Many of the requested AIDS statistics for Los Angeles County and the Service Planning Areas (SPA), cities, and Health Districts (HD) within the county are available in the Advanced HIV Disease (AIDS) Surveillance Summary. Please review the summary report before completing a data request. (This publication is available for download at http://www.publichealth.lacounty.gov/hiv/index.htm in the REPORT section or can be mailed to you upon request via phone: 213-351-8516)

Please Note: Since HIV infection only became reportable in July of 2002, non-AIDS HIV data will not be available until such data are more complete and accurate; therefore requests for information on persons with HIV who do not have AIDS cannot be processed at this time. If the information that you require is not included in the summary report, please submit the following form either online or via fax. Please allow ten working days for completion.

Requestor Contact Information
* First Name:
* Last Name:
Job Title:
* Organization:
* Address:
* City:
* State:
* Zip Code:
* Telephone:
Extension:
Fax:
* Email Address:
* Desired Completion Date:	MM/DD/YYYY
Detailed description of the request: When applicable, please indicate clearly (1) the time period(s) of interest, (2) the disease measurement(s) of interest-such as incidence or prevalence, cases by year of report or by year of diagnosis-(3) the geographical area(s) of interest, (4) the population of interest, (5) the demographic or risk variables for table breakdown, specify if you want cross tables. Note: To keep individual's information confidential, any data cells with less than 5 cases will simply be denoted as '<5'.
1.    * Time period(s): (check all that apply)
All years (cumulative)
Aggregated years: from to
Individual years:
2.    * Disease Measurement: (check all that apply)
Incident AIDS cases (cases occurring by year)
Number of cases by year of diagnosis
Number of cases by year of report
Prevalent AIDS cases (that is, persons living with AIDS)
Other measurements: (please specify)
3.    * Geographic area(s): (check all that apply)         To make multiple selections, hold the CNTL key and click on selection with your mouse
Los Angeles County
Service Planning Area                    (SPA):	ALL Antelope Valley East Metro San Fernando San Gabriel South South Bay West
Health District (HD):	ALL Alhambra Antelope Valley Bellflower Central Compton East LA East Valley El Monte Foothill Glendale Harbor Hollywood-Wilsh Inglewood Long Beach Northeast Pasadena Pomona San Antonio San Fernando South Southeast Southwest Torrance West West Valley Whittier
Area defined by census tract: (please specify)
Area defined by Zip Code: (please specify)
4.     Population of interest: (specify as applicable: age group, gender, race,         mode of exposure, or other demographic/health-related information.)
5.     Demographics/risks: (when applicable, specify desired breakdown          by gender, race/ethnicity, mode of HIV exposure, or specific age group.)
6.     Other type of request or extra information needed:
* How will these data be used?
Journal Article/Letter	General Information
Newspaper/Newsletter	Grant Application
Presentation/Education	Program Evaluation
Advocacy
Other: (please specify)
* How will you like the data to be transmitted?
Mail
Fax
Email with attachment (select one)                                 EXCEL table                    Microsoft WORD file                    PDF file
Other: (Please specify)
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