Form 5 Follow-up Assessment

Nurse Delivered Sexual Risk Reduction Intervention for

HIV-Positive Women in the South

0920-XXXX

Attachment 5

Baseline/Follow-up Assessment

Form Approved

OMB No. 0920-XXXX

Exp. Date __xx/xx/20xx

Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: PRA (0920-XXXX)

Baseline/Follow-up Assessment Questionnaire

Sister to Sister Positive HOPE Project

(Note: Page numbers referenced throughout the assessment refer only to the assessment document)

Administrative:

Study Site: ______________________________________________________________________

Staff ID: ______________________________________________________________________

Assessment Point: ______________________________________________________________________

Date: _________________________________________________________________________

Version of Questionnaire:

Starting Time: ___________________________________________________________________

Ending Time: __________________________________________________________________

DEMOGRAPHICS, PART 1

To begin the interview, I’d like to ask you some background questions. This lets us know something about the people who participate in the project.

In what month and year were you born?

_____/____ (mm/yyyy)

month/year

2098 Refuse to Answer

So that makes you _______ (CALCULATE FROM Q1) years old. If this is not correct please go back to the previous question and change your answer.

Do you consider yourself to be Hispanic or Latina?

1 Yes

0 No  SKIP TO Q5

8 Refuse to Answer

IF Q3 = 1, ASK:

4. Which of the following best describes your ethnic background? (IF MORE THAN ONE COUNTRY NAMED: Which do you feel closest to?) (Choose One)

01 Puerto Rican

02 Dominican

03 Mexican

04 Cuban

05 Central American

06 South American

07 Spaniard, from Spain

08 Other

98 Refuse to Answer

5. For this question you may select more than one option. Do you consider yourself…

01 Black or African American

02 White

03 Asian

04 American Indian or Alaskan Native

05 Native Hawaiian or other Pacific Islander

98 Refuse to Answer

Now some questions about school and work.

What is the highest level of education you have completed? (Choose One)

01 < Grade 8

02 Grades 9 through 11

03 Grade 12 or GED

04 Some college, Associate’s Degree, or Technical Degree

05 Bachelor’s Degree

06 Any post graduate studies

98 Refuse to Answer

Which of the following best describes your current marital status? (Choose One)

1. Married and living with your husband – SKIP TO Q10

2. Married and not living with husband – SKIP TO Q11

3. Legally separated

4. Divorced

5. Widowed

6. Never been married

7. Living with someone and not married

98 Refuse to Answer

Do you have a main or primary partner, that is, a partner who you would call your boyfriend, girlfriend, lover, or significant other?

1 Yes

0 No – SKIP TO Q11

8 Refuse to Answer – SKIPT TO Q11

IF Q8 =1, ASK:

Are you currently living with this person?

1 Yes

0 No - SKIP TO Q11

8 Refuse to Answer – SKIP TO Q11

IF Q9=1, ASK:

How long have you been living together?

___ ___Weeks

___ ___Months

___ ___Years

98 Refuse to Answer

Have you ever been pregnant?

1 Yes

0 No  SKIP TO Q14

8 Refuse to Answer – SKIP TO Q14

IF Q11 = 1, ASK:

Have you had a baby in the last 3 months?

1 Yes

0 No

8 Refuse to Answer

Are you currently pregnant?

1 Yes

0 No

8 Refuse to Answer

14. Are you planning to get pregnant in the future?

1 Yes

0 No

8 Refuse to Answer

15. How many children are you currently taking care of?

___ ___ (# of children)

98 Refuse to Answer – SKIP TO Q17

16. Of the ___ ___ (Q15) children who are living with you, how many are HIV positive?

___ ___ (# of children)

98 Refuse to Answer

The next few questions are about religion.

17. How important to you is religion or spirituality? (Choose One)

01 Very important

02 Somewhat important

03 Slightly important

04 Not at all important

98 Refuse to Answer

18. How often, if at all, do you attend religious or spiritual services? Would you say never, less than once a year, a few times a year, about once a month, once a week or more, or everyday? (Choose One)

01 Never

02 Less than once a year

03 A few times a year

04 About once a month

05 Once a week or more

06 Everyday

98 Refuse to Answer

HOUSING

1. In the last 3 months, that is since _________ (CALCULATE THE DATE) where did you sleep most of the time? (Choose One)

Your own place, a room, apartment, or house that is your home

Temporarily doubled up with others, in someone else’s house, apartment, or room

In a temporary or transitional housing program, or a halfway house

In an SRO, that is, a “single room occupancy” facility, or welfare hotel or motel, or a shelter for homeless people

In jail or prison

In drug treatment, a detox unit, or drug program housing

In a hospital, nursing home, or hospice

On the street

Someplace else

98 Refuse to answer

IF Q1 = 09, ASK:

(Some place else: specify) ___________________________

RELATIONAL/SOCIAL CONTEXT

1. About how many close friends and close relatives do you have, people you feel at ease with and can talk to about what is on your mind?

__ __

98 Refused to Answer

2. People sometimes look to others for companionship, assistance, or other types of support. I am going to read you some statements. Please tell me how often each of these are available to you if you need it? (Choose One for each question) (RF = refused to answer)

	None of the time	A little of the time	Some of the time	Most of the time	All of the time	RF
Some one to help you if you were confined to bed	1	2	3	4	5	8
Someone you can count on to listen to you when you need to talk	1	2	3	4	5	8
Someone to give you advice about a crisis	1	2	3	4	5	8
Someone to take you to the doctor if you needed it	1	2	3	4	5	8
Someone who shows you love and affection	1	2	3	4	5	8
Someone to have a good time with	1	2	3	4	5	8
Someone to give you information to help you understand a situation	1	2	3	4	5	8
Someone to confide in or talk to about yourself or your problems	1	2	3	4	5	8
Someone who hugs you	1	2	3	4	5	8
Someone to get together with for relaxation	1	2	3	4	5	8
Someone to prepare your meals if you were unable to do it yourself	1	2	3	4	5	8
Someone whose advice you really want	1	2	3	4	5	8
Someone to do things with to help you get your mind off things	1	2	3	4	5	8
Someone to help with daily chores if you were sick	1	2	3	4	5	8
Someone to share your most private worries and fears with	1	2	3	4	5	8
Someone to turn to for suggestions about how to deal with a personal problem	1	2	3	4	5	8
Someone to do something enjoyable with	1	2	3	4	5	8
Someone who understands your problems	1	2	3	4	5	8
Someone to love and make you feel wanted	1	2	3	4	5	8

3. The next set of questions asks about some of your experiences, feelings, and opinions about how people with HIV feel and how they are treated. For each one, please tell me if you strongly disagree, disagree, agree, or strongly agree. (Choose One)

	Strongly Disagree	Disagree	Agree	Strongly Agree	RF
a. I feel guilty because I have HIV.	1	2	3	4	8
b. People I know would reject someone with HIV.	1	2	3	4	8
c. I feel I am not as good as others because I have HIV.	1	2	3	4	8
d. People I know would be uncomfortable around someone with HIV.	1	2	3	4	8
e. I never feel ashamed of having HIV.	1	2	3	4	8
f. People I know would not want someone with HIV around their children.	1	2	3	4	8
g. Having HIV makes me feel unclean.	1	2	3	4	8
h. People I know think that a person with HIV is disgusting.	1	2	3	4	8
i. People's attitudes about HIV make me feel worse about myself.	1	2	3	4	8
j. Having HIV makes me feel that I'm a bad person.	1	2	3	4	8
k. People I know would treat someone with HIV like an outcast.	1	2	3	4	8
l. People I know believe that a person who has HIV is dirty.	1	2	3	4	8
m. Having HIV in my body is disgusting to me.	1	2	3	4	8

HEALTH AND WELL-BEING__________________________________________________

Now I would like to ask some questions about your health.

1. When did you first learn that you had HIV? If you are not sure, enter your best guess.

__ __ /____(mm/yyyy)

Refused to Answer 2098

2. What was your most recent CD-4 or T-cell count? Was it …

(Choose One)

1. Less than 200

2. 200-349

3. 350-500

4. 501 or greater

5. I have never had my CD-4 or T-cell count measured

6. I don’t know

08 Refused to Answer

3. Was the result of your viral load test…[Changed response category] (Choose One)

1 Undetectable, that is, less than 400 or less than 40 depending on the type of test

2 Detectable

3 I have never had my viral load measured

4 I don’t know

8 Refused to Answer

4. Has a doctor or other medical provider ever told you that you had Clinically-Diagnosed AIDS? By Clinically-Diagnosed AIDS we mean that you have symptoms or other diseases that were caused by the HIV virus.

1 Yes

0 No

8 Refused to Answer

5. In the past 3 months, has a doctor, nurse, or other health care provider given you a new diagnosis of a sexually transmitted infection other than HIV?

