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Population-Specific HIV/AIDS Status Reports - Feedback Form

For readers interested in the PDF version, the document is available for downloading or viewing: PDF Version PDF Version (56 KB - 2 pages)

 

Please complete and return by fax. Thank you for your interest in the Population-Specifi c HIV/AIDS Status Report - People from Countries where HIV is Endemic – Black people of African and Caribbean descent living in Canada. We would like to take this opportunity to invite your feedback on this report and to join an e-mail list for future updates.

You can contribute to this initiative by:

  • Completing the information below and returning by fax at 613-952-3556 OR
  • sending an e-mail to aidsida@phac-aspc.gc.ca, to receive an electronic version that you can complete and return to us.

The information you provide will be managed and stored securely by the HIV/AIDS Policy, Coordination and Programs Division, Public Health Agency of Canada (PHAC). Please remember to notify us of any change to your e-mail address. The most current version, as well as any updates, of the Population-Specifi c HIV/ AIDS Status Report - People from Countries where HIV is Endemic – Black people of African and Caribbean descent living in Canada, can be accessed on the PHAC website at: http://www.phac-aspc.gc.ca/aids-sida/publication/ps-pd/africacaribbe/index-eng.php.

We thank you for taking the time to respond.

HIV/AIDS Policy, Coordination and Programs Division
Centre for Communicable Diseases and Infection Control
Infectious Disease and Emergency Preparedness Branch
Public Health Agency of Canada

Please complete the information below and fax to the HIV/AIDS Policy, Coordination and Programs Division at 613-952-3556:

1. Name:
2. E-mail:
3. Organization affi liation:
4. Please indicate the category that best describes your current area of work:

  • HIV/AIDS non-governmental service worker
  • Other non-governmental service worker
  • Public Health Practitioner
  • Policy maker (government)
  • Researcher
  • Other (please specify):

5. Please identify the specifi c groups/populations that are the focus of your current work
(check off all that apply):

  • Men who have sex with men
  • People from countries where HIV is endemic
  • Aboriginal Peoples
  • Women
  • People who inject drugs
  • Youth
  • People in prison
  • People living with HIV/AIDS
  • Other (please specify):

6. Please indicate your overall impression of the Status Report:

  • Poor
  • Fair
  • Good
  • Excellent

Comments:

7. How would you rate the usefulness of the Status Report in relation to your work?

  • Poor
  • Fair
  • Good
  • Excellent

Comments:

8. Please provide suggestions and ideas on how the Status Report could be improved in the future (focus, content, lay-out, etc.):