POZ232_December

Quality of Life
Since the advent of effective antiretroviral medication, people living with HIV have been living longer lives. Today’s drugs are easier to take and have fewer side effects, but living with HIV long term can take its toll. POZ wants to know about your quality of life. Please take our survey and let us know how well you are living with HIV.
1) How would you rate your quality of life?

Very goodGoodPoorVery poorNeither good nor poor
2) How much do you worry about your health?

Very muchA moderate amountA littleNot at all
3) How much do you suffer from physical pain?

Very muchA moderate amountA littleNot at all
4) How much does physical pain prevent you from doing what you want to do?

Very muchA moderate amountA littleNot at all
5) How often do you have feelings of despair, anxiety or depression?

AlwaysOftenSeldomNever
6) How much do you enjoy life?

Very muchA moderate amountA littleNot at all
7) Do you get tired easily?

YesNo
8) Do you have any mobility issues?

YesNo
9) Do you have any difficulty sleeping?

YesNo
10) Are your sexual needs fulfilled?

YesNo
11) Are you satisfied with your personal relationships?

Very satisfiedSatisfiedDissatisfiedVery dissatisfiedNeither satisfied nor dissatisfied
12) How much do you worry about money?

Very muchA moderate amountA littleNot at all
13) Are you satisfied with your living conditions?

Very satisfiedSatisfiedDissatisfiedVery dissatisfiedNeither satisfied nor dissatisfied
14) Are you satisfied with the quality of your medical care?

Very satisfiedSatisfiedDissatisfiedVery dissatisfiedNeither satisfied nor dissatisfied
15) How much do you worry about your ability to access medical care?

Very muchA moderate amountA littleNot at all
16) How much do you worry about death?

Very muchA moderate amountA littleNot at all
17) What year were you born?
18) What is your gender?

MaleFemaleTransgenderOther
19) What is your sexual orientation?

StraightGay/LesbianBisexualOther
20) 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
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?
Enter the message as it's shown*
Should be Empty:

Quality of Life