Skip to content

2022 Area 15 Care Needs Survey

As a person living with HIV (PLWH) you have the power and responsibility to shape your care. This is the chance to tell the Department of Health (DOH) what services you need. It will help your DOH and your local planning group decide how to fund and improve services in your area.

 This survey is ANONYMOUS and can take less than 10-15 minutes to complete.
1. What is your gender?(Required.)
2. What is your race? (Select all that apply)(Required.)
3. What is your ethnicity? (Select all that apply)(Required.)
4. How old are you?(Required.)
5. Through which mode of exposure did you get HIV?(Required.)
6. What kind of health insurance or health care coverage do you currently have? (Select all that apply)(Required.)
7. What is your current source of income? (Select all that apply)(Required.)
8. What was your household total or individual income in 2020? (approximately, before taxes)(Required.)
8a. How many dependents does your income support? Please state the number of dependents.
9. What zip code do you live in?(Required.)
10. How often did you receive HIV-related medical care during the past 12 months?(Required.)