PEMS Data Variables and Values for CBOs

HIV Prevention Program Evaluation and Monitoring System for Health Departments and Community-Based Organizations (PEMS)

Attachment C2. PEMS 3.0 Variables for CBOs

PEMS Data Collection for Community-Based Organizations (Training)

OMB: 0920-0696

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PEMS Data Variables and Values
Agency Level
Table: A

General Agency Information

This table is required to be completed by all directly funded grantees.
It is also required for all agencies that indirectly receive CDC funds for HIV prevention AND:
1. Provide HIV prevention services
And/or
2. Provide contracts (using CDC funds) to support the provision of HIV prevention services.
Reported to CDC
Num
A01

Variable Name

Mandatory

Agency Name

HD

CBO

Yes

Yes

Yes

Yes

Definition: The official legal name of the agency or organization.
Instructions: Enter the official name of your agency.
A01a

PEMS Agency ID
Definition: A system generated, numeric, unique identifier for a PEMS agency.
Instructions:

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Num

Variable Name

A02

Mandatory

Community Plan Jurisdiction

HD
Yes

CBO
Yes

Definition: The CDC-directly funded state/territory/city area or region where a state or local
health department receives cooperative agreements for HIV prevention funds to
monitor HIV prevention activities.
Instructions: Select the name of state, city or territory that identifies the jurisdiction in which yo
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina
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PEMS Data Variables and Values
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Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

78

VI

Virgin Islands of the U.S.

80

San Francisco, CA

San Francisco Health Department

81

Los Angeles, CA

Los Angeles Health Department

82

New York City, NY

New York City Health Department

83

Houston, TX

Houston Health Department

84

Chicago, IL

City of Chicago Health Department

85

Philadelphia, PA

City of Philadelphia Health Department

A03

Employer Identification Number (EIN)

HD

Yes

CBO

Yes

Definition: The federal tax identification number that is used to identify a business entity.
Instructions: Enter your agency’s Employer Identification Number (EIN). The EIN is also know

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PEMS Data Variables and Values
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Num
A04

Variable Name

Mandatory

Street Address 1

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: A part of the official mailing address that indicates the primary street and street
number location of the agency.
Instructions: Include the first part of the official mailing address that indicates the primary stree
A05

Street Address 2
Definition: A part of the official mailing address that indicates apartment or suite number, if
applicable, or other information needed to complete the official mailing address
of the agency.
Instructions: Use this second address space to include a suite number, room number, or other

A06

City
Definition: The city in which the official mailing address for the agency is physically located.
Instructions: Enter the name of the city where the agency you entered for variable A01: Agenc

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Num

Variable Name

A08

Mandatory

State

HD
Yes

CBO
Yes

Definition: The state, territory or district in which the official mailing address is physically
located. This must represent one of the 50 states, the District of Columbia, the
U.S. Virgin Islands, or Puerto Rico.
Instructions: Select the name of the state, territory or district where your agency is physically l
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina
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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

74

UM

U.S. Minor Outlying Islands

78

VI

Virgin Islands of the U.S.

A09

Zip Code

HD

CBO

Yes

Yes

Yes

Yes

Definition: The postal zip code for the agency.
Instructions: Enter your agency’s postal zip code.
Code

A10

Value Description

Value Definition

#####-####

Only the 5 digit zip code is mandatory.

Agency Website
Definition: The organization or agency's website address, also known as the universal
resource locator (URL).
Instructions: Enter your agency’s website address if you have one.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

A11

Mandatory

Agency DUNS Number

HD

CBO

Yes

Yes

Yes

Yes

Definition: The Data Universal Numbering System (DUNS) number is a unique nine-digit
identification number which uniquely identifies business entities. It is provided by
the commercial company Dun & Bradstreet.
Instructions: Enter your agency’s unique Data Universal Numbering System (DUNS) number.
A12

Agency Type
Definition: The term(s) used to describe or characterize the type of agencies involved in HIV
prevention activities. This variable is not used to describe the site or setting of
HIV prevention services.
Instructions: Indicate the type of agency that best describes your agency. Remember that this

Code

Value Description

Value Definition

01

State Health Department

A health department and/or health department facility responsible for
providing and/or supporting the provision of direct client services in a
state, district or territorial jurisdiction.

02

Local Health Department

A health department and/or health department facility responsible for
providing and/or supporting the provision of direct client services in a
county or city.

03

Other Public Agency

Other offices or organizations that are supported by public funds and
serve the community at large such as correctional institutions, mental
health facilities, etc.

04

Community Based Organization (CBO)

An agency that has a valid Internal Revenue Service (IRS) 501(c)(3)
tax-exempt status (or state proof of incorporation as a non-profit
organization), and is typically located in the area(s) where the
agency's services are provided.

05

Academic/Research Institution

An organization chartered for educational purposes and providing
college credit or awarding degrees or dedicated to conducting
research in a specific area (e.g. health and human services) with the
aim of advancing knowledge and understanding in this area.

88

Other (specify)

A13

Faith-based

Yes

Yes

Definition: A faith-based agency is a non-governmental agency owned by religiously
affiliated entities such as (1) individual churches, mosques, synagogues,
temples, or other places of worship; or (2) a network or coalition of churches,
mosques, synagogues, temples, or other places of worship.
Instructions: Indicate whether or not your agency is a faith-based agency.
Code

Value Description

Value Definition

0

No

The agency is not a faith-based agency.

1

Yes

The agency is a faith-based agency.

NA

N/A

This information is not applicable to the agency.

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Reported to CDC
Num

Variable Name

A14

Mandatory

Race/Ethnicity Minority Focused

HD

CBO

Yes

Yes

Definition: A non-governmental agency serving a clientele that is composed of 85% or more
of racial/ethnic minority populations.
Instructions: Indicate whether or not your non-governmental agency serves a clientele that is c
Code

Value Description

Value Definition

0

No

The agency does not serve a clientele that is composed of 85% or
more of racial/ethnic minority populations.

1

Yes

The agency does serve a clientele that is composed of 85% or more
of racial/ethnic minority populations.

NA

N/A

This information is not applicable to the agency.

A15

Annual Agency HIV Prevention Budget

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The part of the agency's budget that includes all funds used to conduct
community planning, HIV prevention services, as well as evaluation and capacity
building done in the context of HIV prevention. It also includes STD prevention
specifically to enhance HIV prevention efforts and reduce HIV transmission (as
approved by CDC). The annual budget period is based on the agency's fiscal
year.
Instructions: Enter your agency’s annual HIV Prevention Budget, including all funds used to co
A16

Fiscal Year Start Date
Definition: The beginning of the agency's fiscal year (month/year) which the Annual Agency
HIV Prevention Budget (A15) describes.
Instructions: Enter the beginning of your agency's fiscal year (month/year) for the Annual Agen

A17

Fiscal Year End Date
Definition: The end of the agency's fiscal year (month/year) which the Annual Agency HIV
Prevention Budget (A15) describes.
Instructions: Enter the end of your agency's fiscal year (month/year) for the Annual Agency HI

A18

Directly Funded Agency
Definition: An agency that receives HIV prevention funding directly from the CDC through
an HIV prevention cooperative agreement for a specified reporting period (e.g.,
PA04064 or PA04012).
Instructions: Indicate whether or not your agency receives HIV prevention funding directly from

Code

Value Description

0

No

1

Yes

Value Definition

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

A19

Mandatory

Sources of HIV Prevention Funds

HD

CBO

Yes

Yes

Definition: The source(s) of funding that the agency receives for HIV prevention. The
agency should have a cooperative agreement or contract with the source(s), and
should be able to identify one or multiple sources of funding for all HIV
prevention.
Instructions: Indicate the source(s) of funding that your agency receives for HIV prevention. Ea
Code

Value Description

Value Definition

01.01

Federal-Centers for Disease Control and Prevention (CDC)- Division
of HIV/AIDS Prevention

01.02

Federal-Centers for Disease Control and Prevention (CDC)- Division
of Sexually Transmitted Diseases

01.03

Federal-Centers for Disease Control and Prevention (CDC)- Division
of Adolescent and School Health

01.04

Federal-Health Resources and Services Administration (HRSA)

01.05

Federal-Substance Abuse and Mental Health Services Administration
(SAMHSA)

01.06

Federal-Office of Population Affairs

01.07

Federal-Department of Justice

01.08

Federal-Other (specify)

02.00

State

Funding is provided by an agency of State or territorial government in
which the agency is located.

03.00

Local Government

Funding is provided by an agency of city or county government in
which the agency is located.

03.01

Local Government-Local Source (specify)

03.02

Local Government- Local Source 2 (specify)

04.00

Private Sources

Funding provided by an organization or institution that is not under
federal or public supervision or control.

04.01

Private Sources-Foundations

Funding is provided by an organization or institution whose income is
supported by an endowment or trust fund.

04.02

Private Sources- Donations

Funding is provided through voluntary gifts or contributions of money
given in support of the organization or institution or its activities.

04.03

Private Sources- Companies

Funding is provided by an organization or institution created to
conduct a particular business.

05.00

Agency Generated Sources

Funding is provided by revenue or earnings produced by the
organization or institution or services or products produced.

05.01

Agency Generated Sources-Fees for Service

Funding is generated by a fixed charge for a particular service
provided by the organization or institution.

05.02

Agency Generated Sources-Fundraisers

Funding is generated through an agency-sponsored event that is held
for the purpose of raising money for that agency.

88

Other (specify)

Funding is provided by sources that do not fit into one of the specified
categories listed above.

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Num
A20

Variable Name

Mandatory

Percent Funds from Federal Sources

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The estimated percent of the agency's annual budget for HIV prevention that was
awarded directly by a federal source to the agency, including CDC and non-CDC
federal sources. This does not include federal funds that are awarded indirectly
to the agency (e.g., a CBO who receives CDC funds through a directly funded
CBO or state health department using CDC prevention). An example of an
indirectly funded agency is a CBO who is funded by the state health department
using CDC prevention funds awarded to the state.
Instructions: Enter the estimated percent of your agency’s annual budget for HIV prevention th
A21

Agency Contact Last Name
Definition: The legal last name of the agency's primary contact (e.g., CBO Executive
Director, CBO Director for HIV Prevention, Health Department AIDS Director or
Director of HIV Prevention).
Instructions: Enter the legal last name of the primary contact person for your agency. Be sure

A22

Agency Contact First Name
Definition: The legal first name of the agency's primary contact (e.g., CBO Executive
Director, CBO Director for HIV Prevention, Health Department AIDS Director or
Director of HIV Prevention).
Instructions: Enter the legal first name of the primary contact person you listed in variable A21.

A23

Agency Contact Title
Definition: The official title of the agency's primary contact person (e.g., CBO Executive
Director, CBO Director for HIV Prevention, Health Department AIDS Director or
Director of HIV Prevention).
Instructions: Enter the official title of your agency's primary contact person noted in variables A

A24

Agency Contact Phone
Definition: The telephone area code and number for the agency's primary contact specified
in A21: Agency Contact Last Name and A22: Agency Contact First Name.
Instructions: Enter the main phone number for your agency.

A25

Agency Contact Fax
Definition: The fax area code and number for the agency's primary contact specified in A21:
Agency Contact Last Name and A22: Agency Contact First Name.
Instructions: Enter the main fax number for your agency.

A26

Agency Contact Email
Definition: The email address for the agency's primary contact specified in A21: Agency
Contact Last Name and A22: Agency Contact First Name.
Instructions: Enter the primary email address for your agency.

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Reported to CDC
Num

Variable Name

Table: B

Mandatory

HD

CBO

CDC Program Announcement Award Information

This table is required to be completed by all directly funded grantees (A18 "Directly Funded Agency" = "Yes").
An agency can be directly funded under multiple CDC program announcements. Table B must be completed for each award.
Reported to CDC
Num
B01

Variable Name

Mandatory

CDC HIV Prevention PA Number

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The five-digit Program Announcement (PA) number issued by CDC for EACH
program announcement through which funds were awarded to your agency.
Instructions: Select the five-digit program announcement number issued by CDC for EACH pro
B02

CDC HIV Prevention PA Budget Start Date
Definition: The beginning month and year of a specific CDC Program Announcement
Annual Award period.
Instructions: Specify the beginning month and year of a specific CDC Program Announcement’

B03

CDC HIV Prevention PA Budget End Date
Definition: The end month and year of a specific CDC Program Announcement Annual
Award period.
Instructions: Specify the end month and year of a specific CDC Program Announcement’s AN

B04

CDC HIV Prevention PA Award Number
Definition: A six-digit number that is given to each award granted through a specific CDC
program announcement. This number uniquely identifies each grantee given an
award from a specific program announcement.
Instructions: Enter your unique six-digit number for the award granted through the specific CD

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

B05

Mandatory

Funded CBO HIV Prevention Activity

HD

CBO

No

Yes

Definition: The funding category in the Program Announcement under which a directly
funded CBO receives an award.
Instructions: Specify the funding category under which you received an award. This variable is
Code

Value Description

Value Definition

01

Targeted Outreach + HERR for HR Individuals

The funding category in PA 04064 whose activities include targeted
outreach, HE/RR interventions delivered to individuals and/or small
groups and referral to HIV CTR for individuals at high risk for HIV
infection and transmission.

02

Targeted Outreach + CT for HR Individuals

The funding category in PA 04064 whose activities include targeted
outreach, the provision of HIV CT and post-test counseling and
referral for individuals at high risk for HIV infection and transmission.

03

Prevention for HIV+ and partners

The funding category in PA 04064 whose activities include the
provision of prevention interventions to individuals living with HIV, and
their sex and injection drug-sharing partners.

04

Prevention for persons at very high risk for HIV infection

The funding category in PA 04064 whose activities include the
provision of prevention interventions to seronegative individuals at
very high risk for HIV infection.

05

Prevention - PCRS

The funding category in PA 04064 whose activities include the
elicitation, notification and referral to HIV CTR for those sex and
injection drug-sharing partners of a person who has tested positive
for HIV.

NA

N/A

The variable is not applicable because the agency is not a directly
funded CBO receiving funding under Program Announcement 04064.

B06

Total CDC HIV Prevention Award Amount

Yes

Yes

Yes

Yes

Definition: The total amount of the CDC HIV Prevention award that corresponds to the time
frame provided in B02: CDC HIV Prevention PA Start Date and B03: CDC HIV
Prevention PA End Date.
Instructions: The total annual award amount for the CDC HIV Prevention PA award number no
B06a

Annual CDC HIV Prevention Award Amount Expended
Definition: The total amount of this CDC HIV Prevention award that was expended during
the time frame provided in B02: CDC HIV Prevention PA Start Date and B03:
CDC HIV Prevention PA End Date.
Instructions: At the end of the CDC PA budget period, indicate the total amount of this CDC HI

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PEMS Data Variables and Values
Reported to CDC
Num
B07

Variable Name

Mandatory

Amount Allocated For Community Planning

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: For a specific CDC HIV prevention award, this value represents the costs
associated with conducting the community planning process (e.g., leadership,
coordination, staff support, travel, meeting costs, reproductions, and reimbursed
costs). This should also include costs associated with conducting planning tasks
such as developing an epidemiologic profile, conducting needs assessments,
setting priorities, developing a comprehensive prevention plan, and enhancing
membership recruitment. These activities may be conducted by agency staff or
community planning group members, or these activities may be contracted to an
outside source.
Instructions: At the end of the CDC PA budget period, indicate the amount your agency allocat
B08

Amount Allocated for Prevention Services
Definition: For a specific CDC HIV prevention award, this value represents the costs
associated with the implementation of HIV prevention activities such as
Counseling, Testing, and Referral (CTR); HIV Partner Counseling and Referral
Services (PCRS); laboratory support for HIV CT and PCRS; prevention for HIVinfected persons, Health Education and Risk Reduction (HE/RR); Health
Communication and Public Information (HC/PI); prevention of perinatal
transmission; and the quality assurance, collaboration and coordination costs
associated with these activities.
Instructions: At the end of the CDC PA budget period, indicate the amount your agency allocat

B09

Amount Allocated for Evaluation
Definition: For a specific CDC HIV prevention award, this value represents the costs
associated with conducting evaluation of prevention programs and prevention
community planning. These efforts may be studies conducted by agency staff or
contracted to an outside provider. This value should include cost for staffing and
administering evaluation projects and materials and data processing costs.
Note: Routine quality assurance and program monitoring costs should NOT be
included here. Please include these under allocations for Prevention Services.
Instructions: At the end of the CDC PA budget period, indicate the amount your agency allocat

B10

Amount Allocated for Capacity Building
Definition: For a specific CDC HIV prevention award, this value represents the costs
specifically associated with infrastructure development for health departments
and community-based organizations (CBOs) and for building the capacity of the
agency and its prevention partners to conduct more effective prevention
programs, including capacity building training for evaluation and community
planning. These activities may be conducted by agency staff or contracted to an
outside source. These costs should include staff time, materials, and meeting
costs, as well as quality assurance, collaboration and coordination costs
associated with these activities.
Instructions: At the end of the CDC PA budget period, indicate the amount your agency allocat

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Reported to CDC
Num

Variable Name

B11

Mandatory

Amount Allocated for STD Prevention and Treatment

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: For a specific CDC HIV prevention award, this value represents the costs
associated with augmenting STD detection and treatment services to enhance
HIV prevention efforts and reduce HIV transmission (as approved by CDC).
These costs should include costs associated with STD laboratory support, quality
assurance, and collaboration and coordination related to these activities.
Instructions: At the end of the CDC PA budget period, indicate the amount your agency allocat
B12

Amount Allocated for Other
Definition: For a specific CDC HIV prevention award, this value represents the amount of
the total award used for other activities that are not described in B07-B13. Do not
include amounts used to support general operations or administrative activities.
Instructions: At the end of the CDC PA budget period, indicate the amount your agency expen

B13

Amount Allocated for Indirect Costs
Definition: For a specific CDC HIV Prevention award, this value represents the amount of
that award used to support an agency's general operations or administrative
activities. These costs are not directly attributable to a specific program but are
necessary for the support of that program and the operations of the organization.
Instructions: At the end of the CDC PA budget period, indicate the amount your agency allocat

Table: C

Contractor Information

An agency can award many contracts. An agency providing funding using CDC HIV prevention dollars is required to complete this table for
each contractor.
Reported to CDC
Num
C01

Variable Name

Mandatory

Agency Name

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The official legal name of the contractor.
Instructions: Enter the official legal name of the contractor.
C02

Street Address 1
Definition: A part of the official mailing address that indicates the primary street and street
number location of the contractor.
Instructions: Enter the official mailing address that indicates the primary street and street num

C03

Street Address 2
Definition: A part of the official mailing address that indicates apartment or suite number if
applicable, or other information needed to complete the official mailing address
of the contractor.
Instructions: Use this second address variable for additional information such as a suite numb

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PEMS Data Variables and Values
Reported to CDC
Num
C04

Variable Name

Mandatory

City

HD
Yes

CBO
Yes

Definition: The city in which the official mailing address for the contractor is physically
located.
Instructions: Enter the city in which the contractor you entered for variable C01: Agency Name

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

C06

Mandatory

State

HD
Yes

CBO
Yes

Definition: The state, territory or district in which the official mailing address for the
contractor is physically located. This must represent one of the 50 states, the
District of Columbia, the U.S. Virgin Islands, or Puerto Rico.
Instructions: Select the name of the state, territory or district in which the agency named in C0
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina
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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

74

UM

U.S. Minor Outlying Islands

78

VI

Virgin Islands of the U.S.

C07

Zip Code

HD

CBO

Yes

Yes

Yes

Yes

Definition: The postal zip code of the contractor.
Instructions: Enter the postal zip code for the agency named in C01: Agency Name.
Code

C08

Value Description

Value Definition

#####-####

Only the 5 digit zip code is mandatory.

Phone Number
Definition: The telephone area code and number for the contractor's primary contact
specified in C11: Contact First Name and C12: Contact Last Name.
Instructions: Enter the primary telephone area code and number for the contractor named in C

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Num
C09

Variable Name

Mandatory

Fax Number

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The fax area code and number for the contractor's primary contact specified in
C11: Contact First Name and C12: Contact Last Name.
Instructions: Enter the primary fax area code and number for the contractor named in C01: Ag
C10

Email Address
Definition: The email address for the contractor's primary contact specified in C11: Contact
First Name and C12: Contact Last Name.
Instructions: Enter the primary email address for the contractor named in C01: Agency Name.

C11

Contact First Name
Definition: The legal first name of contractor's primary contact (e.g., CBO Executive
Director, CBO Director for HIV Prevention, Health Department AIDS Director or
Director of HIV Prevention).
Instructions: Enter the legal first name of the primary contact for the contractor named in C01:

C12

Contact Last Name
Definition: The legal last name of the contractor's primary contact (e.g., CBO Executive
Director, CBO Director for HIV Prevention, Health Department AIDS Director or
Director of HIV Prevention).
Instructions: Enter the legal last name for the primary contact of the contractor named in C01:

C13

Employer Identification Number (EIN)
Definition: The federal tax identification number that is used to identify a business entity.
Instructions: Enter the Employer Identification Number (EIN) for the agency named in C01: Ag

C14

DUNS Number
Definition: The Data Universal Numbering System (DUNS) number is a unique nine-digit
identification number which uniquely identifies business entities. It is provided by
the commercial company Dun & Bradstreet.
Instructions: Enter the unique Data Universal Numbering System (DUNS) number for the agen

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Reported to CDC
Num

Variable Name

C15

Mandatory

Agency Type

HD
Yes

CBO
Yes

Definition: The term(s) used to describe or characterize the type of organizations involved in
HIV prevention activities. This variable is not used to describe the site or setting
of HIV prevention services.
Instructions: If your agency is directly funded by CDC, indicate the type of organization that be
Code

Value Description

Value Definition

02

Local Health Department

A Local Health Department includes county or city health
departments and/or their associated facilities.

03

Other Public Agency

Other offices or organizations that are supported by public funds and
serve the community at large such as correctional institutions, mental
health facilities, etc.

04

Community Based Organization (CBO)

An agency that has a valid Internal Revenue Service (IRS) 501(c)(3)
tax-exempt status (or state proof of incorporation as a non-profit
organization), and is typically located in the area(s) where the
agency's services are provided.

05

Academic/Research Institution

An organization chartered for educational purposes and providing
college credit or awarding degrees or dedicated to conducting
research in a specific area (e.g. health and human services) with the
aim of advancing knowledge and understanding in this area.

88

Other

C16

Agency Activities

Yes

Yes

Definition: The type(s) of HIV prevention activities the contractor is funded to provide.
Instructions: Indicate the types of HIV prevention activities that the contractor named in C01: A
Code

Value Description

Value Definition

01

Provision of HIV Prevention Services

HIV prevention services are activities designed to reduce the risk of
HIV infection or transmission to others. These activities include
Counseling, Testing, and Referral (CTR), HIV Partner Counseling
and Referral Services (PCRS), laboratory support for HIV CT and
PCRS, prevention for HIV-infected persons, Health Education and
Risk Reduction (HE/RR) and Health Communication and Public
Information (HC/PI).

02

Capacity Building

Activities that strengthen the core competencies of an organization
and contribute to its ability to develop and implement an effective HIV
prevention intervention and sustain the infrastructure and resource
base necessary to support and maintain the intervention.

03

Community Planning Support

Activities involved in conducting the community planning process
(e.g., leadership, coordination, staff support, travel, meeting costs,
reproductions, and reimbursed costs). This should also include
activities associated with conducting planning tasks such as
developing an epidemiologic profile, conducting needs assessments,
setting priorities, developing a comprehensive prevention plan, and
enhancing membership recruitment.

04

Evaluation

Activities associated with conducting monitoring or evaluation of HIV
prevention programs and HIV prevention community planning.

05

Master Contractor

An agency that does not provide HIV prevention services but uses
CDC funds to award additional contracts to other agencies to provide
HIV prevention services.

88

Other

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Reported to CDC
Num

Variable Name

C17

Mandatory

Faith-based

HD

CBO

Yes

Yes

Definition: A faith-based agency is a non-governmental agency owned by religiously
affiliated entities such as (1) individual churches, mosques, synagogues,
temples, or other places of worship; or (2) a network or coalition of churches,
mosques, synagogues, temples, or other places of worship.
Instructions: Indicate whether or not the contractor is a faith-based agency.
Code

Value Description

Value Definition

0

No

The contract agency is not a faith-based agency.

1

Yes

The contract agency is a faith-based agency.

NA

N/A

This information is not applicable to the contract agency.

C18

Race/Ethnicity Minority Focused

Yes

Yes

Definition: A non-governmental agency serving a clientele that is composed of 85% or more
of racial/ethnic minority populations.
Instructions: Indicate whether or not the contract is non-governmental agency that serves a cli
Code

Value Description

Value Definition

0

No

The contract agency does not serve a clientele that is composed of
85% or more of racial/ethnic minority populations.

1

Yes

The contract agency does serve a clientele that is composed of 85%
or more of racial/ethnic minority populations.

NA

N/A

This information is not applicable to the contract agency.

C19

Contract Start Date-Month

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The calendar month that the contract begins or takes effect.
Instructions: Enter the calendar month that the contract begins or takes effect. Be sure to refe
C20

Contract Start Date-Year
Definition: The calendar year that the contract begins or takes effect.
Instructions: Enter the calendar year the contract begins or takes effect. Be sure to refer to th

C21

Contract End Date- Month
Definition: The calendar month that the contract ends.
Instructions: Enter the calendar month that the contract is scheduled to end. Be sure to refer t

C22

Contract End Date- Year
Definition: The calendar year in which the contract ends. For annual reporting, the total
contract period should not exceed one year (12 month time period).
Instructions: Enter the calendar year in which the contract is scheduled to end. Be sure to refe

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

C23

Mandatory

Total Contract Amount Awarded

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Definition: The total dollar amount awarded to the contractor from the funding agency. This
award applies to the annual budget period (C19: Contract Start Date-Month C22: Contract End Date - Year) and includes funds from all sources.
Instructions: Enter the total dollar amount awarded to the contractor named in C01: Agency Na
C24

Percent of Contract from CDC Funds
Definition: The percent of the total annual contract amount awarded that came from a CDC
program award.
Instructions: If your agency is directly funded by CDC, enter the percent of the total contract a

C25

CDC HIV Prevention Program Announcement Number
Definition: The CDC HIV Prevention Program Announcement Number through which this
contractor is being funded.
Instructions: If your agency is directly funded by CDC, enter your CDC HIV prevention program

C26

CDC HIV Prevention PA Budget Start Date
Definition: The beginning of the CDC Program Announcement Annual Award Period through
which this contractor is being funded.
Instructions: If your agency is directly funded by CDC, enter the beginning of the CDC Progra

C27

CDC HIV Prevention PA Budget End Date
Definition: The end of the CDC Program Announcement Annual Award Period through
which this contractor is being funded.
Instructions: If your agency is directly funded by CDC, enter the end of the CDC Program Anno

C28

Method of Selection
Definition: The procedures or steps followed in selecting how funds are awarded to the
contractor.
Instructions: If your agency is directly funded by CDC, indicate the method by which awards to

Code

Value Description

Value Definition

1

Competitive Process

Selection of a contractor is based on the best response to a formal
proposal for services.

2

Sole Source

Selection of a contractor is based on the unique ability of a particular
contractor to provide a given service.

88

Other

Selection of the contractor was based on some other type of criteria
or locally-defined standard/measures.

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Num
C29

Variable Name

Mandatory

Target Population

HD

CBO

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Definition: The primary population(s) that the contractor will serve.
Instructions: If your agency is directly funded by CDC, indicate the primary target population(s)
C30

Itemized Budget-Personnel
Definition: The amount of the contract budgeted for personnel costs such as salary and
fringe benefits.
Instructions: If your agency is directly funded by CDC, indicate the contract budget amount to

C31

Itemized Budget-Travel
Definition: The amount of the contract budgeted for in-state and out-of-state travel costs
such as mileage reimbursement, airfare, and lodging.
Instructions: If your agency is directly funded by CDC, indicate the contract budget amount to

C32

Itemized Budget-Equipment
Definition: The amount of the contract budgeted for equipment.
Instructions: If your agency is directly funded by CDC, indicate the contract budget amount to

C33

Itemized Budget-Supplies
Definition: The amount of the contract budgeted for supplies, such as general office
supplies, educational material or word processing software.
Instructions: If your agency is directly funded by CDC, indicate the contract amount to be used

C34

Itemized Budget-Contractual
Definition: The amount of the contract budgeted for a subcontracted entity to perform
activities that may be either the same as or directly related to the scope of work
of the project.
Instructions: If your agency is directly funded by CDC, indicate the contract budget amount to

C35

Itemized Budget-Other
Definition: The amount of the contract that is budgeted for other expenses such as postage,
telephone and printing.
Instructions: If your agency is directly funded by CDC, indicate the contract budget amount to

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

C36

Mandatory

Itemized Budget-Indirect Costs

HD

CBO

No

Yes

Definition: The amount of the contract that is budgeted for overhead and/or general
administrative costs. This does not include any of the costs associated with the
other itemized budget categories C31: Itemized Budget: Personnel - C26:
Itemized Budget - Other.
Instructions: If your agency is directly funded by CDC, indicate the contract budget amount to

Table: N

Network Agency

Complete this table for each agency belonging to a referral network or coalition of service providers. Use of this table will facilitate the
tracking and verification of client referrals to services outside the agency.
Reported to CDC
Num
N01

Variable Name

Mandatory

Agency Name

HD

CBO

No

Yes

No

Yes

No

Yes

Definition: The official legal name of the network agency or organization.
Instructions: Enter the official name of the agency in your referral network. Remember to verif
N02

Street Address 1
Definition: A part of the official mailing address that indicates the primary street and street
number location of the network agency or organization.
Instructions: Include the first part of the official mailing address that indicates the primary stree

N04

City
Definition: The city in which the official mailing address for network agency is physically
located.
Instructions: Enter the name of the city where the network agency you entered for variable N01

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Reported to CDC
Num

Variable Name

N06

Mandatory

State

HD

CBO

No

Yes

Definition: The state, territory or district in which the official mailing address of the network
agency is physically located. This must represent one of the 50 states, the
District of Columbia, the U.S. Virgin Islands, or Puerto Rico.
Instructions: Select the name of the state, territory, or district where the network agency or org
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina
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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

74

UM

U.S. Minor Outlying Islands

78

VI

Virgin Islands of the U.S.

N07

Zip Code

HD

CBO

No

Yes

No

Yes

Definition: The postal zip code for the network agency.
Instructions: Enter the postal zip code for the network agency.
Code

N08

Value Description

Value Definition

#####-####

Only the 5 digit zip code is required for entry.

Phone Number
Definition: The telephone area code and number for the network agency's primary contact
specified in N11: Contact First Name and N12: Contact Last Name.
Instructions: Enter the primary telephone area code and number for the network agency's prim

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

N15

Mandatory

Agency Type

HD

CBO

No

Yes

Definition: The term(s) used to describe or characterize the type of organizations involved in
HIV prevention activities. This variable is not used to describe the site or setting
of HIV prevention services.
Instructions: Indicate the type of organization that best describes the network agency named in
Code

Value Description

Value Definition

01

State Health Department

A health department and/or health department facility responsible for
providing and/or supporting the provision of direct client services in a
state or territorial jurisdiction.

02

Local Health Department

A health department and/or health department facility responsible for
providing and/or supporting the provision of direct client services in a
county or city.

03

Other Public Agency

Other offices or organizations that are supported by public funds and
serve the community at large such as correctional institutions, mental
health facilities, etc.

04

Community Based Organization (CBO)

An agency that has a valid Internal Revenue Service (IRS) 501(c)(3)
tax-exempt status (or state proof of incorporation as a non-profit
organization), and is typically located in the area(s) where the
agency's services are provided.

05

Academic/Research Institution

An organization chartered for educational purposes and providing
college credit or awarding degrees or dedicated to conducting
research in a specific area (e.g. health and human services) with the
aim of advancing knowledge and understanding in this area.

88

Other (specify)

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

N17

Mandatory

Service Type

HD

CBO

No

Yes

Definition: The primary service(s) provided by the network agency.
Instructions: Indicate which types of service(s) this agency provides. These are likely the servic
Code

Value Description

Value Definition

01

HIV testing

A diagnostic, laboratory procedure to assess for the presence of HIV
antibodies.

02

HIV confirmatory test

An HIV test designed to confirm the results of a preliminary positive
screening test.

03

HIV prevention counseling

An interactive risk-reduction counseling model usually conducted with
HIV testing, in which the counselor helps the client identify and
acknowledge personal HIV risk behaviors and commit to a single,
achievable behavior change step that could reduce the client's HIV
risk.

04

STD screening and treatment

Provision of testing to determine infection with a sexually transmitted
disease other than HIV or Viral Hepatitis and treatment if infected.

05

Viral Hepatitis screening and treatment

Provision of testing to determine infection with viral hepatitis (A, B,
and C) and treatment if positive or vaccination if negative.

06

Tuberculosis testing

Testing for tuberculosis (TB), prophylactic TB treatment, and clinical
evaluation for active TB disease.

07

Syringe exchange services

Services that provide clean syringes in exchange for used syringes.

08

Reproductive health services

Health care services for female clients who are pregnant or of childbearing age.

09

Prenatal care

Health care services for female clients before and during pregnancy
to monitor the health of the pregnant mother and fetus.

10

HIV medical care/evaluation/treatment

Medical services that address HIV infection including evaluation of
immune system function and screening, treatment, and prevention of
opportunistic infection.

11

IDU risk reduction services

Services that promote practices that reduce the health risks of
injection drug use (i.e., using sterile needles, never sharing needles,
disinfecting needles, disposing of needles).

12

Substance abuse services

Services for the treatment and prevention of drug or alcohol use.

13

General medical care

Professional treatment for illness, injury or routine health care
services (non-HIV related).

14

Partner counseling and referral services

A range of services available to HIV-infected persons, their partners
and affected communities that involves informing current and past
partners that a person who is HIV-infected has identified them as a
sex or injection-drug-paraphernalia-sharing partner and advising
them to have HIV counseling and testing. Notified partners, who may
not have suspected their risk, can then choose whether to be tested
for HIV, enabling those who test HIV positive to receive early medical
evaluation, treatment, and prevention services, including riskreduction counseling.

15

Mental health services

Services to assist with mental illness, developmental disabilities or
difficulty coping with HIV diagnosis or HIV-related conditions.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

HD

CBO

16

Comprehensive Risk Counseling Services

A client-centered HIV prevention counseling activity with the
fundamental goal of promoting the adoption and maintenance of HIV
risk-reduction behaviors by clients with multiple, complex problems
and risk-reduction needs. CRCS provides intensive, on-going,
individualized prevention counseling, support, and service brokerage.
This HIV prevention activity addresses the relationship between HIV
risk and other issues such as substance abuse, STD treatment,
mental health, and social and cultural factors.

17

Other HIV prevention services

Service to address additional prevention service or treatment needs
such as health education, individual counseling, and community level
interventions (e.g., workshops, health fairs).

18

Other support services

Assistance with housing, food, employment, transportation, child
care, domestic violence, support groups and legal services.

