Strong Communities Registration and Survey

Strong Communities Program 2018

In 2018 NMAC’s Treatment Division will implement the second phase of the Strong Communities program. The goal is to promote an intentional discussion among community-based organizations and clinics about the social drivers of HIV and how they intersect with race. In communities of color, the social drivers that foment vulnerability, together with systems of inequality are larger than HIV and thus must be addressed simultaneously. Taking a holistic view allows us to identify the urgency of HIV while integrating the intersectional realities of people’s lives. For these reasons, Strong Communities will revisit Houston, TX, New Orleans, LA, Jackson, MS, Fort Lauderdale, FL, Atlanta, GA and Birmingham, AL.

A customized curriculum based on data collected at your city has been developed and we are offering a training about Race, HIV social drivers and the delivery of services. This will help us understand better how race affects our HIV service delivery.

Fort Lauderdale Training:
Location: Pride Center at Equality Park

Schubert Bldg. Room 200
2040 N Dixie Hwy, Wilton Manors, FL 33305
Date: Thursday, February 8th, 2018.
Time: From 10:30 AM to 4:30 PM

(A delicious lunch will be provided)

Question Title

* 1. Please provide your contact information:

Name *

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

Question Title

* 2. What type of organization do you work for? (check all that apply)

HIV/AIDS-Specific Organization (ASO)

Community-Based Organizations (CBO)

Community Health Center (Ryan White, FQHC, non-profit, etc.)

Other Healthcare Provider (hospital, private practice, for-profit, etc.)

Health Department

Minority-Specific Organization

Faith-Based Organization

Academic/Research Institution

Other (please specify)

Question Title

* 3. Briefly describe the type of HIV services your organization provides (check all that apply)

Prevention

Treatment

Advocacy

Legal

LGBTQ

Medical

Testing and counseling

Mental, behavioral, emotional support

Other (please specify)

Question Title

* 4. How long have you been working or advocating in the HIV field?

Question Title

* 5. Please provide the following demographic information
Race. Select all that apply.

African America or Black

Asian

American Indian or Alaska Native

Caucasian or White

Latinx or Hispanic

Native Hawaiian or other Pacific Islander

Prefer not to disclose

Question Title

* 6. Please provide the following demographic information (optional)
HIV Status. Select one.

Positive

Negative

Unknown

Prefer not to disclose

Question Title

* 7. Please provide the following demographic information
Gender Identity. Select one.

Female

Male

Intersex

Trans man

Trans woman

Gender queer or gender non-conforming

Androgynous

Cross dresser

Two spirit

Prefer not to disclose

Not listed above (please specify)

Question Title

* 8. Please provide the following demographic information
Sexual Orientation. Select one.

Lesbian

Gay

Bisexual

Heterosexual

Queer

Questioning

Two spirit

Same gender loving

Asexual

Pansexual

Prefer not to disclose

Not listed above (please specify)

Question Title

* 9. Please provide the following demographic information
Age. Select one.

Under 20

20-24

25-34

35-44

45-54

55-64

65+

Prefer not to disclose

Question Title

* 10. Social Drivers and Race Programming

	Answer
Is your organizations currently addressing HIV-related Social Drivers?	Is your organizations currently addressing HIV-related Social Drivers? Answer menu
Is your organization having discussions about how HIV-related Social Drivers intersect with race?	Is your organization having discussions about how HIV-related Social Drivers intersect with race? Answer menu
If yes to either, are you in need of capacity building/technical assistance?	If yes to either, are you in need of capacity building/technical assistance? Answer menu

Question Title

* 1. Please provide your contact information:

Question Title

* 2. What type of organization do you work for? (check all that apply)

Question Title

* 3. Briefly describe the type of HIV services your organization provides (check all that apply)

Question Title

* 4. How long have you been working or advocating in the HIV field?

Question Title

* 5. Please provide the following demographic information Race. Select all that apply.

Question Title

* 6. Please provide the following demographic information (optional)HIV Status. Select one.

Question Title

* 7. Please provide the following demographic information Gender Identity. Select one.

Question Title

* 8. Please provide the following demographic information Sexual Orientation. Select one.

Question Title

* 9. Please provide the following demographic information Age. Select one.

Question Title

* 10. Social Drivers and Race Programming

* 5. Please provide the following demographic information
Race. Select all that apply.

* 6. Please provide the following demographic information (optional)
HIV Status. Select one.

* 7. Please provide the following demographic information
Gender Identity. Select one.

* 8. Please provide the following demographic information
Sexual Orientation. Select one.

* 9. Please provide the following demographic information
Age. Select one.