Syringe Exchange Program- Survey

1. Demographics:

Race/Ethnicity: White/African-American/ Asian/Hispanic /Native American/Other

Age: _______

Gender: M / F / Other ________________________

County of Residence: ________________________

Housing Status: Own/ Rent / Live with friends/ family/ Homeless

2. What do you think is the current level of injection drug users in Watertown/Jefferson County?

Very High

High

Medium

Low

3. Do you agree that the current trend of injection drug use (shooting up) in Watertown/Jefferson County NY is increasing?

Agree

Disagree

Don't Know

4. Have you heard of the Syringe Exchange Program (SEP)?

Yes

No

Other

5. Do you think Syringe (Needle) Exchange Programs are effective in stopping the spread of HIV and Hepatitis C from needle sharing?

Agree

Disagree

Don't Know

6. Do you think that Syringe Exchange Programs encourage injection (shooting up) drug use?

Yes

No

If "Yes",why

7. Do you believe a Syringe Exchange Program is needed in Watertown/Jefferson County?

Yes

No

If "No", why

8. Would you support a Syringe Exchange Program (SEP) in Watertown/Jefferson County?

Yes

No

If "No" why

9. Do you understand the purpose of Syringe Exchange Programs?

yes

No

Not Sure

If yes, explain