Data Sources

Notes on data

All the data contained in amfAR's Ending the HIV Epidemic database are compiled from reputable publicly-available databases. As such, all data are freely available for all non-commercial uses.

For any questions about data methods or acceptable use of data, please contact us.

Indicator definitions

Administrative Arrests Processed by U.S. Immmigrations and Customs Enforcement (ICE)

Number of administrative arrests by U.S. Immigration and Customs Enformencement (ICE) Enforcement and Removal Operations (ERO). An administrative arrest is defined as an arrest of an undocumented immigrant for a civil violation of U.S. immigration laws. In other words, these arrests are predicated on the individual having no legal basis to remain in the United States. No criminal action or conviction is necessary for ERO to arrest an individual, as no category of undocumented immigrant is exempt from immigration enforcement. Between FY 17 and FY 18, there was an 11% increase in overall arrests.

Data Source: U.S. Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO)

Available at: https://www.ice.gov/features/ERO-2018

Chlamydia Diagnoses

Number of confirmed diagnoses of chlamydia during a specific calendar year. Infections of chlamydia are normally asymptomatic causing reported diagnoses of chlamydia to be subject to the prevalence of screening and testing for chlamydia. Therefore, changes in the number of diagnoses of chlamydia could reflect changes in the incidence of infection, changes in screening coverage, changes in screening type, or changes in completeness of reporting. Chlamydia infection is associated with increased risk of HIV infection.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Chlamydia Diagnoses per 100,000

Rates of confirmed chlamydia diagnoses per 100,000 population during a specific calendar year. Infections of chlamydia are normally asymptomatic causing reported diagnoses of chlamydia to be subject to the prevalence of screening and testing for chlamydia. Therefore, changes in the number of diagnoses of chlamydia could reflect changes in the incidence of infection, changes in screening coverage, changes in screening type, or changes in completeness of reporting. Chlamydia infection is associated with increased risk of HIV infection.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Counties and States included in the Ending the HIV Epidemic Plan

The Department of Health and Human Services (HHS) has proposed an initiative to "eliminate new HIV infections in our nation." This plan targets 48 counties, Washington, D.C., and San Juan, Puerto Rico, as well as seven states with a substantial rural burden. These areas account for more than 50% of new HIV diagnoses in recent years. The plan aims for a 75% reduction in new HIV infections in these areas in five years, and at least a 90% reduction in ten years.

Data Source: Department of Health and Human Services (HHS)

Available at: https://files.hiv.gov/s3fs-public/Ending-the-HIV-Epidemic-Counties-and-Territories.pdf

Deportations Processed by U.S. Immmigrations and Customs Enforcement (ICE)

Number of removals of immigration violators who are in the country illegally and have received a final order to be removed by U.S. Immigration and Customs Enformencement (ICE) Enforcement and Removal Operations (ERO). ICE defines removals as the obligatory and confirmed movement of an inadmissible or deportable undocumented immigrant out of the United States based on a court order. The removals include both undocumented immigrants arrested by ICE and those apprehended by U.S. Customs and Border Protection (CBP).

Data Source: U.S. Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO)

Available at: https://www.ice.gov/features/ERO-2018

Diagnoses of Congenital Syphilis

Number of cases of congenital syphilis during a specific calendar year. Congenital syphilis is a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Diagnoses of Congenital Syphilis per 100,000 Live Births

Rates of congenital syphilis per 100,000 live births during a specific calendar year. Congenital syphilis is a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Diagnoses of Primary and Secondary Syphilis

Number of confirmed primary and secondary syphilis diagnoses during a specific calendar year. Syphilis infection is associated with increased risk of HIV infection.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Diagnoses of Primary and Secondary Syphilis per 100,000

Number of confirmed primary and secondary syphilis diagnoses per 100,000 population during a specific calendar year. Syphilis infection is associated with increased risk of HIV infection.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Distance to Nearest SSP

Distance to a facility. The geographic distance is calculated in miles using haversine equation between each ZIP code tabulation area (ZCTA) without a facility and the nearest ZCTA containing such a facility. County estimates are averages of the ZCTAs contained in that county. Syringe services program locations are taken from the North American Syringe Exchange Network (NASEN) and does not include programs that do not distribute syringes.

