Form 7 NLAAD_Survey-Revised 6-2-2011

Form Approved

OMB No. 0920-XXXX

Expiration Date XX/XX/20XX

HIV/AIDS Awareness Day Programs

Attachment # 6:

National Latino AIDS Awareness Day Survey

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

NLAAD

EVENT HOLDER SURVEY

The purpose of this part of the survey is to gather information from organizations that registered as NLAAD 2011 participants and that hosted an NLAAD event; we want to get feedback on (1) what was the planning process?; (2)What were the barriers and/or facilitators to planning and implementing an event; and (3) what were the outcomes of the event?

I. Default section (all respondents complete)

1. Respondent Information

Name: Company Address Address 2: City/Town State: Zip/Postal Code Country

Email address

Phone number

2. Organizational Information

What best describes your type of organization?

 Community based 

Local Health Department

 Faith-Based Organization

University

Clinic

Federal Government

Hospital

Media Group

 Corporation

Other



3. From what sources does your organization receive funding from?

Centers for Disease Control and Prevention (CDC)

State health departments

Local health departments 

Private companies

Individuals

Federal agencies

Other:_________

4. Was 2011 your first NLAAD event

   • Yes No I did not conduct an NLAAD event in 2011 

4b. If no, please indicate number of years conducting NLAAD events (please specify)

II. NLAAD 2011 Event

These questions concern your NLAAD 2011 event.
1. When did you first hear about NLAAD 2011?

Less than 1 month before the event1-6 months before the event

6 months prior to a year before the event

Actively involved in NLAAD prior to 2011



2. Did your organization have a planning or organizing committee/coalition for NLAAD 2011?

YesNo

3. When did you start planning for NLAAD 2011?

   • Less than 1 month before the event 

   • 1-3 months before the event 

   • 4-6 months before the event 

   • More than 6 months before the event 



4. When did you hold your 2011 NLAAD activities?

   • Before October 15 

   • On October 15 

• After October 15 



5. Did you provide educational materials at your NLAAD events? YesNo

6. What is the perception of the success of your NLAAD 2011 event for the following:

	Extremely Unsuccessful	Somewhat unsuccessful	Neutral	Somewhat successful	Extremely successful	N/A
Increased number of Latinos tested for HIV at the organization						
Increased number Latinos seeking HIV/AIDS and other health & counseling services						
Increased discussion and awareness in the local Latino community about HIV/AIDS						
Increased number Latinos seeking HIV/AIDS and other health & counseling services						
Increased discussion and awareness in the local HIV/AIDS Community about about Latinos						
Other
Other (please specify)

6. What activities did your organization hold for NLAAD 2011?

• Health fair 

• Candlelight vigil 

• Press conference 

• Skit/play 

• Cultural event 

• Information dissemination 

• Discussion (community forum) 

• Other (please specify) ____________________ 



8. Did your organization conduct HIV testing at your NLAAD 2011 event? YesNo

III. HIV Testing

These questions concern the HIV testing conducted at your NLAAD event (please check all that apply)

1. Where was HIV testing provided at your NLAAD event (please check all that apply).

Health fair

Candlelight vigil

Press conference Skit/play

Cultural event

Discussion (community forum)

Religious service

Community clinic

Community center

Public park

Local hospital

Mobile testing unit

Bar

mall

Other (please specify) ____________________





2. Please enter the total number of HIV testing sites for NLAAD 2011

12345more than 5

2. What type of HIV testing did you provide at your event (mark all that

apply).

Blood drawOral rapid testOral collection (not rapid)finger stick

4. Approximately how many HIV tests did your agency administer? _____

4. How often do you target the following populations for HIV testing? (please mark all that apply)

7

	NLAAD 2011	Other AIDS awareness Days	Through the year	Do not focus on this population	N/A
Hispanic/Latino					
General population					
First-time testers					
Immigrants					
Seniors					
Heterosexual men					
Youth					
Heterosexual women					
Lesbian/bisexual women					
Transgendered					
MSM					
African Americans					
API					
Native Americans					
Sex workers					
Substance users					
HIV-positive					
Other					
O ther (please specify)

5. Do you keep demographic information on the people tested at your NLAAD 2011 activities?

YesNo

IV. NLAAD 2011 Demographics
This concerns the HIV testing demographics you kept at your NLAAD 2011 event.
1. What was the approximate percentage of the following racial/ethnic groups tested at your NLAAD 2011 event?
	0% 10% 20% 30% 40% 50% 60% 70% 80% 90%	100%
Hispanic/Latino	
African	
Americans
		8

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

API























Native























Americans

Sex workers























Substance























users

HIV-positive























Other























Other (please

specify)

2. What was the approximate percentage of various genders/sexuality groups tested at your NLAAD 2011 event?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Heterosexual women























