Today M-D-Y
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At the Center for HIV and Research in Mental Health (CHARM) at the University of Miami (UM), our goal is to improve the health and well-being of the Miami community and beyond. We have a brief survey that will help us find out and describe the health needs of the Miami community. The survey should take approximately 5 minutes . Please know that:
You must be 18 years or older. You do not have to answer any question you feel uncomfortable answering. You have the right to stop the survey at any time or withdraw your information at any time with no consequence. The first part of the survey is potentially anonymous in that it asks about different behaviors and experiences that may or may not apply to you. The second part of the survey asks if you would like to be contacted and potentially invited to participate in future studies at UM that would be related to your responses. At that point, if you select "yes", you will be given the opportunity to type in your name and contact information. If you do not want to be contacted for future studies, you can just select "no", and you will not be asked to put in your name or any of your contact information leaving your survey anonymous. All information provided is kept confidential. And for additional protection, we have something called a Certificate of Confidentiality, which means that although we must comply with the law, we cannot disclose identifiable, sensitive information in response to legal demands (like a subpoena). However, this protection doesn't extend to a demand for information used for auditing or evaluation of federally funded projects, done by the U.S. government.
Now M-D-Y H:M Please click "Now"
Would you be willing to complete our brief survey?
* must provide value
Yes, I would like to do the survey
No, I would NOT like to do the survey or I am younger than 18 years old
No, but I would like to provide my contact information to be contacted about future studies
Do you live in Miami-Dade county or Broward county?
* must provide value
Yes
No
Are you comfortable reading, writing, and speaking in English?
* must provide value
Yes
No
Do you identify as transgender/someone of trans experience?
* must provide value
Yes
No
Unsure
Decline to answer
What is your current gender identity?
* must provide value
Male
Female
Trans male/trans man
Trans female/ trans woman
Genderqueer/gender non-conforming/non-binary
Different identity
Decline to answer
You selected "Different identity" - please specify:
* must provide value
Type "-999" for "Decline to answer"
If you had to describe your gender using these options, which of the following responses best describes your gender today?
* must provide value
Man (including cis and trans men)
Woman (including cis and trans women)
Genderqueer
Gender non-conforming
Non-binary
Gender fluid
Two-spirit
Another gender not listed
Decline to answer
You selected "Another gender not listed" - please specify:
* must provide value
What sex were you assigned at birth, on your original birth certificate?
Male
Female
Intersex
Decline to answer
Which of the following commonly used terms best describes your sexual orientation?
* must provide value
Gay
Lesbian
Bisexual
Heterosexual/"Straight"
Queer
Pansexual
Asexual
Unsure/Questioning/Exploring
Not listed
Decline to answer
You selected "Not Listed" - please specify:
* must provide value
Type "-999" for "Decline to answer"
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
Do you consider yourself to be...? (Check all that apply )
* must provide value
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
Do you consider yourself to be...? (Check all that apply)
* must provide value
You selected "Multi-racial/Mixed" - You can provide more information if needed:
Type "-999" for "Decline to answer"
You selected "Different racial identity" - please specify:
* must provide value
Type "-999" for "Decline to answer"
HIV-positive, detectable viral load
HIV-positive, undetectable viral load
HIV-positive, I don't know my viral load
HIV-negative
I don't know
Decline to answer
HIV Negative
Person living with HIV: detectable viral load
Person living with HIV: undetectable viral load
Person living with HIV: I don't know my viral load
I don't know
Decline to answer
Are you currently prescribed anti-retrovirals (HIV medication)?
* must provide value
Yes
No
Decline to answer
Are you currently prescribed pre-exposure prophylaxis (PrEP)?
* must provide value
No
Yes
No, but I've heard of PrEP
No, and I've never heard of PrEP
Decline to answer
Have you been prescribed PrEP in the last 4 weeks?
* must provide value
Yes
No
Decline to answer
Are you planning to start PrEP in the next 4 weeks?
* must provide value
Yes
No
Decline to answer
Have you been prescribed ART in the last 4 weeks?
* must provide value
Yes
No
Decline to answer
Are you planning to start ART in the next 4 weeks?
* must provide value
Yes
No
Decline to answer
In the last 4 weeks , how good a job did you do at taking it in the way you were supposed to?
* must provide value
Poor
Fair
Good
Very Good
Excellent
Decline to answer
Have you had any sex without a condom in the past 3 months?
* must provide value
Yes, 1 or 2 times
Yes, 3 to 5 times
Yes, more than 5 times
No
Decline to answer
Over the last 2 weeks , how often have you been bothered by any of the following problems?
Have you ever experienced, witnessed, or had to deal with an extremely traumatic event that included actual or threatened death, serious injury, or sexual violence to you or someone else?
* must provide value
Yes
No
Decline to answer
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
What types of drugs did you use? (Check all that apply )
* must provide value
Marijuana
Stimulants (e.g., meth, cocaine, crack)
Heroin
Club drugs/Hallucinogens (e.g., MDMA, Molly, ecstasy, LSD)
Tranquilizers (e.g., GHB, roofies)
Non-medical use of prescription medications (e.g., OxyContin, Vicodin, Fentanyl, Xanax, Valium, Ambien, Ritalin, Adderall)
Other
Decline to answer
You selected "Other" - please specify:
* must provide value
Type "-999" for "Decline to answer"
1 not very true of me
2
3
4
5 very true of me
Decline to answer
In general, would you say your health is...?
* must provide value
Poor
Fair
Good
Very Good
Excellent
Decline to answer
At the Center for HIV and Research in Mental Health (CHARM) at the University of Miami, our goal is to improve the health and well-being of the Miami community and beyond. May we contact you for any surveys or studies we may be conducting at the University of Miami that you may be interested in?
* must provide value
Yes, I do want to be contacted for future research studies
No, I do not want to be contacted
Please fill out your contact information below. When we contact you, we will be identifying ourselves as calling from "the University of Miami regarding a survey you completed".
Yes
No
Yes
No
He, Him
She, Her
They, Them
He, They
She, They
Different pronouns
You selected "Different pronouns" - please specify:
Thank you for your time! Currently, we are only working with individuals 18 years or older.
Thank you for your time! Currently, we are only working with individuals in the greater Miami area.
Thank you for your time and effort! You have been a part of our efforts in improving Miami's health and well-being.