Wales Plus: A HIV Positive Group
Wales Plus is a group of people living in Wales, or from Wales, who are living with HIV.

We are in the early stages of setting up the group, and are looking for people who may be interested in taking part. This could be a group chat or a personal conversation with someone else living with HIV.

All questions are optional.

The group is hosted by Fast Track Cities Cardiff & Vale.

Your information will be held with the strictest of confidence. You have the right to access all personal data in whether as manual records or electronic format. You also have the right to request to have your personal data removed. Contact 21stcenturyhiv@hiv.wales for more information.
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Name
Email
Phone number
How would you prefer to be contacted
Gender: How do you identify?
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What is your age?
We are only looking for people over 18 at the moment.
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Do you live in Wales, or are you from Wales?
Clear selection
Are you living with HIV?
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How long have you been living with HIV?
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What would you like from the group?
How would you like to access group support?
How would you like to access individual support?
Is there anything else you would like to tell us?
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