Attachment I_Informed Consent_6_29_09

ATTACHMENT I

Informed Consent Form

NlAID HIV Vaccine Research Education Initiative

(NHVREI)

Informed Consent to Participate in a Key Influencer Focus Group

You are being asked to participate in a focus group about the National Institute of Allergy and Infectious Diseases (NIAID) HIV Vaccine Research Education Initiative (NHVREI). NIAID is part of the National Institutes of Health, a federal agency within the Department of Health and Human Services. The purpose of this focus group is to help NIAID improve its future educational activities and its understanding of public knowledge, attitudes, and behaviors related to HIV vaccine research.

We are with NOVA Research Company (NOVA). NOVA is an independent evaluator contracted by NIAID to evaluate NHVREI. The focus group will last about 1 hour. A trained person will lead it. Please ask the focus group leader any questions you might have before you agree to participate.

A focus group is an interview with a small group of people on a specific topic. In this group, we will ask you about your experiences and opinions of NHVREI. The information collected from people like you can help identify promising strategies for future HIV prevention education programs.

If everyone in the group agrees, the focus group will be recorded. Transcripts of this recording will be used by the evaluators to remember what was said in the group. We will keep the tapes in a locked cabinet. NIAID will retain ownership of all data collected. When these data are submitted to NIAID, no identifying information will appear.

NOVA will use transcripts to write a report of the group’s experiences and opinions. Your name or other identifying information will NOT be included in the transcripts or in this report. All data in reports will be in aggregate form with no links to individuals preserved.

We will keep what you say private unless we are required by law to disclose it. We will take extra steps to protect your privacy. Everyone in the focus group will be asked not to discuss any information shared by other members of this group with persons who were not part of the group.

You should not feel any physical discomfort from the focus group discussion. If you do not like or feel uncomfortable with any questions, you can choose not to answer them. You can stop participating in the focus group at any time. Participating in the focus group or interview does not cost you anything.

You have the right to have your identity protected. You will not be identified in any of the information reported or published. Your participation is voluntary. You are free to choose not to participate in the focus group. Choosing not to participate will in no way affect your relationship with NIAID, involvement with NHVREI, or your employer.

If you have any questions about this focus group, please contact one of the individuals below.

S. Lisbeth Jarama, PhD

Dan Eckstein

Address: NOVA Research Company

4600 East-West Highway, Suite 700

Bethesda, Maryland 20814

Telephone: 301-986-1891

To participate, please read and sign the form below. We will give you a copy of this signed form at your request.

SIGNATURES

By signing, you indicate that you have read this form and that you understand what you are consenting to and your rights as a research participant.

I agree to take part in a focus group about my experiences with NHVREI.

I consent to be audio-recorded during this focus group.

____Yes ____No (but I still want to be part of the focus group)

______________________ ___________________________ _____________

Participant’s Printed Name Participant’s Signature Date

Thank you for your time!

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