Core Questionnaire
Transgender HIV Behavioral Survey
092007BK Att 3B -- THBS Core Questionnaire June 2008
Core Questionnaire
OMB: 0920-0794
Transgender HIV Behavioral Survey
Attachment 3B
Data Collection Instrument: Behavioral Survey
Form Approved:
OMB No: 0920-XXXX
Expiration Date: MM/DD/YYYY
Transgender HIV Behavioral Survey: Core Questionnaire
_______________________________________________________
Public reporting burden of this collection of information is estimated to average 45 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC Information Collections Review Office, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (XXXXXXXX).
The first questions are about your background. Please remember your
answers will be kept private.
AUTO7. Time core questionnaire began: __ __:__ __ AM PM
1. In the past 12 months, have you been homeless at any time? “Homeless” means you were living on the street, in a shelter, a Single Room Occupancy hotel (SRO), temporarily staying with friends or relatives, or living in a car.
No………………….…………………………… 0
Yes……………………………………………… 1
If Q1 is (0, .R, .D) then skip to Q2
Don't know……………..………………………. .D
1a. Are you currently homeless? “Homeless” means you are living on the street, in a shelter, a Single Room Occupancy hotel (SRO), temporarily staying with friends or relatives, or living in a car.
No………………….……………….………….. 0
Yes….……………………………….……......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
2. What zip code do you live in?
[Refused = .R, Don't know = .D] __ __ __ __ __
3. What country were you born in? [Check only one.]
If INT 2=Puerto Rico then skip to Q4 If Q3 =1, .R, or .D then skip to Q4
Puerto Rico….………………….………….…… 3
Cuba…….………………….………….……….. 4
Other (Specify_________________)………...… 5
Refused to answer………………………….…... .R
Don't know…….………………………….…... .D
3a. What year did you first come to live in the United States?
[Refused=.R, Don't know = .D] __ __ __ __
(Y Y Y Y )
4. What is the highest level of education you completed? [Check only one.]
Never attended school….…………………………. 00
Grades 1 through 8….…………………...……….. 01
Grades 9 through 11..…………………….…….…. 02
Grade 12 or GED...….……..…..………………… 03
Some college, Associate’s Degree, or
Technical Degree………………………………. 04
Bachelor’s Degree..………….…………….……… 05
Any post graduate studies ………….……………. 06
Refused to answer………………..……………….. .R
Don't know……..………………..……………….. .D
5. What best describes your employment status? Are you:
[Check only one.]
Employed full-time………………….…………. 01
Employed part-time……………………………. 02
A homemaker….……….…………………...….. 03
A full-time student…….…….………………… 04
Retired….………..……………………………... 05
Disabled for work….………..…………………. 06
Unemployed………..…………………………... 07
Other………..………………………….............. 08
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
For Respondents who are
not currently homeless (Q1=0, .R, .D) OR Q1a=0, .R, .D):
Say: Next, are some questions about
your household income. "Household income" means the total
amount of money earned and shared by all people living in your
household.
For Respondents who are
currently homeless (Q1a=1): Say: Next, are some questions about
your income. "Income" means the total amount of money you
earn or receive. This includes money other people share with you.
6. What was your [insert household income if Q1=0,R,.D OR Q1a=0,R,.D; insert income if Q1a=1] last year from all sources before taxes? Please indicate which one best corresponds to your yearly income.
Less than $10,000……..
00 $10,000
to $14,999...……
01 $15,000
to $19,999.…….
02 $20,000
to $29,999……..
03 $30,000 to $39,999……..
04 $40,000
to $49,999……..
05 $50,000
or more……..
06 Refused to answer……….
.R Don't know……..……………..
.D
If Q6 is (.R, .D) then skip to Q7
6a. Including yourself, how many people depended on this income?
1………………….…………………………… 1
2……………………………………………... 2
3 ……………………………………………... 3
4 or more people………………..……………... 4
Refused to answer……………………………… .R
Don't know……………..……………………... .D
7. Do you currently have health insurance coverage? This includes Medicaid or Medicare.
No………………….…………………………… 0
If Q7 is (0, .R, .D) then skip to Q9
Refused to answer……………………………… .R Don't know……………..……………………... .D
7a. What kind of health insurance coverage do you currently have? [Check all that apply.]
Private health insurance or HMO……………… 01
Medicaid….……….…………………..……….. 02
Medicare…….…….…………………..……….. 03
TRICARE (CHAMPUS)….………..………….. 04
Veterans Administration coverage………..…… 05
Some other insurance……………….………….. 06
(Specify______________________________)
Refused to answer……………………………… .R
Don't know……………..…………………….. .D
8. Does the insurance cover hormone therapy?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..……………………... .D
8a. Does the insurance cover sex change or sexual reassignment surgeries (SRS)?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..……………………... .D
Healthcare Visit
9. Have you seen a doctor, nurse, or other health care provider in the past 12 months?
If Q9 is (0, .R, .D) then skip to Q10
Refused to answer……………………………… .R
Don't know……………..……………………... .D
9a. At any of those times you were seen, were you offered an HIV test?
An HIV test checks whether someone has the virus that causes AIDS.
No………………….…………………………… 0
Yes……………………………………………... 1 Refused to answer……………………………… .R
Don't know……………..……………………... .D
SAY: Some people are very open about being transgender.
Others prefer to tell only a few people. For the next question, you
will see a list of groups you may have told about you being
transgender. For each one, check “YES” if you have told
some people in the group or check “NO” if you have not.
If you do not know anyone in the group, check “Does not apply
to me.”
10. Which of the following groups have you told about your transgender identity?
No Yes Refused Don’t Does not
to answer Know apply to me
a. Have you told friends who are transgender 0… 1…...R…..D ....N
b. Have you told your gay, lesbian, or bisexual friends 0… 1…...R…..D…..N
c. Have you told your straight friends 0… 1…...R…..D…..N
d. Have you told your family members 0… 1…...R…..D…..N
e. Have you told your current doctor or health care provider 0… 1…...R…..D…..N
f. Have you told your current employer 0… 1…...R…..D…..N
g. Have you told your current partner or spouse 0… 1…...R…..D…..N
SEXUAL BEHAVIOR
SAY: The next questions are about sexual behavior. Some of
the questions are for people who have a penis and some are for
people who have a vagina. To ask you the proper questions, we would
first like to ask about your body.
11. Do you have a surgically constructed vagina?
If Q11 (.R or .D) then skip to the Alcohol Use History Section.
Yes………………………………..…………..... 1
Refused to answer…………………………..….. .R
Don't know……………..………….………........ .D
If Q11=1, SAY: Now we would like to ask you some
questions about having sex with men. Some of the questions may not
apply to you. Please remember your answers will be kept private. For these questions, "having sex" means
oral,
vaginal, or anal sex. Oral sex means your partner put his mouth on
your vagina or you put your mouth
on his penis. Vaginal sex means your partner put his penis in your
vagina. Anal sex means he put his penis in your anus (butt).
If Q11 =0, SAY: Now we would like to ask you some
questions about having sex with men. Some of the questions may not
apply to you. Please remember your answers will be kept private.
For these questions,
"having sex" means oral or anal sex. Oral sex means your
partner put his mouth on your penis or you put your mouth on his
penis. Anal sex means you put your penis in his anus (butt) or he
put his penis in your anus (butt).
Male Sex Partners
13. Have you ever had [insert “oral or anal” if Q11 =0; insert “oral, vaginal, or anal” if Q11=1] sex with a man?
If Q13 in (0, .R, .D) then skip to Q43 in the Female Partner
section
Yes………………………………..…………..... 1
Refused to answer…………………………..….. .R
Don't know……………..………….………........ .D
14. How old were you the first time you had [insert “oral or anal” if Q11 =0; insert “oral, vaginal, or anal” if Q11=1] with a man?
[Refused =.R, Don't know=.D] __ __ years
In the past 12 months, with how many different men have you had [insert “oral or anal” if Q11 =0; insert “oral, vaginal, or anal” if Q11=1] sex?
[Refused = .R, Don't know = .D] ___ ___ ___ ___
If Q15 in (0, .R, .D) then skip to Q43 in the Female Partner
section
Skip Pattern for # of Male Sexual Partners: If Q15=1, ask
Q16a. Otherwise, ask Q16.
FOR Multiple male Partners [Read Say Box and Questions in this column] |
fOR One male Partner [Read Say Box and Question in this column] |
||
SAY: Please describe these sex partners as either main or casual partners:
A “main partner” is a man you have sex with and who you feel committed to above anyone else. This is a partner you would call your boyfriend, significant other, or life partner.
A “casual partner” is a man you have sex with but do not feel committed to or don't know very well.
Refused = .R Don't know = .D |
SAY: Please describe this sex partner.
A “main partner” is a man you have sex with and who you feel committed to above anyone else. This is a partner you would call your boyfriend, significant other, or life partner.
A “casual partner” is a man you have sex with but do not feel committed to or don't know very well.
|
||
Question |
Response |
Skip Pattern |
Question |
16. Of the _____ [insert number from Q15] men you’ve had [insert “oral or anal” if Q11 =0; insert “oral, vaginal, or anal” if Q11=1] sex with in the past 12 months, how many of them were main partners? |
[_____] |
If Q16 = Q15, skip to Say Box before Q18a. |
16a. Was this man a main or a casual partner? Main partner……... 1 Skip to Say Box before Q18a Casual partner…..... 2 Skip to Say Box before Q19a Refused to answer... .R Skip to Q20 Don’t know…….. ... .D Skip to Q20
|
17. How many were casual partners? |
[_____]
|
If Q16 + Q17=Q15, skip to Say Box before Q18a. |
|
Skip Pattern for Multiple Male Partners: If Q15>1 and Q16 in (0, .R, .D) and
Q17=<1, then skip to say box before Q19a. If Q15=1 and Q16a in (2) then skip to say
box before Q19a
MAIN MALE PARTNERS
Multiple Main male Partners [Read questions in this column if Q16>1] Refused = .R, Don't know = .D |
One Main male Partner [Read questions in this column if Q16=1 or Q16a=1] No = 0, Yes = 1, Refused = .R, Don't know =.D |
||||
SAY: The next set of questions is about the _______ [insert number from Q16] male main sex partners you had in the past 12 months. Remember, a main sex partner is someone you feel committed to above anyone else. |
SAY: The next set of questions is about the male main sex partner you had in the past 12 months. Remember, a main sex partner is someone you feel committed to above anyone else. |
||||
Question |
Response |
Skip Pattern |
Question |
Response |
Skip Pattern |
[if Q11=0, then skip to 18c] 18a. Of your ______ [insert number from Q16] male main partners in the past 12 months, with how many did you have vaginal sex? |
[_____]
|
If 0, .R, or .D, skip to Q18c |
[if Q11=0, then skip to 18c] 18a. In the past 12 months, did you have vaginal sex with this man? |
[_____]
|
If 0, .R, or .D, skip to Q18c |
18b. In the past 12 months, with how many of these ______ [insert number from Q18a] men did you have vaginal sex without using a condom? |
[_____]
|
|
18b. In the past 12 months, did you have vaginal sex with him without using a condom? |
[_____] |
|
18c. Of your ______ [insert number from Q16] male main partners in the past 12 months, with how many did you have anal sex? |
[_____]
|
If 0, .R, or .D, skip to Q18e. If 1, ask 18d in the one main partner column. |
18c. In the past 12 months, did you have anal sex with this man? |
[_____]
|
If 0, .R, or .D, skip to Q18e. |
18d. In the past 12 months, with how many of these ______ [insert number from Q18c] men did you have anal sex without using a condom? |
[_____]
|
|
18d. In the past 12 months, did you have anal sex with him without using a condom? |
[_____] |
|
Question |
Response |
Skip Pattern |
Question |
Response |
Skip Pattern |
18e. Of your ______ [insert number from Q16] male main partners in the past 12 months, how many did you give things like money or drugs in exchange for sex? |
[_____]
|
|
18e. In the past 12 months, did you give this man things like money or drugs in exchange for sex? |
[_____]
|
|
18f. Of your ______ [insert number from Q16] male main partners in the past 12 months, how many gave you things like money or drugs in exchange for sex? |
[_____] |
|
18f. In the past 12 months, did this man give you things like money or drugs in exchange for sex? |
[_____] |
|
18g. Of your ____ [insert number from Q16] male main partners, with how many did you have sex for the first time in the past 12 months? |
[_____]
|
If 0, .R, or .D AND Q16 is equal to 0, skip to Q20.