19

Case management

A range of client-centered services that links clients with primary
medical care, psychosocial and other services to insure timely,
coordinated access to medically-appropriate levels of health and
support services, continuity of care, ongoing assessment of the
client’s and other family members’ needs and personal support
systems, and inpatient case-management services that prevent
unnecessary hospitalization or that expedite discharge, as medically
appropriate, from inpatient facilities. This refers to services such as
those provided under the Ryan White CARE Act and is different from
Comprehensive Risk Counseling Services (CRCS).

88

Other

Table: P

Worker

An agency should complete this table for each paid staff or volunteer who provides HIV prevention services to clients.
Reported to CDC
Num
P01

Variable Name

Mandatory

Worker ID

HD

CBO

No

Yes

Definition: A system generated code used to distinguish between persons who are
delivering services to clients within the same agency. It is made up of a
combination of non-identifying characteristics.
Instructions: The system will generate the Worker ID variable once you enter the worker in Tab

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Reported to CDC
Num

Variable Name

P06

Mandatory

Worker Type

HD

CBO

No

Yes

Definition: The role or type of work done by the worker.
Instructions: Choose ALL the categories that describe the role of the worker (e.g., counselor, e
Code

Value Description

Value Definition

01

Counselor

A person who provides client-centered information and assistance to
help individuals reduce their risk(s) for HIV infection and
transmission. Activities may include the provision of risk reduction
messages that are tailored to the specific behaviors, circumstances,
and special needs of the person being served, assisting the client in
the development of plan to reduce his/her risk for HIV infection and
transmission and making referrals to other needed services.

02

Educator

A person who promotes, maintains, and improves individual and
community health by teaching individuals and communities how to
assume responsibility for addressing prevention and health care
issues. This person may be formally trained through an academic
program or trained on-the-job or through other experiences.

03

Health Care Worker

An individual who provides health care services, including care and
treatment of HIV/AIDS patients (e.g. doctor, nurse, physician
assistant, psychiatrist).

04

Outreach Worker

An individual who provides face-to-face prevention services to highrisk individuals where they live or congregate (e.g., in the community).

05

Peer

An individual who is a current or former member of the target
population and is trained to provide education, information or other
prevention services.

06

HIV Test Administrator

An individual qualified to administer rapid and/or conventional HIV
tests.

07

PCRS Provider

A staff member who is trained to do one or more of the following: 1)
introduce the concept to HIV positive clients; 2) assess partner needs
and determining methods to inform partners; 3) locate partners, 4)
inform the potentially exposed sex or needle-sharing partner; and 5)
make referrals to CT or other services.

88

Other

Individuals who deliver all or part of an intervention and who do not fit
into one of the specified categories listed above (e.g. phlebotomist,
lawyer, social worker, celebrity).

P07

Employment Status

No

Yes

Definition: The current condition of employment or labor position that an individual holds
within the agency.
Instructions: Indicate if the worker is a paid employee or a volunteer. If the worker is a contrac
Code

Value Description

Value Definition

1

Paid Staff

Individuals who receive compensation from your agency to provide
direct services to clients.

2

Volunteer

Individuals who provide direct services to clients without
compensation.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

P08

Mandatory

Education Level

HD

CBO

No

Yes

Definition: The highest level of formal education the agency worker has completed.
Instructions: Choose the highest level of education for a particular agency worker. Even thoug
Code

Value Description

Value Definition

0

None

The worker has completed no formal schooling.

2

8th grade or less

The worker has completed up to the 8th grade of formal schooling.

3

Some high school

The worker has completed some years of high school but has not
received a high school diploma, GED or equivalent.

4

High school graduate, GED or equivalent

The worker has graduated from high school or received a GED or
equivalent diploma.

5

Some college

The worker has completed some years of college at a university or
technical college.

6

Bachelor's degree

The worker has received an undergraduate academic degree
typically requiring four years of full-time equivalent preparation.

7

Master's degree

The worker has received an advanced academic degree requiring
one to two years of full-time preparation beyond the bachelor's
degree.

8

Professional degree

The worker has received an advanced degree required for
professional practice. Usually obtained after a bachelor's degree in
fields such as medicine, dentistry, veterinary medicine, or law.

9

Doctorate degree

The worker has received the highest level of academic degree.
Includes Doctor of Philosophy (Ph.D.), Education (Ed.D.), LL.D., and
many other titles. If the person had received Doctor of Medicine
(MD), this should be coded under "Professional degree".

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PEMS Data Variables and Values
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Num

Variable Name

P09

Mandatory

Prevention Intervention Training

HD

CBO

No

Yes

Definition: The prevention intervention training curriculum the agency worker has completed.
Instructions: Indicate the prevention intervention training curriculum the agency worker has co
Code

Value Description

Value Definition

00

None

The agency worker has not completed a CDC-based training
curriculum.

01

Introduction to HIV prevention: "HIV 101"

02

HIV prevention counseling-basic

03

HIV test administration-Conventional

04

HIV test administration-Rapid

05

HIV prevention counseling-Issues for youth

06

HIV prevention counseling-Issues for clients who test positive

07

Supervisory training for HIV CT-quality assurance

08

DEBI-POL

A specialized type of outreach that consists of a group of trusted, wellliked people who are recruited and trained to endorse safer sexual
behaviors in casual, one-on-one conversations with peers in their
own social network at a range of venues and settings.

09

DEBI-Mpowerment

A community-level HIV prevention intervention for young men who
have sex with men. The intervention is run by a core group of 12-20
young gay/bi-sexual men from the community and paid staff.

10

DEBI-Community PROMISE

A community-level STD/HIV prevention intervention that relies on the
outreach work of peer advocates from the target community to deliver
role model stories to members of the target population.

11

DEBI-RAPP

A community-level HIV prevention intervention designed to help lowincome women (aged 15-34) and their partners reduce their risk for
HIV infection. The intervention objectives are to increase consistent
condom use by women and their partners, to change community
norms so that practicing safer sex is seen as the acceptable norm,
and to involve as many people in the community as possible.

12

DEBI-Street Smart

An intensive HIV/AIDS and STD prevention program for youth whose
behaviors place them at very high risk of becoming infected.

13

DEBI-SISTA

A social skills training intervention aimed at reducing HIV sexual risk
behavior among African-American women at highest risk.

14

DEBI-Healthy Relationships

A five-session, small-group intervention for men and women living
with HIV/AIDS that focuses on developing skills and self-efficacy and
positive expectations about new behaviors through modeling
behaviors and practicing new skills.

15

DEBI-Holistic Health Recovery

A 12-session, manual-guided, group level program to reduce harm,
promote health, and improve quality of life for HIV-positive injection
drug users.

16

DEBI-Together Learning Choices

An intervention for young people, (ages 13-29) living with HIV. It is
delivered in small groups using cognitive-behavioral strategies to
change behavior.

17

DEBI-Safety Counts

18

DEBI-VOICES/VOCES

A single-session, video-based HIV/STD prevention workshop
designed to encourage condom use and improve condom negotiation
skills among heterosexual African American and Latino men and
women.

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Num

Variable Name

19

DEBI-Many Men, Many Voices

20

PCRS

21

Evaluation Guidance

22

WILLOW

23

SiHLE

24

CLEAR

25

OPTIONS

88

Other (Specify)

P10

Mandatory

HD

CBO

A six- or seven-session, group level STD/HIV prevention intervention
for gay and bisexual men of color.

Certification Start Date

No

Yes

No

Yes

Definition: The date that the agency worker is eligible to start provision of service(s).
Instructions: For each Worker Type selected in P05: Worker Type, indicate the start date for w
P11

Certification End Date
Definition: The date that the worker is no longer eligible to provide service(s).
Instructions: For each Worker Type selected in P05: Worker Type, tell us the date that the age

Table: S

Site Information

A site is a facility or non-facility based (e.g. park, street corner) setting which serves as a point of service delivery. If an agency has multiple
sites this table is completed for each site.
Reported to CDC
Num

Variable Name

S01

Site ID

Mandatory

HD

CBO

Yes

Yes

Yes

Yes

Definition: A system generated code used to distinguish the locations where an agency
delivers services.
Instructions: The system will generate a Site ID for every site that is entered. The Site ID will b
S03

Site Name
Definition: The official name of the agency's HIV prevention site of service delivery.
Instructions: Enter the official name of the site where your agency provides HIV prevention ser

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PEMS Data Variables and Values
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Num

Variable Name

S04

Mandatory

Site Type

HD

CBO

Yes

Yes

Definition: The setting in which HIV prevention services are provided.
Instructions: Select the site type from the list provided that best represents the setting and/or p
Code

Value Description

Value Definition

F01

In-patient facility

A hospital or other health facility where services are provided to
patients that reside within that facility while they are receiving those
services.

F01.01

In-patient Hospital

F01.50

Inpatient- Drug / Alcohol Treatment

F01.88

Inpatient Facility- Other (specify)

F01.99

Inpatient Facility- Unknown

F02

Outpatient facility

A health care facility where services are provided to patients that do
not reside within that facility while they are receiving services.

F02.03

Outpatient- Private Medical Practice

A non-residential health care facility that is privately owned and/or
operated.

F02.04

Outpatient- HIV Specialty Clinic

A non-residential health care facility that concentrates in the provision
of HIV treatment, care and prevention services.

F02.10

Outpatient- Prenatal/ OBGYN Clinic

A non-residential health care facility that provides obstetric,
gynecological and other pregnancy-related health services.

F02.12

Outpatient- TB Clinic

A non-residential health care facility that specializes in the provision
of tuberculosis treatment, care and prevention services.

F02.19

Outpatient- Drug / Alcohol Treatment Clinic

A non-residential health care facility that provides alcohol and
chemical dependency treatment services.

F02.20

Outpatient- Family Planning

A non-residential health care facility that provides pregnancy testing,
birth control services, and other reproductive health services.

F02.30

Outpatient- Community Mental Health

A non-residential health care facility that provides treatment and
support services for the mentally ill or others with mental health
problems including counseling, case management, treatment,
peer/family support and public education.

F02.51

Outpatient- Community Health Clinic

A non-residential health care facility that provides primary and
preventative health care services to the members of a community in
which it is located.

F02.58

Outpatient- School/University Clinic

A non-residential health clinic that is operated by and provides
services within a school or university setting.

F02.60

Outpatient- Health Department/Public Health Clinic

A non-residential health clinic that is supported by public funds.

F02.61

Outpatient- Health Department/Public Health Clinic-HIV

A non-residential health clinic that is supported by public funds and
provides HIV prevention, diagnosis and treatment services.

F02.62

Outpatient- Health Department/Public Health Clinic-STD

A non-residential health clinic that is supported by public funds and
provides STD prevention, diagnosis and treatment services.

F02.88

Outpatient Facility- Other (Specify)

F02.99

Outpatient Facility- Unknown

F03

Emergency Room

A residential health facility that provides substance abuse treatment
and rehabilitation.

A section of a hospital or clinic staffed and equipped to provide
emergency care to persons requiring immediate medical treatment for
sudden illness or trauma.

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Num

Variable Name

Mandatory

HD

CBO

F04.01

Blood Bank/Plasma Center

A place where blood is collected from donors, typed, separated into
components, stored, and prepared for transfusion to recipients. A
blood bank may be a separate free-standing facility or part of a larger
laboratory in a hospital.

F04.05

HIV Counseling and Testing Site

A facility or non-facility based setting where HIV prevention
counseling and testing services are provided.

F06

Community Setting

A defined area, environment or context in which a group of people
live, work or congregate.

F06.01

Community Setting-AIDS Service Organization- non-clinical

A health association, support agency, or other service actively
involved in the prevention and treatment of AIDS.

F06.02

Community Setting-School/Education facility

A building or place where individuals receive knowledge through
learning and instruction.

F06.03

Community Setting-Church/Mosque/Synagogue/Temple

A building where a group of people who adhere to a common faith
gather for prayer.

F06.04

Community Setting-Shelter/Transitional housing

Shelters are facilities in which people can stay temporarily when they
would otherwise have to sleep on the street. Shelters also
sometimes provide other services (e.g., soup kitchen, job seeking
skills training, job training, support groups), or refer their clients to
agencies that do. Transitional housing is short to long-term housing
(6 to 24 months) available for individuals or families who are
homeless.

F06.05

Community Setting-Commercial

A business or commercial facility (e.g., beauty salon, grocery store,
shopping center) where HIV prevention services may also occur.

F06.06

Community Setting-Residential Area

A primary residence that might include residential neighborhoods or
the common areas of apartment complexes or housing developments.

F06.07

Community Setting-Bar/Club/Adult entertainment

F06.08

Community Setting-Public area

An area, environment or context that is open to the community as a
whole such as a park or city street.

F06.09

Community Setting-Workplace

A location where a worker normally performs his/her job tasks or the
businesses administrative offices. Use this site type for prevention
services delivered to a particular employer's employees.

F06.10

Community Setting- Community center

A facility where the members of a community can gather for social or
cultural activities

F06.12

Individual Residence

An individual's home or place of residence. If Individual Residence is
chosen, no locating information (e.g., address) is collected.

F06.88

Community Setting- Other (specify)

F07

Correctional Facility

F88

Other (Specify)

S08

A penal or correctional facility, prison, jail detention center,
community-based rehabilitation center, or any similar institution
designed for the confinement or rehabilitation of criminal offenders

County

Yes

Yes

Definition: The official three-digit Federal Information Processing Standards (FIPS) code of
the county in which the agency's site is physically located.
Instructions: Select the name of the county where the site you entered for variable S03: Site N

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

S09

Mandatory

State

HD

CBO

Yes

Yes

Definition: The state, territory or district in which the official mailing address for the site is
physically located. This must represent one of the 50 states, the District of
Columbia, the U.S. Virgin Islands, or Puerto Rico.
Instructions: Select the name of the state, territory or district where the site you entered for vari
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina
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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

78

VI

Virgin Islands of the U.S.

S10

Zip Code

HD

Yes

CBO

Yes

Definition: The postal zip code for the site.
Instructions: Enter the postal zip code for the site you entered for variable S03: Site Name.
Code

Value Description

Value Definition

#####-####

Only the 5 digit zip code is mandatory.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

S16

Mandatory

Use of Mobile Unit

HD

CBO

Yes

Yes

Definition: A specialized vehicle is used at the site to provide HIV prevention services
beyond the transport of agency staff to the field and/or for client recruitment.
Instructions: If the site type for the site specified in S03: Site Name is a community setting (S0
Code

Value Description

Value Definition

0

No

A mobile unit is not used at the site to provide HIV prevention
services beyond the transport of agency staff to the field and/or for
client recruitment.

1

Yes

A mobile unit is used at the site to provide HIV prevention services
beyond the transport of agency staff to the field and/or for client
recruitment.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

HD

CBO

Program Planning Level
Table: D

Program Name (Planning)

This table is required to be completed by all agencies that provide HIV prevention services directly to clients.
An agency must report information for each prevention program plan (e.g. the program name, the program 12 month funding cycle, and
name of the community plan jurisdiction in which the program will be implemented).
Reported to CDC
Num
D01

Variable Name

Mandatory

Program Name

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The name of the Program used by an agency to organize one or more program
models designed to provide HIV prevention services to clients and the
interventions that comprise them. The Program Name links the Agency Name
with the Program Model and distinguishes it from similar programs provided
within the same agency.
Instructions: Indicate the name used by the agency to identify this program. If your agency org
D02

Community Planning Jurisdiction
Definition: The CDC-directly funded state, territory, or city health department jurisdiction in
which this program is intended to be delivered.
Instructions: Select the Community Planning Jurisdiction(s) in which this program is intended t

D03

Community Planning Year
Definition: The annual period (e.g., 2005) within the Comprehensive HIV Prevention
Community Plan that guides how the HIV prevention program indicated in D01:
Program Name will be implemented in the jurisdiction.
Instructions: Indicate the Community Planning Year (e.g., 2005) in which this program indicate

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Table: E1

Mandatory

HD

CBO

Program Model and Budget (Planning)

This table is required to be completed by all agencies that provide HIV prevention services directly to clients.
This table provides descriptive information for each prevention program model (defined as the scientific or operational basis for a program,
including the replication model or procedural document on which the program is based) and time period of implementation. A program can
have one or multiple program models.
Reported to CDC
Num
E101

Variable Name

Mandatory

Program Model Name

HD
Yes

CBO
Yes

Definition: A Program Model is the scientific or operational rationale (e.g., evidence-based,
CDC recommended guideline or other basis), that serves as the foundation for
the development of an intervention. The name of the Program Model used by an
agency to represent the specific set of interventions or activities present in a
Program. This variable allows the provider to develop and use a unique name
for a Program Model that distinguishes it from other Program Models within the
same Program.
Instructions: Indicate the name of the Program Model present within this Program. Please rem

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

E102

Mandatory

Evidence Base

HD
Yes

CBO
Yes

Definition: A program model that has been proven effective through research studies that
have shown positive behavioral and/or health outcomes.
Instructions: When indicating the basis for the program model identified in E101: Program Mod
Code

Value Description

Value Definition

1.01

Community PROMISE

A community-level STD/HIV prevention intervention that relies on the
outreach work of peer advocates from the target community to deliver
role model stories to members of the target population.

1.02

Healthy Relationships

A five-session, small-group intervention for men and women living
with HIV/AIDS that focuses on developing skills and self-efficacy and
positive expectations about new behaviors through modeling
behaviors and practicing new skills.

1.03

Holistic Health Recovery

A 12-session, manual-guided, group level program to reduce harm,
promote health, and improve quality of life for HIV-positive injection
drug users.

1.04

Many Men, Many Voices

A six- or seven-session, group level STD/HIV prevention intervention
for gay and bisexual men of color.

1.05

Mpowerment

A community-level HIV prevention intervention for young men who
have sex with men. The intervention is run by a core group of 12-20
young gay/bi-sexual men from the community and paid staff.

1.06

Popular Opinion Leader

A specialized type of outreach that consists of a group of trusted, wellliked people who are recruited and trained to endorse safer sexual
behaviors in casual, one-on-one conversations with peers in their
own social network at a range of venues and settings.

1.07

RAPP

A community-level HIV prevention intervention designed to help lowincome women (aged 15-34) and their partners reduce their risk for
HIV infection. The intervention objectives are to increase consistent
condom use by women and their partners, to change community
norms so that practicing safer sex is seen as the acceptable norm,
and to involve as many people in the community as possible.

1.08

Safety Counts

A cognitive-behavioral intervention to reduce HIV risks among active
drug users and specifically target active crack cocaine and injection
drug users who are at very high risk for HIV/STD infection.

1.09

SISTA

A social skills training intervention aimed at reducing HIV sexual risk
behavior among African-American women at highest risk.

1.1

Street Smart

An intensive HIV/AIDS and STD prevention program for youth whose
behaviors place them at very high risk of becoming infected.

1.11

Together Learning Choices

An intervention for young people, (ages 13-29) living with HIV. It is
delivered in small groups using cognitive-behavioral strategies to
change behavior.

1.12

VOICES/VOCES

A single-session, video-based HIV/STD prevention workshop
designed to encourage condom use and improve condom negotiation
skills among heterosexual African American and Latino men and
women.

1.13

WILLOW

1.14

SiHLE

1.15

CLEAR

1.16

OPTIONS

2.01

Partnership for Health

A brief counseling program for individual men and women living with
HIV/AIDS delivered by medical providers in HIV outpatient clinics.

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Num

Variable Name

Mandatory

HD

CBO

2.02

Project RESPECT

A client-focused, HIV prevention counseling intervention that seeks to
reduce high-risk sexual behaviors and prevent new sexually
transmitted infections among heterosexual clients in STD clinics.

2.03

NIMH Multisite HIV Prevention Trial Group (1998): Project LIGHT
(Living in Good Health Together)

A small group intervention for persons receiving services at STD
clinics or health care clinics with the goals of decreasing unprotected
sexual intercourse and increasing condom use.

3.01

Cohen (1991): Condom Skills Education

A single, 30-minute group condom skills education session for people
waiting in STD clinics.

3.02

Des Jarlais (1992): AIDS/Drug Injection Prevention

A small group intervention to prevent the transition from sniffing
heroin to injecting heroin.

3.03

El-Bassel (1992): Skills Building

A small group intervention to reduce sexual risk behavior and HIV
transmission for women methadone patients.

3.04

McCusker (1992): Informational and Enhanced AIDS Education

A small group informational and enhanced education intervention on
drug- and sex-related HIV risk behaviors for drug abusers.

3.05

Cohen (1992): Group Discussion Condom Promotion

A group video and discussion session about condom use for people
waiting in STD clinics.

3.06

Hobfoll (1994): Reducing AIDS Risk Activities

A small group intervention to enhance AIDS knowledge, attitudes,
and skills and, as a result, to influence behavior change for inner-city
clinics for low-income women.

3.07

Kelly (1994): Cognitive-Behavioral Skills Training Group

A small group intervention concerning high-risk behaviors for highrisk women in urban clinics.

3.08

Wenger (1991): HIV Education, Testing and Counseling

An education, testing, and one-on-one counseling intervention to
reduce high-risk sexual behavior among heterosexuals undergoing
HIV Antibody testing.

3.09

Kelly (1989): Behavioral Self-management and Assertion Skills
(Project ARIES)

A 12-session, small group intervention for a gay men to reduce the
frequency of high-risk sexual practices and increase behavioral skills
for refusing sexual coercions.

3.1

Jemmott (1992): Be Proud! Be Responsible

3.11

Rotheram-Borus (1998): 3-Session and 7-Session Small groups

3.12

Magura (1994): Intensive AIDS Education in Jail

3.13

Sellers (1994): HIV Prevention for Latino Youth

3.14

Orr (1996): Brief Behavioral Intervention

3.15

Eldridge (1997): Behavioral Skills Training

3.16

Get Real About AIDS, 1992

A classroom intervention to postpone the initiation of sexual
intercourse and to reduce the number of high school students
engaging in unsafe sex and drug-using behaviors.

3.17

Stanton (1996): Focus on Kids

A peer network decision-making intervention to increase condom use
among sexually active low-income African-American youths.

3.18

Kirby (1991): Reducing the Risk

A classroom intervention presented through a 10th grade
comprehensive health curriculum to postpone initiation of sexual
intercourse and, among those sexually experienced, to reduce
unprotected sex.

3.19

Get Real About AIDS, 1993

3.2

St. Lawrence (1995): Becoming a Responsible Teen (BART)

A small group intervention to reduce HIV drug- and sex-related risk
behaviors for male adolescent drug users in jail.

A 8-session small group intervention to reduce African-American
adolescents' risk for HIV infection.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

E103

Mandatory

CDC Recommended Guidelines

HD

CBO

Yes

Yes

Definition: An official CDC-endorsed document that describes the policies, procedures and
strategies for implementing specific HIV prevention activities of CTR, PCRS and
CRCS.
Instructions: When indicating the basis for the program model identified in E101: Program Mod
Code

Value Description

Value Definition

1

Counseling, Testing, and Referral

Revised Guidelines for HIV Counseling, Testing and Referral, 2001

2

Comprehensive Risk Counseling Services

HIV Prevention Case Management Guidance, 1997 or Resource
Manual and Implementation Guidance for Prevention Case
Management, Draft; 2004

4

Partner Counseling and Referral Services

HIV Partner Counseling and Referral Services Guidance, 1998

E104

Other Basis for Program Model

Yes

Yes

Definition: The scientific, theoretical or operational rationale that serves as the foundation
for the development of an intervention, other than what is listed as an Evidence
Based model or a CDC Recommended Guideline.
Instructions: When indicating the basis for the program model identified in E101: Program Mod
Code

Value Description

Value Definition

5

Other (Specify)

The source or basis (scientific, theoretical or operational) upon which
the program is modeled, if it is not an evidence-based model or CDC
Guideline noted in E102: Evidence Based or E103: CDC
Recommended Guideline and if there is not a specific study or
published article supporting it.

6

Study (Specify)

The published article or study upon which this program is modeled.

E105

Target Population

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The primary groups of people that this program model and its components are
designed to serve. Target populations are defined by both their risk(s) for HIV
infection or transmission as well as their demographic characteristics and the
characteristics of the epidemic within this population.
Instructions: Indicate the target population(s) intended to be served by this intervention by sele
E107

Program Model Start Date
Definition: The start date of the annual funding period for this program model.
Instructions: Indicate the program model start date (mm/yyyy). Please note that a program mo

E108

Program Model End Date
Definition: The end date of the annual funding period for this program model.
Instructions: Indicate the program model end date (mm/yyyy). Please note that a program mo

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Table: E2

Mandatory

HD

CBO

Program Model and Budget (End of Year)

This table is required to be completed by all agencies that provide HIV prevention services directly to clients.
This table supplements Table E1 with estimates of the amount of funds actually expended (as reported at the end of the agency's fiscal
year) for a specific program model. The provision of funding information at the program model level is required.
Reported to CDC
Num

Variable Name

E201

Mandatory

Program Model Name

HD

CBO

Yes

Yes

Yes

Yes

Definition: The Program Model Name given in variable E101: Program Model Name about
which the end-of-year information in Table E2: Program Model and Budget (End
of Year) will be provided.
Instructions: Select one of the Program Models entered in variable E101: Program Model Nam
E202

Program Model Status
Definition: The operational state of the program model at the time of reporting.
Instructions: Select the value that best describes the condition of the program model you selec

Code

Value Description

Value Definition

1

Completed as planned

The program model was completed according to the timeline outlined
in the program plan.

2

Terminated prematurely

The program model ended before completion and will not be
continued.

3

Ongoing

The program model is continuing at the time of reporting.

E203

Program Model Termination Date

Yes

Yes

Yes

Yes

Definition: The termination date of a program model that was not completed as planned.
Instructions: If you selected the value = "Terminated Prematurely" in variable E202: Program
E204

Funds Expended
Definition: The total annual funds expended to carry out this specific program model during
the annual funding period.
Instructions: Indicate the total annual funds expended to carry out the program model during th

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

E205

Mandatory

Indirect Costs

HD
Yes

CBO
Yes

Definition: Indirect costs refer to general administrative costs associated with
implementation of the program model. These are defined by CDC as allowable
costs which cannot be readily identified with an individual project or program,
(Grantee's Financial Reference Guide for Managing CDC Grants and
Cooperative Agreements, p. 32.)
Instructions: Indicate whether the total annual funds expended includes any general administra
Code

Value Description

Value Definition

0

No

The budget associated with implementing the program model did not
include indirect costs.

1

Yes

The budget associated with implementing the program model did
include direct costs.

E206

Percent CDC Contribution

Yes

Yes

Definition: The percentage of total annual funds expended to carry out a program model
that came from CDC HIV prevention funds.
Instructions: Indicate the percentage of total annual funds expended (as reported in E204: Fun

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Table: F

Mandatory

HD

CBO

Intervention Plan Characteristics

This table is required to be completed by all agencies that provide HIV prevention services directly to clients.
This table provides detailed plan information for each intervention to be delivered as part of a program model (e.g. target population, unit of
delivery, number of sessions, site of service delivery, target number of persons to be reached, activities, and methods of delivery). A
program model can have one or multiple interventions*.
*For Counseling, Testing, and Referral (CTR) and Partner Counseling and Referral Services (PCRS) program models, only one intervention
can be associated with each model.
Reported to CDC
Num

Variable Name

Mandatory

Version ID: 15

HD

CBO

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

F01

Mandatory

Intervention Type

HD
Yes

CBO
Yes

Definition: A classification of interventions that differentiates broad categories of prevention
services. An intervention contains one or more specific activities or methods
used to promote changes that will result in reduced risk for HIV infection or
transmission.
Instructions: Indicate the type of intervention that will be implemented under the Program Mod
Code

Value Description

Value Definition

01

Counseling and Testing

A process through which an individual receives information about HIV
transmission and prevention, information about HIV tests and the
meaning of tests results, HIV prevention counseling to reduce their
risk for transmitting or acquiring HIV, and is provided testing to detect
the presence of HIV antibodies.

02

Health Communication/Public Information

The delivery of planned HIV/AIDS prevention messages through one
or more channels to encourage safe behavior, personal risk-reduction
efforts, the use of HIV prevention services and changing community
norms. Channels of delivery include electronic media, print media,
hotlines, clearinghouses, and presentations/lectures.

03

Partner Counseling and Referral Services

A range of services available to HIV-infected persons, their partners
and affected communities that involves informing current and past
partners that a person who is HIV-infected has identified them as a
sex or injection-drug-paraphernalia-sharing partner and advising
them to have HIV counseling and testing. Notified partners, who may
not have suspected their risk, can then choose whether to be tested
for HIV, enabling those who test HIV positive to receive early medical
evaluation, treatment, and prevention services, including riskreduction counseling.

04

Comprehensive Risk Counseling Services

A client-centered HIV prevention counseling activity with the
fundamental goal of promoting the adoption and maintenance of HIV
risk-reduction behaviors by clients with multiple, complex problems
and risk-reduction needs. CRCS provides intensive, on-going,
individualized prevention counseling, support, and service brokerage.
This HIV prevention activity addresses the relationship between HIV
risk and other issues such as substance abuse, STD treatment,
mental health, and social and cultural factors.

05

Outreach

Interventions generally conducted by peer or paraprofessional
educators face-to-face with high-risk individuals in neighborhoods or
other areas where they typically congregate. Outreach may include
risk reduction counseling, referral to HIV testing, and the distribution
of condoms or educational materials. A major purpose of outreach
activities is to encourage those at high risk to learn their HIV status
and to provide information and assistance in accessing HIV testing
services. Note: The distribution of materials by itself is not
considered outreach, but rather an activity associated with an HC/PI
intervention.

06

Health Education/Risk Reduction

A set of prevention activities provided to individuals or groups to
assist clients in making plans for individual behavior change, to
promote and reinforce safer behaviors and to provide interpersonal
skills training in negotiating and sustaining appropriate behavior
change. Activities range from individual HIV prevention counseling to
group interventions to broad, community-based interventions.

88

Other

Interventions that do not fit one of the prior six categories. These
may include interventions that address substance abuse, mental
health, housing or domestic violence issues.

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Num

Variable Name

F02

Mandatory

Intervention Name/ID

HD

CBO

Yes

Yes

Yes

Yes

Definition: The unique name of the intervention.
Instructions: Indicate the unique name of the intervention selected in F01: Intervention Type.
F03

HIV+ Intervention
Definition: An intervention that primarily or exclusively targets persons living with HIV/AIDS
(PLWHAs) and their sex and/or injection drug using partners.
Instructions: If the intervention specified in F02: Intervention Name will primarily or exclusively t

Code

Value Description

Value Definition

0

No

The intervention does not primarily or exclusively target persons living
with HIV/AIDS (PLWHAs) and their sex and/or injection drug using
partners.

1

Yes

The intervention primarily or exclusively targets persons living with
HIV/AIDS (PLWHAs) and their sex and/or injection drug using
partners.

F04

Perinatal Intervention

Yes

Yes

Definition: An intervention that primarily or exclusively targets pregnant women to reduce
the risk of perinatal HIV transmission.
Instructions: Indicate “Yes” for this variable only if your organization intends to target the HIV t
Code

Value Description

Value Definition

0

No

The intervention does not primarily or exclusively target pregnant
women to reduce the risk of perinatal HIV transmission.

1

Yes

The intervention primarily or exclusively targets pregnant women to
reduce the risk of perinatal HIV transmission.

F05

Total Number of Clients

Yes

Yes

Yes

Yes

Definition: The total annual number of clients intended to be reached by the intervention in
the Program Model period. If there are multiple target populations among those
clients, then this number represents the sum of all clients combined. That is, the
sum of the number provided for each total defined in F06: Sub-total Target
Population, must equal the number given for F05: Total Number of Clients.
Instructions: Calculate how many clients your agency will be able to serve with all cycles of this
F06

Sub-Total Target Population
Definition: The total annual number of clients in each target population identified in variable
E105: Target Population intended to be reached by the intervention in the
Program Model period.
Instructions: If you indicated in E105: Target Population that this Program Model serves more t

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Num

Variable Name

F07

Mandatory

Planned Number of Cycles

HD
Yes

CBO
Yes

Definition: The number of times a complete delivery of an intervention will be delivered to its
intended audience over the program model period.
Instructions: Indicate the number of times that you plan to deliver this intervention in its entirety
Code

Value Description

Value Definition

#,###,###

Number

The specific number of time that the entire intervention is intended to
be delivered during the program model period.

9,999,999

Ongoing

The intervention will be delivered continuously during the program
model period or the number of cycles is dependent on the number of
clients who actually enroll in the intervention and the capacity of the
agency to serve these individuals.

F08

Number of Sessions

Yes

Yes

Definition: A session consists of one or more activities delivered to clients on a given date.
This variable represents the number of sessions in a single cycle of an
intervention.
Instructions: Indicate the total number of sessions planned for one cycle of an intervention that
Code

Value Description

Value Definition

###

Number

The number of sessions in one complete cycle of an intervention.

999

Unknown

The number of sessions will be determined at client service delivery.

F09

Unit of Delivery

Yes

Yes

Definition: The category or grouping of intended clients to be seen per session for a unique
intervention.
Instructions: Indicate how many clients you intend to serve per session. For instance, an inter
Code

Value Description

Value Definition

01

Individual

The provision of service to one person at a time.

02

Couple

The provision of service to two people that are in a sex or drug-using
relationship.

03

Small group

Intervention provided to 2-12 people at the same time and setting.

04

Large group

Intervention provided to more than 12 people at the same time and
setting.

05

Community

An intervention that addresses a population as a whole, rather than
individuals or small/large groups, (i.e. community mobilizations, social
marketing campaigns, community-wide events, health fairs, policy
interventions, and structural interventions) and may include the use of
broadcast media.

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Num

Variable Name

F10

Activity

Mandatory

HD
Yes

CBO
Yes

Definition: The specific actions or components that are proposed to occur during the
implementation of a particular intervention session.
Instructions: Indicate the specific action(s) that you intend to undertake during the implementat
Code

Value Description

Value Definition

03.00

HIV testing

A diagnostic, laboratory procedure to assess for the presence of HIV
antibodies.

04.00

Referral

A process by which immediate client needs for prevention, care, and
supportive services are assessed and prioritized and clients are
provided with information and assistance in identifying and accessing
specific services (such as, setting up appointments and providing
transportation). Note: The provision of a referral also includes a plan
for tracking whether or not the client accessed the referral.

05.00

Personalized risk assessment

The process by which an individual client, a provider or both working
together identify, acknowledge, and understand the details and
context of the client's HIV risk. The assessment should explore
previous risk reduction efforts and identify successes and challenges
of those efforts.

06.00

Elicit partners

The process by which the provider assists the index client in
identifying partners and other sexual and drug-injecting networks at
high risk for transmission of HIV who might benefit from testing and/or
medical examination. (These networks do not include sex partners of
the HIV-infected individual but are made up of individuals who share
social relationships involving sex or drug use.).

07.00

Notification of exposure

The process of informing a HIV-positive client's sex and/or needle
sharing partners of their exposure to HIV. This activity is only
applicable if the intervention type is Partner Counseling and Referral
Services (PCRS).

08.01

Information-HIV/AIDS transmission

Any general information, written or verbal, given to an individual or a
group on HIV/AIDS and how it is transmitted.

08.02

Information-Abstinence/postpone sexual activity

Any information, written or verbal, given to an individual or a group on
abstaining from sexual activity or postponing sexual activity.

08.03

Information-Other sexually transmitted diseases

Any information, written or verbal, given to an individual or a group on
STDs (other than HIV or viral hepatitis), how it is transmitted, how to
reduce risk for transmission or infection, or treatment options.

08.04

Information-Viral hepatitis

Any information on viral hepatitis, how it is transmitted, and/or how to
reduce risk for transmission or infection, or treatment options.

08.05

Information-Availability of HIV/STD counseling and testing

Any information, written or verbal, given to an individual or a group
about where and how to access HIV-related CTR or STD counseling
and testing. This includes referral lists that only list CTR and/or STD
counseling and testing sites.

08.06

Information-Availability of partner notification and referral services

Any information, written or verbal, given to an individual or a group
about where and how to access partner notification services. The
availability information provided is exclusive to PCRS. This includes
referral lists that only list PCRS sites.

08.07

Information-Living with HIV/AIDS

Any information, written or verbal, given to an individual or a group
living with HIV/AIDS specific to living with the disease.

08.08

Information-Availability of social services

Any information, written or verbal, given to an individual or a group
about how and where to access social services. This could include a
referral list that only includes social services agencies or providers.

08.09

Information-Availability of medical services

Any information, written or verbal, given to an individual or a group
about how and where to access HIV medical services. This could
include a referral list that only includes HIV medical care providers.
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Num

Variable Name

Mandatory

HD

CBO

08.10

Information - Sexual risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce sexual risk for HIV transmission or infection.

08.11

Information-IDU risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce injection drug use risk for HIV transmission or infection.

08.12

Information-IDU risk free behavior

Any information, written or verbal given to an individual or a group on
abstaining from injection drug use or only using new needles and
disposing of them appropriately.

08.13

Information-Condom/barrier use

Any information, written or verbal, given to an individual or a group
regarding appropriate use and disposal of condoms or other barrier
methods.

08.14

Information-Negotiation/Communication

Any information, written or verbal, given to an individual or a group
regarding communication of desire for safer practices and negotiating
safer practices with partners (sexual and needle sharing).

08.15

Information-Decision making

Any information, written or verbal, given to an individual or a group
regarding the steps and techniques needed for reassessing, planning
and using judgment to avoid situations that may expose them to HIV
infection or transmission risk and/or decision to engage in a risk
behavior.

08.16

Information-Disclosure of HIV status

Any information, written or verbal, given to an individual or a group
regarding disclosure of their HIV status, applicable laws,
accompanying ramifications, and options regarding non-disclosure.

08.17

Information-Providing prevention services

Any information, written or verbal, given to an individual or a group on
how to communicate prevention messages and/or demonstrate risk
reduction skills with others.

08.18

Information-HIV testing

Any information, written or verbal, given to an individual, couple, or
group regarding HIV testing including explanation of the testing
process and meaning of results, behavioral risks for infection, and
importance of knowing their status.

08.19

Information-Partner notification

Any information, written or verbal, given to an individual or a group
regarding the notification of possible exposure to HIV and
accompanying ramifications, behaviors associated with possible
exposure, and consideration of alternatives or information on how to
notify partners regarding possible exposure.

08.20

Information-HIV medication therapy adherence

Any information, written or verbal, given to an individual or a group
regarding HIV medication therapy, benefits and risk, medical therapy
alternatives, and importance of adhering to medication therapy for
HIV.

08.21

Information-Alcohol and drug use prevention

Any information, written or verbal, given to an individual or a group on
the negative effects and consequences of alcohol and drug use and
its relationship to HIV transmission or infection risk behavior including
strategies to avoid or abstain from use.

08.22

Information-Sexual Health

Any information, written or verbal, given to an individual or a group on
reproductive health, sexuality, sexual development and similar topics.

08.23

Information - TB testing

Any information, written or verbal, given to an individual, couple, or
group on TB, how it is transmitted, and/or how to reduce risk for
transmission or infection, or treatment options.

08.66

Information-Other

Any information, written or verbal, given to an individual or group that
cannot be captured in any of the other information codes.

09.01

Demonstration-Condom/barrier use

Provider or participant demonstration (using a teaching tool) of
appropriate use and disposal of condoms or other barrier methods.

09.02

Demonstration-IDU risk reduction

Provider or participant demonstration of how to safely dispose of
syringes or how to use bleach kits to clean works.

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HD

CBO

09.03

Demonstration-Negotiation/Communication

Provider or participant demonstration of how to communicate desire
for safer practices and how to negotiate safer practices with partners
(sexual and needle sharing).

09.04

Demonstration-Decision making

Provider or participant demonstration of steps, and techniques
needed for reassessing, planning and using judgment to avoid
situations that may expose them to HIV infection or transmission risk
and/or decision to engage in a risk behavior.

09.05

Demonstration-Disclosure of HIV status

Provider or participant demonstration of techniques to disclose
seropositive status or discuss issues relevant to disclosure.

09.06

Demonstration-Providing prevention services

Provider or participant demonstration of how to communicate
prevention messages or demonstrate risk reduction skills with others .

09.07

Demonstration-Partner notification

Provider or participant demonstration of how to notify partners
regarding possible exposure to HIV or how to discuss issues relevant
to partner notification.

09.66

Demonstration-Other

Any provider or participant demonstration of a skills or technique that
is not decision making, IDU risk reduction, condom/barrier use,
negotiation and communication, disclosure, or providing prevention
services.

10.01

Practice-Condom/barrier use

Participant practice (using a teaching tool) of appropriate condom
and/or barrier use and disposal during the intervention session.

10.02

Practice-IDU risk reduction

Participant practice of safe needle use and disposal including the use
of bleach kits to clean works during the intervention session(s).

10.03

Practice-Negotiation/ Communication

Participant practice communication of desire for safer practices and
negotiation of safer practices with partners (sexual and needle
sharing) during the intervention session(s).

10.04

Practice-Decision making

Participant practice using steps and techniques needed for
reassessing, planning and using judgment to avoid situations that
may expose them to HIV infection or transmission risk and/or decision
to engage in a risk behavior.

10.05

Practice-Disclosure of HIV status

Participant practice of techniques to disclose seropositive status or
discuss issues relevant to disclosure.

10.06

Practice-Providing prevention services

Participant practice communication of prevention messages and/or
demonstration of risk reduction skills with others during intervention
session(s).

10.07

Practice-Partner notification

Participant practice of how to notify partners regarding possible
exposure to HIV or how to discuss issues relevant to partner
notification.

10.66

Practice-Other

Participant practice of a skill or technique that is not decision making,
IDU risk reduction, condom/barrier use, negotiation and
communication, disclosure, or providing prevention services.

11.01

Discussion-Sexual risk reduction

Facilitation of discussion with individuals or groups involving
examination of sexual risk behaviors (self or others) and
accompanying ramifications, examination of attitudes and feelings
about their risks, consideration of alternatives, and decision making to
reduce sexual risk.

11.02

Discussion-IDU risk reduction

Facilitation of discussion with individuals or groups involving
examination of IDU risk and accompanying ramifications, examination
of attitudes and feelings about their risks, consideration of
alternatives, and decision making to reduce IDU risk.

11.03

Discussion-HIV testing

Facilitation of discussion with individuals, couples, or groups
regarding HIV testing including explanation of the testing process and
meaning of results, discussion of behavioral risks for infection,
examination of attitudes and feelings about their risks, consideration
of alternatives, and decision making to know their status and reduce
HIV transmission risk.
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Variable Name

Mandatory

HD

CBO

11.04

Discussion-Other sexually transmitted diseases

Facilitation of discussion with individuals or groups regarding sexually
transmitted diseases (other than HIV), involving an examination of
behavioral risks and accompanying ramifications, examination of
attitudes and feelings about their risks, consideration of alternatives,
treatment alternatives, and decision making to reduce behavioral risk
for other sexually transmitted diseases and/or seek treatment.

11.05

Discussion-Disclosure of HIV status

Facilitation of discussion with individuals or groups regarding
techniques to disclose seropositive status or discuss issues relevant
to disclosure.

11.06

Discussion-Partner notification

Facilitation of discussion with individuals or groups regarding how to
notify partners regarding possible exposure to HIV or how to discuss
issues relevant to partner notification.

11.07

Discussion-HIV medication therapy adherence

Facilitation of discussion with individuals or groups regarding HIV
medication therapy and accompanying ramifications, examination of
attitudes and feelings about HIV medication therapy, discussion of
medical therapy alternatives, and decision making to begin and
adhere to medication therapy for HIV.

11.08

Discussion-Abstinence/postpone sexual activity

Facilitation of discussion with individuals or groups on abstaining from
sexual activity or postponing the initiation of sexual activity and
accompanying ramifications including an examination of risks
associated with sexual activities, discussion of alternatives, and
decision making to abstain or postpone sexual activity.

11.09

Discussion-IDU risk free behavior

Facilitation of discussion with individuals or groups on abstaining from
injection drug use or only using new needles and disposing
appropriately.

11.10

Discussion-HIV/AIDS transmission

Facilitation of discussion with individuals or groups on HIV/AIDS and
how HIV is transmitted.

11.11

Discussion-Viral hepatitis

Facilitation of discussion with individuals or groups on viral hepatitis,
how it is transmitted, and/or how to reduce risk for transmission or
infection, or treatment options.

11.12

Discussion-Living with HIV/AIDS

Facilitation of discussion with individuals or groups on living with
HIV/AIDS and ramifications of living with HIV/AIDS, examination of
attitudes and feelings about living with the disease.

11.13

Discussion-Availability of HIV/STD counseling and testing

Facilitation of discussion with individuals or groups on where and how
to access HIV-related CTR or STD counseling and testing and may
include the importance of knowing your status. This includes referral
lists that only list CTR and/or STD counseling and testing sites.

11.14

Discussion-Availability of partner notification and referral services

Facilitation of discussion with individuals or groups on where and how
to access partner notification services.

11.15

Discussion-Availability of social services

Facilitation of discussion with individuals or groups on how and where
to access social services.

11.16

Discussion-Availability of medical services

Facilitation of discussion with individuals or groups on how and where
to access HIV medical care. Discussion may include options
regarding available services.

11.17

Discussion-Condom/barrier use

Facilitation of discussion with individuals or groups on the appropriate
use and disposal of condoms or other barrier methods and
accompanying ramifications, examination of attitudes and feelings
about condom use, and decision making regarding use of
condoms/barriers.

11.18

Discussion- Negotiation/Communication

Facilitation of discussion with individuals or groups on communication
of desire for safer practices and negotiating safer practices with
partners (sexual and needle sharing), including discussion of
accompanying ramifications, examination of attitudes and feeling,
and decision making regarding communicating and negotiating safer
practices.

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Num

Variable Name

Mandatory

HD

CBO

11.19

Discussion-Decision making

Facilitation of discussion with individuals or groups on steps and
techniques needed for reassessing, planning and using judgment to
avoid situations that may expose them to HIV infection or
transmission risk and/or decision to engage in a risk behavior.

11.20

Discussion-Providing prevention services

Facilitation of discussion with individuals or groups on communicating
prevention message and/or demonstrating risk reduction skills with
others.

11.21

Discussion-Alcohol and drug use prevention

Facilitation of discussion with individuals or groups on the negative
effects and consequences of alcohol and drug use and its
relationship to HIV transmission or infection risk including strategies
to avoid or abstain from use.

11.22

Discussion-Sexual Health

Facilitation of discussion with individuals or groups on reproductive
health, sexuality, sexual development, and similar topics.

11.23

Discussion-TB testing

Facilitation of discussion with individuals or groups about TB, how it is
transmitted, and/or how to reduce risk for transmission or infection, or
treatment options.

11.66

Discussion-Other

Discussion with individuals or groups regarding HIV infection,
transmission, or risk reduction issues and accompanying
ramifications, examination of attitudes and feelings about these
issues, consideration of alternatives, and decision making to reduce
HIV infection, transmission, or risk reduction. Issues do not include
sexual or IDU risk reduction, HIV testing, other sexually transmitted
diseases, HIV status disclosure, partner notification, or HIV
medication therapy.

12.01

Other testing-Pregnancy

Provision of testing to determine pregnancy.

12.02

Other testing-STD

Provision of testing to determine infection with a sexually transmitted
disease other than HIV or Viral Hepatitis.

12.03

Other testing-Viral hepatitis

Provision of testing to determine infection with viral hepatitis.

12.04

Other testing-TB

Provision of testing to determine infection with tuberculosis.

13.01

Distribution-Male condoms

Provision of male condoms by handing them out or placing them in a
location to be accessed by consumers at no cost to the consumer.

13.02

Distribution-Female condoms

Provision of female condoms by handing them out or placing them in
a location to be accessed by consumers at no cost to the consumer.

13.03

Distribution-Safe sex kits

Provision of packages that minimally contain a condom (male or
female), lubricant, and instruction for proper use. May include other
materials at no cost to the consumer.

13.04

Distribution-Safer injection/bleach kits

Provision of packages that minimally contain a small bottle of bleach
and needle cleaning instructions. Packages may include bottle caps
for cookers, cotton, alcohol wipes, and bottles of water for rinsing
needles. Materials are provided at no cost to the consumer.

13.05

Distribution-Lubricants

Provision of water based lubricants at no cost to the consumer as
part of HIV prevention activities.

13.06

Distribution-Education materials

Provision of printed materials designed to be learning or teaching
aids by handing them out, placing in a location to be accessed by
consumers, or electronic dissemination at no cost to the consumer.

13.07

Distribution-Referral lists

Provision of lists of specific organizations that provide a specific set of
HIV prevention, care, or support services with contact information.
The agencies listed are known by the provider to be reliable sources
for those services based on provider knowledge and experience.
Lists may be disseminated by handing them out, placing them in a
location to be accessed by the consumer, or emailed to consumers.

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Variable Name

Mandatory

HD

CBO

13.08

Distribution-Role model stories

Provision stories of individuals who have changed their behaviors or
plan to change their behaviors to reduce their risk for HIV
transmission or infection. Stories may be disseminated by handing
them out, placing them in a location to be accessed by the consumer,
or emailed to consumers.

13.66

Distribution-Other

Provision of materials or supplies to consumers with the intent to
decrease their risk for HIV transmission or infection and/or to improve
health outcomes. Distribution may include dissemination in person,
by placing materials in locations to be accessed by consumers, sent
to consumers electronically or land mail. Does not include condoms,
safer sex kits, bleach kits, lubricants, education materials, referral
lists, or role model stories.

14.01

Post-intervention follow up

Individual or group meeting or contact with participant(s) of an
intervention after the last session of the intervention to assess or
discuss changes targeted by the intervention and/or revisions to risk
reduction goals and/or strategies.

14.02

Post-intervention booster session

An intervention session conducted with participant(s) of an
intervention after the last session to review and reinforce risk
reduction skills and information addressed by the intervention.

15.00

HIV Testing History Survey

The provision of the "HIV Testing History Survey." This value choice
is applicable only to those organizations who are funded by CDC to
administer the survey.

88

Other (specify)

Any HIV prevention activity not captured in other value choices.

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Num

Variable Name

F11

Mandatory

Delivery Method

HD

CBO

No

Yes

Definition: The medium(s) or channel(s) through which the intervention is delivered.
Instructions: Indicate how you plan to deliver the intervention, such as delivering it in person, vi
Code

Value Description

Value Definition

01.00

In person

The intervention is delivered by an individual or a group of individuals
in the physical presence of the client(s). Includes counseling, face to
face discussions, facilitating group activities, lectures, presentations,
etc.

02.00

Internet

The use of email, chat rooms, or websites to deliver information to
clients electronically.

03.00

Printed Materials

The use of pamphlets, direct mailing, magazines, newspapers,
posters, billboards, etc. If chosen, please specify the subcategory
(value codes 3.01-3.04) for printed material.

03.01

Printed Materials-magazines/newspapers

Magazine: a bound periodical published at regular intervals under the
same title containing articles of specific interest. Newspaper: a
periodical that is folded rather than bound and published at regular
intervals under the same title containing news, opinions,
advertisements, and other items of current, often local, interest.

03.02

Printed Materials-pamphlets/brochures

Pamphlet/Brochure: A short, printed publication that is unbound or
has a paper binding written to inform on a specific topic or to address
a public issue or event. This can be multiple pages bound in a
booklet form or single page folded in panels. In the context of HIV
prevention, it is typically used to promote practices (such as safer
sex), services (such as counseling and testing) information (such as
HIV transmission risk).

03.04

Printed Materials-posters/billboards

Posters: a single sheet sign posted or displayed used to advertise
simple messages or as an advertisement for goods and services.
Typically used to promote practices (such as safer sex), services
(such as counseling and testing) information (such as HIV
transmission risk), or products (condoms). Billboards: large signs or
posters that are typically outdoors on which messages or
advertisements are placed with the intent to be viewed by the general
public. Typically used to promote practices (such as safer sex),
services (such as counseling and testing) information (such as HIV
transmission risk), or products (condoms).

04.00

Radio

The use of radio broadcasts using public service announcements,
commercial air time, and the inclusion of messages in radio
programs, etc.

05.00

Telephone

The use of telephones or telephone "hot lines".

06.00

Television

The use of televised broadcasts using public service announcements,
commercial air time, etc.

07.00

Video

The use of pre-recorded visual and audio messages not delivered via
broadcast or cable TV (e.g., on a VHS tape or DVD).

88

Other (specify)

The use of methods or mediums to deliver the intervention other than
those that are listed in the other value choices (1.0-7.0). If chosen,
please specify the delivery method.

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Num

Variable Name

F12

Mandatory

Language of Intervention Delivery

HD

CBO

No

Yes

Definition: The primary language(s) in which the intervention is delivered.
Instructions: Indicate the primary language in which the intervention is delivered.
Code

Value Description

Value Definition

01

English

The intervention will be delivered primarily in English.

02

Spanish

The intervention will be delivered primarily in Spanish.

03

Arabic

The intervention will be delivered primarily in Arabic.

04

Cambodian

The intervention will be delivered primarily in Cambodian.

05

Cantonese

The intervention will be delivered primarily in Cantonese.

06

Creole/French

The intervention will be delivered primarily in Creole/French.

07

Farsi

The intervention will be delivered primarily in Farsi.

08

Haika

The intervention will be delivered primarily in Haika.

09

Hindi

The intervention will be delivered primarily in Hindi.

10

Japanese

The intervention will be delivered primarily in Japanese.

11

Korean

The intervention will be delivered primarily in Korean.

12

Lao

The intervention will be delivered primarily in Lao.

13

Mandarin

The intervention will be delivered primarily in Mandarin.

14

Russian

The intervention will be delivered primarily in Russian.

15

Tagalog

The intervention will be delivered primarily in Tagalog.

16

Thai

The intervention will be delivered in Thai.

17

Vietnamese

The intervention will be delivered primarily in Vietnamese.

88

Other

The intervention will be delivered in a language other than the
languages specified in the categories above.

F13

Detailed Behavior Data Collection

Yes

Yes

Definition: An indication of whether the intervention involves the collection of Table I: Client
Behavior Details.
Instructions: Indicate whether this particular intervention will include the collection of Table I: Cl
Code

Value Description

Value Definition

0

No

Table I: Client Behavior Details data will not be collected for this
intervention.

1

Yes

Table I: Client Behavior Details data will be collected for this
intervention.

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Num

Variable Name

F14

Mandatory

Level of Data Collection

HD

CBO

Yes

Yes

Definition: The type of client service data, (i.e., client-level or aggregate-level), that will be
collected during an intervention.
Instructions: Indicate if client service data for the intervention will be collected at the aggregate
Code

Value Description

Value Definition

1

Individual

Client-level data associated with this intervention will be collected.

2

Aggregate

Aggregate-level data associated with this intervention will be
collected.

F15

Duration of Intervention Cycle

Yes

Yes

Yes

Yes

Definition: A number that represents the period of time over which the predetermined
number of sessions that comprise an intervention is to be delivered.
Instructions: Enter the number that represents the period of time over which the predetermined
F16

Unit of Duration
Definition: The measure of time used to describe the duration of the intervention cycle.
Instructions: Indicate the specific measure of time in "days" or "months" used to describe the d

Code

Value Description

Value Definition

1

Month(s)

The intervention cycle will be delivered over a specified number of
months.

2

Day(s)

The intervention cycle will be delivered over a specified number of
days.

F17

Specified Recall Period

Yes

Yes

Definition: Indicate the recall period used for the collection of detailed behavior data.
Instructions: If variable F13: Detailed Behavioral Data Collection = “Yes”, then specify the recal
Code

Value Description

Value Definition

01

15 days

The recall period used during the collection of Table I: Client
Behavior Details will be 15 days. The recall period chosen should be
used at intake, the final session and any other point of data collection
for the intervention (e.g., midpoint or post-intervention follow-up).

02

30 days

The recall period used during the collection of Table I: Client
Behavior Details will be 30 days. The recall period chosen should be
used at intake, the final session and any other point of data collection
for the intervention (e.g., midpoint or post-intervention follow-up).

03

90 days

The recall period used during the collection of Table I: Client
Behavior Details at intake will be 90 days.

04

Local period (Specify)

The recall period used during the collection of Table I: Client
Behavior Details will be a locally-defined period of time other than 15,
30, or 90 days. The recall period chosen should be used at intake,
the final session and any other point of data collection for the
intervention (e.g., midpoint or post-intervention).

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Num

Variable Name

Mandatory

HD

CBO

Client Level
Table: G1

Client Characteristics-Demographic

This table is required to be completed by all agencies that provide HIV prevention interventions individually to clients (e.g. counseling and
testing, CRCS, PCRS).
It is also required for some interventions delivered in groups or through outreach.
Reported to CDC
Num

Variable Name

G101

Mandatory

Date Collected

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The date client demographic data were collected.
Instructions: Enter the date that client demographic data were collected.
G102

PEMS Client Unique Key
Definition: A system generated code that is used to distinguish between clients receiving
HIV prevention services within a particular agency.
Instructions: The system will generate a unique, non-identifying code to represent each client r

G112

Date of Birth-Year
Definition: The calendar year in which the client was born.
Instructions: Enter the year in which the client was born.

G113

Calculated Age
Definition: The client's age at the time of data collection. This variable should be collected if
the client's year of birth (G112: Date of Birth-Year) is not recorded.
Instructions: The system will generate the client’s age at the time client demographic data wer

G114

Ethnicity
Definition: The client's self report of whether they are of Hispanic or Latino origin. Standard
OMB ethnicity codes are applied.
Instructions: Indicate whether the client reported that he or she is Hispanic/Latino or not Hispa

Code

Value Description

Value Definition

77

Refused to answer

The client declines or is unwilling to report his/her ethnicity.

99

Don't know

The client reports that they are unaware of their ethnicity.

E1

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race.

E2

Not Hispanic or Latino

A person not identified by the definition of Hispanic or Latino.

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Num

Variable Name

G115

Mandatory

Ethnicity Expanded

HD

CBO

Yes

Yes

Definition: A more detailed description of the client's Hispanic or Latino background based
on their self-reported ethnicity in variable G114: Ethnicity. Expanded OMB
ethnicity codes are applied.
Instructions: If the client's reported “Ethnicity” is “Hispanic or Latino,” then the “Ethnicity Expan
Code

Value Description

Value Definition

E1.01

Spaniard

Source = OMB Ethnicity Codes

E1.01.001

Andalusian

Source = OMB Ethnicity Codes

E1.01.002

Asturian

Source = OMB Ethnicity Codes

E1.01.003

Castillian

Source = OMB Ethnicity Codes

E1.01.004

Catalonian

Source = OMB Ethnicity Codes

E1.01.005

Belearic Islander

Source = OMB Ethnicity Codes

E1.01.006

Gallego

Source = OMB Ethnicity Codes

E1.01.007

Valencian

Source = OMB Ethnicity Codes

E1.01.008

Canarian

Source = OMB Ethnicity Codes

E1.01.009

Spanish Basque

Source = OMB Ethnicity Codes

E1.02.001

Mexican American

Source = OMB Ethnicity Codes

E1.02.002

Mexicano

Source = OMB Ethnicity Codes

E1.02.003

Chicano

Source = OMB Ethnicity Codes

E1.02.004

La Raza

Source = OMB Ethnicity Codes

E1.02.005

Mexican American Indian

Source = OMB Ethnicity Codes

E1.03

Central American

Source = OMB Ethnicity Codes

E1.03.001

Costa Rican

Source = OMB Ethnicity Codes

E1.03.002

Guatemalan

Source = OMB Ethnicity Codes

E1.03.003

Honduran

Source = OMB Ethnicity Codes

E1.03.004

Nicaraguan

Source = OMB Ethnicity Codes

E1.03.005

Panamanian

Source = OMB Ethnicity Codes

E1.03.006

Salvadoran

Source = OMB Ethnicity Codes

E1.03.007

Central American Indian

Source = OMB Ethnicity Codes

E1.03.008

Canal Zone

Source = OMB Ethnicity Codes

E1.04

South American

Source = OMB Ethnicity Codes

E1.04.001

Argentinean

Source = OMB Ethnicity Codes

E1.04.002

Bolivian

Source = OMB Ethnicity Codes

E1.04.003

Chilean

Source = OMB Ethnicity Codes

E1.04.004

Columbian

Source = OMB Ethnicity Codes

E1.04.005

Ecuadorian

Source = OMB Ethnicity Codes

E1.04.006

Paraguayan

Source = OMB Ethnicity Codes

E1.04.007

Peruvian

Source = OMB Ethnicity Codes

E1.04.008

Uruguayan

Source = OMB Ethnicity Codes

E1.04.009

Venezuelan

Source = OMB Ethnicity Codes
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Num

Variable Name

Mandatory

E1.04.010

South American Indian

Source = OMB Ethnicity Codes

E1.05

Latin American

Source = OMB Ethnicity Codes

E1.06

Puerto Rican

Source = OMB Ethnicity Codes

E1.07

Cuban

Source = OMB Ethnicity Codes

E1.08

Dominican

Source = OMB Ethnicity Codes

G116

Race

HD

Yes

CBO

Yes

Definition: A client's self-reported classification of the biological heritage with which they
most closely identify. Standard OMB race codes are applied.
Instructions: Indicate the client’s self reported race using standard OMB race codes. Record a
Code

Value Description

99

Don't know

The client reports that they are unaware of their race.

R1

American Indian or Alaska Native

A person having origins in any of the original peoples of North or
South America (including Central America), and who maintains tribal
affiliation or community attachment.

R2

Asian

A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian Subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.

R3

Black or African American

A person having origins in any of the black racial groups of Africa.

R4

Native Hawaiian or Pacific Islander

A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.

R5

White

A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.

G117

Value Definition

Race Expanded

Yes

Yes

Yes

Yes

Definition: A more detailed description of the client's racial background based on their selfreported race in variable G116: Race. Expanded OMB race codes are applied.
Instructions: If the client provides a more detailed description of their racial background reporte
Code

Value Description

Value Definition

OMB

OMB Values

OMB lists will be provided.

G118

More Than One Race (system generated)
Definition: A system generated variable that is used to identify if a client has reported more
than one race in variable G116: Race.
Instructions: The system will generate the value for this variable based on information entered i

Code

Value Description

Value Definition

0

No

The client did not report more than one of the racial categories
specified in G116: Race.

1

Yes

The client reported more than one of the racial categories specified in
G116: Race.

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Num

Variable Name

G120

Mandatory

State/Territory of Residence

HD

CBO

Yes

Yes

Definition: The state, territory or district where the client was currently residing at the time of
service delivery.
Instructions: Select the state, territory or district where the client lives at the time services are
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina

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Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

78

VI

Virgin Islands of the U.S.

G121

English Speaking?

HD

CBO

No

Yes

Definition: A confirmation of whether the client speaks English.
Instructions: Indicate whether the client speaks English.
Code

Value Description

Value Definition

0

No

The client does not speak English.

1

Yes

The client speaks English.

99

Don't Know

The provider does not know whether or not the client speaks English.

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Num

Variable Name

G122

Mandatory

Primary Language

HD

CBO

No

Yes

Definition: The language most often used by the client.
Instructions: Specify the primary language that is most often used by the client. If G121: Engli
Code

Value Description

Value Definition

01

English

The language primarily or most often used by the client is English.

02

Spanish

The language primarily or most often used by the client is Spanish.

03

Arabic

The language primarily or most often used by the client is Arabic.

04

Cambodian

The language primarily or most often used by the client is Cambodian.

05

Cantonese

The language primarily or most often used by the client is Cantonese.

06

Creole/French

The language primarily or most often used by the client is
Creole/French.

07

Farsi

The language primarily or most often used by the client is Farsi.

08

Haika

The language primarily or most often used by the client is Haika.

09

Hindi

The language primarily or most often used by the client is Hindi.

10

Japanese

The language primarily or most often used by the client is Japanese.

11

Korean

The language primarily or most often used by the client is Korean.

12

Lao

The language primarily or most often used by the client is Lao.

13

Mandarin

The language primarily or most often used by the client is Mandarin.

14

Russian

The language primarily or most often used by the client is Russian.

15

Tagalog

The language primarily or most often used by the client is Tagalog.

16

Thai

The language primarily or most often used by the client is Thai.

17

Vietnamese

The language primarily or most often used by the client is
Vietnamese.

88

Other (specify)

If the language primarily or most often used by the client is a
language other than the languages specified in the categories above,
specify the language.

G123

Assigned Sex at Birth

Yes

Yes

Definition: The biological sex assigned to the client at birth, (i.e., the sex noted on the
client's birth certificate).
Instructions: Indicate whether the client reports being physically born a male or female (i.e., bei
Code

Value Description

Value Definition

01

Male

The sex that produces spermatozoa by which female ova are
fertilized.

02

Female

The sex that produces ova, can conceive and bear offspring/children.

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Num

Variable Name

G124

Mandatory

Current Gender

HD
Yes

CBO
Yes

Definition: The client's current self-reported sexual identity.
Instructions: Select the variable value that most closely describes the client's current, self-repo
Code

Value Description

Value Definition

01

Male

The behavioral, cultural, or psychological traits typically associated
with the male sex.

02

Female

The behavioral, cultural, or psychological traits typically associated
with the female sex.

03

Transgender-MTF

Individuals whose physical or birth sex is male but whose gender
expression and/or gender identity is female. Note: MTF = male to
female.

04

Transgender-FTM

Individuals whose physical or birth sex is female but whose gender
expression and/or gender identity is male. Note: FTM = female to
male.

G127

Level of Education

No

Yes

Definition: The level of formal education last completed by the client.
Instructions: Indicate the highest level of education that the client has completed.
Code

Value Description

Value Definition

01

No schooling completed

The client has not received any formal schooling.

02

8th grade or less

The highest grade that the client completed was eighth grade or a
lower grade.

03

Some high school

The client completed some grades of high school but did not
graduate or receive a GED or equivalent.

04

High school graduate, GED or equivalent

The client graduated from high school or received a GED or
equivalent.

05

Some college

The client received an associate or technical degree or attended a
college or university but did not receive a bachelor's degree.

06

Bachelor's degree

The client received a degree that normally requires at least 4 but not
more than 5 years of full-time equivalent college-level work.

07

Post graduate degree

The client received completed a Masters, Doctorate, and/or other
professional degrees.

66

Not asked

The provider did not ask the client about his/her level of education.

77

Refused to answer

The client declines or is unwilling to report his/her level of education.

99

Don't know

The client reports that they are unaware of their level of education.

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Num

Variable Name

Table: G2

Mandatory

HD

CBO

Client Characteristics-Risk Profile

This table is required to be completed by all agencies that provide HIV prevention interventions individually to clients (e.g. counseling and
testing, CRCS, PCRS).
It is also required for some interventions delivered in groups or through outreach.
Reported to CDC
Num

Variable Name

G200

Mandatory

Date Collected

HD

CBO

Yes

Yes

Yes

Yes

Definition: The date client risk profile data are collected.
Instructions: Enter the date on which these risk profile data are collected.
G201

Incarcerated
Definition: In the 90 days prior to data collection, the client is or has been imprisoned or
confined to a jail or penitentiary for at least 24 hours.
Instructions: Indicate if the client has been incarcerated in the last 90 days, (i.e., 90 days prior

Code

Value Description

Value Definition

0

No

The client has not been incarcerated.

1

Yes

The client has been incarcerated.

66

Not asked

The provider did not ask the client whether he/she had been
incarcerated.

77

Refused to answer

The client declines or is unwilling to report if he/she had been
incarcerated.

G202

Sex Worker

Yes

Yes

Definition: In the 90 days prior to data collection, the client has derived some or part of his
or her income or compensation from engaging in sexual intercourse. This would
include prostitutes (brothel workers, street workers, escorts, bar girls/in-house
prostitutes, call girls/call boys), adult film actors/actresses, and full body
masseuses. Update definition with: In addition to money, anything else the client
considers to be compensation from sex work is included (e.g., drugs, housing,
etc.). The intent of this variable is to assess the extent to which a client identifies
themselves as a sex worker.
Instructions: Indicate whether the client has derived some or part of his or her income or comp
Code

Value Description

Value Definition

0

No

The client has not engaged in sexual intercourse with paying clients.

1

Yes

The client has engaged in sexual intercourse with paying clients.

66

Not asked

The provider did not ask the client whether he/she had engaged in
sexual intercourse with paying clients.

77

Refused to answer

The client declines or is unwilling to report whether he/she engaged
in sexual intercourse with paying clients.

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Num

Variable Name

G203

Mandatory

Housing Status

HD

CBO

Yes

Yes

Definition: The type of living arrangement(s) in which the client has resided (e.g., short-term
facility, community residence, house, apartment, homeless), in the 90 days prior
to data collection.
Instructions: Specify the type(s) of living arrangements that the client has had in the last 90 da
Code

Value Description

Value Definition

01

Permanent housing

Includes apartments, houses, foster homes, long-term residences,
and boarding homes, as long as they are not time limited.

02

Non-permanent housing

Includes homeless, as well as transient or transitional housing.

03

Institution

An establishment that provides living quarters and care for the
elderly, chronically ill or mentally/physically handicapped.

66

Not asked

The provider did not ask the client about his/her housing status.

77

Refused to answer

The client declines or is unwilling to report his/her housing status.

88

Other

The client reported housing status other than what is described in the
categories above.

99

Don't know

The client reported that they are unaware of their housing status.

G204

Previous HIV test

Yes

Yes

Definition: The client's self-report of having had at least one prior HIV test before these data
were collected.
Instructions: Indicate if the client reports having at least one prior HIV test before these data w
Code

Value Description

Value Definition

0

No

The client reported that they have never had an HIV test.

1

Yes

The client reported that they have had at least one previous HIV test.

66

Not asked

The provider did not ask the client about having a prior HIV test.

77

Refused to answer

The client declines or is unwilling to report if he/she has had a
previous HIV test.

99

Don't Know

The client reported that they are unaware if they have had a previous
HIV test.

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Num

Variable Name

G205

Mandatory

Self Reported HIV Test Result

HD

CBO

Yes

Yes

Definition: The client's self-reported test result from his/her most recent HIV test.
Instructions: If the client reports having had a previous HIV test (i.e. G204: Previous HIV Test
Code

Value Description

Value Definition

01

Positive

The client reported that their HIV serostatus is positive based on a
confirmatory test result.

02

Negative

The client reported that their HIV serostatus is negative.

03

Preliminary Positive/Indeterminate

The client reports that he/she received either a “Preliminary positive”
test result (i.e., the client had a reactive HIV rapid test but did not
receive the results of the associated conventional confirmatory test)
or an “Indeterminate” test result (i.e., the client received results but
those results did not conclusively indicate whether he/she is HIVpositive or HIV-negative).

66

Not asked

The provider did not ask the client about his/her HIV serostatus.

77

Refused to answer

The client declines or is unwilling to report his/her HIV serostatus.

99

Don't know

The client reports that they are unaware of their HIV serostatus.

G206

Date of Last HIV Negative Test (only if HIV-)

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The self-reported date of the client’s most recent HIV negative test.
Instructions: If the client's self reported HIV serostatus is negative (G205: Self-Reported HIV S
G207

Date of First HIV Positive Test (only if HIV+)
Definition: The self-reported date of the client’s first positive HIV test.
Instructions: If the client’s self-reported HIV serostatus is positive (G205: Self-Reported HIV Te

G208

In HIV Medical Care/Treatment (only if HIV+)
Definition: The client's self-report of currently receiving HIV medical care and treatment
through antiretroviral therapy or prophylactic treatment for opportunistic
infections.
Instructions: If the client’s self-reported HIV serostatus is positive (G205: Self-Reported HIV St

Code

Value Description

Value Definition

0

No

The client reported they are not currently receiving medical
care/treatment for HIV infection or AIDS.

1

Yes

The client reports they are currently receiving medical care/treatment
for HIV infection or AIDS.

66

Not asked

The provider did not ask the client if they were currently receiving
medical care/treatment for HIV infection or AIDS.

77

Refused to answer

The client declines or is unwilling to report if they are currently
receiving medical care/treatment for HIV infection or AIDS.

99

Don't know

The client reports that they are unaware if they are receiving medical
care/treatment for HIV infection or AIDS.

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Num

Variable Name

G209

Mandatory

Pregnant (only if female)

HD

CBO

Yes

Yes

Definition: The self-reported pregnancy status of the client.
Instructions: If the client is female (G123: Assigned Sex at Birth = “Female”), then indicate whe
Code

Value Description

Value Definition

0

No

The client reports she is not pregnant.

1

Yes

The client reports she is pregnant.

66

Not asked

The provider did not ask the client if she was currently pregnant.

77

Refused to answer

The client declines or is unwilling to report if she is currently pregnant.

99

Don't know

The client reports that she is unaware if she is currently pregnant.

G210

In Prenatal Care (only if pregnant)

Yes

Yes

Definition: The self-reported status of the pregnant client's receipt of regular health care
during pregnancy.
Instructions: If the client is pregnant (G209: Pregnant = “Yes”), indicate whether she is receivin
Code

Value Description

Value Definition

0

No

The client reports she is not currently receiving prenatal care.

1

Yes

The client reports she is currently receiving prenatal care.

66

Not asked

The provider did not ask the client if she was currently receiving
prenatal care.

77

Refused to answer

The client declines or is unwilling to report if she is currently receiving
prenatal care.

99

Don't know

The client reports that she is unaware if she is currently receiving
prenatal care.

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Num

Variable Name

G211

Mandatory

Client Risk Factors

HD

CBO

Yes

Yes

Definition: A description of the risk factor(s) that placed the client at potential risk for HIV
exposure and/or transmission. It is crucial to accurately identify a client’s risk
behaviors. Accurate identification of risks can be used to determine if a program
designed to target specific risk behaviors is effectively identifying appropriate
clients.
Instructions: Select all of the activities that the client has been involved in within the last 90 day
Code

Value Description

Value Definition

01

Injection drug use

The client has used illicit injection drugs/substances (including
narcotics, hormones, silicon, etc.). Illicit injection drugs/substances
are those for which a client does not have a prescription (or which the
client uses in a way other than is prescribed) or drugs/substances
that are not available over the counter (or which are used in a way
other than intended).

02

Sex with transgender

The client has had anal or vaginal intercourse (protected or
unprotected) with a person known to him/her to be a transgender..

03

Sex with female

The client has had anal or vaginal intercourse (protected or
unprotected) with a female.

04

Sex with male

The client has had anal or vaginal intercourse (protected or
unprotected) with a male.

05

No risk identified

The client reports no risk factors that may have placed the client at
potential risk for HIV exposure and/or transmission.

66

Not asked

The provider did not ask the client about his/her risk factors.

77

Refused to answer

The client declined or was unwilling to report his/her risk factors.

88

Other

The client reported risk factors other than what is described in the
categories described above. These include risk factors such as being
a hemophiliac or transfusion/transplant recipient.

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Num

Variable Name

G212

Mandatory

Additional Client Risk Factors

HD

CBO

Yes

Yes

Definition: If the client's risk factors involve sexual activity, these are additional factors that
further describe the client's sexual risk for HIV exposure and/or transmission.
Instructions: Use this variable only if the client reported sex with male, female, or transgender
Code

Value Description

Value Definition

00

No additional risk information specified

The client reported no additional risk or additional partner information
was not available.

01

Exchange sex for drugs/money/or something they needed

The client participated in sex events in exchange for drugs or money
or something they needed.

02

While intoxicated and/or high on drugs

The client used alcohol and/or illicit drugs before and/or during sex.

03

With person who is an IDU

The client has had a sex with a person who he/she knew to be an
IDU.

04

With person who is HIV positive

The client has had a sex with a person who he/she knew was HIV+.

05

With person of unknown HIV status

The client has had sex with a person whose HIV status is unknown to
either the client or to the partner.

06

With person who exchanges sex for drugs/money

The client has had a sex with a person who he/she knows exchanges
sex for drugs/money.

07

With person who is a known MSM

The client is female and has had sex with a person who she knows
has male to male sex.

08

With anonymous partner

The client has had sex with a person whose identity was unknown to
the client. A person’s identity is a set of behavioral or personal
characteristics by which that person is known. This can include
information about a person’s name, address, and habits that allow
the client to identify the person.

09

With person who has hemophilia or transfusion/transplant recipient

The client has had sex with a person who he/she knows has
hemophilia or is a transfusion/transplant recipient.

66

Not asked

The provider did not ask the client about additional sexual risk factors.

77

Refused to answer

The client declines or is unwilling to report additional sexual risk
factors.

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Num

Variable Name

G213

Mandatory

Recent STD (Not HIV)

HD

CBO

Yes

Yes

Definition: The client's self-reported or laboratory confirmed status of having been
diagnosed with syphilis, gonorrhea, or Chlamydia.
Instructions: Indicate if the client has been diagnosed with syphilis, gonorrhea, or Chlamydia in
Code

Value Description

Value Definition

00

No

The client reported that he/she has not been diagnosed with syphilis,
gonorrhea, or Chlamydia.

01.01

Yes-self report

The client reported that he/she has been diagnosed with syphilis,
gonorrhea, or Chlamydia.

01.02

Yes-laboratory confirmed

There is documentation from a licensed testing facility confirming that
the client has had syphilis, gonorrhea, or Chlamydia.

66

Not asked

The provider did not ask the client if he/she had been diagnosed with
syphilis, gonorrhea, or Chlamydia.

77

Refused

The client declines or is unwilling to provide information on whether or
not he/she has been diagnosed with syphilis, gonorrhea, or
Chlamydia.

99

Don't know

The client reports that he/she is unaware of being diagnosed with
syphilis, gonorrhea, or Chlamydia.

G214

Injection Drugs/Substances

No

Yes

Definition: The client's self-reported drugs/substances that they have injected in the past 90
days.
Instructions: If the client’s risk includes injection drug use (G211: Client Risk Factors = "Injectio
Code

Value Description

01

Heroin and cocaine together

02

Heroin alone

03

Cocaine alone

04

Crack

05

Amphetamines, speed, crystal, meth, ice

06

Other narcotic drugs

07

Hormones

08

Steroids

09

Silicone

10

Botox

11

Other medical substances

Value Definition

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Num

Variable Name

G215

Mandatory

Internet Sex Partners

HD

CBO

No

Yes

Definition: The client's self report of having had sex with someone they met initially on the
Internet.
Instructions: Indicate whether the client has had sex within the last 90 days with someone who
Code

Value Description

Value Definition

0

No

The client reports that he/she has not initially met a sex partner on
the Internet.

1

Yes

The client reports that he/she has initially met a sex partner on the
Internet.

77

Refused to answer

The client declines or is unwilling to report if he/she had initially met a
sex partner on the Internet.

99

Don't know

The client reports that he/she is unaware of initially meeting a sex
partner on the Internet.

Table: G3

Client Characteristics-Confirmed HIV Status

This table is relevant when a client presents proof of a confirmed HIV test result to a provider, or when a client receives a confirmed HIV
test result at your agency. Confirmation of HIV status occurs in two ways. A client can present test result documents from another agency,
in which case the provider will complete this table. If a client receives HIV testing activities within the agency, these variables correspond to
the confirmed test result documented in Table X-1 and, in CPEMS, will be pre-populated with this information.
Reported to CDC
Num

Variable Name

G301

Mandatory

Confirmed HIV Test Result

HD

CBO

Yes

Yes

Definition: The client's HIV serostatus confirmed either through documentation (e.g., lab
results) from another agency, or from HIV test results provided within an agency.
Instructions: If you have documentation of the client's previous HIV test with confirmed test res
Code

Value Description

Value Definition

01

Positive/Reactive

A test result that is reactive on an initial ELISA test, repeatedly
reactive on a second ELISA run on the same specimen, and
confirmed positive on a Western blot or other supplemental test
indicating that the client is infected with HIV.

02

NAAT-positive

A test result that was previously negative or indeterminate but is
reactive based on a nucleic acid testing.

03

Negative

A test result that is non-reactive on an initial ELISA test indicating the
absence of HIV infection or ELISA was repeatedly reactive and a
confirmatory test (Western Blot or IFA) was negative.

04

Indeterminate

A test result that has not been precisely determined. A possible
result of a Western-blot, which might represent a recent HIV infection
or a false positive.

05

Invalid

The test result cannot be confirmed due to conditions related to errors
in the testing technology, specimen collection, or transport.

06

No result

No result was obtained even though the specimen was drawn (e.g.,
blood sample hemolyzed, blood tube broke, blood tube lost in transit,
unable to draw blood from veins).

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Num

Variable Name

G302

Mandatory

HIV Test Date

HD

CBO

Yes

Yes

Yes

Yes

Definition: The date of the confirmatory HIV test.
Instructions: Indicate the date that the confirmatory HIV test was conducted. Similar to G301:
G303

Confirmed Documentation Source
Definition: The source of the confirmed HIV test result.
Instructions: Indicate the source of the documentation that confirms the client's HIV test result.

Code

Value Description

Value Definition

01

Within Agency

A confirmatory HIV test result for the client was provided by your
agency, (e.g., the client was tested within your agency).

02

External Test Result - Agency Provided

Documentation of a confirmatory HIV test result was provided by
another agency (e.g., the client received an HIV test from another
agency and the agency sent documentation of the confirmed test
result to your agency).

03

External Test Result - Client Provided

Documentation of a confirmatory HIV test result conducted by
another agency was provided by the client (e.g., the client received
an HIV test from another agency and provided your agency with
documentation of the confirmed test result).

G304

Confirmation Date

Yes

Yes

Definition: The date the confirmed HIV test result was received by your agency (not the date
the test was conducted).
Instructions: Indicate the date that the confirmed HIV test result was received by your agency.

Table: H

Client Intervention Characteristics

This table is required to be completed by all agencies that provide HIV prevention interventions individually to clients (e.g. counseling and
testing, CRCS, PCRS).
It is also required for some interventions delivered in groups or through outreach.
These data are captured for each provider/client interaction (including date of service provision, activities, and the site where the interaction
occurred).
Reported to CDC
Num
H01

Variable Name

Mandatory

Intervention Name/ID

HD

CBO

Yes

Yes

Definition: An Intervention Name/ID that was entered by your agency in Table F.
Instructions: Select from a list of Intervention Names generated from variable F02: Intervention

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Num

Variable Name

H01a

Mandatory

Cycle

HD

CBO

Yes

Yes

Yes

Yes

Definition: One complete delivery of all the intended sessions for a particular intervention.
This variable is relevant to those interventions that have a predetermined or
targeted number of sessions (as defined by the variable, F08: Number of
Sessions).
Instructions: Enter the cycle number associated with the session delivered. For example, if this
H02

Intended Number of Sessions
Definition: The total number of sessions intended for this cycle of an intervention whose
intended number of sessions can differ depending on the needs of individual
clients (e.g., CRCS). This variable is only entered at the first session.
Instructions: Use this variable in cases where F08: Number of Sessions = “Unknown.” Variabl

Code

Value Description

Value Definition

###

Number

The number of sessions in one complete cycle of the intervention.

999

Unknown

The number of sessions is unknown or will be determined based on
the needs of the client.

H04a

Form ID

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: A code or identification number used to uniquely identify and connect data
collected on a standardized form for a given intervention.
Instructions: If you use a standardized form to collect data for the intervention specified in H01:
H04b

Case Number
Definition: A number to uniquely identify a PCRS case within an agency. This number is
system-generated when establishing a PCRS case or can be a locally-developed
or assigned number that is key-entered by the provider (e.g., interview record
number).
Instructions: Select the applicable PCRS case number that has been assigned to this PCRS c

H05

Session Number
Definition: The session number within a particular intervention cycle about which data are
being entered for this client.
Instructions: For interventions with more than one session, enter the session number within the

H06

Session Date-Month (req for system operation)
Definition: The calendar month in which the session was delivered to the client.
Instructions: Enter the month during which this session was delivered to the client.

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H07

Variable Name

Mandatory

Session Date-Day (req for system operation)

HD

CBO

Yes

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Definition: The calendar day in which the session was delivered to the client.
Instructions: Enter the day during which this session was delivered to the client.
H08

Session Date-Year (req for system operation)
Definition: The calendar year in which the session was delivered to the client.
Instructions: Enter the year during which this session was delivered to the client

H09

PEMS Worker ID
Definition: A system generated code used to distinguish between persons who are
delivering services to clients by a combination of non-identifying characteristics.
Instructions: Choose from a list of workers, established in Table P: Worker, the worker(s) who

H10

Site Name/ID
Definition: The official name of the agency's site of HIV prevention service delivery where
the session took place.
Instructions: Indicate the site where the session took place by selecting from a list of sites esta

H11

Duration of Session
Definition: The amount of time that the session lasted. This variable is required for CRCS
interventions only.
Instructions: Indicate the actual number of minutes that the session lasted. This variable is req

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Num

Variable Name

H13

Mandatory

Recruitment Source

HD
Yes

CBO
Yes

Definition: The means by which the client became aware of and/or entered into the
intervention. This would include how the client learned about the intervention
(e.g., informational flyer, outreach worker, partner referral) or was motivated to
take action in seeking services or enrollment into an intervention.
Instructions: Select the variable value that describes how the client became aware of or entere
Code

Value Description

Value Definition

01

Agency

The client became aware of and/or entered the intervention due to an
agency referral.

02

HC/PI

The client became aware of and/or entered the intervention due to
exposure to one or more of the following: Public Service
Announcement (PSAs), billboards, pamphlets, posters, hotlines,
newspapers, magazines, websites, presentations, and lectures. This
value is non-applicable for recruitment to PCRS.

03

Self

The client became aware of and/or entered the intervention due to
knowledge of potential exposure and without recognition of referral or
source of information. This values is non-applicable for PCRS if the
client is a partner.

04

Partner

The client became aware of and/or entered the intervention through
the recommendation/support of a sex/needle sharing partner, who is
not identified as an outreach peer. This value is non-applicable for
PCRS if the client is the index client.

05

Friend and/or family member

The client became aware of and/or entered the intervention through
the recommendation/support of friends or family members. This
value is not applicable for PCRS.

88

Other (specify)

A recruitment source cannot be identified by any of the other
categories.

99

Don't know

The client reports that he/she is unaware of how they became aware
of and/or initially entered the intervention.

H15

Recruitment Source-Network Agency Name/ID

No

Yes

Definition: The name of the agency that referred the client to the intervention, if applicable.
Variables H15-H19 are only applicable if the recruitment source was an agency.
Instructions: If H13: Recruitment Source = “Agency”, then select the name of the agency that

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Num

Variable Name

H18

Mandatory

Recruitment Source-Service/Intervention Type (only 1st session, and if agency
referral)

HD
Yes

CBO
Yes

Definition: If the client entered CTR through an agency referral, this variable is used to
specify the type of service or intervention the referring agency provides. This
variable is recorded at the first session only.
Instructions: If H13: Recruitment Source = “Agency”, indicate the type of service or intervention
Code

Value Description

Value Definition

01

Counseling and Testing

The client was referred to this intervention from a counseling and
testing intervention.

02

Health Communication/Public Information

The client was referred to this intervention from a Health
Communication/Public Information intervention.

03

Partner Counseling and Referral Services

The client was referred to this intervention from a Partner Counseling
and Referral Services (PCRS) intervention.

04

Comprehensive Risk Counseling Services

The client was referred to this intervention from a Comprehensive
Risk Counseling Services intervention.

05

Outreach

The client was referred to this intervention from an Outreach
intervention.

06

Health Education/Risk Reduction

The client was referred to this intervention from a Health
Education/Risk Reduction intervention.

07

Intake/screening

The client was referred to this intervention during an intake or a risk
screening process.

88

Other

The intervention type cannot be identified by the other intervention
types.

99

Don't know

The client reports that he/she is unaware of the type of intervention
they were receiving at the time they were provided with information or
a referral to this intervention.

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Num

Variable Name

H19

Mandatory

Recruitment Source-Site type ( if agency referral)

HD
Yes

CBO
Yes

Definition: The setting that best describes from where the referral was given.
Instructions: If H13: Recruitment Source = “Agency”, indicate the site type that best describes t
Code

Value Description

Value Definition

F01

Inpatient Facility

A hospital or other health facility where services are provided to
patients that reside within that facility while they are receiving those
services.

F01.01

Inpatient- Hospital

F01.50

Inpatient- Drug / Alcohol Treatment

F01.88

Inpatient Facility- Other (specify)

F01.99

Inpatient Facility- Unknown

F02

Outpatient Facility

A health care facility where services are provided to patients that do
not reside within that facility while they are receiving services.

F02.03

Outpatient- Private Medical Practice

A non-residential health care facility that is privately owned and/or
operated.

F02.04

Outpatient- HIV Specialty Clinic

A non-residential health care facility that concentrates in the provision
of HIV treatment, care and prevention services.

F02.10

Outpatient- Prenatal/ OBGYN Clinic

A non-residential health care facility that provides obstetric,
gynecological and other pregnancy-related health services.

F02.12

Outpatient- TB Clinic

A non-residential health care facility that specializes in the provision
of tuberculosis treatment, care and prevention services.

F02.19

Outpatient- Drug / Alcohol Treatment Clinic

A non-residential health care facility that provides alcohol and
chemical dependency treatment services.

F02.20

Outpatient- Family Planning

A non-residential health care facility that provides pregnancy testing,
birth control services, and other reproductive health services.

F02.30

Outpatient- Community Mental Health

A non-residential health care facility that provides treatment and
support services for the mentally ill or others with mental health
problems including counseling, case management, treatment,
peer/family support and public education.

F02.51

Outpatient- Community Health Clinic

A non-residential health care facility that provides primary and
preventative health care services to the members of a community in
which it is located.

F02.58

Outpatient- School/University Clinic

A non-residential health clinic that is operated by and provides
services within a school or university setting.

F02.60

Outpatient- Health Department/Public Health Clinic

A non-residential health clinic that is supported by public funds.

F02.61

Outpatient- Health Department/Public Health Clinic-HIV

A non-residential health clinic that is supported by public funds and
provides HIV prevention, diagnosis and treatment services.

F02.62

Outpatient- Health Department/Public Health Clinic-STD

A non-residential health clinic that is supported by public funds and
provides STD prevention, diagnosis and treatment services.

F02.88

Outpatient Facility- Other (specify)

F02.99

Outpatient Facility- Unknown

F03

Emergency Room

A residential health facility that provides substance abuse treatment
and rehabilitation.

A section of a hospital or clinic staffed and equipped to provide
emergency care to persons requiring immediate medical treatment for
sudden illness or trauma.

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Num

Variable Name

Mandatory

HD

CBO

F04.01

Blood Bank, Plasma Center

A place where blood is collected from donors, typed, separated into
components, stored, and prepared for transfusion to recipients. A
blood bank may be a separate free-standing facility or part of a larger
laboratory in a hospital.

F04.05

HIV Counseling & Testing Site

A facility or non-facility based setting where HIV prevention
counseling and testing services are provided.

F06

Community Setting

A defined area, environment or context in which a group of people
live, work or congregate.

F06.01

Community Setting-AIDS Service Organization- non-clinical

A health association, support agency, or other service actively
involved in the prevention and treatment of AIDS.

F06.02

Community Setting-School/Education facility

A building or place where individuals receive knowledge through
learning and instruction.

F06.03

Community Setting-Church/Mosque/Synagogue/Temple

A building where a group of people who adhere to a common faith
gather for prayer.

F06.04

Community Setting-Shelter/Transitional housing

Shelters are facilities in which people can stay temporarily when they
would otherwise have to sleep on the street. Shelters also
sometimes provide other services (e.g., soup kitchen, job seeking
skills training, job training, support groups), or refer their clients to
agencies that do. Transitional housing is short to long-term housing
(6 to 24 months) available for individuals or families who are
homeless.

F06.05

Community Setting-Commercial

A business or commercial facility (e.g., beauty salon, grocery store,
shopping center) where HIV prevention services may also occur.

F06.06

Community Setting-Residential

A primary residence that might include residential neighborhoods or
the common areas of apartment complexes or housing developments.

F06.07

Community Setting-Bar/Club/Adult entertainment

A location that is typically open late at night and that provides
entertainment (e.g., singing, dancing) as well as food and drink.

F06.08

Community Setting-Public area

An area, environment or context that is open to the community as a
whole such as a park or city street.

F06.09

Community Setting-Workplace

A location where a worker normally performs his/her job tasks or the
businesses administrative offices. Use this site type for prevention
services delivered to a particular employer's employees.

F06.10

Community Setting- Community center

A facility where the members of a community can gather for social or
cultural activities.

F06.88

Community Setting- Other (specify)

F07

Correctional Facility

F88

Other (Specify)

A penal or correctional facility, prison, jail detention center,
community-based rehabilitation center, or any similar institution
designed for the confinement or rehabilitation of criminal offenders.

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Num

Variable Name

H20

Activity

Mandatory

HD
Yes

CBO
Yes

Definition: The specific actions or components of an intervention in which the client
participated or in which they received during this particular session.
Instructions: Select all of the activities that occurred during this session. Describe what was a
Code

Value Description

Value Definition

03.00

HIV testing

A diagnostic, laboratory procedure to assess for the presence of HIV
antibodies.

04.00

Referral

A process by which immediate client needs for prevention, care, and
supportive services are assessed and prioritized and clients are
provided with information and assistance in identifying and accessing
specific services (such as, setting up appointments and providing
transportation). Note: The provision of a referral also includes a plan
for tracking whether or not the client accessed the referral.

05.00

Personalized risk assessment

The process by which an individual client, a provider or both working
together identify, acknowledge, and understand the details and
context of the client's HIV risk. The assessment should explore
previous risk reduction efforts and identify successes and challenges
of those efforts.

06.00

Elicit partners

The process by which the provider assists the index client in
identifying partners and other sexual and drug-injecting networks at
high risk for transmission of HIV who might benefit from testing and/or
medical examination. (These networks do not include sex partners of
the HIV-infected individual but are made up of individuals who share
social relationships involving sex or drug use.)

07.00

Notification of exposure

The process of informing a HIV-positive client's sex and/or needle
sharing partners of their exposure to HIV. This activity is only
applicable if the intervention type is Partner Counseling and Referral
Services (PCRS).

08.01

Information-HIV/AIDS transmission

Any general information, written or verbal, given to an individual or a
group on HIV/AIDS and how it is transmitted.

08.02

Information-Abstinence/postpone sexual activity

Any information, written or verbal, given to an individual or a group on
abstaining from sexual activity or postponing sexual activity.

08.03

Information-Other sexually transmitted diseases

Any information, written or verbal, given to an individual or a group on
STDs (other than HIV or viral hepatitis), how it is transmitted, how to
reduce risk for transmission or infection, or treatment options.

08.04

Information-Viral hepatitis

Any information on viral hepatitis, how it is transmitted, and/or how to
reduce risk for transmission or infection, or treatment options.

08.05

Information-Availability of HIV/STD counseling and testing

Any information, written or verbal, given to an individual or a group
about where and how to access HIV-related CTR or STD counseling
and testing. This includes referral lists that only list CTR and/or STD
counseling and testing sites.

08.06

Information-Availability of partner notification and referral services

Any information, written or verbal, given to an individual or a group
about where and how to access partner notification services. The
availability information provided is exclusive to PCRS. This includes
referral lists that only list PCRS sites.

08.07

Information-Living with HIV/AIDS

Any information, written or verbal, given to an individual or a group
living with HIV/AIDS specific to living with the disease.

08.08

Information-Availability of social services

Any information, written or verbal, given to an individual or a group
about how and where to access social services. This could include a
referral list that only includes social services agencies or providers.

08.09

Information-Availability of medical services

Any information, written or verbal, given to an individual or a group
about how and where to access HIV medical services. This could
include a referral list that only includes HIV medical care providers.
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Num

Variable Name

Mandatory

HD

CBO

08.10

Information - Sexual risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce sexual risk for HIV transmission or infection.

08.11

Information-IDU risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce injection drug use risk for HIV transmission or infection.

08.12

Information-IDU risk free behavior

Any information, written or verbal given to an individual or a group on
abstaining from injection drug use or only using new needles and
disposing of them appropriately.

08.13

Information-Condom/barrier use

Any information, written or verbal, given to an individual or a group
regarding appropriate use and disposal of condoms or other barrier
methods.

08.14

Information-Negotiation/Communication

Any information, written or verbal, given to an individual or a group
regarding communication of desire for safer practices and negotiating
safer practices with partners (sexual and needle sharing).

08.15

Information-Decision making

Any information, written or verbal, given to an individual or a group
regarding the steps and techniques needed for reassessing, planning
and using judgment to avoid situations that may expose them to HIV
infection or transmission risk and/or decision to engage in a risk
behavior.

08.16

Information-Disclosure of HIV status

Any information, written or verbal, given to an individual or a group
regarding disclosure of their HIV status, applicable laws,
accompanying ramifications, and options regarding non-disclosure.

08.17

Information-Providing prevention services

Any information, written or verbal, given to an individual or a group on
how to communicate prevention messages and/or demonstrate risk
reduction skills with others.

08.18

Information-HIV testing

Any information, written or verbal, given to an individual, couple, or
group regarding HIV testing including explanation of the testing
process and meaning of results, behavioral risks for infection, and
importance of knowing their status.

08.19

Information-Partner notification

Any information, written or verbal, given to an individual or a group
regarding the notification of possible exposure to HIV and
accompanying ramifications, behaviors associated with possible
exposure, and consideration of alternatives or information on how to
notify partners regarding possible exposure.

08.20

Information-HIV medication therapy adherence

Any information, written or verbal, given to an individual or a group
regarding HIV medication therapy, benefits and risk, medical therapy
alternatives, and importance of adhering to medication therapy for
HIV.

08.21

Information-Alcohol and drug use prevention

Any information, written or verbal, given to an individual or a group on
the negative effects and consequences of alcohol and drug use and
its relationship to HIV transmission or infection risk behavior including
strategies to avoid or abstain from use.

08.22

Information-Sexual Health

Any information, written or verbal, given to an individual or a group on
reproductive health, sexuality, sexual development and similar topics.

08.23

Information-TB testing

Any information, written or verbal, given to an individual, couple, or
group on TB, how it is transmitted, and/or how to reduce risk for
transmission or infection, or treatment options

08.66

Information-Other

Any information, written or verbal, given to an individual or group that
cannot be captured in any of the other information codes.

09.01

Demonstration-Condom/barrier use

Provider or participant demonstration (using a teaching tool) of
appropriate use and disposal of condoms or other barrier methods.

09.02

Demonstration-IDU risk reduction

Provider or participant demonstration of how to safely dispose of
syringes or how to use bleach kits to clean works.

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Variable Name

Mandatory

HD

CBO

09.03

Demonstration-Negotiation/Communication

Provider or participant demonstration of how to communicate desire
for safer practices and how to negotiate safer practices with partners
(sexual and needle sharing).

09.04

Demonstration-Decision making

Provider or participant demonstration of steps, and techniques
needed for reassessing, planning and using judgment to avoid
situations that may expose them to HIV infection or transmission risk
and/or decision to engage in a risk behavior.

09.05

Demonstration-Disclosure of HIV status

Provider or participant demonstration of techniques to disclose
seropositive status or discuss issues relevant to disclosure.

09.06

Demonstration-Providing prevention services

Provider or participant demonstration of how to communicate
prevention messages or demonstrate risk reduction skills with others.

09.07

Demonstration-Partner notification

Provider or participant demonstration of how to notify partners
regarding possible exposure to HIV or how to discuss issues relevant
to partner notification.

09.66

Demonstration-Other

Any provider or participant demonstration of a skills or technique that
is not decision making, IDU risk reduction, condom/barrier use,
negotiation and communication, disclosure, or providing prevention
services.

10.01

Practice-Condom/barrier use

Participant practice (using a teaching tool) of appropriate condom
and/or barrier use and disposal during the intervention session.

10.02

Practice-IDU risk reduction

Participant practice of safe needle use and disposal including the use
of bleach kits to clean works during the intervention session(s).

10.03

Practice-Negotiation/ Communication

Participant practice communication of desire for safer practices and
negotiation of safer practices with partners (sexual and needle
sharing) during the intervention session(s).

10.04

Practice-Decision making

Participant practice using steps and techniques needed for
reassessing, planning and using judgment to avoid situations that
may expose them to HIV infection or transmission risk and/or decision
to engage in a risk behavior.

10.05

Practice-Disclosure of HIV status

Participant practice of techniques to disclose seropositive status or
discuss issues relevant to disclosure.

10.06

Practice-Providing prevention services

Participant practice communication of prevention messages and/or
demonstration of risk reduction skills with others during intervention
session(s).

10.07

Practice-Partner notification

Participant practice of how to notify partners regarding possible
exposure to HIV or how to discuss issues relevant to partner
notification.

10.66

Practice-Other

Participant practice of a skill or technique that is not decision making,
IDU risk reduction, condom/barrier use, negotiation and
communication, disclosure, or providing prevention services.

11.01

Discussion-Sexual risk reduction

Facilitation of discussion with individuals or groups involving
examination of sexual risk behaviors (self or others) and
accompanying ramifications, examination of attitudes and feelings
about their risks, consideration of alternatives, and decision making to
reduce sexual risk.

11.02

Discussion-IDU risk reduction

Facilitation of discussion with individuals or groups involving
examination of IDU risk and accompanying ramifications, examination
of attitudes and feelings about their risks, consideration of
alternatives, and decision making to reduce IDU risk.

11.03

Discussion-HIV testing

Facilitation of discussion with individuals, couples, or groups
regarding HIV testing including explanation of the testing process and
meaning of results, discussion of behavioral risks for infection,
examination of attitudes and feelings about their risks, consideration
of alternatives, and decision making to know their status and reduce
HIV transmission risk.
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Num

Variable Name

Mandatory

HD

CBO

11.04

Discussion-Other sexually transmitted diseases

Facilitation of discussion with individuals or groups regarding sexually
transmitted diseases (other than HIV), involving an examination of
behavioral risks and accompanying ramifications, examination of
attitudes and feelings about their risks, consideration of alternatives,
treatment alternatives, and decision making to reduce behavioral risk
for other sexually transmitted diseases and/or seek treatment.

11.05

Discussion-Disclosure of HIV status

Facilitation of discussion with individuals or groups regarding
techniques to disclose seropositive status or discuss issues relevant
to disclosure.

11.06

Discussion-Partner notification

Facilitation of discussion with individuals or groups regarding how to
notify partners regarding possible exposure to HIV or how to discuss
issues relevant to partner notification.

11.07

Discussion-HIV medication therapy adherence

Facilitation of discussion with individuals or groups regarding HIV
medication therapy and accompanying ramifications, examination of
attitudes and feelings about HIV medication therapy, discussion of
medical therapy alternatives, and decision making to begin and
adhere to medication therapy for HIV.

11.08

Discussion-Abstinence/postpone sexual activity

Facilitation of discussion with individuals or groups on abstaining from
sexual activity or postponing the initiation of sexual activity and
accompanying ramifications including an examination of risks
associated with sexual activities, discussion of alternatives, and
decision making to abstain or postpone sexual activity.

11.09

Discussion-IDU risk free behavior

Facilitation of discussion with individuals or groups on abstaining from
injection drug use or only using new needles and disposing
appropriately.

11.10

Discussion-HIV/AIDS transmission

Facilitation of discussion with individuals or groups on HIV/AIDS and
how HIV is transmitted.

11.11

Discussion-Viral hepatitis

Facilitation of discussion with individuals or groups on viral hepatitis,
how it is transmitted, and/or how to reduce risk for transmission or
infection, or treatment options.

11.12

Discussion-Living with HIV/AIDS

Facilitation of discussion with individuals or groups on living with
HIV/AIDS and ramifications of living with HIV/AIDS, examination of
attitudes and feelings about living with the disease.

11.13

Discussion-Availability of HIV/STD counseling and testing

Facilitation of discussion with individuals or groups on where and how
to access HIV-related CTR or STD counseling and testing and may
include the importance of knowing your status. This includes referral
lists that only list CTR and/or STD counseling and testing sites.

11.14

Discussion-Availability of partner notification and referral services

Facilitation of discussion with individuals or groups on where and how
to access partner notification services.

11.15

Discussion-Availability of social services

Facilitation of discussion with individuals or groups on how and where
to access social services.

11.16

Discussion-Availability of medical services

Facilitation of discussion with individuals or groups on how and where
to access HIV medical care. Discussion may include options
regarding available services.

11.17

Discussion-Condom/barrier use

Facilitation of discussion with individuals or groups on the appropriate
use and disposal of condoms or other barrier methods and
accompanying ramifications, examination of attitudes and feelings
about condom use, and decision making regarding use of
condoms/barriers.

11.18

Discussion- Negotiation/Communication

Facilitation of discussion with individuals or groups on communication
of desire for safer practices and negotiating safer practices with
partners (sexual and needle sharing), including discussion of
accompanying ramifications, examination of attitudes and feeling,
and decision making regarding communicating and negotiating safer
practices.

