NZHF Survey

Survey Aim

This survey is being run by the Herpes Foundation to gain a better understanding of the way that people with herpes have dealt with the medical and emotional issues arising from having the infection, and the sort of support they have found, or would find, useful.

Privacy and confidentiality are very important to the Herpes Foundation. The data collected will only be available to those authorised by the Herpes Foundation to analyse the findings. No contact details will be collected.

In the following survey you will be offered multiple choices and more than one answer may be appropriate for each question. When filled out click the "Submit" button at the end of the survey.

1) Demographic details
Age:	(required)
Gender:	(required)
Country of residence:	(required)
Area in NZ where you live:	(required)
Ethnicity:

2) Do you have herpes? (required)

a.	I have been diagnosed by medical professionals as having herpes
b.	I have not been medically diagnosed but am certain I have herpes
c.	I think I may have herpes but am not certain
d.	I don't have herpes but my partner does - click here for partner survey

3) How long have you had or been aware of having Herpes

Years:
Months:

4) Did you visit a GP or clinic

a.	When you first noticed the symptoms
b.	Later on to get a diagnosis
c.	Haven't yet, but will
d.	Do not intend to use conventional medical service

5) If you visited a GP or clinic what did they do?

		Yes
a.	Took a sexual health history
b.	Did a genital examination
c.	Took a swab
d.	Offered you a blood test
e.	Offered you some written information
f.	Offered you some medication
g.	Prescribed some medication
h.	Indicated or implied that as you didn't have any symptoms then you didn't have the virus
i.	Explained it is hard to tell unless you come when you have symptoms
j.	Discussed sexual transmission and transmission risk reduction
k.	Other please explain:

6) Have you visited a GP or clinic in NZ or overseas

		Yes
a.	New Zealand
b.	Overseas

7) Have you had a diagnosis of genital herpes confirmed by:

		Yes
a.	A swab taken from the lesion
b.	A blood test
c.	A genital examination
d.	None of the above
e.	Other please explain:

8) Who diagnosed your genital herpes

a.	GP
b.	Sexual Health
c.	Family Planning
d.	Other (please describe):

9) If you visited a health professional for a diagnosis were they:

		Yes
a.	Comfortable discussing sexual health matters
b.	Familiar with herpes facts
c.	Helpful in making you feel comfortable discussing sexual health matters

10) If the health professional did not appear comfortable or did not help you to feel comfortable discussing sexual health matters did that appear to be due to:

		Yes
a.	The health professional being ill at ease with the topic of sexual health
b.	The health professional making judgements about people who have sexually-transmitted infection
c.	The body language of the health professional

11) How do you think you got the virus?

		Possibly	Probably	Certainly	N/A
a.	Through receiving oral sex from someone who had ‘cold sores’
b.	Intercourse with someone who knew they had genital herpes and who informed me beforehand
c.	Intercourse with someone who knew they had genital herpes and who informed me afterwards
d.	Intercourse with someone who knew they had genital herpes but who did not inform me
e.	Intercourse with someone who did not know they had genital herpes
f.	Uncertain	Yes
g.	Other (please explain):	Yes

12) In terms of treatment for genital herpes

		Yes
a.	I use a continuous/long-term suppressive oral anti-viral medication (acyclovir)
b.	I treat each episode with oral anti-viral medication (acyclovir)
c.	I use alternative/complimentary medicines
d.	Please describe alternative/complimentary treatment

e.	I have not used any form of treatment because
	- The symptoms are so mild treatment isn't necessary
	- I didn't know there was effective treatment
f.	Other (please explain):

13) Prior to contracting HSV did you discuss sexual health with each new partner:

14) Since contracting herpes do you discuss sexual health and herpes with each new partner

15) How has having herpes impacted on your relationship(s)?

a.	The symptoms of herpes have had no effects/ limited effects upon my subsequent sexual relationships
b.	The emotional impact of the diagnosis has had no effects/limited effects upon emotional intimacy in subsequent sexual relationships
c.	The physical symptoms have been disruptive of sexual intimacy
d.	The emotional impact of the diagnosis has had a significant impact on relationship intimacy
e.	Since getting herpes I have avoided having any sexual relationships

16) What sort of support have you found has been helpful to you?

a.	Medical practitioners
b.	Written information pamphlets
c.	Website(s) if possible please clarify which websites have been most helpful

d.	Toll free helpline
e.	Support group or talking to a person with herpes
f.	Friends and/or family
g.	Internet information/online support
h.	Clear information on the facts around herpes (from what source)

i.	Other (what

17) What sort of support would be helpful to you or to others in your situation?

a.	more knowledgeable medical practitioners
b.	more emotional support from health professionals
c.	easier access to face-to-face support group
d.	access to online support specifically for New Zealanders
e.	Better written information on the facts around herpes
f.	toll free helpline
g.	Other (please explain)

18) If you have told partners about a herpes diagnosis, what range of responses have you experienced?

		Always	Mostly	Some- times	Never	N/A
a.	Informed
b.	Supportive
c.	Unsupportive
d.	Uninformed

19) How did you hear about this survey?

a.	Noticed some media about the education campaign
b.	Attended one of the Herpes Foundation meetings
c.	Through a herpes support group
d.	From a friend
e.	Saw it on the Herpes Foundation website
f.	Saw it referred to on another website
g.	Other (please explain):

Any other comments:

(including "quotes" we may pass anonymously to Medical Professionals.)

Thank you for taking the time to complete this survey.

If you would like further help you can:

Ring us toll free 0508 11 12 13 and speak to a counsellor
Email us at info@herpes.co.nz
Click here to have a information pack sent to you

Partner Survey

1)Are you a partner – or former partner – of someone who has or had herpes?

Yes

2)Did your partner know they had Herpes at the outset of the relationship?

Yes
No

3) How did you find out your partner had Herpes?

a.	Partner told me when our relationship commenced
b.	Partner told me as soon as they found out
c.	I sensed something was wrong and asked

NZHF Survey

Survey Aim

In the following survey you will be offered multiple choices and more than one answer may be appropriate for each question. When filled out click the "Submit" button at the end of the survey.

1) Demographic details

2) Do you have herpes? (required)

3) How long have you had or been aware of having Herpes

4) Did you visit a GP or clinic

5) If you visited a GP or clinic what did they do?

6) Have you visited a GP or clinic in NZ or overseas

7) Have you had a diagnosis of genital herpes confirmed by:

8) Who diagnosed your genital herpes

9) If you visited a health professional for a diagnosis were they:

10) If the health professional did not appear comfortable or did not help you to feel comfortable discussing sexual health matters did that appear to be due to:

11) How do you think you got the virus?

12) In terms of treatment for genital herpes

13) Prior to contracting HSV did you discuss sexual health with each new partner:

14) Since contracting herpes do you discuss sexual health and herpes with each new partner

15) How has having herpes impacted on your relationship(s)?

16) What sort of support have you found has been helpful to you?

17) What sort of support would be helpful to you or to others in your situation?

18) If you have told partners about a herpes diagnosis, what range of responses have you experienced?

19) How did you hear about this survey?

Any other comments:

If you would like further help you can:

Partner Survey

1)Are you a partner – or former partner – of someone who has or had herpes?

2)Did your partner know they had Herpes at the outset of the relationship?

3) How did you find out your partner had Herpes?

4) How did it affect your relationship with that partner?

5) Where did you get information about Herpes from?

6)How helpful did you find that information?

Any other comments:

If you would like further help you can: