Appointment Questionnaire

Take this questionnaire to help you plan questions for your next appointment

A personalised report will be generated for you based on your responses. It is confidential and we will not store any of your responses.

Do you find yourself thinking about any of the following regularly?

You can select more than one

That people judge me

How HIV will affect my life and what I like to do

How HIV will affect my health long-term

Relationships and protecting others

That I could do more to lead a healthy life

None of these but other things are on my mind

I’m not worried about anything at the moment

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How long have you been living with HIV for?

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Which statement best describes how you manage your HIV?

I could do more to manage my HIV

I feel in control. HIV doesn’t rule my life

I’m still coming to terms with living with HIV

I take my treatment as prescribed and am managing my HIV well

None of these

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Which statement best describes your health?

You can select more than one

I feel healthy and living with HIV has encouraged me to lead a healthier lifestyle

Right now I feel healthy

I feel healthy now but I worry about the future

I feel unwell more than I feel well

My mental health is affecting my general wellbeing

My physical health needs outweigh my mental health needs

None of these

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Which statement best describes how often you talk about living with HIV?

I prefer to be discreet about my HIV status

I have a good support network to talk to about my health and wellbeing

I am very open about my status and discuss it as and when I need to

I would like to have someone I could talk to more about my HIV

None of these

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How often do you miss taking your tablets in a typical month?

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What is the main reason for this?

Forget

Unpleasant side-effects prevent me from taking my tablets every day

I don’t want people to see me take them in social situations

Spontaneous plans mean I don’t always have my treatment with me

I’m concerned that other drugs I use affect the HIV treatment I take (recreational, other prescribed or over the counter drugs)

Other reasons

Not applicable

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In the last month, how often have you had difficulty sleeping?

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Which best describes your doctor’s appointment?

I always ask for my viral load and CD4 count/percentage

If my doctor says I’m fine that’s all I need to know

I never understand my test results

There isn’t enough time to talk about everything I would like to

My appointment is led by me and my needs. I discuss everything I want to

I always want to know all my test results including viral load, glucose, cholesterol and others

I often forget to mention things that have been on my mind

None of these

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