On-Line Seed Screening Tool
Momentum Seed Application Form
Thank you for your interest in being a seed for the Momentum study!
The Momentum Health Study is a sexual health study of gay, bisexual and other men who have sex with men in Greater Vancouver. Momentum aims to report new estimates of HIV prevalence among men who have sex with men (MSM) in the region.
With the expansion of antiretroviral therapy for treatment of HIV and the development of Pre-Exposure Prophylaxis (PrEP), we are interested in how men are responding to these developments.
This study uses Respondent Driven Sampling (RDS). RDS is a form of peer-recruited network sampling, where participants receive study vouchers to give to their friends so they can participate too.
A "seed" is one of the study's first participants, and is purposefully selected to help recruit other participants. To see if you meet the criteria to be one of the first participants in the study, please answer the following questions as honestly as possible. Your answers will be recorded in a secure, password-protected database accessible only to study staff.
What's your first name?
Please enter your email address and/or phone number, so we can invite you to participate if you are eligible for the study:
Have you participated in the Momentum study before?
What is your age (how old are you)?
What neighborhood do you currently live in? (If you don't know the name of the neighbourhood then enter the nearest main intersection):
What term(s) best describe your sexual orientation? (Choose all that apply)
I use another term to describe my sexual orientation. Please Specify:
Momentum is a study of men who have sex with men, including trans men and men who identify on the trans-masculine spectrum. Do you gender identify as a man?
What terms do you use to describe your gender? (Check all that apply.)
Genderqueer / Gender non-conforming
I use another term to describe my gender. Please specify:
What is your HIV status?
HIV negative and on PrEP (Pre-Exposure Prophylaxis)
I don't know
Prefer not to answer
What single or multiple ethnic group(s) or family background(s) do you identify with? (Check all that apply.)
Aboriginal or Indigenous (for example Canadian First Nations, Métis, Inuit, American Indian, or North, Central, or South American Indigenous Peoples)
British (for example English, Scottish, Welsh)
Other Eastern & Western European (Irish, Italian, Greek, German, Spanish, Dutch, Belgian, Flemish, Ukrainian, Polish, Russian)
East Asian (for example Chinese, Taiwanese, Japanese, Korean)
South Asian (for example Indian, Punjabi, Pakistani, Sri Lankan, Bangladeshi)
South East Asian (for example Vietnamese, Cambodian, Filipino, Malaysian, Thai, Indonesian, Laotian)
West Asian (For example Iranian, Persian, Afghan, Assyrian)
Arab or North African (for example Egyptian, Saudi Arabian, Iraqi, Kuwaiti, Libyan, Moroccan)
Latin American (for example Mexican, Guatemalan, Costa Rican, Brazilian, Chilean, Argentinian)
African (for example East, West, Sub-Saharan African)
Black (for example African-Canadian or other Black ancestries)
Pacific (for example Hawaiian, Guamanian/Chamorro, Samoan, or from other Pacific Islands)
I use another term to describe my ethnicity or family background. Please specify:
Have you been sexually active in the past 6 months?
In the past 6 months, I have had sex with one or more...
(Choose all that apply)
Genderqueer/ gender non-conforming person
Two-spirit, or gay aboriginal, person
Someone who uses another term to describe their gender (please specify):
About how many gay, bisexual or other men who have sex with men, including trans guys, who you know well, would you feel comfortable talking to about the Momentum study to encourage them to participate?
(This can include gay/bi guys you see or speak to regularly; e.g., close friends, boyfriends, spouses, regular sex partners, roommates, relatives, people you regularly hang out with, etc.)
Are you connected to any gay men's or LGBTQ community group or organization (for example gay sports teams, gay men's health organizations, LGBT community centre etc.)?
Yes, please specify:
Who encouraged you to apply to be a Momentum seed? (Choose all that apply)
An outreach worker, service provider or study staff
A friend, lover, boyfriend, or partner
I found out about it on Facebook
Other, please specify:
Thank you! We will contact you if you meet the participation criteria.