Paper and Pencil Questionnaire

Formative Research to Inform an HIV Testing Social Marketing Campaign for African American Men Who Have Sex with Men (MSM)

0762_Att3b.Paper and Pencil Survey_081709

Paper and Pencil Questionnaire

OMB: 0920-0762

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ATTACHMENT 3B:

Formative Research to Inform an HIV Testing Social Marketing Campaign for African American Men Who Have Sex with Men (MSM”), formerly known as Formative Research to Inform an HIV Testing Social Marketing Campaign for African American Heterosexual Men



DATA COLLECTION INSTRUMENTS - PAPER AND PENCIL SURVEY














Form Approved

OMB No. 0920-0762

Expiration Date xx/xx/xxxx

Formative Research To Inform An Hiv Testing Social Marketing Campaign For African American Men Who Have Sex With Men (MSM)

Consumer Paper-and-Pencil Questionaire

Public reporting burden of this collection of information is estimated to average 10 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 (0920-0762)


A subset of questions from the items below appropriate for the allotted time frame will be selected for use during the interview process. Questions selected will be used consistently across all participants.


Consumer Paper-and-Pencil Questionnaire


I. Demographics


  1. How old are you?

________

  1. What is the highest grade or year of school you finished?

Never attended school or only attended kindergarten

Grades 1 through 8 (elementary)

Grades 9 through 11 (some high school)

Grade 12 or GED (high school graduate)

College 1 year to 3 years (some college or technical school)

College 4 years or more (college graduate)



  1. Which best describes your total personal income during the past year?

No income

Under $4,999

$5,000 to $9,999

$10,000 to $14,999

$15,000 to $19,999

$20,000 to $24,999

$25,000 to $29,999

$30,000 to $34,999

$35,000 to $39,999

$40,000 or more

Refuse to answer………………………………………………………… ……..



  1. Which of the following statements best describes your current employment situation?

Working full-time

Working part-time

Unemployed or laid off

Other [Specify:_______________]

Refuse to answer

  1. Are you currently a college student?

Yes

No

  1. Do you have a primary care doctor?

Yes

No

  1. Do you have health insurance?

Yes (Skip 9)

No

  1. How do you pay for your health care needs?

Self pay/cash

Go to free clinics

Other [Specify:_______________]



Skip 10

  1. What kind of health insurance do you have [MARK ALL THAT APPLY]

Private insurance, either through an employer or that I purchased on my own

Medicare, a federal govt. program for people age 65 or older and certain
disabled people

Medicaid, a state program that helps people with low income

The military, TRICARE, or the VA

Some other source [SPECIFY: ____________________________]

  1. Which do you consider yourself to be?

Gay, homosexual, or same gender loving

Bisexual or two spirited

Straight or heterosexual

Other [Specify:_______________]

None of the above/unsure

Refuse to answer




II. Knowledge, Attitudes, Beliefs about HIV



  1. Please indicate whether you think each statement is true, false or if you don’t know.

True

False

Don't know

a. People can get HIV even though they had sex with only one person.

b. There is still no cure for HIV/AIDS.

c. You can tell that somebody has HIV just by looking at them.

d. A man may be at risk for HIV if he had unprotected anal sex with a man. By unprotected, we mean sex without a condom.

e. There is a test available to tell whether a person has HIV.

f. Treatment and support programs are available to people like me who might test positive for HIV.

g. People are automatically tested for HIV when they go to the doctor if their blood is drawn.

h. There are medications available to treat HIV




  1. Please indicate how much you agree or disagree with each of the following statements.

Strongly disagree

Disagree

Neither
agree nor disagree

Agree

Strongly agree

a. HIV is not my problem.

b. There are medications available to treat HIV.

c. I don’t need to worry about getting HIV because I know everything about my partners.

d. HIV is not something I think about often.

e. Knowing my HIV status helps me take responsibility for myself.

f. Knowing my HIV status helps me take responsibility for others.

g. HIV is not a big problem in my community.

h. I should get tested for HIV because I may be at risk.

i. People need education to learn how to avoid getting HIV.

j. I am less likely than most people to get HIV.

k. HIV is a death sentence.

l. If I test positive for HIV my name will be reported to the government.

m. I am afraid to find out if I am HIV positive.

n. I don’t think about HIV a lot.


