Join PrEP4All's #PrEPSaves PrEP Users' Union

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

In the summer of 2023, as one of the leading organizations fighting for a federally-funded National PrEP Program, PrEP4All launched the #PrEPSaves campaign to highlight how a National PrEP Program could address significant barriers to PrEP faced by PrEP users.

The #PrEPSaves PrEP Users Union will expand on this work in a more comprehensive way by elevating the voices of PrEP users in media and key policy discussions, while supporting PrEP users with PrEP policy education, and ultimately, direct engagement with key policymakers and stakeholders. PrEP4All will work together with PrEP users to take action to protect their rights to comprehensive HIV prevention access and hold government, pharmaceutical companies, and insurers accountable in creating reasonable conditions for fair and equitable access.

If you are current or former PrEP user, or someone who has had significant barriers preventing PrEP access, fill out this form to join the #PrEPSaves PrEP Users' Union to take action towards making PrEP accessible for everyone.

Email *

By completing this form to join the #PrEPSaves PrEP Users' Union (P2U), I agree that I am not a staff person, ambassador, or representative of any pharmaceutical companies that manufactures, sells, or researches HIV medications or products. Should this change while I am a member of the P2U, I will notify PrEP4All immediately before further engaging in P2U activities. *

I agree.

Required

First Name *

Last Name *

Date of Birth (MM/DD/YYYY) *

YYYY

City *

State *

Zip Code (Five Digit) *

Gender Identity (Check All That Apply)

Cisgender Man

Cisgender Woman

Transgender Man

Transgender Woman

Non-Binary/Gender Non-Conforming

GenderQueer

Two Spirit

Prefer Not To Answer

Other:

Sexual Identity (Check All That Apply)

Straight/Heterosexual

Bisexual/Pansexual

Gay/Homosexual

Lesbian/Homosexual

Queer

Same-Gender Loving

Prefer Not To Answer

Other:

Race/Ethnicity

What is your PrEP status? *

I use oral PrEP daily or long-acting injectable PrEP

I use oral PrEP On Demand/2-1-1

I have barriers that prevent me from accessing or staying on PrEP

I am a former PrEP user (by choice)

If given the opportunity, would you be interested in talking to news media outlets about personal experiences accessing and using PrEP? *

Yes

If given the opportunity, would you be interested in being a part of future #PrEPSaves campaigns? *

Yes

How knowledgable are you about advocacy towards a National PrEP Program? *

Very knowledgable

Somewhat knowledgable

I am not currently knowledgable about advocacy towards a National PrEP Program

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms