POZ Focus Healthy Partnership 2017 Survey

POZ FOCUS-HEALTHY PARTNERSHIP
We want to hear from you! After reading POZ Focus: Healthy Partnership, please take the following survey . We appreciate your feedback.
1) How long have you been living with HIV?

Less than one yearOne to five yearsFive to ten years10 to 15 yearsMore than 15 years
2) How would you rate your relationship with your HIV health care provider?

ExcellentGoodFairPoor
3) Are you comfortable talking to your health care provider about your treatment options?

YesNo
4) When you talk with your health care provider about your HIV treatment options, what do you discuss? (Check all that apply.)

When I should start or switch treatmentHow well my current treatment is workingShort- and long-term side effects of HIV medsInteractions between HIV meds and other drugs I am taking (including herbal remedies)Strategies for my long-term healthScreenings that are needed for other diseases and health conditions
5) Are you honest and open with your health care provider about your needs?

YesNo
6) Do you keep a running list of questions to ask your health care provider at your next appointment?

YesNo
7) Have you ever had to switch health care providers because the relationship was not working?

YesNo
8) Please rate the overall quality of this issue of this POZ Focus.

ExcellentGoodFairPoor
9) What year were you born?
10) What is your gender?

MaleFemaleTransgenderOther
11) What is your sexual orientation?

StraightGay/lesbianBisexualOther
12) What is your yearly personal 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
13) 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
14) What is your zip code?
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POZ FOCUS-HEALTHY PARTNERSHIP