III. HIV Testing


  1. Which of the following best describes your HIV testing behavior?

I have never been tested and am not concerned that I am at risk

I have never been tested but have thought about getting tested to be sure
I am okay

I have been tested at least once, but not on a regular basis

I test regularly or after any situation where I might have been exposed to HIV

  1. Have you ever been tested for HIV?

Yes (Skip to Q16)

No

15. Below is a list of reasons why some people have not been tested for HIV. Which of these are the main reasons why you have not been tested? Please select one or more of the following reasons. [MARK ALL THAT APPLY]

You have not been sexually active

You have not had unprotected sex

You were afraid to find out if you were HIV positive

You didn’t want to think about HIV or about being HIV positive

You didn’t think you were at risk of being HIV positive

You don’t like needles

You don’t trust the results to be kept private

You had to wait too long for the results

You didn’t know where to get tested

You trust your sex partner

Some other reason [SPECIFY: ____________________________]



16. When was your last HIV test?

Less than 3 months ago

3-6 months ago

7-12 months ago

More than 12 months ago

Never had an HIV test


17. Did you get the results of your last HIV test?

Yes

No


18. Why didn’t you get the results of your last HIV test?

I didn’t want to know

I was afraid the results might be positive

I forgot

I thought the doctor would call me to tell me my results

Other:__________________________

19. Where did you have your last HIV test?

Private doctor

STD or AIDS clinic or testing site

Hospital or emergency room

Public health department

At home

Drug treatment facility

Prison or jail

Other location (SPECIFY:__________________)

20. The last time you were tested for HIV, how was the test given to you?

Blood was drawn from your vein

Your finger was pricked and blood was taken from the prick

A saliva test where someone else took a swab from your mouth



21. Which of these are the main reasons for your last HIV test? Please select one or more of the following reasons. [MARK ALL THAT APPY]

Just to find out, worried that you are infected

A doctor, nurse or other health care provider asked you to

The Health Department asked you to

Your sex partner asked you to

You found out your sex partner cheated

Already had an STD

You were starting a new relationship

Other reason [SPECIFY: ____________________]



22. How often do you get an HIV test? _____________



23. How often do you think you should get tested for HIV?

Every 2 months

Every 3-6 months

Every 7-12 months

Every couple of years

Don’t know………………………………………………………………………...

24. How often do you think someone should get tested for HIV if they…


Every 2 1-3 months

Every 4 3-6 months

Every 7-12 months

Every couple of years

Don’t know

Always have sex with a condom






Have had sex without a condom






Have a sex partner who is HIV positive






Have unprotected sex with a partner whose HIV status they don’t know






Have had more than one sex partner since their last HIV test






Exchange sex or money for drugs






Inject drugs






Have sex with a person who injects drugs








25. Do you get an HIV test after any situation when you think you might have been exposed to HIV?

Yes……………………………………………………………………………

No……………………………………………………………………………..



26. On a scale from 1 to 6, where 1 is extremely bad and 6 is extremely good, how would you rate getting tested for HIV every 3 to 6 months?




1

2

3

4

5

6


Extremely bad







Extremely good



27. On a scale from 1 to 6, where 1 is extremely bad and 6 is extremely good, how would you rate getting tested for HIV at every 12 months?


1

2

3

4

5

6


Extremely bad







Extremely good



28. On a scale from 1 to 6, where 1 is extremely harmful and 6 is extremely beneficial, how would you rate getting an HIV test every 3 to 6 months?