Otherwise, if 0, .R, or .D, AND Q17 is not equal to 0, skip to Say Box before Q19a.
Otherwise, if 1 ask Q18h in the one main partner column |
18g. Did you have sex with this man for the first time in the past 12 months? |
[_____] |
If 0, .R, or .D AND Q16a=1 or Q17=0, skip to Q20.
Otherwise, if 0, .R, or .D, AND Q17 is not equal to 0, .R. .D then skip to Say Box before Q19a. |
18h. With how many of these ____ [insert number from Q18g] men did you discuss BOTH your HIV status and their HIV status before you had sex for the first time? |
[_____] |
|
18h. Did you discuss BOTH your HIV status and his HIV status before you had sex for the first time? |
[_____] |
|
CASUAL PARTNERS
Multiple casual male Partners [Read questions in this column if Q17>1] Refused = .R, Don't know = .D |
One casual male Partner [Read questions in this column if Q17=1 or Q16a=2] No = 0, Yes = 1, Refused = .R, Don't know = .D |
||||
SAY: The next set of questions is about the _______ [insert number from Q17] male casual sex partners you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well. |
SAY: The next set of questions is about the male casual sex partner you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well. |
||||
Question |
Response |
Skip Pattern |
Question
|
Response |
Skip Pattern |
[if Q11=0, then skip to 19c] 19a. Of your ______ [insert number from Q17] male casual partners in the past 12 months, with how many did you have vaginal sex? |
[_____]
|
If 0, .R, or .D, skip to Q19c.
If 1 then ask 19b in the one casual partner column. |
[if Q11=0, then skip to 19c] 19a. In the past 12 months, did you have vaginal sex with this man? |
[_____]
|
If 0, .R, or .D, skip to Q19c. |
19b. In the past 12 months, with how many of these ______ [insert number from Q19a] men did you have vaginal sex without using a condom? |
[_____]
|
|
19b. In the past 12 months, did you have vaginal sex with him without using a condom? |
[_____] |
|
19c. Of your ______ [insert number from Q17] male casual partners in the past 12 months, with how many did you have anal sex? |
[_____]
|
If 0, .R, or .D, skip to Q19e.
If 1 then ask 19d in the one casual partner column. |
19c. In the past 12 months, did you have anal sex with this man?
|
[_____]
|
If 0, .R, or .D, skip to Q19e.
|
19d. In the past 12 months, with how many of these ______ [insert number from Q19c] men did you have anal sex without using a condom? |
[_____] |
|
19d. In the past 12 months, did you have anal sex without using a condom? |
[_____] |
|
Question |
Response |
Skip Pattern |
Question
|
Response |
Skip Pattern |
19e. Of your ______ [insert number from Q17] male casual partners in the past 12 months, how many did you give things like money or drugs in exchange for sex? |
[_____]
|
|
19e. In the past 12 months, did you give this man things like money or drugs in exchange for sex? |
[_____]
|
|
19f. Of your ______ [insert number from Q17] male casual partners in the past 12 months, how many gave you things like money or drugs in exchange for sex? |
[_____] |
|
19f. In the past 12 months, did this man give you things like money or drugs in exchange for sex? |
[_____] |
|
19g. Of your ____ [insert number from Q17] male casual partners, with how many did you have sex for the first time in the past 12 months? |
[_____]
|
If 0, .R, or .D skip to Q20. |
19g. Did you have sex with this man for the first time in the past 12 months? |
[____] |
If 0, .R, or .D, skip to Q20. |
19h. With how many of these ____ [insert number from Q19g] men did you discuss BOTH your HIV status and their HIV status before you had sex for the first time? |
[_____]
|
|
19h. Did you discuss BOTH your HIV status and his HIV status before you had sex for the first time? |
[____] |
|
20. In the past 12 months, has anyone ever forced you to have sex with them?
No……………………..………………............... 0 Yes………………………..………….………… 1
Refused to answer…………………..………….. .R
Don’t Know…………….……………................. .D
Last Male Sex Partner
21yy. Now we would like you to think about the last time you had sex with a man. In what year did you last have sex with a man?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
21mm. In [insert year from Q21yy here], in what month did you last have sex with a man?
Month: ___ ___ [Refused = .R, Don't know = .D]
Auto8 . Date of last sex with a man: 21mm/21yy
If Auto8 over 12 months ago skip to the female sex partner
section If Q21YY = .REF or .DK or [Q21YY-year of
interview > 0 and Q21MM=REF or DK] skip to the female sex partner
section.
22. Was the man you had sex with that last time a main or casual partner?
Main sex partner………...................................... 1
Casual sex partner……….................................... 2
Refused to answer................................................ .R
Don’t know……….............................................. .D
23. When you had sex that last time, did you have sex with this partner in exchange for things
like money, drugs, food, shelter or transportation?
N
If Q23 is (0, .R, .D)
and Q11c ne 1 then skip to Q27 If
Q23 is (0, .R, .D) and Q11c =1 then skip to Q24
Refused to answer…………………..………….. .R
Don’t Know…………….……………................ .D
23a. When you had sex that last time, did you give him things in exchange for sex or
did he give you things in exchange for sex? [Check only one.]
If Q23a is (0, .R, .D)
and Q11c ne 1 then skip to Q27 If
Q23a is (0, .R, .D) and Q11c =1 then skip to Q24
He gave me things in exchange for sex ……… 1
Refused to answer…………………..…...……… .R
Don't know…………….…………………....... .D
23b. What did he give you in exchange for sex? [Check all that apply.]
Money ………….………………………..……..…… 1
Drugs…………………….………………………….. 2
Shelter or a place to stay………….………………… 3
Something else (Specify:_________________).…… 4
Refused to answer…………………..…...……..…… .R
Don't know…………….…………………................ .D
If
Q11 ne 1 then skip to Q27
24. Think about the last man you had sex with. When you had sex that last time, did you have vaginal sex?
No.……………………………………..……….. 0
If Q24 is (0, .R, .D) then skip to Q27
Refused to answer…………… …..…….……… .R
Don't know……………..………………............ .D
25. During vaginal sex that last time, did you use a condom?
If Q25 is (0, .R, .D) then skip to Q27
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
25a. Did you use the condom the whole time?
No………………….……………….…………... 0
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
26. Think about the last man you had sex with. During the past 12 months, how comfortable
were you asking this partner to use a condom during vaginal sex? Were you:
Very
comfortable……….………..…………..….
1
Somewhat comfortable…………….….…..…….
2
Not comfortable……………..………….....……
3
You did not use a condom……....………………
4
Refused
to answer…………………..…….……..
.R
Don’t Know……………..……………...….........
.D
27. The last time you had sex with a man, did you have receptive anal sex where he put
his penis in your anus (butt)?
If
Q27 is (0, .R, .D) then skip to Q29
Yes…………………………………………….. 1
Refused to answer…………………..…….……. .R
Don't know……..……………………...…........ .D
28. During receptive anal sex that last time, did he use a condom?
No………………….……………….…………... 0
If
Q28 is (0, .R, .D) then skip to Q29
Don't know.……………..……………….......... .D
28a. Did he use the condom the whole time?
No………………….……………….…………... 0
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
29. The last time you had sex with a man, did you have insertive anal sex where you put
your penis in his anus (butt)?
If Q29=1 then skip to Q30
Yes……………………………………………… 1
Refused to answer…………… …..…….……… .R
Don't know……………..………………............ .D
Skip Pattern: If Q29 is (0, .R, .D) then ask Q29a.
29a. So this means that you only had oral sex the last time you had sex. Is that correct?
If Q29a=1 then skip to Q32
Yes……………………………………………… 1
Refused to answer…………… …..…….……… .R
Skip Pattern: If Q29a is (0, .R, .D) then skip to Q31.
30. During insertive anal sex, the last time you had sex, did you use a condom?
If Q30 is (0, .R, .D) then skip to Q31
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
30a. Did you use the condom the whole time?
No………………….……………….…………... 0
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
31. Think about the last man you had sex with. During the past 12 months, how
comfortable were you asking this last partner to use a condom during anal sex?
Were you:
Very
comfortable……….………..…………..….
1
Somewhat comfortable…………….….…..…….
2
Not comfortable ……………………….....……
3
You did not use a condom…………………...….
4
Refused
to answer…………………..…….……..
.R
Don’t Know……………..……………...….........
.D
32. Before or during the last time you had sex with this partner, did you use:
[Check only one.]
If Q32 is (1, .R, .D) then skip to Q33
Alcohol and drugs ……………………......……. 3
Neither one….……………..……..….…………. 4
Refused to answer.………..…..……...…….…... .R
Don't know…..…..……….…...…….…...…...... .D
32a. Which drugs did you use? [Check all that apply.]
Marijuana ….……………..…..…...……….………. 1
Speedballs (heroin and cocaine together) .………… 2
Heroin ….……………..…..…...….…………….…. 3
Crack Cocaine….……………..…..…...….………... 4
Powdered cocaine ….……………..…..…...….…… 5
Crystal meth (tina, crank, ice) ….……………..…… 6
X or Ecstasy ….……………..…..…...….…………. 7
Special K (ketamine) ….……………..…..…...….… 8
GHB ….……………..…..…...….…………………. 9
Painkillers (Oxycontin, Vicodin, Percocet) ….……. 10
Downers (Valium, Ativan, Xanax) ….……………. 11
Hallucinogens (LSD, mushrooms) ….……………... 12
Poppers ….……………..…..…...….……………… 13
Viagra, Levitra, Cialis…………………………… 14
Other drug (Specify:_______________) ........…….. 15
Refused to answer…………………..…….……....... .R
Don't know……………..……………...….............. .D
33. The last time you had sex with this partner, did you know his HIV status?
No………………….……………….…………... 0
If Q33 is (0, .R, .D) then skip to Q34
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
33a. What was his HIV status?
HIV-negative……………………………..……. 1
HIV-positive…...….…………………..……….. 2
Indeterminate……………………………..……. 3
Refused to answer.…………………………….. .R
34. Was this partner younger than you, older than you, or the same age as you?
If Q34 is (0, .R, .D) then skip to Q35
About the same age………………………… 2
Refused to answer…………………………..….. .R
Don't know……………..………….………...... .D
34a. What was his age? ___ ___ ___
[Refused=.R, Don't know=.D]
35. Have you ever talked to this partner about you being transgender?
No………………….…………………..………. 0
Yes………………………………………..…….. 1
Refused to answer……………………………… .R
Don't know……………..…………………….. .D
36. Has this partner ever injected drugs like heroin, cocaine, or speed?
No………………….…………………..………. 0
Yes………………………………………..…….. 1
Refused to answer……………………………… .R
Don't know……………..…………………….. .D
37. Has this partner ever used crack cocaine?
No………………….………….……………….. 0
Yes………………………………..…………..... 1
Refused to answer…………………………..….. .R
Don't know……………..………….………...... .D
38. Has this partner ever been in prison or jail for more than 24 hours?
No………………….………….……………….. 0
Yes………………………………..…………..... 1
Refused to answer…………………………..….. .R
Don't know……………..………….………...... .D
Skip Pattern: If Q22 is (2, .R, .D) then skip to Q41.
