Thank you for registering to receive a self test kit. HIV self-testing empowers people to find out their HIV status wherever and whenever they want with results in 20 minutes. The fear of stigma deters many people from accessing HIV testing services. HIV self-testing gives people the freedom to test anonymously, confidentially and privately and has been shown to reach people who would not otherwise be reached by testing services.

If you are requesting a mailed kit, all information will be kept confidential and mailed to you in nondescript packaging within 3-5 days.

Are you receiving a self test kit in person or by mail?

Program

First Name

Last Name

What is your address?

To better serve our communities, GCAPP collects the following demographic information. Your decision to share personal demographic information is entirely voluntary; if you choose not to share there will be no penalty or consequences and you will still have full access to GCAPP’s services and resources.

All information you share is kept confidential to the full extent allowed by law. All data is secured within GCAPP’s database accessible only to the evaluation team and GCAPP staff.

Demographic Information

Race

Other Race

Are you hispanic, latino, or latinx?

Gender

Other Gender

Personal Pronoun

Other Pronoun

Sexual Orientation

Other Orientation

County of Residence

Have you ever been tested for HIV?

What made you want to receive the HIV self test this time?

Contact Information