Sexually Transmitted Infection and HIV Co-Diagnosis Data Request, F-03346A (01/2025)

Instructions: The Wisconsin Department of Health Services (DHS) Sexually Transmitted Infection (STI) Unit produces statewide, regional, and county-level summaries of annual STI data, including data tables and visualizations that can be found on the DHS STI Surveillance Data web page. If you require data that is not already provided in these annual reports, please fill out this form.

1. Requester name

First
Last

2. Requester job title

3. Name of person/entity requesting data (if requesting for someone else)

4. Type of request

5. Email address

6. Phone number (optional)

7. Provide a brief overview of your request, including how you plan to use the information, any questions you are trying to answer with the requested data, and how the information may be shared with the public. Context provided here will help HIV epidemiologists to best provide the requested data.

8. When do you need the data provided? In general, please provide at least two weeks’ notice for most requests. Time may vary depending upon capacity and the complexity of the request.

9. Among people with an HIV diagnosis co-diagnosed with an STI, select the type(s) of co-diagnosis you are interested in along with the definition of co-diagnosis that best suits your needs (check all needed).

Type of HIV/STI co-diagnosis:

HIV + Syphilis (all stages)
HIV + Chlamydia
HIV + Gonorrhea

10. Co-Diagnosis Definition:

Option 3. Among people newly diagnosed both with HIV and an STI
Note: In this instance, the diagnoses should occur within 30 days. The date of infection will be based upon the first diagnosis received. For example, a person first diagnosed with HIV on 12/15/2022 who was later diagnosed with an STI on 1/2/2023 would be considered a co-diagnosis and the patient would be reflected in 2022 counts rather than 2023 counts.

11. Provide a time period and stratification for your data** (for example, annual for 2023; data from 2024 by quarter)

Time period

Year(s):

12. Stratification:

Please enter an 'other' value for this selection.

13. If you want this data stratified by demographics, select the stratification(s) (select all needed):

Gender **
Race/ethnicity (combined variable)
Age group: 0-14, 15-44, 45-64, 65+
Age group: 0-14, 15-24, 25-44, 45-64, 65-84, 85+
Age group: 0-17, 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75+
Age group: 0-12, 13-24, 25-34, 35-44, 45-54, 55-64, 65+
Age group: 0-14, 15-19, 20-29, 30-39, 40-49, 50-59, 60+
Other, specify: Please enter an 'other' value for this selection.

14. If you want these data stratified by geography, select the stratification(s) (select all needed):

City
County
Other, specify: Please enter an 'other' value for this selection.

Data related to STI data only will require a separate request using Sexually Transmitted Infection Data Request (F-03346). Data related to HIV only can be requested by emailing Yi Ou at yi.ou@dhs.wisconsin.gov. Data related to co-diagnoses with STIs or HIV and other, non-sexually transmitted infections or diseases (for example, COVID or influenza) will not be provided.

Not all requests will be able to be filled, but DHS epidemiologists will work with requestors to ensure data provided meets the needs of the requestor and does not violate DHS data sharing policies.

*Note DHS suppression policies will be applied to all data requests and data will be provided de-identified. Data for demographic stratifications will not be provided if the count by disease and stratification is less than five cases or has an estimated population size (denominator) less than 100.

**Data prior to 2011 may not be provided. Annual STI counts and rates for years as early as 2011 by demographics level may be found on the DHS STI Surveillance Data webpage. Annual HIV counts and rates for years as early as 2017 may be found on the DHS HIV Surveillance Data webpage.

***HIV data are provided by gender identity rather than sex assigned at birth.