39. How long have you been having a sexual relationship with this partner?
Less than a year………………….…………… 1
If Q39 is (.R, .D) then skip to Q41
More than a year, but less than 3 years………… 3
More than 3 years………… 4
Refused to answer…………………………..….. .R
Don't know……………..………….………...... .D
If Q39 is (3, 4) then skip to Q39b
39a. As far as you know, during the time you were having a sexual relationship with this partner, did he have sex with other people? Would you say he: [Check only one.]
Definitely did not………………….…………… 0
Probably did not……………………………….. 1
Probably did…………………………………… 2
Definitely did ………………….………………. 3
Refused to answer…………………………..….. R
Don't know……………..………….………...... D
If Q39 is (1, 2) then skip to Q40
39b. As far as you know, during the past 12 months when you were having a sexual relationship with this partner, did he have sex with other people? Would you say he: [Read choices, Check only one.]
Definitely did not………………….…………… 0
Probably did not……………………………….. 1
Probably did…………………………………… 2
Definitely did ………………….………………. 3
Refused to answer…………………………..….. R
Don't know……………..………….………...... D
If Q39 is (3, 4) then skip to Q40a
40. During the time you were having a sexual relationship with this partner, did you have sex with other people?
No………………….……………….…………... 0
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
If Q39 is (1, 2) then skip to Q41
40a. During the past 12 months when you were having a sexual relationship with this partner, did you have sex with other people?
No………………….……………….…………... 0
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
If Q39 is (4) then skip to Q42
41. Where did you first meet this partner? [Check only one.]
On the internet..….………………..……………. 01
At a ball..….………………..……………. 02
At a bar or club.….............................……….... 03
On the stroll or while doing sex work...……….. 04
Through friend(s).………………..……………. 05
Somewhere else (Specify:___________) 06
Refused to answer…………..….………………. .R
Don't know…..………..……..…………….......
.D
F
If Q11=1 SAY: Now we would like to ask you some
questions about having sex with women. Some of the questions may
not apply to you. Please remember your answers will be kept private. For these questions, "having sex" means
oral,
vaginal, or anal sex. Oral sex means your partner put her mouth on
your vagina or you put your mouth
on her vagina.
If Q11=0 then skip to
say box before Q43alt
43. Have you ever had sex with a woman?
If Q43 is (0, .R, .D)
then skip to Say Box before Q44 If
Q43 is (1) then skip toQ43a
Yes……………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..……………………..... .D
If Q11=0 SAY: Now we would like to ask you some
questions about having sex with women. Some of the questions may
not apply to you. Please remember your answers will be kept private. For these questions,
"having sex" means oral or anal sex. Oral sex means your
partner put her mouth on your penis or you put your mouth on her
vagina. Anal sex means you put your penis in her anus (butt).
43(alt). Have you ever had oral, vaginal, or anal sex with a woman?
No………………….…………………………… 0
If Q43(alt) is (0, .R,
.D) then skip to Say Box before Q44
Refused to answer……………………………… .R
Don't know……………..……………………..... .D
43a. How old were you the first time you had oral, vaginal, or anal sex with a woman?
__ __ years [Refused=.R, Don't know=.D]
43b. In the past 12 months, with how many different women have you had vaginal or anal sex?
___ ___ ____ ____ [Refused = .R, Don't know = .D]
If Q43b is (0, .R, .D)
then skip to Say Box before Q44;
If
Q43b is (1) then skip to Q43d
Multiple sex partners
43c. In the past 12 months, with how many of these ______ [insert number from Q43b] women
did you have vaginal or anal sex without using a condom?
___ ___ ____ ____ [Refused = .R, Don't know = .D]
If Q43b is greater than
1, Skip to Say Box before Q44
Single sex partner
43d. In the past 12 months, did you have vaginal or anal sex with her without using a condom?
No………………….…………………………… 0
Yes……………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..……………………..... .D
Transgender Partners
SAY: The next questions are about transgender persons with
whom you have had sex. By “transgender” we mean persons
who were born either male or female but who identify or live as the
opposite gender. Your answers to these questions will help us
understand how to ask about sexual behaviors with transgender
persons in future surveys.
44. In the past 12 months, with how many different transgender persons have you had vaginal or anal sex?
___ ___ ____ ____ [Refused = .R, Don't know = .D]
If Q44 is (0, .R, .D)
then skip to Say Box before Q45 If
Q44 is (1) then skip to Q44c
Multiple sex partners
44a. In the past 12 months, with how many of these ______ [insert number from Q44] persons did you have vaginal or anal sex without using a condom?
___ ___ ____ ____ [Refused = .R, Don't know = .D]
44b. Did you include any of these ______ [insert number from Q44] persons among your male and female sex partners in the earlier questions about sex partners?
No …………….…………………………… 0
If Q44b is ( 0 1 .D
.R), skip to Q44e
Refused to answer……………………………… .R
Don't know……………..……………………..... .D
Single sex partner
44c. In the past 12 months, did you have vaginal or anal sex with this person without using a condom?
No …………….…………………………… 0
Yes………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..……………………..... .D
44d. Did you include this person among your male and female sex partners in the earlier questions about sex partners?
No …………….…………………………… 0
Yes………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..……………………..... .D
Last transgender sex partner
44e. Was the last transgender person you had sex with assigned a male or female sex at birth?
Male …………….…………………………… 1
Female………………………………………... 2
Refused to answer……………………………… .R
Don't know……………..……………………..... .D
ALCOHOL USE HISTORY
SAY: The next questions are about alcohol use.
Please remember your answers will be kept private. For these
questions, "a drink of alcohol" means a 12 oz beer, a 5 oz
glass of wine, or a 1.5 oz shot of liquor.
1 Regular Beer 1 Glass of Wine 1 Shot of Liquor
12 oz. 5 oz. (Whisky, Vodka, Gin, etc.)1.5 oz.
45. In the past 12 months, did you drink any alcohol such as beer, wine, malt liquor, or hard liquor?
No……………………………………………… 0
Q45 is (0, .R, .D) then skip to Say Box before Q46
Refused to answer……………………………… .R
Don't know……………………………………. .D
45a. In the past 30 days, on how many days did you drink any alcohol?
If Q45a is (0, .R, .D) then skip to Say Box before Q46
[Refused =.R, Don't know=.D] __ __
45b. On the days when you drank alcohol in the past 30 days, about how many drinks did you have on average?
[Refused =.R, Don't know=.D] __ __
45c. In the past 30 days, how many times did you have 5 or more alcoholic drinks in one sitting?
[Refused =.R, Don't know=.D] __ __
DRUG USE HISTORY
HORMONES and SILICONE
SAY: The next questions are about hormone use.
This means hormones that you have used to change your body to make
it more feminine in appearance.
46. Have you ever used hormones to change your body? This would include hormones that are applied topically, taken orally, or injected. “Applied topically” means hormones are applied to the skin.
If Q46 is (0, .R, .D) then skip to Say Box before Q64
Yes……………………………………………… 1
Refused to answer…..………………………….. .R
Don’t know………..…………………………… .D
47. Did you use these hormones in the past 12 months?
If Q47 is (0, .R, .D) then skip to Say Box before Q64
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don’t Know……………..……………………... .D
47a. Are you currently receiving hormone therapy under the supervision of a healthcare provider?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don’t Know……………..……………………... .D
48. Have you ever injected or been injected with hormones?
If Q48 is (0, .R, .D) then skip to Say Box before Q64
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don’t Know……………..……………………... .D
49yy. In what year was your last hormone injection?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
49mm. In [insert year from Q49yy here], in what month was your last hormone injection?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO9: Date of last hormone injection: 49mm/49yy
If Auto9 is over 12 months ago skip to Say Box before Q64
If Q49YY = .REF or .DK or [Q49YY-year of
interview > 0 and Q49MM=REF or DK] skip to Say Box before Q64
50. How often did you get hormone injections in the past 12 months?
[Check only one.]
More than once a month (or twice a week)……. 1
Once a month…………………………….. 2
Less than once a month..……………………... 3
Refused to answer…..………………………….. .R
Don’t know………..…………………………… .D
51. How are you getting hormones for your injections? [Check all that apply.]
Through a prescription from a doctor ……………… 1
Off the Internet……………………………....….. 2
From someone on the street ………………….. 3
From a friend ……………………………....….. 4
Other ……………………………………………….…... 5
(Specify___________________________________)
Refused to answer……………………………………….… .R
Don’t know………..……………………………………… .D
52. In the last 12 months, who performed the hormone injections? [Check all that apply.]
M
If Q52 not =1 then skip to Q54
Doctor or nurse in the US …………………………..........….. 2
Doctor or nurse in another country………………...……….. 3
A person who is not a doctor or nurse but regularly performs
this service for transgender people ………………….……..
4
A friend ………………………………………………..…….... 5
Other (Specify___________________________________).…... 6
Refused to answer……………………………………………….… .R
Don’t know………..……………………………………………… .D
Say: In the past 12 months when you injected yourself
with hormones, where did you get the needles for the injections?
No Yes RF DK
53a. Did you get needles for hormone injections
from a pharmacy or drug store? 0… 1… .R. .D
53b. Did you get needles for hormone injections
from a doctor's office, clinic, or hospital? 0… 1… .R. .D
53c. Did you get needles for hormone injections
from a friend, acquaintance, relative, or sex partner? 0… 1… .R. .D
53d. Did you get them from a needle or drug dealer,
shooting gallery, hit house, or off the street? 0… 1… .R. .D
53e. Did you get needles for hormone injections
from a needle exchange program? 0… 1… .R. .D
53f. Did you get needles for hormone injections
from off the internet? 0… 1… .R. .D
53g. Did you get your needles for hormone injections
from any other places? 0… 1… .R. .D
If Q53g is (0, .R, .D) then skip to Q54
53h. Where else have you gotten needles for hormone injections? ___________________________
54. In the past 12 months when you got hormone injections, how often were new, sterile needles used? A new, sterile needle is a needle that has never used before by anyone, even you.
[Check only one.]
Never……….…….…………………..………… 0
Rarely…………….……………….……..……. 1
About half the time…………………………….. 2
Most of the time…..……..……………………... 3
Always.….……………..………………………. 4
Refused to answer…..………………………….. .R
Don’t know………..…………………………… .D
54a In the past 12 months when you got hormone injections, have you shared a vial of hormones with someone else?
No………….…………………………………… 0
If Q54a is (0, .R., .D) then skip to
Say Box before Q55
Refused to answer…………………………..… .R
Don't know……………..……………………... .D
54b When you shared a vial of hormones with someone else, did you use the hormones in the vial after someone else did?
If Q54b is (0, .R., .D) then skip to
Say Box before Q55
Yes…………………………………………….. 1
Refused to answer…………………………..… .R
Don't know……………..……………………... .D
54c In the past 12 months, how often did the person, who used the same vial before you, use a new, sterile needle? A new, sterile needle is a needle that has never used before by anyone, even you.
