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A cross sectional study on substance abuse which cause to increase HIV prevalence among TG community
Please enable JavaScript in your browser to complete this form.
Name
Contact number
Age:
Qualification:
Marital Status
Source of income
Monthly Income
Have you ever taken the substance/drugs?
*
Yes
No
Why do you take the substance/drugs?
*
What type of substance/drug do you take?
*
Heroine
Hash
Cocaine
Ice/Crystal meth
Other (Please specify)
How do you intake this/these substance/drugs?
*
From where do you get the substance/drugs?
*
When did you take the substance/drugs for the first time?
*
Do you easily afford the substance/drugs?
*
Yes
No
If not, how do you manage to buy the drugs?
*
Are you unable to stop using substance/drugs when you want to?
*
Yes
No
Have you ever had blackouts or flashbacks as a result of substance/drug use?
*
Yes
No
Do you ever feel bad or guilty about your substance/drug use?
*
Yes
No
Have you neglected your family/partner because of your use of substance/drugs?
*
Yes
No
Have you engaged in illegal activities in order to obtain substance/drugs?
*
Yes
No
Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking substance/drugs?
*
Yes
No
Have you had Psychological problems as a result of your substance/drug use (e.g., Anxiety, depression)?
*
Yes
No
Do you want to get treatment of substance/drug abuse?
*
Yes
No
Has anybody (person, institution, NGO etc) reached you out for the treatment?
*
Submit
A cross sectional study on substance abuse which cause to increase HIV prevalence among TG community
Please enable JavaScript in your browser to complete this form.
Name
Contact number
Age
Qualification
Marital Status
Source of income
Monthly Income
Have you ever taken the substance/drugs?
*
Yes
No
Why do you take the substance/drugs?
*
What type of drug do you take?
*
Heroine
Hash
Cocaine
Ice/Crystal meth
Other (Please specify)
How do you intake this/these substance/drugs?
*
From where do you get the substance/drugs?
*
When did you take the substance/drugs for the first time?
*
Do you easily afford the substance/drugs?
*
Yes
No
If not, how do you manage to buy the substance/drugs?
*
Are you unable to stop using substance/drugs when you want to?
*
Yes
No
Have you ever had blackouts or flashbacks as a result of substance/drug use?
*
Yes
No
Do you ever feel bad or guilty about your substance/drug use?
*
Yes
No
Have you neglected your family/partner because of your use of substance/drugs?
*
Yes
No
Have you engaged in illegal activities in order to obtain substance/drugs?
*
Yes
No
Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking substance/drugs?
*
Yes
No
Have you had Psychological problems as a result of your substance/drug use (e.g., Anxiety, depression)?
*
Yes
No
Do you want to get treatment of substance/drug abuse?
*
Yes
No
Has anybody (person, institution, NGO etc) reached you out for the treatment?
*
Submit
