2012 RW client survey

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* 1. My Zip Code:

ZIP:

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* 2. When were you born?

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* 3. My County:

Bledsoe

Bradley

Franklin

Grundy

Hamilton

Marion

McMinn

Meigs

Polk

Rhea

Sequatchie

Other (please specify)

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* 4. Are you currently enrolled in Ryan White services?

Yes

Don't know

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* 5. Are you currently receiving any HIV services?

Yes

Don't know

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* 6. When did you first test positive for HIV?

Year

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* 7. Where did you test positive for HIV?

State:

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* 8. Other (please specify) :

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* 9. How do you think you got HIV? (select ALL that apply)

Having sex with men

Having sex with women

Sharing needles or works

Born with HIV

Occupational exposure

Blood products or transfusion

Don't know

Other (please specify)

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* 10. My last CD4/TCell count was:

____________

I don't know

Other (please specify)

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* 11. My last viral load wais:

Undetectable

____________

I don't know

Other (please specify)

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* 12. Are you currently taking drugs to treat HIV?

Yes

Don't know

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* 13. Has a doctor ever diagnosed you with AIDS?

Yes

I don't know

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* 14. How long after testing positive did you start getting HIV services?

Within a month

1-6 months

More than 6 months

More than 1 year

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* 15. What would have helped you get HIV care sooner after testing positive? (Check ALL that apply)

Nothing-I got help right away

Knowing how important early care was for my health

Not having to take care of family/other people

Knowing who to call / where to go

Not using drugs / alcohol

Not being so afraid

Other (specify)

Other (please specify)

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* 16. In the last year, how often did you see your doctor about HIV?

Never

1-2 times

3-4 times

More than 4 times

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* 17. If you have not seen a doctor in the last year, why not?

I do not feel sick

I do not have transportation

I do not have childcare

I do not trust them

They are not available

Other (please specify)

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* 18. Who gave you the MOST information about HIV treatments?

Doctor/Nurse Practitioner

Nurse/Other Healthcare Worker

Case Manager/Social Worker

Friend(s)

Support Groups

Newspapers/Books

The Internet

Other (Please specify)

Other (please specify)

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* 19. When you see your case manager, does he/she explain things clearly?

Yes

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* 20. When you see your doctor, does he/she explain things clearly?

Yes

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* 21. When you go to the doctor for HIV care, has anyone ever talked to you about HIV prevention?

Yes

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* 22. Is it easy for you to talk with your doctor about your HIV treatment?

Yes

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* 23. Do you know what happens if you miss your doses of HIV drugs?

Yes

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* 24. How is your physical health compared to a year ago?

Worse

Same

Better

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* 25. How is your mental health compared to a year ago?

Worse

Same

Better

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* 26. In the last year, how many times have you gone to the emergency room BECAUSE OF HIV, including follow-up visits?

None

1-2

More than 2

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* 27. The list below includes the Ryan White services currently offered in the Southeast Tennessee area. Check the 3 most important to you.

Doctor visits & lab tests

HIV medications

Dental care

Emergency HIV drug and utility assistance

Food voucher

Case management

Transportation to medical appointments

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* 28. The list below includes services NOT currently offered as part of the Ryan White services in the Southeast Tennessee area. Which of these are the 3 most important to you?

Early prevention services

Help paying for health insurance premiums

Home Health Care

In home nursing care / medical equipment

Hospice services

Dietician / Nutrition therapy

Childcare services during care appointments

Children's HIV care services

Emergency financial assistance

Food bank / home delivered meals

HIV prevention education (for positives)

Mental health counseling

Substance abuse treatment services

Outreach services

Translation services

Permanency services

Support groups / Pastoral care

Information and referral to services

Rehabilitation services

Respite care

Treatment adherence counseling

Other (please specify)

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* 29. What do you worry about most? (You may continue on the last page if needed)

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* 30. Healthcare Services: Tell us about your HIV healthcare service needs. In the last year, did you NEED to....

	Did not need	Needed & received	Needed & DID NOT receive
See a doctor or a specialist?	See a doctor or a specialist? Did not need	See a doctor or a specialist? Needed & received	See a doctor or a specialist? Needed & DID NOT receive
Get a laboratory or other diagnostic test?	Get a laboratory or other diagnostic test? Did not need	Get a laboratory or other diagnostic test? Needed & received	Get a laboratory or other diagnostic test? Needed & DID NOT receive
See an eye doctor?	See an eye doctor? Did not need	See an eye doctor? Needed & received	See an eye doctor? Needed & DID NOT receive
Get help paying for drugs?	Get help paying for drugs? Did not need	Get help paying for drugs? Needed & received	Get help paying for drugs? Needed & DID NOT receive
See a dentist?	See a dentist? Did not need	See a dentist? Needed & received	See a dentist? Needed & DID NOT receive
See a mental health counselor?	See a mental health counselor? Did not need	See a mental health counselor? Needed & received	See a mental health counselor? Needed & DID NOT receive
Enroll in a drug treatment program?	Enroll in a drug treatment program? Did not need	Enroll in a drug treatment program? Needed & received	Enroll in a drug treatment program? Needed & DID NOT receive
Get in-home care?	Get in-home care? Did not need	Get in-home care? Needed & received	Get in-home care? Needed & DID NOT receive
Get home medical or health supplies?	Get home medical or health supplies? Did not need	Get home medical or health supplies? Needed & received	Get home medical or health supplies? Needed & DID NOT receive
See a physical therapist?	See a physical therapist? Did not need	See a physical therapist? Needed & received	See a physical therapist? Needed & DID NOT receive
See a rehabilitation therapist?	See a rehabilitation therapist? Did not need	See a rehabilitation therapist? Needed & received	See a rehabilitation therapist? Needed & DID NOT receive
Enroll in drug prevention program?	Enroll in drug prevention program? Did not need	Enroll in drug prevention program? Needed & received	Enroll in drug prevention program? Needed & DID NOT receive
Use children's HIV care?	Use children's HIV care? Did not need	Use children's HIV care? Needed & received	Use children's HIV care? Needed & DID NOT receive
Stay in a nursing home?	Stay in a nursing home? Did not need	Stay in a nursing home? Needed & received	Stay in a nursing home? Needed & DID NOT receive
Enroll in hospice care?	Enroll in hospice care? Did not need	Enroll in hospice care? Needed & received	Enroll in hospice care? Needed & DID NOT receive

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* 31. Support Services: Tell us about your HIV support services needs in the last year, did you NEED to...

	Did not need	Needed & received	Needed & DID NOT receive
See a case manager?	See a case manager? Did not need	See a case manager? Needed & received	See a case manager? Needed & DID NOT receive
Talk to an HIV+ peer advocate?	Talk to an HIV+ peer advocate? Did not need	Talk to an HIV+ peer advocate? Needed & received	Talk to an HIV+ peer advocate? Needed & DID NOT receive
Get legal assistance or advice?	Get legal assistance or advice? Did not need	Get legal assistance or advice? Needed & received	Get legal assistance or advice? Needed & DID NOT receive
Attend a support group?	Attend a support group? Did not need	Attend a support group? Needed & received	Attend a support group? Needed & DID NOT receive
Get spiritual counseling or support?	Get spiritual counseling or support? Did not need	Get spiritual counseling or support? Needed & received	Get spiritual counseling or support? Needed & DID NOT receive
Get grief counseling?	Get grief counseling? Did not need	Get grief counseling? Needed & received	Get grief counseling? Needed & DID NOT receive
Get education about HIV treatments?	Get education about HIV treatments? Did not need	Get education about HIV treatments? Needed & received	Get education about HIV treatments? Needed & DID NOT receive
Get help taking my HIV drugs?	Get help taking my HIV drugs? Did not need	Get help taking my HIV drugs? Needed & received	Get help taking my HIV drugs? Needed & DID NOT receive
Get help with translation / interpreting?	Get help with translation / interpreting? Did not need	Get help with translation / interpreting? Needed & received	Get help with translation / interpreting? Needed & DID NOT receive
Get educational non-medical HIV services?	Get educational non-medical HIV services? Did not need	Get educational non-medical HIV services? Needed & received	Get educational non-medical HIV services? Needed & DID NOT receive
Get food voucher?	Get food voucher? Did not need	Get food voucher? Needed & received	Get food voucher? Needed & DID NOT receive
Get childcare?	Get childcare? Did not need	Get childcare? Needed & received	Get childcare? Needed & DID NOT receive
Get transportation to medical appointments?	Get transportation to medical appointments? Did not need	Get transportation to medical appointments? Needed & received	Get transportation to medical appointments? Needed & DID NOT receive

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* 32. Other Services: In the last year, did you NEED to...

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* 33. Barriers to Care:
During the past year, have you had difficulty getting HIV services for any of the following reasons?

DEMOGRAPHIC INFORMATION

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* 34. What is your racial or ethnic background?

African-American / Black

Caucasian / White

Latino / Hispanic

Asian / Pacific Islander

Native American / Native Alaskan

Other (specify)

Other (please specify)

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* 35. What is your native language?

English

Spanish

American Sign Language (ASL)

Other (specify)

Other (please specify)

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* 36. What is your gender?

Male

Female

Transgender - Male to Female

Transgender - Female to Male

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* 37. How much education do you have?

Less than 12th grade

High school diploma/ GED

Some college

Undergraduate degree

Postgraduate school/degree

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* 38. Are you currently...