Never……….…….…………………..………… 0
Rarely…………….……………….……..……. 1
About half the time…………………………….. 2
Most of the time…..……..……………………... 3
Always.….……………..………………………. 4
Refused to answer…..………………………….. .R
Don’t know………..…………………………… .D
55. Have you ever gotten a hormone injection at the same time that at least one other person did?
No………….…………………………………… 0
If Q55 is (0, .R., .D) then skip to
Say Box before Q64
Refused to answer…………………………..… .R
Don't know……………..……………………... .D
56. In the past 12 months, with how many people did you use a needle after someone else had injected hormones with it?
[Refused = .R, Don't know = .D] __ __ __
Last time injected hormones with someone
57yy. In what year did you last get a hormone injection at the same time that at least one other person did?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
57mm. In [insert year from Q57yy here], in what month was the last time you got a hormone injection at the same time that at least one other person did?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO10: Date last injected hormones together: 57mm/57yy
If Auto10 is over 12 months ago skip to Say Box before Q64
If Q57YY = .REF or .DK or [Q57YY-year of
interview > 0 and Q57MM=REF or DK] skip to Say Box before Q64
SAY: The next questions are about the last time you
got a hormone injection at the same time that at least one other
person also got an injection.
58. At that time, how many other persons were getting hormone injections besides yourself?
[Refused = .R, Don't know = .D] __ __ __
59. At that time, did you use the same needle that at least one other person did?
If Q59 in (1, .R, .D) then skip to Q60
Yes…………………………………………….. 1
Refused to answer…………………………..… .R
Don't know……………..……………………... .D
59a. During this last time, did you get injected with a new sterile needle? A new, sterile needle is a needle never used before by anyone, even you.
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
60. That last time you got injected at the same time as someone else, did you use a vial of hormones after someone else did?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..… .R
Don't know……………..…………………….. .D
If Q58>1 then skip to Say Box before Q64;
If Q59=0 and Q60=0 then skip to Say Box
before Q64
SAY: Think about the last time you got a
hormone injection at the same time someone else also got an
injection. The next questions are about that person who got a
hormone injection at the same time you did.
61. Did you know the HIV status of the person you were injecting with?
No………………….……………….…………... 0 Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
61a. What was their HIV status?
HIV-negative……………………………..…...... 1
HIV-positive…...….…………………..……….. 2
Indeterminate……………………………..……. 3
Refused to answer.……………………………... .R
62. Did you know if they had been tested for hepatitis C?
No………………….……………….…………... 0
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
62a. What was the result of their hepatitis C test?
Negative……………………………..…............. 1 Positive…...….…………………..………......... 2
Refused to answer.……………………………... .R
63. Think about the person who got a hormone injection at the same time you did. Which of the following best describes your relationship to this person? Would you say this person was a: [Check only one.]
Sex partner ……………………………….…… 1
Friend or acquaintance ………………………… 2
Relative ………………………………………… 3
A person with access to needles or hormones.. 4
Stranger..........................................…………….. 5
Other (specify________________)……………. 6
Refused to answer………………...……………. .R
Don't know……………..……..…..………….. .D
SAY: The next questions are about substances
like silicone that are injected to change the shape of the body.
64. Have you ever injected, or been injected with, a substance like silicone to change the shape of your body?
IfQ64 is (0, .R, .D) then skip to Say Box before Q76
Yes……………………………………………… 1
Refused to answer…………………………..…. .R
Don’t Know……………..……………………... .D
65. What substances did you inject to change the shape of your body?
S
If Q65 is (.R, .D) then skip to Say Box before Q76 If Q65 =1 then skip to Q66yy
Some other substance……….....….. 2
Silicone and some other substance…… 3
Refused to answer…..…………………….. .R
Don’t know………..……………………… .D
65a. What were these other substances?
______________________________________ (Refused=.R; Don’t know=.D)
66yy. In what year was the last time you got injected with [insert “Silicone or some other substance” if
Q65=1 or 3; “this substance” if Q65=2 ]?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
66mm. In [insert year from Q66yy here], in what month was the last time you got injected with [insert “Silicone or some other substance” if Q65=1 or 3; “this substance” if Q65=2]?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO11: Date of last silicone injection: 66mm/66yy
If AUTO11 is over 12 months ago then skip to Say Box before
Q76
If Q66YY = .REF or .DK or [Q66YY-year of
interview > 0 and Q66MM=REF or DK] skip to Say Box before Q76
67. In the past 12 months, how often were you injected with silicone or some other substance to change your appearance?
[Check only one.]
If Q67 is (0) then skip to Say Box before Q76
Once …………….……..……. 1
Twice………………………….. 2
3 to 5 times..……………………... 3
5 to 10 times………………………….. 4
More than 10 times.………………………. 5
Refused to answer…..………………………….. .R
Don’t know………..…………………………… .D
68. Where did you get [insert “the Silicone and the other substance(s)” if Q65=3; “Silicone” if Q65=1; “this substance” if Q65=2]? [Check all that apply.]
Through a prescription from a doctor ……………… 1
From someone on the street ………………….. 2
From a friend ……………………………....….. 3
Other ……………………………………………….…... 4
(Specify___________________________________)
Refused to answer……………………………………….… .R
Don’t know………..……………………………………… .D
69. In the last 12 months, who performed the injections? [Check all that apply.]
D
If Q69 not = 1 then skip to Q71
Doctor or nurse in another country ………………...……….. 2
A person who is not a doctor or nurse but regularly performs
this service for transgender people ………………….……..
3
A friend ………………………………………………..…….... 4
Myself ……………………………………………………….. 5
Other (Specify___________________________________).…... 6
Refused to answer…………………………………………… .R
Don’t know………..………………………………………… .D
Say: In the past 12 months when you injected yourself
with Silicone or some other substance, where did you get the needles
for the injections?
No Yes RF DK
70a. Did you get needles for silicone injections
from a pharmacy or drug store? 0… 1… .R. .D
70b. Did you get needles for silicone injections
from a doctor's office, clinic, or hospital? 0… 1… .R. .D
70c. Did you get needles for silicone injections
from a friend, acquaintance, relative, or sex partner? 0… 1… .R. .D
70d. Did you get them from a needle or drug dealer,
shooting gallery, hit house, or off the street? 0… 1… .R. .D
70e. Did you get needles for silicone injections
from a needle exchange program? 0… 1… .R. .D
70f. Did you get needles for silicone injections
from off the internet? 0… 1… .R. .D
70g. Did you get your needles for silicone injections
If Q70g is (0, .R, .D) then skip to Q71
70h. Where else have you gotten needles for silicone injections? ___________________________
71. A new, sterile needle is a needle never used before by anyone, even you. In the past 12 months when you were injected with [insert “Silicone or some other substance” if Q65=1 or 3;; “this substance” if Q65=2], how often was a new, sterile needle?
[Check only one.]
Never……….…….…………………..………… 0
Rarely…………….……………….……..……. 1
About half the time…………………………….. 2
Most of the time…..……..……………………... 3
Always.….……………..………………………. 4
Refused to answer…..………………………….. .R
Don’t know………..…………………………… .D
72. In the past 12 months, have you ever gotten injected with [insert “Silicone or some other substance” if Q65=1 or 3; “this substance” if Q65=2] at the same time that at least one other person got injected?
If Q72 in (0, .R, .D) then skip to Say Box before Q76
Refused to answer…………………………..… .R
Don't know……………..……………………... .D
73yy. In what year did you last get injected with [insert “Silicone or some other substance” if Q65=1 or 3; “this substance” if Q65=2],at the same time that at least one other person got injected?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
73mm. In [insert year from Q73yy here], in what month was the last time you got injected with
[insert “Silicone or some other substance” if Q65=1 or 3; “this substance” if Q65=2], at the same time as someone else?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO12: Date last shared silicone injection with someone. 73mm/73yy
SAY: The next questions are about this last
time you got injections of [insert “Silicone or some
other substance” if Q65=3; “this substance” if
Q65=2], at the same time as at least one other person did.
74. At that time, how many other persons were also getting injections besides yourself?
[Refused = .R, Don't know = .D] __ __ __
75. At that time, did you get injected using a new, sterile needle? A new, sterile needle is a needle never used before by anyone, even you.
No………….…………………………………… 0 Yes…………………………………………….. 1
Refused to answer…………………………..… .R
Don't know……………..……………………... .D
I
SAY: The next questions are about injection drug use.
This means injecting drugs yourself or having someone who isn't a
health care provider inject you. It does not include drugs that
were prescribed to you. It does not mean hormone or silicone
injections. Please remember your answers will be kept private.
76. Have you ever in your life shot up or injected any drugs other than those prescribed for you? By shooting up, we mean anytime you might have used drugs with a needle, either by mainlining, skin popping, or muscling.
If Q76 is (0, .R, .D) then skip to
Say Box before Q95
Yes……………………………………………… 1
Refused to answer……………………………… .R
Don't know……………..……………………... .D
76a. Think back to the very first time you injected any drugs, other than those prescribed for you. How old were you when you first injected any drug other than hormones or silicone?
[Refused = .R, Don't know = .D] __ __ years old
76yy. In what year did you last inject any drug other than hormones or silicone?
Year: __ __ __ __ [Refused = .R, Don't know = .D]
76mm. In [insert year from Q76yy here], in what month did you last inject any drug other than hormones or silicone?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO13: Date of last drug injection: 76mm/76yy
If AUTO13 > 12 months then skip to Say Box before Q95
SAY: The next questions are about injection
drug use in the past 12 months. The word "needles" means
both needles and syringes. In the past 12 months when you injected,
did you get your needles at any of the following places?
No Yes RF DK
77a. Did you get needles for injecting drugs
from a pharmacy or drug store? 0… 1… .R. .D
77b. Did you get needles for injecting drugs
from a doctor's office, clinic, or hospital? 0… 1… .R. .D
77c. Did you get needles for injecting drugs
from a friend, acquaintance, relative, or sex partner? 0… 1… .R. .D
77d. Did you get them from a needle or drug dealer,
shooting gallery, hit house, or off the street? 0… 1… .R. .D
77e. Did you get needles for injecting drugs
from a needle exchange program? 0… 1… .R. .D
77f. Did you get needles for silicone injections
from off the internet? 0… 1… .R. .D
77g. Did you get your needles for injecting drugs
from any other places? 0… 1… .R. .D
77h. Where else have you gotten needles to inject drugs? ___________________________
If Q77g is (0, .R, .D) then skip to Q78
78. A new, sterile needle is a needle never used before by anyone, even you. In the past 12 months when you injected, how often did you use a new, sterile needle?
[Check only one.]
Never……….…….…………………..………… 0
Rarely…………….……………….……..……. 1
About half the time…………………………….. 2
Most of the time…..……..……………………... 3
Always.….……………..………………………. 4
Refused to answer…..………………………….. .R
Don’t know………..…………………………… .D
SAY: Next are questions about how often you
might have injected drugs in the past 12 months. Please remember
your answers will be kept private. In the past 12 months, how often
did you inject:
More More More Less
than than than than
Didn't once a Once a once a Once a once a Once a once a Refused use day day week week month month month to answer
79a. Heroin and cocaine
together (speedballs)..00.. 01…..02…..03…...04……05….....06…….07…….R
79b. Heroin alone……….. 00…01…..02…..03…...04……05….....06…….07…….R
79c. Powdered cocaine
alone……………….. 00…01…..02…..03…...04……05….....06…….07…….R
79d. Crack cocaine……… 00…01…..02…..03…...04……05…….06……07……..R
79e. Crystal meth (tina,
crank, or ice)…….... 00.. 01…..02…..03…...04……05….....06…….07……..R
79f. Oxycontin………..… 00…01…..02…..03…...04……05….....06…….07……..R
79g. Other injected drug… 00…01…..02…..03…...04……05…....06…….07……..R
SAY: Next are questions about your injecting behaviors
in the past 12 months. Remember these questions do not include
hormone or silicone injections.