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Num

Variable Name

Mandatory

HD

CBO

11.19

Discussion-Decision making

Facilitation of discussion with individuals or groups on steps and
techniques needed for reassessing, planning and using judgment to
avoid situations that may expose them to HIV infection or
transmission risk and/or decision to engage in a risk behavior.

11.20

Discussion-Providing prevention services

Facilitation of discussion with individuals or groups on communicating
prevention message and/or demonstrating risk reduction skills with
others.

11.21

Discussion-Alcohol and drug use prevention

Facilitation of discussion with individuals or groups on the negative
effects and consequences of alcohol and drug use and its
relationship to HIV transmission or infection risk including strategies
to avoid or abstain from use.

11.22

Discussion-Sexual Health

Facilitation of discussion with individuals or groups on reproductive
health, sexuality, sexual development, and similar topics.

11.23

Discussion-TB testing

Facilitation of discussion with individuals or groups about TB, how it is
transmitted, and/or how to reduce risk for transmission or infection, or
treatment options.

11.66

Discussion-Other

Discussion with individuals or groups regarding HIV infection,
transmission, or risk reduction issues and accompanying
ramifications, examination of attitudes and feelings about these
issues, consideration of alternatives, and decision making to reduce
HIV infection, transmission, or risk reduction. Issues do not include
sexual or IDU risk reduction, HIV testing, other sexually transmitted
diseases, HIV status disclosure, partner notification, or HIV
medication therapy.

12.01

Other testing-Pregnancy

Provision of testing to determine pregnancy.

12.02

Other testing-STD

Provision of testing to determine infection with a sexually transmitted
disease other than HIV or Viral Hepatitis.

12.03

Other testing-Viral hepatitis

Provision of testing to determine infection with viral hepatitis.

12.04

Other testing-TB

Provision of testing to determine infection with tuberculosis.

13.01

Distribution-Male condoms

Provision of male condoms by handing them out or placing them in a
location to be accessed by consumers at no cost to the consumer.

13.02

Distribution-Female condoms

Provision of female condoms by handing them out or placing them in
a location to be accessed by consumers at no cost to the consumer.

13.03

Distribution-Safe sex kits

Provision of packages that minimally contain a condom (male or
female), lubricant, and instruction for proper use. May include other
materials at no cost to the consumer.

13.04

Distribution-Safer injection/bleach kits

Provision of packages that minimally contain a small bottle of bleach
and needle cleaning instructions. Packages may include bottle caps
for cookers, cotton, alcohol wipes, and bottles of water for rinsing
needles. Materials are provided at no cost to the consumer.

13.05

Distribution-Lubricants

Provision of water based lubricants at no cost to the consumer as
part of HIV prevention activities.

13.06

Distribution-Education materials

Provision of printed materials designed to be learning or teaching
aids by handing them out, placing in a location to be accessed by
consumers, or electronic dissemination at no cost to the consumer.

13.07

Distribution-Referral lists

Provision of lists of specific organizations that provide a specific set of
HIV prevention, care, or support services with contact information.
The agencies listed are known by the provider to be reliable sources
for those services based on provider knowledge and experience.
Lists may be disseminated by handing them out, placing them in a
location to be accessed by the consumer, or emailed to consumers.

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Num

Variable Name

Mandatory

HD

CBO

13.08

Distribution-Role model stories

Provision stories of individuals who have changed their behaviors or
plan to change their behaviors to reduce their risk for HIV
transmission or infection. Stories may be disseminated by handing
them out, placing them in a location to be accessed by the consumer,
or emailed to consumers.

13.66

Distribution-Other

Provision of materials or supplies to consumers with the intent to
decrease their risk for HIV transmission or infection and/or to improve
health outcomes. Distribution may include dissemination in person,
by placing materials in locations to be accessed by consumers, sent
to consumers electronically or land mail. Does not include condoms,
safer sex kits, bleach kits, lubricants, education materials, referral
lists, or role model stories.

14.01

Post-intervention follow up

Individual or group meeting or contact with participant(s) of an
intervention after the last session of the intervention to assess or
discuss changes targeted by the intervention and/or revisions to risk
reduction goals and/or strategies.

14.02

Post-intervention booster session

An intervention session conducted with participant(s) of an
intervention after the last session to review and reinforce risk
reduction skills and information addressed by the intervention.

15.00

HIV Testing History Survey

The provision of the "HIV Testing History Survey." This value choice
is applicable only to those organizations who are funded by CDC to
administer the survey.

88

Other (specify)

Any HIV prevention activity not captured in other value choices.

H21

Incentive Provided

No

Yes

Definition: A type of reward that was presented to the client as compensation for the client's
time and participation in the session, (e.g., voucher for transportation, food,
money, or other small reward).
Instructions: Indicate whether or not the client received an incentive of any type for participatin
Code

Value Description

Value Definition

0

No

An incentive was not provided to the client as compensation for the
client's time and participation in the session.

1

Yes

An incentive was provided to the client as compensation for the
client's time and participation in the session.

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Num

Variable Name

H22

Mandatory

Unit of Delivery

HD

CBO

Yes

Yes

Definition: The category or grouping of clients receiving prevention services per session.
Instructions: Indicate how many clients received the session at the same time. This variable d
Code

Value Description

Value Definition

01

Individual

The intervention/session was provided to one person at a time.

02

Couple

The intervention/session was provided to two people that are in a sex
or drug-using relationship.

03

Small group

The intervention/session was provided to 2-12 people at the same
time and setting.

04

Large group

The intervention/session was provided to more than 12 people at the
same time and setting.

05

Community

The intervention/session was provided to a population as a whole,
rather than individuals or small/large groups, (i.e. community
mobilizations, social marketing campaigns, community-wide events,
health fairs, policy interventions, and structural interventions).

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Num

Variable Name

H23

Mandatory

Delivery Method

HD

CBO

Yes

Yes

Definition: The medium(s) or channel(s) through which the intervention session is delivered.
Instructions: Indicate how the intervention was delivered (e.g., in person, by using a video, ove
Code

Value Description

Value Definition

01.00

In person

The intervention is delivered by an individual or a group of individuals
in the physical presence of the client(s). Includes counseling, face to
face discussions, facilitating group activities, lectures, presentations,
etc.

02.00

Internet

The use of email, chat rooms, or websites to deliver information to
clients electronically.

03.00

Printed Materials

The use of pamphlets, direct mailing, magazines, newspapers,
posters, billboards, etc. If chosen, please specify the subcategory
(value codes 3.01-3.04) for printed material.

03.01

Printed Materials-magazines/newspapers

Magazine: a bound periodical published at regular intervals under the
same title containing articles of specific interest. Newspaper: a
periodical that is folded rather than bound and published at regular
intervals under the same title containing news, opinions,
advertisements, and other items of current, often local, interest.

03.02

Printed Materials-pamphlets/brochures

A short, printed publication that is unbound or has a paper binding
written to inform on a specific topic or to address a public issue or
event. This can be multiple pages bound in a booklet form or single
page folded in panels. In the context of HIV prevention, it is typically
used to promote practices (such as safer sex), services (such as
counseling and testing) information (such as HIV transmission risk).

03.04

Printed Materials-posters/billboards

Posters: a single sheet sign posted or displayed used to advertise
simple messages or as an advertisement for goods and services.
Typically used to promote practices (such as safer sex), services
(such as counseling and testing) information (such as HIV
transmission risk), or products (condoms). Billboards: large signs or
posters that are typically outdoors on which messages or
advertisements are placed with the intent to be viewed by the general
public. Typically used to promote practices (such as safer sex),
services (such as counseling and testing) information (such as HIV
transmission risk), or products (condoms).

04.00

Radio

The use of radio broadcasts using public service announcements,
commercial air time, and the inclusion of messages in radio
programs, etc.

05.00

Telephone

The use of telephones or telephone "hot lines".

06.00

Television

The use of televised broadcasts using public service announcements,
commercial air time, etc.

07.00

Video

The use of pre-recorded visual and audio messages not delivered via
broadcast or cable TV (e.g., on a VHS tape or DVD).

88

Other (specify)

The use of methods or mediums to deliver the intervention other than
those that are listed in the other value choices (1.0-7.0). If chosen,
please specify the delivery method.

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Num

Variable Name

Table: I

Mandatory

HD

CBO

Client Behavior Details

This table is required to be completed by all agencies that provide HIV prevention interventions individually to clients (EXCLUDING
counseling and testing and PCRS).
It is also required for some interventions delivered in groups.
This table supplements the information that is collected using the demographic and behavioral risk profile (Tables G1 and G2) variables.
These data should be collected at intake, final session, and intermittently during an intervention, as appropriate.
Reported to CDC
Num

Variable Name

I01

Mandatory

Behavior Recall Period

HD

CBO

Yes

Yes

Definition: The time period for which the client is asked to remember engaging in a specific
behavior.
Instructions: Indicate each recall period you intend to use in the collection of variables in Table
Code

Value Description

Value Definition

01

15 days

The recall period used during the collection of Table I: Client
Behavior Details will be 15 days.

02

30 days

The recall period used during the collection of Table I: Client
Behavior Details will be 30 days.

03

90 days

The recall period used during the collection of Table I: Client
Behavior Details at intake will be 90 days.

04

Local period (specify)

The recall period used during the collection of Table I: Client
Behavior Details will include a local period specified as __ number of
days.

I02

Client Risk Factors

Yes

Yes

Definition: A description of the client’s risk factor(s) within the specified recall period that
placed the client at potential risk for HIV exposure and/or transmission.
Instructions: Select all of the activities that the client has been involved in within the recall peri
Code

Value Description

Value Definition

01

Injection drug use

Illicit use of injection drugs/substances (including narcotics,
hormones, silicone, etc.). Illicit injection drugs/substances are those
for which a client does not have a prescription (or which the client
uses in a way other than is prescribed) or drugs/substances that are
not available over the counter (or which are used in a way other than
intended).

02

Sex with transgender

Sex refers to anal or vaginal intercourse.

03

Sex with female

Sex refers to anal or vaginal intercourse.

04

Sex with male

Sex refers to anal or vaginal intercourse.

05

No risk identified

The client reports no risk factors that may have placed the client at
potential risk for HIV exposure and/or transmission.

77

Refused to answer

The client declines or is unwilling to report his/her risk factors.

88

Other (specify)

Includes hemophiliac, transfusion/transplant recipient.

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Num

Variable Name

I03

Mandatory

Number of sex partners

HD

CBO

Yes

Yes

Definition: The number of partners with whom the client has had anal or vaginal sex in a
specified behavioral recall period.
Instructions: If the client indicated that she or he has had sex with a male, female or transgend
Code

Value Description

Value Definition

77

Refused to answer

The client declines or is unwilling to report his/her number of sex
partners.

88

Don't know

The client reports that he/she is unaware of his/her number of sex
partners.

###

I04

Number of sex partners with serodiscordant or HIV status unknown

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The number of sex partners in a specified behavioral recall period who were
serodiscordant with the client (i.e., one sex partner is HIV negative and the other
sex partner is HIV positive) or who HIV serostatus the client did not know.
Instructions: Of the number of sex partners identified in I03: Number of Sex Partners, indicate
Code

Value Description

Value Definition

####
77

Refused to answer

88

Don't know

I05

Number of HIV status unknown sex partners that were Anonymous
Definition: The number of sex partners whose HIV serostatus the client did not know and
whose identity was also unknown to the client.
Instructions: Of the number of sex partners identified in I04: Number of Sex Partners with sero
Code

Value Description

77

Refused to answer

88

Don't know

Value Definition

####

I06

Total number of sex events
Definition: The number of times that the client had anal or vaginal sex (protected and
unprotected) in a specified behavioral recall period.
Instructions: If the client indicated that she or he has had sex with a male, female or transgend
Code

Value Description

Value Definition

####
77

Refused to answer

The client declines or is unwilling to report his/her number of sex
events.

88

Don't know

The client reports that he/she is unaware of his/her number of sex
events.

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Num

Variable Name

I07

Mandatory

Number of sex events with serodiscordant or HIV status unknown partners

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The number of times the client had anal or vaginal sex (protected and
unprotected) with a serodiscordant partner (i.e., one sex partner is HIV negative
and the other sex partner is HIV positive), or partner whose serostatus was
unknown in a specified behavioral recall period.
Instructions: Indicate the number of times the client has had anal or vaginal sex (both protecte
Code

Value Description

Value Definition

####
77

Refused to answer

88

Don't know

I08

Number of unprotected sex events
Definition: The number of times that the client had unprotected anal or vaginal sex with any
partner in a specified behavioral recall period.
Instructions: Indicate the total number of times the client had unprotected anal or vaginal sex w
Code

Value Description

Value Definition

####
77

Refused to answer

88

Don't know

I09

Number of Unprotected Sex Events with a serodiscordant or HIV status unknown
partner (Total)
Definition: The total number of times the client had unprotected anal or vaginal sex with a
serodiscordant partner or a partner whose HIV serostatus was unknown.
Instructions: Of the number of sex events identified in I08: Number of Unprotected Sex Events,
Code

Value Description

Value Definition

77

Refused to answer

The client declines or is unwilling to report his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
partner.

88

Don't know

The client reports that he/she is unaware of his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
partner.

####

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Num

Variable Name

I10

Mandatory

Number of Unprotected Sex Events with a serodiscordant or HIV status unknown
partner (Male)

HD

CBO

Yes

Yes

Definition: The total number of times the client had unprotected anal or vaginal sex with a
serodiscordant male partner (e.g., one sex partner is HIV negative and the other
sex partner is HIV positive), or an male partner whose HIV status was unknown
in a specified behavioral recall period.
Instructions: Of the number of sex events identified in I09: Number of Unprotected Sex Events
Code

Value Description

Value Definition

####
77

Refused to answer

The client declines or is unwilling to report his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
male partner.

88

Don't know

The client reports that he/she is unaware of his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
male partner.

I11

Number of Unprotected Sex Events with a serodiscordant or HIV status unknown
partner (Female)

Yes

Yes

Definition: The total number of times the client had unprotected anal or vaginal sex with a
serodiscordant female partner (e.g., one sex partner is HIV negative and the
other sex partner is HIV positive), or a female partner whose HIV status was
unknown in a specified behavioral recall period.
Instructions: Of the number of sex events identified in I09: Number of Unprotected Sex Events
Code

Value Description

Value Definition

77

Refused to answer

The client declines or is unwilling to report his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
female partner.

88

Don't know

The client reports that he/she is unaware of his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
female partner.

####

I12

Number of Unprotected Sex Events with a serodiscordant or HIV status unknown
partner (Transgender)

Yes

Yes

Definition: The total number of times the client had unprotected anal or vaginal sex with a
serodiscordant transgender partner (e.g., one sex partner is HIV negative and
the other sex partner is HIV positive), or a transgender partner whose HIV status
was unknown in a specified behavioral recall period.
Instructions: Of the number of sex events identified in I09: Number of Unprotected Sex Events
Code

Value Description

Value Definition

####
77

Refused to answer

The client declines or is unwilling to report his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
transgender partner.

88

Don't know

The client reports that he/she is unaware of his/her number of
unprotected sex events with a serodiscordant or HIV status unknown
transgender partner.

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Num

Variable Name

I15

Mandatory

Number of Unprotected Sex Events while intoxicated and/or high on non-injection
drugs

HD

CBO

No

Yes

Definition: The number of times that the client had unprotected sex while intoxicated and/or
high on drugs in a specified behavioral recall period. The intent of this variable is
not on risks due to injection practices but to capture the effects of illicit drug use
on an individual's judgment to decide to have protected or unprotected sex.
Instructions: Indicate the number of times during the recall period (I01: Behavioral Recall Perio
Code

Value Description

Value Definition

####
77

Refused to answer

The client declines or is unwilling to report the types of non-injection
drugs his/her number of unprotected sex events while intoxicated
and/or high on non-injection drugs.

88

Don't know

The client reports that he/she is unaware of his/her number of
unprotected sex events while intoxicated and/or high on non-injection
drugs.

I16

What drugs?

No

Yes

Definition: If the client reports unprotected sex events while intoxicated and/or high on noninjection drugs indicate which of the non-injection drugs were used before or
during the sex events.
Instructions: If the client indicates that he or she did have sex while high on non-injection drugs
Code

Value Description

01

Amphetamine, meth, speed, crystal, crank, etc.

02

Crack

03

Cocaine (smoked, snorted)

04

Downers (Valium, Ativan, Xanax)

05

Pain killers (Oxycontin, Percocet)

06

Hallucinogens such as LSD

07

Ecstasy

08

Club drugs such as GHB, ketamine

09

Heroin (smoked, snorted)

10

Marijuana

11

Poppers (amyl nitrite)

12

Alcohol

77

Refused to answer

88

Other (specify)

99

Don't know

Value Definition

The client declines or is unwilling to report the types of non-injection
drugs used before or during a sex event.

The client reports that he/she is unaware of the types of non-injection
drugs used before or during a sex event.

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Num

Variable Name

I17

Mandatory

Number of Needle Sharing Events

HD
Yes

CBO
Yes

Definition: The number of times that the client shared needles/syringes in a specified
behavioral recall period.
Instructions: If the client indicated that he or she has used injection drugs during the recall peri
Code

Value Description

Value Definition

77

Refused to answer

The client declines or is unwilling to report his/her number of needle
sharing events.

88

Don't know

The client reports that he/she is unaware of his/her number of needle
sharing events.

####

I18

Number of Injection Drug Events with a serodiscordant or HIV status unknown partner

Yes

Yes

Definition: The number of times that the client shared needles/syringes with a
serodiscordant partner (i.e., one sex partner is HIV negative and the other sex
partner is HIV positive), or partner whose HIV status was unknown in a specified
behavioral recall period.
Instructions: Of the number of times the client shared a needle or syringe during the recall peri
Code

Value Description

Value Definition

####
77

Refused to answer

The client declines or is unwilling to report his/her number of needle
sharing events with a serodiscordant or HIV status unknown partner.

88

Don't know

The client reports that he/she is unaware of his/her number of needle
sharing events with a serodiscordant or HIV status unknown partner.

Table: PCRS- PCRS Case
This table provides details for a PCRS case. A PCRS case will indirectly associate an HIV+ index case to his/her partners and the
intervention through which services are provided.
Reported to CDC
Num

Variable Name

PCR101

Mandatory

Case Number

HD

CBO

Yes

Yes

Yes

Yes

Definition: A number to uniquely identify a PCRS case within an agency. This number is
system-generated when establishing a PCRS case in PEMS but can also be a
locally-developed or assigned number that is key-entered by the provider (e.g.,
interview record number).
Instructions: Select the system-generated PCRS case number or enter the locally-defined cas
PCR102

Intervention Name/ID
Definition: A unique Intervention Name/ID that was entered by your agency in Table F:
Program/Intervention Plan.

Instructions: Select from a list of Intervention Names generated from variable F02: Intervention

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Num

Variable Name

PCR103

Mandatory

Case Open Date

HD

CBO

Yes

Yes

Yes

Yes

Definition: The calendar date on which the PCRS case was opened at this agency.
Instructions: Enter the date on which the PCRS case was opened at this agency.
PCR104

Case Close Date
Definition: The calendar date on which the PCRS case was closed at this agency.

Instructions: Enter the date on which the PCRS case was closed at this agency.

Table: PCRS- PCRS Partner
This table provides details about partners for a PCRS case and will include partner identifying and locating information as well as services
received by the partner.
Reported to CDC
Num

Variable Name

PCR201

Mandatory

Case Number

HD

CBO

Yes

Yes

Yes

Yes

Definition: A number to uniquely identify a PCRS case within an agency. This number is
system-generated when establishing a PCRS case in PEMS (Table PCR1: Case)
but can also be a locally-developed or assigned number that is key-entered by
the provider (e.g., interview record number).
Instructions: Select the applicable PCRS case number that has been assigned to this PCRS c
PCR202

Partner Unique Key
Definition: A system-generated code that is used to uniquely identify and distinguish
between partners of an index case for PCRS interventions within a particular
agency. This variable is used to link partners to a specific PCRS case number
(PCR101: Case Number). Each Partner Unique Key is associated with a specific
PCRS case number.

Instructions: The system will generate a unique, non-identifying code to represent each partner

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Num

Variable Name

PCR207

Mandatory

Partner Type

HD

CBO

Yes

Yes

Definition: The partner's sex and needle-sharing relationship with the index client. This
relationship could involve sexual relations between the client and the partner,
needle-sharing between the client and partner, both sex and needle-sharing, or a
relationship in which both the client and partner belong to the same social
network contact.
Instructions: For each partner identified, indicate whether the partner and client are sex partner
Code

Value Description

Value Definition

01

Sex partner

A person who engages in any type of sexual activity with the index
client.

02

Needle-sharing partner

A person who engages in any type of needle-sharing activity (e.g.,
shares needles to inject drug intravenously), with the index client.

03

Both sex and needle sharing partner

A person who engages in any type of sexual activity and needlesharing activity (e.g., shares needles to inject drug intravenously),
with the index client.

04

Social network

A person not identified by the index client as a direct sex or needlesharing partner, but who is part of a group of individuals who share
social relationships involving sex or drug use.

PCR208

Spouse

Yes

Yes

Yes

Yes

Definition: The partner is legally married (i.e., the husband or wife) to the index client.
Instructions: Indicate if the partner is the spouse of the index client.
Code

Value Description

Value Definition

0

No

The partner is not the index client's husband or wife.

1

Yes

The partner is the index client's husband or wife.

PCR209

Notification Plan
Definition: The method that will be used to inform the partner that he or she has been
potentially exposed to HIV.

Instructions: Indicate the planned method agreed upon by the index client and PCRS provider f
Code

Value Description

Value Definition

01

Provider

The PCRS provider, with the consent of the HIV-infected client, takes
the responsibility for informing the partner of his or her possible
exposure to HIV and referring them to HIV counseling, testing, and
other support services.

02

Client

The HIV-infected client informs his or her partners of their possible
exposure to HIV and refers them to HIV counseling, testing, and other
support services.

03

Dual

The HIV-infected client informs his or her partners of their possible
exposure to HIV and refers them to HIV counseling, testing, and other
support services in the presence of the PCRS provider.

04

Contract

The PCRS provider and HIV-infected client negotiate a time frame for
the client to inform his or her partners of their possible exposure to
HIV. If the client is unable to inform a partner within an agreed-upon
time, the provider has the permission to notify and refer partners to
HIV counseling, testing, and other support services.

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Num

Variable Name

PCR212

Mandatory

Date of Birth-Year

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The calendar year in which the partner was born.
Instructions: Enter the year in which the partner was born.
PCR213

Calculated Age
Definition: The partner's age at the time of data collection.

Instructions: Enter the partner's age at the time of data collection. This variable is system-gen
PCR214

Ethnicity
Definition: The partner's self report of whether they are of Hispanic or Latino origin.

Instructions: Indicate whether the partner reported that he or she is Hispanic/Latino or not Hisp
Code

Value Description

Value Definition

77

Refused to answer

The client declines or is unwilling to report his or her ethnicity.

99

Don't know

The client reports that they are unaware of their ethnicity.

E1

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race.

E2

Not Hispanic or Latino

A person not identified by the definition of Hispanic or Latino.

PCR215

Race

Yes

Yes

Definition: A partner's self-reported classification of the biological heritage with which they
most closely identify. Standard OMB race codes are applied.
Instructions: Indicate the partner's self reported race using standard OMB race codes. Record
Code

Value Description

Value Definition

99

Don't know

The client reports that they are unaware of their race.

R1

American Indian or Alaska Native

A person having origins in any of the original peoples of North or
South America (including Central America), and who maintains tribal
affiliation or community attachment.

R2

Asian

A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian Subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.

R3

Black or African American

A person having origins in any of the black racial groups of Africa.

R4

Native Hawaiian or Pacific Islander

A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.

R5

White

A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.

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Num

Variable Name

PCR215a

Mandatory

Assigned Sex at Birth

HD

CBO

Yes

Yes

Definition: The biological sex assigned to the partner at birth, (i.e., the sex noted on the
client's birth certificate).
Instructions: Indicate whether the partner reports being physically born a male or female (i.e., b
Code

Value Description

Value Definition

01

Male

The sex that produces spermatozoa by which female ova are
fertilized.

02

Female

The sex that produces ova, can conceive and bear offspring/children.

PCR216

Current Gender

Yes

Yes

Definition: The partner's current self-reported sexual identity.
Instructions: Select the variable value that most closely describes the partner's current, self-re
Code

Value Description

Value Definition

01

Male

The behavioral, cultural, or psychological traits typically associated
with the male sex.

02

Female

The behavioral, cultural, or psychological traits typically associated
with the female sex.

03

Transgender-MTF

Individuals whose physical or birth sex is male but whose gender
expression and/or gender identity is female. Note: MTF = male to
female.

04

Transgender-FTM

Individuals whose physical or birth sex is female but whose gender
expression and/or gender identity is male. Note: FTM = female to
male.

PCR217

English Speaking?

No

Yes

Definition: A confirmation of whether the partner speaks English.
Instructions: Indicate whether the partner speaks English.
Code

Value Description

Value Definition

0

No

The client does not speak English.

1

Yes

The client speaks English.

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Num

Variable Name

PCR218

Mandatory

Primary Language

HD

CBO

No

Yes

Definition: The language most often used by the partner.
Instructions: Specify the primary language or language most often used by the partner. If G12
Code

Value Description

Value Definition

01

English

The language primarily or most often used by the partner is English.

02

Spanish

The language primarily or most often used by the partner is Spanish.

03

Arabic

The language primarily or most often used by the partner is Arabic.

04

Cambodian

The language primarily or most often used by the partner is
Cambodian.

05

Cantonese

The language primarily or most often used by the partner is
Cantonese.

06

Creole/French

The language primarily or most often used by the partner is
Creole/French.

07

Farsi

The language primarily or most often used by the partner is Farsi.

08

Haika

The language primarily or most often used by the partner is Haika.

09

Hindi

The language primarily or most often used by the partner is Hindi.

10

Japanese

The language primarily or most often used by the partner is Japanese.

11

Korean

The language primarily or most often used by the partner is Korean.

12

Lao

The language primarily or most often used by the partner is Lao.

13

Mandarin

The language primarily or most often used by the partner is Mandarin.

14

Russian

The language primarily or most often used by the partner is Russian.

15

Tagalog

The language primarily or most often used by the partner is Tagalog.

16

Thai

The language primarily or most often used by the partner is Thai.

17

Vietnamese

The language primarily or most often used by the partner is
Vietnamese.

88

Other (specify)

PCR230

Session Date

Yes

Yes

No

Yes

Definition: The date the partner participated in the session.
Instructions: Indicate the date the partner participated in the session.
PCR231

Worker ID
Definition: A system generated code used to distinguish between persons who are
delivering services to clients by a combination of non-identifying characteristics.

Instructions: Choose from a list of workers, established in Table P: Worker, the worker(s) who

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Num

Variable Name

PCR233

Mandatory

Activity

HD

CBO

Yes

Yes

Definition: The specific actions or components of an intervention in which the partner
participated or received during this particular session.
Instructions: Select all of the activities that occurred during this session. Describe what was ac
Code

Value Description

Value Definition

04.00

Referral

A process by which immediate client needs for prevention, care, and
supportive services are assessed and prioritized and clients are
provided with information and assistance in identifying and accessing
specific services (such as, setting up appointments and providing
transportation). Note: The provision of a referral also includes a plan
for tracking whether or not the client accessed the referral.

05.00

Personalized risk assessment

The process by which an individual client, a provider or both working
together identify, acknowledge, and understand the details and
context of the client's HIV risk. The assessment should explore
previous risk reduction efforts and identify successes and challenges
of those efforts.

06.00

Elicit partners

The process by which the provider assists the index client in
identifying partners and other sexual and drug-injecting networks at
high risk for transmission of HIV who might benefit from testing and/or
medical examination. (These networks do not include sex partners of
the HIV-infected individual but are made up of individuals who share
social relationships involving sex or drug use.).

07.00

Notification of exposure

The process of informing a HIV-positive client's sex and/or needle
sharing partners of their exposure to HIV. This activity is only
applicable if the intervention type is Partner Counseling and Referral
Services (PCRS).

08.01

Information-HIV/AIDS transmission

Any general information, written or verbal, given to an individual or a
group on HIV/AIDS and how it is transmitted.

08.02

Information-Abstinence/postpone sexual activity

Any information, written or verbal, given to an individual or a group on
abstaining from sexual activity or postponing sexual activity.

08.03

Information-Other sexually transmitted diseases

Any information, written or verbal, given to an individual or a group on
STDs (other than HIV or viral hepatitis), how it is transmitted, how to
reduce risk for transmission or infection, or treatment options.

08.04

Information-Viral hepatitis

Any information on viral hepatitis, how it is transmitted, and/or how to
reduce risk for transmission or infection, or treatment options.

08.05

Information-Availability of HIV/STD counseling and testing

Any information, written or verbal, given to an individual or a group
about where and how to access HIV-related CTR or STD counseling
and testing. This includes referral lists that only list CTR and/or STD
counseling and testing sites.

08.06

Information-Availability of partner notification and referral services

Any information, written or verbal, given to an individual or a group
about where and how to access partner notification services. The
availability information provided is exclusive to PCRS. This includes
referral lists that only list PCRS sites.

08.07

Information-Living with HIV/AIDS

Any information, written or verbal, given to an individual or a group
living with HIV/AIDS specific to living with the disease.

08.08

Information-Availability of social services

Any information, written or verbal, given to an individual or a group
about how and where to access social services. This could include a
referral list that only includes social services agencies or providers.

08.09

Information-Availability of medical services

Any information, written or verbal, given to an individual or a group
about how and where to access HIV medical services. This could
include a referral list that only includes HIV medical care providers.

08.10

Information - Sexual risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce sexual risk for HIV transmission or infection.
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Num

Variable Name

Mandatory

HD

CBO

08.11

Information-IDU risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce injection drug use risk for HIV transmission or infection.

08.12

Information-IDU risk free behavior

Any information, written or verbal given to an individual or a group on
abstaining from injection drug use or only using new needles and
disposing of them appropriately.

08.13

Information-Condom/barrier use

Any information, written or verbal, given to an individual or a group
regarding appropriate use and disposal of condoms or other barrier
methods.

08.14

Information-Negotiation/Communication

Any information, written or verbal, given to an individual or a group
regarding communication of desire for safer practices and negotiating
safer practices with partners (sexual and needle sharing).

08.15

Information-Decision making

Any information, written or verbal, given to an individual or a group
regarding the steps and techniques needed for reassessing, planning
and using judgment to avoid situations that may expose them to HIV
infection or transmission risk and/or decision to engage in a risk
behavior.

08.16

Information-Disclosure of HIV status

Any information, written or verbal, given to an individual or a group
regarding disclosure of their HIV status, applicable laws,
accompanying ramifications, and options regarding non-disclosure.

08.17

Information-Providing prevention services

Any information, written or verbal, given to an individual or a group on
how to communicate prevention messages and/or demonstrate risk
reduction skills with others.

08.18

Information-HIV testing

Any information, written or verbal, given to an individual, couple, or
group regarding HIV testing including explanation of the testing
process and meaning of results, behavioral risks for infection, and
importance of knowing their status.

08.19

Information-Partner notification

Any information, written or verbal, given to an individual or a group
regarding the notification of possible exposure to HIV and
accompanying ramifications, behaviors associated with possible
exposure, and consideration of alternatives or information on how to
notify partners regarding possible exposure.

08.20

Information-HIV medication therapy adherence

Any information, written or verbal, given to an individual or a group
regarding HIV medication therapy, benefits and risk, medical therapy
alternatives, and importance of adhering to medication therapy for
HIV.

08.21

Information-Alcohol and drug use prevention

Any information, written or verbal, given to an individual or a group on
the negative effects and consequences of alcohol and drug use and
its relationship to HIV transmission or infection risk behavior including
strategies to avoid or abstain from use.

08.22

Information-Sexual Health

Any information, written or verbal, given to an individual or a group on
reproductive health, sexuality, sexual development and similar topics.

08.23

Information-TB testing

Any information, written or verbal, given to an individual, couple, or
group on TB, how it is transmitted, and/or how to reduce risk for
transmission or infection, or treatment options

08.66

Information-Other

Any information, written or verbal, given to an individual or group that
cannot be captured in any of the other information codes.

09.01

Demonstration-Condom/barrier use

Provider or participant demonstration (using a teaching tool) of
appropriate use and disposal of condoms or other barrier methods.

09.02

Demonstration-IDU risk reduction

Provider or participant demonstration of how to safely dispose of
syringes or how to use bleach kits to clean works.

09.03

Demonstration-Negotiation/Communication

Provider or participant demonstration of how to communicate desire
for safer practices and how to negotiate safer practices with partners
(sexual and needle sharing).

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Num

Variable Name

Mandatory

HD

CBO

09.04

Demonstration-Decision making

Provider or participant demonstration of steps, and techniques
needed for reassessing, planning and using judgment to avoid
situations that may expose them to HIV infection or transmission risk
and/or decision to engage in a risk behavior.

09.05

Demonstration-Disclosure of HIV status

Provider or participant demonstration of techniques to disclose
seropositive status or discuss issues relevant to disclosure.

09.06

Demonstration-Providing prevention services

Provider or participant demonstration of how to communicate
prevention messages or demonstrate risk reduction skills with others.

09.07

Demonstration-Partner notification

Provider or participant demonstration of how to notify partners
regarding possible exposure to HIV or how to discuss issues relevant
to partner notification.

09.66

Demonstration-Other

Any provider or participant demonstration of a skills or technique that
is not decision making, IDU risk reduction, condom/barrier use,
negotiation and communication, disclosure, or providing prevention
services.

10.01

Practice-Condom/barrier use

Participant practice (using a teaching tool) of appropriate condom
and/or barrier use and disposal during the intervention session.

10.02

Practice-IDU risk reduction

Participant practice of safe needle use and disposal including the use
of bleach kits to clean works during the intervention session(s).

10.03

Practice-Negotiation/ Communication

Participant practice communication of desire for safer practices and
negotiation of safer practices with partners (sexual and needle
sharing) during the intervention session(s).

10.04

Practice-Decision making

Participant practice using steps and techniques needed for
reassessing, planning and using judgment to avoid situations that
may expose them to HIV infection or transmission risk and/or decision
to engage in a risk behavior.

10.05

Practice-Disclosure of HIV status

Participant practice of techniques to disclose seropositive status or
discuss issues relevant to disclosure.

10.06

Practice-Providing prevention services

Participant practice communication of prevention messages and/or
demonstration of risk reduction skills with others during intervention
session(s).

10.07

Practice-Partner notification

Participant practice of how to notify partners regarding possible
exposure to HIV or how to discuss issues relevant to partner
notification.

10.66

Practice-Other

Participant practice of a skill or technique that is not decision making,
IDU risk reduction, condom/barrier use, negotiation and
communication, disclosure, or providing prevention services.