Based on analysis originally published at CROI: 220 Vulnerable Counties: One Year Later

Data Source: amfAR Analysis

Available at: http://opioid.amfar.org/indicator/num_SSPs

Distance to Nearest Substance Abuse Facility providing MAT

Distance to a facility. The geographic distance is calculated in miles using haversine equation between each ZIP code tabulation area (ZCTA) without a facility and the nearest ZCTA containing such a facility. County estimates are averages of the ZCTAs contained in that county. Facilities locations are taken from The National Survey of Substance Abuse Treatment Facilities (N-SSATS) and is limited to facilities that report providing at least one form of medication-assisted treatment.

Based on analysis originally published at CROI: 220 Vulnerable Counties: One Year Later

Data Source: amfAR Analysis

Available at: http://opioid.amfar.org/indicator/SMAT_fac

Estimated Acute Hepatitis C Cases per 100,000

Estimated number of acute (newly diagnosed) cases of hepatitis C in one year, per 100,000 population, calculated from CDC reported cases. CDC estimates the actual number of acute cases to be 13.9 times the number of reported cases. This estimate does not capture the total number of people living with both acute and chronic hepatitis C, and therefore underrepresents the actual number of cases. According to the CDC, acute hepatitis C leads to chronic infection in 75-85% of cases. Hepatitis C has been a nationally notifiable disease since 1994, yet not all states report usable data and no HCV data are available at the county level, undermining the ability to surveil the epidemic and identify potential outbreaks.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/hepatitis/statistics/

Estimated Cases of Acute Hepatitis C

Estimated number of acute (newly diagnosed) cases of hepatitis C in one year, calculated from CDC reported cases. CDC estimates the actual number of acute cases to be 13.9 times the number of reported cases. This estimate does not capture the total number of people living with both acute and chronic hepatitis C, and therefore underrepresents the actual number of cases. According to the CDC, acute hepatitis C leads to chronic infection in 75-85% of cases. Hepatitis C has been a nationally notifiable disease since 1994, yet not all states report usable data and no HCV data are available at the county level, undermining the ability to surveil the epidemic and identify potential outbreaks.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/hepatitis/statistics/

Estimated HIV Prevalence Rate per 100,000

Estimated number of people living with HIV, diagnosed and undiagnosed,per 100,000 among adults and adolescents ≥ 13 years. This is modeled data, and useful for identifying gaps in HIV diagnosis which must be addressed.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Estimated Number of People Living with HIV

Estimated number of people living with HIV, diagnosed and undiagnosed, among adults and adolescents ≥ 13 years. This is modeled data, and useful for identifying gaps in HIV diagnosis which must be addressed.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Facilities Providing Substance Abuse Services

Number of facilities that provide substance abuse services. Data are from The National Survey of Substance Abuse Treatment Facilities (N-SSATS) - an annual survey of U.S. facilities offering treatment services for alcohol and drug abuse. Types of care include substance abuse treatment, detoxification, transitional housing or halfway houses, prescribing of buprenorphine and/or naltrexone, or SAMHSA-certified Opioid Treatment Programs. Facilities include hospital inpatient, residential, or outpatient. Data for the most recent year are downloaded from https://findtreatment.samhsa.gov/. Data for prior years are sourced from published facility directories.

Data Source: Substance Abuse and Mental Health Services Administration.

Available at: https://wwwdasis.samhsa.gov/dasis2/nssats.htm

Federally Qualified Health Centers (FQHC)

Federally Qualified Health Centers (FQHCs) are community-based health service providers funded under HRSA's Health Center Program. The program sets requirements for providing comprehensive health care services including primary, preventative, mental health, and substance abuse services regardless of an individual's ability to pay or their health insurance status.

