LA County Department of Public Health - AIDS/HIV Statistics Request Form

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HIV Statistics Request Form * Required Fields

Many of the requested HIV statistics within Los Angeles County are available by demographic groups and geographic areas in the Annual HIV Surveillance Reports and the LA County online health data query system Please utilize these resources before submitting a special data request for customized reports.

In addition, downloadable data sets, statistics, and maps for persons living with a diagnosed HIV infection (PLWH) in Los Angeles County are available at the ZIP code level at AIDSVu.org under Resources/Downloadable Maps and Resources.

For other specific requests on HIV surveillance data and statistics, please submit the following form either online or via fax. Alternatively, you may call HIV Surveillance Data Request Hotline at (213) 351-8516 (option 2) for assistance. The minimum turn-around time for a standard data request is 10 working days.

Requestor Contact Information

* First Name:

* Last Name:

Job Title:

* Organization Type:

Other (please specify):

* Organization Name:

* Address:

* City:

* State:

* Zip Code:

* Telephone:

Extension:

Fax:

* Email Address:

Purpose

* What is/are your project/research question(s)?

* How will these data be used?

Media:		Please specify your selection(s) (e.g. NPR, LA Times, Daily Bruin):
Academia:		Other (please specify):
Public Health:		Other (please specify):
Other:		Other (please specify):

Data Specifications

NOTE: Before describing the requested data, please keep in mind that multidimensional tables may result in small numbers. To keep individual's information confidential, any data cells with less than 5 cases will simply be denoted as '<5'. Cross tabulations cannot be provided where (1) stratum-specific population denominators are <100, (2) the totals would allow for the calculation of the number and/or (3) a cell contributes to the majority of events. Further, hospital, physician or site-specific aggregate statistics will not be released.

* Please describe the data you are interested in. Additionally you may also make your selection(s) below (see 1. and 2.). Unless otherwise specified, the time period for data requests is based on the period during which cases were reported.

1. Disease measurement by year(s), time period(s), and geographic area(s) (select all that apply)

* Disease measurement(s)
	*Stage of HIV infection:	*Measure of interest:	New diagnoses Living with diagnosis Cumulative diagnoses Annual deaths Other (please specify):

* Time period(s)
	All years (cumulative) Aggregated years: from to Individual years: Other (please specify):

* Geographic area(s)
	Los Angeles County Service Planning Area (SPA): To make multiple selections, hold the CTRL key and click on selections with your mouse. Area defined by ZIP Code: (please specify) Other (please specify):

2. Demographic and risk factors (select all that apply)

Demographics
	Sex at birth:
	Age group(s):	Other (please specify):
	Race/ethnicity:	All Black Hispanic or Latino White Asian/Pacific Islander American Indian/Alaska Native

Risk factor(s):
	Transmission category:	All Men who have sex with men (MSM) Injection drug users (IDU) MSM/IDU Hemophilia Heterosexual contact Perinatal exposure Other (please specify):
Other characteristics
	Other (please specify):

Data Delivery Method

* Desired Completion Date: MM/DD/YYYY

Desired delivery format (optional) Unless otherwise specified, you will receive the data as an email attachment in PDF format.

Email with attachment in another format (please specify):

Fax

Mail

Other (Please specify):

By submitting this data request I agree to the following provisions:

Protecting the confidentiality of HIV/AIDS surveillance information is the foremost concern of the Division of HIV and STD Programs (DHSP). The release of surveillance data containing individually identifying information is strictly prohibited. The terms and conditions for the release of data must be consistent with applicable laws.
DHSP reserves the right to suppress data to maintain case confidentiality.
All publications using the data provided must acknowledge DHSP. The following is a suggested citation:
Los Angeles Department of Public Health, Division of HIV and STD Programs.
The dissemination of any interpretations or findings based upon the data provided must be accompanied by the following disclaimer:
The authorized release of HIV/AIDS summary data by the Los Angeles Department of Public Health, Division of HIV and STD Programs, should not be construed as an endorsement of any analyses, interpretations, or conclusions reached by the author(s).
The data provided will be used only for the purposes stated in the data request form.

The time period for data requests is based on the period during which cases were reported, unless otherwise specified. Please submit your request only if data is not available at AIDSVu.org, the LA County online health data query system, or in our Annual HIV Surveillance Reports at http://publichealth.lacounty.gov/dhsp/Reports.htm/.

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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.