01 Yes

02 No

98 Refuse to Answer

6. In general, would you say your health is...(Choose One)

1 Excellent

2 Very Good

3 Good

4 Fair

5 Poor

8 Refused to Answer

7. The following questions are about activities you might do during a typical day. For each item, rate how much your health limits you in these activities.

(Choose One for each question)

	Limited A Lot	Limited A Little	Not Limited At All	RF
a. The kinds or amounts of vigorous activities you can do, like lifting heavy objects, running or participating in strenuous sports.	1	2	3	8
b. The kinds or amounts of moderate activities you can do, like moving a table, carrying groceries or bowling.	1	2	3	8
c. Walking uphill or climbing (a few flights of stairs).	1	2	3	8
d. Bending, lifting or stooping.	1	2	3	8
e. Walking one block.	1	2	3	8
f. Eating, dressing, bathing or using the toilet.	1	2	3	8

8. Does your health keep you from working at a job, doing work around the house or going to school?

1 Yes

0 No

8 Refused to Answer

9. Have you been unable to do certain kinds or amounts of work, housework, or schoolwork because of your health? 1 Yes

0 No

8 Refused to Answer

10. For the following items, please select the choice that best describes how you have felt during the last week. (Choose One for each question)

	Rarely (<1 day)	Some days (1-2 days)	Occasionally (3-4 days)	Most days (5-7 days)	Refused to Answer
a. During the last week, how often were you bothered by things that usually don't bother you?	0	1	2	3	8
b. During the last week, how often did you have trouble keeping your mind focused on what you were doing?	0	1	2	3	8
c. During the last week, how often did you feel depressed?	0	1	2	3	8
d. During the last week, how often did you feel that everything you did was an effort?	0	1	2	3	8
e. During the last week, how often did you feel hopeful about the future?	0	1	2	3	8
f. During the last week, how often did you feel fearful?	0	1	2	3	8
g. During the last week, how often was your sleep restless?	0	1	2	3	8
h. During the last week, how often were you happy?	0	1	2	3	8
i. During the last week, how often did you feel lonely?	0	1	2	3	8
j. During the last week, how often could you not get "going"?	0	1	2	3	8

AUDIO-CASI SECTION OF INSTRUMENT BEGINS. [DATA COLLECTORS – PLEASE SKIP TO Q1A AND PILOT TEST THIS SECTION USING FACE-TO-FACE INTERVIEW]

ACASI1 An important part of this interview is the sections you will conduct completely on your own using the computer and the headphones. Before you begin, I will help you go through a short practice session to learn how to use the computer. Let me quickly point out the keys you will use. The computerized practice session that follows will go through what each key does in greater detail.

Practice Questions

READ: So that you are comfortable answering these questions using the computer, the first few questions will be for practice. These will give you an idea of the different types of questions you will see during the interview, and will give you a chance to ask your host any questions before you get started. Now, use the mouse to click on the "Next Question" button to begin.

PRA1. Some of the questions will ask you to answer either YES or NO. For example, "Are you wearing blue today?"

1 Yes

0 No

PRA2. Some of the questions will ask you to pick one answer from a list, such as, How much do you agree with this statement? Blue is my favorite color. (Choose one)

1 Strongly Disagree

2 Disagree

3 Neither Disagree nor Agree

4 Agree

5 Strongly Agree

8 Refuse to Answer

PRA3. Some of the questions will ask you to pick one or more answers from a list of choices, such as, what colors do you like the most? Please check all that apply, then click on the "NEXT QUESTION" button. (Check all that apply)

__ Red

__ Blue

__ Green

__ Yellow

__ Purple

PRA4. Some of the questions will ask you to enter a number, such as, how many colors did you choose on the previous question? After entering the number, click on the "NEXT QUESTION" button.

__ __

READ: Sometimes the computer will tell you that the number that you have entered is not a possible response, and that you have to go back and give another answer. For example, on the previous question if you entered the number 6, the computer would tell you that the highest number you could have chosen is 5 since there were only 5 colors listed. Please click on the "NEXT QUESTION" button.

PRA5. So that you see what this screen looks like, enter a number higher than 5 and press "Next Question." A box will appear saying, Number too big. Click OK and then click on the "Clear" button and enter the correct number.

__

PRA6. A few of the questions will ask you to enter a date. In this practice question you will be asked to enter today's date, indicating the year, month, and day. Using the arrow keys on either side of the boxes, indicate today's year, today's month and today's day. After entering the date, please click on the "NEXT QUESTION" button.

__ __ / __ __ / __ __ __ __ mm / dd / yyyy

If PRA6 is not equal to TODAY then READ: "You have entered the date other than today's date. Please re-answer this question." skip to PRA6.

PRA7. Finally, some of the questions will ask you to spell out your answer using a keyboard on the screen that you click with the mouse you are using. Now you try it by answering the question, "My mother's name is." After entering the name, please click "NEXT QUESTION."

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

PRA8. Has this been enough practice using the computer? If it has been, click YES and you can get started. If not, click NO and you will get a few more practice questions.

1 Yes Skip to instruction before A1

0 No

READ: Try a few more questions for you to practice getting used to the computer...

PRA9. Do you like watching TV?

1 Yes

0 No

PRA10. My favorite thing about TV is sports. (Choose one)

0 Strongly Disagree

1 Disagree

2 Neither Disagree or Agree

3 Agree

4 Strongly Agree

PRA11. Can you tell me what kinds of food you like? Please check all that apply, and then click "NEXT QUESTION." (Check all that apply)

__ Pasta

__ Salad

__ Steak

__ Sweets

__ Other things not listed here

PRA12. How many things that you don't like about the city did you choose from the list in the previous question? After entering the number, please click on the "NEXT QUESTION" button.

__ __

PRA13. So that you see again what the screen looks like when you enter an answer that is too high or low, try to enter a number greater than 5 for the question. A box will appear saying, Number too big. Click OK and then click on the "Clear" buttton and enter the correct number.

__

PRA14. What is your favorite month and year? After entering the date, please click on the "NEXT QUESTION" button.

__ __ / __ __ __ __ mm / yyyy

(Year)

PRA15. My favorite actor's first name is? After entering the name, please click on the "NEXT QUESTION" button.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

PRA16. Is that enough practice on the computer? If so, just click READY TO GET STARTED and the interview will begin. If you would like some more help with the computer, just ask your host to help you. (Choose one)

0 Ready to get started

READ: Great. Now you will answer questions on your own. Remember that your answers are secure. If you need help, ask your host. Please click on the "NEXT QUESTION" button.

ALCOHOL AND DRUG USE MEASURES

These questions are about drinking alcohol and use of other substances. Remember that all of your answers will be kept secure and protected, and that you can skip any question you do not want to answer.

1A. Did you ever in your life have a whole drink of any alcoholic beverage like wine, beer or liquor? We are not asking about times when you only had a sip or two from a drink. [shortened from original]

1 Yes

0 Noà SKIP TO Q8

8 Refused to Answer – SKIP TO Q8

If Q1A =1, ASK:

1B. In the last 3 months, how often did you drink beer, wine, or liquor? (Choose One)

1 Never in the last 3 months à SKIP TO Q3

2 Less than once a month

3 Once to 3 times a month

4 Once or twice a week

5 3-4 times a week

6 Everyday or nearly everyday

8 Refused to Answer - SKIP TO Q3

2. On the days when you drank, how many drinks did you usually have? (Choose One)

0 A few sips or less than one drink

1 One drink

2 Two drinks

3 Three drinks

4 Four drinks

5 Five drinks

6 More than five drinks

8 Refused to Answer

2. Have you ever felt that you should cut down on your drinking?

1 Yes

0 No

8 Refused to Answer

2. Have you ever been annoyed by people criticizing your drinking?

1 Yes

0 No

8 Refused to Answer

2. Have you ever felt guilty about your drinking?

1 Yes

0 No

8 Refused to Answer

2. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang over?

1 Yes

0 No – SKIP TO Q8

8 Refused to Answer – SKIP TO Q8

IF 1B=1 SKIP Q7

7. Has this happened to you more than one time in the last 3 months days

1 Yes

0 No

8 Refused to Answer

Ask everyoneNow here are some questions about drug use in the last 3 months. Remember that all of your answers will be kept secure and protected, and that you can skip any question you do not want to answer.

	Yes	No	RF
8. In the last 3 months have you used marijuana, hashish, weed, pot, or reefer, even one time?	1	0	8
9. In the last 3 months have you used cocaine by itself, even one time?	1	0	8
10. In the last 3 months have you used crack or free-base by itself, even one time?	1	0	8
11. In the last 3 months have you used heroin by itself, even one time?	1	0	8
12. In the last 3 months have you used heroin and cocaine together, sometimes called a speedball, even one time?	1	0	8
13. In the last 3 months have you used methadone without a prescription, or more than a doctor told you, even one time?	1	0	8
14. In the last 3 months have you used sedatives, tranquilizers, or downers without a prescription, or more than a doctor told you to, even one time?	1	0	8
15. In the last 3 months have you used methamphetamines, amphetamines, uppers, speed, crystal or ice even one time?	1	0	8

IF “YES” TO ANY IN Q8-Q15, ASK Q16-Q23 FOR EACH DRUG USED.

IF YES to Q8

16. In the last 3 months, how often did you usually use marijuana, hashish, weed, pot, or reefer? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

IF YES to Q9

17. In the last 3 months, how often did you usually use cocaine by itself? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

IF YES to Q10

18. In the last 3 months, how often did you usually use crack or free-base by itself? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

IF YES to Q11

19. In the last 3 months, how often did you usually use heroin by itself? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

IF YES to Q12

20. In the last 3 months, how often did you usually use heroin and cocaine together, sometimes called a speedball? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

IF YES to Q13

21. In the last 3 months, how often did you usually use methadone without a prescription or more than a doctor told you? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

IF YES to Q14

22. In the last 3 months, how often did you usually use sedatives, tranquilizers, or downers without a prescription or more than a doctor told you to? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

IF YES to Q15

23. In the last 3 months, how often did you usually use methamphetamines, amphetamines, uppers, speed, crystal or ice? (Choose One)

	Less than once a month	Once to 3 times a month	Once or twice a week	3-4 times a week	Everyday or nearly everyday	RF
	05	04	03	02	01	08

24. The next question is about injecting, “shooting,” or “skin popping” drugs, including those that you injected into yourself or others injected into you. Do not include drugs for things like allergies and diabetes, or HIV medications. In the last 3 months, did you inject drugs?

1 Yes

0 No

8 Refused to Answer

25. These next questions are about stressful things that sometimes happen to people.

ASK EVERYONE:

a. In the last 3 months, has there been a time when you did not have enough money to pay for the things you needed to live, like food or clothing?

1 Yes

0 No

8 Refused to Answer

b. In the last 3 months, have you had to stop work when you wanted to work, been laid off or fired? 1 Yes

0 No

8 Refused to Answer

c. In the last 3 months, have you had difficulty finding a job?

1 Yes

0 No

8 Refused to Answer

d. In the last 3 months, have you had to stop work when you wanted to work?

1 Yes

0 No

8 Refused to Answer

e. In the last 3 months, have you been in danger of losing your home or not having a safe place to live?

1 Yes

0 No

8 Refused to Answer

f. In the last 3 months, have you experienced a break up with a husband/partner/lover?

1 Yes

0 No

8 Refused to Answer

g. In the last 3 months, has your child had serious health problems?

1 Yes

0 No

8 Refused to Answer

h. In the last 3 months, have you experienced change in childcare arrangements?

1 Yes

0 No

8 Refused to Answer

i. In the last 3 months, have you lost custody of a child?

1 Yes

0 No

8 Refused to Answer

Now I’d like to ask you some questions about any experience you have had with violence or abuse

j. Did you ever experience a sexual assault or rape as a child or teenager, that is, when you were 17 years of age or younger?

1 Yes

0 No

8 Refused to Answer

k. In the last 3 months, have you experienced sexual assault or rape?

1 Yes

0 No

8 Refused to Answer

l. Did you ever experience a physical assault or abuse as a child or teenager, that is, when you were 17 years of age or younger?

1 Yes

0 No

8 Refused to Answer

m. In the last 3 months, have you experienced physical assault or abuse by someone other than your partner?

1 Yes

0 No

8 Refused to Answer

Now I’d like to ask you some questions about any experiences you may have had with losing someone close to you.

n. Have you ever experienced losing a child through death?

1 Yes

0 No

8 Refused to Answer

o. In the last 3 months, have you experienced losing a spouse/partner, family member or friend through death? By losing, we mean when someone dies, moves away, or is no longer available.

1 Yes

0 No

8 Refused to Answer

p. In the last 3 months, has your spouse/partner or family member (other than your child) had serious health problems?

1 Yes

0 No

8 Refused to Answer

q. In the last 3 months, have you became pregnant but did not want to be pregnant?

1 Yes

0 No

8 Refused to Answer

r. In the last 3 months, have you terminated a pregnancy?

1 Yes

0 No

8 Refused to Answer

s. In the last 3 months, have you experienced a miscarriage or stillbirth?

1 Yes

0 No

8 Refused to Answer

Now we are going to talk about your HIV status

t. In the last 3 months, have you told a family member or friend your HIV status?

1 Yes

0 No

8 Refused to Answer

u. In the last 3 months, was your HIV status revealed against your wishes?

1 Yes

0 No

8 Refused to Answer

v. In the last 3 months, have you experienced changes or difficulties having sex?

1 Yes

0 No

8 Refused to Answer

26. At any time have you been concerned about the following when disclosing your HIV status? (Check all that apply)

1. Rejection

2. Stigma

3. Fear of violence

4. Accused of being unfaithful or sleeping around

5. Implying that your partner is unfaithful or sleeping around

6. Fear of being cut off from financial resources

7. State laws

8. Other (specify ______________________________________________)

27. Which of the following best describes you? (Choose One)

01 Heterosexual or straight

02 Homosexual, gay, queer, or lesbian

03 Bisexual

04 Not sure/questioning

05 Other (Specify _____________________________)

08 Refused to Answer

SEXUAL BEHAVIOR MEASURES [TO DATA COLLECTORS – Please remember in the actual trial this section will be done by A-CASI. So you may feel that some of the questions are worded awkwardly (“please enter…”) – but please leave the questions as they are worded when pilot testing.]

The next section is about the sex that you have had over the last 3 months, that is, since (CALCULATE THE DATE).

Different people have different definitions of “sex.” In this study, by sex we mean

vaginal sex, which is when a man puts his penis in a woman’s vagina,

anal sex, which is when a man puts his penis in a woman’s rectum or butt, or

oral sex, which is when a man puts his penis in a woman’s mouth, or when a person puts his or her mouth on a woman’s genitals.

1. According to the definition of sex we are using for this study, did you have sex in the last 3 months, that is, since (CALCULATE THE DATE)?

1 Yes

0 No SKIP TO HEDONISTIC OUTCOME EXPECTANCIES (page 57 Q9)

8 Refused to Answer SKIP TO HEDONISTIC OUTCOME EXPECTANCIES (page 57 Q9)

SEX WITH MAIN PARTNER

IF Q1=1 , ASK:

2. In the last 3 months, that is, since (CALCULATE THE DATE) did you have a main or a primary sex partner; that is, a partner who you would call your boyfriend, girlfriend, husband, wife, lover, or significant other?

1 Yes

0 No SKIP TO page 34 Q1-B

8 Refused to Answer SKIP TO page 34 Q1-B

If Q2 =1, ASK:

3. Please give initials for your main partner so that we can be clear which partner we're talking about in the following questions. If you had more than one main partner in the last 3 months, select the one person that you feel closest to. Please enter initials for your main partner now. Then press “ENTER” to continue. If you have any questions about how to do this, please ask the interviewer for assistance. _______________

3a. Shortly, you will be asked questions about your main partner. By main partner we mean the person whose initials you entered into the computer. That person’s initials appear on this screen. Enter “1" and then the ENTER key to continue.

4. Is your main partner male or female?

01 Male

02 Female SKIP TO page 34 Q1-A

5. How many times did you have vaginal sex with your main partner in the past 3 months?

_____ times vaginal sex

998 Refuse to Answer

6. Think about all of the times you had vaginal sex with your main partner in the last 3 months. How many times did you have vaginal sex when he was not wearing a condom?

____ times without a condom

998 Refuse to Answer

7. How many times did you have anal sex with your main partner in the past 3 months?

_____ times anal sex

998 Refuse to Answer

8. Think about all of the times that you had anal sex with your main partner in the last 3 months. How many times did you have anal sex with him when he was not wearing a condom?

____ times without a condom

998 Refuse to Answer

9. How many times did you perform oral sex on your main partner in the past 3 months?

_____ times oral l sex

998 Refuse to Answer

10. In the last 3 months, how many times did you perform oral sex on your main partner when he was not wearing a condom?

____ times without a condom

998 Refuse to Answer

11. In the last 3 months, did you have sex with your main partner to get money, drugs, or something else you needed like a place to stay?

1 Yes

0 No

8 Refused to Answer

12. What was your HIV status when you started having sex with your main partner? Were you HIV positive or HIV negative or did you not know your HIV status? (Choose One)

1. I was HIV Positive

2. I was HIV Negative à SKIP TO Q14

3. I didn’t know my status  SKIP TO Q14

13. Did you tell your main partner that you were HIV positive before you had sex with him for the first time?

1 Yesà SKIP TO Q15

0 No

8 Refused to Answer – SKIP TO Q15

14. Since then, have you told your main partner that you are HIV positive?

1 Yes

0 No

8 Refused to Answer

15. Has your main partner told you whether he is HIV+ or HIV- (Choose One)

01 My main partner is HIV Positive.

02 My main partner is HIV Negative.

03 My main partner does not know his HIV status.

04 My main partner has never told me about his HIV status.

08 Refused to Answer

16. In the last 3 months, did you talk to your main partner about safer sex or using condoms?

1 Yes

0 No SKIP TO Q17-2

8 Refused to Answer – SKIP TO Q17-2

17. In the last 3 months, did you ask your main partner to use a condom?

1 Yes

0 No

8 Refused to Answer

17-2. In the last 3 months, how often did you use alcohol or drugs before or during sex with your main partner? (Choose One)

1 Everytime

2 Most of the time

3 Sometimes

4 Almost never

5 Never

8 Refused to Answer

PARTNER OUTCOME EXPECTANCIES SCALE

READ: These next questions are about [MAIN PARTNER’S INITIAL]'s thoughts and feelings about using condoms. Please tell us how strongly you agree or disagree with the following statements.

