www.powerusa.org

1. Page 1 (Two Pages)- THIS SURVEY IS ONLY FOR PEOPLE WITH HIV

Page1 / 2
 
 50% of survey complete.
Page 1 of 2

Question Title

1. How old are you?

Question Title

2. What is your ethinicity?

Question Title

3. What is your gender?

Question Title

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

Question Title

5. Are you currently taking HIV medications?

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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?

Question Title

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

Question Title

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

Question Title

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)

Question Title

16. Have you had facial wasting (lipoatrophy)?

Question Title

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

T