11.01

Discussion-Sexual risk reduction

Facilitation of discussion with individuals or groups involving
examination of sexual risk behaviors (self or others) and
accompanying ramifications, examination of attitudes and feelings
about their risks, consideration of alternatives, and decision making to
reduce sexual risk.

11.02

Discussion-IDU risk reduction

Facilitation of discussion with individuals or groups involving
examination of IDU risk and accompanying ramifications, examination
of attitudes and feelings about their risks, consideration of
alternatives, and decision making to reduce IDU risk.

11.03

Discussion-HIV testing

Facilitation of discussion with individuals, couples, or groups
regarding HIV testing including explanation of the testing process and
meaning of results, discussion of behavioral risks for infection,
examination of attitudes and feelings about their risks, consideration
of alternatives, and decision making to know their status and reduce
HIV transmission risk.

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Num

Variable Name

Mandatory

HD

CBO

11.04

Discussion-Other sexually transmitted diseases

Facilitation of discussion with individuals or groups regarding sexually
transmitted diseases (other than HIV), involving an examination of
behavioral risks and accompanying ramifications, examination of
attitudes and feelings about their risks, consideration of alternatives,
treatment alternatives, and decision making to reduce behavioral risk
for other sexually transmitted diseases and/or seek treatment.

11.05

Discussion-Disclosure of HIV status

Facilitation of discussion with individuals or groups regarding
techniques to disclose seropositive status or discuss issues relevant
to disclosure.

11.06

Discussion-Partner notification

Facilitation of discussion with individuals or groups regarding how to
notify partners regarding possible exposure to HIV or how to discuss
issues relevant to partner notification.

11.07

Discussion-HIV medication therapy adherence

Facilitation of discussion with individuals or groups regarding HIV
medication therapy and accompanying ramifications, examination of
attitudes and feelings about HIV medication therapy, discussion of
medical therapy alternatives, and decision making to begin and
adhere to medication therapy for HIV.

11.08

Discussion-Abstinence/postpone sexual activity

Facilitation of discussion with individuals or groups on abstaining from
sexual activity or postponing the initiation of sexual activity and
accompanying ramifications including an examination of risks
associated with sexual activities, discussion of alternatives, and
decision making to abstain or postpone sexual activity.

11.09

Discussion-IDU risk free behavior

Facilitation of discussion with individuals or groups on abstaining from
injection drug use or only using new needles and disposing
appropriately.

11.10

Discussion-HIV/AIDS transmission

Facilitation of discussion with individuals or groups on HIV/AIDS and
how HIV is transmitted.

11.11

Discussion-Viral hepatitis

Facilitation of discussion with individuals or groups on viral hepatitis,
how it is transmitted, and/or how to reduce risk for transmission or
infection, or treatment options.

11.12

Discussion-Living with HIV/AIDS

Facilitation of discussion with individuals or groups on living with
HIV/AIDS and ramifications of living with HIV/AIDS, examination of
attitudes and feelings about living with the disease.

11.13

Discussion-Availability of HIV/STD counseling and testing

Facilitation of discussion with individuals or groups on where and how
to access HIV-related CTR or STD counseling and testing and may
include the importance of knowing your status. This includes referral
lists that only list CTR and/or STD counseling and testing sites.

11.14

Discussion-Availability of partner notification and referral services

Facilitation of discussion with individuals or groups on where and how
to access partner notification services.

11.15

Discussion-Availability of social services

Facilitation of discussion with individuals or groups on how and where
to access social services.

11.16

Discussion-Availability of medical services

Facilitation of discussion with individuals or groups on how and where
to access HIV medical care. Discussion may include options
regarding available services.

11.17

Discussion-Condom/barrier use

Facilitation of discussion with individuals or groups on the appropriate
use and disposal of condoms or other barrier methods and
accompanying ramifications, examination of attitudes and feelings
about condom use, and decision making regarding use of
condoms/barriers.

11.18

Discussion- Negotiation/Communication

Facilitation of discussion with individuals or groups on communication
of desire for safer practices and negotiating safer practices with
partners (sexual and needle sharing), including discussion of
accompanying ramifications, examination of attitudes and feeling,
and decision making regarding communicating and negotiating safer
practices.

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Num

Variable Name

Mandatory

HD

CBO

11.19

Discussion-Decision making

Facilitation of discussion with individuals or groups on steps and
techniques needed for reassessing, planning and using judgment to
avoid situations that may expose them to HIV infection or
transmission risk and/or decision to engage in a risk behavior.

11.20

Discussion-Providing prevention services

Facilitation of discussion with individuals or groups on communicating
prevention message and/or demonstrating risk reduction skills with
others.

11.21

Discussion-Alcohol and drug use prevention

Facilitation of discussion with individuals or groups on the negative
effects and consequences of alcohol and drug use and its
relationship to HIV transmission or infection risk including strategies
to avoid or abstain from use.

11.22

Discussion-Sexual Health

Facilitation of discussion with individuals or groups on reproductive
health, sexuality, sexual development, and similar topics.

11.23

Discussion-TB testing

Facilitation of discussion with individuals or groups about TB, how it is
transmitted, and/or how to reduce risk for transmission or infection, or
treatment options.

11.66

Discussion-Other

Discussion with individuals or groups regarding HIV infection,
transmission, or risk reduction issues and accompanying
ramifications, examination of attitudes and feelings about these
issues, consideration of alternatives, and decision making to reduce
HIV infection, transmission, or risk reduction. Issues do not include
sexual or IDU risk reduction, HIV testing, other sexually transmitted
diseases, HIV status disclosure, partner notification, or HIV
medication therapy.

12.01

Other testing-Pregnancy

Provision of testing to determine pregnancy.

12.02

Other testing-STD

Provision of testing to determine infection with a sexually transmitted
disease other than HIV or Viral Hepatitis.

12.03

Other testing-Viral hepatitis

Provision of testing to determine infection with viral hepatitis.

13.01

Distribution-Male condoms

Provision of male condoms by handing them out or placing them in a
location to be accessed by consumers at no cost to the consumer.

13.02

Distribution-Female condoms

Provision of female condoms by handing them out or placing them in
a location to be accessed by consumers at no cost to the consumer.

13.03

Distribution-Safe sex kits

Provision of packages that minimally contain a condom (male or
female), lubricant, and instruction for proper use. May include other
materials at no cost to the consumer.

13.04

Distribution-Safer injection/bleach kits

Provision of packages that minimally contain a small bottle of bleach
and needle cleaning instructions. Packages may include bottle caps
for cookers, cotton, alcohol wipes, and bottles of water for rinsing
needles. Materials are provided at no cost to the consumer.

13.05

Distribution-Lubricants

Provision of water based lubricants at no cost to the consumer as
part of HIV prevention activities.

13.06

Distribution-Education materials

Provision of printed materials designed to be learning or teaching
aids by handing them out, placing in a location to be accessed by
consumers, or electronic dissemination at no cost to the consumer.

13.07

Distribution-Referral lists

Provision of lists of specific organizations that provide a specific set of
HIV prevention, care, or support services with contact information.
The agencies listed are known by the provider to be reliable sources
for those services based on provider knowledge and experience.
Lists may be disseminated by handing them out, placing them in a
location to be accessed by the consumer, or emailed to consumers.

13.08

Distribution-Role model stories

Provision stories of individuals who have changed their behaviors or
plan to change their behaviors to reduce their risk for HIV
transmission or infection. Stories may be disseminated by handing
them out, placing them in a location to be accessed by the consumer,
or emailed to consumers.
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Reported to CDC
Num

Variable Name

Mandatory

HD

CBO

13.66

Distribution-Other

Provision of materials or supplies to consumers with the intent to
decrease their risk for HIV transmission or infection and/or to improve
health outcomes. Distribution may include dissemination in person,
by placing materials in locations to be accessed by consumers, sent
to consumers electronically or land mail. Does not include condoms,
safer sex kits, bleach kits, lubricants, education materials, referral
lists, or role model stories.

14.01

Post-intervention follow up

Individual or group meeting or contact with participant(s) of an
intervention after the last session of the intervention to assess or
discuss changes targeted by the intervention and/or revisions to risk
reduction goals and/or strategies.

14.02

Post-intervention booster session

An intervention session conducted with participant(s) of an
intervention after the last session to review and reinforce risk
reduction skills and information addressed by the intervention.

88

Other (specify)

Any HIV prevention activity not captured in other value choices.

PCR234

Site ID

Yes

Yes

Yes

Yes

Definition: The official name of the agency's site of HIV prevention service delivery where
the session took place.
Instructions: Select the site name used to identify your primary agency. Please note that when
PCR235

Partner Risk Factors
Definition: A description of the risk factor(s) within the last 90 days that placed the partner at
potential risk for HIV exposure and/or transmission.

Instructions: Select all of the activities that the partner has been involved in within the last 90 d
Code

Value Description

Value Definition

01

Injection drug use

The partner has used illicit injection drugs/substances (including
narcotics, hormones, silicon, etc.). Illicit injection drugs/substances
are those for which a client does not have a prescription (or which the
client uses in a way other than is prescribed) or drugs/substances
that are not available over the counter (or which are used in a way
other than intended).

02

Sex with transgender

The client has had anal or vaginal intercourse (protected or
unprotected) with a person known to him/her to be a transgender..

03

Sex with female

The partner has had anal or vaginal intercourse (protected or
unprotected) with a female.

04

Sex with male

The partner has had anal or vaginal intercourse (protected or
unprotected) with a male.

05

No risk identified

The partner reports no risk factors that may have placed the client at
potential risk for HIV exposure and/or transmission.

66

Not asked

The provider did not ask the partner about his/her risk factors.

77

Refused to answer

The partner declined or was unwilling to report his/her risk factors.

88

Other

The partner reported risk factors other than what is described in the
categories described above. These include risk factors such as being
a hemophiliac or transfusion/transplant recipient.

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Num

Variable Name

PCR236

Mandatory

Additional Partner Risk Factors

HD

CBO

Yes

Yes

Definition: If the partner's risk factors involve sexual activity, these are additional factors that
further describe the partner's sexual risk for HIV exposure and/or transmission
within the 90 day recall period.
Instructions: Use this variable only if the partner reported sex with male, female, or transgende
Code

Value Description

Value Definition

00

No additional risk information specified

The partner reported no additional risk or additional information
about his/her partners was not available.

01

Exchange sex for drugs/money/or something they needed

The partner participated in sex events in exchange for drugs or
money or something they needed.

02

While intoxicated and/or high on drugs

The partner used alcohol and/or illicit drugs before and/or during sex.

03

With person who is an IDU

The partner has had a sex with a person who he/she knew was an
IDU.

04

With person who is HIV positive

The partner has had a sex with a person who he/she knew was HIV+.

05

With person of unknown HIV status

The partner has had a sex with a person whose HIV status is
unknown to the partner.

06

With person who exchanges sex for drugs/money

The partner has had a sex with a person who he/she knows
exchanges sex for drugs/money.

07

With person who is a known MSM

The partner is female and has had sex with a person who she knows
has male to male sex.

08

With anonymous partner

The partner has had sex with a person whose identity was unknown
to the partner. A person’s identity is a set of behavioral or personal
characteristics by which that person is known. This can include
information about a person’s name, address, and habits that allow
the partner to identify the person.

09

With person who has hemophilia or transfusion/transplant recipient

The partner has had sex with a person who he/she knows has
hemophilia or is a transfusion/transplant recipient.

66

Not asked

The provider did not ask the partner about additional sexual risk
factors.

77

Refused to answer

The partner declines or is unwilling to report additional sexual risk
factors.

Table: X-1

HIV Test

This table is completed for each HIV antibody test conducted for a client.
Intervention type = CT
Activity = HIV testing
Reported to CDC
Num
X101

Variable Name

Mandatory

Test Sequence Number

HD

CBO

Yes

Yes

Definition: A number assigned to each test to indicate the order of tests within a testing
intervention cycle where multiple tests are performed.
Instructions: Indicate the sequence number within this testing intervention cycle that is assigne

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Num

Variable Name

X102

Mandatory

Test ID number

HD

CBO

Yes

Yes

Yes

Yes

Definition: A free form text field to enter the rapid test or laboratory identification number for
this test. This field could also be used to record the lot number of a rapid test.
Instructions: Indicate the rapid test identification number or a laboratory identifier for this test.
X103

Test Technology
Definition: A description of the type of test or test methods used to screen for HIV
antibodies.
Instructions: Indicate the type of HIV test technology used for this test.

Code

Value Description

Value Definition

01

Conventional

A standard test used to detect antibodies to HIV, typically referred to
as an EIA or ELISA (Enzyme-linked immunosorbant assay).

02

Rapid

A test to detect antibodies to HIV that can be collected and processed
within a short interval of time (e.g., approximately 10-60 minutes).

88

Other

Additional testing technologies that are not considered conventional
or rapid such as oral mucosa or urine based tests.

X104

HIV Test Election

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: An indication of whether the test is linked to a name or is anonymous.
Instructions: Indicate if the written test record is linked to the client's name.
Code

Value Description

Value Definition

0

Tested anonymously

The HIV test was not linked to the client's name.

1

Tested confidentially

The HIV test was confidential.

77

Refused testing

The client refused to take an HIV test.

X105

Sample Day
Definition: The calendar day on which the specimen for the HIV test was collected.
Instructions: Indicate the day that the specimen for the HIV test was collected.

X106

Sample Month
Definition: The calendar month in which the specimen for the HIV test was collected.
Instructions: Indicate the month that the specimen for the HIV test was collected.

X107

Sample Year
Definition: The calendar year in which the specimen for the HIV test was collected.
Instructions: Indicate the year that the specimen for the HIV test was collected.

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Num

Variable Name

X108

Mandatory

Confirmatory Test

HD

CBO

Yes

Yes

Definition: An HIV test designed to confirm the results of a preliminary positive screening
test.
Instructions: Indicate if the HIV test is a confirmatory test following a preliminary positive test.
Code

Value Description

0

No

The HIV test was an initial or preliminary test.

1

Yes

The HIV test was a confirmatory test following an initial test with a
preliminary positive/reactive test result.

X109

Value Definition

Type of Specimen

Yes

Yes

Definition: The type of biological material or sample used to test for HIV antibodies.
Instructions: Indicate the type of specimen (e.g., blood, oral, urine) used for this HIV test.
Code

Value Description

Value Definition

01

Blood-finger stick

Whole blood, plasma, or serum drawn with a needle from a finger tip.

02

Blood-venipuncture

Whole blood, plasma, or serum drawn with a needle from a vein,
usually in the forearm.

03

Blood-spot

A drop of whole blood dried on blotting paper.

04

Oral mucosal transudate

A cell sample taken with a mouth swab from the soft tissue lining the
inside of the mouth and gums.

05

Urine

The liquid product filtered from the blood by the kidneys.

X110

HIV Test Result

Yes

Yes

Definition: The outcome of the current HIV test.
Instructions: Indicate the result of this HIV test.
Code

Value Description

Value Definition

01

Positive/Reactive

A test result that is reactive on an initial ELISA test, repeatedly
reactive on a second ELISA run on the same specimen, and
confirmed positive on a Western blot or other supplemental test
indicating that the client is infected.

02

NAAT-positive

A test result that was previously negative or indeterminate but is
reactive based on nucleic acid testing.

03

Negative

A test result that is non-reactive on an initial ELISA test indicating the
absence of HIV infection or an ELISA that was repeatedly reactive
and the confirmatory test (Western Blot or IFA) was negative.

04

Indeterminate

A test result that has not been precisely determined. A possible
result of a Western-blot, which might represent a recent HIV infection
or a false positive.

05

Invalid

A test result cannot be confirmed due to conditions related to errors in
the testing technology, specimen collection, or transport.

06

No result

No result was obtained even though the specimen was drawn (e.g.,
blood sample hemolyzed, blood tube broke, blood tube lost in transit,
unable to draw blood from veins).

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Num

Variable Name

X111

Mandatory

Provision of Result

HD

CBO

Yes

Yes

Definition: The act of informing the client of his or her HIV test result.
Instructions: Indicate whether the result of this HIV test was provided to the client.
Code

Value Description

Value Definition

0

No

The result of this HIV test was not provided to the client.

1

Yes

The result of this HIV test was provided to the client.

X112

Provision of Result Date-Month

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The calendar month in which the client's HIV test result was provided to the client.
Instructions: Indicate the month in which the client was provided the result of this HIV test.
X113

Provision of Result Date-Day
Definition: The calendar day on which the client's HIV test result was provided to the client.
Instructions: Indicate the day on which the client was provided with the result of this HIV test.

X114

Provision of Result Date-Year
Definition: The calendar year in which the client's HIV test result was provided to the client.
Instructions: Indicate the year in which the client was provided with the result of this HIV test.

X115

Reason Results Not Provided
Definition: An explanation for why the HIV test result was not provided to the client.
Instructions: Select the reason why the HIV test result was not provided to the client.

Code

Value Description

Value Definition

01

Refused notification

The client refused to accept notification of his/her HIV test result from
the provider.

02

Did not return/Could not locate

The client did not return for his/her HIV test result or could not be
located to administer the test result.

03

Obtained results from another agency

The client received his/her HIV test results from another agency.

88

Other (specify)

The client received his/her HIV test result for a reason other than
those described above.

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Num

Variable Name

X116

Mandatory

If rapid reactive, did client provide confirmatory sample?

HD

CBO

Yes

Yes

Definition: An indication of whether the client provided another sample for confirmatory
testing of a reactive result from a positive test.
Instructions: If the type of HIV test used for this test was a rapid test (X103: Test Technology =
Code

Value Description

01

Yes

2.01

No - Client refused

2.02

No - Client referred

Table: X-2

Value Definition

HIV Test History for HIV Incidence Modeling

This table collects HIV test history for incidence modeling. Complete this table if you are currently funded through surveillance to collect
HIV incidence data. Collect these data for each client accessing counseling and testing services.
Intervention type = CT
Activity = HIV Testing History Survey
Reported to CDC
Num

Variable Name

X202

Mandatory

Pre/Post Test Questionnaire

HD

CBO

Yes

Yes

Definition: Indicate if this survey information is obtained through a pre-test or post-test
questionnaire.
Instructions: Remember that a reactive (positive) result on a rapid HIV test is not confirmed. T
Code

Value Description

Value Definition

1

Pre-Test (HIV test status unknown)

Typically indicates that testing history information was collected
before the HIV test was administered, usually at pre-test counseling.
This value should also be selected if the information was collected
after the test was administered, but before the result was known (for
example, the information was collected during the waiting period after
the test was administered but before the results were returned). It
would also be selected if the information were collected after a rapid
HIV test result is given but before the confirmatory result is known.

2

Post-Test (HIV test status known)

Typically indicates that the testing history information was obtained at
the post-test counseling session after the test result was given to the
client, although the information may be collected at a later time when
the results are known to the client.

X203

Date of Survey

Yes

Yes

Definition: Indicate the date of the survey.
Instructions: Enter the date that the survey was administered.

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Num

Variable Name

X204

Mandatory

Reason for Current Test

HD

CBO

Yes

Yes

Definition: The client’s reason for seeking an HIV test, either the current HIV test, or the first
HIV test from which the client received an HIV positive diagnosis, that is, the test
that began the testing sequence that resulted in the client’s first confirmed HIV
positive result.
Instructions: Select all reasons that apply. If the client reports that the reason he/she is being t
Code

Value Description

Value Definition

01

Because you are concerned that you might have been exposed to
HIV in the past 6 months?

Asks whether the client was tested because he/she had a recent
experience or an experience in the 6 months before the client’s first
HIV-positive test (unsafe sex or injection drug use, accidental needle
stick, etc.) that he/she felt put him/her at risk for HIV infection. In this
case, a positive test result would be more likely to be an incident case.

02

Because you get tested routinely, and it was time for you to get tested Asks whether the client gets tested regularly (every 3 months, 6
again?
months, yearly, etc.). It is not asking whether the test is part of routine
medical care, which could mean that the client has an HIV antibody
test every time he/she sees the doctor, regardless of the interval.

03

Because you are just checking to make sure you are HIV negative?

Asks if the client has no particular reason other than to reassure
him/herself (for example, some people test when they start a new
relationship or have some other change in their life).

04

Because it was required by either insurance, the military, a court
order, or for some other required reason?

Asks if the test is not the client’s idea, but rather is a requirement of
some other entity.

77

Refused

88

Because there is some other reason you want to get tested? (Specify) Allows the client to give another reason for testing that may not have
been asked (other reasons might include pregnancy or the test may
have been suggested as follow up for a blood donation).

99

Don’t Know

X205

Ever Positive HIV Test

Yes

Yes

Definition: Indicate if participant has ever had a positive HIV test result
Instructions: It is important to note that a reactive rapid HIV test that has not been confirmed is
Code

Value Description

0

No

1

Yes

7

Refused

9

Don't know

Value Definition

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Reported to CDC
Num

Variable Name

X205a

Mandatory

Date First Positive Test Available

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: Indicate if the date of the first positive test is available.
Instructions:
Code

Value Description

0

No

1

Yes

66

Not asked

77

Refused

99

Don't Know

X206

Value Definition

First Tested Positive for HIV
Definition: The date that the specimen (oral fluid, blood, urine) was collected for the client’s
first positive HIV test, not the date the result was received.
Instructions: If the client reports that he/she has had a confirmed rapid HIV test, the test date t

X207

First Tested Positive for HIV- Anonymous
Definition: The client was not required to provide a name at the time of the HIV test, and the
client was given a number or other unique identifier to receive his/her results.
Instructions:

Code

Value Description

Value Definition

0

No

The client’s first ever positive test was not an anonymous test. He/she
was required to provide a name in order to be tested. He/she may or
may not have received a code or some other unique identifier that
could be used to receive test results.

1

Yes

The client’s first ever positive test was an anonymous test in which
he/she was not required to provide a name in order to be tested and
he/she received a code or some other unique identifier that was used
to receive test results.

77

Refused

The client declines or is unwilling to report if his/her first positive test
was anonymous.

99

Don't know

The client does not know if his/her first positive test was anonymous.

X208

What was the name of the place where you got your first positive HIV test

Yes

Yes

Definition: The name of the agency that provided the positive HIV test.
Instructions: Enter the name of the agency where the client received his/her first positive HIV t

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

X209

Mandatory

State Where First Tested Positive

HD

CBO

Yes

Yes

Definition: The state where the test was administered. That is, the state of the physical
location where the client’s first positive test was performed.
Instructions:
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina

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Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

78

VI

Virgin Islands of the U.S.

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HD

CBO

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

X210

Mandatory

Site Type of First Positive

HD

CBO

Yes

Yes

Definition: The setting that best describes where the first HIV positive test was performed.
Instructions:
Code

Value Description

Value Definition

F01

Inpatient Facility

A hospital or other health facility where services are provided to
patients that reside within that facility while they are receiving those
services.

F01.01

Inpatient- Hospital

F01.50

Inpatient- Drug / Alcohol Treatment

F01.88

Inpatient Facility- Other (specify)

F01.99

Inpatient Facility- Unknown

F02

Outpatient Facility

A health care facility where services are provided to patients that do
not reside within that facility while they are receiving services.

F02.03

Outpatient- Private Medical Practice

A non-residential health care facility that is privately owned and/or
operated.

F02.04

Outpatient- HIV Specialty Clinic

A non-residential health care facility that concentrates in the provision
of HIV treatment, care and prevention services.

F02.10

Outpatient- Prenatal/ OBGYN Clinic

A non-residential health care facility that provides obstetric,
gynecological and other pregnancy-related health services.

F02.12

Outpatient- TB Clinic

A non-residential health care facility that specializes in the provision
of tuberculosis treatment, care and prevention services.

F02.19

Outpatient- Drug / Alcohol Treatment Clinic

A non-residential health care facility that provides alcohol and
chemical dependency treatment services.

F02.20

Outpatient- Family Planning

A non-residential health care facility that provides pregnancy testing,
birth control services, and other reproductive health services.

F02.30

Outpatient- Community Mental Health

A non-residential health care facility that provides treatment and
support services for the mentally ill or others with mental health
problems including counseling, case management, treatment,
peer/family support and public education.

F02.51

Outpatient- Community Health Clinic

A non-residential health care facility that provides primary and
preventive health care services to the members of a community in
which it is located.

F02.58

Outpatient- School/University Clinic

A non-residential health clinic that is operated by and provides
services within a school or university setting.

F02.60

Outpatient- Health Department/Public Health Clinic

A non-residential health clinic that is supported by public funds.

F02.61

Outpatient- Health Department/Public Health Clinic-HIV

A non-residential health clinic that is supported by public funds and
provides HIV prevention, diagnosis and treatment services.

F02.62

Outpatient- Health Department/Public Health Clinic-STD

A non-residential health clinic that is supported by public funds and
provides STD prevention, diagnosis and treatment services.

F02.88

Outpatient Facility- Other (specify)

F02.99

Outpatient Facility- Unknown

F03

Emergency Room

A residential health facility that provides substance abuse treatment
and rehabilitation.

A section of a hospital or clinic staffed and equipped to provide
emergency care to persons requiring immediate medical treatment for
sudden illness or trauma.

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Num

Variable Name

Mandatory

HD

CBO

F04.01

Blood Bank, Plasma Center

A place where blood is collected from donors, typed, separated into
components, stored, and prepared for transfusion to recipients. A
blood bank may be a separate free-standing facility or part of a larger
laboratory in a hospital.

F04.05

HIV Counseling & Testing Site

A facility or non-facility based setting where HIV prevention
counseling and testing services are provided.

F06

Community Setting

A defined area, environment or context in which a group of people
live, work or congregate.

F06.01

Community Setting-AIDS Service Organization- non-clinical

A health association, support agency, or other service actively
involved in the prevention and treatment of AIDS.

F06.02

Community Setting-School/Education facility

A building or place where individuals receive knowledge through
learning and instruction.

F06.03

Community Setting-Church/Mosque/Synagogue/Temple

A building or place where a group of people who adhere to a
common faith gather for prayer.

F06.04

Community Setting-Shelter/Transitional housing

Shelters are facilities in which people can stay temporarily when they
would otherwise have to sleep on the street. Shelters also sometimes
provide other services (e.g., soup kitchen, job seeking skills training,
job training, support groups), or refer their clients to agencies that do.
Transitional housing is short to long-term housing (6 to 24 months)
available for individuals or families who are homeless.

F06.05

Community Setting-Commercial

A business or commercial facility (e.g., beauty salon, grocery store,
shopping center) where HIV prevention services may also occur.

F06.06

Community Setting-Residential

A primary residence that might include residential neighborhoods or
the common areas of apartment complexes or housing developments.

F06.07

Community Setting-Bar/Club/Adult entertainment

F06.08

Community Setting-Public area

An area, environment or context that is open to the community as a
whole such as a park or city street.

F06.09

Community Setting-Workplace

A location where a worker normally performs his/her job tasks or the
businesses administrative offices. Use this site type for prevention
services delivered to a particular employer's employees.

F06.10

Community Setting- Community center

A facility where the members of a community can gather for social or
cultural activities.

F06.88

Community Setting- Other (specify)

F07

Correctional Facility

F88

Facility Other (specify)

A penal or correctional facility, prison, jail detention center,
community-based rehabilitation center, or any similar institution
designed for the confinement or rehabilitation of criminal offenders.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

X211

Mandatory

Reason for First Positive Test

HD

CBO

Yes

Yes

Definition: The client’s reason for seeking the first HIV test from which the client received an
HIV positive diagnosis, that is, the test that began the testing sequence that
resulted in the client’s first confirmed HIV positive result.
Instructions: Select all reasons that apply. If the client reports that the reason he/she is being t
Code

Value Description

Value Definition

01

Because you are concerned that you might have been exposed to
HIV in the past 6 months?

Asks whether the client was tested because he/she had a recent
experience or an experience in the 6 months before test (unsafe sex
or injection drug use, accidental needle stick, etc.) that he/she felt put
him/her at risk for HIV infection. In this case, a positive test result
would be more likely to be an incident case.

02

Because you get tested routinely, and it was time for you to get tested Asks whether the client gets tested regularly (every 3 months, 6
again?
months, yearly, etc.). It is not asking whether the test is part of routine
medical care, which could mean that the client has an HIV antibody
test every time he/she sees the doctor, regardless of the interval.

03

Because you are just checking to make sure you are HIV negative?

Asks if the client had no particular reason other than to reassure
him/herself (for example, some people test when they start a new
relationship or have some other change in their life).

04

Because it was required by either insurance, the military, a court
order, or for some other required reason?

Asks if the test is not the client’s idea, but rather is a requirement of
some other entity.

77

Refused

88

Because there is some other reason you want to get tested? (Specify) Allows the client to give another reason for testing that may not have
been asked (other reasons might include pregnancy or the test may
have been suggested as follow up for a blood donation).

99

Don’t Know

X212

Ever Negative HIV test

Yes

Yes

Definition: Asks whether the client has had a previous HIV test and received a HIV-negative
test result. The test can either be a standard HIV test or a rapid HIV test.
Instructions:
Code

Value Description

Value Definition

0

No

The client has not had a prior test with an HIV-negative result. Either
the current test is the client’s first HIV test, or the client’s only prior
result from an HIV test was positive.

1

Yes

The client has had a prior test with an HIV-negative result.

77

Refused to answer

99

Don't know (don't remember)

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Num

Variable Name

X212a

Mandatory

Date Last Negative Test Available

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: Indicate if the date of the last negative test is available.
Instructions:
Code

Value Description

0

No

1

Yes

66

Not asked

77

Refused

99

Don't Know

X213

Value Definition

Date of Last Negative Test
Definition: The date that the specimen (oral fluid, blood, urine) was collected for the client’s
most recent negative HIV test, not the date the result was received.
Instructions: If the client reports that he/she has had a negative rapid HIV test, the test date to

X214

What was the name of the place where you got your last negative test?
Definition: The name of the agency that provided the client’s most recent HIV negative test
result.
Instructions: Enter the name of the agency where the client received his/her most recent negat

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PEMS Data Variables and Values
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Num

Variable Name

X215

Mandatory

State Where Last Tested Negative

HD

CBO

Yes

Yes

Definition: The state where the test was administered. That is, the state of the physical
location where the client’s most recent negative test was performed.
Instructions:
Code

Value Description

Value Definition

01

AL

Alabama

02

AK

Alaska

04

AZ

Arizona

05

AR

Arkansas

06

CA

California

08

CO

Colorado

09

CT

Connecticut

10

DE

Delaware

11

DC

District of Columbia

12

FL

Florida

13

GA

Georgia

15

HI

Hawaii

16

ID

Idaho

17

IL

Illinois

18

IN

Indiana

19

IA

Iowa

20

KS

Kansas

21

KY

Kentucky

22

LA

Louisiana

23

ME

Maine

24

MD

Maryland

25

MA

Massachusetts

26

MI

Michigan

27

MN

Minnesota

28

MS

Mississippi

29

MO

Missouri

30

MT

Montana

31

NE

Nebraska

32

NV

Nevada

33

NH

New Hampshire

34

NJ

New Jersey

35

NM

New Mexico

36

NY

New York

37

NC

North Carolina

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Num

Variable Name

Mandatory

38

ND

North Dakota

39

OH

Ohio

40

OK

Oklahoma

41

OR

Oregon

42

PA

Pennsylvania

44

RI

Rhode Island

45

SC

South Carolina

46

SD

South Dakota

47

TN

Tennessee

48

TX

Texas

49

UT

Utah

50

VT

Vermont

51

VA

Virginia

53

WA

Washington

54

WV

West Virginia

55

WI

Wisconsin

56

WY

Wyoming

60

AS

American Samoa

64

FM

Federated States of Micronesia

66

GU

Guam

68

MH

Marshall Islands

69

MP

Northern Mariana Islands

70

PW

Palau

72

PR

Puerto Rico

78

VI

Virgin Islands of the U.S.

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HD

CBO

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

X216

Mandatory

Site Type of Last Negative

HD

CBO

Yes

Yes

Definition: The setting that best describes where the most recent HIV negative test was
performed.
Instructions:
Code

Value Description

Value Definition

F01

Inpatient Facility

A hospital or other health facility where services are provided to
patients that reside within that facility while they are receiving those
services.

F01.01

Inpatient- Hospital

F01.50

Inpatient- Drug / Alcohol Treatment

F01.88

Inpatient Facility- Other (specify)

F01.99

Inpatient Facility- Unknown

F02

Outpatient Facility

A health care facility where services are provided to patients that do
not reside within that facility while they are receiving services.

F02.03

Outpatient- Private Medical Practice

A non-residential health care facility that is privately owned and/or
operated.

F02.04

Outpatient- HIV Specialty Clinic

A non-residential health care facility that concentrates in the provision
of HIV treatment, care and prevention services.

F02.10

Outpatient- Prenatal/ OBGYN Clinic

A non-residential health care facility that provides obstetric,
gynecological and other pregnancy-related health services.

F02.12

Outpatient- TB Clinic

A non-residential health care facility that specializes in the provision
of tuberculosis treatment, care and prevention services.

F02.19

Outpatient- Drug / Alcohol Treatment Clinic

A non-residential health care facility that provides alcohol and
chemical dependency treatment services.

F02.20

Outpatient- Family Planning

A non-residential health care facility that provides pregnancy testing,
birth control services, and other reproductive health services.

F02.30

Outpatient- Community Mental Health

A non-residential health care facility that provides treatment and
support services for the mentally ill or others with mental health
problems including counseling, case management, treatment,
peer/family support and public education.

F02.51

Outpatient- Community Health Clinic

A non-residential health care facility that provides primary and
preventive health care services to the members of a community in
which it is located.

F02.58

Outpatient- School/University Clinic

A non-residential health clinic that is operated by and provides
services within a school or university setting.

F02.60

Outpatient- Health Department/Public Health Clinic

A non-residential health clinic that is supported by public funds.

F02.61

Outpatient- Health Department/Public Health Clinic-HIV

A non-residential health clinic that is supported by public funds and
provides HIV prevention, diagnosis and treatment services.

F02.62

Outpatient- Health Department/Public Health Clinic-STD

A non-residential health clinic that is supported by public funds and
provides STD prevention, diagnosis and treatment services.

F02.88

Outpatient Facility- Other (specify)

F02.99

Outpatient Facility- Unknown

F03

Emergency Room

A residential health facility that provides substance abuse treatment
and rehabilitation.

A section of a hospital or clinic staffed and equipped to provide
emergency care to persons requiring immediate medical treatment for
sudden illness or trauma.

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Num

Variable Name

Mandatory

HD

CBO

F04.01

Blood Bank, Plasma Center

A place where blood is collected from donors, typed, separated into
components, stored, and prepared for transfusion to recipients. A
blood bank may be a separate free-standing facility or part of a larger
laboratory in a hospital.

F04.05

HIV Counseling & Testing Site

A facility or non-facility based setting where HIV prevention
counseling and testing services are provided.

F06

Community Setting

A defined area, environment or context in which a group of people
live, work or congregate.

F06.01

Community Setting-AIDS Service Organization- non-clinical

A health association, support agency, or other service actively
involved in the prevention and treatment of AIDS.

F06.02

Community Setting-School/Education facility

A building or place where individuals receive knowledge through
learning and instruction.

