Impact of Lipodystrophy on Quality of Life and Self Esteem

1. How old are you?

2. What is your ethinicity?

3. What is your gender?

4. How long have you known that you are HIV positive?

5. Are you currently taking HIV medications?

6. If you are taking or have taken medications for HIV, how long have you taken them (total years)?

7. Have you taken any of these medications in the past?

8. Have you had body shape changes after starting HIV medications in the past?

9. What kind of body changes are you experiencing or have you experienced?

10. Have you experienced depression or anxiety due to the body changes?

11. Have you ever thought of killing yourself due to your body changes?

12. Have you ever thought about not taking your HIV medications or have you ever stopped taking them because of fear of worsening your body changes?

13. Have the body changes cause you to: (check all that apply)

14. What have you done to try to reverse your body changes? (check all that apply)

15. Have your insurance, ADAP/Ryan White clinic, HMO, health care system (for countries outside the US) and/or supplier patient assistance program paid for ANY of the solution(s) mentioned in the answer(s) in the previous question? (Check all that apply)

16. Have you had facial wasting (lipoatrophy)?

17. What option have you used to improve your facial lipoatrophy? (check all that apply)