Thank you for agreeing to complete this survey. The Boston Eligible Metropolitan Area (EMA) Planning Council is working with the Boston Public Health Commission on a project to determine the needs of people living with HIV (PLWH) in the Boston EMA region. As part of this project, this survey is being used to get information from consumers about themselves and the services that are used and needed. We hope the information we collect here will help create better health programs for PLWH.

·  All information you provide in this survey is anonymous. Do not write your name.
·  If there are questions you don’t feel comfortable answering, you don’t have to answer them. 
·  Completing this survey takes approximately 10-20 minutes.
·  Disclaimer: This study began in March 2019. If you filled out this survey in 2019, please do not submit another. 
 
If you have any questions about this project or if you would like assistance in completing this survey, please contact Liz Rios at (617) 534-2413 or 617-947-4299, email: erios@bphc.org.

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* 1. By agreeing to participate in this study you are confirming that you are:

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* 2. What is your age?

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* 3. What is your gender?

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* 4. What is your sexual orientation?

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* 5. Are you Latinx, Hispanic or Spanish?

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* 6. What is your race? [Select all that apply]

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* 7. Which WRITTEN and/SPOKEN language do you PREFER to use for any legal matters (documents, contracts, motor vehicle registry, banking, etc.)?

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* 8. Which SPOKEN language do you speak most of the time (with friends and family)?

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* 9. What is the best description of your immigration status?

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* 10. What is your current zip code?

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* 11. Were you living at this zip code when you were diagnosed?

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* 12. If NO, where were you living (city/state/country) when you were diagnosed?

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* 13. What year did you first test positive for HIV?

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* 14. What year, if applicable, did you first start taking HIV medications?

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* 15. If you are you currently taking HIV medications, during the past 6 months, have you ever stopped taken any of them for more than a week (i.e. 7 days in a row or longer)?

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* 16. If YES, why? [Select all that apply]

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* 17. At your last viral load blood test, did your provider tell you that you were you virally undetectable?

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* 18. How do you get to your appointments or run errands? [Select all that apply]

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* 19. What services in the community are you accessing?  [Select all that apply]

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* 20. If you want to receive more services, what is preventing you? [Select all that apply]

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* 21. What additional services would you like to access that are not available?

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* 22. If you have accessed services in the past that you are no longer, what made you stop?

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* 23. Are you frustrated with any of the services you are receiving?

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* 24. If YES, why? [Select all that apply]

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