Employed full time

Employed part time

Unemployed looking for work

Unemployed waiting on disability

On disability

Retired

Other (please specify)

What is your household size (including only legally married spouse and dependent children/adults)?

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* 39. Adults:

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* 40. Children:

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* 41. What is your household income (including only legally married spouse and dependent children/adults)?

Less than $10,000

$10,001 to $20,000

$20,001 to $30,000

$30,001 to $50,000

$50,001 and above

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* 42. What type of health insurance do you have?

None

Medicaid

Medicare

Medicaid + Medicare

Medicare + Supplemental

Veterans

TennCare

Private Insurance

	Yes	No
The cost of drugs or services	The cost of drugs or services Yes	The cost of drugs or services No
Waiting list for services	Waiting list for services Yes	Waiting list for services No
Long wait to be seen at office or clinic	Long wait to be seen at office or clinic Yes	Long wait to be seen at office or clinic No
Lack of transportation	Lack of transportation Yes	Lack of transportation No
Lack of childcare	Lack of childcare Yes	Lack of childcare No
Language barrier / communication problems	Language barrier / communication problems Yes	Language barrier / communication problems No
Lack of trust that my care would be confidential	Lack of trust that my care would be confidential Yes	Lack of trust that my care would be confidential No
Fear of disclosing my HIV status	Fear of disclosing my HIV status Yes	Fear of disclosing my HIV status No
Services not available	Services not available Yes	Services not available No
Did not qualify financially	Did not qualify financially Yes	Did not qualify financially No
Discrimination because of gender (male / female)	Discrimination because of gender (male / female) Yes	Discrimination because of gender (male / female) No
Discrimination because of sexual orientation (gay/lesbian/bisexual)	Discrimination because of sexual orientation (gay/lesbian/bisexual) Yes	Discrimination because of sexual orientation (gay/lesbian/bisexual) No
Discrimination because of gender identity/expression (transgender)	Discrimination because of gender identity/expression (transgender) Yes	Discrimination because of gender identity/expression (transgender) No
Discrimination because of Race	Discrimination because of Race Yes	Discrimination because of Race No
Did not know where to go for services	Did not know where to go for services Yes	Did not know where to go for services No

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* 1. My Zip Code:

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* 2. When were you born?

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* 3. My County:

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* 4. Are you currently enrolled in Ryan White services?

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* 5. Are you currently receiving any HIV services?

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* 6. When did you first test positive for HIV?

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* 7. Where did you test positive for HIV?

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* 8. Other (please specify) :

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* 9. How do you think you got HIV? (select ALL that apply)

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* 10. My last CD4/TCell count was:

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* 11. My last viral load wais:

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* 12. Are you currently taking drugs to treat HIV?

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* 13. Has a doctor ever diagnosed you with AIDS?

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* 14. How long after testing positive did you start getting HIV services?

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* 15. What would have helped you get HIV care sooner after testing positive? (Check ALL that apply)

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* 16. In the last year, how often did you see your doctor about HIV?

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* 17. If you have not seen a doctor in the last year, why not?

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* 18. Who gave you the MOST information about HIV treatments?

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* 19. When you see your case manager, does he/she explain things clearly?

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* 20. When you see your doctor, does he/she explain things clearly?

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* 21. When you go to the doctor for HIV care, has anyone ever talked to you about HIV prevention?

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* 22. Is it easy for you to talk with your doctor about your HIV treatment?

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* 23. Do you know what happens if you miss your doses of HIV drugs?

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* 24. How is your physical health compared to a year ago?

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* 25. How is your mental health compared to a year ago?

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* 26. In the last year, how many times have you gone to the emergency room BECAUSE OF HIV, including follow-up visits?

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* 27. The list below includes the Ryan White services currently offered in the Southeast Tennessee area. Check the 3 most important to you.

Question Title

* 28. The list below includes services NOT currently offered as part of the Ryan White services in the Southeast Tennessee area. Which of these are the 3 most important to you?

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* 29. What do you worry about most? (You may continue on the last page if needed)

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* 30. Healthcare Services: Tell us about your HIV healthcare service needs. In the last year, did you NEED to....

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* 31. Support Services: Tell us about your HIV support services needs in the last year, did you NEED to...

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* 32. Other Services: In the last year, did you NEED to...

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* 33. Barriers to Care:During the past year, have you had difficulty getting HIV services for any of the following reasons?

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* 34. What is your racial or ethnic background?

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* 35. What is your native language?

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* 36. What is your gender?

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* 37. How much education do you have?

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* 38. Are you currently...

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* 39. Adults:

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* 40. Children:

* 33. Barriers to Care:
During the past year, have you had difficulty getting HIV services for any of the following reasons?