18. I think that [MAIN PARTNER’S INITIAL] would be mad at me if I asked him to use condoms. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

19. I think [INITIAL] would be proud of me if I asked him to use condoms. 1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

20. I think that [INITIAL] would hit me if I asked him to use condoms. 1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

21. I think that [INITIAL] would break up with/leave me if I asked him to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

22. I think that [INITIAL] would be supportive if I asked him to use condoms. 1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

23. I think that [INITIAL] would think I have other partners if I asked him to use condoms. 1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

24. I think that [INITIAL] would appreciate it if I asked him to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

25. I think that [INITIAL] would be jealous if I asked him to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

SELF EFFICACY FOR SAFER VAGINAL SEX

READ: Many people respond differently when it comes to using condoms in various situations. For the following situations, how sure are you that you can use a condom for vaginal sex with [MAIN PARTNER’S INITIAL], even if you have never been in that exact situation?

26. When you have vaginal sex with [MAIN PARTNER’S INITIAL], you can convince him to use a condom even if he does not want to. (Choose one)

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

27. When you have vaginal sex with [INITIAL], you can convince him to use a condom absolutely every time you have sex with him.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

28. When you have vaginal sex with [INITIAL], you can use a condom even if you both really want to feel close.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

29. When you have vaginal sex with [INITIAL], you can use a condom even if you are making up after a fight.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

30. When you have vaginal sex with [INITIAL], you can use a condom even if he wants to have a baby.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

31. When you have vaginal sex with [INITIAL], you can use a condom even if he might lose his erection.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

32. When you have vaginal sex with [INITIAL], you can use a condom even if you have not used them before.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

33. When you have vaginal sex with [INITIAL], you can use a condom even if you are very turned on.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

34. When you have vaginal sex with [INITIAL], you can use a condom even if you have been high or drinking alcohol.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

CONDOM USE SELF-EFFICACY

The next questions are about how likely it is that you could do each of these following things with [MAIN PARTNER’S INITIAL], your main partner. Your choices are very unlikely, somewhat unlikely, somewhat likely, and very likely. How likely is it that:

(Choose One for each question)

	Very unlikely	Somewhat unlikely	Somewhat likely	Very likely	RF
35. You could think up a good way of talking about using condoms with [INITIAL]?	1	2	3	4	8
36. You could actually talk to [INITIAL] about using condoms?	1	2	3	4	8
37. You could get [INITIAL] to agree to use a condom?	1	2	3	4	8
38. If [INITIAL] said no, how likely is it that you could bring it up again?	1	2	3	4	8

PARTNER NORM MEASURE

READ: Please tell us how strongly do you agree or disagree with the following statements

39. My main partner thinks a condom should be used when we have vaginal sex. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

40. When it comes to safer vaginal sex with my main partner, I want to do what he thinks I should do.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

INDEX OF SPOUSE ABUSE SCALE

These next questions are about how [MAIN PARTNER’S INITIAL], your main partner may have treated you in the last 3 months. Please tell us how often each of the following happened. Your options are never, rarely, sometimes, frequently, and very frequently.

Your main partner…(Choose One for each question)

[DELETED N/A OPTION]

	Never	Rarely	Sometimes	Frequently	Very Frequently	RF
41.Belittled you (made fun of you)	1	2	3	4	5	8
42. Demanded obedience to his desire	1	2	3	4	5	8
43. Became angry if you tell him he is drinking too much.	1	2	3	4	5	8
Made you perform sex acts that you do not enjoy or like.	1	2	3	4	5	8
Became very upset if dinner, housework, or laundry was not done when he thought it should be.	1	2	3	4	5	8
Was jealous and suspicious of your friends.	1	2	3	4	5	8
Punched you with his fists.	1	2	3	4	5	8
Told you that you are ugly and unattractive.	1	2	3	4	5	8
Told you that you could not manage or take care of yourself without him.	1	2	3	4	5	8
Acted like you are his personal servant	1	2	3	4	5	8
Insulted or shamed you in front of others.	1	2	3	4	5	8
Became very angry if you disagreed with his point of view.	1	2	3	4	5	8
Threatened you with a weapon.	1	2	3	4	5	8
Was stingy in giving you enough money to run your home.	1	2	3	4	5	8
Belittled you intellectually.	1	2	3	4	5	8
Demanded that you stay at home to take care of the children.	1	2	3	4	5	8
Beat you so badly that you had to see a doctor.	1	2	3	4	5	8
Felt that you should not work or go to school.	1	2	3	4	5	8
Was not a kind person. (was an unkind person).	1	2	3	4	5	8
Did not want you to socialize with your female friends.	1	2	3	4	5	8
Demanded sex whether you wanted it or not.	1	2	3	4	5	8
Screamed or yelled at you.	1	2	3	4	5	8
Slapped you about the face and head.	1	2	3	4	5	8
Became abusive when he drank.	1	2	3	4	5	8
Ordered you around.	1	2	3	4	5	8
Had no respect for your feelings.	1	2	3	4	5	8
Acted like a bully towards you.	1	2	3	4	5	8
Frightened you.	1	2	3	4	5	8
Treated you like you are stupid	1	2	3	4	5	8
Acted like he would like to kill you.	1	2	3	4	5	8

Relationships Sexual Relationship Power Scale

Now I would like to ask you some more questions about your relationship with [MAIN PARTNER’S INITIAL], your main partner in the last 3 months. For each of the following statements, tell me whether you strongly agree, agree, disagree, or strongly disagree with it. (Choose One for each question)

	Strongly agree	Agree	Disagree	Strongly disagree	RF
Most of the time, you do what [MAIN PARTNER’S INITIAL] wants to do.	1	2	3	4	8
[INITIAL] will not let you wear certain things.	1	2	3	4	8
When you and [INITIAL] are together, you are pretty quiet.	1	2	3	4	8
[INITIAL] has more say than you do about important decisions that affect both of you.	1	2	3	4	8
[INITIAL] tells you who you can spend time with.	1	2	3	4	8
You feel trapped or stuck in your relationship	1	2	3	4	8
[INITIAL] does what he wants, even if you do not want him to.	1	2	3	4	8
You are more committed to your relationship than [INITIAL] is.	1	2	3	4	8
When you and [INITIAL] disagree, he gets his way most of the time.	1	2	3	4	8
[INITIAL] gets more out of your relationship than you do.	1	2	3	4	8
[INITIAL] always wants to know where you are.	1	2	3	4	8
[INITIAL] may be having sex with someone else	1	2	3	4	8

For each of the following statements, please tell me who made these decisions in your relationship with [MAIN PARTNER’S INITIAL], your main partner in the last 3 months. Your choices are your main partner, both of you equally, or you. (Choose One for each question)

	Your main partner	Both of you equally	You	RF
Who usually had more say about whose friends you went out with?	1	2	3	8
Who usually had more say about whether you had sex?	1	2	3	8
Who usually had more say about what you did together?	1	2	3	8
Who usually had more say about how often you saw each other?	1	2	3	8
Who usually had more say about when you talked about serious things?	1	2	3	8
In general, who do you think had more power in your relationship?	1	2	3	8
Who usually had more say about whether you used condoms?	1	2	3	8
Who usually had more say about what types of sex you had?	1	2	3	8

SEX WITH OTHER PARTNERS. - (All Respondents)

1-a. The next questions are about other sex partners, that is partners other than [MAIN PARTNER’S INITIAL] that you already told me about. In the last 3 months, did you have sex with anyone other than [INITIAL]?

1 Yes

0 NoàSKIP TO HEDONISTIC OUTCOME EXPECTANCIES page 57 Q9

IF MAIN PARTNER WAS NOT REPORTED BUT PARTICIPANT REPORTED HAVING SEX

1-b. You told me that you had sex in the last 3 months but did not have a main partner. This means that you had sex with partners other than a main partner in the last 3 months. If this is correct please click on the “YES” button. If this is not correct please click on the “NO” button.

YES – GO TO Q2

NO – GO BACK TO Q1 ON PAGE 22

The next questions are about your other sex partners you had in the last 3 months.

2. How many of these other partners were male?

_____

2-2. How many of these other partners were female?