Data Source: Human Resources and Services Administration (HRSA)

Available at: https://data.hrsa.gov/data/about

Gonorrhea Diagnoses

Number of confirmed diagnoses of gonorrhea during a specific calendar year. Infections of gonorrhea are normally asymptomatic causing reported rates of gonorrhea to be subject to the prevalence of screening and testing for gonorrhea. Therefore, changes in the number of diagnoses of gonorrhea could reflect changes in the incidence of infection, changes in screening coverage, changes in screening type, or changes in completeness of reporting. Gonorrhea infection is associated with increased risk of HIV infection.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Gonorrhea Diagnoses per 100,000

Rates of confirmed gonorrhea diagnoses per 100,000 population during a specific calendar year. Infections of gonorrhea are normally asymptomatic causing reported rates of gonorrhea to be subject to the prevalence of screening and testing for gonorrhea. Therefore, changes in the number of diagnoses of gonorrhea could reflect changes in the incidence of infection, changes in screening coverage, changes in screening type, or changes in completeness of reporting. Gonorrhea infection is associated with increased risk of HIV infection.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Hepatitis C Prevalence per 100,000

Estimated number of persons living with chronic Hepatitis C, scaled by adult population. These estimates are modeled for people currently living with HCV at the time indicated. This would exclude those who have received treatment and been cured of HCV as well as the 15-25% of people infected with HCV that spontaneously clear the virus without treatment. HCV surveillance data are not routinely collected by the CDC. Data for 2010 come from HepVu. Data cited here as 2016 were reported in JAMA, Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016 and covers the timeframe of 2013-2016. Data are not available for Puerto Rico.

Methodology Change: Prior to January 2, 2019 this indicator tracked cases of people testing positive for HCV antibodies. A positive Hepatitis C antibody test means that a person has ever been exposed to the virus but may no longer be infected. This likely overestimated the actual current prevalence rate.

Data Source: 2010: HepVu. Emory University, Rollins School of Public Health.
2016: JAMA, Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016

Available at: https://hepvu.org

HIV/STD Criminalization Laws

Laws criminalizing exposure and/or transmission of HIV, and sentencing enhancements affecting people living with HIV.

Data Source: Center for HIV Law & Policy | Centers for Disease Control and Prevention (CDC)

Available at:

Center for HIV Law & Policy: http://www.hivlawandpolicy.org/sourcebook
CDC: https://www.cdc.gov/hiv/policies/law/states/exposure.html

HIV Viral Suppression Rates among Diagnosed PLHIV

HIV viral suppression rates were measured using laboratory data from 42 jurisdictions that reported complete CD4 and viral load test results to the CDC at the end of 2016 for ages 13 years and older diagnosed with HIV by the beginning of 2015 and alive at the end of 2016. Viral suppression refers to reducing a person’s viral load to undetectable levels through antiretroviral treatment (ART). More specifically, viral suppression was defined as a viral load result of <200 copies/mL at the most recent viral load test during the previous year. In the event that multiple viral load tests were performed during the same month, the highest viral load was used. The basis of the viral suppression cutoff was based on the definition of viral failure, a viral load of ≥ 200 copies/mL, which may indicate a lack of adherence to ART. Individuals who are virally suppressed have effectively no risk of transmitting HIV to others through sex.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Homeless Population

Housing and Urban Development's (HUD) Point-in-Time (PIT) estimates count the number of sheltered and unsheltered homeless individuals on a single night during the last ten days of January as part of the Continuum of Care (CoC) Homeless Assistance Program. Each CoC conducts interview and observational assessments of the homeless population as an annual snapshot. Data capture both sheltered and unsheltered homeless populations as well as demographic information, including HIV/AIDS status.

