POZ232_December

Equal Treatment?
Discrimination comes in many forms and is often rooted in a person’s race, age, sex or religion. When discrimination is related to HIV, it can negatively affect a person’s ability to access support, care and treatment. POZ wants to know about your experiences with discrimination.
1) Have you experienced discrimination because of your HIV status?

YesNoI’m not HIV positive.
2) Have you experienced discrimination because of another reason (race, age, sex, religion)?

YesNo
3) How often do you encounter discrimination?

OftenRarelySometimesNever
4) Have you experienced discrimination in a public setting, such as a restaurant or a park?

YesNo
5) Have you experienced discrimination in a classroom?

YesNo
6) Have you experienced discrimination at your workplace?

YesNo
7) Have you experienced discrimination at a doctor’s office or health care facility

YesNo
8) Have you ever been unreasonably stopped or questioned by the police or a security officer?

YesNo
9) Have you ever felt threatened due to discrimination?

YesNo
10) Have you ever been denied any type of service due to discrimination?

YesNo
11) Have you ever been denied health care or treatment due to discrimination?

YesNo
12) Have you ever received inadequate health care or treatment due to discrimination?

YesNo
13) Has the possibility of discrimination ever prevented you from seeking health care or treatment?

YesNo
14) How much does discrimination affect your mental health or well-being?

A lotNot very muchSomewhatNot at all
15) Have you ever filed a complaint against someone because of discrimination?

YesNo
16) Do you believe that if you filed a discrimination complaint justice would be served

YesNo
17) Do you believe enough is being done in the United States to combat discrimination?

YesNo
18) What year were you born?
19) What is your gender?

MaleFemaleTransgenderOther
20) What is your sexual orientation?

StraightGay/LesbianBisexualOther
21) What is your ethnicity? (Check all that apply.)

American Indian or Alaska NativeArab or Middle EasternAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhiteOther
22) What is your current level of education?

Some high schoolHigh school graduateSome collegeBachelor’s degree or higher
23) What is your zip code?
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Equal Treatment?