Form Approved
OMB No. 0920-0762
Expiration Date xx/xx/xxxx
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
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
How old are you?
________
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)
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………………………………………………………… ……..
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
Are you currently a college student?
Yes
No
Do you have a primary care doctor?
Yes
No
Do you have health insurance?
Yes (Skip 9)
No
How do you pay for your health care needs?
Self pay/cash
Go to free clinics
Other [Specify:_______________]
Skip 10
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: ____________________________]
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
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True |
False |
Don't know |
a. People can get HIV even though they had sex with only one person. |
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b. There is still no cure for HIV/AIDS. |
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c. You can tell that somebody has HIV just by looking at them. |
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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. |
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e. There is a test available to tell whether a person has HIV. |
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f. Treatment and support programs are available to people like me who might test positive for HIV. |
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g. People are automatically tested for HIV when they go to the doctor if their blood is drawn. |
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h. There are medications available to treat HIV |
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Strongly disagree |
Disagree |
Neither
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Agree |
Strongly agree |
a. HIV is not my problem. |
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b. There are medications available to treat HIV. |
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c. I don’t need to worry about getting HIV because I know everything about my partners. |
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d. HIV is not something I think about often. |
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e. Knowing my HIV status helps me take responsibility for myself. |
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f. Knowing my HIV status helps me take responsibility for others. |
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g. HIV is not a big problem in my community. |
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h. I should get tested for HIV because I may be at risk. |
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i. People need education to learn how to avoid getting HIV. |
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j. I am less likely than most people to get HIV. |
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k. HIV is a death sentence. |
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l. If I test positive for HIV my name will be reported to the government. |
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m. I am afraid to find out if I am HIV positive. |
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n. I don’t think about HIV a lot. |
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III. HIV Testing
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
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…
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Every
2 |
Every
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Every 7-12 months |
Every couple of years |
Don’t know |
Always have sex with a condom |
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Have had sex without a condom |
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Have a sex partner who is HIV positive |
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Have unprotected sex with a partner whose HIV status they don’t know |
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Have had more than one sex partner since their last HIV test |
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Exchange sex or money for drugs |
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Inject drugs |
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Have sex with a person who injects drugs |
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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?
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1 |
2 |
3 |
4 |
5 |
6 |
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Extremely bad |
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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?
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1 |
2 |
3 |
4 |
5 |
6 |
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Extremely bad |
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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?
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1 |
2 |
3 |
4 |
5 |
6 |
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Extremely harmful |
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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?
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1 |
2 |
3 |
4 |
5 |
6 |
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Extremely harmful |
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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.
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?
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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) |
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b. Whatstea (www.whatstea.com) |
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c. Walk4mewednesdays (www.walk4mewednesdays.com) |
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d. Keithpoykin (www.keithboykin.com) |
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e. Adam4Adam (www.Adam4Adam.com) |
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f. Gay (www.gay.com) |
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g. Rod 2.0 (http://rodonline.typepad.com) |
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h. Clay Cane (http://claycane.blogspot.com) |
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i. Facebook (www.facebook.com) |
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j. Myspace (www.myspace.com) |
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k. Other: [Specify:______________] |
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l. Other: [Specify:______________] |
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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
72. Indicate how much you trust each of the following sources of HIV information.
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Trust very much |
Trust somewhat |
Distrust somewhat |
Do not trust at all |
Refuse to answer |
My doctor, nurse, or health care professional |
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WebMD (Health website) |
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www.thebody.com |
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AIDS organization in my local community |
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Centers for Disease Control and Prevention (CDC) |
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A major university medical center |
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State or local health department |
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A local hospital or health care system |
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Other [Speciify:__________________]
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Other [Speciify:__________________]
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Other [Speciify:__________________]
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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.
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Years |
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Months |
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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.
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Strongly disagree |
Disagree |
Neither
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Agree |
Strongly Agree |
Refuse to Answer |
88. Because of new treatments for HIV, I think HIV-negative men are taking more sexual risks. |
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89. Because of new treatments for HIV, I’m more willing to have unprotected sex with someone who is HIV positive. |
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90. Because of new treatments for HIV, I’m less concerned about being infected by someone else. |
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Please tell us how much you disagree or agree with each of the following statements about your sexual relationships with other men.
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Strongly disagree |
Disagree |
Neither
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Agree |
Strongly Agree |
Refuse to Answer |
91. Whenever I think a lot about being gay or bisexual, I feel proud. |
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92. Sometimes I wish I were heterosexual. |
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93. Whenever I think a lot about being gay or bisexual, I feel critical of myself. |
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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 _____________
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
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
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
| File Type | application/msword |
| File Title | Consumer Paper-and-Pencil Questionnaire |
| Author | dqg7 |
| Last Modified By | tfs4 |
| File Modified | 2009-08-17 |
| File Created | 2009-08-17 |