1

2

3

4

5

6


Extremely harmful







Extremely beneficial



29. On a scale from 1 to 6, where 1 is extremely harmful and 6 is extremely beneficial, how would you rate getting an HIV test at least every 12 months?


1

2

3

4

5

6


Extremely harmful







Extremely beneficial



30. Do you know a place where you can get an HIV test?

Yes

No (Skip to Q26 Q34)

31. Is this place in your community?

Yes

No

32. Do you know a place where you can get a FREE HIV test?

Yes

No (Skip to Q26 Q34)

33. Is this place in your community?

Yes

No

34. Have you talked to your partner about the importance of getting an HIV test?

Yes

No



35. It is important to get tested for HIV so that people who test positive can start getting treated right away.

Strongly agree

Agree

Disagree

Strongly disagree



36. Have you ever talked to anyone, other than your partner, such as friends or family, about getting an HIV test?

Yes

No


37. If a free test was available to see if you have HIV, would you take it?

Yes

No

38. Engaging in anal sex without a condom is a primary risk factor for HIV/AIDS transmission.

True

False



39. How likely is it that you will get tested for HIV in the next 3-6 months?

Very likely

Somewhat likely

Neither likely or unlikely

Somewhat unlikely

Very unlikely



40. How likely is it that you will get tested for HIV in the next 12 months?

Very likely

Somewhat likely

Neither likely or unlikely

Somewhat unlikely

Very unlikely



41. In the past 12 months, which of the following HIV/AIDS prevention activities or events have you participated in? [MARK ALL THAT APPY]

Read an HIV-related publication or newspaper

Attended a safer sex workshop

Attended (or led) a workshop or community forum about HIV-related issues

Looked at a website with information about HIV prevention

Looked at an ad about HIV prevention

Read a news or magazine article about HIV prevention

Watched a TV show or announcement with information about HIV prevention

None of these activities/events

Refuse to answer

42. In the past 12 months, which of the following gay community activities or events have you participated in? Choose all that apply.

Attended gay pride parade or festival

Read a gay newspaper

Belonged to a gay club, professional group, or community organization

Took part in the house, ball, or court systems

Went to a gay bar or nightclub

Worked out at a gay gym

Logged on to a gay website, chat room, or online service

None of these activities/events

Refuse to answer


IV. Channel Research


43. Do you use a computer?

Yes

No

44. Do you use the Internet?

Yes

No

45. Where do you usually connect to the Internet?

Home

School

Work

Library

Friend’s house

Internet café

PDA or Blackberry

Cell phone

Other [Specify:___________________________]

46. When you connect to the Internet, do you use…

Dial-up

DSL

Cable modem

PDA or Blackberry

Cell phone

Other [Specify:_________________________]

47. How many hours per day do you use the Internet for reasons other than work or school?

_________________

48. What do you do when you go online? Mark all that apply.

Email

Look up sports news/information

Look up news/current events

Instant message (IM)

Play games

Download music

Shop/make purchases

Look for employment

Watch video

Listen to online radio

Watch online TV

Look up health information

Visit chat rooms

Make travel plans

Use social networking websites (such as Myspace or Facebook)

Visit gay websites

Visit adult websites

Visit dating websites

49. Have you ever used the Internet to look up health related topics?

Yes

No

50. Have you ever used the Internet to look up information about HIV?

Yes

No



51. I trust the information about HIV that I have found on the Internet.

Strongly agree

Agree

Disagree

Strongly disagree



52. How often do you go online to socialize with other black gay men?



Never

Less than once a month

Once a month

2-3 times a month

1-2 times a week

3-6 times a week

About once a day

More than once a day

  • 53. How often do you go online to seek sexual partners?

