EmailMeForm
Name
*
First
Last
Email
*
Your primary profession/discipline
*
Your highest earned degree/credential
*
Are you affiliated with a college or university? If so which one?
*
Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino American or Spanish
Native Hawaiian or Other Pacific Islander
White
What is your gender? Please select
Male
Female
Transgender
Other. Please list your current gender identity
How did you hear about this webinar
*
Word of mouth
Recommended from my school
Other
Do you provide HIV prevention counseling and testing services to clients/patients?
*
Yes
No
If No, Stop here. You can skip over the next set of questions and jump to the webinar you wish to register for below.
...If you provide services for clients/patients with HIV or Hepatitis C, please continue...
If Yes; How many YEARS have you been providing services directly to clients/patients living with:
HIV (round up to the nearest whole year)
HCV (round up to the nearest whole year)
Do you provide services directly to clients/patients living with HIV or Hepatitis C?
Yes
No
Do you provide HCV prevention counseling and testing services to clients/patients?
Yes
No
Do you prescribe HIV pre-exposure prophylaxis (PrEP) to clients/patients?
Yes
No
Do you prescribe antiretroviral therapy (ART) to clients/patients?
Yes
No
Estimate the NUMBER of clients/patients living with HIV to whom you provided direct services in the past YEAR
Estimate the NUMBER of clients/patients living with HCV to whom you provided direct services in the past YEAR
Estimate the PERCENTAGE of your clients/patients living with HIV in the past YEAR who are receiving antiretroviral therapy
None
1-24%
25-49%
50-74%
>75%
Estimate the PERCENTAGE of your clients/patients living with HCV in the past YEAR who are receiving antiretroviral therapy
None
1-24%
25-49%
50-74%
>75%
Please let us know which webinar(s) you would like to attend
09/17/20 Clinical Advances for the Prevention, Care, & Treatment of HIV/HCV Among MSI College Students
10/08/20 HIV/HCV and COVID-19: What Clinical Providers Need to Know
10/22/20 PrEP and Other Biomedical Interventions: A Guide for Medical Providers
11/05/20 Sexual Orientation and Gender Identity (SOGI): Addressing HIV Disparities to Improve Health Outcomes of Persons Living with HIV
12/03/20 Addressing Intersectionality of Intimate Partner Violence on College Campuses in the era of COVID-19
01/14/21 Substance Use, HIV, and Young Adults: A Guide for Clinical Providers
02/11/21 Culturally Appropriate Engagement and Service Delivery: Enhancing Linkage & Retention to HIV
02/25/21 Integrating Mental Health into HIV Care for College Students
03/11/21 Next Generation of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for College Students
03/25/21 HIV Care Continuity During Emergencies & Disasters