THE AMAAD INSTITUTE
 

The AMAAD Institute is committed to forming a compassionate, informed response to the growing concerns around HIV and Substance Use in the South Los Angeles area.   This questionnaire is designed to drive proactive community engagement and mobilization.  Your feedback will help capture necessary data to effectively and appropriately respond to our community needs.

2. Do you live, work, or socialize in South L.A.? *
3. How would you identify yourself? (Gender) *
 
4. How would you describe your sexual orientation? *
 
5. What is your race/ethnicity? (check all that apply) *
 
6. What is your living situation? *
 
7. Have you ever been arrested? *
7a. Have you ever spent time in jail? (County or City) *
7b. Have you ever spent time in prison? (State or Federal) *
8. Have you ever had sex for money, food, drugs, or place to sleep? *
9. When is the last time you were tested for HIV? *
10. Do you know your HIV Status? *
10a. Are you HIV positive? *
10b. Are you currently receiving care or treatment for your HIV? *
11. Have you ever been diagnosed with a STD ? (e.g., Chlamydia, Gonorrhea, Syphilis, etc.) *
11a. Which STD were you diagnosed with? (check all that apply) *
 
12. Have you ever received a mental health diagnosis? *
13. Have you ever used ANY (street/recreational/party) drugs? *
14. Have you ever used Crystal Meth? *
15. How often have you used Crystal Meth? *
16. The use of Crystal Meth is a major issue for my age/peer group? *
17. Are you aware of places people can go to get support or treatment for Crystal Meth Addiction? *
19. If you needed support services, what geographic area would you prefer to receive services? (Check all that apply) *
 
20. What type of support are you most comfortable with? *
 
21. Would you be open to being contacted to participate in a future discussion to provide your opinions? *