  • Never

  • Less than once a month

  • Once a month

  • 2-3 times a month

  • 1-2 times a week

  • 3-6 times a week

  • About once a day

  • More than once a day

54. How often do you visit the following websites?


Daily

2 -5 Times a week

Once a week

2-3 Times a month

Once a month

Less than once a month




Never

a. Blackgaychat (www.BGCLive.com)

b. Whatstea (www.whatstea.com)

c. Walk4mewednesdays (www.walk4mewednesdays.com)

d. Keithpoykin (www.keithboykin.com)

e. Adam4Adam (www.Adam4Adam.com)

f. Gay (www.gay.com)

g. Rod 2.0 (http://rodonline.typepad.com)








h. Clay Cane (http://claycane.blogspot.com)








i. Facebook (www.facebook.com)

j. Myspace (www.myspace.com)

k. Other: [Specify:______________]

l. Other: [Specify:______________]



  1. How often do you read banner ads on websites for men seeking men?

Always

Sometimes

Rarely

Never

56. How often do you click on banner ads on websites for men seeking men?

Always

Sometimes

Rarely

Never

57. How likely would you be to click on a banner ad about HIV testing?

Always

Sometimes

Rarely

Never

58. How worried would you be about your privacy if you got information about HIV testing online?

Very worried

Somewhat worried

A little bit worried

Not worried at all

59. How often do you read gay blogs?

Always

Sometimes

Rarely

Never

60. Do you use a cell phone?

Yes

No

61. Do you send/receive text messages on your cell phone?

Yes

No

62. I would be interested in getting information about HIV testing via text messaging.

Strongly agree

Agree

Disagree

Strongly disagree

63. How worried would you be about your privacy if you got information about HIV testing via text messaging?

Very worried

Somewhat worried

A little bit worried

Not worried at all

64. How many hours of TV do you watch per week? ____________ hours

65. Which of the following TV channels or networks do you regularly watch?

ABC

CBS

NBC

A&E

ESPN

Food Network

Fox News

Comedy Central

BET

HGTV

HBO

Bravo

MTV

VH1

Showtime

TV One

Other [Specify:______________________]

66. Which of the following do you subscribe to or read regularly in the print version? By regularly, we mean at least once a month.

Your local newspaper…………………………………………………………………

Clik Magazine…………………………………………………………………………

Vibe…………………………………………………………………………………….

The Source…………………………………………………………………………….

The Advocate………………………………………………………………………….

Genre …………………………………………………………………………………..

Out……………………………………………………………………………………..

Other [Specify:______________________________]……………………………….



67. What radio stations do you listen to most often? _______

68. What type of music or programming do you listen to on the radio?

Rhythm and blues (R&B)

Jazz

Talk

Gospel

Pop

Rock

Hip hop/Rap

Country

Urban

Sports talk

Dance/techno

Latin

Other [Specify:_______________________]

69. How many hours per week do you listen to an iPod or other MP3 player? _________

70. How likely would you be to listen to a podcast about HIV prevention or testing? (Podcasting is a form of audio broadcasting over the Internet.)

Very likely

Somewhat likely

Not at all likely



71. How often do you take public transportation?

Never

Less than once a month

Once a month

2-3 times a month

1-2 times a week

3-6 times a week

About once a day

More than once a day



V. Source Credibility

72. Indicate how much you trust each of the following sources of HIV information.


Trust very much

Trust somewhat

Distrust somewhat

Do not trust at all

Refuse to answer

My doctor, nurse, or health care professional

WebMD (Health website)

www.thebody.com






AIDS organization in my local community

Centers for Disease Control and Prevention (CDC)

A major university medical center

State or local health department

A local hospital or health care system

Other [Speciify:__________________]


Other [Speciify:__________________]


Other [Speciify:__________________]




VI. Risk Behaviors

These next few questions are about your personal behaviors, including sexual activity. Please remember that your answers are kept private.

73. During the past 12 months, how many people did you have sex with? ________

74. How many of your partners in the past 12 months were men? ________

75. How many of your partners in the past 12 months were women? ________

76. Did you have anal sex with any of your male partner(s) in the past 12 months?

Yes

No (Skip to Q78)

Refuse to answer

77. When you had anal sex with your male partner(s) in the past 12months, how often did you and your partner use a condom?