F06.03

Community Setting-Church/Mosque/Synagogue/Temple

A building or place where a group of people who adhere to a
common faith gather for prayer.

F06.04

Community Setting-Shelter/Transitional housing

Shelters are facilities in which people can stay temporarily when they
would otherwise have to sleep on the street. Shelters also sometimes
provide other services (e.g., soup kitchen, job seeking skills training,
job training, support groups), or refer their clients to agencies that do.
Transitional housing is short to long-term housing (6 to 24 months)
available for individuals or families who are homeless.

F06.05

Community Setting-Commercial

A business or commercial facility (e.g., beauty salon, grocery store,
shopping center) where HIV prevention services may also occur.

F06.06

Community Setting-Residential

A primary residence that might include residential neighborhoods or
the common areas of apartment complexes or housing developments.

F06.07

Community Setting-Bar/Club/Adult entertainment

F06.08

Community Setting-Public area

An area, environment or context that is open to the community as a
whole such as a park or city street.

F06.09

Community Setting-Workplace

A location where a worker normally performs his/her job tasks or the
businesses administrative offices. Use this site type for prevention
services delivered to a particular employer's employees.

F06.10

Community Setting- Community center

A facility where the members of a community can gather for social or
cultural activities.

F06.88

Community Setting- Other (specify)

F07

Correctional Facility

F88

Facility Other (specify)

X217

A penal or correctional facility, prison, jail detention center,
community-based rehabilitation center, or any similar institution
designed for the confinement or rehabilitation of criminal offenders.

Number of Times Tested for HIV in Past 2 years

Yes

Yes

Definition: The number of completed HIV tests the client had in the previous two years. If
the client has a known HIV positive result then the counselor documents the
number of completed HIV tests the client had in the two years before the first HIV
positive test. The current test or the first positive test is included in this count.
Instructions: This question can be confusing because it requests that the counselor include the

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PEMS Data Variables and Values
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Num

Variable Name

X218

Mandatory

Date First Time Tested Available

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Definition: Indicate if the date of the first HIV test is available.
Instructions:
Code

Value Description

0

No

1

Yes

66

Not asked

77

Refused

99

Don't know

X218a

Value Definition

First Time Ever Tested
Definition: The month and year of the very first time the client ever sought, and received an
HIV test.
Instructions: Only a test that the client sought, and received, is documented here. For exampl

X219

Medication in Last 6 Months
Definition: The client's self-report of having taken any medications to treat or try to prevent
HIV or hepatitis infection in the 6 months prior to the date of the HIV test.
Instructions:

Code

Value Description

Value Definition

0

No

The client has not taken antiretroviral medication in the previous 6
months.

1

Yes

The client has taken antiretroviral medication in the previous 6
months.

77

Refused

99

Don't know

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PEMS Data Variables and Values
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Num

Variable Name

X220

Mandatory

Type of Medication

HD

CBO

Yes

Yes

Yes

Yes

Definition: Which ones? [If not sure of time period, ask “Which medicines COULD you have
taken in the past six months?”]
Instructions: Select all medications cited by the client. Prompts that might assist the client inclu
Code

Value Description

01

Agenerase

02

Combivir

03

Crixivan

04

Epivir

05

Fortovase

06

Hivid

07

Invirase

08

Kaletra

10

Norvir

11

Rescriptor

12

Retrovir

13

Sustiva

14

Trizivir

15

Videx

16

Videx EC

17

Viracept

18

Viramune

19

Viread

20

Zerit

21

Ziagen

22

Emtriva

23

Reyataz

24

Fuzeon

25

Truvada

26

Lexiva

88

Other (specify)

X221

Value Definition

First Day of Medication
Definition: The date of the first day on which the client took antiretroviral medication.
Instructions:

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Num

Variable Name

X222

Mandatory

Currently on Medication

HD

CBO

Yes

Yes

Definition: The client reports currently taking antiretroviral medication.
Instructions:
Code

Value Description

Value Definition

0

No

The client is not currently taking antiretroviral medication.

1

Yes

The client is currently taking antiretroviral medication.

77

Refused

The client declines or is unwilling to report if he/she is currently taking
antiretroviral medication.

99

Don't know

The client does not know if he/she is currently taking antiretroviral
medication.

X223

Last Day of Medication

Yes

Yes

Definition: The date of the last day on which the client took antiretroviral medication. If the
client previously answered “Yes” to the question regarding whether he/she is
currently taking HIV or ARV medication, then the last day of HIV or ARV
medication should be the date that the survey is being completed. If the client
answered “Yes” to the question regarding whether he/she has taken HIV or ARV
medication in the last 6 months, then the date of the last day of HIV or ARV
medication should be a date within the past 6 months.
Instructions:

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Table: X-3

Mandatory

HD

CBO

Attempt to Locate

This table is to be completed for each index client or partner to be located. While this table is intended to be for PCRS, it may be used
optionally for any intervention.
Intervention type = PCRS
Reported to CDC
Num

Variable Name

X301

Mandatory

Locate Method

HD

CBO

No

Yes

Definition: The strategy used to search for and determine the location of the index client or
the index client's partner.
Instructions: For each attempt made to locate the index client or index client's partner(s), indic
Code

Value Description

Value Definition

01

Field

The PCRS provider made an attempt to locate the index client or
partner outside the office or clinic setting. This includes efforts made
to locate the index client or partner during routine outreach activities
or field visits.

02

Agency Identified

The PCRS provider delivered PCRS services immediately following
the index client's or partner's receipt of another service provided in
the agency (e.g. immediately following receipt of CTR).

03

Telephone

The PCRS provider made an attempt to locate the index client or the
partner by telephone.

04

Internet

The PCRS provider made an attempt to locate the index client or
partner through use of the Internet (e.g., chat rooms).

05

Mail

The PCRS provider made an attempt to locate the index client or
partner through electronic or ground mail.

88

Other (specify)

X302

Attempt Outcome

Yes

Yes

Definition: The result of a PCRS provider's attempt to locate the index client or the index
client's partner(s).
Instructions: For each attempt made to locate the index client or the index client's partner, indi
Code

Value Description

Value Definition

01

Unable to locate

The provider did not locate the index client or partner during this
attempt.

02

Located

The provider did locate the index client or partner during this attempt.

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Num

Variable Name

X303

Mandatory

Reason for Unsuccessful Attempt

HD

CBO

No

Yes

Definition: The explanation for why the location attempt was not achieved.
Instructions: If the attempt to locate the index client or index client's partner was unsuccessful (
Code

Value Description

Value Definition

01

Deceased

The index client or partner is no longer alive.

02

Out of jurisdiction

The index client or partner resides outside of the jurisdiction in which
the provider is authorized to provide services.

88

Other (specify)

X304

Attempt Date

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The date on which the attempt to locate the index client or index client's partner
was made.
Instructions: Indicate the date the attempt to locate the index client or index client's partner wa
X305

Worker ID
Definition: A system generated code used to distinguish between persons who are
delivering services to clients by a combination of non-identifying characteristics.
Instructions: Choose from a list of workers established in Table P: Worker, the worker who ma

X306

Enrollment Status
Definition: The decision made by the index client or the index client's partner to enroll in
PCRS services.
Instructions: If X302: Attempt Outcome = "Locate", indicate if the index client or index client's p

Code

Value Description

Value Definition

1

Accept

The index client or partner enrolled in PCRS.

2

Refused

The index client or partner chose not to enroll in PCRS.

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Reported to CDC
Num

Variable Name

Table: X-5

Mandatory

HD

CBO

Elicit partners

This table is to be completed for each enrolled PCRS index client to capture partner information (e.g. recall period, number of partners).
Intervention type = PCRS
Reported to CDC
Num

Variable Name

X501

Mandatory

Partner Information Provided

HD

CBO

Yes

Yes

Definition: The index client provided information about his or her sex and/or needle sharing
partners or social network contacts.
Instructions: Indicate if the index client provided names, descriptions, and/or locating informati
Code

Value Description

Value Definition

1

Yes

The index client provided locating information about his/her sex
and/or needle sharing partners or social network contacts.

2

No - elicit again

The index client did not provide locating information about his/her sex
and/or needle sharing partners or social network contacts but
information may be available/provided in the future. The provider
should attempt to elicit locating information from the index client
again.

3

No - closed

The index client did not provide locating information about his/her sex
and/or needle sharing partners or social network contacts because
this information does not exist or is not available.

X502

Time Period for Recall (in months)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The period of time as defined in months for which the client is asked to
remember and report his or her number of sex and/or needle sharing partners
and social network contacts.
Instructions: If partner information was provided (X501: Partner Information Provided = "Yes"),
X503

Total Number of Partners
Definition: The total number of partners reported by the client over a specified recall period.
Instructions: Enter the total number of partners identified by the index client. This includes all

X503a

Number of Male Partners
Definition: The number of male partners reported by the client over a specified recall period.
Instructions: Of the total number of partners reported in X503: Total Number of Partners, indic

X503b

Number of Female Partners
Definition: The number of female partners reported by the client over a specified recall
period.
Instructions: Of the total number of partners reported in X503: Total Number of Partners, indic

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Reported to CDC
Num

Variable Name

X503c

Mandatory

Number of Transgender Partners

HD

CBO

Yes

Yes

Yes

Yes

Definition: The number of transgender partners reported by the client over a specified recall
period.
Instructions: Of the total number of partners reported in X503: Total Number of Partners, indic
X504

Number of Anonymous Partners
Definition: The total number of partners whose identity was unknown to the client at the time
of the sex and/or needle sharing event.
Instructions: Of the total number of partners reported in X503: Total Number of Partners, indic

Table: X-6

Notification of Exposure

This table is completed for each partner located to determine their knowledge of exposure and HIV status.
Intervention type = PCRS
Reported to CDC
Num

Variable Name

X601

Mandatory

Notification Method

HD

CBO

Yes

Yes

Definition: The process used to inform an index client's partner that he/she has been
exposed to HIV.
Instructions: Indicate the method used to notify each partner identified in X503: Total Number
Code

Value Description

Value Definition

01

Provider notification

The PCRS provider, with the consent of the HIV-infected client, takes
the responsibility for informing the partner of his/her possible
exposure to HIV and referring them to counseling, testing, and other
support services.

02

Dual notification

The HIV-infected client informs the partner of his/her serostatus in the
presence of the PCRS provider.

03

Client notification - coaching provided

The HIV-infected client informs his or her partners of their possible
exposure to HIV and refers them to counseling, testing, and other
support services after receiving guidance from the PCRS provider.
This guidance includes advice on the best ways to inform each
partner, how to respond to a partner's reactions and how and where
the partner can access HIV counseling and testing and other support
services .

04

Client notification - coaching not provided

The HIV-infected client informs his or her partners of their possible
exposure to HIV and refers them to counseling, testing, and other
support services.

05

Refused notification

The index client's partner refused to be informed of his or her
possible exposure to HIV.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

X602

Mandatory

Previous HIV test

HD

CBO

Yes

Yes

Definition: The partner's self-report of having had a prior HIV test.
Instructions: Indicate if the partner reports having a previous HIV test.
Code

Value Description

Value Definition

0

No

The index client's partner reported that they have never had an HIV
test.

1

Yes

The index client's partner reported that they have had a previous HIV
test.

66

Not asked

The provider did not ask the index client's partner about having a
prior HIV test.

77

Refused to answer

The index client's partner declines or is unwilling to report if he/she
has had a previous HIV test.

99

Don't Know

The index client's partner reported that they are unaware if they have
had a previous HIV test.

X603

Self-Reported HIV Test Result

Yes

Yes

Definition: The client's self-reported test result from his/her most recent HIV test prior to
notification.
Instructions: If the partner reports having had a previous HIV test (i.e. X602: Previous HIV Test
Code

Value Description

Value Definition

01

Positive

The index client's partner reported that his or her HIV status is
positive based on a confirmatory test result.

02

Negative

The index client's partner reported that his or her HIV status is
negative.

03

Preliminary Positive/Indeterminate

The index client's partner reported that he/she received either a
“Preliminary positive” test result (i.e., the index client's partner had a
reactive HIV rapid test but did not receive the results of the
associated conventional confirmatory test) or an “Indeterminate” test
result (i.e., the index client's partner received results but those results
did not conclusively indicate whether he/she is HIV-positive or HIVnegative).

66

Not asked

The provider did not ask the client about his or her HIV status.

77

Refused to answer

The index client's partner declines or is unwilling to report his or her
HIV status.

99

Don't Know

The index client's partner reports that they are unaware of their HIV
status.

X604

Date of Last HIV Test

Yes

Yes

Definition: The date of the partner's last HIV test.
Instructions: If the partner reports having a previous HIV test (X602: Previous HIV test = "Yes),

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Reported to CDC
Num

Variable Name

Table: X-7

Mandatory

HD

CBO

Referral

This table is completed for all clients receiving a referral.
Reported to CDC
Num
X701

Variable Name

Mandatory

PEMS Referral Code

HD

CBO

Yes

Yes

Yes

Yes

Definition: A PEMS generated unique code that is used by the agency to track client
referrals to other agencies.
Instructions: Enter the PEMS system-generated referral code for the referral made for this clie
X702

Referral Date
Definition: The date on which the referral was made for the client.
Instructions: This is a system-generated variable that is pre-populated based on the date of the

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Num

Variable Name

X703

Mandatory

Referral Service Type

HD

CBO

Yes

Yes

Definition: The service to which the client was referred.
Instructions: Select the service to which client was referred (e.g., HIV testing, PCRS, HE/RR).
Code

Value Description

Value Definition

01

HIV testing

A diagnostic, laboratory procedure to assess for the presence of HIV
antibodies.

02

HIV confirmatory test

An HIV test designed to confirm the results of a preliminary positive
screening test.

03

HIV prevention counseling

An interactive risk-reduction counseling model usually conducted with
HIV testing, in which the counselor helps the client identify and
acknowledge personal HIV risk behaviors and commit to a single,
achievable behavior change step that could reduce the client's HIV
risk.

04

STD screening and treatment

Provision of testing to determine infection with a sexually transmitted
disease other than HIV or Viral Hepatitis and treatment if infected.

05

Viral Hepatitis screening and treatment

Provision of testing to determine infection with viral hepatitis (A, B,
and C) and treatment if positive or vaccination if negative.

06

Tuberculosis testing

Testing for tuberculosis (TB), prophylactic TB treatment, and clinical
evaluation for active TB disease.

07

Syringe exchange services

Services that provide clean syringes in exchange for used syringes.

08

Reproductive health services

Health care services for female clients who are pregnant or of childbearing age.

09

Prenatal care

Health care services for female clients before and during pregnancy
to monitor the health of the pregnant mother and fetus.

10

HIV medical care/evaluation/treatment

Medical services that address HIV infection including evaluation of
immune system function and screening, treatment, and prevention of
opportunistic infection.

11

IDU risk reduction services

Services that promote practices that reduce the health risks of
injection drug use (i.e., using sterile needles, never sharing needles,
disinfecting needles, disposing of needles).

12

Substance abuse services

Services for the treatment and prevention of drug or alcohol use.

13

General medical care

Professional treatment for illness, injury or routine health care
services (non-HIV related).

14

Partner counseling and referral services

A range of services available to HIV-infected persons, their partners
and affected communities that involves informing current and past
partners that a person who is HIV-infected has identified them as a
sex or injection-drug-paraphernalia-sharing partner and advising
them to have HIV counseling and testing. Notified partners, who may
not have suspected their risk, can then choose whether to be tested
for HIV, enabling those who test HIV positive to receive early medical
evaluation, treatment, and prevention services, including riskreduction counseling.

15

Mental health services

Services to assist with mental illness, developmental disabilities or
difficulty coping with HIV diagnosis or HIV-related conditions.

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PEMS Data Variables and Values
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Num

Variable Name

Mandatory

HD

CBO

16

Comprehensive Risk Counseling Services

A client-centered HIV prevention counseling activity with the
fundamental goal of promoting the adoption and maintenance of HIV
risk-reduction behaviors by clients with multiple, complex problems
and risk-reduction needs. CRCS provides intensive, on-going,
individualized prevention counseling, support, and service brokerage.
This HIV prevention activity addresses the relationship between HIV
risk and other issues such as substance abuse, STD treatment,
mental health, and social and cultural factors.

17

Other prevention services

Service to address additional prevention service or treatment needs
such as health education, individual counseling, and community level
interventions (e.g., workshops, health fairs).

18

Other support services

Assistance with housing, food, employment, transportation, child
care, domestic violence, support groups and legal services.

19

Case management

A range of client-centered services that links clients with primary
medical care, psychosocial and other services to insure timely,
coordinated access to medically-appropriate levels of health and
support services, continuity of care, ongoing assessment of the
client’s and other family members’ needs and personal support
systems, and inpatient case-management services that prevent
unnecessary hospitalization or that expedite discharge, as medically
appropriate, from inpatient facilities. This refers to services such as
those provided under the Ryan White CARE Act and is different from
Comprehensive Risk Counseling Services (CRCS).

88

Other

X703a

Internal Referral Site ID

No

Yes

No

Yes

Definition: The agency's site (as established in Table S: Site) where the client was referred
for additional services by another provider within that agency. The Site ID is a
system generated code used to distinguish the sites of service delivery within an
agency.
Instructions: If you are referring a client to a service delivery site that is a part of your agency, i
X704

Network Agency Name(s)
Definition: The name of the agency to which the client is being referred.
Instructions: If you are referring a client to an agency that is listed as one of your Network Age

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Num

Variable Name

X705

Mandatory

Referral Follow-up

HD

CBO

Yes

Yes

Definition: The method that will be used to verify that the client accessed the services to
which he or she was referred.
Instructions: Indicate the method that will be used to determine whether the client accessed th
Code

Value Description

Value Definition

00

None

There is no plan to verify that the client accessed this referral. If this
value is chosen, the reason for no referral follow-up should be
specified in X711: Referral notes.

01

Active referral

The referring provider will directly link the client to the service provider
or agency (e.g., the provider physically accompanies or transports the
client to the agency).

02

Passive referral-agency verification

The referring provider will confirm the outcome of a referral through
information received by the receiving agency (e.g., the referring
provider contacts the agency or receives confirmation through a
referral "kick-back" card from the agency where the client was
referred).

03

Passive referral-client verification

The referring provider will confirm the outcome of a referral through
information provided by the client, (e.g., client self-report).

X706

Referral Outcome

Yes

Yes

Definition: The current status of the referral based on activities to verify that the service was
accessed.
Instructions: Select the value that reflects the current status of this referral follow-up. The syst
Code

Value Description

Value Definition

01

Pending

The referring agency has not yet confirmed whether the client
accessed the service to which he or she was referred.

02

Confirmed- Accessed service

The referring agency has confirmed whether the client accessed the
service to which he or she was referred.

03

Confirmed- Did not access service

The referring agency has confirmed that the client had not accessed
the service to which he or she was referred.

04

Lost to follow up

Within 60 days of the referral date (X702: Referral Date < 60 days),
access of the service to which the client was referred can't be
confirmed or denied. The system will automatically mark a referral as
“Lost to follow-up” if a referral has not been verified within 60 days of
the referral date.

05

No follow-up

The referral was not tracked to confirm whether the client accessed
the referred service.

X706a

Confirmed Internal Referral Site Name

No

Yes

Definition: The site within the agency where the client accessed the service to which they
were referred. The Site ID is a system generated code used to distinguish the
sites of service delivery within an agency.
Instructions: If the client accessed the referred service at a site within your agency, indicate th

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Num

Variable Name

X707

Mandatory

Confirmed Network Agency Name

HD

CBO

No

Yes

Yes

Yes

Yes

Yes

Definition: The name of the agency where the client accessed the service to which they
were referred.
Instructions: If the client accessed the service to which they were referred from an agency liste
X710

Referral Close Date
Definition: The date when the outcome of the referral was confirmed or lost to follow-up.
Instructions: Within 60 days of the date entered in X702: Referral Date, indicate the date when

X712

HIV Test Performed
Definition: A client received an HIV test as a result of a referral from PCRS to CTR.
Instructions: If the client was referred to CTR from PCRS, indicate if the client was tested for H

Code

Value Description

Value Definition

0

No

The client did not receive an HIV test as a result of a referral to this
agency/site for CTR.

1

Yes

The client received an HIV test as a result of a referral to this
agency/site for CTR.

X713

HIV Test Result

Yes

Yes

Definition: The outcome of an HIV test.
Instructions: If the client received an HIV test (X712: HIV Test Performed = "Yes"), as a result
Code

Value Description

Value Definition

01

Positive/Reactive

A test result that is reactive on an initial ELISA test, repeatedly
reactive on a second ELISA run on the same specimen, and
confirmed positive on a Western blot or other supplemental test
indicating that the client is infected.

03

Negative

A test result that is non-reactive on an initial ELISA test indicating the
absence of HIV infection or an ELISA that was repeatedly reactive
and the confirmatory test (Western Blot or IFA) was negative.

04

Indeterminate

A test result that has not been precisely determined. A possible
result of a Western-blot, which might represent a recent HIV infection
or a false positive.

05

Invalid

A test result cannot be confirmed due to conditions related to errors in
the testing technology, specimen collection, or transport.

06

No result

No result was obtained even though the specimen was drawn (e.g.,
blood sample hemolyzed, blood tube broke, blood tube lost in transit,
unable to draw blood from veins).

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Num

Variable Name

X714

Mandatory

Confirmatory Test

HD

CBO

Yes

Yes

Definition: An HIV test designed to confirm the results of a preliminary positive screening
test.
Instructions: Indicate if the HIV test (X712: HIV Test Performed) is a confirmatory test following
Code

Value Description

0

No

The HIV test was an initial or preliminary test.

1

Yes

The HIV test was a confirmatory test following an initial test with a
preliminary positive/reactive test result.

X715

Value Definition

HIV Test Verification

Yes

Yes

Definition: The process or method by which the result of an HIV test was determined.
Instructions: Indicate whether the HIV test result (H713: HIV Test Result) was verified by the pr
Code

Value Description

Value Definition

01

Verification by provider

The client's receipt of an HIV test was confirmed by the agency
where the test was performed.

02

Client self-report

The client's receipt of an HIV test was confirmed by the client who
received the HIV test.

X716

Date of Birth-Year

Yes

Yes

Yes

Yes

Definition: The self-reported year of birth of the referred client.
Instructions: If this referral is being made during an intervention in which you are collecting agg
X717

Ethnicity
Definition: The client's self report of whether they are of Hispanic or Latino origin.
Instructions: If this referral is being made during an intervention in which you are collecting agg

Code

Value Description

Value Definition

77

Refused to answer

The client declines or is unwilling to report his/her ethnicity.

99

Don't Know

The client reports that he/she is unaware of their ethnicity.

E1

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central
America, or other Spanish culture or origin, regardless of race.

E2

Not Hispanic or Latino

A person not identified by the definition of Hispanic or Latino.

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Num

Variable Name

X718

Mandatory

Race

HD

CBO

Yes

Yes

Definition: A client's self-reported classification of the biological heritage with which they
most closely identify. Standard OMB race codes are applied.
Instructions: If this referral is being made during an intervention in which you are collecting agg
Code

Value Description

Value Definition

77

Refused

The client declines or is unwilling to report his/her race.

99

Don't Know

The client reports that he/she is unaware of their race.

R1

American Indian or Alaska Native

A person having origins in any of the original peoples of North or
South America (including Central America), and who maintains tribal
affiliation or community attachment.

R2

Asian

A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian Subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam

R3

Black or African American

A person having origins in any of the black racial groups of Africa.

R4

Native Hawaiian or Pacific Islander

A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands

R5

White

A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.

X719

Current Gender

Yes

Yes

Definition: The client's current self-reported sexual identity.
Instructions: If this referral is being made during an intervention in which you are collecting agg
Code

Value Description

Value Definition

01

Male

The behavioral, cultural, or psychological traits typically associated
with the male sex.

02

Female

The behavioral, cultural, or psychological traits typically associated
with the female sex.

03

Transgender-MTF

Individuals whose physical or birth sex is male but whose gender
expression and/or gender identity is female. Note: MTF = male to
female.

04

Transgender-FTM

Individuals whose physical or birth sex is female but whose gender
expression and/or gender identity is male. Note: FTM = female to
male.

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Num

Variable Name

X720

Mandatory

Risk Category

HD

CBO

Yes

Yes

Definition: A type of sex or drug using behavior that places an individual at risk for HIV
infection or transmission.
Instructions: If this referral is being made during an intervention in which you are collecting agg
Code

Value Description

Value Definition

01

Male to male sexual contact

Men who are at risk through unprotected sex with another male.

02

Male to male sexual contact and unsafe injection drug practices

Men who are at risk from both unprotected male to male sexual
contact and unsafe injection drug practices (e.g., sharing needles,
using dirty needles).

03

Unsafe drug injection practices

Men and women who are at risk through unsafe drug injection
practices (e.g., sharing needles, using dirty needles).

04

Sexual contact involving transgender and unsafe injection drug
practices

Men and women who are at risk from both unprotected sexual
contact involving trangenders and unsafe injection drug practices
(e.g., sharing needles, using dirty needles).

05

Sexual contact involving transgender

Men and women who are at risk through unprotected sexual contact
involving trangenders.

06

Heterosexual contact

Men and women who are at risk through unprotected heterosexual
sex with an HIV infected partner.

88

Other

X721

Self Reported HIV Test Result

Yes

Yes

Definition: The client's self-reported test result from his/her most recent HIV test.
Instructions: If this referral is being made during an intervention for which there is not a Table
Code

Value Description

Value Definition

01

Positive

The client reports that his/her HIV status is positive.

02

Negative

The client reports that his/her HIV status is negative.

03

Preliminary Positive/Indeterminate

The client reports that he/she received either a “Preliminary positive”
test result (i.e., the client had a reactive HIV rapid test but did not
receive the results of the associated conventional confirmatory test)
or an “Indeterminate” test result (i.e., the client received results but
those results did not conclusively indicate whether he/she is HIVpositive or HIV-negative).

66

Not asked

The provider did not ask the client about his/her HIV status.

77

Refused to answer

The client declines or is unwilling to report his/her HIV status.

99

Don't Know

The client reports that he/she is unaware of their HIV status.

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Num

Variable Name

Mandatory

HD

CBO

Aggregate Level
Table: AG

HE/RR and Outreach

This table is completed for each outreach and HE/RR event delivered in a specific site at a specified time.
Data is reported in aggregate.
Data specific to clients may be entered as count or percentage (AG8a-AG13c).
Reported to CDC
Num
AG00

Variable Name

Mandatory

Intervention Name

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: An Intervention Name/ID that was entered by your agency in Table F.
Instructions: Select from a list of Intervention Names generated from variable F02: Intervention
AG01

Session Number
Definition: The session number within a particular intervention cycle about which data for
this session or event are being entered.
Instructions: Indicate the session or event number in this particular intervention cycle. For inte

AG02

Date of Event/Session
Definition: The calendar date on which the event or session was delivered to clients.
Instructions: Enter the date on which the event or session occurred.

AG03

Duration of Event/Session
Definition: The amount of time (in minutes) the session or event lasted.
Instructions: Indicate the actual number of minutes that the session or event lasted.

AG04

Number of Client Contacts
Definition: The total number of clients attending the HE/RR session or the total number of
Outreach contacts made during the session/event specified in AG01:
Session/Event Number.
Instructions: Enter the total number of clients attending the HE/RR session or number of outre

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Num

Variable Name

AG05a

Mandatory

Delivery Method

HD

CBO

Yes

Yes

Definition: The medium(s) or channel(s) through which the intervention is delivered.
Instructions: Indicate how the intervention was delivered (e.g., in person, by using a video, ove
Code

Value Description

Value Definition

01.00

In person

The intervention is delivered by an individual or a group of individuals
in the physical presence of the client(s). Includes counseling, face to
face discussions, facilitating group activities, lectures, presentations,
etc.

02.00

Internet

The use of email, chat rooms, or websites to deliver information to
clients electronically.

03.00

Printed Materials

The use of pamphlets, direct mailing, magazines, newspapers,
posters, billboards, etc. If chosen, please specify the subcategory
(value codes 3.01-3.04) for printed material.

03.01

Printed Materials-magazines/newspapers

Magazine: a bound periodical published at regular intervals under the
same title containing articles of specific interest. Newspaper: a
periodical that is folded rather than bound and published at regular
intervals under the same title containing news, opinions,
advertisements, and other items of current, often local, interest.

03.02

Printed Materials-pamphlets/brochures

A short, printed publication that is unbound or has a paper binding
written to inform on a specific topic or to address a public issue or
event. This can be multiple pages bound in a booklet form or single
page folded in panels. In the context of HIV prevention, it is typically
used to promote practices (such as safer sex), services (such as
counseling and testing) information (such as HIV transmission risk).

03.04

Printed Materials-posters/billboards

Posters: a single sheet sign posted or displayed used to advertise
simple messages or as an advertisement for goods and services.
Typically used to promote practices (such as safer sex), services
(such as counseling and testing) information (such as HIV
transmission risk), or products (condoms). Billboards: large signs or
posters that are typically outdoors on which messages or
advertisements are placed with the intent to be viewed by the general
public. Typically used to promote practices (such as safer sex),
services (such as counseling and testing) information (such as HIV
transmission risk), or products (condoms).

04.00

Radio

The use of radio broadcasts using public service announcements,
commercial air time, and the inclusion of messages in radio
programs, etc.

05.00

Telephone

The use of telephones or telephone "hot lines".

06.00

Television

The use of televised broadcasts using public service announcements,
commercial air time, etc.

07.00

Video

The use of pre-recorded visual and audio messages not delivered via
broadcast or cable TV (e.g., on a VHS tape or DVD).

88

Other (specify)

The use of methods or mediums to deliver the intervention other than
those that are listed in the other value choices (1.0-7.0). If chosen,
please specify the delivery method.

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Num

Variable Name

AG05b

Mandatory

Activity

HD

CBO

Yes

Yes

Definition: The specific actions or components of an intervention in which the clients
participated in or received during this particular session.
Instructions: Select all of the activities that occurred during this session or event. Describe wh
Code

Value Description

Value Definition

04.00

Referral

A process by which immediate client needs for prevention, care, and
supportive services are assessed and prioritized and clients are
provided with information and assistance in identifying and accessing
specific services (such as, setting up appointments and providing
transportation). Note: The provision of a referral also includes a plan
for tracking whether or not the client accessed the referral.

08.01

Information-HIV/AIDS transmission

Any general information, written or verbal, given to an individual or a
group on HIV/AIDS and how it is transmitted.

08.02

Information-Abstinence/postpone sexual activity

Any information, written or verbal, given to an individual or a group on
abstaining from sexual activity or postponing sexual activity.

08.03

Information-Other sexually transmitted diseases

Any information, written or verbal, given to an individual or a group on
STDs (other than HIV or viral hepatitis), how it is transmitted, how to
reduce risk for transmission or infection, or treatment options.

08.04

Information-Viral hepatitis

Any information on viral hepatitis, how it is transmitted, and/or how to
reduce risk for transmission or infection, or treatment options.

08.05

Information-Availability of HIV/STD counseling and testing

Any information, written or verbal, given to an individual or a group
about where and how to access HIV-related CTR or STD counseling
and testing. This includes referral lists that only list CTR and/or STD
counseling and testing sites.

08.06

Information-Availability of partner notification and referral services

Any information, written or verbal, given to an individual or a group
about where and how to access partner notification services. The
availability information provided is exclusive to PCRS. This includes
referral lists that only list PCRS sites.

08.07

Information-Living with HIV/AIDS

Any information, written or verbal, given to an individual or a group
living with HIV/AIDS specific to living with the disease.

08.08

Information-Availability of social services

Any information, written or verbal, given to an individual or a group
about how and where to access social services. This could include a
referral list that only includes social services agencies or providers.

08.09

Information-Availability of medical services

Any information, written or verbal, given to an individual or a group
about how and where to access HIV medical services. This could
include a referral list that only includes HIV medical care providers.

08.10

Information - Sexual risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce sexual risk for HIV transmission or infection.

08.11

Information-IDU risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce injection drug use risk for HIV transmission or infection.

08.12

Information-IDU risk free behavior

Any information, written or verbal given to an individual or a group on
abstaining from injection drug use or only using new needles and
disposing of them appropriately.

08.13

Information-Condom/barrier use

Any information, written or verbal, given to an individual or a group
regarding appropriate use and disposal of condoms or other barrier
methods.

08.14

Information-Negotiation/Communication

Any information, written or verbal, given to an individual or a group
regarding communication of desire for safer practices and negotiating
safer practices with partners (sexual and needle sharing).

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Num

Variable Name

Mandatory

HD

CBO

08.15

Information-Decision making

Any information, written or verbal, given to an individual or a group
regarding the steps and techniques needed for reassessing, planning
and using judgment to avoid situations that may expose them to HIV
infection or transmission risk and/or decision to engage in a risk
behavior.

08.16

Information-Disclosure of HIV status

Any information, written or verbal, given to an individual or a group
regarding disclosure of their HIV status, applicable laws,
accompanying ramifications, and options regarding non-disclosure.

08.17

Information-Providing prevention services

Any information, written or verbal, given to an individual or a group on
how to communicate prevention messages and/or demonstrate risk
reduction skills with others.

08.18

Information-HIV testing

Any information, written or verbal, given to an individual, couple, or
group regarding HIV testing including explanation of the testing
process and meaning of results, behavioral risks for infection, and
importance of knowing their status.

08.19

Information-Partner notification

Any information, written or verbal, given to an individual or a group
regarding the notification of possible exposure to HIV and
accompanying ramifications, behaviors associated with possible
exposure, and consideration of alternatives or information on how to
notify partners regarding possible exposure.

08.20

Information-HIV medication therapy adherence

Any information, written or verbal, given to an individual or a group
regarding HIV medication therapy, benefits and risk, medical therapy
alternatives, and importance of adhering to medication therapy for
HIV.

08.21

Information-Alcohol and drug use prevention

Any information, written or verbal, given to an individual or a group on
the negative effects and consequences of alcohol and drug use and
its relationship to HIV transmission or infection risk behavior including
strategies to avoid or abstain from use.

08.22

Information-Sexual Health

Any information, written or verbal, given to an individual or a group on
reproductive health, sexuality, sexual development and similar topics.

08.23

Information-TB testing

Any information, written or verbal, given to an individual, couple, or
group on TB, how it is transmitted, and/or how to reduce risk for
transmission or infection, or treatment options

08.66

Information-Other

Any information, written or verbal, given to an individual or group that
cannot be captured in any of the other information codes.

09.01

Demonstration-Condom/barrier use

Provider or participant demonstration (using a teaching tool) of
appropriate use and disposal of condoms or other barrier methods.

09.02

Demonstration-IDU risk reduction

Provider or participant demonstration of how to safely dispose of
syringes or how to use bleach kits to clean works.

09.03

Demonstration-Negotiation/Communication

Provider or participant demonstration of how to communicate desire
for safer practices and how to negotiate safer practices with partners
(sexual and needle sharing).

09.04

Demonstration-Decision making

Provider or participant demonstration of steps, and techniques
needed for reassessing, planning and using judgment to avoid
situations that may expose them to HIV infection or transmission risk
and/or decision to engage in a risk behavior.