_____

[CREATE A LOGIC CHECK Q2+Q2-2>0]

Ask if Q2 (# of other male partners) >0

3. Earlier you told me that you had __ other male partners in the last 3 months. How many of these partners were HIV positive? If you don’t know their HIV status, please enter 0. ___

4. How many of your other male partners were HIV negative? If you don’t know their HIV status, please enter 0. ___

Q2 MIUUS Q3 MINUS Q4 = Q5 [INSERT THE NUMBER BELOW]

5. This means that you had __ other male partners whose HIV status was unknown. If this is not correct please go back to the previous questions and change your answers.

If Q3 (# of HIV+ other male partners)>0

6-1. You told me that you had __ other partners who were HIV positive in the last 3 months. In the last 3 months, did you have vaginal sex with these __ HIV positive other partners?

1 Yes

0 No – SKIP TO 6-4

8 Refused to Answer – SKIP TO 6-4

6-2. How many times did you have vaginal sex with HIV positive other partners in the last 3 months?

____ times vaginal sex

998 Refuse to Answer

6-3. Think about all of the times you had vaginal sex with these __ HIV positive other partners in the last 3 months. How many times did you have vaginal sex when they were not wearing a condom?

_ ___ times without a condom

998 Refuse to Answer

6-4. In the last 3 months, did you have anal sex with these __ HIV positive other partners? By anal sex we mean that he put his penis in your rectum or butt.

1 Yes

0 No – SKIP TO 6-7

8 Refused to Answer – SKIP TO 6-7

6-5. How many times did you have anal sex with HIV positive other partners in the last 3 months?

____ times anal sex

998 Refuse to Answer

6-6. Think about all of the times you had anal sex with these __ HIV positive other partners in the last 3 months. How many times did you have anal sex when they were not wearing a condom? ____ times without a condom

998 Refuse to Answer

6-7. In the last 3 months, did you have oral sex with these __ HIV positive other partners? By oral sex we mean when he put at least the head of his penis in your mouth.

1 Yes

0 No – SKIP TO 6-10

8 Refused to Answer – SKIP TO 6-10

6-8. How many times did you have oral sex with HIV positive other partners in the last 3 months?

____ times oral sex

998 Refuse to Answer

6-9. Think about all of the times you had oral sex with these __ HIV positive other partners in the last 3 months. How many times did you have oral sex when they were not wearing a condom?

6-10. In the last 3 months, did you have sex with any of the ___ HIV positive other partners to get money, drugs, or something else you needed like a place to stay?

1 Yes

0 No

8 Refused to Answer

6-11. Have you told these ___ HIV positive other partners that you are HIV positive? (new question) (Choose One)

1 I told none of them that I am HIV positive

2 I told some of them that I am HIV positive

3 I told all of them that I am HIV positive

8 Refused to Answer

6-12. In the past 3 months, how often did you use alcohol or drugs before or during sex with these ___ HIV positive other partners? (new question from INSPIRE) (Choose One)

1 Everytime

2 Most of the time

3 Sometimes

4 Almost never

5 Never

8 Refused to Answer

PARTNER OUTCOME EXPECTANCIES SCALE

READ: These next questions ask your opinion about what your ___ HIV positive other partners’ thoughts and feelings about using condoms. Please tell us how strongly you agree or disagree with the following statements.

6-13. I think that my ___ HIV positive other partner(s) would be mad at me if I asked them to use condoms. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

6-14. I think that my ___ HIV positive other partner(s) would be proud of me if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

6-15. I think that my ___ HIV positive other partner(s) would hit me if I asked them to use condoms. 1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

6-16. I think that my ___ HIV positive other partners would break up with me if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

6-17. I think that my ___ HIV positive other partners would be supportive if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

6-18. I think that my ___ HIV positive other partners would think I have other partners if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

6-19. I think that my ___ HIV positive other partners would appreciate it if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

6-20. I think that my ___ HIV positive other partners would be jealous if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

SELF EFFICACY FOR SAFER VAGINAL SEX

READ: Many people respond differently when it comes to using condoms in various situations. For the following situations, how sure are you that you can use a condom for vaginal sex with your ___ HIV positive other partners, even if you have never been in that exact situation?

6-21. When you have vaginal sex with the __ HIV positive other partners, you can convince them to use a condom even if they do not want to. (Choose one)

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

6-22. When you have vaginal sex with the __ HIV positive other partners, you can convince them to use a condom absolutely every time you have sex with them.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

6-23. When you have vaginal sex with the __ HIV positive other partners, you can use a condom even if they might lose his erection.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

6-24. When you have vaginal sex with the __ HIV positive other partners, you can use a condom even if you have not used them before.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

6-25. When you have vaginal sex with the __ HIV positive other partners, you can use a condom even if you are very turned on.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

6-26. When you have vaginal sex with the __ HIV positive other partners, you can use a condom even if you have been high or drinking alcohol.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

CONDOM USE SELF-EFFICACY

Now I am going to ask you about how likely it is that you could do each of these following things with your ___ HIV positive other partners. Your choices are very unlikely, somewhat unlikely, somewhat likely, and very likely. How likely is it that: (Choose One for each question)

	Very unlikely	Somewhat unlikely	Somewhat likely	Very likely	RF
6-30. You could think up a good way of talking about using condoms with your HIV positive other partners?	1	2	3	4	8
6-31.You could actually talk to your HIV positive other partners about using condoms?	1	2	3	4	8
6-32.You could get your HIV positive other partners to agree to use a condom?	1	2	3	4	8
6-33.If your HIV positive other partners said no, how likely is it that you could bring it up again?	1	2	3	4	8

PARTNER NORM MEASURE

READ: Please tell us how strongly do you agree or disagree with the following statements

6-34. Most of my ___ HIV positive other partners think a condom should be used when we have vaginal sex. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

35. When it comes to safer vaginal sex with these __ HIV positive other partners, I want to do what they think I should do.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

INDEX OF SPOUSE ABUSE SCALE

These next questions are about how your HIV positive other partners may have treated you in the last 6 months. Please tell me how often each of the following happened. Your options are never, rarely, sometimes, frequently, and very frequently.

Your HIV positive other partners…(Choose One for each question)

	Never	Rarely	Sometimes	Frequently	Very Frequently	RF
6-36. Made you perform sex acts that you do not enjoy or like.	1	2	3	4	5	8
6-37Punched you with his fists.	1	2	3	4	5	8
6-38Told you that you are ugly and unattractive.	1	2	3	4	5	8
6-39Threatened you with a weapon.	1	2	3	4	5	8
6-40Beat you so badly that you had to see a doctor.	1	2	3	4	5	8
6-41Was not a kind person. (was an unkind person).	1	2	3	4	5	8
6-42Demanded sex whether you wanted it or not.	1	2	3	4	5	8
6-43Screamed or yelled at you.	1	2	3	4	5	8
6-44. Slapped you about the face and head.	1	2	3	4	5	8
6-45Became abusive when he drank.	1	2	3	4	5	8
6-46Acted like a bully towards you.	1	2	3	4	5	8
6-47Frightened you.	1	2	3	4	5	8
6-48Acted like he would like to kill you.	1	2	3	4	5	8

IF page 22 Q4= 0 go to instruction before Page 49 Q8-1

If page 22 Q4 (# of HIV-negative other male partners)>0 ask

7-1. You told me that you had __ other partners who were HIV negative in the last 3 months. In the last 3 months, did you have vaginal sex with these __ HIV negative other partners?

1 Yes

0 No – SKIP TO 7-4

8 Refused to Answer – SKIP TO 7-4

7-2. How many times did you have vaginal sex with HIV negative other partners in the last 3 months?

____ times vaginal sex

998 Refuse to Answer

7-3. Think about all of the times you had vaginal sex with these __ HIV negative other partners in the last 3 months. How many times did you have vaginal sex when they were not wearing a condom?

____ times without a condom

998 Refuse to Answer

7-4. In the last 3 months, did you have anal sex with these __ HIV negative other partners? By anal sex we mean that a man put his penis in your rectum or butt.

1 Yes

0 No – SKIP TO 7-7

8 Refused to Answer – SKIP TO 7-7

7-5. How many times did you have anal sex with HIV negative other partners in the last 3 months?

____ times vaginal sex

998 Refuse to Answer

7-6. Think about all of the times you had anal sex with these __ HIV negative other partners in the last 3 months. How many times did you have anal sex when they were not wearing a condom? ____ times without a condom

998 Refuse to Answer

7-7. In the last 3 months, did you have oral sex with these __ HIV negative other partners? By oral sex we mean when he put at least the head of his penis in your mouth.

1 Yes

0 No – SKIP TO 7-10

8 Refused to Answer – SKIP TO 7-10

6-2. How many times did you have oral sex with HIV negative other partners in the last 3 months? -

____ times vaginal sex

998 Refuse to Answer

7-9. Think about all of the times you had oral sex with these __ HIV negative other partners in the last 3 months. How many times did you have oral sex when they were not wearing a condom? ____ times without a condom

998 Refuse to Answer

7-10. In the last 3 months, did you have sex with any of the ___ HIV negative other partners to get money, drugs, or something else you needed like a place to stay?