Never used a condom

Occasionally used a condom

Usually used a condom

Always used a condom

Refuse to answer

78. Do you currently have a main sex partner—that is, a partner you would call your spouse, significant other, or life partner?

Yes

No (Skip to Q 82)

Refuse to answer

79. How long have you and your main partner been together? If you and your main partner have been together for less than 1 month, please enter 1 month as your answer.






Years


Months



Refuse to answer

80. Is your main partner male, female, or transgender?

Male

Female

Transgender

Refuse to answer

81. What is your main partner’s HIV status?

My main partner is HIV negative

My main partner is HIV positive

My main partner has not been tested for HIV

My main partner has not told me his or her HIV status

Refuse to answer

82. Have you heard of barebacking?

Yes

No

Refuse to answer

83. Do you consider yourself to be a barebacker?

Yes……………………………………………………………………………….

No……………………………………………………………………….……….

Refuse to answer………………………………………………………………...



These next questions are about drug or alcohol use. Again, please remember that everything you tell us is confidential.



84. In the past 12 months, which of the following drugs or alcohol did you use? Do not include drugs that you have injected. (Check all that apply)



Alcohol



Ecstasy (E, X, MDMA)



GHB (G, GBL)



Heroin



Marijuana (pot)



Methamphetamines, other amphetamine (Crystal Meth, Speed, Tina)



Other hallucinogens (LSD, mushrooms, Peyote, or Mescaline)



PCP (Angel Dust, wet, wicky sticks)



Poppers (Amyl Nitrate)



Powdered Cocaine



Rock or Crack Cocaine



Rohypnol (Ruffies)



Special K (Katamine, K)



Tranquilizers, Barbiturates or recreational use of prescription drugs to get high (Codeine, Vicondin or Hydrocodone, Percocet, Darvon, Oxycontin or Oxycodone, Demoral, Dilaudid, Valium, Librium, Seconal, Xanax)



Viagra or similar drugs (Levitra, Cialis)

None



85. In the past 12 months, have you injected any illegal, illicit, or street drugs?

Yes

No (skip to 88)



86. In the past 30 days, on how many different days did you inject any drug? ___________



87. How many times in the past 12 months have you used a syringe after someone else had already used it?

No time

1 time

2 times

3-5 times

6-10 times

More than 10 times



Now please tell us how much you disagree or agree with the following statements about HIV treatments.


Strongly disagree

Disagree

Neither
agree nor disagree

Agree

Strongly Agree

Refuse to Answer

88. Because of new treatments for HIV, I think HIV-negative men are taking more sexual risks.

89. Because of new treatments for HIV, I’m more willing to have unprotected sex with someone who is HIV positive.

90. Because of new treatments for HIV, I’m less concerned about being infected by someone else.

VII. THEORETICAL CONSTRUCTS

Please tell us how much you disagree or agree with each of the following statements about your sexual relationships with other men.



Strongly disagree

Disagree

Neither
agree nor disagree

Agree

Strongly Agree

Refuse to Answer

91. Whenever I think a lot about being gay or bisexual, I feel proud.

92. Sometimes I wish I were heterosexual.

93. Whenever I think a lot about being gay or bisexual, I feel critical of myself.


Perceived Behavioral Control

94. If you wanted to get an HIV test at least every 12 months, how sure are you that you could?

Very sure I could not

Somewhat sure I could not

Slightly sure I could

Somewhat sure I could

Very sure I could



95. If you could find a free testing site, how sure are you that you could get tested for HIV at least every 12 months?

Very sure I could not

Somewhat sure I could not

Slightly sure I could

Somewhat sure I could

Very sure I could



96. If you had to travel far to find a free testing site, how sure are you that you could get tested for HIV at least every 12 months?

