Officials from the Minnesota Department of Health are comparing it to the “bad old days” of the early 1990’s – rates of new HIV cases among young gay and bi men in 2009 are on track to match similar rates from 1992, when much of gay America was being ravaged by the worst of the HIV pandemic.

According to an announcement emailed by MDH to many of the state’s HIV testers and service providers early last month, 75 Minnesotans ages 15 to 25 had tested positive for HIV between January and September. That’s a 27 percent increase over new HIV cases in the same age group for all of 2008, driving overall HIV rates up 25 percent from the same time last year.

Most of the new HIV cases are likely to be in the Twin Cities metropolitan area based on past trends and the 2009 data, said Peter Carr the Director of the HIV and STD Unit at the Minnesota Department of Health. While some of the dramatic new increase is borne by women, Carr said, and there were increases in communities of color, most of the increase was among gay and bisexual men.

However, as troubling as this increase is, says Carr, public health officials don’t have a good idea about what’s driving the problem. Without this knowledge, health workers are hamstrung as they try to re-evaluate prevention strategies that are either not working, or not working well enough.

“Most of the important ‘why’ questions are anecdotal,” Carr told TheColu.mn. “The data’s not as hard on that as the simple epidemiology.”

In response, Carr said his department was launching an early review of 2009’s HIV data, in hopes of figuring out what’s driving this dramatic and unexpected surge in new infections. The analysis is due out at the end of this month.

Rob Yaeger, also with MDH’s HIV unit, cautioned that part of the surge may be the result of more people seeking regular HIV tests as a result of health education efforts within the gay and bi communities. “The question is not when they were tested, but when were they infected?,” Yaeger told TheColu.mn.

When thinking about solutions, however, Yaeger said problem is compounded by “mini-epidemics” within the larger Minnesota gay and bisexual community. Immigrants to Minnesota, Latino Minnesotans, African-American Minnesotans, and White Minnesotans, for example, are dealing with different sets of issues around HIV, he said, and couldn’t be lumped together.

“We can’t be thinking about one-size-fits-all about prevention and care,” he said

The information Carr and his colleagues uncover in their analysis will certainly be shared with other states and the federal government, Carr said, and will hopefully be included in the new National HIV/AIDS Strategy, currently being developed by Obama administration.

This is the first of a four-part series on the dramatic increase in reported incidence of HIV infection among gay and bisexual Minnesotan men, ages 15-24. Stay tuned for experts’ views on what might be driving this rise in cases, for the health system’s limitations as it tries to respond, and what the young men impacted and threatened by this crisis think.