1 Yes

0 No

8 Refused to Answer

7-11. Have you told these ___ HIV negative other partners that you are HIV positive? (Choose One)

1 I told none of them that I am HIV positive

2 I told some of them that I am HIV positive

3 I told all of them that I am HIV positive

8 Refused to Answer

7-12. In the past 90days, how often did you use alcohol or drugs before or during sex with these ___ HIV negative other partners? (Choose One)

1 Everytime

2 Most of the time

3 Sometimes

4 Almost never

5 Never

8 Refused to Answer

PARTNER OUTCOME EXPECTANCIES SCALE

READ: These next questions ask your opinion about what your ___ HIV negative other partners’ thoughts and feelings about using condoms. Please tell us how strongly you agree or disagree with the following statements.

7-13. I think that my ___ HIV negative other partners would be mad at me if I asked them to use condoms. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-14. I think that my ___ HIV negative other partners would be proud of me if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-15. I think that my ___ HIV negative other partners would hit me if I asked them to use condoms. 1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-16. I think that my ___ HIV negative other partners would break up with me if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-17. I think that my ___ HIV negative other partners would be supportive if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-18. I think that my ___ HIV negative other partners would think I have other partners if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-19. I think that my ___ HIV negative other partners would appreciate it if I them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-20. I think that my ___ HIV negative other partners would be jealous if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

SELF EFFICACY FOR SAFER VAGINAL SEX

READ: Many people respond differently when it comes to using condoms in various situations. For the following situations, how sure are you that you can use a condom for vaginal sex with your ___ HIV negative other partners, even if you have never been in that exact situation?

7-21. When you have vaginal sex with the __ HIV positive other partners, you can convince them to use a condom even if they do not want to. (Choose one)

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

7-22. When you have vaginal sex with the HIV negative other partners, you can convince them to use a condom absolutely every time you have sex with them.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

7-23. When you have vaginal sex with the __ HIV negative other partners, you can use a condom even if they might lose their erection.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

7-24. When you have vaginal sex with the __ HIV negative other partners, you can use a condom even if you have not used them before.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

7-25. When you have vaginal sex with the __ HIV negative other partners, you can use a condom even if you are very turned on.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

7-26. When you have vaginal sex with the __ HIV negative other partners, you can use a condom even if you have been high or drinking alcohol.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

CONDOM USE SELF-EFFICACY

Now I am going to ask you about how likely it is that you could do each of these following things with your ___ HIV negative other partners. Your choices are very unlikely, somewhat unlikely, somewhat likely, and very likely. How likely is it that: (Choose One for each question)

	Very unlikely	Somewhat unlikely	Somewhat likely	Very likely	RF
7-30. You could think up a good way of talking about using condoms with your HIV negative other partners?	1	2	3	4	8
7-31.You could actually talk to your HIV negative other partners about using condoms?	1	2	3	4	8
7-32.You could get your HIV negative other partners to agree to use a condom?	1	2	3	4	8
7-33.If your HIV negative other partners said no, how likely is it that you could bring it up again?	1	2	3	4	8

PARTNER NORM MEASURE

READ: Please tell us how strongly do you agree or disagree with the following statements

7-34. Most of my ___ HIV negative other partners think a condom should be used when we have vaginal sex. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

7-35. When it comes to safer vaginal sex with these __ HIV negative other partners, I want to do what they think I should do.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

INDEX OF SPOUSE ABUSE SCALE – ADAPTED

These next questions are about how your HIV negative other partners may have treated you in the last 3 months. Please tell me how often each of the following happened. Your options are never, rarely, sometimes, frequently, and very frequently.

Your HIV negative other partners…(Choose One for each question)

[DELETED N/A OPTION]

	Never	Rarely	Sometimes	Frequently	Very Frequently	RF
7-36. Made you perform sex acts that you do not enjoy or like.	1	2	3	4	5	8
7-37 Punched you with his fists.	1	2	3	4	5	8
7-38 Told you that you are ugly and unattractive.	1	2	3	4	5	8
7-39 Threatened you with a weapon.	1	2	3	4	5	8
7-40 Beat you so badly that you had to see a doctor.	1	2	3	4	5	8
7-41 Was not a kind person. (was an unkind person).	1	2	3	4	5	8
7-42 Demanded sex whether you wanted it or not.	1	2	3	4	5	8
7-43. Screamed or yelled at you.	1	2	3	4	5	8
7-44. Slapped you about the face and head.	1	2	3	4	5	8
7-45 Became abusive when he drank.	1	2	3	4	5	8
7-46 Acted like a bully towards you.	1	2	3	4	5	8
7-47 Frightened you.	1	2	3	4	5	8
7-48 Acted like he would like to kill you.	1	2	3	4	5	8

IF PAGE 34 Q5=0 go to hedonistic ON page 50 q9

If Q5 (# of unknown status other male partners)>0 ask

8-1. You told me that you had __ other partners whose HIV status was unknown in the last 3 months. We will call them “unknown status other partners.” In the last 3 months, did you have vaginal sex with these __ unknown status partners?

1 Yes

0 No – SKIP TO 8-4

8 Refused to Answer – SKIP TO 8-4

8-2. How many times did you have vaginal sex with unknown status other partners in the last 3 months?

____ times vaginal sex

998 Refuse to Answer

8-3. Think about all of the times you had vaginal sex with these __ unknown status other partners in the last 3 months. How many times did you have vaginal sex when they were not wearing a condom?

8-4. In the last 3 months, did you have anal sex with these __ unknown status other partners? By anal sex we mean that a man put his penis in your rectum or butt.

1 Yes

0 No – SKIP TO 8-7

8 Refused to Answer – SKIP TO 8-7

8-5. How many times did you have anal sex with unknown status other partners in the last 3 months?

____ times anal sex

998 Refuse to Answer

8-6. Think about all of the times you had anal sex with these __ unknown status other partners in the last 3 months. How many times did you have anal sex when they were not wearing a condom?

8-7. In the last 3 months, did you have oral sex with these __ unknown status other partners? By oral sex we mean when a man put at least the head of his penis in your mouth.

1 Yes

0 No – SKIP TO 8-10

8 Refused to Answer – SKIP TO 8-10

8-8. How many times did you have oral sex with unknown status other partners in the last 3 months?

____ times oral sex

998 Refuse to Answer

8-9. Think about all of the times you had oral sex with these __ unknown status other partners in the last 3 months. How many times did you have oral sex when they were not wearing a condom?

8-10. In the last 3 months, did you have sex with any of the ___ unknown status other partners to get money, drugs, or something else you needed like a place to stay?

1 Yes

0 No

8 Refused to Answer

8-11. Have you told these ___ unknown status other partners that you are HIV positive? (Choose One)

1 I told none of them that I am HIV positive

2 I told some of them that I am HIV positive

3 I told all of them that I am HIV positive

8 Refused to Answer

8-12. In the past 90days, how often did you use alcohol or drugs before or during sex with these ___ unknown status other partners? (Choose One)

1 Everytime

2 Most of the time

3 Sometimes

4 Almost never

5 Never

8 Refused to Answer

PARTNER OUTCOME EXPECTANCIES SCALE

READ: These next questions ask your opinion about what your ___ unknown status other partners’ thoughts and feelings about using condoms. Please tell us how strongly you agree or disagree with the following statements.

8-13. I think that my ___ unknown status other partners would be mad at me if I asked them to use condoms. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

8-14. I think that my ___ unknown status other partners would be proud of me if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

8-15. I think that my ___ unknown status other partners would hit me if I asked them to use condoms. 1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

8-16. I think that my ___ unknown status other partners would break up with me if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

8-17. I think that my ___ unknown status other partners would be supportive if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

8-18. I think that my ___ unknown status other partners would think I have other partners if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

8-19. I think that my ___ unknown status other partners would appreciate it if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

8-20. I think that my ___ unknown status other partners would be jealous if I asked them to use condoms.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

SELF EFFICACY FOR SAFER VAGINAL SEX FROM INSPIRE

READ: Many people respond differently when it comes to using condoms in various situations. For the following situations, how sure are you that you can use a condom for vaginal sex with your ___ unknown status other partners, even if you have never been in that exact situation?

8-21. When you have vaginal sex with the __ unknown status other partners, you can convince them to use a condom even if they do not want to. (Choose one)

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

8-22. When you have vaginal sex with the __ unknown status other partners, you can convince them to use a condom absolutely every time you have sex with them.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

8-23. When you have vaginal sex with the __ unknown status other partners, you can use a condom even if they might lose their erection.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

8-24. When you have vaginal sex with the __ unknown status other partners, you can use a condom even if you have not used them before.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

8-25. When you have vaginal sex with the __ unknown status other partners, you can use a condom even if you are very turned on.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

8-26. When you have vaginal sex with the __ unknown status other partners, you can use a condom even if you have been high or drinking alcohol.

