1. I am providing feedback about:
www.hivla.org (Web site)
HIV L.A. print directory

2. How did you hear about HIV L.A.?
Saw an advertisement
Received a copy from a service provider
Internet
Received a copy in the mail
Other (specify)

3. Please select the sections of this directory that you have consulted (select all that apply):
Case Management
Drug Treatment
Fact Sheets
Food and Nutrition
HIV/STD Testing
Housing
Hotlines and Crisis Lines
Legal Services
Medical Resources
Mental Health
Prevention
Public Benefits
Transportation
Women/Youth Services
Work-related Resources
Work-related Resources
Other (specify)

4. What sections would you like to see added to this directory?
Type your response here

5. Did the use of this Website increase your knowledge of available HIV/AIDS services in L.A. County?
Yes
No

6. Did you access services as a result of using this directory?
Yes
No

7. Do you plan to use this directory again?
Yes
No

8. Is the information in this directory helpful, user-friendly and easy to read and understand?
Yes
No

9. Please give an overall rating of this directory:
Excellent
Good
Neutral
Fair
Poor

10. Please provide any additional comments you may have, including suggestions for improving this directory, or positive or negative reactions: Type your response here

Please provide some demographic information about yourself. This information is anonymous and will help us better tailor our services.

11. Gender (choose only one response):
Female
Male
Transgender (M to F)
Transgender (F to M)

12. What is your age?:
18 or younger
19 - 29
30 - 49
50+

13. What is your ZIP code?:

14. What languages are you comfortable speaking? (Please check all that apply.)
English
Spanish
Sign Language
Other (specify) 

15. Which best describes your racial/ethnic background? (Please choose only one.)
White/Caucasian
American Indian/Alaska Native
Black/African American
Hispanic/Latino
Asian/Native Hawaiian/Other Pacific Islander
Other (specify) 

16. How do you identify yourself? (Please choose only one.)
Gay/Homosexual
Bisexual
Heterosexual/Straight
Lesbian/Homosexual
Transgender

17. What is your current source of income? (Check all that apply.
No income
Public assistance program (SSI, SDI, Unemployment, General Relief)
Employment
Retirement/Pension

18. Are you HIV-positive?
Yes
No
Don't know 
Decline to answer

19. If you are HIV positive, how long have you known that you are HIV positive?
Less than 6 months
6 months to 1 year
More than 1 year but less than 5 years
5 years or more

THANK YOU FOR PARTICIPATING IN THIS SURVEY!
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