Vaccine Hesitancy Survey

AIDS United has received funding from Johnson & Johnson to address vaccine hesitancy in the People Living with HIV community. We are hoping to understand the barriers, motivations, and beliefs of PLWH who are vaccine hesitant and have not been vaccinated with any of the three (3) vaccines that are available in the United States. The survey should only take about 13 minutes, and your responses are completely anonymous. Questions marked with an asterisk (*) are required. However, if you would like to enter for a chance to receive a gift card for completing the survey, you can enter your email in a separate Google Form. If you have any questions about the survey, please email us: policy@aidsunited.org. We really appreciate your input!

(Please scroll and/or click “Ok/Next” to continue.)

Question Title

* ELECTRONIC CONSENT: Please select your choice below. You may print a copy of this consent form for your records. Clicking on the “Agree” button indicates that
· You have read the above information
· You voluntarily agree to participate
· You are 18 years of age or older

Agree

Disagree

Vaccine Hesitancy Survey

Question Title

* ELECTRONIC CONSENT: Please select your choice below. You may print a copy of this consent form for your records. Clicking on the “Agree” button indicates that · You have read the above information · You voluntarily agree to participate · You are 18 years of age or older

* ELECTRONIC CONSENT: Please select your choice below. You may print a copy of this consent form for your records. Clicking on the “Agree” button indicates that
· You have read the above information
· You voluntarily agree to participate
· You are 18 years of age or older