The Georgia Department of Public Health is developing a new statewide campaign to promote syphilis and HIV testing for pregnant women.

We are looking for women, currently residing in Georgia, to share their experiences about why syphilis and HIV testing is/was an important part of their prenatal health care. Individuals should be currently pregnant or have given birth in the past five years.  

Selected individuals will be photographed and have their stories audio recorded for the multi-media campaign. The campaign, including outdoor, radio, and digital media messages, as well as printed community materials, is expected to be released in the Spring of 2019 across Georgia.

If you are interested in participating in this campaign, please complete the following questionnaire. It should take about 10 minutes. Please also attach a recent photo of yourself with your completed questionnaire.

Completed questionnaires must be submitted by 11:59 pm on Thursday, February 28, 2019.

* indicates required questions.

If you have any questions, please contact Trina Scott (email: trinas@kff.org).

Question Title

* 1. Please fill out the following information.