Very sure I could not

Somewhat sure I could not

Slightly sure I could

Somewhat sure I could

Very sure I could



97. If you could get the results of your HIV test within 20 minutes, how sure are you that you could get tested for HIV at least every 12 months?

Very sure I could not

Somewhat sure I could not

Slightly sure I could

Somewhat sure I could

Very sure I could



97. If you knew that your results would be kept confidential, how sure are you that you could get tested for HIV at least every 12 months?

Very sure I could not

Somewhat sure I could not

Slightly sure I could

Somewhat sure I could

Very sure I could

98. If you wanted to use a condom every time you have anal sex, how sure are you that you could?

Very sure I could not

Somewhat sure I could not

Slightly sure I could

Somewhat sure I could

Very sure I could



Perceived Social Norm

99. Most people who are important to me think I should get tested for HIV at least every 12 months. By important to me, we mean people like friends, family, and anyone else who is an important part of your life.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

100. Most of my sexual partners get tested for HIV at least every 12 months.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

101. Most Black gay men I know get tested for HIV at least every 12 months.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

102. Most Black gay men I know have been tested for HIV.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

103. Most people who are important to me think I should use a condom every time I have anal sex.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

104. Most Black gay men I know use a condom every time they have anal sex.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer


105. Tell me how risky you think each behavior is for getting HIV. Use a Scale where 0 is lowest risk and 100 is highest risk. Please assign any number in that range to each of the behaviors listed.

Deep kissing _____________

Receptive anal sex (“bottom”) with a condom _____________

Receptive anal sex (“bottom”) without a condom _____________

Mutual masturbation _____________

Receptive oral sex (“giving a blow job”) with a condom _____________

Receptive oral sex (“giving a blow job”) without a condom _____________

Insertive anal sex (“top”) with a condom _____________

Receptive anal sex (“top”) without a condom _____________

VIII. Understanding of HIV/AIDS Issues

The following questions ask about your understanding of HIV-related risk.

106. How would you rate your understanding of HIV prevention?

Poor

Fair

Good

Very good

Excellent

Refuse to answer

107. How would you rate your understanding of the risks of different behaviors for transmitting HIV?

Poor

Fair

Good

Very good

Excellent

Refuse to answer

108. Thinking about your sexual partner(s) and the sex you have had over the past 30 days, how would you rate your own risk of being infected with HIV during that time?

Very risky

Somewhat risky

Slightly risky

Undecided/not sure

Slightly safe

Somewhat safe

Very safe

Refuse to answer

IX. MasCULINE IDENTITY

109. I have little in common with most other males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

110. Men are confusing to me.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

111. I don’t feel connected with any group of males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

112. I don’t know of any particular group of males with whom I identify.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

113. I am not like most males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

114. I often wonder whether there are other men like myself.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

115. Basically I am different from my male friends.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

116. I find it difficult to describe who I am as a man.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

117. I don’t understand why men are the way they are.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

118. I believe there are no other males who think the way I do about things.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

119. I feel comfortable relating to different types of males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

120. I feel connected with various types of males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

121. I find differences in men interesting.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

122. I believe there is something wrong with guys who are different from me, my male friends, and other males like me.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

123. I understand differences in men.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

124. It does not matter to me whether my friends and I are all alike.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

125. I share a common bond with all males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

126. Although I feel most similar to some males, I am also similar to all males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

127. I am similar in many ways to all males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

128. Although males may differ in some ways, we are essentially all the same.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

129. I have much in common with most other males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

130. To some degree, I identify with all males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

131. I only feel connected with a certain group of males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

132. It is important that I share a particular commonality with a certain group of males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

133. Most of my social activities are centered around a particular group of male friends.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

134. I feel a common bond with my male friends, but not so much with other males.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

135. There are only certain types of males with whom I relate.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

136. My male friends and I all share the same perspective.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

137. Others might consider my friends and I a clique.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer



X. StiGMA

Sometimes people have negative experiences based upon how others react to race/ethnicity or sexual orientation. This next set of questions asks about some of those possible experiences.



