Skype, Facetime, or Video chat
Browse by Domain
Individual Level
How did you primarily communicate with the person you received the most support form? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
How did you primarily communicate with the person you received the most support form? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Video gaming platforms
The next section asks about your experiences with telling others about your health care wishes. These questions may be uncomfortable to think about. There are no right or wrong answers - your answers will help us to understand whether men are talking about these issues with other people in their lives. How much have you thought about:
talking with your doctors about who you want your medical decision maker to be?
When mentoring or providing advice to others in the LGBT community, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Text, messenger or Twitter
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Psychotherapy (i.e. 1-on-1 counseling, hypnosis, cognitive behavioral therapy, trauma-based therapy, conventional talk therapy)
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Group-based therapy (e.g., drop-in, live-in, or coaching groups)
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Prayer/Religion-based therapy (i.e. ex-gay ministry, talked with a pastor/clergy, exorcism)
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Gender role reinforcement (i.e. counselor/clinician encouraged heterosexual dating/sexual relationships)
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Aversion therapy (i.e. electric shock, convulsion, nausea-inducing, rubber bandshock in presence of homoerotic images)
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Pharmacological treatments (i.e. chemical castration)
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Other [please specify]:
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
None of the Above
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing. Have you ever experienced any of these conversion therapies?
Prefer not to say
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing.
How old were you when you first experienced any form of conversion therapy?
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing.
Thinking of your FIRST experience, how much was it YOUR decision to seek conversion therapy?
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing.
Which of the following best describes the frequency in which you attended conversion therapies? In other words, how often did your therapy sessions occur?
The next few questions will ask you about lifetime experiences you may have had with conversion therapies. Conversion therapies, also referred to as reparative or reorientation therapies, are therapies designed to change an individual?s sexual attraction (from same-sex attraction to opposite-sex attraction), gender identity, and/or gender expression. We are specifically interested in how these prior experiences have shaped your overall health and wellbeing.
Thinking of the time between your FIRST and LAST experience, for how long did you attend conversion therapies?
In the next section, we are asking questions about your current emotional state. To what extent over the past 6 months have you been bothered by the following?
Feeling Threatened
The next set of questions asks about your own gender identity and relationships with trans people. By trans people, we mean transgender, transsexual, and other people who may not people. By trans people, we mean transgender, transsexual, and other people who may not identify or be identified as fitting easily into a male/female categorization.
Have you had any sexual activity in the last six months with a trans person? [Definition: Sexual activity includes oral sex, anal or butt sex, vaginal sex, and any touching of genital or anal areas, with or without ejaculation. This definition includes deep kissing]
In the next section, we are asking questions about your current emotional state. To what extent over the past 6 months have you been bothered by the following?
Trouble Sleeping
Regarding the people you trust and depend on, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Regarding the people you trust and depend on, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
In person
Regarding the people you trust and depend on, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Over the phone
Regarding the people you trust and depend on, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Text, messenger, or Twitter
Regarding the people you trust and depend on, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Skype, Facetime or video chat
Regarding the people you trust and depend on, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Video gaming platforms
When you turn to people to talk in times of need, how do you primarily communicate with those people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Text, messenger, or Twitter
Please answer the following questions about yourself by indicating the extent of your agreement using the following scale. Be as honest as you can throughout, and try not to let your responses to one question influence your response to other questions. There are no right or wrong answers.
I don't get upset too easily.
When mentoring or providing advice to others in the LGBT community, how do you primarily communicate with these people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Skype, Facetime or Video chat
When you turn to people to talk in times of need, how do you primarily communicate with those people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Skype, Facetime, or Video chat
When you turn to people to talk in times of need, how do you primarily communicate with those people? Rank the top three methods you used, with number one being the method you used most. If you only used one or two, leave the rest blank.
Video gaming platforms
Voluntary activity is unpaid work, not just belonging to an organization or group. It should be of service or benefit to other people or the community and not only to one's family or personal friends. During the last 12 months, did you do volunteer work in any of the following areas?
Any kind of other voluntary activities
The next section asks about your experiences with telling others about your health care wishes. These questions may be uncomfortable to think about. There are no right or wrong answers - your answers will help us to understand whether men are talking about these issues with other people in their lives. Have you:
talked with your doctor about who you want your medical decision maker to be?
The next section asks about your experiences with telling others about your health care wishes. These questions may be uncomfortable to think about. There are no right or wrong answers - your answers will help us to understand whether men are talking about these issues with other people in their lives. Have you:
talked to your medical decision maker about whether health situations would makelife not worth living?
The next section asks about your experiences with telling others about your health care wishes. These questions may be uncomfortable to think about. There are no right or wrong answers - your answers will help us to understand whether men are talking about these issues with other people in their lives. Have you:
talked to your doctor about whether health situations would make your life not worth living?
The next section asks about your experiences with telling others about your health care wishes. These questions may be uncomfortable to think about. There are no right or wrong answers - your answers will help us to understand whether men are talking about these issues with other people in their lives. How much have you thought about:
talking with your decision maker about whether health situations would make yourlife not worth living?
The next section asks about your experiences with telling others about your health care wishes. These questions may be uncomfortable to think about. There are no right or wrong answers - your answers will help us to understand whether men are talking about these issues with other people in their lives. How much have you thought about:
talking with your doctors about whether health situations would make your life not worth living?
Please answer the following questions about yourself by indicating the extent of your agreement using the following scale. Be as honest as you can throughout, and try not to let your responses to one question influence your response to other questions. There are no right or wrong answers.
If something can go wrong for me, it will
The next set of questions asks about your own gender identity and relationships with trans people. By trans people, we mean transgender, transsexual, and other people who may not people. By trans people, we mean transgender, transsexual, and other people who may not identify or be identified as fitting easily into a male/female categorization.
In the last six months, with how many trans women have had you sexual activity? By trans women, we mean people who were born as male but express themselves as female or trans-feminine.
The next set of questions asks about your own gender identity and relationships with trans people. By trans people, we mean transgender, transsexual, and other people who may not people. By trans people, we mean transgender, transsexual, and other people who may not identify or be identified as fitting easily into a male/female categorization.
In the last six months, with how many trans women did you have anal sex?
Interpersonal/Dyadic/Relationship Level
Thinking about the last 6 months, how much support did you get from the following people? (By support, we mean things like: loaning you money, help out when you're sick, run errands for you, provide transportation for you, help with any other task that you can't complete on your own, or by taking the time to really listen to you to help you deal with a problem)
Co-workers
Do you discuss your risk of transmitting HIV to others with any of the following?
Casual sexual partners
Do you discuss your risk of transmitting HIV to others with any of the following?
Family
Do you discuss your risk of transmitting HIV to others with any of the following?
Friends
Do you discuss your risk of transmitting HIV to others with any of the following?
Main sexual partners
Do you discuss your risk of transmitting HIV to others with any of the following?
Other Person
Do you discuss your risk of transmitting HIV to others with any of the following?
Healthcare provider
Do you discuss your risk of transmitting HIV to others with any of the following?
Religious Figure