1 Absolutely Sure I Cannot

2 Pretty Sure I Cannot

3 Not Sure

4 Pretty Sure I Can

5 Absolutely Sure I Can

8 Refused to Answer

CONDOM USE SELF-EFFICACY

Now I am going to ask you about how likely it is that you could do each of these following things with your ___ unknown status other partners. Your choices are very unlikely, somewhat unlikely, somewhat likely, and very likely. How likely is it that: (Choose One for each question)

	Very unlikely	Somewhat unlikely	Somewhat likely	Very likely	RF
8-30. You could think up a good way of talking about using condoms with your unknown status other partners?	1	2	3	4	8
8-31.You could actually talk to your unknown status other partners about using condoms?	1	2	3	4	8
8-32.You could get your unknown status other partners to agree to use a condom?	1	2	3	4	8
8-33.If your unknown status other partners said no, how likely is it that you could bring it up again?	1	2	3	4	8

PARTNER NORMS

READ: Please tell us how strongly do you agree or disagree with the following statements

8-34. Most of my ___ unknown status other partners think a condom should be used when we have vaginal sex. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

8-35. When it comes to safer vaginal sex with these __ unknown status other partners, I want to do what they think I should do.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

INDEX OF SPOUSE ABUSE SCALE

These next questions are about how your unknown status other partners may have treated you in the last 6 months. Please tell me how often each of the following happened. Your options are never, rarely, sometimes, frequently, and very frequently.

Your unknown status other partners…(Choose One for each question)

	Never	Rarely	Sometimes	Frequently	Very Frequently	RF
8-36. Made you perform sex acts that you do not enjoy or like.	1	2	3	4	5	8
8-37Punched you with his fists.	1	2	3	4	5	8
8-38Told you that you are ugly and unattractive.	1	2	3	4	5	8
8-39Threatened you with a weapon.	1	2	3	4	5	8
8-40Beat you so badly that you had to see a doctor.	1	2	3	4	5	8
8-41Was not a kind person. (was an unkind person).	1	2	3	4	5	8
8-42Demanded sex whether you wanted it or not.	1	2	3	4	5	8
8-43. Screamed or yelled at you.	1	2	3	4	5	8
8-44. Slapped you about the face and head.	1	2	3	4	5	8
8-45Became abusive when he drank.	1	2	3	4	5	8
8-46Acted like a bully towards you.	1	2	3	4	5	8
8-47Frightened you.	1	2	3	4	5	8
8-48Acted like he would like to kill you.	1	2	3	4	5	8

HEDONISTIC OUTCOME EXPECTANCIES SCALE

ASK EVERYONE

READ: The next several statements are about how you might feel about condoms. For each item, please indicate how much you agree or disagree with the statement.

9. Condoms ruin the mood. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

10. Sex doesn't feel as good when you use a condom.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

11. Sex with condoms doesn't feel natural.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

12. Using condoms breaks up the rhythm of sex.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

13. Condoms can make my partner lose his hard on.

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

14. Condoms rub and cause irritation

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

15. Condoms cost too much

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refused to Answer

READ: The next several statements are about getting condoms.

15. Do you know where to get condoms in your community?

1 Yes

0 No

8 Refused to Answer

16. Do you have problems getting transportation to go and buy or get condoms?

1 Yes

0 No

8 Refused to Answer

SELF EVALUATIVE OUTCOME EXPECTANCIES SCALE

READ: The next several statements are about how you might feel in certain situations when

having sex with someone whose HIV status is unknown or who you know is HIV negative. For

each item, please indicate how much you agree or disagree with the statement. If a question

does not apply to you,think about how you would feel if you were in that situation.

17. If I had sex without a condom with an HIV negative or unknown status partner, I would regret it or feel guilty the next day. (Choose one)

1 Strongly Disagree

2 Disagree

3 Neither Disagree or Agree

4 Agree

5 Strongly Agree

8 Refused to Answer

18. I would feel good about myself if I had safer sex with an HIV negative or unknown status partner.

1 Strongly Disagree

2 Disagree

3 Neither Disagree or Agree

4 Agree

5 Strongly Agree

8 Refused to Answer

19. I would feel good about myself if I used a condom with an HIV negative or unknown status partner.

1 Strongly Disagree

2 Disagree

3 Neither Disagree or Agree

4 Agree

5 Strongly Agree

8 Refused to Answer

20. Having sex with an HIV negative or unknown status partner without a condom would make me feel bad about myself.

1 Strongly Disagree

2 Disagree

3 Neither Disagree or Agree

4 Agree

5 Strongly Agree

8 Refused to Answer

21. I would be pretty hard on myself if I had unsafe sex with an HIV negative or unknown status partner.

1 Strongly Disagree

2 Disagree

3 Neither Disagree or Agree

4 Agree

5 Strongly Agree

8 Refused to Answer

22. If I had unsafe sex with an HIV negative or unknown status partner, I would not feel bad

about it.

1 Strongly Disagree

2 Disagree

3 Neither Disagree or Agree

4 Agree

5 Strongly Agree

8 Refused to Answer

KNOWLEDGE QUESTIONS

READ: Please tell us if the following statements are true or false. If you don't know the answer, please enter unsure.

23. Once you have H.I.V., you cannot get infected with another strain of H.I.V. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

24. Anal sex and vaginal sex are riskier than oral sex for transmitting H.I.V. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

25. An H.I.V. positive person only needs to go to the doctor when they feel bad. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

26. It is possible to transmit H.I.V. through oral sex. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

27. H.I.V. is cured when the viral load test comes back undetectable. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

28. Becoming infected with another sexually transmitted disease can cause an HIV positive person to get sick quicker

1 True

2 False

3 Unsure

8 Refuse to Answer

29. Using a latex condom is highly effective in reducing the risk of transmitting H.I.V. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

30. It is important to take your H.I.V. medications the way your provider says you should. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

31. If an H.I.V. positive person has another sexually transmitted disease, it is easier for them to transmit H.I.V. to others. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

32. Regular medical care is important for anyone who is H.I.V. positive. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

33. If you keep missing doses of your H.I.V. medicines, the virus can become resistant to the medicines. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

34. Once you have H.I.V., getting other sexually transmitted diseases cannot hurt you. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

35. When lab tests tell you the virus is undetectable then you can stop taking your medications. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

36. If your CD4 or T cell count goes up, your immune system is getting stronger. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

37. You can still transmit H.I.V. even when your viral load is undetectable. (Choose one)

1 True

2 False

3 Unsure

8 Refuse to Answer

38. Have you ever used a female condom?

1 Yes

0 No –SKIP TO Q42

8 Refused to Answer – SKIP TO Q42

IF YES

39. How easy was it for you to use a female condom? (Choose One)

1. Very easy

2. Easy

3. Difficult

4. Very difficult

8. Refused to Answer

40. Would you use a female condom again?

1 Yes

0 No

8 Refuse to answer

41. Would you recommend that other women use a female condom?

1 Yes

0 No

8 Refuse to answer

42. Have you ever put a condom on a man’s penis?

1 Yes

0 No –SKIP TO Q1

8 Refused to answer – SKIP TO Q1

43. How easy was it to put a condom on a man’s penis? (Choose One)

1. Very easy

2 Easy

3 Difficult

4 Very difficult

8 Refused to Answer

44. Have you ever put a condom on a man’s penis using your mouth?

1 Yes

0 No – SKIP TO Q41

8 Refused to Answer – SKIP TO Q41

IF YES

45. How easy was it for you to put a condom on a man’s penis using your mouth? (Choose One)

1 Very easy

2 Easy

3 Difficult

4 Very difficult

8 Refused to Answer

That concludes this section of the questionnaire. Please let your interviewer know that you are finished with this section.

[AUDIO-CASI SECTION OF THE ASSESSMENT IS COMPLETE. REMAINDER OF INTERVIEW IS INTERVIEWER-ADMINISTERED VIA CAPI.]

DEMOGRAPHICS, PART 2

The next few questions are about any work you may have done for money.

1. What best describes your current employment status? (Choose One)

1. Employed full-time

2. Employed part-time

3. Unemployed

08 Refuse to Answer

2. I am going to read you a list of various ways people bring in money or get support for living expenses. For each item, please tell me if it has been a source of money or support for you at any time in the last 3 months.

Was this a source of money or support for you at any time in the last 3 months?	Yes	No	RF
Income from a regular full or part-time job	1	0	8
Money from occasional work	1	0	8
Money from activities that could get you arrested (e.g., commercial sex work, selling illegal drug)	1	0	8
Public assistance (e.g., Social Security Disability Income or SSDI, Food Stamps, welfare payments)	1	0	8
E. Other	1	0	8

2-2. If Other, please specify (Record answer verbatim)______________________________________________________________________

3. Over the last 30 days, that is, since (REFERENCE DATE) what was your total household income from all sources mentioned in the previous questions?

