HIV/AIDS in Minnesota: Annual Review For more information, please contact: Allison La Pointe, HIV/AIDS Surveillance Coordinator allison.lapointe@state.mn.us (651) 201-4032 Hepatitis A, B & C in Minnesota, 2011 Minnesota Department of Health Hepatitis Surveillance System 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. Minnesota Hepatitis Surveillance System Hepatitis B reportable since 1987 Hepatitis C reportable since 1998 Passive data collection Introduction Data in this presentation are current through 2011 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 Data Source: Minnesota Viral Hepatitis Surveillance System Data limitations The slides rely on data from HCV and HBV cases diagnosed through 2011 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. Data Source: Minnesota Viral Hepatitis Surveillance System Acute Viral Hepatitis Acute case: Infected within the last six months Symptomatic Reported rate per 100,000 population of acute viral hepatitis United States, 1998-2009 Data Source: Surveillance for Acute Viral Hepatitis --- United States, 2007, May 22, 2009 / 58(SS03);1-27 Number of Acute Cases per year Minnesota, 1998-2011 Data Source: MN Viral Hepatitis Surveillance System Chronic Viral Hepatitis 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 Reported Number of Persons Living with HCV in MN As of December 31, 2011, 37,303* 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 HCV Infected Persons Identified through Passive Surveillance in MN through 2011 N=84,863** 37,303 Estimated unidentified HCV infected persons HCV infected persons* identified through passive surveillance 47,560 *Includes all acute, chronic, probable chronic, and resolved cases. Data Source: MN Viral Hepatitis Surveillance System **http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm Persons Living with HCV in MN by Current Residence, 2011 Total number with residence information= 35,883 (1420 missing residence information) 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. Data Source: MN Viral Hepatitis Surveillance System Persons Living with HCV in MN by Age, 2011 Median Age: 55 Data Source: MN Viral Hepatitis Surveillance System Persons Living HCV in MN by Gender*, 2011 *Includes anonymous methadone patients Data Source: MN Viral Hepatitis Surveillance System Persons Living with Chronic HCV in Minnesota by Race, 2011 Afr Amer = African American /Black Asian=Asian or Pacific Islander Amer Ind = American Indian Other = Multi-racial persons or persons with other race Persons Living with HCV in Minnesota rates (per 100,000 persons*), 2011 *Rates calculated using 2010 U.S. Census data Excludes 11,819 persons with multiple races or unknown race Data Source: MN Viral Hepatitis Surveillance System Overview of Chronic HBV in MN Chronic case: Infected for over six months Includes cases with no evidence of recent infection Asymptomatic or symptomatic Reported Number of Persons with Chronic HBV in MN As of December 31, 2011, 20,216* 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 Persons Living with HBV in MN by Current Residence, 2008 Total number with residence information = 19,501 (761 missing residence information) 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. Data Source: MN Viral Hepatitis Surveillance System Persons with Chronic HBV in MN by Age, 2011 Median Age: 42 Data Source: MN Viral Hepatitis Surveillance System Chronic HBV in MN by Gender, 2011 Data Source: MN Viral Hepatitis Surveillance System Persons Living with Chronic HBV in Minnesota by Race, 2011 Persons with unknown race=3,205 Data Source: MN Viral Hepatitis Surveillance System Afr Amer = African American /Black Asian=Asian or Pacific Islander Amer Ind = American Indian Other = Multi-racial persons or persons with other race Persons Living with Chronic HBV in Minnesota by Race rates (per 100,000 persons*), 2011 *Rates calculated using 2010 U.S. Census data Data Source: MN Viral Hepatitis Surveillance System Excludes 2524 cases with multiple races and unknown race Hepatitis C in Young Adults Age of Hepatitis C Cases by year, 2001-2011 Data Source: Minnesota Viral Hepatitis Surveillance System HIV and Hepatitis B, C co-infection HIV and Hepatitis B and/or C As of December 31, 2011, 20,216* persons are assumed alive and living in MN with chronic HBV Of the 20,216 , 288 (1.4%) are living with HIV and Hep B As of December 31, 2011, 37,303* persons are assumed alive and living in MN with chronic HCV Of the 37,303, 523 (1.4%) are living with HIV and Hep C * 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. Data Sources: Minnesota HIV/AIDS Surveillance System and Minnesota Hepatitis Surveillance System Thank you! Kristin.sweet@state.mn.us 651.201.4888 Hepatitis Programs Cheri Booth, MPH Awareness Events • • • • • • May is National Hepatitis Awareness month May 9th, HCV Tribal Summit- Mahnomen, MN May 15th is National Hispanic Hepatitis day May 19th is National Testing day July 28th is World Hepatitis day October 10-11th- Statewide Viral Hepatitis Symposium- Bloomington, MN Testing Programs • There are 7 MDH-funded testing sites which provide screening for hepatitis C – – – – – – – – – Red Door Clinic Clinic 555 MAP- MN AIDS Project Sacred Spirits Indigenous People’s Task Force Broadway Family Medicine (Outreach) RAAN- Rural AIDS Action Network Project Recovery MN Transgender Health Coalition Testing Programs • Two (2) sites also provide hepatitis B screening and confirmatory testing for both HBV and HCV – Red Door Clinic – Clinic 555 Risk-Based Service Promotion • Focuses limited resources on targeting those persons with the highest degree of risk. These risks are determined by epidemiological/ research evidence from the CDC and supported by data collected in our own state. • Focus of services for: – those at primary risk of infection – those who are undiagnosed and/ or not medically managed High Risk Target Populations • HCV Risk groups – Persons who Inject Drugs (PWID), especially those under the age of 30yrs. Includes those with any history of injection drug use. – Persons who have a sexual partner infected with HCV – Persons who received tattoos while incarcerated or in a non-professional setting – Vietnam Era military veterans who have not been screened – Persons who received blood or blood products prior to 1992 and have not yet been screened. – Infants and children born to HCV+ mothers. High Risk Target Populations • HBV Risk groups. Unvaccinated persons who: – Inject Drugs (PWID). Includes those with any history of injection drug use. – Have a sexual partner infected with HBV – Have multiple sexual partners and history of other STDs – MSM- Men who have sex with men. – Persons born outside the United States* and those born to HBV+ mothers. • Particularly on countries with higher rates of endemicity. (CDC recommendations) Resources • New CDC education/ awareness campaign • Trusted web sites/ programs – HBV/HCV Advocate – National Viral Hepatitis Roundtable – Asian Liver Center at Stanford University • MN resources • Chemical health – Harm Reduction Coalition • GLBT health – www.GLBThealth.org – http://lgbthealth.webolutionary.com/ • National Hepatitis Support – www.Hep4Help.org Resources http://www.cdc.gov/hepatitis/KnowMoreHepatitis.htm Resources • VA Hepatitis C Resource Centers – http://www.hepatitis.va.gov • HBV/HCV Advocate – www.hcvadvocate.org • Harm Reduction Coalition – http://harmreduction.org This webinar has been recorded and will posted at: http://www.health.state.mn.us/divs/idepc/diseases/hiv/hivstatistics.html Contact information for today’s speakers: HIV/AIDS Surveillance: allison.lapointe@state.mn.us - 651.201.4032 Hepatitis Surveillance: kristin.sweet@state.mn.us - 651.201.4888 Hepatitis Prevention: cheri.booth@state.mn.us - 651.201.4035