Data Source: Housing and Urban Development (HUD)

Available at: https://www.hudexchange.info/programs/coc/coc-homeless-populations-and-subpopulations-reports/

HOPWA Allocations and Awards

The Housing Opportunities for Persons With AIDS (HOPWA) Program is the only Federal program dedicated to the housing needs of people living with HIV/AIDS. Under the HOPWA Program, HUD makes grants to local communities, States, and nonprofit organizations for projects that benefit low-income persons living with HIV/AIDS and their families.

Data Source: Department of Housing and Urban Development

Available at: https://www.hudexchange.info/grantees/allocations-awards/?params=%7B%22limit%22%3A20%2C%22COC%22%3Afalse%2C%22sort%22%3A%22%22%2C%22min%22%3A%22%22%2C%22years%22%3A%5B%5D%2C%22dir%22%3A%22%22%2C%22grantees%22%3A%5B%5D%2C%22state%22%3A%22%22%2C%22programs%22%3A%5B8%5D%2C%22max%22%3A%22%22%7D

HRSA Awards Supporting EHE Programming

The Health Resources and Services Administration (HRSA) has made awards supporting the EHE initiative in two categories. Primary Care HIV Prevention (PHCP) Awards are focused on outreach activities, expansion of HIV testing, PrEP, and linkage to treatment, partnerships, and supporting human resources costs. Additionally, select Ryan White programs in EHE jurisdictions separately received awards to improve linkage, retention, and return to care efforts for individuals not currently accessing succesful treatment.

Data Source: Health Resources and Services Administration (HRSA)

Available at:

Linkage to HIV Care after Diagnosis

The linkage of an HIV positive person to HIV medical treatment was measured by the documentation of a CD4 or viral load test within a month of their HIV diagnosis. This indicator only applies to states with complete laboratory data on CD4 and viral load results.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

New HIV Diagnoses

Number of new HIV diagnoses in one year, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) diagnoses are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 5 persons.

Data sharing agreements between Alaska, Kansas, Nebraska, and North Carolina and the Centers for Disease Control and Prevention (CDC) were updated in June 2018. These states updated their agreements to reduce public dissemination of county level data. For Alaska and Nebraska, state agreements prohibit all county level data from being released. For Kansas and North Carolina, only select county data are available. Data for 2017 are presented as restricted. Data for 2016 and earlier are sourced from archived CDC data no longer available on CDC's Atlas Plus platform.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

New HIV Diagnoses per 100,000

Number of new HIV diagnoses per 100,000 in one year, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) diagnoses are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 5 persons.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Number of Homeless Shelter Beds

Housing and Urban Development's (HUD) Housing Inventory Count (HIC) is conducted every January to count the number of shelter beds available as part of the Continuum of Care (CoC) Homeless Assistance Program. The HIC data contain characteristics on the number of beds, seasonality of beds, target populations for the shelters, and sources of federal funding.

Data Source: Housing and Urban Development (HUD)

Available at: https://www.hudexchange.info/resource/3031/pit-and-hic-data-since-2007/

Number of Incarcerated Individuals Diagnosed with HIV

People in the custody of state and federal correctional authorities known to be living with HIV. Note that this does not include the majority of incarcerated indivuduals in county and local jail systems.

Data Source: Bureau of Justice Statistics (BJS)

Available at: https://www.bjs.gov/index.cfm?ty=pbdetail&iid=6026

Number of Individuals Accessing PrEP

Number of individuals aged ≥16 prescribed PrEP during the specified year. CDC data are sourced from IQVIA Real World Data-Longitudinal Prescriptions database that covers prescriptions from all sources. IQVIA data do capture race, ethnicity, sex, and age categories but these data are only released at the national level.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Number of People Living with Diagnosed HIV

Number of people living with diagnosed HIV, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) persons are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 5 persons.

