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Reference Information
 

1	Date
2	Respondent's Principal Role in Faith Community	Spiritual Leader Organization Leader Group Leader HIV/AIDS Coordinator Member
3	Respondent's Gender	Male   Female
4	Respondent's Age
5	* Name of Respondent
6	* Mobile Telephone Number
7	* Email Address
8	* What is your HIV status?	Don’t Know   HIV-positive   HIV-negative

* Optional