* 1. What is your first name?

* 2. What is your last name?

* 3. What is the best phone number to reach you?

* 4. Do you have any alternative phone number?

* 5. What is the best time to contact you:

* 6. What is your email address?

* 7. In what state or U.S. territory do you live?

* 8. Have you ever been diagnosed as being HIV-positive?

* 9. If Yes, what medication(s) are you currently taking for HIV?

Thank you for your time. Please click “Done”. We will review your answers and may contact you with further questions to see if you qualify for the study.