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                                        Confidentiality Statement

Howard County Health Department (HCHD) takes your privacy seriously. Any personal information provided in this survey will be kept confidential and protected by HIPPA. Your responses will only be used for this survey project. Participation is voluntary, and you may stop at any time. If you have any questions or concerns about privacy, please contact Tunde Alake at oalake@howardcountymd.gov. Thank you for your participation in this important initiative.
Section 1: Demographic Information
Demographic Information (questions 1-4)

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* 1. Age:

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* 2. Gender Identity:

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* 3. What is your race/ethnicity? Please select all that apply:

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* 4. Please choose your residential zip-code (choose only one)

Section 2: Awareness of Injectable PrEP Medication
Awareness of Injectable PrEP Medication  (questions 5-7)

Please choose your level of agreement with the following statements on a scale of 1 to 5, where 1 means "Strongly Disagree" and 5 means "Strongly Agree."

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* 5. I have heard about an injectable medication for PrEP.

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* 6. I would like to learn more about an injectable medication for PrEP.

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* 7. I am not interested in using an injectable medication for PrEP.

Section 3: Concerns about to Taking injectable Prep
Concerns about to Taking injectable Prep (questions 8-15)

Please choose your level of agreement with the following statements on a scale of 1 to 5, where 1 means "Strongly Disagree" and 5 means "Strongly Agree."

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* 8. I have concerns about how well injectable PrEP prevents HIV.

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* 9. I have concerns about the safety of Injectable PrEP.

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* 10. I am worried about potential side effects of Injectable PrEP.

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* 11. I need to know more about the benefits of Injectable PrEP.

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* 12. I am concerned about the cost of injectable PrEP.

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* 13. I would feel negatively judged by others if I take Injectable PrEP.

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* 14. I am worried that it will be difficult to get Injectable PrEP medication.

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* 15. Other reasons (if no other reason, please put N/A):

0 of 15 answered
 

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