(READ IF NECESSARY): By household income we mean any money that you made

over the last 30 days, plus any money that anyone else made who has lived with you

over the last 30 days.) (Choose One)

1 Less than $500

2 $500-$999

3 $1000-$1499

4 $1500-$1999

5 $2000 and above

8 Refuse to Answer

4. Do you currently have health insurance coverage? This includes Medicaid or Medicare?

1 Yes

2 No

98 Refuse to Answer

5. What kind of health insurance do you currently have, if any? (Choose all that apply)

1 Private Insurance

2 Medicaid

3 Medicare

4 ADAP/ADAP+

5 Other public insurance

6 None

8 Refused to Answer

Next, I would like to ask you a few questions about your incarceration history. Remember, that all of your answers will be kept secure and protected, and that you can skip any question you do not want to answer.

6. Have you ever spent at least one night in jail or prison?

1 Yes

0 No SKIP TO Q1

8 Refused to Answer – SKIP TO Q1

7. In the last 3 months, how much time were you in jail or prison? (R can answer in DAYS, WEEKS, or MONTHS, but answer cannot exceed equivalent to 90 days, and answer cannot be in YEARS.)

Number of Days/Weeks/Months

___ ___ Days

___ ___Weeks

___ ___Months

98 Refused to Answer

MEDICAL SERVICES AND ADHERENCE TO MEDICATIONS

Next are some questions about different services you may have received.

1. Where do you usually go to get medical care? (Choose One)

01 No regular source of care SKIP TO Q7

02 Emergency Room/Department SKIP TO Q6

03 Urgent Care Clinic

04 Health Department Clinic

05 Hospital Clinic

06 Private Physician’s Office

07 Other

08 Refused to Answer

IF Q1=7, ASK:

Other (specify) _________________________

2. Where do you usually go to get HIV medical care? (Choose One)

01 No regular source of care SKIP TO Q7

02 Emergency Room SKIP TO Q6

03 Urgent Care Clinic

04 Health Department Clinic

05 Hospital Clinic

06 Private Physician’s Office

07 Other

08 Refused to Answer

IF Q1=7, ASK:

Other (specify) _________________________

IF Q1=3-7, ASK

3. How long have you been receiving HIV medical care at this place?

Number of Weeks/Months/Years

___ ___Weeks

___ ___Months

___ ___Years

98 Refused to Answer

IF Q=3-7, ASK:

4. In the last 3 months, that is since (CALCULATE DATE), did you miss any HIV medical appointments that were scheduled for you?

Yes

00 No

02 Not relevant, no medical appointments were scheduled

08 Refused to Answer

Now I’d like to ask you a couple of questions about how you get from place to place.

IF Q1 =3-7, ASK:

5. How do you usually get to your doctor for HIV medical care? (Choose One)

01 Drive my own car

02 Drive some one else’s car

03 Friend or family member drives me

04 A cab or car service I pay for

05 A van, cab or car service that is free to me

06 Public transportation like a bus

07 Walk

08 Other

98 Refused to Answer

If Q5= 8, ASK:

Other (specify) ________________________________________________________________

IF Q=2-7 ASK

6. How long does it take you to get to your doctor or to the place where you usually go to get HIV medical care?

___ ___ Minutes

___ ___ Hours

98 Refused to Answer

ASK EVERYONE

7. Have you ever taken medication for depression?

1. Yes

0. No – SKIP TO Q9

8 Refused to Answer – SKIP TO Q9

8. In the last 3 months, did you take medication for depression?

1 Yes

0 No

8 Refused to Answer

This next section of the interview is about medications.

ASK EVERYONE:

9. Have you ever taken HIV medications?

1 Yes

0 No  SKIP TO Q13

8 Refused to Answer – SKIP TO Q13

IF Q9 =1, ASK:

10. Are you currently taking any HIV medications?

1 Yes

0 No SKIP TO Q21

8 Refused to Answer – SKIP TO Q26

11. How long have you been taking HIV medications?

___ ___Weeks

___ ___ Months

___ ___ Years

98. Refused to Answer

12. Who helps you pay for your prescription drugs? (Choose All that Apply)

1. Medicaid

2. Private Insurance

3. ADAP (including Ryan White funds)

4. Clinical Trials

5. Medicare

6. Other

7. No one [CREATE A LOGIC CHECK] – SKIP TO Q24

8. Refused to Answer – SKIP TO Q24

ASK EVERONE

13. The next set of questions ask how you feel about taking HIV medications whether or not you have ever taken HIV medications in the past. I would like to know how you feel about taking HIV medications. Please indicate how strongly you agree or disagree with the following statements.

13-1. The side effects of HIV medicines are not as bad as people think.

01 Strongly Disagree

2. Disagree

3. Neither agree nor disagree

04 Agree

05 Strongly Agree

08 Refused to Answer

13-2. Taking HIV medicines makes people sicker.

01 Strongly Disagree

2. Disagree

3. Neither agree nor disagree

04 Agree

05 Strongly Agree

08 Refused to Answer

13-3. The side effects of HIV medicines are worse than not taking them.

01 Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

08 Refused to Answer

13-4. People who take HIV medicines are taking good care of themselves.

01 Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

08 Refused to Answer

13-5. People who take HIV medications feel better when they stop taking them.

01 Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

05 Strongly Agree

08 Refused to Answer

13-6. Taking HIV medicines could mean that people will find out that a person has HIV.

01 Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

08 Refused to Answer

13-7. I believe that my health will be better if I take HIV medicines.

01 Strongly Disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly Agree

08 Refused to Answer

13-8.Taking HIV medications makes people feel better in the long run.

01 Strongly Disagree

02 Disagree

3. Neither agree nor disagree

4. Agree

05 Strongly Agree

08 Refused to Answer

14. During the last 3 months, has any case manager, social service agency or paid provider worked with you in any of the following ways?

	Yes	No	RF
Developing or revising a plan for dealing with your needs?	1	0	8

Helping you get or refer you to specific medical services?	1	0	8
Helping you to get HIV medications or to pay for HIV medications?	1	0	8
D. Helping you get or refer you to specific social services such as housing, meal program, transportation services?	1	0	8
E. Escorting you or going with you to your medical appointments?	1	0	8
F. Periodically checking on how you are doing or asking whether you are getting the services you need?	1	0	8
G. Filling out forms for benefits?	1	0	8
H. Talking with you or giving you advice about your personal life or problems you are having?	1	0	8
I. Talking to you or giving you advice about drug or alcohol use?	1	0	8
J. Talking to you or giving you advice about practicing safer sex?	1	0	8
K. Talking to you or giving you advice about taking your HIV/AIDS medication?	1	0	8
Talking to you or giving you advice about domestic violence assistance?	1	0	8
Talking to you, giving you advice or referring you to mental health, emotional or psychological services?	1	0	8
Talking to you or giving you advice about partner notification?	1	0	8

15. Here are some questions about different types of problems people sometimes have in getting medical care.

ASK EVERYONE:

At any time in the last 3 months, that is since (CALCULATE DATE), did you delay or not get the medical assistance you thought you needed because…	Yes	No	RF
It cost too much or it wasn't covered by insurance?	1	0	8
B. You were concerned that your HIV status might be disclosed?	1	0	8
C. The staff at the office or clinic were not competent to deal with your problem?	1	0	8
D. You didn't know or weren't sure where to go?	1	0	8
E. You had transportation problems and it was difficult to get to the clinic or agency?	1	0	8
F. The staff at the office or clinic were often not polite, were disrespectful, or were insensitive to your needs?	1	0	8
G. You weren't sure that the staff at the office or clinic would understand your problems?	1	0	8
H. The staff did not listen to your problems or needs?	1	0	8
I. You had childcare problems or you needed someone to take care of your children?	1	0	8
J. You were nervous or afraid of what the doctor or service provider might say?	1	0	8
K. It takes too long to get an appointment or to see someone who might help you?	1	0	8

16. In the past year, are they any HIV programs or classes or groups that you have attended?

Yes 1

No 0

Refused to Answer 8

17. IF YES, what is the name of the program? ___________________________________

That was the last question in the interview. Now I’d like to ask you a question that you can answer any way you like.

18. If you could change one thing about help that is or is not available to persons living with HIV what would that be?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Attitudes toward A-CASI Questions (Use at 3month Follow-up Assessment Interview ONLY)

In this survey, you answered some questions asked by a person and other questions asked by a computer. The following questions ask you about your experience with using the computer for this survey. Please indicate how much you agree or disagree with each of the following statements.

I felt comfortable using the computer. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

I prefer to do the survey with a person rather than a computer. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

Overall, I could not understand the questions I heard on the computer. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

Compared to an interview with a person, the computer made it harder for me to be open and honest about my sexual and drug using behavior. (Choose one)

1 Strongly disagree

2 Disagree

3 Neither disagree nor agree

4 Agree

5 Strongly agree

8 Refuse to Answer

How much computer experience did you have before you participated in this study? (Choose one)

1 None

2 Some

3 A lot

8 Refuse to Answer

130

88