80. In the past 12 months, with how many people did you use a needle after they injected with it?
[Refused = .R, Don't know = .D] __ __ __
81. In the past 12 months, with how many people did you use the same cooker, cotton, or water that they had already used. By “water,” we mean water for rinsing needles or preparing drugs.
[Refused = .R, Don't know = .D] __ __ __
82. In the past 12 months, with how many people did you use drugs that had been divided with a syringe that they had already used?
[Refused = .R, Don't know = .D] __ __ __
83 In the past 12 months, how often did you use needles that someone else had already injected with? [Check only one.]
Never……….…….…………………..………… 0
Rarely…………….……………….……..……. 1
About half the time…………………………….. 2
Most of the time…..……..……………………... 3
Always.….……………..………………………. 4
Refused to answer……………..……………….. .R
Don’t know………..…………………………… .D
84. In the past 12 months when you injected, how often did you use cookers, cottons, or water that someone else had already used? [Read choices, Check only one.]
Never……….…….…………………..………… 0
Rarely…………….……………….……..……... 1
About half the time…………………………….. 2
Most of the time…..……..……………………... 3
Always.….……………..………………………. 4
Refused to answer……………..……………….. .R
85. During the past 12 months when you injected, how often did you use drugs that had been divided with a syringe that someone else had already injected with? [Check only one.]
Never……….…….…………………..………… 0
Rarely…………….……………….……..…….. 1
About half the time……………………………. 2
Most of the time…..……..……………………... 3
Always.….……………..………………………. 4 Refused to answer……………..……………….. .R
Don’t know………..…………………………… .D
SAY: The next questions are about the last
time you injected drugs, not including hormones, with someone
else.
86yy. What year was the last time you injected drugs with someone?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
86mm. In [Insert year from Q86yy], in what month did you last inject drugs with someone?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO14. Date of last IDU: 86mm/86yy
If Q80 =0 then skip to Q88
87. The last time you injected with this person, did you use a needle after they injected with it?
No………….…………………………………… 0
If Q87 = 1 then skip to Q88
Refused to answer…………………………..… .R
Don't know……………..……………………... .D
87a. A new, sterile needle is a needle never used before by anyone, even you. The last time you injected drugs, did you use a new sterile needle to inject?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
If Q81 = 0 then skip to Q89
88. Think about the last time you injected drugs at the same time as someone else. The last time you injected with this person, did you use the same cooker, cotton, or water that they had already used?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..… .R
Don't know……………..…………………….. .D
If Q82 = 0 then skip to Q90
89. The last time you injected with this person, did you use drugs that had been divided with a syringe that they had already injected with?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..… .R
Don't know……………..…………………….. .D
SAY: The next questions are about this last
person you injected with.
90. Is this person male, female, or transgender?
Female….…………………….……………..… 2
Transgender, MTF………….……………..… 3
Transgender, FTM…………….……………..… 4
Refused to answer…………………………..… .R
Don't know……………..…………………….. .D
91. Has this person ever had sex with a man?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..… .R
Don't know……………..…………………….. .D
92. The last time you injected with this person, did you know their HIV status?
If Q92 is (0, .R, .D) then skip to Q93
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
92a. What was their HIV status?
HIV-negative……………………………..…...... 1
HIV-positive…...….…………………..……….. 2
Indeterminate……………………………..……. 3
Refused to answer.……………………………... .R
93. Think about the last person you injected drugs with. The last time you injected with this person, did you know if they had been tested for hepatitis C?
If Q93 is (0, .R, .D) then skip to Q94
Yes….……………………………….…….......... 1
Refused to answer………………………..…….. .R
Don't know.……………..……………….......... .D
93a. What was the result of their hepatitis C test?
Negative……………………………..…............. 1
Positive…...….…………………..………......... 2
Refused to answer.……………………………... .R
94. Which of the following best describes your relationship to this person? Would you say this person was a: [Check only one.]
Sex partner ……………………………….…… 1
Friend or acquaintance ………………………… 2
Relative ………………………………………… 3
Needle or drug dealer………………………….. 4
Stranger..........................................…………….. 5
Other (specify________________)……………. 6
Refused to answer………………...……………. .R
Don't know……………..……..…..………….. .D
N
SAY: We would like to ask you about drugs that
you may have used but did not inject. These drugs are referred to as
non-injection drugs and include drugs like marijuana, crystal,
cocaine, crack, club drugs, painkillers, or poppers. It does not
include hormones. Please remember your answers will be kept private.
95. In the past 12 months, have you used any non-injection drugs, other than those prescribed for you?
If Q95 in (0) then skip to
Say Box before Q98
Refused to answer……………………………… .R
Don't know……………..…………………….. .D
More More More Less
than than than than
Didn't once a Once a once a Once a once a Once a once a Refused
use day day week week month month month to answer
96a. Crystal meth (tina, crank, or ice) 00 01 02 03 04 05 06 07 .R
96b. Crack cocaine 00 01 02 03 04 05 06 07 .R
96c. Powdered cocaine that is
smoked or snorted 00 01 02 03 04 05 06 07 .R
96d. Downers such as Valium, Ativan, or
Xanax not prescribed to you 00 01 02 03 04 05 06 07 .R
96e. Painkillers such as Oxycontin, Vicodin,
or Percocet not prescribed to you 00 01 02 03 04 05 06 07 .R
96f. Hallucinogens such as
LSD or mushrooms 00 01 02 03 04 05 06 07 .R
96g. X or Ectasy 00 01 02 03 04 05 06 07 .R
96h. Special K (ketamine) 00 01 02 03 04 05 06 07 .R
96i. GHB 00 01 02 03 04 05 06 07 .R
96j. Heroin that is smoked or snorted 00 01 02 03 04 05 06 07 .R
96k. Marijuana 00 01 02 03 04 05 06 07 .R
96l. Poppers ( amyl nitrate) 00 01 02 03 04 05 06 07 .R
96m. Other drug 00 01 02 03 04 05 06 07 .R
(Specify___________)
97. In the past 12 months, have you used Viagra, Levitra or Cialis?
No………….………………………………….. 0
If Q97 is (0, .R, .D) then
skip to Say Box before Q98
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
If Q96a in (0, .R) then skip to Say Box before Q98
97a. You told me that you used crystal meth (tina, crank, ice). In the past 12 months, did you use Viagra, Levitra or Cialis at the same time you used crystal meth?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
ALCOHOL AND DRUG TREATMENT
SAY: Next are questions about alcohol and drug
treatment programs. These include out-patient, in-patient, and
residential treatment programs; and detox, methadone treatment, or
12-step programs.
98. Have you ever participated in an alcohol or drug treatment program?
If Q98 in (0, .R, .D) then
skip to Say Box before Q99
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
98a. Have you participated in an alcohol treatment program in the past 12 months?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
98b. In the past 12 months, did you try to get into an alcohol treatment program but were unable to?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
98c. Have you participated in a drug treatment program in the past 12 months?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
98d. In the past 12 months, did you try to get into a drug treatment program but were unable to?
No………….………………………………….. 0
Yes…………………………………………….. 1
Refused to answer…………………………..…. .R
Don't know……………..……………………... .D
HIV TESTING EXPERIENCES
SAY: The next questions are about getting
tested for HIV. Remember, an HIV test checks whether someone has the
virus that causes AIDS.
99. Have you ever been tested for HIV?
If Q99 in (0, .R, .D) then skip Instructions before Q113
No…………………………...…………..............
0
Yes………………..…………………….............. 1
Refused to answer……………………………… .R
Don't know……………..……………………... .D
100yy. In what year was your first HIV test?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
100mm. In [Insert year from Q100yy], in what month was your first HIV test?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO15. Date of first HIV test: 100mm/100yy
101. In the past 2 years, that is, since [insert calculated date 2 years prior to AUTO2], how many times have you been tested for HIV?
If Q101 >1, skip to Q103. If Q101 =1, then go to Q102 If Q101 is (0, .R, .D) then skip to Q113
102. That time you got tested for HIV in the past 2 years, did you get the result of the test?
[Give dates as reference points if needed.]
If Q102 is (0, .R, .D) then skip to Q104
If Q102 is=1, then skip to 105yy
No…………………………...…………..............
0
Yes………………..…………………….............. 1
Refused to answer……………………………… .R
Don't know……………..……………………... .D
103. Of the ____ [insert number from Q101] times you were tested for HIV in the past 2 years, how many times did you get the results of those tests?
If
Q101= Q103 or Q103 in (.R , .D) then skip to Q105
[Refused = .R, Don't know = .D] ___ ___ ___
104. Think about the last time you didn’t get your HIV test result. What was the main reason you didn’t get your result? [Choose only one reason type.]
It is too soon, the results are not available yet.………….. 01
You thought someone would contact you……………….. 02
You are afraid of getting a positive result..…...…………. 03
You are too busy to get your result………………..…….. 04
You forgot to get your results……………………….…... 05
Staff at testing site are not transgender sensitive……..….. 06
You don’t care care about result…………………………. 07
You were in jail and got released before getting result…… 08
Testing location has an inconvenient location or hours.….. 09
You lost appointment card, paperwork, or ID number …... 10
Other……………………..………………………………... 11
Refused……………………………………………............. .R
Don’t know…….....……..………………………………… .D
105yy. In what year was your most recent HIV test?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
105mm. In [Insert year from 105yy], in what month was your most recent HIV test?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO16. Date of most recent HIV test: 105mm/105yy
If Q105YY = .REF or .DK or [Q105YY-year of interview =1 and
Q105MM=REF or DK] then ask the following confirmation question.
Otherwise skip to Q106:
105_confirmation. Was your most recent HIV test in the past 12 months?
No…………………………...………….............. 0
Yes………………..…………………….............. 1
Refused to answer……………………………… .R
Don't know……………..……………………... .D
If AUTO16- AUTO2 (interview date) is > 5 years ago then
skip to Q111.
106. When you got tested in ____/____ [insert date from AUTO16], where did you get tested?
Doctor’s office……………………………………… 01
Hospital or medical center………………………….. 02
HIV organization…………………………………… 03
If Q106 is not 02, then skip to Q107.
Needle exchange program…………………………… 05
Mobile HIV testing unit ……………………………. 06
Correctional facility (jail or prison)………………… 07
Drug treatment program………………..…………… 08
At home…………..………………………………..… 09
Other………..………………………….……………… 10
Refused………………………………………............ .R
Don’t know…….....……..……………………............ .D
106a. You indicated you were tested in a hospital or medical center in ____/____ [insert date from AUTO16], was it while inpatient, in the emergency room, or in another outpatient facility?
Inpatient……………..………. 01
In the emergency room……………………………. 02
Another outpatient facility……………….………… 03
Refused……………………………………….... .. .R
Don’t know…….....……..……………………........ .D
Say: The next questions are about reasons why people
get tested for HIV. When you got tested in _____/______ [insert
date from AUTO16], why did you get tested:
to answer know
107a. Because you thought or were worried you might have been
exposed to HIV in the 6 months before the test?………….…… 0 1 .R .D
107b. Because you get tested on a regular basis and it was time for you
to get tested again?……………………………………………… 0 1 .R .D
107c. Because you were just checking to make sure you were
HIV negative?............................................................................... 0 1 .R .D
107d. Because your doctor or health care provider recommended you
get tested?..................................................................................... 0 1 .R .D
107e. Because you were required to get tested by either insurance,
the military, a court order, or by some other agency?………….. 0 1 .R .D
107f. Because there was some other reason you wanted to get tested?........................................................................................... 0 1 .R .D
(Specify other reason ___________________________)
108. An anonymous HIV test means you were not required to give your name to get tested. You may have been given an identification number or code to get your test results. When you got tested in _____ / ______ [insert date from AUTO16], was it anonymous?
