Survey – Are You Eligible?

We are doing several research studies to better understand HIV infection and how we can potentially cure HIV infection. The purpose of this survey is to help us determine if you are eligible for our clinical trials and to collect information on patients who want to participate in future clinical trials.

This survey is voluntary and no compensation will be provided. If you agree to complete the survey, you will be asked to answer survey questions. The survey asks questions about your HIV status, current stage of HIV and medications to treat HIV. It also asks about whether you have cancer, and what types of treatment you have received. The survey takes 10 minutes to complete.

Please leave your contact information if you want to be contacted about an HIV study. With your permission, we will keep your name and contact information as well as your answers to survey questions to contact you for future studies for 5 years. Only study staff will have access to this information, and the information will be kept on a password protected computer. You may be contacted by a research coordinator, study nurse or physician to answer additional questions about your eligibility for specific studies. If you do not want to provide your name, or if you have additional questions, you can contact us directly via the e-mail on this web site (hivontrial.org).

We will keep your survey responses confidential. But we cannot guarantee total confidentiality. There is a small risk that participation in this survey will result in accidental release of your name or information you provide. We have many safeguards in place to avoid this, including storing records on secure computers with restricted access. We will not use your personal information in any reports about this study, such as journal articles or presentations at scientific meetings. Completing the survey may benefit you by allowing you to see if you are eligible for research studies. You do not have to complete this survey. You are free to say yes or no. There is no penalty or loss of benefits for saying no. Whatever you decide, your regular medical care will not change. If you decide you do not want us to have your contact information, you can contact us and we will remove it from our database.

The Fred Hutchinson Institutional Review Board may need to look at your survey responses for quality assurance. If you have any questions about your rights as a research participant, call Karen Hansen in the Hutchinson Center’s Institutional Review Office at 206-667-4867.

If you agree to the above, please push the following button to advance to the survey.

AGREE