Exit PILLAR HIV Home Testing Program Eligibility Screening Question Title * 1. What ZIP code do you reside in? Question Title * 2. Are you HIV positive? Yes No Unknown Question Title * 3. Are you over the age of 17? Yes No Question Title * 4. What sex were you assigned at birth? Male Female Question Title * 5. What race/ethnic group(s) do you consider yourself to be a member of? White or Caucasian Black or African American Hispanic or Latino Asian American Indian or Alaska Native Native Hawaiian or other Pacific Islander Other Question Title * 6. In the past 12 months, what were the gender(s) of your sexual partners? Male Female Trans (Male to Female) Trans (Female to Male) Other Question Title * 7. If you would like for a representative from PILLAR to inform you whether you qualify, please provide the following information: Name (first initial, full last name) Phone Number Email Done