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RetHealth - Help Us Understand Your Needs
This form is anonymous and it's for anyone that has tested positive for HIV. The information and insights you provide will help us serve you better and tackle the most pressing needs of people living with HIV.
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RetHealth - Your Number 1 HealthTech provider for HIV treatment and care.
RetHealth - Your Number 1 HealthTech provider for HIV treatment and care.
Kindly confirm if you have tested positive for HIV. *
If No, do you have a close friend or relative that has tested positive?
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On a scale of 1 - 5, how challenging do you find "Access to Antiretroviral Drugs"? *
A Little Challenging
Highly Challenging
On a scale of 1 - 5, how challenging do you find "Visits to the Hospital"? *
A Little Challenging
Highly Challenging
On a scale of 1 - 5, how difficult is receiving treatment and healthcare from an HIV Hospital/doctor/test-centre? *
A Little difficult
Very difficult
What are your biggest challenges with receiving HIV treatment and care? *
On a scale of 1 - 5, How important is a medical counsellor? *
Not so Important
Very Important
On a scale of 1 - 5, How has contacting HIV affected your mental health? *
Not at all
Highly degrading
What other major challenges have you faced? *
If you could solve one problem on dealing with HIV, what problem would you solve?
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