Heterosexual men























Lesbian/bisexual women























Transgendered























Gay/bisexual or MSM























3. Of those tested, what was the approximate percentage in the following age groups?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18 yrs or younger























19-25 year olds















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26-35 years olds



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36-45 year olds



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46-55 year olds



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56-65 year olds



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66 years +























4. How many people tested positive at your 2011 NLAAD activities?

________________________

9

5. Of those that tested positive for HIV, how many were given referrals to obtain other services?

________________________

22. NLAAD 2011 Campaign Kit

1. How did you first hear about the NLAAD 2011 campaign kit?

2. How did you receive the 2011 NLAAD campaign kit?

• Delivery 

• At a conference or meeting 

• Download 

• Read it on website 

• Other ____________________ 



4. Did you find the following 2011 NLAAD campaign kits parts useful?

	Completely not useful	Somewhat Not useful	Neutral	Somewhat useful	Completely useful
Posters					
Working with Latino communities					
Working with religious/spiritual communities					
Working with rural communities					
How to prepare for an NLAAD event					
How to build coalitions					
How to prepare a press release					
How to organize a press conference					
How to obtain a proclamation or resolution					
How to work with the media at your NLAAD event					
					10

VI. Media Coverage

NLAAD is featured in several media outlets. The following questions refer to whether you were exposed or partnered with media

1. Did members of your organization create any of the following for NLAAD 2011 (check all that apply).

• None 

• Media advisory 

• Press release 

• Editorial 

• Web page 

• Listserve announcement 

• Media interview 

• Public service announcement 

• Other __________________________ 



2. Did your organization use the NLAAD 2011 posters? YesNo

3. How would you rate your level of satisfaction with the NLAAD 2011 poster?

ExtremelyUnsatisfiedneutralsatisfiedExtremely

Unsatisfied Satisfied

4. What media outlets did your organization utilize to advertise for your NLAAD 2011 events (check all that apply)

None

NLAAD Website

Own Website

Radio

TV Ads

Newspaper ads

Health fairs

Flyers

Other _______________________________

5. Did your organization work with the following media outlets for NLAAD 2011?

None

Newspaper

Magazine

Radio

• Website 

• TV station 

• Other ___________________ 

6. Did you see NLAAD 2011 mentioned in the following media outlets (check all that apply)

• Nothing 

• NLAAD website 

• Another organization website 

• Listserve announcement 

• Radio 

• TV Ads 

• TV coverage 

• Newspaper Ads 

• Newspaper editorials 

• Health fairs 

• Flyers 

• Other ________________ 



7. Prior to NLAAD 2011, did your organization have previous experience working the media?

YesNo

7. did your organization experience any difficulties communicating with the media for NLAAD 2011?

YesNo

7. if your organization experienced difficulty communicating with the media, how would you characterize the difficulties (check all that apply)?

• Cultural/language barriers 

• Funding shortage 

• Not enough time 

• Not enough staff at org to work with the media 

• Media was not responsive 

• No media contacts 

• Did not have prior knowledge on how to work with media outlets 

• Others ___________________ 

VII. NLAAD 2011 Barriers

We’re always looking to improve NLAAD. These questions concern the possible barriers you may have had to implementing an NLAAD 2011 event.

1. What do you feel were barriers to hosting an NLAAD event in 2011 (check all that apply)?

• None 

• Funding 

• Staff 

• Time/scheduling 

• No access to HIV tests/HIV testers 

• Do not know other organizations to partner or collaborate with 

• Limited health dept. support 

• Limited experience organizing NLAAD event 

• Other ____________________ 


2. How familiar are you with the following kinds of events?
		Extremely unfamiliar	Somewhat	Neutral	Somewhat familiar	Extremely familiar
			unfamiliar
	NLAAD					
	Media events					
	HIV testing					
	events
	Activities in the					
	Latino
	community
	Partnering with					
	HIV/AIDS orgs.
	Working with					
	the health dept.
	Other AIDS					
	awareness day
	(please specify
	below)
	Other day

VIII. NLAAD 2010

We’re always looking to improve NLAAD. These questions concern potential barriers to participating in NLAAD 2010 for your organization.

1. What is the likelihood that you will host an NLAAD event in 2010?

2. What barriers would prevent you from holding an NLAAD event in 2010 (check all that apply)?

1. None

2. Funding

3. Staff

4. Time/scheduling

5. Do not know other organizations to partner or collaborate with

6. Limited health dept. support

7. Limited experience organizing such an event

8. Other ____________________

3. Please rate the following:

		Definitely	Somewhat	neutral	Somewhat	Definitely
		important	unimportant		important	unimportant
	How important is it to continue with national Latino AIDS awareness day?					
	How important is the media to the success of NLAAD?					
	How important is the support of the CDC to the success of NLAAD?					
	How does NLAAD compare to other AIDS Awareness days for your org					