09.05

Demonstration-Disclosure of HIV status

Provider or participant demonstration of techniques to disclose
seropositive status or discuss issues relevant to disclosure.

09.06

Demonstration-Providing prevention services

Provider or participant demonstration of how to communicate
prevention messages or demonstrate risk reduction skills with others.

09.07

Demonstration-Partner notification

Provider or participant demonstration of how to notify partners
regarding possible exposure to HIV or how to discuss issues relevant
to partner notification.

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Num

Variable Name

Mandatory

HD

CBO

09.66

Demonstration-Other

Any provider or participant demonstration of a skills or technique that
is not decision making, IDU risk reduction, condom/barrier use,
negotiation and communication, disclosure, or providing prevention
services.

10.01

Practice-Condom/barrier use

Participant practice (using a teaching tool) of appropriate condom
and/or barrier use and disposal during the intervention session.

10.02

Practice-IDU risk reduction

Participant practice of safe needle use and disposal including the use
of bleach kits to clean works during the intervention session(s).

10.03

Practice-Negotiation/ Communication

Participant practice communication of desire for safer practices and
negotiation of safer practices with partners (sexual and needle
sharing) during the intervention session(s).

10.04

Practice-Decision making

Participant practice using steps and techniques needed for
reassessing, planning and using judgment to avoid situations that
may expose them to HIV infection or transmission risk and/or decision
to engage in a risk behavior.

10.05

Practice-Disclosure of HIV status

Participant practice of techniques to disclose seropositive status or
discuss issues relevant to disclosure.

10.06

Practice-Providing prevention services

Participant practice communication of prevention messages and/or
demonstration of risk reduction skills with others during intervention
session(s).

10.07

Practice-Partner notification

Participant practice of how to notify partners regarding possible
exposure to HIV or how to discuss issues relevant to partner
notification.

10.66

Practice-Other

Participant practice of a skill or technique that is not decision making,
IDU risk reduction, condom/barrier use, negotiation and
communication, disclosure, or providing prevention services.

11.01

Discussion-Sexual risk reduction

Facilitation of discussion with individuals or groups involving
examination of sexual risk behaviors (self or others) and
accompanying ramifications, examination of attitudes and feelings
about their risks, consideration of alternatives, and decision making to
reduce sexual risk.

11.02

Discussion-IDU risk reduction

Facilitation of discussion with individuals or groups involving
examination of IDU risk and accompanying ramifications, examination
of attitudes and feelings about their risks, consideration of
alternatives, and decision making to reduce IDU risk.

11.03

Discussion-HIV testing

Facilitation of discussion with individuals, couples, or groups
regarding HIV testing including explanation of the testing process and
meaning of results, discussion of behavioral risks for infection,
examination of attitudes and feelings about their risks, consideration
of alternatives, and decision making to know their status and reduce
HIV transmission risk.

11.04

Discussion-Other sexually transmitted diseases

Facilitation of discussion with individuals or groups regarding sexually
transmitted diseases (other than HIV), involving an examination of
behavioral risks and accompanying ramifications, examination of
attitudes and feelings about their risks, consideration of alternatives,
treatment alternatives, and decision making to reduce behavioral risk
for other sexually transmitted diseases and/or seek treatment.

11.05

Discussion-Disclosure of HIV status

Facilitation of discussion with individuals or groups regarding
techniques to disclose seropositive status or discuss issues relevant
to disclosure.

11.06

Discussion-Partner notification

Facilitation of discussion with individuals or groups regarding how to
notify partners regarding possible exposure to HIV or how to discuss
issues relevant to partner notification.

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Num

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Mandatory

HD

CBO

11.07

Discussion-HIV medication therapy adherence

Facilitation of discussion with individuals or groups regarding HIV
medication therapy and accompanying ramifications, examination of
attitudes and feelings about HIV medication therapy, discussion of
medical therapy alternatives, and decision making to begin and
adhere to medication therapy for HIV.

11.08

Discussion-Abstinence/postpone sexual activity

Facilitation of discussion with individuals or groups on abstaining from
sexual activity or postponing the initiation of sexual activity and
accompanying ramifications including an examination of risks
associated with sexual activities, discussion of alternatives, and
decision making to abstain or postpone sexual activity.

11.09

Discussion-IDU risk free behavior

Facilitation of discussion with individuals or groups on abstaining from
injection drug use or only using new needles and disposing
appropriately.

11.10

Discussion-HIV/AIDS transmission

Facilitation of discussion with individuals or groups on HIV/AIDS and
how HIV is transmitted.

11.11

Discussion-Viral hepatitis

Facilitation of discussion with individuals or groups on viral hepatitis,
how it is transmitted, and/or how to reduce risk for transmission or
infection, or treatment options.

11.12

Discussion-Living with HIV/AIDS

Facilitation of discussion with individuals or groups on living with
HIV/AIDS and ramifications of living with HIV/AIDS, examination of
attitudes and feelings about living with the disease.

11.13

Discussion-Availability of HIV/STD counseling and testing

Facilitation of discussion with individuals or groups on where and how
to access HIV-related CTR or STD counseling and testing and may
include the importance of knowing your status. This includes referral
lists that only list CTR and/or STD counseling and testing sites.

11.14

Discussion-Availability of partner notification and referral services

Facilitation of discussion with individuals or groups on where and how
to access partner notification services.

11.15

Discussion-Availability of social services

Facilitation of discussion with individuals or groups on how and where
to access social services.

11.16

Discussion-Availability of medical services

Facilitation of discussion with individuals or groups on how and where
to access HIV medical care. Discussion may include options
regarding available services.

11.17

Discussion-Condom/barrier use

Facilitation of discussion with individuals or groups on the appropriate
use and disposal of condoms or other barrier methods and
accompanying ramifications, examination of attitudes and feelings
about condom use, and decision making regarding use of
condoms/barriers.

11.18

Discussion- Negotiation/Communication

Facilitation of discussion with individuals or groups on communication
of desire for safer practices and negotiating safer practices with
partners (sexual and needle sharing), including discussion of
accompanying ramifications, examination of attitudes and feeling,
and decision making regarding communicating and negotiating safer
practices.

11.19

Discussion-Decision making

Facilitation of discussion with individuals or groups on steps and
techniques needed for reassessing, planning and using judgment to
avoid situations that may expose them to HIV infection or
transmission risk and/or decision to engage in a risk behavior.

11.20

Discussion-Providing prevention services

Facilitation of discussion with individuals or groups on communicating
prevention message and/or demonstrating risk reduction skills with
others.

11.21

Discussion-Alcohol and drug use prevention

Facilitation of discussion with individuals or groups on the negative
effects and consequences of alcohol and drug use and its
relationship to HIV transmission or infection risk including strategies
to avoid or abstain from use.

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Num

Variable Name

Mandatory

HD

CBO

11.22

Discussion-Sexual Health

Facilitation of discussion with individuals or groups on reproductive
health, sexuality, sexual development, and similar topics.

11.23

Discussion-TB testing

Facilitation of discussion with individuals or groups about TB, how it is
transmitted, and/or how to reduce risk for transmission or infection, or
treatment options.

11.66

Discussion-Other

Discussion with individuals or groups regarding HIV infection,
transmission, or risk reduction issues and accompanying
ramifications, examination of attitudes and feelings about these
issues, consideration of alternatives, and decision making to reduce
HIV infection, transmission, or risk reduction. Issues do not include
sexual or IDU risk reduction, HIV testing, other sexually transmitted
diseases, HIV status disclosure, partner notification, or HIV
medication therapy.

12.01

Other testing-Pregnancy

Provision of testing to determine pregnancy.

12.02

Other testing-STD

Provision of testing to determine infection with a sexually transmitted
disease other than HIV or Viral Hepatitis.

12.03

Other testing-Viral hepatitis

Provision of testing to determine infection with viral hepatitis.

12.04

Other testing-TB

Provision of testing to determine infection with tuberculosis.

13.01

Distribution-Male condoms

Provision of male condoms by handing them out or placing them in a
location to be accessed by consumers at no cost to the consumer.

13.02

Distribution-Female condoms

Provision of female condoms by handing them out or placing them in
a location to be accessed by consumers at no cost to the consumer.

13.03

Distribution-Safe sex kits

Provision of packages that minimally contain a condom (male or
female), lubricant, and instruction for proper use. May include other
materials at no cost to the consumer.

13.04

Distribution-Safer injection/bleach kits

Provision of packages that minimally contain a small bottle of bleach
and needle cleaning instructions. Packages may include bottle caps
for cookers, cotton, alcohol wipes, and bottles of water for rinsing
needles. Materials are provided at no cost to the consumer.

13.05

Distribution-Lubricants

Provision of water based lubricants at no cost to the consumer as
part of HIV prevention activities.

13.06

Distribution-Education materials

Provision of printed materials designed to be learning or teaching
aids by handing them out, placing in a location to be accessed by
consumers, or electronic dissemination at no cost to the consumer.

13.07

Distribution-Referral lists

Provision of lists of specific organizations that provide a specific set of
HIV prevention, care, or support services with contact information.
The agencies listed are known by the provider to be reliable sources
for those services based on provider knowledge and experience.
Lists may be disseminated by handing them out, placing them in a
location to be accessed by the consumer, or emailed to consumers.

13.08

Distribution-Role model stories

Provision stories of individuals who have changed their behaviors or
plan to change their behaviors to reduce their risk for HIV
transmission or infection. Stories may be disseminated by handing
them out, placing them in a location to be accessed by the consumer,
or emailed to consumers.

13.66

Distribution-Other

Provision of materials or supplies to consumers with the intent to
decrease their risk for HIV transmission or infection and/or to improve
health outcomes. Distribution may include dissemination in person,
by placing materials in locations to be accessed by consumers, sent
to consumers electronically or land mail. Does not include condoms,
safer sex kits, bleach kits, lubricants, education materials, referral
lists, or role model stories.

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Num

Variable Name

Mandatory

HD

CBO

14.01

Post-intervention follow up

Individual or group meeting or contact with participant(s) of an
intervention after the last session of the intervention to assess or
discuss changes targeted by the intervention and/or revisions to risk
reduction goals and/or strategies.

14.02

Post-intervention booster session

An intervention session conducted with participant(s) of an
intervention after the last session to review and reinforce risk
reduction skills and information addressed by the intervention.

88

Other (specify)

Any HIV prevention activity not captured in other value choices.

AG05c

Incentive Provided (only for HE/RR)

No

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: A type of reward that was presented to the client as compensation for the client's
time and participation in the session, (e.g., voucher for transportation, food,
money, or other small reward).
Instructions: Indicate whether or not the client received an incentive of any type for participatin
AG06

Site Name/ID
Definition: The official name of the agency's site of HIV prevention service delivery where
the session or event took place.
Instructions: Indicate the site where the session or event took place by selecting from a list of s

AG07

Worker ID
Definition: A system generated code used to distinguish between persons who are
delivering services to clients by a combination of non-identifying characteristics.
Instructions: Choose from a list of workers, established in Table P: Worker, the worker(s) who

AG08a

Client Primary Risk- MSM
Definition: The proportion (number) or percent of the total number of clients who reported
male-to-male sexual contact (MSM) as a primary risk for HIV exposure or
transmission.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG08b

Client Primary Risk- IDU
Definition: The proportion (number) or percent of the total number of clients who reported
injection drug use (IDU) as a primary risk for HIV exposure or transmission.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG08c

Client Primary Risk- MSM/IDU
Definition: The proportion (number) of the total number of clients who reported both male-tomale sexual contact (MSM) and injection drug use (IDU) as a primary risk for HIV
exposure or transmission.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica

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Variable Name

AG08d

Mandatory

Client Primary Risk- Sex Involving Transgender

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The proportion (number) or percent of the total number of clients who reported
sexual contact with transgenders as a primary risk for HIV exposure or
transmission.
Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG08e

Client Primary Risk- Heterosexual Contact
Definition: The proportion (number) or percent of the total number of clients who reported
male to female sexual contact as a primary risk for HIV exposure or transmission.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG08f

Client Primary Risk- Other/Risk Not Identified
Definition: The proportion (number) or percent of the total number of clients whose primary
risk for HIV exposure or transmission was unknown or who reported a risk
behavior other than what is listed in the categories above.
Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica

AG09a

Client Gender-Male
Definition: The proportion (number) or percent of the total number of clients who reported
their gender was male.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG09b

Client Gender- Female
Definition: The proportion (number) or percent of the total number of clients who reported
their gender was female.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG09c

Client Gender-Transgender MTF
Definition: The proportion (number) or percent of the total number of clients who reported
their gender was transgender - male to female (MTF).

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG09d

Client Gender- Transgender FTM
Definition: The proportion (number) or percent of the total number of clients who reported
their gender was transgender - female to male (FTM).

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica

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Num

Variable Name

AG10a

Mandatory

Client Ethnicity- Hispanic or Latino

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The proportion (number) or percent of the total number of clients who reported
they were Hispanic or Latino.
Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG10b

Client Ethnicity- Not Hispanic or Latino
Definition: The proportion (number) or percent of the total number of clients who reported
they were not Hispanic or Latino.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG11a

Client Race- American Indian or Alaska Native
Definition: The proportion (number) or percent of the total number of clients who reported
they were American Indian or Alaska Native.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG11b

Client Race- Asian
Definition: The proportion (number) or percent of the total number of clients who reported
they were Asian.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG11c

Client Race- Black or African American
Definition: The proportion (number) or percent of the total number of clients who reported
they were African-American.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG11d

Client Race- Native Hawaiian or Other Pacific Islander
Definition: The proportion (number) or percent of the total number of clients who reported
they were Native Hawaiian or Other Pacific Islander.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG11e

Client Race- White
Definition: The proportion (number) or percent of the total number of clients who reported
they were White.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG12a

Client Age- Under 13 years
Definition: The proportion (number) or percent of the total number of clients who reported
they were less than 13 years of age.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica

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Num

Variable Name

AG12b

Mandatory

Client Age- 13-18 years

HD

CBO

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Definition: The proportion (number) or percent of the total number of clients who reported
they were between 13-18 years of age.
Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG12c

Client Age- 19-24 years
Definition: The proportion (number) or percent of the total number of clients who reported
they were between 19-24 years of age.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG12d

Client Age- 25-34 years
Definition: The proportion (number) or percent of the total number of clients who reported
they were between 25-34 years of age.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG12e

Client Age- 35-44 years
Definition: The proportion (number) or percent of the total number of clients who reported
they were between 35-44 years of age.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG12f

Client Age- 45 years and over
Definition: The proportion (number) or percent of the total number of clients who reported
they were 45 years of age and over.
Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica

AG13a

HIV Status- Positive
Definition: The proportion (number) or percent of the total number of clients who reported
they were HIV positive.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG13b

HIV Status- Negative
Definition: The proportion (number) or percent of the total number of clients who reported
they were HIV negative.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica
AG13c

HIV Status- Unknown
Definition: The proportion (number) or percent of the total number of clients who reported
their HIV status was unknown.

Instructions: Of the total number of clients reported in AG04: Number of Client Contacts, indica

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Num

Variable Name

AG14a

Mandatory

Materials Distributed- Male Condoms

HD

CBO

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Definition: The number of male condoms distributed to clients during this session or event.
Instructions: If you indicated that male condoms were distributed during this intervention (AG0
AG14b

Materials Distributed- Female Condoms
Definition: The number of female condoms distributed to clients during this session or event.

Instructions: If you indicated that female condoms were distributed during this intervention (AG
AG14c

Materials Distributed- Bleach or Safer injection Kits
Definition: The estimated number of bleach or safer injection kits distributed to clients
during this session or event.

Instructions: If you indicated that bleach or safer injection kits were distributed during this inter
AG14d

Materials Distributed- Education Materials
Definition: The estimated number of educational brochures/pamphlets or other educational
materials distributed to clients during this session or event.

Instructions: If you indicated that educational materials were distributed during this intervention
AG14e

Materials Distributed- Safe Sex Kits
Definition: The estimated number of safe sex kits distributed to clients during this session or
event.

Instructions: If you indicated that safer sex kits were distributed during this intervention (AG05b
AG14f

Materials Distributed- Referral lists
Definition: The estimated number of referral lists distributed to clients during this session or
event.
Instructions: If you indicated that referral lists were distributed during this intervention (AG05b:

AG14g

Materials Distributed- Role Model Stories
Definition: The estimated number of role model stories distributed to clients during this
session or event.

Instructions: If you indicated that role model stories were distributed during this intervention (A
AG14h

Materials Distributed- Other (specify)
Definition: The estimated number of other HIV prevention materials distributed to clients
during this session or event.

Instructions: If you indicated that other materials were distributed during this intervention (AG0

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Num

Variable Name

Table: HC

Mandatory

HD

CBO

Health Communication/Public Information

This table is completed for each Health Communication/Public Information (HC/PI) event delivered to a group of individuals during a
specified period of time (e.g. a single lecture or a series of PSIs) and for each ongoing HC/PI interventions (e.g. hotline, website). Data is
reported in aggregate.
Reported to CDC
Num
HC01

Variable Name

Mandatory

Intervention Name

HD

CBO

Yes

Yes

Definition: An Intervention Name/ID that was entered by your agency in Table F.
Instructions: Select from a list of Intervention Names generated from variable F02: Intervention

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Num

Variable Name

HC02

Mandatory

HC/PI Delivery method

HD

CBO

Yes

Yes

Definition: The medium(s) or channel(s) through which the intervention is delivered.
Instructions: Indicate how the intervention was delivered (e.g., in person, by using a video, ove
Code

Value Description

Value Definition

01.00

In person

The intervention is delivered by an individual or a group of individuals
in the physical presence of the client(s). Includes counseling, face to
face discussions, facilitating group activities, lectures, presentations,
etc.

02.00

Internet

The use of email, chat rooms, or websites to deliver information to
clients electronically.

03.00

Printed Materials

The use of pamphlets, direct mailing, magazines, newspapers,
posters, billboards, etc. If chosen, please specify the subcategory
(value codes 3.01-3.04) for printed material.

03.01

Printed Materials-magazines/newspapers

Magazine: a bound periodical published at regular intervals under the
same title containing articles of specific interest. Newspaper: a
periodical that is folded rather than bound and published at regular
intervals under the same title containing news, opinions,
advertisements, and other items of current, often local, interest.

03.02

Printed Materials-pamphlets/brochures

A short, printed publication that is unbound or has a paper binding
written to inform on a specific topic or to address a public issue or
event. This can be multiple pages bound in a booklet form or single
page folded in panels. In the context of HIV prevention, it is typically
used to promote practices (such as safer sex), services (such as
counseling and testing) information (such as HIV transmission risk).

03.04

Printed Materials-posters/billboards

Posters: a single sheet sign posted or displayed used to advertise
simple messages or as an advertisement for goods and services.
Typically used to promote practices (such as safer sex), services
(such as counseling and testing) information (such as HIV
transmission risk), or products (condoms). Billboards: large signs or
posters that are typically outdoors on which messages or
advertisements are placed with the intent to be viewed by the general
public. Typically used to promote practices (such as safer sex),
services (such as counseling and testing) information (such as HIV
transmission risk), or products (condoms).

04.00

Radio

The use of radio broadcasts using public service announcements,
commercial air time, and the inclusion of messages in radio
programs, etc.

05.00

Telephone

The use of telephones or telephone "hot lines".

06.00

Television

The use of televised broadcasts using public service announcements,
commercial air time, etc.

07.00

Video

The use of pre-recorded visual and audio messages not delivered via
broadcast or cable TV (e.g., on a VHS tape or DVD).

88.88

Other (specify)

The use of methods or mediums to deliver the intervention other than
those that are listed in the other value choices (1.0-7.0). If chosen,
please specify the delivery method.

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Num

Variable Name

HC03

Activity

Mandatory

HD

CBO

Yes

Yes

Definition: The specific actions or components of an intervention in which the clients
participated in or received during this particular event.
Instructions: Select all of the activities that occurred during this event. Describe what was actu
Code

Value Description

Value Definition

04.00

Referral

A process by which immediate client needs for prevention, care, and
supportive services are assessed and prioritized and clients are
provided with information and assistance in identifying and accessing
specific services (such as, setting up appointments and providing
transportation). Note: The provision of a referral also includes a plan
for tracking whether or not the client accessed the referral.

08.01

Information-HIV/AIDS transmission

Any general information, written or verbal, given to an individual or a
group on HIV/AIDS and how it is transmitted.

08.02

Information-Abstinence/postpone sexual activity

Any information, written or verbal, given to an individual or a group on
abstaining from sexual activity or postponing sexual activity.

08.03

Information-Other sexually transmitted diseases

Any information, written or verbal, given to an individual or a group on
STDs (other than HIV or viral hepatitis), how it is transmitted, how to
reduce risk for transmission or infection, or treatment options.

08.04

Information-Viral hepatitis

Any information on viral hepatitis, how it is transmitted, and/or how to
reduce risk for transmission or infection, or treatment options.

08.05

Information-Availability of HIV/STD counseling and testing

Any information, written or verbal, given to an individual or a group
about where and how to access HIV-related CTR or STD counseling
and testing. This includes referral lists that only list CTR and/or STD
counseling and testing sites.

08.06

Information-Availability of partner notification and referral services

Any information, written or verbal, given to an individual or a group
about where and how to access partner notification services. The
availability information provided is exclusive to PCRS. This includes
referral lists that only list PCRS sites.

08.07

Information-Living with HIV/AIDS

Any information, written or verbal, given to an individual or a group
living with HIV/AIDS specific to living with the disease.

08.08

Information-Availability of social services

Any information, written or verbal, given to an individual or a group
about how and where to access social services. This could include a
referral list that only includes social services agencies or providers.

08.09

Information-Availability of medical services

Any information, written or verbal, given to an individual or a group
about how and where to access HIV medical services. This could
include a referral list that only includes HIV medical care providers.

08.10

Information - Sexual risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce sexual risk for HIV transmission or infection.

08.11

Information-IDU risk reduction

Any information, written or verbal, given to an individual or a group on
how to reduce injection drug use risk for HIV transmission or infection.

08.12

Information-IDU risk free behavior

Any information, written or verbal given to an individual or a group on
abstaining from injection drug use or only using new needles and
disposing of them appropriately.

08.13

Information-Condom/barrier use

Any information, written or verbal, given to an individual or a group
regarding appropriate use and disposal of condoms or other barrier
methods.

08.14

Information-Negotiation/Communication

Any information, written or verbal, given to an individual or a group
regarding communication of desire for safer practices and negotiating
safer practices with partners (sexual and needle sharing).

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Num

Variable Name

Mandatory

HD

CBO

08.15

Information-Decision making

Any information, written or verbal, given to an individual or a group
regarding the steps and techniques needed for reassessing, planning
and using judgment to avoid situations that may expose them to HIV
infection or transmission risk and/or decision to engage in a risk
behavior.

08.16

Information-Disclosure of HIV status

Any information, written or verbal, given to an individual or a group
regarding disclosure of their HIV status, applicable laws,
accompanying ramifications, and options regarding non-disclosure.

08.17

Information-Providing prevention services

Any information, written or verbal, given to an individual or a group on
how to communicate prevention messages and/or demonstrate risk
reduction skills with others.

08.18

Information-HIV testing

Any information, written or verbal, given to an individual, couple, or
group regarding HIV testing including explanation of the testing
process and meaning of results, behavioral risks for infection, and
importance of knowing their status.

08.19

Information-Partner notification

Any information, written or verbal, given to an individual or a group
regarding the notification of possible exposure to HIV and
accompanying ramifications, behaviors associated with possible
exposure, and consideration of alternatives or information on how to
notify partners regarding possible exposure.

08.20

Information-HIV medication therapy adherence

Any information, written or verbal, given to an individual or a group
regarding HIV medication therapy, benefits and risk, medical therapy
alternatives, and importance of adhering to medication therapy for
HIV.

08.21

Information-Alcohol and drug use prevention

Any information, written or verbal, given to an individual or a group on
the negative effects and consequences of alcohol and drug use and
its relationship to HIV transmission or infection risk behavior including
strategies to avoid or abstain from use.

08.22

Information-Sexual Health

Any information, written or verbal, given to an individual or a group on
reproductive health, sexuality, sexual development and similar topics.

08.23

Information-TB testing

Any information, written or verbal, given to an individual, couple, or
group on TB, how it is transmitted, and/or how to reduce risk for
transmission or infection, or treatment options

08.66

Information-Other

Any information, written or verbal, given to an individual or group that
cannot be captured in any of the other information codes.

09.01

Demonstration-Condom/barrier use

Provider or participant demonstration (using a teaching tool) of
appropriate use and disposal of condoms or other barrier methods.

09.02

Demonstration-IDU risk reduction

Provider or participant demonstration of how to safely dispose of
syringes or how to use bleach kits to clean works.

09.03

Demonstration-Negotiation/Communication

Provider or participant demonstration of how to communicate desire
for safer practices and how to negotiate safer practices with partners
(sexual and needle sharing).

09.04

Demonstration-Decision making

Provider or participant demonstration of steps, and techniques
needed for reassessing, planning and using judgment to avoid
situations that may expose them to HIV infection or transmission risk
and/or decision to engage in a risk behavior.

09.05

Demonstration-Disclosure of HIV status

Provider or participant demonstration of techniques to disclose
seropositive status or discuss issues relevant to disclosure.

09.06

Demonstration-Providing prevention services

Provider or participant demonstration of how to communicate
prevention messages or demonstrate risk reduction skills with others.

09.07

Demonstration-Partner notification

Provider or participant demonstration of how to notify partners
regarding possible exposure to HIV or how to discuss issues relevant
to partner notification.

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Num

Variable Name

Mandatory

HD

CBO

09.66

Demonstration-Other

Any provider or participant demonstration of a skills or technique that
is not decision making, IDU risk reduction, condom/barrier use,
negotiation and communication, disclosure, or providing prevention
services.

11.01

Discussion-Sexual risk reduction

Facilitation of discussion with individuals or groups involving
examination of sexual risk behaviors (self or others) and
accompanying ramifications, examination of attitudes and feelings
about their risks, consideration of alternatives, and decision making to
reduce sexual risk.

11.02

Discussion-IDU risk reduction

Facilitation of discussion with individuals or groups involving
examination of IDU risk and accompanying ramifications, examination
of attitudes and feelings about their risks, consideration of
alternatives, and decision making to reduce IDU risk.

11.03

Discussion-HIV testing

Facilitation of discussion with individuals, couples, or groups
regarding HIV testing including explanation of the testing process and
meaning of results, discussion of behavioral risks for infection,
examination of attitudes and feelings about their risks, consideration
of alternatives, and decision making to know their status and reduce
HIV transmission risk.

11.04

Discussion-Other sexually transmitted diseases

Facilitation of discussion with individuals or groups regarding sexually
transmitted diseases (other than HIV), involving an examination of
behavioral risks and accompanying ramifications, examination of
attitudes and feelings about their risks, consideration of alternatives,
treatment alternatives, and decision making to reduce behavioral risk
for other sexually transmitted disease and/or seek treatment.

11.05

Discussion-Disclosure of HIV status

Facilitation of discussion with individuals or groups regarding
techniques to disclose seropositive status or discuss issues relevant
to disclosure.

11.06

Discussion-Partner notification

Facilitation of discussion with individuals or groups regarding how to
notify partners regarding possible exposure to HIV or how to discuss
issues relevant to partner notification.

11.07

Discussion-HIV medication therapy adherence

Facilitation of discussion with individuals or groups regarding HIV
medication therapy and accompanying ramifications, examination of
attitudes and feelings about HIV medication therapy, discussion of
medical therapy alternatives, and decision making to begin and
adhere to medication therapy for HIV.

11.08

Discussion-Abstinence/postpone sexual activity

Facilitation of discussion with individuals or groups on abstaining from
sexual activity or postponing the initiation of sexual activity and
accompanying ramifications including an examination of risks
associated with sexual activities, discussion of alternatives, and
decision making to abstain or postpone sexual activity.

11.09

Discussion-IDU risk free behavior

Facilitation of discussion with individuals or groups on abstaining from
injection drug use or only using new needles and disposing
appropriately.

11.10

Discussion-HIV/AIDS transmission

Facilitation of discussion with individuals or groups on HIV/AIDS and
how HIV is transmitted.

11.11

Discussion-Viral hepatitis

Facilitation of discussion with individuals or groups on viral hepatitis,
how it is transmitted, and/or how to reduce risk for transmission or
infection, or treatment options.

11.12

Discussion-Living with HIV/AIDS

Facilitation of discussion with individuals or groups on living with
HIV/AIDS and ramifications of living with HIV/AIDS, examination of
attitudes and feelings about living with the disease.

11.13

Discussion-Availability of HIV/STD counseling and testing

Facilitation of discussion with individuals or groups on where and how
to access HIV-related CTR or STD counseling and testing and may
include the importance of knowing your status. This includes referral
lists that only list CTR and/or STD counseling and testing sites.

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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

HD

CBO

11.14

Discussion-Availability of partner notification and referral services

Facilitation of discussion with individuals or groups on where and how
to access partner notification services.

11.15

Discussion-Availability of social services

Facilitation of discussion with individuals or groups on how and where
to access social services.

11.16

Discussion-Availability of medical services

Facilitation of discussion with individuals or groups on how and where
to access HIV medical care. Discussion may include options
regarding available services.

11.17

Discussion-Condom/barrier use

Facilitation of discussion with individuals or groups on the appropriate
use and disposal of condoms or other barrier methods and
accompanying ramifications, examination of attitudes and feelings
about condom use, and decision making regarding use of
condoms/barriers.

11.18

Discussion- Negotiation/Communication

Facilitation of discussion with individuals or groups on communication
of desire for safer practices and negotiating safer practices with
partners (sexual and needle sharing), including discussion of
accompanying ramifications, examination of attitudes and feelings,
and decision making regarding communicating and negotiating safer
practices.

11.19

Discussion-Decision making

Facilitation of discussion with individuals or groups on steps and
techniques needed for reassessing, planning and using judgment to
avoid situations that may expose them to HIV infection or
transmission risk and/or decision to engage in a risk behavior.

11.20

Discussion-Providing prevention services

Facilitation of discussion with individuals or groups on communicating
prevention message and/or demonstrating risk reduction skills with
others.

11.21

Discussion-Alcohol and drug use prevention

Facilitation of discussion with individuals or groups on the negative
effects and consequences of alcohol and drug use and its
relationship to HIV transmission or infection risk including strategies
to avoid or abstain from use.

11.22

Discussion-Sexual Health

Facilitation of discussion with individuals or groups on reproductive
health, sexuality, sexual development, and similar topics.

11.23

Discussion-TB testing

Facilitation of discussion with individuals or groups about TB, how it is
transmitted, and/or how to reduce risk for transmission or infection, or
treatment options.

11.66

Discussion-Other

Discussion with individuals or groups regarding HIV infection,
transmission, or risk reduction issues and accompanying
ramifications, examination of attitudes and feelings about these
issues, consideration of alternatives, and decision making to reduce
HIV infection, transmission, or risk reduction. Issues do not include
sexual or IDU risk reduction, HIV testing, other sexually transmitted
diseases, HIV status disclosure, partner notification, or HIV
medication therapy.

13.01

Distribution-Male condoms

Provision of male condoms by handing them out or placing them in a
location to be accessed by consumers at no cost to the consumer.

13.02

Distribution-Female condoms

Provision of female condoms by handing them out or placing them in
a location to be accessed by consumers at no cost to the consumer.

13.03

Distribution-Safe sex kits

Provision of packages that minimally contain a condom (male or
female), lubricant, and instruction for proper use. May include other
materials at no cost to the consumer.

13.04

Distribution-Safer injection/bleach kits

Provision of packages that minimally contain a small bottle of bleach
and needle cleaning instructions. Packages may include bottle caps
for cookers, cotton, alcohol wipes, and bottles of water for rinsing
needles. Materials are provided at no cost to the consumer.

13.05

Distribution-Lubricants

Provision of water based lubricants at no cost to the consumer as
part of HIV prevention activities.
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PEMS Data Variables and Values
Reported to CDC
Num

Variable Name

Mandatory

HD

CBO

13.06

Distribution-Education materials

Provision of printed materials designed to be learning or teaching
aids by handing them out, placing in a location to be accessed by
consumers, or electronic dissemination at no cost to the consumer.

13.07

Distribution-Referral lists

Provision of lists of specific organizations that provide a specific set of
HIV prevention, care, or support services with contact information.
The agencies listed are known by the provider to be reliable sources
for those services based on provider knowledge and experience.
Lists may be disseminated by handing them out, placing them in a
location accessed by the consumer, or e-mailed to consumers.

13.08

Distribution-Role model stories

Provision stories of individuals who have changed their behaviors or
plan to change their behaviors to reduce their risk for HIV
transmission or infection. Stories may be disseminated by handing
them out, placing them in a location to be accessed by the consumer,
or e-mailed to consumers.

13.66

Distribution-Other

Provision of materials or supplies to consumers with the intent to
decrease their risk for HIV transmission or infection and/or to improve
health outcomes. Distribution may include dissemination in person,
by placing materials in locations to be accessed by consumers, sent
to consumers electronically or by land mail. Does not include
condoms, safer sex kits, bleach kits, lubricants, education materials,
referral lists, or role model stories.

88

Other (specify)

Any HIV prevention activity not captured in other value choices.

HC05

Event Start Date

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

No

Yes

Definition: The calendar date on which the event began.
Instructions: Indicate the date on which the intervention began.
HC06

Event End Date
Definition: The calendar date on which the event ended.
Instructions: Indicate the date on which the event ended.

HC06a

Data Reported as of Date
Definition: The date on which the data collected and entered for this event was last updated.

Instructions: Indicate the date on which the data collected and entered for this event was last u
HC14

Distribution-Male condoms
Definition: The number of male condoms that were distributed during the event.
Instructions: If one of the activities performed during the event was the distribution of male con

HC15

Distribution-Female condoms
Definition: The number of female condoms that were distributed during the event.
Instructions: If one of the activities performed during the event was the distribution of female c

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PEMS Data Variables and Values
Reported to CDC
Num
HC16

Variable Name

Mandatory

Distribution-Lubricants

HD

CBO

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

Definition: The number of lubricants that were distributed during the event.
Instructions: If one of the activities performed during the event was the distribution of lubricants
HC17

Distribution-Bleach or Safer injection Kits
Definition: The number of bleach or safer injection kits that were distributed during the event.
Instructions: If one of the activities performed during the event was the distribution of bleach or

HC18

Distribution-Referral Lists
Definition: The number of referral lists that were distributed during the event.
Instructions: If one of the activities performed during the event was the distribution of referral li

HC19

Distribution-Safe sex kits
Definition: The number of safe sex kits that were distributed during the event.
Instructions: If one of the activities performed during the event was the distribution of safe sex

HC20

Distribution-Other
Definition: The number of other items that were distributed during the event.
Instructions: If one of the activities performed during the event was the distribution of other mat

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File Typeapplication/pdf
File TitleVariables at a Glance
Authorzdu5
File Modified2006-11-13
File Created2006-11-01

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