Experiences Related to Your Race/Ethnicity



138. Have you EVER IN YOUR LIFE been made fun of, harassed, or called names because of your race or ethnicity?

Yes

No (Skip to Q140)

139. How often did this occur in the last 12 months? ____________ times

140. Have you EVER IN YOUR LIFE been verbally threatened because of your race or ethnicity?

Yes

No (Skip to Q142)

141. How often did this occur in the last 12 months? ____________ times

142. Have you EVER IN YOUR LIFE been physically threatened or attacked because of your race or ethnicity?

Yes

No (Skip to Q144)

143. How often did this occur in the last 12 months? ____________ times

144. Have you EVER IN YOUR LIFE been stopped or harassed by the police because of your race or ethnicity?

Yes

No (Skip to Q146)

145. How often did this occur in the last 12 months? _ __________ times

146. Overall, when you have been treated differently based on your race/ethnicity, how stressful have these experiences been for you?

Not at all

Somewhat

A moderate amount

Quite a bit

Refuse to answer


Experiences Related to Your Sexual Orientation

147. Have you EVER IN YOUR LIFE been made fun of, harassed, or called names (like "faggot") because of your sexual orientation?

Yes

No (Skip to Q149)

148. How often did this occur in the last 12 months? ___________ times

149. Have you EVER IN YOUR LIFE been verbally threatened because of your sexual orientation?

Yes

No (Skip to Q151)

150. How often did this occur in the last 12 months? ____________ times

151. Have you EVER IN YOUR LIFE been physically threatened or attacked because of your sexual orientation?

Yes

No (Skip to Q153)

152. How often did this occur in the last 12 months? ____________ times

153. Have you EVER IN YOUR LIFE been stopped or harassed by the police because of your sexual orientation?

Yes

No (Skip to Q155)

154. How often did this occur in the last 12 months? ____________ times

155. Have your family or friends EVER made fun of gay people in front of you?

Yes

No (Skip to Q158)

156. How often did this occur in the last 12 months? ____________ times

157. Overall, when you have been treated differently based on your sexual orientation, how stressful have these experiences been for you?

Not at all

Somewhat

A moderate amount

Quite a bit

Refuse to answer


Experiences in the Gay Community

158. Sexual partners have wanted me only because of my race or ethnicity; they pay no attention to other personal characteristics.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

159. I've been turned down for sex because of my race or ethnicity.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

160. I've been made to feel unwanted online because of my race or ethnicity.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

161. I've felt white gay men have acted as if they're better than me because of my race or ethnicity.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

162. I've felt ignored or invisible where white gay men hang out because of my race or ethnicity.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

163. I've felt that white gay men are uncomfortable around me because of my race or ethnicity.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

164. Overall, when you have been treated differently in the gay community due to your race/ethnicity, how stressful have these experiences been for you?

Not at all

Somewhat

A moderate amount

Quite a bit

Refuse to answer

165. How much have these experiences in the gay community influenced where you look for sexual partners?

Not at all

Somewhat

A moderate amount

Quite a bit

Refuse to answer

166. How much have these experiences in the gay community influenced who your sexual partners are?

Not at all

Somewhat

A moderate amount

Quite a bit

Refuse to answer


Experiences with Friends

167. Heterosexual/straight friends have appeared uncomfortable around me because of my sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

168. I have lost heterosexual/straight friends because of my sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

169. Heterosexual/straight friends have distanced themselves because of my sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

170. Overall, when these experiences with friends have occurred, how stressful have they been for you?

Not at all

Somewhat

A moderate amount

Quite a bit

Refuse to answer

Experiences with Family

171. At times, my parents have made it understood that a boyfriend or lover would not be welcome in their home.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

172. Family members have pressured me at different times to get married to a woman.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

173. Being open with my family about my sexual orientation has meant risking being cut out of their lives.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

174. At times, acting in a manly or masculine manner has felt important when I'm with my family.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

175. Overall, when these experiences with family have occurred, how stressful have they been for you?

Not at all

Somewhat

A moderate amount

Quite a bit

Refuse to answer



Please indicate how much you disagree or agree with each statement.

