About You

This is some basic information to let us know who you are. All your responses will be kept confidential.

Question Title

* 1. Are you living with HIV?

Question Title

* 2. What is your gender identity?

Question Title

* 3. In what year were you diagnosed?

Question Title

* 4. Which of these best describes your age range?

Question Title

* 5. Which best describes your race or ethnicity?

Question Title

* 6. Enter your name (optional, but required to be eligible for the gift card drawing)

Question Title

* 7. Enter your email address (optional, but required to be eligible for the gift card drawing)