Post-test Survey

Form Approved

OMB No. 0920-0840

Expiration Date 01/31/2013

Development of a Motion Comic for HIV/STI Prevention Among Young People – ages 15-24

Participant Post-Test Survey

Public reporting burden of this collection of information is estimated to average 15 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: OMB-PRA (0920-0840)

MOTION COMIC POST TEST SURVEY

Study ID No. _____

A. EXPERIENCE AND ATTITUDES ABOUT HIV TESTING

1. Do you plan to get tested for HIV sometime in the next 3 months (90 days)?

___ Yes ___ No

2. How much do you agree or disagree with the following statements?

a. I am/would be too scared to get an HIV test.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

b. If I was offered a chance to get an HIV test, I would get it.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

c. Everybody who has had unprotected sex should get an HIV test.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

d. I know where to get an HIV test.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

e. I get tested for HIV regularly.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

f. I get an HIV test before I have sex with a new sex partner.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

g. I ask all new sex partners when their last HIV test was and the result.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

h. Everyone regardless of if they are sexually active should get an HIV test.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

B. HIV STIGMA

1. I would sit next to an HIV-positive person.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

2. People who got HIV through sex or drug use have gotten what they deserve.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

3. I would be afraid to live with an HIV-positive person.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

4. I would buy fruit from someone who I knew was HIV-positive.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

5. I would not eat in a restaurant if I found out that someone there was HIV-positive.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

6. I would date someone who is HIV positive.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

C. HIV/STD KNOWLEDGE

1. You can always tell if your partner has as an STD.

___True ___ False

2. All people who have been infected with HIV quickly show serious signs of being infected.

___True ___ False

3. You can’t get HIV by sharing knives, forks, or cups with a person who has HIV.

___True ___ False

4. Wearing a condom correctly will protect you from most STDs.

___True ___ False

5. If a woman uses birth control pills, it lowers her risk for getting HIV.

___True ___ False

6. Using oil based lubricants such as Vaseline or Crisco with condoms will reduce the risk of getting HIV/STD.

___True ___ False

7. There is no cure for AIDS.

___True ___ False

8. Having another sexually transmitted disease like Gonorrhea or Herpes increases a person’s risk of becoming infected with HIV.

___True ___ False

9. Having sexual intercourse without a condom increases a person’s risk of becoming infected with HIV/STD.

___True ___ False

10. A person can get HIV by sharing a glass of water with someone who has HIV.

___True ___ False

11. Withdrawal, or pulling out the penis before climax will always prevent HIV/STD transmission.

___True ___ False

12. There is a vaccine (shot) that can prevent people from getting HIV.

___True ___ False

13. There is a vaccine (shot) that can prevent people from getting some STDs.

___True ___ False

14. A person is likely to get HIV by deep kissing (putting their tongue in their partner's mouth) if his/her partner has HIV.

___True ___ False

15. There is a female condom that can help decrease a woman's chance of getting HIV/STD.

___True ___ False

16. A person cannot get HIV if she or he is taking antibiotics.

__True ___ False

17. By taking an HIV test one week after having unprotected sex, it can be determined if a person has been infected.

__True ___ False

D. CONDOM ATTITUDES AND KNOWLEDGE

1. Condoms ruin the mood.

__ Strongly agree __ Agree ___ Neither agree or disagree __ Disagree __ Strongly disagree

2. Sex doesn’t feel as good when you use a condom.

__ Strongly agree __ Agree ___ Neither agree or disagree __ Disagree __ Strongly disagree

3. Sex with condoms doesn’t feel natural.

__ Strongly agree __ Agree ___ Neither agree or disagree __ Disagree __ Strongly disagree

4. I know how to put on a male condom correctly.

__ Strongly agree __ Agree ___ Neither agree or disagree __ Disagree __ Strongly disagree

5. Condoms are easy to use.

__ Strongly agree __ Agree ___ Neither agree or disagree __ Disagree __ Strongly disagree

6. I am embarrassed to ask my partner to use a condom.

__Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

7. I would insist on using a condom, even if my partner did not want to use one.

__ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

8. Space should be left at the tip of a condom when it is put on the penis.

__True ___ False

9. The time to put on a condom is right before a man cums or ejaculates.

__True ___ False

10. When a man uses a condom, he should unroll it first and then slip it on.

__True ___ False

E. Behavioral Intentions

1. Thinking of the occasions when you may have sexual intercourse in the next 3 months (90 days), how often do you think you will use condoms?

___Never ___ Occasionally ___About half the time ___Most times ___Always

2. Thinking of the occasions when you may have sexual in the next 3 months (90 days), how likely do you think it is you will attempt to negotiate safe sex?

___Never ___ Occasionally ___About half the time ___Most times ___Always

3. Thinking about the next 90 days how likely is it you will get an HIV Test

___Extremely unlikely ____ Unlikely ____ Neutral ___ Likely ___Extremely likely

4. Thinking about the next 90 days how likely is it you will get an STD Test

___Extremely unlikely ____ Unlikely ____ Neutral ___ Likely ___Extremely likely

5. How likely is it that you will remain abstinent in the next 3 months (90 days)

___Extremely unlikely ____ Unlikely ____ Neutral ___ Likely ___Extremely likely

6. Thinking of the number of sex partners you have had in the last three months, how likely do you think you will reduce the number of partners you will have?

___Extremely unlikely ____ Unlikely ____ Neutral ___ Likely ___Extremely likely

F. SATISFACTION

1. Do you think that a motion comic about HIV prevention is a good way to reach young people like yourself?

__ Not at all ___ A little ___ Somewhat ___ Very much

2. How interesting was the story portrayed in the motion comic to you?

__ Not at all ___ A little ___ Somewhat ___ Very much

3. How much did you relate to the characters in the motion comic?

__ Not at all ___ A little ___ Somewhat ___ Very much

4. How interested would you be in seeing additional episodes of the motion comic?

__ Not at all ___ A little ___ Somewhat ___ Very much

5. How interested do you think your friends would be in watching the motion comic?

__ Not at all ___ A little ___ Somewhat ___ Very much

6.Would you recommend/share this with your friends?

__ Not at all ___ A little ___ Somewhat ___ Very much