176. People with HIV/AIDS face a great deal of unfair discrimination or persecution from others.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

177. Even among men who have sex with men, there is discrimination against people with HIV.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

178. There is a split in the gay community between men who are HIV-negative and those who are positive.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer



179. I am concerned that if I were to turn out positive on a future HIV test, that I would be discriminated against by other men who have sex with men.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree



Dealing with Others’ Reactions to My Race/Ethnicity

180. I talk with friends to deal with racism and negative attitudes towards Blacks that I encounter.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

181. When I feel treated unfairly or discriminated against because of being Black, there are family members I can rely on to be there for me.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

182. My faith/spirituality gives me strength and comfort that helps to deal with others' racism.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

183. If I'm treated unfairly or disrespectfully due to my race/ethnicity, I speak up and challenge the person's actions or beliefs.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

184. I keep my life private as a way to avoid others' racism or negative attitudes about Blacks.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

185. When I hear others express racism or negative attitudes about Blacks, I just shrug it off.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

186. When others express racist attitudes or prejudices towards others of different ethnicities, I try to educate them.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

187. A way I deal with others' prejudice is by hanging out with persons of my race/ethnicity.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

188. I avoid race/ethnicity-based rejection at bars or clubs by using the Internet to hook up with other men.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

189. I avoid race/ethnicity-based rejection at bars or clubs by using phone lines to hook up with other men.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

190. When people get to know me as a person, it changes their prejudices or judgments about my race/ethnicity.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer



Dealing with Others’ Reactions to My Sexual Orientation

191. I talk with friends to deal with homophobia and negative reactions to my sexual orientation that I encounter.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

192. When I feel treated unfairly or discriminated against because of my sexual orientation, there are family members I can rely on to be there for me.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

193. My faith/spirituality gives me strength and comfort that helps to deal with others' homophobia and negative reactions to my sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

194. If I'm treated unfairly or disrespectfully due to my sexual orientation, I speak up and challenge the person's actions or beliefs.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

195. I keep my life private as a way to avoid others' negative attitudes or prejudices based on sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

196. When I hear others express negative attitudes or prejudices due to my sexual orientation, I just shrug it off.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

197. When others express negative attitudes about my sexual orientation, I try to educate them.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

198. I sometimes laugh at "fag" or "dyke" jokes to fit in with people I'm with.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

199. When heterosexual friends and/or family start talking about things like dating or relationships, I usually avoid participating.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

200. When a public figure, policy or law is discriminatory to gays, bisexuals and lesbians, I tell people what I think.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

201. Letting people get to know me as person is a good way to change their negative attitudes about my sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

202. I have had to pretend I'm straight in order to be accepted.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

203. I avoid actions, like holding hands with another man in public, that would reveal my sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

204. I sometimes talk about past or made-up relationships with women, while avoiding mention of relationships with men.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

205. When I'm asked about my sexual orientation, I usually answer in an honest and matter-of-fact way.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

206. I am very careful about who I let know about my sexual orientation.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer

207. When people express negative stereotypes about homosexuality, I try to explain to them that there are more similarities than differences between male-male and heterosexual relationships.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer



208. I openly confront others when I hear a homophobic remark or joke.

Strongly disagree

Disagree

Neither agree nor disagree

Agree

Strongly agree

Refuse to answer






END



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File Typeapplication/msword
File TitleConsumer Paper-and-Pencil Questionnaire
Authordqg7
Last Modified Bytfs4
File Modified2009-08-17
File Created2009-08-17

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