No………………….…………………………… 0
Yes……………………………………............... 1
Refused to answer……………………………… .R
Don't know……………..……………............... .D
109. When you got tested in ____/____ [insert date from AUTO16], was it a rapid test where you could get your results within a couple of hours?
No………………….…………………………… 0
Yes……………………………………………… 1
Refused to answer………………………………. .R
Don't know……………..……………………... .D
110. Did the test in ____/____ [insert date from AUTO16] use a swab from your mouth, blood from your finger, or blood from your arm?
Swab from mouth……………………………… 1
Blood from finger……………………………..... 2
Blood from arm …………..……………………. 3
Other (specify ___________________)……….. 4
Refuse to answer ……............…………………. .R
Don’t know ……………………………………. .D
111. What was the result of your most recent HIV test? [Check only one.]
If Q111 =1 then skip to Instructions before Q113 If Q111
=2 then skip to Q115
Positive………………………….………............ 2
Never obtained results………………….…......... 3
Indeterminate…………..……………..………… 4 Refused to answer…………...….………………. .R
Don't know…...………………………….......... .D
112. Before your test in ____/_____ [insert date from AUTO16], did you ever test positive for HIV?
If Q112=1 then skip to Q116
Yes……………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..……………………... .D
Calculate
months since last HIV TEST WAS DONE: AUTO2
(Interview
date)-AUTO16; use confirmation question for 105 if necessary If
calculated interval since last HIV test was done <
12 months ago or unknown then skip to Q114 If
calculated interval since last HIV test was done > 12 months ago
then skip to Q113
[
PERSONS
WHO HAVE
NOT TESTED
FOR HIV IN THE PAST 12 MONTHS]
Say: Next is a list of reasons why some people have
not been tested for HIV. Please indicate if the following are
reasons why you have not been tested for HIV in the
past 12 months. Have you not been tested in the past 12
months:
Refused
No Yes to answer
113a. Because you think you are at low risk for HIV infection?.... 0 1 .R
113b. Because you were afraid of finding out that you had HIV?... 0 1 .R
113c. Because you were worried your name would be
reported to the government if you tested positive?................ 0 1 .R
113d. Because you were afraid of someone finding
out about the test result?.................................................….. 0 1 .R
113e. Because you were afraid of losing your job, insurance,
or housing if you tested positive?.......................................... 0 1 .R
113f. Because you didn’t have the money or the insurance to
pay for the test?...................................................................... 0 1 .R
113g. Because you didn’t have time?….…………….……….…… 0 1 .R
113h. Because you didn’t know where to go to get tested?.............. 0 1 .R
113i. Because you couldn’t get transportation to a testing place?.. 0 1 .R
113j. Because you don’t like needles?............................................ 0 1 .R
If
only one "yes" response in Q113a-j, then skip t 114.
If
more than one
"yes" response for Q113a-j, ask
Q113k.
113k. Which of these reasons was the most important reason you have not been tested for HIV in the past 12 months? _______ [Refused to answer=.R, Don’t know=.D]
List
each of the above reasons marked “Yes.” in 113a-113j.
114. Some people without the HIV virus take HIV or AIDS medicines because they think it might reduce their chances of getting HIV. We don't know if this works. AIDS medicines are also known as antireterovirals, HAART, or the AIDS cocktail. In the past 6 months, did you take any AIDS medicines to reduce your chance of getting HIV?
No………………….…………………………… 0
If Q114 is (0,1, .R, .D) then skip to Q135
Refused to answer……………………………… .R
Don't know……………………………………… .D
[PERSONS WHO HAVE TESTED HIV POSITIVE]
115. Was your test in ____/_____ [insert date from AUTO15] your first positive test?
No………………….…………………………… 0
If Q115 is (1, .R, .D) then skip to Q120
Refused to answer……………………………… .R
Don't know……………………………………. .D
116yy. In what year did you first test positive?
Year: ___ ____ ____ ____ [Refused = .R, Don't know = .D]
116mm. In [insert year from 116yy], in what month did you first test positive?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO17. Date of first positive test: 116mm/116yy
117. When you first tested positive in ____/______ [insert date from AUTO17], where did you get tested?
Doctors office ……….. 01
Hospital or medical center……...….………….. …. 02
If Q117 not equal to 02, skip to Q118
Community public health clinic… 04
Needle exchange program.…...……..………….. …. 05
Mobile testing unit… 06
Correctional facility (jail or prison)……………. … 07
Drug treatment program………………..………. 08
At home…………..………………………………. 09
Other………..………………………….………… 10
Refused……………………………………….... .. .R
Don’t know…….....……..……………………........ .D
117a. You indicated you were tested in a hospital or medical center in ____/____ [insert date from AUTO17], was it while inpatient, in the emergency room, or in another outpatient facility?
Inpatient……………..………. 01
In the emergency room……………………………. 02
Another outpatient facility……………….………… 03
Refused……………………………………….... .. .R
Don’t know…….....……..……………………........ .D
Say: When you got tested in ____/____ [insert date from
AUTO17], did you get tested for any of the
following reasons:
to answer know
118a. Because you thought or were worried you might have been
exposed to HIV in the 6 months before the test?………………. 0 1 .R .D
118b. Because you get tested on a regular basis and it was time for you
to get tested again?……………………………………………… 0 1 .R .D
118c. Because you were just checking to make sure you were
HIV negative?.…………………………………………………. 0 1 .R .D
118d. Because your doctor or health care provider recommended you
get tested?.................................................................................... 0 1 .R .D
118e. Because you were required to get tested by either insurance,
the military, a court order, or by some other agency……………. 0 1 .R .D
118f. Because there was some other reason you wanted to get
tested?............................................................................................ 0 1 .R .D
(Specify other reason ___________________________)
119. An anonymous HIV test means you were not required to give your name to get tested. You may have been given an identification number or code to get your test results. When you first tested positive in _____ / ______ [insert date from AUTO17], was it anonymous?
No………………….…………………………… 0
Yes……………………………………................ 1
Refused to answer……………………………… .R
Don't know…………….………………………. .D
120. After you tested positive, were you asked by someone from the health department or your health care provider to give the names of your sex or drug use partners so they could be notified that they may have been exposed to HIV?
If Q120 in (0, .R, .D) then skip to Q121
Refused to answer……………………………… .R
Don't know……………..……………………... .D
120a. Did you give the names of any of your partners when asked?
If Q120a in (1, .R, .D) then skip to Q121
Yes……………………………………............... 1
Refused to answer……………………………… .R
Don't know……………..……………............... .D
120b. What is the main reason you didn’t give any names of your partners when asked?
You didn’t know their name(s) or how to contact them.................................. 01
You wanted to contact them personally....………………….......................... 02
You were in shock, busy coping, or couldn’t think clearly at that time……. 03
You were afraid someone would tell your partner(s) that you are infected…. 04
You were afraid your partner(s) would react badly if they found out……….. 05
You didn’t care whether partner(s) knew they may
be infected ……………………...…….….................................................. 06
Your partner(s) already knew they were positive…….................................... 07
Other……………………..…………………………...................................... 08
Refused……………………………………………………………………… .R
Don’t know….……..………………...……………………………………… .D
121. A negative HIV test is one that showed you did not have HIV infection. Before your first positive test in _____ / ______ [insert date from AUTO16 or AUTO17], did you ever have a negative HIV test?
If Q121 is (0, .R, .D) then skip to Q123
Yes……………………………………................ 1
Refused to answer……………………………… .R
Don't know…………….………………………. .D
122yy. In what year did you take your last negative HIV test? We want to know the year that you got tested, not the year that you got your results
Year: ___ ___ ___ ___ [Refused = .R, Don't know = .D]
122mm. In [Insert year from 122yy], in what month did you have your last negative HIV test (again, in what month did you have the test, not get your results)?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO18. Date of PLWH last negative HIV test: 122mm/122yy
123. In the 2 years before your first positive test in _____ / ______ [insert date from AUTO16 or AUTO17], how many times did you get tested for HIV? Don't include your first positive test in that total number.
[Refused = .R, Don't know = .D] ___ ___ ___ ___
124. Some people take HIV or AIDS medicines because they think it might reduce their chances of getting HIV. We don't know if this works. AIDS medicines are also known as antireterovirals, HAART, or the AIDS cocktail. In the 6 months before your first positive test, did you take any AIDS medicines to reduce your chance of getting HIV?
No………………….…………………………… 0
Yes……………………………………................ 1
Refused to answer……………………………… .R
Don't know…………….………………………. .D
125. Have you ever been seen by a doctor, nurse, or other health care provider for care related to your HIV infection?
If Q125 =1 then skip to Q127 If Q125 is (.R, .D) then skip to
Instructions before Q131
Yes……………………………………………... 1
Refused to answer……………………………… .R
Don't know……………..………....................... .D
126. What are the reasons you have never gone to a health care provider for care related to your HIV infection? [Choose only one reason.]
You feel good …………..……………………………………. 01
You don't want to think about being HIV positive……..…..... 02
You don’t have money or insurance…..………….………….. 03
You couldn’t find a transgender-sensitive doctor……………. 04
You can’t find a health care provider or don’t know
where to go…………….…………...................................... 05
The doctor or clinic has inconvenient location or hours…….. 06
You are too busy……………………………………………. 07
You forgot to go or missed an appointment…………………. 08
You were on the street………………………………………. 09
You have an appointment in the near future………..………. 10
Other……………………..………………………………….. 11 Refused……………………………………………………….. .R
Don’t know……………………..………………….................. .D
If
only one response in Q126, then skip to Q127yy.
If
more than one
response for Q126, ask
Q126a.
126a. Which of these reasons was the most important reason you have have never gone to a health care provider for care related to your HIV infection?
_______ [Refused to answer=.R, Don’t know=.D]
List
each of the above reasons marked in Q126.
127yy. In what year did you first go to your health care provider after learning you had HIV?
Year: ___ ___ ___ ___ [Refused = .R, Don't know = .D]
127mm. In [insert year from 127yy], in what month did you first go to your health care provider after learning you had HIV?
Month: ___ ___ [Refused = .R, Don't know = .D]
A
Refer to date of first
positive HIV test (Auto16 or Auto17)
If auto19 - first positive HIV test >
3 months before first provider visit then ask the next questionQ128 If auto19 - first positive HIV test ≤ 3
months before first provider visit then skip to Q129 If
interval cannot be determined (date missing) then skip to Q129
128. Some people go to a health care provider soon after learning they are positive. What is the main reason you didn’t go to a health care provider soon after you learned of your HIV infection? [Choose only one reason.]
You felt good ……………..…........................................... 01
You didn't want to think about being HIV positive……… 02
You didn’t have money or insurance…..………….…….. 03
You couldn’t find a transgender-sensitive doctor………... 04
You couldn't find health care provider or didn’t know
where to go…………….…………..................................... 05
The doctor or clinic had inconvenient location or hours…. 06
You were too busy ……………………………………….. 07
You forgot to go or missed an appointment……………….. 08
You were on the street……………………………………. 09
You were unable to get an appointment……...................... 10
Other……………………..……………………………….. 11
Refused………………………………………………....... .R
Don’t know……………………..…………………............. .D
129yy. In what year did you last go to your health care provider for HIV care?