Data sharing agreements between Alaska, Kansas, Kentucky, Nebraska, and North Carolina and the Centers for Disease Control and Prevention (CDC) were updated in June 2018. These states updated their agreements to reduce public dissemination of county level data. For Alaska and Nebraska, state agreements prohibit all county level data from being released. For Kansas, Kentucky, and North Carolina, only select county data are available. Data for 2016 and 2008 through 2013 are presented as restricted. Data for 2014 and 2015 are sourced from archived CDC data no longer available on CDC's Atlas Plus platform.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Number of People with Hepatitis C

Estimated number of persons living with chronic Hepatitis C (HCV). These estimates are modeled for people currently living with HCV at the time indicated. This would exclude those who have received treatment and been cured of HCV as well as the 15-25% of people infected with HCV that spontaneously clear the virus without treatment. HCV surveillance data are not routinely collected by the CDC. Data for 2010 come from HepVu. Data cited here as 2016 were reported in JAMA, Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016 and covers the timeframe of 2013-2016. Data are not available for Puerto Rico.

Data Source: 2010: HepVu. Emory University, Rollins School of Public Health.
2016: JAMA, Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016

Available at: https://hepvu.org

Number or People Living with Diagnosed HIV per 100,000

Number of people living with diagnosed HIV per 100,000, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) persons are suppressed.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Percent of People Experiencing Poverty

Percent of population experiencing poverty in the last 12 months sourced from the U.S. Census American Community Survey (ACS). ACS estimates are based on household size and family income and benchmarked to poverty income threshholds. All individuals in a family are considered to have experienced poverty if the total family income is below the threshhold. Poverty is a known risk factor for HIV.

Data Source: United State Census.

Available at: https://data.census.gov

Percent of People without Health Insurance

Percent of the civilian noninstitutionalized population under age 65 with no health insurance coverage. Data are from the Selected Economic Characteristics table from the American Community Survey 5-Year Estimates.

Data Source: United States Census.

Available at: https://data.census.gov

Percent of PLHIV who are Aware of their Status

An HIV diagnosis was classified as HIV if the infection was determined to be Stage 3 HIV, and confirmed as an HIV infection during a specific time period. Trends based on this data should not include data from 2017 as the 2017 data is preliminary data due to a 7 month reporting delay.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Percent of Population Latinx

Percent of Population Latinx. Population estimates are from the United States Census' Annual Estimates of the Resident Population, all ages.

Data Source: United States Census.

Available at: https://data.census.gov

Percent of Prison Population Diagnosed with HIV

Percent of people in the custody of state and federal correctional authorities known to be living with HIV. Note that this does not include the majority of incarcerated indivuduals in county and local jail systems.

Data Source: Bureau of Justice Statistics (BJS)

Available at: https://www.bjs.gov/index.cfm?ty=pbdetail&iid=6026

Planned Parenthood Affiliated Facilities

Planned Parenthood Federation of America (PPFA) and their affiliated clinics provide comprehensive sexual and reproductive health services and education to clients, including HIV services. Recently, Planned Parenthood, along with other family planning organizations and programs, was forced to withdraw from the federal Title X family planning program due to an adminstration rule prohibiting recipients from offering their patients referrals for abortion services or providing abortion services at the same site. This rule change could impact negatively the HIV response, per an amfAR analysis.

Data Source: Planned Parenthood Federation of America (PPFA)

Available at: https://www.plannedparenthood.org/get-care

PrEP Coverage for Individuals with PrEP Indications

Percent of people meeting CDC PrEP indication guidelines that are accessing PrEP. Coverage levels are based on the number of people accessing PrEP and the estimated number of people with indications for PrEP as calculated by the CDC. PrEP need estimates were based on census data to estimate the number of men who have sex with men in a given jurisdiction and adjusted for those who are HIV negative and with data from the National Health and Nutrition Examination Survey (NHANES). HIV transmission category data were also used to triangulate PrEP need to prevent transmissions through heterosexual or needle-sharing contacts.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Providers Licensed to Administer Buprenorphine

Number of providers (including RNs and PAs) authorized to treat opioid dependency with buprenorphine. This includes providers at substance abuse treatment facilities, as well as DATA-certified providers. The national number is updated weekly from SAMHSA's Physician and Program Data webpage. State and county providers counts represented here are limited to those providers that have chosen to be publicly identified on SAMHSA's treatment locator and are therefore lower than the national total when summed.

