SURVEY Retention in Care
Knowing your HIV status is only part of the battle to becoming well if you have HIV. Connecting to and staying in care is also necessary for a long and healthy life. POZ wants to hear about your experiences trying to access the health care system after testing positive. Please take our confidential survey and let us know what barriers you faced.
1
Before testing positive, how often did you visit your primary care physician?
10
❑ Several times a year ❑ Once a year ❑ Every couple of years ❑ Never
2
Where did you get tested for HIV?
3
How soon after taking an HIV test did you learn that you were positive?
4
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14
❑ No
15
16
❑ No
How soon after testing positive did you see an HIV specialist or other health care provider regarding your HIV diagnosis?
❑ 0–1 month ❑ 2–5 months ❑ 6–9 months
❑ 10–12 months ❑ More than a year ❑ I haven’t yet
17
❑ No
Do you receive emotional support from your family and/or friends in regards to your HIV status?
❑ Yes
❑ No
Did anyone follow up with you to make sure you saw an HIV specialist or other health care provider?
❑ Yes 9
12
13
Did anyone ask you about your living situation (housing, finances, transportation, insurance, etc.) and make referrals if you needed assistance?
❑ Yes
8
❑ No
Have you ever been treated poorly at your doctor’s office or clinic?
❑ Yes
❑ No (skip to question 6)
Were you provided with information on how to connect to an HIV specialist or other health care provider?
❑ Yes 7
11
Was the HIV counseling helpful and informative?
❑ Yes 6
❑ 1–2 weeks later ❑ More than two weeks later
Did you receive counseling before and after your HIV test?
❑ Yes 5
❑ I didn’t know whom to see for HIV care ❑ I didn’t trust doctors ❑ I didn’t want to take medication ❑ I didn’t feel sick ❑ I felt ashamed/embarrassed about having HIV ❑ I didn’t have health insurance/treatment was too expensive ❑ I didn’t have transportation ❑ I didn’t have time for appointments ❑ I didn’t have childcare ❑ I couldn’t get away from work ❑ I was afraid of being criminalized ❑ Other
❑ Anonymous/confidential HIV testing site ❑ AIDS service organization (ASO) ❑ Community-based health clinic ❑ Emergency room/hospital ❑ General practitioner ❑ Mobile HIV testing van ❑ Ob/gyn ❑ Other
❑ Within an hour ❑ Same day ❑ 1–7 days later
If you waited more than a month to visit an HIV specialist or health care provider, what was the reason? (Check all that apply.)
❑ No
What year were you born? ________________ What is your gender?
❑ Male ❑ Female ❑ Transgender ❑ Other What is your sexual orientation?
❑ Straight ❑ Bisexual
❑ Gay/lesbian ❑ Other
What is your ethnicity? (Check all that apply.)
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
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): ________________
What is your ZIP code? ________________
Please fill out this confidential survey at poz.com/survey or mail it to: Smart + Strong, ATTN: POZ Survey #179, 462 Seventh Avenue, 19th Floor, New York, NY 10018-7424