This survey attempts to understand if you are eligible to be screened for a UCSF study examining the effects of aging with HIV. You will be asked to answer a series of questions about your memory, thinking and communication. The survey should take 10 to 15 minutes to complete.
All data obtained from this survey will be kept confidential and will only be reported in an aggregate format (by reporting only combined results and never reporting individual ones). All questionnaires will be concealed, and no one other than the primary investigator and assistant researchers will have access to them. The data collected will be stored in the HIPPA-compliant, Qualtrics-secure database until it has been deleted by the primary investigator.
Participation in this survey is completely voluntary. You have the right to skip any answers or to stop the survey at any time.
You can talk to the study doctor about any questions or concerns you have about this study. Contact your study doctor, Dr. Victor Valcour through his assistant at (415) 476-1688.
For questions about your rights while taking part in this study, call the office of the Committee on Human Research, UCSF's Institutional Review Board (a group of people who review the research to protect your rights) at (415) 476-1814.
I have read and understood the above consent form and desire of my own free will to complete the following survey.