Supporting Choices: HIV and Disclosure in the Workplace
Resize font:

Thank you for accessing the Supporting Choices: HIV and Disclosure in the Workplace Survey.

We are a research team from the University of Manitoba conducting a project to develop a decision and communication aid to assist people living with HIV make choices about disclosure of their health status in the workplace. In this first phase of the study we are interested in finding out about current practices, issues, successes, and what resources are currently available to support people living with HIV to make disclosure decisions. As someone who is knowledgeable about the issues related to HIV and disclosure, we are inviting you to participate in this short survey. The questionnaire consists of 20 questions and will take you approximately 10 to 15 minutes to complete. You may receive more than one invitation to do the survey, but please complete the questionnaire only once.

Your participation in this online survey is completely voluntary. You are not required to provide any information such as your name, address or telephone number, and you don't have to answer any questions you don't want to. The survey system will not record your e-mail address or IP (Internet Protocol) address. At the end of the survey you will be given the option to access another webpage if you would like to leave your contact information to be contacted for future discussions about this research. This contact page will not be linked to your survey responses.

The risks of participating in this online survey are low. However, you may feel discomfort in answering some of the questions.

If you agree to participate in the survey, please note that you must complete the survey in one sitting (in other words, the system won't let you save your survey responses and return to complete them later). Also please note that when you submit your questionnaire responses, you will not be able to withdraw them as we cannot link the responses back to you.

The University of Manitoba Health Research Ethics Board has approved this research project. The survey will be hosted by a secure web application called REDCap. Data collected using REDCap is stored and controlled by the University of Manitoba.

By submitting the survey it is implied that you have given your consent. Your responses are highly valued and will provide meaningful results that will assist us to develop more effective processes for supporting people living with HIV to make workplace disclosure decisions.

If you have any questions or concerns regarding the survey, please contact Gayle Restall at or by phone at 204-975-7736.

Page 1 of 8

You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.
The response has now been removed for the last question for which you selected a value. You may now enter a new response for that question and continue the survey.
This value you provided is not a number. Please try again.
This value you provided is not an integer. Please try again.
The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.
The value you provided must be within the suggested range.
The value you provided is outside the suggested range.
This value is admissible, but you may wish to verify.
The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).
This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.
This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.
This field must be a valid email address (like Please re-enter it now.
The value you provided could not be validated because it does not follow the expected format. Please try again.
/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4})) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4})) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/
/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4})) (\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/
/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4})) (\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/
/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3])(:[0-5]\d){2}$/