Year: ___ ___ ___ ___ [Refused = .R, Don't know = .D]
129mm. In [insert year from 129yy], in what month did you last go to your health care provider for HIV care?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO20. Date last went to health care provider for HIV care: 129mm/129yy
Calculate interval last went to health care provider or
AUTO20- AUTO2.
If interval ≤ 6 months since last
provider visit then skip to Q131 If interval > 6 months since last
provider visit then ask the next question (Q130) If interval cannot be
determined (date missing) then skip to Q131
1
30.
What is the main reason you have not gone to a health care provider
for HIV care in the
past 6 months? [Choose only one reason.]
You felt good …………………..…........................................ 01
Your CD4 count and viral load were good………………….. 02
You don't want to think about being HIV positive……..…..... 03
You didn’t have money or insurance…..………….………… 04
You couldn’t find a transgender-sensitive doctor…………… 05
You couldn't find health care provider or didn’t know
where to go…………….………….......................................... 06
The doctor or clinic has inconvenient location or hours…...... 07
You were too busy
You forgot to go or missed an appointment………………… 08
You have an appointment pending………..………………… 09
You were on the street………………………………………. 10
Other……………………..…………………………………. 11
Refused……………………………………………………… .R
Don’t know……………...……..…………………................ .D
131. Medicines to treat HIV and AIDS are also known as antiretroviral medicines, HAART, or the AIDS cocktail. Are you currently taking any of these medicines to treat your HIV infection?
If Q131=0 then skip to Q131b If Q131 is (.R, .D) then skip to Q132
Yes………………………………………..……. 1
Refused to answer…………………………….. .R
Don't know……………..………………........... .D
131a. Have you ever given your AIDS medicines to a sex partner who was HIV-negative because you thought it might protect them from getting HIV?
No………………….…………………..……… 0
If Q131a is (0, 1, .R, .D) then skip to Q132
Refused to answer…………………………….. .R
Don't know……………..………………........... .D
131b. What is the main reason you have never taken any antiretroviral medicines?
[Choose only one reason.]
You feel good...……..………………………………………… 01
Your CD4 count and viral load are good………....................... 02
Your doctor advised you to delay treatment…..…………........ 03
You don't want to think about being HIV positive…………… 04
You are worried about interfering with hormone treatment......... 05
You are worried about other side effects …..…….….................. 06
You don't have money or insurance……….…………....……… 07
You just recently started into medical care……………………. 08
Other……………………..…………………….......................... 09
Refused…………………………………………………………. .R
Don’t know……………………….………………...................... .D
132. As far as you know, when someone visits their doctor for a regular check-up or exam, is it routine practice for a doctor to ask someone to take a test for HIV, or do patients have to ask their doctor to perform this test?
Routine practice ………………………………. 1
Have to ask …………………………………… 2
Refused to answer………………………..…… .R
Don’t know.……………..……………………… .D
Interviewer Instructions: If interview day = 2, 4, 6, 8, 10,
12, 14, 16, 18, 20, 22, 24, 26, 28, or 30, then skip to Q134;
Otherwise, ask Q133
133. Listen to the following two statements and indicate which comes closer to your opinion:
HIV testing should be treated just like routine screening for other diseases, and should be included as part of regular check-ups and exams; or
HIV testing should be treated differently from routine screening for other diseases, and should require special procedures, such as written permission from the patient in order to perform the test?
A (routine screening) …………………………. 1
B (special procedures) ……………………....... 2
Refused to answer………………………..……. .R
Don’t know.……………..……………………… .D
134. Listen to the following two statements and indicate which comes closer to your opinion:
HIV testing should be treated differently from routine screening for other diseases, and should require special procedures, such as written permission from the patient in order to perform the test; or
HIV testing should be treated just like routine screening for other diseases, and should be included as part of regular check-ups and exams?
A (special procedures) ………………………….1
B (routine screening) ………………………….. 2
Refused to answer………………………..…….. .R
Don’t know.……………..……………………... .D
HEALTH CONDITIONS
SAY: The next questions are about hepatitis,
an infection of the liver.
135. Has a doctor, nurse or other health care provider ever told you that you had hepatitis?
No………………….…………………………… 0
If Q135 is (0, .R, .D) then skip to Q137
Refused to answer……………………………… .R
Don't know……………..……………................ .D
135a. What type or types of hepatitis have you had? [Check all that apply.]
If Q135a is (0, 1, 4, .R, .D) then skip to Q137
Hepatitis B………………….………….............. 1
Hepatitis C……………………………............... 2
Other……………..…………….………………. 3
(If Other: Specify__________________)
Refused to answer……………………………… .R
Don't know……………..……………................ .D
136. When were you told you had hepatitis C?
6 months ago or less.…………………………… 0
More than 6 months ago, but less than 1 year.…. 1
1 year ago or more……………………………… 2
Refused to answer…………………..………….. .R
Don't know……………..…………...………… .D
136a. Have you ever taken medicine to treat your hepatitis C infection?
No……………………..………………............... 0
If Q136a is (1, .R, .D) then skip to the box before Q138
Refused to answer…………………..………….. .R
Don't know……………..…………...………… .D
137. Now I'm going to ask you about getting tested for hepatitis C. Have you ever had a blood test to check for hepatitis C infection?
No……………………..………………............... 0
If Q137 is (0, .R, .D) then skip to the box before Q138
Refused to answer…………………..………….. .R
Don't know………..………………...………… .D
137a. When did you have your most recent hepatitis C test?
[Check only one.]
6 months ago or less.…………………..……….. 0
More than 6 months ago, but less than 1 year….. 1
1 year ago or more……………………………… 2
Refused to answer…………………..………….. .R
Don't know……………..…………...………… .D
If Q135a=1 AND (Q111=2 OR Q112=1) then ask Q138; Otherwise, if Q135a=1 AND (Q111 ≠ 2 and
Q112 ≠ 1) then ask Q139; Otherwise, if Q135a ≠ 1 then skip to
Q140
SAY: The next questions are about treatment for
Hepatitis B.
138. You said you tested positive for HIV. In the 6 months before your first positive HIV test, did you take any medicines to treat your hepatitis B infection?
If Q136a is (0, .R, .D) then skip to Q140
Refused to answer……………………………… .R
Don't know……………..……………................ .D
139. In the past 6 months, did you take any medicines to treat your hepatitis B infection?
No………………….…………………………… 0 Yes………………………….…………............... 1
Refused to answer……………………………… .R
Don't know……………..……………................ .D
140. There are vaccines or shots that can prevent some types of hepatitis.
Have you ever had a hepatitis vaccine?
No………………….…………………………… 0
If Q140 is (0, .R, .D) then skip to Q147
Refused to answer…………………..………….. .R
Don't know……..…………………...………… .D
140a. What type or types of hepatitis vaccine have you had?
[Check only one.]
Hepatitis A vaccine..……………………………. 1
Hepatitis B vaccine……………………………... 2
Hepatitis A and B vaccines………..…………… 3
Refused to answer..………………..…………… .R
Don't know………………..…………............... .D
141. Have you ever had a TB skin test?
No……………………..……………….............. 0
If Q141 is (0, .R, .D) skip to Q147
Refused to answer……………………………… .R
Don't know……………..……………............... .D
142. Have you ever had a positive TB skin test?
No……………………..……………….............. 0
Yes………………………..………….………… 1
Refused to answer……………………………… .R
Don't know……………..……………............... .D
143yy. In what year was your last skin test for TB?
Year: ___ ___ ___ ___ [Refused = .R, Don't know = .D]
143mm. In [insert year from 143yy], in what month was your last skin test for TB?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO21. Date last had a skin test for TB: 143mm/143yy
144. When you got tested for TB in [insert date from AUTO20], where did you get tested?
Doctor’s office 01
Hospital or medical center……...….………….. …. 02
HIV counseling and testing site……..……………… 03
Community public health clinic… 04
Needle exchange program.…...……..………….. …. 05
Mobile testing unit … 06
Correctional facility (jail or prison)……………. … 07
Drug treatment program………………..………. 08
At home…………..………………………………. 09
Other………..………………………….………… 10
Refused……………………………………….... .. .R
Don’t know…….....……..……………………........ .D
145. Has a doctor or nurse ever told you that you had TB the disease? By TB disease, we mean have you been sick with TB and not just had a positive skin test?
If Q145 is (0, .R, .D) skip to Q147
Yes………………………..………….………… 1
Refused to answer……………………………… .R
Don't know……………..……………............... .D
146yy. In what year were you diagnosed with TB disease?
Year: ___ ___ ___ ___ [Refused = .R, Don't know = .D]
146mm. In [insert year from 146yy], in what month were you diagnosed with TB disease?
Month: ___ ___ [Refused = .R, Don't know = .D]
AUTO22. Date diagnosed with TB: 146mm/146yy
Say: Next are questions about sexually transmitted
diseases or STDs. In the past 12 months, has a doctor, nurse, or
other health care provider told you that you had any of the
following STDs?
No Yes Refused Don’t
to answer Know
147a. Syphilis……………..……………………. 0 1 .R .D
147b. Gonorrhea (clap or drip)…………………. 0 1 .R .D
147c Chlamydia…………..…………………….. 0 1 .R .D
147d. Genital herpes (HSV) .…………………… 0 1 .R .D
147e. Genital warts (HPV)……………………… 0 1 .R .D
147f. Any Other STDs…..……………………… 0 1 .R .D
THE FOLLOWING QUESTION IS ASKED SEPARATELY FOR RESPONDENTS WHO
ANSWERED YES TO 144A-F.1.
147a.1 In the past 12 months, how many different times did you have
_________?
147f.1 INSERT EACH STD RESPONDENT SAID YES TO IN Q147A-F.1
[Refused
= .R, Don't know = .D] ___ ___ ___
IF Q147A=0, ASK Q148. OTHERWISE, SKIP TO Q149.
148. Even though a health care provider didn't tell you that you had syphilis, did you have a test to check for syphilis in the past 12 months?
No……………………..……………….............. 0
Yes………………………..………….………… 1
Refused to answer……………………………… .R
Don't know……………..……………............... .D
HIV TESTING IN JAIL
SAY: The next questions are about HIV testing
experiences you may have had with the criminal justice system.
Please remember your answers will be kept private.
1
If Q149 is (0, .R, .D) then skip to Say Box Q153
Yes………………………………….…………... 1
Refused to answer………………..…………….. .R
Don't know….……………………...…………… .D
149a. Think about the last time you were arrested and booked. How much time did you spend in detention, jail, or prison?
L
If Q149a is (1, .R, .D) then skip to Q150
24 hours or more……………………………….. 2
Refused………………………………………… .R
Don't know…………………………………….. .D
149b. How many days were you in detention, jail, or prison?
___ ___ ___ # of days
[Refused=.R, Don't know=.D]
150. The last time you were in detention, jail, or prison, did you get a test for HIV?
N
If Q150 is (0, .R, .D) then skip to Q151
Refused to answer…………………..………….. .R
Don't know…………….……………................. .D
150a. Did you get the results of that HIV test?
No………………….…………………………… 0
Yes………………………..………….…………. 1
Refused to answer…………………..………….. .R
Don't know……………..…………...…………. .D
151. The last time you were in detention, jail, or prison, did you get a test for hepatitis C?
N
If Q151 is (0, .R, .D) then skip to Say Box before Q153
Refused to answer…………………..………….. .R
Don't know…………….……………................. .D
151a. Did you get the results of that hepatitis C test?
