HIV AND HEPATITIS C
According to the Centers for Disease Control and Prevention, about 3.2 million people in the United States are chronically infected with hepatitis C virus (HCV). Hepatitis C is also common in people living with HIV—between 25 and 33 percent of all HIV-positive people in the United States are coinfected. POZ wants to know what you know about hepatitis C and to find out if you’ve been tested and/or treated for the virus.
1
How is hepatitis C transmitted? (Check all that apply.)
❑ Exposure to infected blood in health care settings ❑ A mosquito bite ❑ Sharing a needle or works to inject drugs ❑ Sharing food with someone infected with HCV ❑ Being born to a mother with HCV ❑ Sharing personal care items, such as razors or toothbrushes ❑ Getting a piercing or tattoo using unsterile equipment ❑ Receiving a blood transfusion or organ transplant
10
If you have not been treated, why not?
11
What type of physician or health care provider is/was responsible for managing your hepatitis?
before 1992
❑ Having sexual contact with someone infected with HCV 2
Have you ever been tested for hepatitis C?
3
If yes, why did you get tested?
❑ Yes
❑ No
❑ Primary care physician (not a specialist) ❑ Infectious disease specialist ❑ Gastroenterologist ❑ Hepatologist ❑ Other: _______________________________
❑ Not sure
❑ My health care provider suggested I get tested ❑ I asked to be tested ❑ I was notified by a blood/tissue donation organization or a
12 Where do you get your hepatitis C information? (Check all that apply.)
❑ My health care provider ❑ Friends and family ❑ The Internet ❑ Magazines or books ❑ Hepatitis newsletters ❑ Hepatitis support groups ❑ A national or local organization
public health official saying that I might be infected
❑ Other: _______________________________
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4
If you have not been tested, why not?
❑ I do not believe I am at risk for HCV infection ❑ The test was never offered to me ❑ I don’t want to be tested ❑ Other: _______________________________
5
Are you currently coinfected with HIV and hepatitis C?
6
How long ago were you diagnosed with hepatitis C?
❑ Yes
❑ No (skip to question 13)
❑ Less than 1 year ago ❑ 6 to 10 years ago
❑ 1 to 5 years ago ❑ More than 10 years ago
7
Have you ever had a liver biopsy?
8
Do you have liver disease?
9
Have you ever been treated for hepatitis C?
❑ Yes ❑ Yes ❑ Yes
❑ No ❑ No ❑ No
❑ I haven’t discussed treatment with my health care provider ❑ My health care provider told me I don’t need to be treated ❑ I cannot be treated because of another medical condition ❑ I am worried about the side effects of treatment ❑ I cannot afford the cost of treatment ❑ I am waiting for new medications to become available ❑ Other: _______________________________
13
What year were you born? _____
14
What is your gender?
15
What is your sexual orientation?
16
What is your ethnicity? (Check all that apply.)
17
What is your ZIP code? ________________
❑ Not sure ❑ Not sure
❑ Male ❑ Transgender ❑ Straight ❑ Bisexual
❑ Female ❑ Other ❑ Gay/lesbian ❑ Other
❑ American Indian or Alaska Native ❑ Arab or Middle Eastern ❑ Asian ❑ Black or African American ❑ Hispanic or Latino ❑ Native Hawaiian or other Pacific Islander ❑ White ❑ Other (please specify): ________________
Please fill out this confidential survey at poz.com/survey or mail it to: Smart + Strong, ATTN: POZ Survey #171, 462 Seventh Avenue, 19th Floor, New York, NY 10018-7424