POZ232_December

You and COVID-19
More than a year into the pandemic, COVID-19 vaccines are being administered nationwide, but the coronavirus continues to take a toll on all of our lives. POZ wants to know how COVID-19 has affected you and your health.
1) How long have you been living with HIV?

Less than one year1–5 years5–10 years10–15 years15–20 years20 years or moreI’m not HIV positive.
2) Have you had COVID-19?

YesNo (Skip to question 5.)
3) How were your symptoms of COVID-19?

MildModerateSevere
4) Are you still experiencing symptoms of COVID-19?

YesNo
5) Has anyone in your family had COVID-19?

YesNo
6) Do you know anyone who has died of COVID-19?

YesNo
7) Have you used telemedicine to connect to health care services during the pandemic?

YesNo
8) Have you had any difficulty accessing health care services during the pandemic?

YesNo
9) Have you had any difficulty refilling your HIV medications during the pandemic?

YesNoI don’t take HIV meds.
10) Have you gotten a COVID-19 vaccine?

Yes (Skip to question 12No
11) If you haven’t gotten a COVID-19 vaccine, will you get one?

YesNoMaybe
12) Do you think people living with HIV should be prioritized for the COVID-19 vaccine?

YesNo
13) How much have you struggled during the COVID-19 pandemic?

A lotSomewhatNot at all
14) How would you describe your mental health during the COVID-19 pandemic?

ExcellentGoodFairPoor
15) Have you experienced stress due to COVID-19?

YesNo
16) What year were you born?
17) What is your gender?

MaleFemaleTransgenderOther
18) What is your sexual orientation?

StraightGay/LesbianBisexualOther
19) 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
20) What is your current level of education?

Some high schoolHigh school graduateSome collegeBachelor’s degree or higher
21) What is your annual household income?

Less than $15,000$15,000–$34,999$35,000–$49,999$50,000–$74,999$75,000–$99,999$100,000 or more
22) What is your zip code?
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You and COVID-19