No………………….…………………………… 0
Yes………………………..………….…………. 1
Refused to answer…………………..………….. .R
Don't know……………..…………...…………. .D
If Q47a is 1 then ask Q152. Otherwise, skip to Q153
152. You indicated that you are currently receiving hormone therapy under the supervision of a healthcare provider. Were you able to continue hormone therapy under the supervision of a healthcare provider the last time when you were in detention, jail, or prison?
No……………………..………………........................ 0 Yes………………………..………….…………......... 1
I was not receiving hormone therapy at the time…….. N
Refused to answer………………………………......... R
Don’t Know…………….…………….......................... .D
ASSESSMENT OF PREVENTION ACTIVITIES
Say:
Next
I'd like to ask you about HIV prevention activities in your area.
153. In the past 12 months, have you gotten any free condoms, not counting those given to you by a friend, relative, or sex partner?
If Q153 is (0, .R, .D) skip to Instructions before Q154
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
If Q153a is 2 then skip to Q153d If Q153a is .D or .R skip to Instructions
before Q154
153a. Did someone give you the condoms or did you pick them up?
Someone gave you condoms………..……………………………... 1
You picked condoms up…………………………………………… 2
Both (Someone gave you condoms AND
you picked condoms up)……… ………………………………….. 3
Refused to answer…………………………………………………. .R
Don’t Know……………..…………………………………………. .D
153b. Which type of organizations did the person or persons who gave you the condoms work for?
[Check all that apply.]
HIV/AIDS-focused community organization …………………… 1
Transgender organization ………………………………………. 2
Gay or Lesbian organization……………………………………… 3
Needle exchange program………………………..……………… 4
Community public health clinic…………………….…………… 5
Drug treatment program………………………………………….. 6
Other (Specify _________________________)……………….. 7
Refused to answer……………………………………………….. .R
Don’t Know……………..………………………………………. .D
If Q153b is 2 DK or REF and Q153a=3 then skip to Q153d
If Q153b is 2 DK or REF and Q153 ne 3 then
skip to Q153e
153c. Did any of the people who gave you free condoms work for a transgender program at those organizations?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
153d. When you picked-up the condoms, did you pick them up at any of the following places?
[Check all that apply.]
HIV/AIDS-focused community organization …………………. 1
Transgender organization ……………………………………… 2
Gay or Lesbian organization …………………………………… 3
Needle exchange program ……………………………………… 4
Community public health clinic………………………………… 5
Drug treatment program………………………………………… 6
Business (like a bar, retail store, etc.) ………………………….. 7
Pride or other similar event……………………………………… 8
Other (Specify ___________________________)...................... 9
Refused to answer……………………………………………….. .R
Don’t Know……………..………………………………………. .D
153e. Have you used any of the free condoms you received?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
If no IDU or hormone injection in the past 12 months (Auto
13<12m and Q50=0) skip to instructions before Q155
154. In the past 12 months, have you gotten any new sterile needles for free, not including those given to you by a friend, relative, or sex partner?
If Q154 is (0, .R, .D) then skip to Instructions before Q155
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
154a. Did you get the free sterile needles at any of the following places?
[Check all that apply.]
HIV/AIDS-focused community organization …………………. 1
Transgender organization ……………………………………… 2
Gay or Lesbian organization …………………………………… 3
If Q154a is 2, .R or .D then skip to Q154c
Community public health clinic………………………………… 5
Drug treatment program………………………………………… 6
Business (like a bar, retail store, etc.) ………………………….. 7
Pride or other similar event……………………………………… 8
Other (Specify ___________________________)...................... 9
Refused to answer……………………………………………….. .R
Don’t Know……………..………………………………………. .D
154b. Did you get sterile needles from a transgender program at those organizations?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
154c. Have you used any of the free sterile needles you received?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
155. In the past 12 months, have you gotten any new cookers or cottons for free, not including those given to you by a friend, relative, or sex partner?
If Q155 is (0, .R, .D) then skip to Q156
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
155a. Did you get those free items at any of the following places?
[Check all that apply.]
HIV/AIDS-focused community organization …………………. 1
Transgender organization ……………………………………… 2
If Q155a is 2, .R or .D then skip to Q155c
Needle exchange program ……………………………………… 4
Community public health clinic………………………………… 5
Drug treatment program………………………………………… 6
Business (like a bar, retail store, etc.) ………………………….. 7
Pride or other similar event……………………………………… 8
Other (Specify ___________________________)...................... 9
Refused to answer……………………………………………….. .R
Don’t Know……………..………………………………………. .D
155b. Did you get those free items from a transgender program at those organizations?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
155c. Have you used the free cookers or cottons that you received?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
156. Not counting the times when you had a conversation as part of an HIV test.In the past 12 months, have you had a one-on-one conversation with an outreach worker, counselor, or prevention program worker about ways to prevent HIV?
If Q156 is (0, .R, .D) then skip to Q157
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
156a. Which type of organization did they work for?
[Check all that apply.]
HIV/AIDS-focused community organization …………………… 1
If Q156a is (2, .R, .D) then skip to Q156c
Gay or Lesbian organization …………………………………….. 3
Needle exchange program ……………………………………….. 4
Community public health clinic………………………………….. 5
Drug treatment program………………………………………….. 6
Other (Specify: ___________________________....................... 7
Refused to answer……………………………………………….. .R
Don’t Know……………..……………………………………….. .D
156b. Was the one-on-one conversation(s) with someone from a transgender program at those organizations?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
156c. During those one-on-one conversation(s), did you:
No Yes Refused Don't
to answer Know
1. Discuss ways to talk to a partner about safe sex?....... 0 1 .R .D
If yes, ask:
1a. Practice ways to talk to a partner about safe sex?..... 0 1 .R .D
2. Discuss ways to effectively use condoms?…...…….. 0 1 .R .D
If yes, ask:
2a. Practice ways to effectively use condoms?............... 0 1 .R .D
[If IDU in past 12 months(Auto14<12m), ask:]
3. Discuss how to prepare for safe drug-injections?…... 0 1 .R .D
If yes, ask:
3a. Practice safe drug-injecting practices?……….....….. 0 1 .R .D
[If hormone injection in past 12 months (Auto9<12m), ask:]
4. Discuss how cleaning needles for hormone injections is different from
cleaning needles for injecting other drugs?………… 0 1 .R .D
If yes, ask:
4a. Practice cleaning needles for hormone injections?… 0 1 .R .D
[If silicone or other substance injections in past 12 months (Auto11<12m), ask:]
5. Discuss safety issues related to injecting silicone and similar substances?
0 1 .R .D
If any of Q156c.1-Q156c.5=1 then ask:
156d. How transgender-sensitive were these discussions?
Not sensitive at all……………….………….. 1
A little sensitive……………………..………. 2
Somewhat sensitive…………….…………… 3
Very sensitive……………………..………… 4 Refused……………….…............................... .R
Don’t Know………….……………………… .D
157. Not including discussions you may have had with a group of friends. In the past 12 months have you been a participant in any organized session(s) involving a small group of people to discuss ways to prevent HIV?
If Q157 is (0, .R, .D) then skip to Q158
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
157a. Which type of organization sponsored those sessions? [Check all that apply.]
HIV/AIDS-focused community organization …………………… 1
Transgender organization ……………………………………….. 2
Gay or Lesbian organization …………………………………….. 3
If Q157a is (2, .R, .D) then skip to Q157c
Community public health clinic………………………………….. 5
Drug treatment program………………………………………….. 6
Other (Specify: ___________________________....................... 7
Refused to answer……………………………………………….. .R
Don’t Know……………..……………………………………….. .D
157b. Were these sessions sponsored by a transgender program at those organizations?
No………………….……………………………………………… 0
Yes………………………..………….……………………………. 1
Refused to answer…………………..…........................................... .R
Don’t Know…………………………...………............................... .D
157c. During those organized group session(s), did you:
No Yes Refused Don't
to answer Know
1. Discuss ways to talk to a partner about safe sex?....... 0 1 .R .D
If yes, ask:
1a. Practice ways to talk to a partner about safe sex?..... 0 1 .R .D
2. Discuss ways to effectively use condoms?…...…….. 0 1 .R .D
If yes, ask:
2a. Practice ways to effectively use condoms?............... 0 1 .R .D
[If IDU in past 12 months(Auto14<12m), ask:]
3. Discuss how to prepare for safe drug-injections?…... 0 1 .R .D
If yes, ask:
3a. Practice safe drug-injecting practices?……….....….. 0 1 .R .D
[If hormone injection in past 12 months (Auto9<12m), ask:]
4. Discuss how cleaning needles for hormone injections is different from
cleaning needles for injecting other drugs?………… 0 1 .R .D
If yes, ask:
4a. Practice cleaning needles for hormone injections?… 0 1 .R .D
[If silicone or other substance injections in past 12 months (Auto11<12m), ask:]
5. Discuss safety issues related to injecting silicone and similar substances?
0 1 .R .D
If any of Q157c.1-Q157c.5=1 then ask:
157d. How transgender-sensitive were these discussions?
Not sensitive at all……………….………….. 1
A little sensitive……………………..………. 2
Somewhat sensitive…………….…………… 3
Very sensitive……………………..………… 4 Refused……………….…............................... .R
Don’t Know………….……………………… .D
Transgender Definition Evaluation
SAY: The
next question is about people who were born one gender, but who
identify or live as the opposite gender.
158. Which of the following terms have you used to describe your gender identity?
[Check all that apply.]
Transexual ……………….…………………………………………. 1
Transgender ………………………………………..………………. 2
Transwoman ……………………………………….. ……………… 3
Bigender or Third gender………………………………..…………. 4
Cross-dresser or transvestite……………………………………….. 5
Gender bender……………………………………..……………….. 6
Gender queer………………………………………….……………. 7
Gender variant…….………………………………………………… 8
Butch queen……………………………………………..………….. 9
Fem queen …………………….……..……..……..……..………… 10
Girl…………………….…………………………………………… 11
Female impersonator……………………………………………….. 12
Female or woman…………………………………………………… 13
Other (Specify: ________________________) …………………… 14
None of the above – Only used ‘Male’ or ‘Man’ to describe gender 15
Refused……………….…...............……..……..……..……………. .R
Don’t Know………….………………………….……..…………… .D
SAY: Thank you for taking the time to participate in
this survey. Please bring this computer to the researchers.
AUTO23. Time ACASI ended: __ __:__ __ AM PM
ACASI Evaluation
INTERVIEWER SAY: Thank you for taking the survey. I
want to ask you a few questions about the questionnaire to help us
improve it
INT8. What is the passcode? ___ ___ ___ ___ ___ ___
159. Were there any questions that were especially difficult to answer?
If 0 then skip to Q161
Yes………………………..………….…………. 1
Refused to answer…………………..…............... .R
Don’t Know…………………………...……….. .D
160. What are some of the reasons why they were difficult to answer?
___________________________________________________________
[Refused = .R, Don't know = .D]
161. Were there any questions that were especially offensive to you?
If 0 then skip toAuto24
Yes………………………..………….…………. 1
Refused to answer…………………..…............... .R
Don’t Know…………………………...………... .D
162. What are some of the reasons why you felt these were offensive?
___________________________________________________________
[Refused = .R, Don't know = .D]
INTERVIEWER NOTE: Please thank the respondent
AUTO24. Time core questionnaire ended: __ __:__ __ AM PM
| File Type | application/msword |
| File Title | Appendix A – Eligibility Questionnaire |
| Author | DHAP USER |
| Last Modified By | taj4 |
| File Modified | 2008-07-10 |
| File Created | 2008-06-17 |
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