Data Source: Substance Abuse and Mental Health Services Administration

Available at: https://findtreatment.samhsa.gov/locator

Receipt of HIV Care among Diagnosed PLHIV

The number of people living with HIV who received medical treatment for an entire year was measured by the documentation of HIV diagnosis at the beginning of the previous year, the documentation of complete CD4 and viral load test results throughout the entire year (i.e. one or more tests), and the confirmation that the person was alive at the end of the following year. This indicator only applies to states with complete laboratory data on CD4 and viral load test results.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Ryan White HIV Medical Providers

The Ryan White HIV/AIDS Program provides a comprehensive system of care that includes primary medical care and essential support services for people living with HIV who are uninsured or underinsured. The Program works with cities, states, and local community-based organizations to provide HIV care and treatment services to more than half a million people each year. HRSA maintains data on service providers actively seeing patients under the program.

Data Source: Human Resources and Services Administration (HRSA)

Available at: https://data.hrsa.gov/data/about

State Anti-Discrimination Laws in Private Health Coverage

Insurance non-discrimination laws protect LGBT people from being unfairly denied health insurance coverage or from being unfairly excluded from coverage for certain health care procedures on the basis of sexual orientation or gender identity. LGBT people bear the greatest burden of the HIV epidemic in the US, and access to all necessary health care is crucial to overcoming this disparity.

Data Source: Movement Advancement Project

Available at: https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies

State Expansion of Medicaid Eligibility

Under the Affordable Care Act (ACA) states can elect to expand Medicaid eligibility to all individuals below 138% of the federal poverty limit. In states that do expand Medicaid, 100% of the cost of the expansion for the first 10 years is covered by the federal government. After 10 years, the federal government will continue to cover 90% of the cost of expansion, with the remainder coming from state budgets. Section 1115 of the ACA allows states to apply for waivers allowing the state to operate the expansion in ways that are inconsistent with the standards in the ACA. Waivers do not inherently suggest that states operating under such waivers are less comprehensive than others.

Data Source: Kaiser Family Foundation

Available at: https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/

Syringe Exchange Program Legality

Indicates whether states have specifically authorized syringe service programs statewide in legislation. States where local units have interpreted state laws to allow syringe access services or where no law prohibits syringe exchange are considered to permit syringe exchange programs. States with pilot programs, those where syringe exchange would require legislative action and/or supportive interpretation of local laws, or those with pending syringe exchange legislation are considered illegal. State laws were gathered from the HIV Prevention Justice Alliance, and compared against current syringe exchange program legislation on state government websites to review accuracy and up-to-date status.

Data Source: HIV Prevention Justice Alliance.

Available at: http://www.preventionjustice.org/wp-content/uploads/2017/03/TAG-IDU-HIV-and-HCV-prevention-webinar-3.20.17.pdf

Syringe Exchange Programs

Total number of syringe exchange programs. The directory of syringe exchange programs is aggregated by self-reporting to the North American Syringe Exchange Network (NASEN) and is therefore unlikely to be a comprehensive and complete list of all syringe exchange programs. Does not include programs that do not distribute syringes. Syringe exchange programs wishing to be identified in the database should contact NASEN to be added to the file.

Data Source: North American Syringe Exchange Network.

Available at: https://nasen.org/directory

Unemployment Rate

Unemployment rate, from the Bureau of Labor Statistics (BLS) Local Area Unemployment Statistics (LAUS) program. Rates are annual averages.

Data Source: Bureau of Labor Statistics Local Area Unemployment Statistics

Available at: https://www.bls.gov/lau