Consent Form

You are invited to participate in a research study about anxiety and depression in African American women living with HIV. The researcher is inviting African American women diagnosed and living with HIV for one year or longer to be in the study. This form is part of a process called “informed consent” to allow you to understand this study before deciding whether to take part.

This study is being conducted by a researcher named Lisa Connors, a doctoral student at Walden University. 

Background Information:
This study aims to understand how disenfranchised grief, social support loss, and stigma foster anxiety and depression in African Americans diagnosed and living with HIV. The information gained from this research study may be used to facilitate more supportive services for African American women being diagnosed and living with HIV. 

If you agree to be in this study, you will be asked to:
  • Complete a demographic questionnaire and surveys that take approximately 8-15 minutes to complete. 
Here are some sample questions:
  • Is feeling sorry for me make the person a witness? 
  • Is there a particular person around when I am in need?
  • Did people stop calling after learning I have HIV? 
Voluntary Nature of the Study:
Research should only be done with those who freely volunteer. We respect your decision to join or not. If you decide to join the study now, you can change your mind later. You may stop at any time. The researcher seeks 160 volunteers for this study. 

Risks and Benefits of Being in the Study:
Being in this study could involve some risk of the minor discomforts that can be encountered in daily life, such as stress or revealing personal information. This study would pose minimal risk to your well-being with the protections in place. If participating in this research study poses some discomfort, you may contact 211 for support resources in your local area or the National HIV/AIDS hotline at 1-800-232-4636, which is available 24/7 with information and referrals to local hotlines, testing centers, and counseling. 

This study offers no direct benefits to individual volunteers. This study aims to benefit society by providing insights on developing targeted support groups, improving services for African American women living with HIV, and educating the community about issues surrounding HIV. 

Although there is no payment for participating in this research study, the researcher greatly appreciates your time and information. Thank you so much for your attention and participation.

The researcher is required to protect your privacy. Your identity will be kept anonymous within the limits of the law. The researcher will not ask for your name at any time. The researcher will not use your personal information for any purposes outside of this research project. Also, the researcher will not include anything that could identify you in the study reports. If the researcher were to share this dataset with another researcher in the future, the researcher must remove all identifying details before sharing; this would not involve another round of obtaining informed consent. Data will be kept secure by Lisa Connors on a password-protected laptop, and any notes will be securely locked in a file cabinet only accessed by this researcher. Data will be kept for a period of at least five years, as required by the university.
Contacts and Questions:
You can ask questions of the researcher by email at If you want to talk privately about your rights as a participant or any negative parts of the study, you can call Walden University’s Research Participant Advocate at 612-312-1210. Walden University’s approval number for this study is 05-12-22-0246708, and it expires on May 11, 2023.

You might wish to retain this consent form for your records. You may ask the researcher or Walden University for a copy at any time using the contact information above. 

Obtaining Your Consent: 

If you understand the study and wish to volunteer, please indicate your consent by clicking the "Next" button below: