CROSS-SITE Baseline Assessment - PHMC

Development and Testing of an HIV Prevention Intervention Targeting Black Bisexually-Active Men

10BA_Att 3C_Baseline

CROSS-SITE Baseline Assessment - PHMC

OMB: 0920-0863

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Development and Testing of an HIV Prevention Intervention

Targeting Black Bisexually-Active Men








Attachment 3C


CROSS-SITE BASELINE INSTRUMENT and SITE SPECIFIC QUESTIONS


(Note: Same baseline instrument for all sites;

PHMC and Nova specific sections begin with yellow highlight.

CSU does not have site specific questions.))


Form Approved

OMB No. 0920-xxxx

Expiration Date:


Cross-Site Baseline Instrument

MULTI-SITE BASELINE


A. DEMOGRAPHICS


To begin the interview, I’d like to ask you some background questions. This lets us know something about the people who participate in the project. For the following questions, either check the appropriate box or fill in your answer in the spaces provided. Remember, your responses are will be kept private.


  1. What is your age? |_____|_____| years old



  1. What is your ethnicity?

Hispanic or Latino

Not Hispanic or Latino



3. What is your race? (Check all that apply)

American Indian or Alaska Native (skip next question)

Asian (skip next question)

Black or African American

Native Hawaiian or Other Pacific Islander (skip next question)

White

  1. How do you describe your African/Black cultural background? (Check ALL that apply)

African-American

Black Latino

Caribbean/West Indian

African immigrant

Other_______________________________________





5. Are you currently employed?

1 = Full time

2 = Part time/ Occasional

3 = Unemployed

4 = Retired

5 = Unable to work (disabled)



6. Are you currently a full time or part time student?

1 = Full time

2 = Part time

3 = Not a student




7. What has been your main source of income in the last 12 months?

Job you had Unemployment benefits

Veterans benefits Illegal or possibly illegal source

Welfare payment SSI/Disability

Spouse, partner, boyfriend/girlfriend Other family or friends

No income

Panhandling other



8. Thinking about the past 12 months, how much was your total income?

1 = Less than $5,000

2 = $5,000 - $9,999

3 = $10,000 - $19,999

4 = $20,000 - $29,999

5 = $30,000 - $39,999

6 = $40,000 - $49,999

7 = $50,000 - $59,999

8 = $60,000 or more


9. How many people other than yourself depend upon your income?

1 = 0

2 = 1

3 = 2

4 = 3

5 = 4 or more



10. How many children do you have? _________



11. How many of these children have you raised, are currently raising or helping to raise?



12. Are you married?

I am married to a woman

I am married to a man

I am not married



  1. Currently, who do you live with most of the time? (Check ALL that apply)

Alone

Parents

Friends

Other relatives

Partner, lover, or spouse

Your children

Other people not mentioned (please specify):__________________






14. What is the highest grade you have completed? (Check only one)

Less than eighth grade

More than eighth grade but did not complete High School

GED/High School Diploma

Tech School/Some college

College graduate or higher


  1. Do you think of yourself as…

1 = Heterosexual or "Straight"

2 = Homosexual or Gay or same gender loving

3 = Bisexual

4 = Unsure/ Questioning

5 = Other ______________________________

6 = None



16. What is the zip code of your current home or place where you stay? |_____|_____|_____|_____|___

777 Don’t Know



17. In the past 12 months, have ever spent one night without a regular place to stay? (a shelter, transitional housing facility, or a public or private place like a car or a park)

No Yes


  1. Do you consider yourself to be currently homeless?

No Yes




B. HIV AND STD TESTING/HISTORY AND PERCEIVED RISK



Now we would like to ask some questions about your health. There are several diseases or infections that can be transmitted during sex. These are sometimes called venereal diseases or sexually transmitted diseases. We will be using the term sexually transmitted disease or STD to refer to them in the next few questions. Although HIV is a sexually transmitted disease, we will be asking you about it in a different part of this survey.



1. In the past 12 months, were you told by a health care provider, such as a doctor or nurse that you had any of the following sexually transmitted diseases?



Gonorrhea 0 No 1 Yes

Syphilis 0 No 1 Yes

Genital herpes 0 No 1 Yes

Chlamydia 0 No 1 Yes

Genital Warts (also known as HPV or Human Papilloma Virus) 0 No 1 Yes

Hepatitis B virus 0 No 1 Yes

Hepatitis C virus 0 No 1 Yes

Some other STD, but not HIV (Please enter your answer here_____________) 0 No 1 Yes



2. When was the last time you had a check-up for STDs or were tested for STDs. Do not include an HIV test in this answer. Was it…



___Within the past 30 days

___2-3 months ago

___4-6 months ago

___7-12 months ago

___1-2 years ago

___3 or more years ago

___I have never had a check-up or been tested for STDs









You are now going to be asked some questions about your HIV status and about your experiences taking the HIV test. Please remember that this survey is kept private. It is for HIV-positive men as well as HIV-negative men.


3. Have you ever taken an HIV test?


___0 No (SKIP to….)

___1 Yes



4. How many times in your life have you taken an HIV test and gotten your test results? Do not count tests you have taken but did not get your results. Please estimate if you are not exactly sure.



__ __ __



5. When was your last HIV test? Please estimate if you are not exactly sure.


___ Within the past 30 days

___ 2-3 months ago

___ 4-6 months ago

___ 7-12 months ago

___ 1-2 years ago

___ 3 or more years ago

6. What was the result of your last HIV test? (Choose one)

___1 HIV-Negative (Do not have HIV) (skip next two questions.)

___2 HIV-Positive (Do have HIV) Skip to #8

___3 I did not get the result of my last test (go to next question)

___4 Inconclusive/Indeterminate (the result was neither positive or negative)



7. The last time you did get the results from an HIV test, what was your result? (Choose one) [Asked only of respondents who indicate answer choice 3 or 4 above]

___1 HIV-Negative (Do not have HIV)

___2 HIV-Positive (Do have HIV)

___3 Inconclusive/Indeterminate (the result was neither positive or negative)

___4 I have never gotten any HIV test results


8. What was the month and year that you first tested positive for HIV? Please estimate if you are not exactly sure.

__ __ / __ __ __ __ month year



If HIV-positive, skip to next section.



Perceived Risk for HIV


On a scale from 1 to 10, with 1 being extremely unlikely and 10 being extremely likely.


9. How likely is it that you are infected with HIV now? _____


10. How likely do you think it is that you will become infected with HIV in your lifetime? _____



Testing Intentions

11. How often do you plan to get tested in the future?

1. Every 3 months

2. Every 6 months

3. Once a year

4. Once every couple of years

5. I don’t plan to get tested in the future


C. NETWORK SIZE QUESTIONS


For the next set of questions, please think about all the men you know in [CITY].



1. Approximately, how many men who have sex with men in [CITY] do you know personally? That is, you know their name, who they are and how to contact them, they also know you and you have seen or talked to them in the last 6 months.



__ __ __ __

0000 zero (Skip to #4)

2. Of those [Response to 1] men, how many are Black?

__ __ __ __

0000 zero (Skip to #4)


3. Of those [Response to 2] Black men, how many have sex with women to the best of your knowledge?

__ __ __ __


4. Which of the following best describes the person who referred you to the study? (Choose best description)

1 Friend

2 Acquaintance

3 Current sexual partner

4 Former sexual partner

5 Relative

6 Co-worker

6 Study or agency staff person

7 Other:_______________

D. LACK of SUPPORT/ ALIENATION



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



1. There is no one I can talk to about the important decisions in my life.

1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree



2. I feel no one respects who I am.

1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree



3. No one really understands my most private worries and fears.

1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree



4. There is no one I can depend on to lend me $50 if I needed it for an emergency.

1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree


5. I often feel isolated and alone.

1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree


E. DISCLOSURE

The next few questions are about the people in your life who you may have told about your sexual relationships. Please answer the following questions as honestly as you can.



  1. Have you told at least one person that you have sex with men?



0 = No (SKIP to Question #3)

1 = Yes



2. Who have you told that you have sex with men? (Check all that apply)

A My mother or the woman who raised me

0 = No

1 = Yes

2 = Do not have that person in my life



B My father or the man who raised me

0 = No

1 = Yes

2 = Do not have that person in my life



C My brother(s) [If have more than one, we would like to know if you have told at least one of your brothers]

0 = No

1 = Yes

2 = Do not have that person in my life


D My sister(s) [[If have more than one, we would like to know if you have told at least one of your sisters]

0 = No

1 = Yes

2 = Do not have that person in my life


E My minister or priest

0 = No

1 = Yes

2 = Do not have that person in my life

F My doctor or medical provider

0 = No

1 = Yes

2 = Do not have that person in my life

3. About how many of your heterosexual/straight male friends know that you have sex with men?

1 = All

2 = More than half

3 = About half

4 = Less than half

5 = None


4. About how many of your heterosexual/straight female friends know that you have sex with men?

1 = All

2 = More than half

3 = About half

4 = Less than half

5 = None


For each of the following statements, mark the response that best indicates your experience. Please be as honest as possible in your responses.


1----------2----------3-----------4----------5----------6----------7

Disagree Neither agree Agree

Strongly or disagree Strongly



  1. I prefer to keep my sexual relationships rather private.

  1. I keep careful control over who knows about my sexual relationships with men.


  1. My sexual behavior is nobody's business.

  1. If you are not careful who you let know that you have sex with men, you can get very hurt.

  1. I think very carefully before I let someone know that I have sex with other men.


  1. My sexual orientation is a very personal and private matter.

F. IDENTITY/COMMUNITY AFFILIATION

The next few questions are about homosexual and bisexual men in the black community. Please indicate how strongly you agree or disagree with the following statements.



Integrated Race & Sexuality Scale (Scale limited to 4 items)

READ: Please indicate how strongly you agree or disagree with the following statements.

  1. Black homosexual and bisexual men contribute to black communities.

1 Strongly Disagree

2 Disagree

3 Mildly Disagree

4 Mildly Agree

5 Agree

6 Strongly Agree



  1. Both my race and my sexuality are important to who I am as a man.

1 Strongly Disagree

2 Disagree

3 Mildly Disagree

4 Mildly Agree

5 Agree

6 Strongly Agree



  1. Black homosexual and bisexual men can play an important role in Black families.

1 Strongly Disagree

2 Disagree

3 Mildly Disagree

4 Mildly Agree

5 Agree

6 Strongly Agree



  1. A Black man who has sex with men can still be a strong man.

1 Strongly Disagree

2 Disagree

3 Mildly Disagree

4 Mildly Agree

5 Agree

6 Strongly Agree






Community Attachment

We are interested in learning more about the people that you feel closest to. Please answer the following questions.



5. When you think about your closest male friends, are they mostly:

1. Gay/homosexual

2. Straight but mess around with guys

3. Bisexual

4. Heterosexual/Straight

5. No one group, my friends are sexually diverse



6. When you think about your closest female friends, are they mostly:

1. Lesbian/Homosexual

2. Straight

3. Bisexual

4. No one group, my friends are sexually diverse










G. SEXUAL RISK


1. In general, are you sexually attracted to …


1 Only men

2 Mostly men

3 Both men and women equally

4 Mostly women

5 Only women

6 Other (SPECIFY):

We would like to ask you about your sexual experiences with males, females and transgender persons. By transgender, we mean both male-to-female, that is, those who were born male but now identify as women or as transgender/transsexual and female-to-male that is, those who were born female but now identify as men or as transgender/transsexual. Please answer each of the following questions as accurately as possible. Remember that you may prefer not to answer any question.


Now, we would like to ask you about the people you have recently had sex with. For the following questions, we will ask you about oral, vaginal and anal sex. Oral sex refers to mouth on penis, vagina, or anus. Vaginal sex refers to penis in vagina. Anal sex refers to penis in butt or anus.


  1. How many women have you had sex with in the past 3 months? By sex we mean fingering, hand jobs, oral sex, vaginal sex, or anal sex?


  1. How many men have you had sex with in the past 3 months? By sex we mean jacking off, oral sex, or anal sex?


  1. How many male-to-female transgender women have you had sex with in the past 3 months? By sex we mean jacking off, oral sex, vaginal sex, anal sex?


For the following questions, we will ask you about your experiences with main partners. We define main partner as someone with whom you have a relationship in which there is both emotional and sexual involvement (e.g., boyfriend / girlfriend, husband / wife, partner, lover).


  1. How many main partners have you had since the age of 18? __

  1. How many of these main partners have been women?

2 How many of these main partners have been men?

3 How many of these main partners have been male-to-female transgender?


  1. In the future, do you see yourself being with main partners who are (mark all that apply).

  1. Women

  2. Men

  3. Male-to-female transgender

  4. Female-to-male transgender

  5. I do not see myself having main partners in the future





A. MAIN Male Partners



Please answer the following questions thinking about a ‘main’ male sex partner that you have had in the past 3 months. By a main partner, we mean someone you are in or have been in a relationship with like (sites provide examples).



1. During the past 3 months, how many main male partners have you had ?________



(IF JUST ONE MAIN MALE PARTNER)



1a. Please type the initials or nickname of your main male partner.


________ (MAIN MALE PARTNER 1 INITIALS)


(IF MORE THAN ONE MAIN PARTNER, READ)


1b. Please type the initials or nickname of your most recent main male partner.


________ (MAIN MALE PARTNER 1 INITIALS)


2. How long have you been sexually involved with MAIN MALE PARTNER 1?

(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)

Years_____

Months____

Weeks_____


3. During the time you were sexually involved with MAIN MALE PARTNER 1, did you have sex with anyone else?

1= Yes

2= No

8= Prefer not to answer


4. During the time you were sexually involved with MAIN MALE PARTNER 1, did he have sex with anyone else?

1= Yes

2= No

3= I do not know

8= Prefer not to answer


5. What is MAIN MALE PARTNER 1’s current HIV status?

1 = HIV-positive (He has HIV) (Skip to 5)

2 = HIV-negative (He does not have HIV) (Skip to 5)

3 = I do not know or not sure of his status

4 = Prefer not to answer


6. Could you tell me what you think his HIV status is? (Skip to 6)

1 = He has HIV

2 = He does not have HIV


7. How did you learn about his HIV status?

1 He told me directly

2 I guessed based on other things he has talked about

3 I guessed based on things I had seen in his home

4 Someone else told me

5 His physical appearance

6 We got tested together

7 I saw his test results

8 I went with him to get his test results

9 Other

8. Does he know your HIV status?

1. Yes

2. No

3. I don’t know


9. In the past 3 months, what types of sex did you engage in with (MAIN PARTNER 1)? Mark all that apply.

  1. Anal sex (topping or bottoming) (if NOT checked SKIP to non-main male partner section)

  2. Oral sex (sucking or getting sucked)

  3. Jacking off (SKIP to next section)

  4. We did not have sex


10. How many times in the past 3 months did you top (MAIN MALE PARTNER 1) (put your penis in his butt) WITHOUT a condom?_______

11. How many times in the past 3 months did you top (MAIN MALE PARTNER 1) WITH a condom?_______

12. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 1) (he put his penis in your butt) WITHOUT a condom?_______

13. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 1) WITH a condom?_______


(IF JUST ONE MAIN MALE PARTNER) Skip to next section.

(IF MORE THAN ONE MAIN PARTNER, READ) Please answer the following questions about your second to last main male partner.


Please type the initials or nickname of the other main male partner you have had in the past 3 months.


________ (MAIN MALE PARTNER 2 INITIALS)



14. How long have you been sexually involved with MAIN MALE PARTNER 2?

(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)

Years_____

Months____

Weeks_____


15. During the time you were sexually involved with MAIN MALE PARTNER 2, did you have sex with anyone else?

1= Yes

2= No

8= Prefer not to answer


16. During the time you were sexually involved with MAIN MALE PARTNER 2, did he have sex with anyone else?

1= Yes

2= No

3= I do not know

8= Prefer not to answer



17. What is MAIN MALE PARTNER 2’s current HIV status?

1 = HIV-positive (He has HIV) (Skip to 15)

2 = HIV-negative (He does not have HIV) (Skip to 15)

3 = I do not know or not sure of his status

4 = Prefer not to answer


18. Could you tell me what you think his HIV status is? (Skip to 16)

1 = He has HIV

2 = He does not have HIV


19. How did you learn about his HIV status?

1 He told me directly

2 I guessed based on other things he has talked about

3 I guessed based on things I had seen in his home

4 Someone else told me

5 His physical appearance

6 We got tested together

7 I saw his test results

8 I went with him to get his test results

9 Other

20. Does he know your HIV status?

1 Yes

2 No

3 I don’t know


21. In the past 3 months, what types of sex did you engage in with (MAIN MALE PARTNER 2)? Mark all that apply.

  1. Anal sex (topping or bottoming) (if NOT checked SKIP to next section)

  2. Oral sex (sucking or getting sucked)

  3. Jacking off

  4. We did not have sex

22. How many times in the past 3 months did you top (MAIN MALE PARTNER 2) WITHOUT a condom?_______

23. How many times in the past 3 months did you top (MAIN MALE PARTNER 2) WITH a condom?_______

24. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 2) WITHOUT a condom?_______

25. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 2) WITH a condom?_______

B. Non-Main Male Partners (not including main sex partners above)

[INTRO FOR MEN WITH BOTH MAIN AND NON-MAIN MALE PARTNERS] Now I am going to ask about sexual activities with men other than a main partner in the past 3 months. We will call these men non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.

1. How many non-main male sex partners did you have in the past 3 months?

  1. ________ (If ZERO SKIP to next applicable section)

[INTRO FOR MEN WITH NO MAIN PARTNERS] Now I am going to ask you about sexual activities with men other than main partners in the past 3 months. We will call them non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.

1a. How many male sex partners did you have in the past 3 months?

  1. ________ (If ZERO SKIP to female partner section)

2. How often were you high on drugs or alcohol when you had sex with these XX men in the past 3 months?

  1. Always

  2. Most of the time

  3. Half of the time

  4. A few times

  5. Never


Number of Non-Main Male Partners by HIV Status

You said that you had sex with XX non-main male sex partners in the past 3 months,

3. How many of these XX men were you unsure or did not know their HIV status?_______ (If ‘0’,SKIP questions about unknown status partners)

4. How many of these XX men did you believe were HIV-positive (had the virus that causes AIDS)? _______ (If ‘0’, SKIP questions about HIV positive partners)

5. How many of these XX men did you believe were HIV-negative (did NOT have the virus that causes AIDS)?_____ (If ‘0’, SKIP questions about HIV negative non-main partners)

Anal Sex with Unknown Status non-main male partners


6. How many of your (##) male non-main partners whose HIV status you did not know did you have anal sex with (topping or bottoming) in the past 3 months? ________ PARTNERS

7. How many times in the past 3 months did you top (put your penis in their butt) these (Q17##) partners without a condom? _______ TIMES

8. How many times in the past 3 months did you top these (##) partners with a condom? ­­­­­­_______TIMES

9. How many times in the past 3 months did you bottom (they put their penis in your butt) these (Q17##) partners without a condom? _______ TIMES

10. How many times in the past 3 months did you bottom these (Q17##) partners with a condom? _______ TIMES

Anal Sex with HIV-positive non-main male partners


11. How many of your ## HIV-positive male non-main partner(s) did you have anal sex with (topping or bottoming) in the past 3 months?________ PARTNERS

12. How many times in the past 3 months did you top (put your penis in their butt) these ## partners without a condom? _______ TIMES

13. How many times in the past 3 months did you top these ## partners with a condom? _______ TIMES

14. How many times in the past 3 months did you bottom (they put their penis in your butt) these ## partners without a condom? _______TIMES

15. How many times in the past 3 months did you bottom these ## partners with a condom?

_______ TIMES

Anal Sex with HIV-negative non-main male partners

16. How many of your (##) HIV-negative male non-main partner(s) did you have anal sex with (topping or bottoming) in the past 3 months?________

17. How many times in the past 3 months did you top (put your penis in their butt) these (Q7##) partners without a condom? _______

18. How many times in the past 3 months did you top these ## partners with a condom?

19. How many times in the past 3 months did you bottom (they put their penis in your butt) these ## partners without a condom? _______

20. How many times in the past 3 months did you bottom (they put their penis in your butt) these ## partners with a condom? _______

21. With how many of these XX (total non-main anal sex partners) men did you talk about your HIV status before having sex? _____



Exchange Sex with Male Partners

22. In the past 3 months have you given or received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex with a man?

1) Yes – PROCEED WITH EXCHANGE SEX QUESTIONS

2) No – SKIP TO FEMALE PARTER QUESTIONS

IF YES TO EXCHANGE SEX WITH MALES

22a. In the past 3 months, how many men have you given any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex?

___________ NUMBER OF PARTNERS HE PAID FOR SEX

22b. In the past 3 months, from how many men have you received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex?

___________ NUMBER OF PARTNERS WHO PAID HIM FOR SEX

22c. How many times in the past 3 months did a male partner pay you and you had anal sex WITHOUT a condom?______ TIMES HE WAS PAID FOR ANAL SEX WITHOUT CONDOM

22d. How many times in the past 3 months did a male partner pay you and you had anal sex WITH a condom?______ TIMES HE WAS PAID FOR ANAL SEX WITH CONDOM

22e. How many times in the past 3 months did you pay a male partner you had anal sex WITHOUT a condom?______ TIMES HE PAID FOR ANAL SEX WITHOUT CONDOM

22f. How many times in the past 3 months did you pay a male partner you had anal sex WITH a condom?______ TIMES HE PAID FOR ANAL SEX WITH CONDOM



C. MAIN Female Partners

Please answer the following questions thinking about a ‘main’ female sex partner that you have had in the past 3 months. By a main partner, we mean someone you are or have been in a relationship with like ‘your woman‘, girlfriend, or wife (sites provide examples).



  1. During the past 3 months, how many main female partners have you had?

________MAIN FEMALE PARTNERS



IF MORE THAN ONE MAIN FEMALE PARTNER, READ) Please answer the following questions about your most recent main female partner.


1a. Please type the initials or nickname of your most recent main female partner.


________ MAIN FEMALE PARTNER 1 INITIALS


2. How long have you been sexually involved with MAIN FEMALE PARTNER 1?

(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)

Years_____

Months____

Weeks_____


3. During the time you were sexually involved with MAIN FEMALE PARTNER 1, did you have sex with anyone else?

1= Yes

2= No

8= Prefer not to answer


4. During the time you were sexually involved with MAIN FEMALE PARTNER 1, did she have sex with anyone else?

1= Yes

2= No

3= I do not know

8= Prefer not to answer


5. What is MAIN FEMALE PARTNER 1’s current HIV status?

1 = HIV-positive (She has HIV) (Skip to 5)

2 = HIV-negative (She does not have HIV) (Skip to 5)

3 = I do not know or not sure of her status

4 = Prefer not to answer


6. Could you tell me what you think her HIV status is? (Skip to 6)

1 = She has HIV

2 = She does not have HIV


7. How did you learn about her HIV status?

1 She told me directly

2 I guessed based on other things she has talked about

3 I guessed based on things I had seen in her home

4 Someone else told me

5 Her physical appearance

6 We got tested together

7 I saw her test results

8 I went with her to get his test results

9 Other

8. Does she know your HIV status?

1 Yes

2 No

3 I don’t know


9. In the past 3 months, what types of sex did you engage in with MAIN FEMALE PARTNER 1? Mark all that apply.

  1. Vaginal or anal sex (if not marked, SKIP to non-main female partners’ section)

  2. Oral sex or going down/ getting sucked

  3. Fingering her/getting a hand job / masturbating

  4. We did not have sex


Vaginal Sex and Condom Use with Main Female Partner 1


10. How many times in the past 3 months did you have vaginal sex (penis in vagina) with MAIN FEMALE PARTNER 1 WITHOUT a condom?_______


11. How many times in the past 3 months did you have vaginal sex with MAIN FEMALE PARTNER 1 WITH a condom?_______


Anal Sex and Condom Use with Main Female Partner 1


12. How many times in the past 3 months did you have anal sex (penis in the butt) with MAIN FEMALE PARTNER 1 WITHOUT a condom?_______


13. How many times in the past 3 months did you have anal sex with MAIN FEMALE PARTNER 1 WITH a condom?_______


14. Does MAIN FEMALE PARTNER 1 know that you have ever had sex with men?

1=Yes

2=No


15. Does MAIN FEMALE PARTNER know that you had sex with a man in the past year?

1=Yes

2=No



(IF JUST ONE MAIN FEMALE PARTNER) Skip to non-main female partner section.



(IF MORE THAN ONE MAIN FEMALE PARTNER, READ) Please answer the following questions about your second-to-last main female partner.


Please type the initials or nickname of another main female partner you have had in the past 3 months.


________ (MAIN FEMALE PARTNER 2 INITIALS)


16. How long have you been sexually involved with MAIN FEMALE PARTNER 1?

(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)

Years_____

Months____

Weeks_____


17. During the time you were sexually involved with MAIN FEMALE PARTNER 2, did you have sex with anyone else?

1= Yes

2= No

8= Prefer not to answer


18. During the time you were sexually involved with MAIN FEMALE PARTNER 2, did she have sex with anyone else?

1= Yes

2= No

3= I do not know

8= Prefer not to answer


19. What is MAIN FEMALE PARTNER 2’s current HIV status?

1 = HIV-positive (She has HIV) (Skip to 17)

2 = HIV-negative (She does not have HIV) (Skip to 17)

3 = I do not know or not sure of her status

4 = Prefer not to answer


20. Could you tell me what you think her HIV status is? (Skip to 18)

1 = She has HIV

2 = She does not have HIV


21. How did you learn about her HIV status?

1 She told me directly

2 I guessed based on other things she has talked about

3 I guessed based on things I had seen in her home

4 Someone else told me

5 Her physical appearance

6 We got tested together

7 I saw her test results

8 I went with her to get his test results

9 Other

22. Does she know your HIV status?

1 Yes

2 No

3 I don’t know

23. In the past 3 months, what types of sex did you engage in with FEMALE MAIN PARTNER 2?

Mark all that apply.

  1. Vaginal or anal sex (fucking) (if not marked, SKIP to non-main female partners’ section)

  2. Oral sex or going down/ getting sucked

  3. Fingering her/ getting a hand job / masturbating

  4. We did not have sex


Vaginal Sex and Condom Use with Female Main Partner 2


24. How many times in the past 3 months did you have vaginal sex (penis in vagina) with FEMALE MAIN PARTNER 2 WITHOUT a condom?_______ TIMES


25. How many times in the past 3 months did you have vaginal sex with FEMALE MAIN PARTNER 2 WITH a condom?_______ TIMES


Anal Sex and Condom Use with Female Main Partner 2


26. How many times in the past 3 months did you have anal sex (penis in the butt) with FEMALE MAIN PARTNER 2 WITHOUT a condom?_______ TIMES


27. How many times in the past 3 months did you have anal sex with FEMALE MAIN PARTNER 2 WITH a condom?_______ TIMES


28. Does FEMALE MAIN PARTNER 2 know that you have ever had sex with men?

1=Yes

2=No


29. Does FEMALE MAIN PARTNER 2 know that you had sex with a man in the past year?

1=Yes

2=No




D. Non-Main Female Partners

[INTRO FOR MEN WITH BOTH MAIN AND NON-MAIN FEMALE PARTNERS] Now I am going to ask about sexual activities with women other than your main partner in the past 3 months. We will call these non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.


1. How many non-main female sex partners did you have in the past 3 months?

______ NUMBER OF NON-MAIN FEMALE PARTNERS

(If ZERO SKIP to TRANSGENDER section)



[INTRO FOR MEN WITH NON-MAIN FEMALE PARTNERS ONLY] Now I am going to ask about sexual activities with women other than main partners in the past three months. We will call them non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.


2. How many non-main female sex partners did you have in the past 3 months?

______ NUMBER OF NON-MAIN FEMALE PARTNERS

(If ZERO SKIP to TRANSGENDER section)

3. How often were you high on drugs or alcohol when you had sex with these XX female partner(s) in the past 3 months?

  1. Always

  2. Most of the time

  3. Half of the time

  4. A few times

  5. Never

4. Did any of these XX female partners know that you have ever had sex with men?

1=Yes

2=No


5. Did any of these XX female partners know that you had sex with a man in the past year?

1=Yes

2=No


Number of Non-Main Female Partners and HIV Status


6. How many of your XX non-main female sex partners in the past 3 months were you unsure/ did not know their HIV status?_______ (If ‘0’, SKIP questions 23-29) NOTE: We will call these unknown status partners.


7. How many of your XX non-main female sex partners in the past 3 months did you believe were HIV-positive (had the virus that causes AIDS)? _______ (If ‘0’, SKIP questions 16-22)


8. How many of your XX non-main female sex partners in the past 3 months did you believe were HIV-negative (did NOT have the virus that causes AIDS)?_____ (If ‘0’, SKIP questions 9-15)


Vaginal and Anal Sex with Unknown Status non-main male partners


9. How many of your (##) female non-main partner(s) whose status you did not know did you have vaginal or anal sex with in the past 3 months? ________ PARTNERS

10. How many times in the past 3 months did you have vaginal sex with these (##) partners without a condom? _______TIMES

11. How many times in the past 3 months did you have vaginal sex with these ## partners with a condom? ______TIMES

12. How many times in the past 3 months did you have anal sex with these ## partners without a condom? _______TIMES

13. How many times in the past 3 months did you have anal sex with these ## partners with a condom? _______TIMES


Vaginal and anal Sex with HIV-positive non-main female partners


14. How many of your (##) HIV-positive female non-main partner(s) did you have vaginal or anal sex with in the past 3 months? ________ PARTNERS

15. How many times in the past 3 months did you have vaginal sex with these (Q7##) partners without a condom? _______TIMES

16. How many times in the past 3 months did you have vaginal sex with these ## partners with a condom? ______TIMES

17. How many times in the past 3 months did you have anal sex with these ## partners without a condom? _______TIMES

18. How many times in the past 3 months did you have anal sex with these ## partners with a condom? _______TIMES

Vaginal and Anal Sex with HIV-negative non-main female partners

19. How many of your (##) HIV-negative female non-main partner(s) did you have vaginal or anal sex with in the past 3 months?________ PARTNERS

20. How many times in the past 3 months did you have vaginal sex with these (Q7##) partners without a condom? _______TIMES

21. How many times in the past 3 months did you have vaginal sex with these ## partners with a condom? ______TIMES

22. How many times in the past 3 months did you have anal sex with these ## partners without a condom? _______TIMES

23. How many times in the past 3 months did you have anal sex with these ## partners with a condom? _______TIMES

24. With how many of these XX (total non-main vaginal and anal female sex partners) women did you talk about your HIV status before having sex? _____


EXCHANGE SEX

25. In the past 3 months, have you given or received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex with woman?

1) Yes

2) No (skip to next applicable section)

25a. In the past 3 months, how many women have you given any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex? ___________

25b. In the past 3 months, from how many women have you received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex? ___________

25c. How many times in the past 3 months did a woman pay you and you had vaginal sex WITHOUT a condom?______

25d. How many times in the past 3 months did a woman pay you and you had vaginal sex WITH a condom?______

25e. How many times in the past 3 months did you pay a woman you had anal sex WITHOUT a condom?______

25f. How many times in the past 3 months did you pay a woman you had anal sex WITH a condom?

______





E. Main Transgender Partners

Please answer the following questions thinking about a ‘main’ transgender sex partner that you have had in the past 3 months. By a main partner, we mean someone you are or have been in a relationship with like (sites provide examples).



1. During the past 3 months, how many main transgender women partners have you had? ________



(IF MORE THAN ONE MAIN TRANSGENDER PARTNER, READ) Please answer the following questions about your most recent main transgender partner.


Please type the initials or nickname of your most recent main transgender partner


__________ (MAIN TRANSGENDER PARTNER 1 INITIALS)



2. How long have you been sexually involved with MAIN TRANSGENDER PARTNER 1?

(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)

Years_____

Months____

Weeks_____


3. During the time you were sexually involved with MAIN TRANSGENDER PARTNER 1, did you have sex with anyone else?

1= Yes

2= No

8= Prefer not to answer


4. During the time you were sexually involved with MAIN TRANSGENDER PARTNER 1, did she have sex with anyone else?

1= Yes

2= No

3= I do not know

8= Prefer not to answer


5. What is MAIN TRANSGENDER PARTNER 1’s current HIV status?

1 = HIV-positive (She has HIV) (Skip to 5)

2 = HIV-negative (She does not have HIV) (Skip to 5)

3 = I do not know or not sure of her status

4 = Prefer not to answer


6. Could you tell me what you think her HIV status is? (Skip to 6)

1 = She has HIV

2 = She does not have HIV


7. How did you learn about her HIV status?

1 She told me directly

2 I guessed based on other things she has talked about

3 I guessed based on things I had seen in her home

4 Someone else told me

5 Her physical appearance

6 We got tested together

7 I saw her test results

8 I went with her to get his test results

9 Other

8. Does she know your HIV status?

1 Yes

2 No

3 I don’t know


9. In the past 3 months, what types of sex did you engage in with MAIN TRANSGENDER PARTNER 1? Mark all that apply.

  1. Vaginal or anal sex (fucking) (if NOT checked SKIP to next section)

  2. Oral sex or sucking or getting sucked

  3. Jacking off/ fingering/getting a hand job

  4. We did not have sex.


10. How many times in the past 3 months did you put your penis in the vagina or butt of MAIN TRANSGENDER PARTNER 1WITHOUT a condom?_______


11. How many times in the past 3 months did you put your penis in the vagina or butt of MAIN TRANSGENDER PARTNER 1WITH a condom?_______



(IF JUST ONE MAIN PARTNER) Skip to next section.


(IF MORE THAN ONE MAIN TRANSGENDER PARTNER)

Please type the initials or nickname of another main transgender partner you have had in the past 3 months.


(MAIN TRANSGENDER PARTNER 2 INITIALS)


12. How long have you been sexually involved with MAIN TRANSGENDER PARTNER 2?

(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)

Years_____

Months____

Weeks_____


13. During the time you were sexually involved with MAIN MALE PARTNER 2, did you have sex with anyone else?

1= Yes

2= No

8= Prefer not to answer


14. During the time you were sexually involved with MAIN MALE PARTNER 2, did he have sex with anyone else?

1= Yes

2= No

3= I do not know

8= Prefer not to answer



15. What is MAIN TRANSGENDER PARTNER 2’s current HIV status?

1 = HIV-positive (She has HIV) (Skip to 13)

2 = HIV-negative (She does not have HIV) (Skip to 13)

3 = I do not know or not sure of her status

4 = Prefer not to answer


16. Could you tell me what you think her HIV status is? (Skip to 14)

1 = She has HIV

2 = She does not have HIV


17. How did you learn about her HIV status?

1 She told me directly

2 I guessed based on other things she has talked about

3 I guessed based on things I had seen in her home

4 Someone else told me

5 Her physical appearance

6 We got tested together

7 I saw her test results

8 I went with her to get his test results

9 Other

18. Does she know your HIV status?

1 Yes

2 No

3 I don’t know

19. In the past 3 months, what types of sex did you engage in with TRANSGENDER PARTNER 2? Mark all that apply.

  1. Vaginal or anal sex (fucking) (if NOT checked SKIP to next section)

  2. Oral sex or sucking or getting sucked

  3. Jacking off/ fingering/getting a hand job

  4. We did not have sex.


20. How many times in the past 3 months did you put your penis in the vagina or butt of TRANSGENDER PARTNER 2WITHOUT a condom?_______


21. How many times in the past 3 months did you put your penis in the vagina or butt of TRANSGENDER PARTNER 2 WITH a condom?_______


F. Other Transgender Partners (not including main sex partners above)

[INTRO FOR MEN WITH MAIN AND NON-MAIN TRANSGENDER PARTNERS] Now I am going to ask about sexual activities with transgender partners other than your main partner in the past 3 months. We will call these non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.

1. How many non-main transgender sex partners did you have in the past 3 months?

__________ (IF ZERO SKIP to next applicable section)

[INTRO FOR MEN WITH NON-MAIN TRANSGENDERPARTNERS ONLY] Now I am going to ask you about sexual activities with non-main transgender partners in the past 3 months. We realize that some of the questions are very personal. The answers that you give will be kept private.

1a. How many non-main transgender sex partners did you have in the past 3 months?

__________ (IF ZERO SKIP to next applicable section)

2. How often were you high on drugs or alcohol when you had sex with these XX non-main transgender partner(s) in the past 3 months?

  1. Always

  2. Most of the time

  3. Half of the time

  4. A few times

  5. Never

3. How many of these ## non-main transgender sex partners in the past 3 months did you believe were HIV-negative (did NOT have the virus that causes AIDS)?_____ (If ‘0’, SKIP questions 9-14)

4. How many of your non-main transgender sex partners in the past 3 months did you believe were HIV-positive (had the virus that causes AIDS)? _______ (If ‘0’, SKIP questions 15-20)

5. How many of your non-main transgender sex partners in the past 3 months were you unsure about/ did not know their HIV status?_______ (If ‘0’, SKIP questions 21-26) NOTE: We will call these unknown status partners.


HIV-negative transgender partners


6. Thinking about your NN HIV-negative non-main transgender partner(s), how many in the past 3 months did you have vaginal sex (penis in vagina) or anal sex (penis in butt) with?________

7. Thinking about your NX HIV-negative non-main transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITHOUT a condom?_______

8. Thinking about your NX HIV-negative non-main transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITH a condom?_______



HIV-positive transgender partners


9. Thinking about your PP HIV-negative transgender partner(s), how many in the past 3 months did you have vaginal sex (penis in vagina) or anal sex (penis in butt) with?________

10. Thinking about your PX HIV-positive transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITHOUT a condom?_______

11. Thinking about your PX HIV-positive transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITH a condom?_______


HIV-unknown transgender partners


12. Thinking about your UU unknown status transgender partner(s), how many in the past 3 months did you have vaginal sex (penis in vagina) or anal sex (penis in butt) with?________

13. Thinking about your UU HIV-unknown transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITHOUT a condom?_______

14. Thinking about your UU HIV-unknown transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITH a condom?_______


15. With how many of these XX (total non-main vaginal and anal sex partners) transgender partners did you talk about your HIV status before having sex? _____



EXCHANGE SEX

16. In the past 3 months, have you given or received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex with a transgender woman?

1) Yes

2) No (skip to next applicable section)

16a. In the past 3 months, how many transgender partners have you given any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex? ___________

16b. In the past 3 months, from how many transgender partners have you received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex?___________

16c. How many times in the past 3 months did a transgender partner pay you and you had vaginal sex WITHOUT a condom?______

16d. How many times in the past 3 months did a transgender partner pay you and you had vaginal sex WITH a condom?______

16e. How many times in the past 3 months did you pay a transgender partner and you had anal sex WITHOUT a condom?______

16f. How many times in the past 3 months did you pay a transgender partner and you had anal sex WITH a condom? ______









H. PARTNER CHARACTERISTICS



A. Main Male Partner

Please answer the following questions about male partners in the past 12 months. We will first ask you questions about your most recent main male partner (MAIN MALE 1).


1. What is the race/ ethnicity of MAIN MALE PARTNER 1? (Check all that apply)


American Indian or Alaska Native

Asian

Black or African American

Hispanic/Latino

Native Hawaiian or Other Pacific Islander

White


2. How many years older or younger than you is MAIN MALE PARTNER 1?


1= More than 10 years older

2= 5-10 years older

3= 2-4 years older

4= About the same age as me (<2 years older or younger)

5= 2-4 years younger

6= 5-10 years younger

7= More than 10 years younger


3. What was/is your relationship with MAIN MALE PARTNER 1? (Choose one)


1= Someone you are/were in love with

2= Someone you know/knew well, but were not in love with

3= Someone you know/knew, but not well

4= Someone you just met (SKIP to 10)


4. As far as you know, would MAIN MALE PARTNER 1 describe himself as….


1= Straight

2= Gay

3= Bisexual

4= Other_____________

5= None

8=Prefer not to answer


5. As far as you know, is MAIN MALE PARTNER 1 sexually active with…


1= Men only (SKIP to 9)

2= Men and women

3= Women only

4= I do not know

8= Prefer not to answer



6. Has MAIN MALE PARTNER 1 told his female partner(s) about his sexual behavior with other men?


1= Yes

2= No

3= I do not know

8= Prefer not to answer



7. What did you do sexually with MAIN MALE PARTNER the last time you had sex with him in the past 12 months? (Check all that apply)


  1. Had anal sex with a condom

  2. Had anal sex without a condom

  3. Had oral sex



8. During the past 12 months, how often (do/ did) either you or MAIN MALE PARTNER1 use drugs to get high or intoxicated before or during anal sex with one another?


1= Always

2= Almost always

3= Sometimes

4= Rarely

5= Never


9. How often did you use a condom when you had anal sex with MAIN MALE PARTNER 1 in the past 12 months?


1= Always

2= Almost always

3= Sometimes

4= Rarely

5= Never


10. What do you think is the likelihood that you could have given MAIN MALE PARTNER 1 a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely



11. What do you think is the likelihood that MAIN MALE PARTNER 1 could have given you a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely



B. Non-main Male Partner


1. Please type the initials or nickname of your last non-main male partner?


________ (NON-MAIN MALE PARTNER 1)




2. What is the race/ ethnicity of NON-MAIN MALE PARTNER 1? (Check all that apply)


American Indian or Alaska Native

Asian

Black or African American

Hispanic/Latino

Native Hawaiian or Other Pacific Islander

White


3. How many years older or younger than you is NON-MAIN MALE PARTNER 1?


1= More than 10 years older

2= 5-10 years older

3= 2-4 years older

4= About the same age as me (<2 years older or younger)

5= 2-4 years younger

6= 5-10 years younger

7= More than 10 years younger


4. What was/is your relationship with NON-MAIN MALE PARTNER 1? (Choose one)


1= Someone you are/were in love with

2= Someone you know/knew well, but were not in love with

3= Someone you know/knew, but not well

4= Someone you just met (SKIP to 25)

5= Someone you paid to have sex (SKIP to 25)

6= Someone who paid you to have sex (SKIP to 25)


5. As far as you know, would NON-MAIN MALE PARTNER 1 describe himself as….


1= Straight

2= Gay

3= Bisexual

4= Other_____________

5= None

8=Prefer not to answer


6. As far as you know, is NON-MAIN MALE PARTNER 1 sexually active with…


1= Men only (SKIP to 24)

2= Men and women

3= Women only

4= I do not know

8= Prefer not to answer


7. Has NON-MAIN MALE PARTNER 1 told his female partner(s) about his sexual behavior with other men?


1= Yes

2= No

3= I do not know

8= Prefer not to answer


8. What did you do sexually with NON-MAIN MALE PARTNER 1 the last time you had sex with him in the past 12 months? (Check all that apply)

  1. Had anal sex with a condom

  2. Had anal sex without a condom

  3. Had oral sex


9. During the past 12 months, how often (do/ did) either you or NON-MAIN MALE PARTNER 1 use drugs to get high or intoxicated before or during anal sex with one another?


1= Always

2= Almost always

3= Sometimes

4= A few times

5= Never


10. How often did you use a condom when you had anal sex with NON-MAIN MALE PARTNER in the past 12 months?


1= Always

2= Almost always

3= Sometimes

4= A few times

5= Never


12. What do you think is the likelihood that you could have given NON-MAIN MALE PARTNER 1 a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely


13. What do you think is the likelihood that NON-MAIN MALE PARTNER 1 could have given you a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely


C. Main Female Partner


Please answer the following questions about female partners in the past 12 months. We will ask you separate questions about MAIN FEMALE 1 and your last non-main female sexual partner.


1. What is the race/ethnicity of MAIN FEMALE PARTNER 1? (Check all that apply)


American Indian or Alaska Native

Asian

Black or African American

Hispanic/Latina

Native Hawaiian or Other Pacific Islander

White


2. How many years older or younger than you is MAIN FEMALE PARTNER 1?


1= More than 10 years older

2= 5-10 years older

3= 2-4 years older

4= About the same age as me (<2 years older or younger)

5= 2-4 years younger

6= 5-10 years younger

7= More than 10 years younger


3. What was/is your relationship with MAIN FEMALE PARTNER 1? (Choose one)


1= Someone you are/were in love with

2= Someone you know/knew well, but were not in love with

3= Someone you know/knew, but not well

4= Someone you just met (SKIP to 7)



4. What did you do sexually with MAIN FEMALE PARTNER 1 the last time you had sex with her in the past 12 months? (Choose all that apply)


    1. Had vaginal sex with a condom

    2. Had vaginal sex without a condom

    3. Had anal sex with a condom

    4. Had anal sex without a condom

    5. Had oral sex




5. During the past 12 months, how often (do/ did) either you or MAIN FEMALE PARTNER 1 use drugs to get high or intoxicated before or during sex with each other?


1= Always

2= Almost always

3= Sometimes

4= Rarely

5= Never



6. How often did you use a condom when you had vaginal or anal sex with MAIN FEMALE PARTNER 1 in the past 12 months?


1= Always

2= Almost always

3= Sometimes

4= Rarely

5= Never


7. What do you think is the likelihood that you could have given MAIN FEMALE PARTNER 1 a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely


8. What do you think is the likelihood that MAIN FEMALE PARTNER 1 could have given you a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely


9. Did/does MAIN FEMALE PARTNER 1 know that you have had sex with men in the past 12 months?


1= Yes

2= No

8= Prefer not to answer



D. Non-main Female Partner


1. Please type the initials or nickname of your last non-main female partner?


________ (NON-MAIN FEMALE PARTNER 1)



2. What is the race/ ethnicity of NON-MAIN FEMALE PARTNER 1? (Check all that apply)


American Indian or Alaska Native

Asian

Black or African American

Hispanic/Latina

Native Hawaiian or Other Pacific Islander

White


3. How many years older or younger than you is NON-MAIN FEMALE PARTNER 1?


1= More than 10 years older

2= 5-10 years older

3= 2-4 years older

4= About the same age as me (<2 years older or younger)

5= 2-4 years younger

6= 5-10 years younger

7= More than 10 years younger


4. What was/is your relationship with NON-MAIN FEMALE PARTNER 1? (Choose one)


1= Someone you are/were in love with

2= Someone you know/knew well, but were not in love with

3= Someone you know/knew, but not well

4= Someone you just met (SKIP to 20)

5= Someone you paid to have sex (SKIP to 20)

6= Someone who paid you to have sex (SKIP to 20)


5. What did you do sexually with NON-MAIN FEMALE PARTNER 1 the last time you had sex with her in the past 12 months? (Check all that apply)

  1. Had vaginal sex with a condom

  2. Had vaginal sex without a condom

  3. Had anal sex with a condom

  4. Had anal sex without a condom

  5. Had oral sex


6. During the past 12 months, how often (do/ did) either you or NON-MAIN FEMALE PARTNER 1 use drugs to get high or intoxicated before or during sex with each other?


1= Always

2= Almost always

3= Sometimes

4= Rarely

5= Never


7. How often did you use a condom when you had vaginal or anal sex with NON-MAIN FEMALE PARTNER 1 in the past 12 months?


1= Always

2= Almost always

3= Sometimes

4= Rarely

5= Never


8. What do you think is the likelihood that you could have given NON-MAIN FEMALE PARTNER 1 a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely


9. What do you think is the likelihood that NON-MAIN FEMALE PARTNER 1 could have given you a sexually transmitted disease in the past 12 months?


1= Very unlikely

2= Unlikely

3= Likely

4= Very likely


10. Did/does NON-MAIN FEMALE PARTNER 1 know that you have had sex with men in the past 12 months?


1= Yes

2= No

8= Prefer not to answer



I. MENTAL HEALTH



I am going to show you a list of problems and complaints that people sometimes have. For each one, tell me how much that problem has bothered or distressed you during the past week, including today. Please tell me whether each problem has bothered you not at all, a little bit, moderately, quite a bit, or extremely.



HOW OFTEN DO YOU EXPERIENCE . . .



1. Faintness or dizziness? (Choose one)

1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

2. Feeling no interest in things? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

3. Nervousness or shakiness inside? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer



4. Pains in heart or chest? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer



5. Feeling lonely? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

6. Feeling tense or keyed up? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

7. Nausea or upset stomach? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

8. Feeling blue or sad? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

9 Not Applicable

9. Being suddenly scared for no reason? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

10. Trouble getting your breath? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

11. Having urges to beat, injure, or harm someone? (Choose one)

1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

8 Prefer not to answer

12. Having urges to break or smash things? (Choose one)

1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

8 Prefer not to answer



13. Feelings of worthlessness? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

14. Episodes of terror or panic? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

15. Numbness or tingling in parts of your body? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

16. Feeling hopeless about the future? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

17. Feeling so restless that you could not sit still? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

18. Feeling weak in parts of your body? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

19. Thoughts of ending your life? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer

20. Feeling fearful? (Choose one) 1 Not At All

2 A Little Bit

3 Moderately

4 Quite A Bit

5 Extremely

8 Refuse to Answer



Hostility Items

21. Feeling easily annoyed or irritated (Choose one)

1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

8 Prefer not to answer



22. ..temper outbursts that you could not control? (Choose one)

1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

8 Prefer not to answer

5 Extremely

8 Prefer not to answer

23. ....having urges to beat, injure, or harm someone? (Choose one)

1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

8 Prefer not to answer

24. ...having urges to break or smash things? (Choose one)

1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

8 Prefer not to answer

25. ...getting into frequent arguments? (Choose one)1 Not at all

2 A little bit

3 Moderately

4 Quite a bit

5 Extremely

8 Prefer not to answer



J. TRAUMA HISTORY


These next questions are about terrible or frightening things that sometimes happen to people.

Please answer yes or no to each of the following questions.


0 = No

1 = Yes

8 = Prefer not to answer


General Disaster and Trauma


  1. Has someone ever used force or threats to rob or attempt to rob you?    

                                           

  1. Have you ever seen someone seriously injured or killed?                                                                      


  1. Have you ever had a close friend or family member who was murdered?                                  


  1. Have you ever had a spouse, romantic partner, or child die?              


  1. Have you ever had a serious or life-threatening illness (other than HIV)? 



  1. Have you ever received news of a serious injury, life-threatening illness or unexpected death of someone close to you?


  1. Have you ever had to engage in combat while in military service in an official or unofficial war zone?


Physical and Sexual Experiences

                                                                                                                       

  1. Has anyone ever made you have oral, anal or vaginal sex against your will?


  1. How old were you the first time this happened?

                                        

  1. Has anyone ever touched private parts of your body or made you touch theirs, under force or threat?      


  1. How old were you the first time this happened?

                    

  1. Before you turned 16, did you ever have oral, anal, or vaginal sex with someone who was 5 or more years older than you?


  1. What was the sex of this person or persons?

  1. Male

  2. Female


  1. When you were 16 or 17 years old, did you ever have oral, anal, or vaginal sex with someone who was 10 or more years older than you?


  1. What was the sex of this person or persons?

  1. Male

  2. Female



  1. Has anyone ever attacked you with a gun, knife or some other weapon?                  


  1. Has anyone ever attacked you without a weapon and seriously injured you?                               


  1. Has anyone in your family ever beaten, "spanked" or pushed you hard enough to cause injury?                            



K. INTIMATE PARTNER VIOELNCE


IPV WITH ANY FEMALE PARTNER PAST 12 MONTHS

The next questions are about times that you may have fought with a female sexual partner in the past 12 months, including times you may have caused injuries, even though this may not have been intentional.

1. In the past 12 months, did you ever hit, slap, punch, shove, choke, kick, shake or otherwise physically hurt any of your female sexual partners?

___ Yes

___ No

___ Prefer not to answer


2.In the past 12 months, did you ever make any female sexual partners take part in sexual activities that she did not want to, including touching that made her feel uncomfortable?

___ Yes

___ No

___ Prefer not to answer


3. In the past 12 months, did you ever physically force a female sexual partner to have vaginal, oral or anal sex with you?

___ Yes

___ No

___ Prefer not to answer


4. In the past 12 months, did any of your female sexual partners ever receive injuries, such as bruises, cuts, black eyes, or broken bones as a result of being hurt by you?

___ Yes

___ No

___ Prefer not to answer



IPV WITH ANY MALE PARTNER PAST 12 MONTHS

The next questions are about times that you may have fought with a male sexual partner in the past 12 months, including times you may have caused injuries, even though this may not have been intentional.


5a. In the past 12 months, did you ever hit, slap, punch, shove, choke, kick, shake or otherwise physically hurt any of your male sexual partners?

___ Yes

___ No

___ Prefer not to answer



5b. In the past 12 months, did any of your male sexual partners ever hit, slap, punch, shove, choke, kick, shake or otherwise physically hurt you?


___ Yes

___ No

___ Prefer not to answer


6a. In the past 12 months, did you ever physically force a male sexual partner to have oral or anal sex with you?

___ Yes

___ No

___ Prefer not to answer


6b. In the past 12 months, did any of your male sexual partners ever physically force you to have oral or anal sex?

___ Yes

___ No

___ Prefer not to answer


7a. In the past 12 months, did any of your male sexual partners ever receive injuries, such as bruises, cuts, black eyes, or broken bones as a result of being hurt by you?

___ Yes

___ No

___ Prefer not to answer


7b. In the past 12 months, did you ever receive injuries, such as bruises, cuts, black eyes, or broken bones as a result of being hurt by a male sexual partner?

___ Yes

___ No

___ Prefer not to answer


L. SUBSTANCE USE


The next section asks about your experience of using alcohol and other substances.  These include substances that can be smoked, swallowed, snorted, inhaled, injected or taken in the form of pills. Remember that all of your answers will be kept private, and that you can skip any question you do not want to answer..



1. Have you ever been in an alcohol recovery program or drug treatment program?

0=No

1=Yes

8=Prefer not to answer


2. In the past 90 days, how often did you drink any kind of beverage that contained alcohol?

1=Three or more times a day

2=Two times a day

3=Once a day

4=Nearly every day

5=Three or four times a week

6=Once or twice a week

7=Two or three times a month

8=About once a month

9=Less than once a month

0 = no alcohol use in the last 90 days (SKIP TO #4 BELOW)


3. In the last 90 days, on a typical day when you drank alcohol, how many drinks did you have?

By a drink I mean a can or bottle of beer, wine cooler, glass of wine, mixed drink, or a shot of hard liquor.


_______ # of drinks



4. During the last year have you had a feeling of guilt or remorse after drinking? (Remorse)

0=No

1=Yes

8=Prefer not to answer

9=Don’t Know


5. During the last year has a friend or a family member ever told you about things you said or did while you were drinking that you could not remember? (Amnesia)

0=No

1=Yes

8=Prefer not to answer

9=Don’t Know


6. During the last year have you failed to do what was normally expected from you because of drinking?

0=No

1=Yes

8=Prefer not to answer

9=Don’t Know


7. Do you sometimes take a drink when you first get up in the morning?

0=No

1=Yes

8=Prefer not to answer

9=Don’t Know




In the past three months, how often have you…

 

 

Never

Once or Twice

Monthly

Weekly

Daily or Almost Daily

8. Used marijuana (weed, pot, etc.)?

0

1

2

3

4

9. Used powdered cocaine?


0

1

2

3

4

10. Used crack or rock cocaine?

0

1

2

3

4

11. Used methamphetamine (crystal meth, tina, crank, etc)?

0

1

2

3

4

12. Used poppers or inhaled nitrites?

0

1

2

3

4

13. Used Club Drugs (Ecstacy, GHB, Special K, etc.)?

0

1

2

3

4

14. Used heroin ?

0

1

2

3

4

15. Used other opioids that were not prescribed to you like OxyContin, Codeine, Methadone, Vicodin, or Demerol

0

1

2

3

4

16. Used depressants that were not prescribed to you like Valium, Xanax, Halcion, Rohypnol, Mebaral, Klonopin

0

1

2

3

4

17. Used other stimulants that were not prescribed to you like Ritalin and Dexedrine

0

1

2

3

4

18. In the past three months, how often have you used Viagra, Cialis or Levitra without a prescription?



0

1

2

3

4







M. INCARCERATION

For the following questions, please focus on your entire lifetime. We ask about having been in jail, prison or a detention facility in order to better understand how to serve people with this experience. We do not ask about why you may have gone to prison or jail

1. As an adult or youth, did you ever spend more than one day in a jail, prison or detention facility? 1 Yes

2 No (Skip to question #5)

8 Prefer not to answer

2. During your entire lifetime, about how many times have you been incarcerated (held in jail, prison or detention facility)?

__ __ __ times

3. During your entire lifetime, about how much time have you spent in jail, prison, or a detention facility altogether?

  1. Less than 1 week

b. 7-30 days

c. 1-5 months

d. 6-11 months

e. 1-2 years

f. 3-5 years

g. 6 or more years



4. When were you last incarcerated? Enter the year and month that that you were last released from a jail, prison, or detention facility.

__ __ / __ __ __ __ mm / yyyy

5. Are you currently on parole or probation?


1 Yes

2 No

8 Prefer not to answer



READ: Remember, none of the information you report will be shared with your parole or probation officer.

The next questions are about any time that you spent incarcerated during your entire lifetime. The questions ask specifically about sex with other men or with transgender women. Unless otherwise specified, sex refers vaginal, anal, or oral sex or mutual masturbation.



6. Did you ever have sex with a man or a transgender female while you were in prison or jail?

1 = Yes

2 = No (skip to 2)

8 = Prefer not to answer



6a. Not including any childhood sexual contact, did your first sexual experience with a man or transgender female occur while you were in jail or prison?

1 = Yes

2 = No

8 = Prefer not to answer


7. At any point in your lifetime, when you were in prison or jail, did you participate in any of the following with a man or a transgender female?


a. Mutual masturbation?

1 = Yes

2 = No

8 = Prefer not to answer


b. Oral sex?

1 = Yes

2 = No

8 = Prefer not to answer


c. Anal sex?

1 = Yes

2 = No

8 = Prefer not to answer



8. At any point in your lifetime, were you coerced or forced to engage in sexual activity with someone while you were in prison or jail?

1 = Yes

2 = No

8 = Prefer not to answer




N. HIV STIGMA

The next set of questions asks about some of your feelings and opinions about HIV/AIDS. Please indicate how much you agree or disagree with the following statements: 1. People who have HIV or AIDS should be isolated from the rest of society.

1. Strongly Disagree

2. Disagree,

3. Agree

4. Strongly Agree

8. Prefer not to answer



2. People who have HIV or AIDS should only date other HIV positive people.

1. Strongly Disagree

2. Disagree,

3. Agree

4. Strongly Agree

8. Prefer not to answer



3. People who have HIV or AIDS are not sexually desirable.

1. Strongly Disagree

2. Disagree,

3. Agree

4. Strongly Agree

8. Prefer not to answer



4. People who have HIV or AIDS are more sexually promiscuous than most people.

1. Strongly Disagree

2. Disagree,

3. Agree

4. Strongly Agree

8. Prefer not to answer



5. The promiscuity of people who are gay is the reason why HIV/AIDS exists.

1. Strongly Disagree

2. Disagree,

3. Agree

4. Strongly Agree

8. Prefer not to answer



6. AIDS is a punishment from God.

1. Strongly Disagree

2. Disagree,

3. Agree

4. Strongly Agree

8. Prefer not to answer


O. SPIRITUALITY


The next few questions ask about religion and spirituality. Please answer each of the questions as honestly as you can.

1. What is your current religious affiliation?

0 = None

1= Protestant Christian

2= Non-denominational Christian

3= Born Again Christian

4= Catholic

5= Muslim

6= Jehovah’s Witness

7= Other, specify (e.g., Seventh Day Adventist, Buddhist, etc.)

97= Don't Know

98= Prefer not to answer

99= Not Applicable


1a. If other, what is the name of your religion?_______________



2. How often do you attend religious services of any kind?

1 = Never (Skip #2, 3)

2 = Less than once a month

3 = Once a month

4 = 2-3 times a month

5 = At least once a week

8 = Prefer not to answer


3. Approximately how many people are Black at the place you worship?

1 = All

2 = More than half

3 = About half

4 = Less than half

5 = None

8 = Prefer not to answer





4. I am able to be open about my sexuality in my religious community.

1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree

5 = I don't have a religious community

8 = Prefer not to answer




5. My religious beliefs make me feel bad about having sex with other men.

1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree

5 = I don't have religious beliefs

8 = Prefer not to answer


6. My health is solely in God’s hands


1 = Strongly agree

2 = Agree somewhat

3 = Disagree somewhat

4 = Strongly disagree

5 = I don't have religious beliefs

8 = Prefer not to answer



7. How important is religion or spirituality in your life?

0 = not important at all

1 = a little important

2 = somewhat important

3 = very important

7 = Don't Know

8 = Prefer not to answer

9 = Not Applicable


P. TREATMENT OPTIMISM


The following section refers to combination treatments, “Drug Cocktails” or HAART for HIV/AIDS. Please indicate how much you agree with each statement.

____________

Strongly Somewhat Somewhat Strongly

Disagree Disagree Agree Agree

______


1. HIV positive persons who take HIV

medications are less likely to infect

their sex partners during unsafe sex. 1 2 3 4


2. New AIDS treatments make it

easier to relax about unsafe sex. 1 2 3 4


3. Men like me are less worried

about HIV because of new treatments. 1 2 3 4


4. My friends practice more unsafe

sex because of new HIV treatments.

1 2 3 4

5.It is safe to have anal sex without a condom

with an HIV positive man who has an

undetectable viral load. 1 2 3 4




Q. MEDICAL HISTORY FOR HIV-POSITIVE MEN

         

The next set of questions is about the medical care and treatment you have received for your HIV infection.





1. Are you receiving regular/ongoing medical care for your H I V infection?

1 Yes

0 No

8 Prefer not to answer

9 Not Applicable


2. Please enter the year and month of your most recent visit to a medical provider for your HIV infection.

__ __ / __ __ __ __ mm / yyyy



3. What was your most recent CD4 (t-cell) count? ________



4. Indicate your VIRAL LOAD the last time it was measured. (Choose one)

1 Undetectable

2 Detectable but less than 5000

3 5,001- 10,000

4 10,001 - 30,000

5 30,001 or more

6 Haven’t had VL measured

7 Don’t know

5. Are you currently taking medication for HIV?

1 Yes

0 No

8 Prefer not to answer



6. In what month and year did you begin taking HIV medications? _______(mm/yyyy)



7. How do you usually take your medications? Choose one of the following:


1. I always take all of my pills, on time and according to directions

2. I always take all of my pills, but not always on time and according to directions

3. I sometimes miss or forget to take my pills

4. I’m not too careful about taking pills

5. I don’t take them at all




Self efficacy for disclosure of HIV status


The following section asks questions about disclosing your HIV status to sexual partners who are HIV-negative or who don’t know their own HIV status. Remember, all of your answers are private.


8. I can disclose my HIV status before having sex, even to a really hot new sex partner.


1 = Absolutely sure I cannot
2 = Somewhat sure I cannot
3 = Unsure if I can or cannot
4 = Somewhat sure I can
5 = Absolutely sure I can



9. I can disclose my HIV status before having sex, even to a really hot new sex partner who I think might be HIV negative.


1 = Absolutely sure I cannot
2 = Somewhat sure I cannot
3 = Unsure if I can or cannot
4 = Somewhat sure I can
5 = Absolutely sure I can



10. I can disclose my HIV status before having sex even if my partner did not know I was HIV positive the first time we had sex.     


1 = Absolutely sure I cannot
2 = Somewhat sure I cannot
3 = Unsure if I can or cannot
4 = Somewhat sure I can
5 = Absolutely sure I can



11. I can disclose my HIV status before having sex even if I was worried that my partner wouldn't have sex with me if they knew.


1 = Absolutely sure I cannot
2 = Somewhat sure I cannot
3 = Unsure if I can or cannot
4 = Somewhat sure I can
5 = Absolutely sure I can



12. I can disclose my HIV status before having sex even to a sex partner who hasn't told me their HIV status.   


1 = Absolutely sure I cannot
2 = Somewhat sure I cannot
3 = Unsure if I can or cannot
4 = Somewhat sure I can
5 = Absolutely sure I can


  

R. SOCIAL DESIRABILITY

Listed below are a few statements about your relationships with others. How much is each statement true or false for you?

1 = Definitely True

2 = Mostly True

3 = Don’t Know

4 = Mostly False

5 = Definitely False

8 = Prefer not to answer



1. I am always courteous, even to people who are disagreeable.





2. There have been occasions when I took advantage of someone.





3. I sometimes try to get even rather than forgive and forget.





4. I sometimes feel resentful when I don't get my way.



5. No matter who I’m talking to, I’m always a good listener.

























3C.1 PHMC: SITE-SPECIFIC BASELINE QUESTIONS


ACASI Section

Flesch-Kincaid =7.1 – self-administered section

Self-Esteem (18-items Beck Self-Esteem Self Scale )

Below is a list of adjectives that some people use to describe themselves. Please read each pair of adjectives and place an ‘X’ at the point along the line which best describes you right now.

A

Successful











Unsuccessful


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










Attractive







Unattractive


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










P opular







Unpopular


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










I ndependent







Dependent


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










H onest







Dishonest


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










D esirable







Undesirable


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










S trong







Weak


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










Smart







Dumb


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










Powerful







Powerless


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










Lovable







Unlovable


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










Pleasant







Unpleasant


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










E fficient







Inefficient


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










R esponsible







Irresponsible


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










G enerous







Selfish


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










W orthwhile







Worthless


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










I nteresting







Boring


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










Knowledgeable







Ignorant


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much










G ood







Bad


1

2

3

4

5

6

7

8

9

10



Very Much


Slightly



Very Much
















CAPI Section


For the remainder of the interview, I will ask you some questions and I will enter your answers into the computer. Please remember all of your answers are private. If you have a question about anything in this section of the survey, please stop me before we go on. You don't have to answer any of the questions if you don't want to. If anything we talk about today makes you uncomfortable and you would like to talk to a doctor or a counselor, I can give you some referral information after the interview.
Do you have any questions for me before we start?

Coping

I am now going to ask you to think about the most stressful event or problem you have experienced during the past 2 months (60 days).

Would you please briefly describe the event/problem?

(Probes: What happened, where it happened (if appropriate), who was involved, what made the event important)


______________________________________________________________________


______________________________________________________________________


______________________________________________________________________


______________________________________________________________________


______________________________________________________________________


______________________________________________________________________



On a scale from 1 to 10, with 1 being not at all stressful and 10 being very stressful, how stressful would you rate this event/problem?






1

2

3

4

5

6

7

8

9

10

Not at all Stressful





Very Stressful











Coping (28-item Brief COPE measure: Carver, C. S. (1997). Reliability for the 14 scales ranges from .54 to .90.)


The following statements are some ways people have reacted or dealt with stressful situations in their lives. Thinking about the situation you just described to me, and how you reacted to it, please tell me how much you did each of the following. Your answer choices are: I didn't do this at all, I did this a little bit, I did this a medium amount, or I did this a lot. Please remember there are no right or wrong answers.








I didn’t do this at all

(1)

I did this a little bit

(2)

I did this a medium amount

(3)

I did this a lot

(4)

  1. I’ve been turning to work or other activities to take my mind off things.

1

2

3

4

  1. I’ve been concentrating my efforts on doing something about the situation I’m in.

1

2

3

4

  1. I’ve been saying to myself “this isn’t real.”

1

2

3

4

  1. I’ve been using alcohol or other drugs to make myself feel better.

1

2

3

4

  1. I’ve been getting emotional support from others.

1

2

3

4

  1. I’ve been giving up trying to deal with it.

1

2

3

4

  1. I’ve been taking action to try to make the situation better.

1

2

3

4

  1. I’ve been refusing to believe that it has happened.

1

2

3

4

  1. I’ve been saying things to let my unpleasant feelings escape.

1

2

3

4

  1. I’ve been getting help and advice from other people.

1

2

3

4

  1. I’ve been using alcohol or other drugs to help me get through it.

1

2

3

4

  1. I’ve been trying to see it in a different light, to make it seem more positive.

1

2

3

4

  1. I’ve been criticizing myself.

1

2

3

4

  1. I’ve been trying to come up with a strategy about what to do.

1

2

3

4

  1. I’ve been getting comfort and understanding from someone.

1

2

3

4

  1. I’ve been giving up the attempt to cope.

1

2

3

4

  1. I’ve been looking for something good in what is happening.

1

2

3

4

  1. I’ve been making jokes about it.

1

2

3

4

  1. I’ve been doing something to think about it less, such as going to movies, watching TV, reading, daydreaming,
    sleeping, or shopping.

1

2

3

4

  1. I’ve been accepting the reality of the fact that it has happened.

1

2

3

4

  1. I’ve been expressing my negative feelings.

1

2

3

4

  1. I’ve been trying to find comfort in my religion or spiritual beliefs.

1

2

3

4

  1. I’ve been trying to get advice or help from other people about what to do.

1

2

3

4

  1. I’ve been learning to live with it.

1

2

3

4

  1. I’ve been thinking hard about what steps to take.

1

2

3

4

  1. I’ve been blaming myself for things that happened.

1

2

3

4

  1. I’ve been praying or meditating.

1

2

3

4

  1. I’ve been making fun of the situation.

1

2

3

4



Condom Self-Efficacy: Male Partners (Items from DiIorio et al. (1997))

I would like to get your opinion on some statements about using condoms with your male partners. For each statement that I read, please tell me from 1 to 5, with 1 being not at all sure you can do it to and with 5 being completely sure you can do it when you are having sex with your male partners?






(1)

Not at all sure I can do

(2)

Somewhat unsure

(3)

Undecided

(4)

Somewhat Sure

(5)

Completely sure I can do

(8)

Refuse to Answer

(9)

Not Applicable

  1. I can talk to every new partner about the importance of using condoms.

1

2

3

4

5

8

9

  1. I can find another way to get off (such as mutual masturbation) when a condom isn’t available.

1

2

3

4

5

8

9

  1. I can use a condom without fumbling even if the room is dark.

1

2

3

4

5

8

9

  1. I can put a condom on myself or my partner so that it will not slip or break.

1

2

3

4

5

8

9

  1. I can get every potential partner to use a condom with me.

1

2

3

4

5

8

9

  1. I can use a condom with a new partner without breaking the mood.

1

2

3

4

5

8

9

  1. I can remember to use a condom, even if I’m drunk or high

1

2

3

4

5

8

9



Condom Self-Efficacy: Female Partners (Items from DiIorio et al. (1997))


I would like to get your opinion on some statements about using condoms with your female partners. For each statement that I read, please tell me from 1 to 5, with 1 being not at all sure you can do it to and with 5 being completely sure you can do it when you are having sex with your male partners?











(1)

Not at all sure I can do

(2)

Somewhat unsure

(3)

Undecided

(4)

Somewhat Sure

(5)

Completely sure I can do

(8)

Refuse to Answer

(9)

Not Applicable

  1. I can talk to every new partner about the importance of using condoms.

1

2

3

4

5

8

9

  1. I can find another way to get off (such as mutual masturbation) when a condom isn’t available.

1

2

3

4

5

8

9

  1. I can use a condom without fumbling even if the room is dark.

1

2

3

4

5

8

9

  1. I can put a condom on myself or my partner so that it will not slip or break.

1

2

3

4

5

8

9

  1. I can get every potential partner to use a condom with me.

1

2

3

4

5

8

9

  1. I can use a condom with a new partner without breaking the mood.

1

2

3

4

5

8

9

  1. I can remember to use a condom, even if I’m drunk or high

1

2

3

4

5

8

9





Attitudes about Health and AIDS (6-item Locus of Control from FACT Survey).

I would like to get your opinion on some statements about your health and HIV. For each statement that I read, please tell me if you strongly agree, agree, disagree or strongly disagree?













Strongly Agree

Agree

Disagree

Strongly Disagree

  1. If you take the right steps, you can avoid HIV.

4

3

2

1

  1. More than anything else, chance determines whether you get HIV.

4

3

2

1

  1. You are in control of whether you get HIV.

4

3

2

1

  1. If it is meant to be, you will get HIV.

4

3

2

1

  1. If you get HIV, it is a matter of fate.

4

3

2

1

  1. Your own behavior determines whether you get HIV.

4

3

2

1







Internalized Homonegativity (items from Nungesser Homosexual attitudes Inventory and HIV Center for Clinical & Behavioral Studies at the New York State Psychiatric Institute =.92)

The following are some statements that people can make about being gay or bisexual.

For each statement, please indicate if you Strongly Agree, Agree, Disagree or Strongly

Disagree. If you feel that a statement does not apply to you, please select the "Not

Applicable" button on the right side of the screen.

(1)

Strongly Agree

(2)

Agree

(3)

Disagree

(4)

Strongly Disagree

(8)

Refuse to Answer

(9)

Not Applicable

  1. A gay/bisexual man can have just as fulfilling a life as a straight man.

1

2

3

4

8

9

  1. Sometimes I dislike myself for being gay/bisexual/ attracted to men.

1

2

3

4

8

9

  1. I am confident that my desire for men does not make me inferior.

1

2

3

4

8

9

  1. I feel stress and conflict within myself over having sex with men.

1

2

3

4

8

9

  1. It is important to me that at least some of my friends are gay, bisexual or lesbian.

1

2

3

4

8

9

  1. Sometimes I wish I were not gay/bisexual/attracted to men.

1

2

3

4

8

9

  1. I have no regrets about my desire for men.

1

2

3

4

8

9

  1. I sometimes feel guilty because I have sex with men.

1

2

3

4

8

9





Exposure to HIV messages and interventions (CARDS survey)

Now I am going to ask you some questions about any information you might have gotten about HIV/AIDS in the past 12 months.













(1)

Yes

(2)

No

((3)

Refuse to Answer

  1. In the past 12 months, have you gotten information about HIV/AIDS from your regular primary health care provider?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from family members?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from friends?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from newspapers or magazines with a primarily Black or African American audience (for example The Sunday Sun, The Tribune, Essence, Ebony, etc)?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from other newspapers or magazines?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from TV or radio stations with a primarily Black or African American audience (for example, TV One, BET, Power 99, or 100.3 The Beat)?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from other TV or radio stations?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from internet sites with a primarily Black or African American audience (for example Adam4Adam, BlackPlanet, etc.)?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS from other internet sites?

1

2

3

  1. In the past 12 months, have you gotten information about HIV/AIDS, such as written materials, talked to an outreach worker, take an HIV/STI test or received free condoms from community organizations?

1

2

3


1j1. IF 1J is YES: What organization was this? Any other organizations?



(Check all that apply)

ActionAIDS

GALAEI

Philadelphia Health Centers

BEBASHI

Jonathan Lax Center

Planned Parenthood

Calcutta House

Germantown Settlement

Project H.O.M.E.

CODAAP

Mazzoni Center

Prevention Point

COMHAR

Partnerships Comprehensive

Care Practice

The SafeGuards Project

Congreso

St. Joseph’s Hospital

The Colours Organization

Covenant House

One Day at a Time (ODAAT)

Washington West Project

Gaudenzia Inc.

Philadelphia FIGHT

William Way Center

Other:

Other:

Other:


1j2 Which of the following did you receive at ________________

(Check all that apply)

____ a. Written material, flyers, pamphlets

____ b. Talked one-on-one with an outreach worker, case manager, or other staff

____ c. Attended a group meeting

____ d. Got an HIV or STI test

____ e. Condoms

I am now going to ask you a few questions about HIV prevention activities in the past 12 months.




2. In the past 12 months, have you participated in any sessions sponsored by a community-based organization or other places involving a small group of people talking about HIV/AIDS or other sexually transmitted infections, or sexual behavior?

____ 1 Yes

____ 0 No

____ 7 Don't Know

____ 8 Refuse to Answer



2a. IF YES: What community organization was this? Any other organization?

Ask the following for each organization they mention:

Organization

What was the name of the program or intervention?

How many times did you meet in the past 12 months?

What was the main topic of the discussion?















3. In the past 12 months, have you talked with someone, such as a case manager or

counselor at a community-based organization or other places in an individual or one-on-one session about HIV/AIDS or other sexually transmitted infections, or sexual behavior? Please do not include times when it was only an HIV test.

____ 1 Yes

____ 0 No

____ 7 Don't Know

____ 8 Refuse to Answer

3a. IF YES: What community organization was this? Any other organization?

Ask the following for each organization they mention:

Organization

What was the name of the program or intervention?

How many times did you meet in the past 12 months?

What was the goal or purpose for the meeting?













4. In the past 12 months, have you participated in any surveys or research about

HIV/AIDS or other sexually transmitted infections, sexual risk or sexual behavior? (Probe: Have you answered any questions like this either on a computer, on a paper questionnaire, or with an interviewer?)

____ 1 Yes

____ 0 No

____ 7 Don't Know

____ 8 Refuse to Answer



4a. IF YES: What community organization was this? Any other organization?

Ask the following for each organization they mention:

Organization

What was the name of the project or program?

Where did you do the survey??

What was the main topic of the survey?

























Masculinity Ideology (12-items adapted from Multicultural Masculinity Ideology Scale: Doss & Hopkins (1998) CARDS reliability for these items: = .87)

Next are some statements about the expectations people may have about men. For each of the following statements, please tell me if you Strongly Agree, Agree, Disagree or Strongly Disagree.

(1)

Strongly Agree

(2)

Agree

(3)

Disagree

(4)

Strongly Disagree

(8)

Refuse to Answer

(9)

Not Applicable

  1. A guy should prove his masculinity by having sex with a lot of people

1

2

3

4

8

9

  1. A guy should have sexual intercourse as early as he can in his life

1

2

3

4

8

9

  1. Guys should not cry even when something really bad happens.

1

2

3

4

8

9

  1. In a relationship, guys should have sexual intercourse as often as possible.

1

2

3

4

8

9

  1. A guy should always have a woman he is dating

1

2

3

4

8

9

  1. To be a guy, you've got to be tough.

1

2

3

4

8

9

  1. Even if a guy is not rich, he should try to look that way

1

2

3

4

8

9

  1. A guy should not show affection to those he loves.

1

2

3

4

8

9

  1. The best way a man can care for his family is to get the highest paying job he can.

1

2

3

4

8

9

  1. Strong anger is a natural emotion for a guy to show.

1

2

3

4

8

9

  1. Being athletic or good at a sport should be important for a guy.

1

2

3

4

8

9

  1. Guys should not try to solve problems by fighting.

1

2

3

4

8

9

  1. It is very important for a guy to have children to carry his name.

1

2

3

4

8

9




3C.2 NOVA: SITE-SPECIFIC BASELINE QUESTIONS


HIV/STD KNOWLEDGE QUESTIONNAIRE


The following statements are about STDs (Sexually Transmitted Diseases) and HIV. Please indicate whether you think the statement is “true” or “false”. If you aren’t sure, choose “don’t know”.


  1. Douching after sex helps protect you from STDs.


  1. You can’t get the AIDS virus through a cut in your skin.


  1. You can’t always tell if your partner has as STD.


  1. Pre-ejaculatory fluids (pre-cum) carry HIV.


  1. People who have HIV generally feel sick right away.


  1. You can’t get HIV by sharing knives and forks or a bathroom with a person who has HIV.


  1. An untreated STD can possibly result in being unable to have children.


  1. Condoms with spermicide will protect you from most STDs.


  1. Women can spread STDs to men when they don’t use condoms.


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


  1. Having an STD puts you at greater risk for getting HIV.


  1. If a person has HIV, it is still safe to kiss them on the lips, as you would kiss a friend or relative.


  1. The most effective way to prevent the spread of HIV is abstinence from sex.


  1. Sheep skin condoms are better than latex condoms for preventing HIV.


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


  1. All STDs, except for HIV, can be cured with antibiotics.



Condom Use Self-Efficacy Scale (CUSES)


The following questions ask about your feelings about using condoms, using the following scale:


1=Strongly Agree

2=Agree

3=Undecided

4=Disagree

5=Strongly Disagree



  1. I feel confident in my ability to put a condom on myself or my partner.


  1. I feel confident I could purchase condoms without feeling embarrassed.


  1. I feel confident I could remember to carry a condom with me should I need one.


  1. I feel confident in my ability to discuss condom usage with any partner I might have.


  1. I feel confident in my ability to suggest using condoms with a new partner.


  1. I feel confident I could suggest using a condom without my partner feeling "diseased".


  1. I feel confident in my own or my partner's ability to maintain an erection while using a condom.


  1. I would feel embarrassed to put a condom on myself or my partner.


  1. If I were to suggest using a condom to a partner, I would feel afraid that he or she would reject me.


  1. If I were unsure of my partner's feelings about using condoms, I would not suggest using one.


  1. I feel confident in my ability to use a condom correctly.


  1. I would feel comfortable discussing condom use with a potential sexual partner before we ever had any sexual contact (such as hugging, kissing, caressing, etc.)


  1. I feel confident in my ability to persuade a partner to accept using a condom when we have intercourse.


  1. I feel confident I could gracefully remove and dispose of a condom after we have intercourse.


  1. If my partner and I were to try to use a condom and did not succeed, I would feel embarrassed to try to use one again (such as not being able to unroll condom, putting it on backwards, or awkwardness).


  1. I would not feel confident suggesting using condoms with a new partner because I would be afraid he or she would think I've had a homosexual experience.


  1. I would not feel confident suggesting using condoms with a new partner because I would be afraid he or she would think I have a sexually transmitted disease.


  1. I would not feel confident suggesting using condoms with a new partner because I would be afraid he or she would think I thought they had a sexually transmitted disease.


  1. I would feel comfortable discussing condom use with a potential partner before we ever engaged in intercourse.


  1. I feel confident in my ability to incorporate putting a condom on myself or my partner into foreplay.


  1. I feel confident that I could use a condom with a partner without "breaking the mood."


  1. I feel confident in my ability to put a condom on myself or my partner quickly.


  1. I feel confident I could use a condom during intercourse without reducing any sexual sensations.

  2. I feel confident that I would remember to use a condom even after I have been drinking.


  1. I feel confident that I would remember to use a condom even if I were high.


  1. If my partner didn't want to use a condom during intercourse, I could easily convince him or her that it was necessary to do so.


  1. I feel confident that I could use a condom successfully.


  1. I feel confident I could stop to put a condom on myself or my partner even in the heat of passion.



Rosenberg Self-Esteem Scale


The following statements deal with your general feelings about yourself. Choose the answer that best describes your feelings.


Strongly Agree

Agree

Disagree

Strongly Disagree


  1. I feel that I am a person of worth, at least on an equal basis with others.


  1. I feel that I have a number of good qualities.


  1. All in all, I am inclined to feel that I am a failure.

  2. I am able to do things as well as most other people.


  1. I feel I do not have much to be proud of.

  2. I take a positive attitude toward myself.

  3. On the whole, I am satisfied with myself.


  1. I wish I could have more respect for myself.


  1. I certainly feel useless at times.


  1. At times I think I am no good at all.




The Multi-Group Ethnic Identity Measure (MEIM) (Phinney, 1992)


In this country, people come from many different countries and cultures, and there are many different words to describe the different back­grounds or ethnic groups that people come from. Some examples of the names of ethnic groups are Hispanic or Latino, Black or African American, Asian American, Chinese, Filipino, American Indian, Mexican American, Caucasian or White, Italian American, and many others. These questions are about your ethnicity or your ethnic group and how you feel about it or react to it.


Please fill in: In terms of ethnic group, I consider myself to be ____________________


Use the numbers below to indicate how much you agree or disagree with each statement.


(4) Strongly agree (3) Agree (2) Disagree (1) Strongly disagree


1. I have spent time trying to find out more about my ethnic group, such as its history, traditions, and customs.

2. I am active in organizations or social groups that include mostly members of my own ethnic group.

3. I have a clear sense of my ethnic background and what it means for me.

4. I think a lot about how my life will be affected by my ethnic group membership.

5. I am happy that I am a member of the group I belong to.

6. I have a strong sense of belonging to my own ethnic group.

7. I understand pretty well what my ethnic group membership means to me.

8. In order to learn more about my ethnic background, I have often talked to other people about my ethnic group.

9. I have a lot of pride in my ethnic group.

10. I participate in cultural practices of my own group, such as special food, music, or customs.

11. I feel a strong attachment towards my own ethnic group.

12. I feel good about my cultural or ethnic background.

13. My ethnicity is:

(1) Asian or Asian American, including Chinese, Japanese, and others

(2) Black or African American

(3) Hispanic or Latino, including Mexican American, Central American, and others

(4) White, Caucasian, Anglo, European American; not Hispanic

(5) American Indian/Native American

(6) Mixed; Parents are from two different groups

(7) Other (write in): _____________________________________

14. My father's ethnicity is: (use numbers above)

15. My mother's ethnicity is: (use numbers above)



Klein Sexual Orientation Grid


Using the following scale, choose the answer that corresponds to your feelings, actions, and thoughts.



For Categories A through E:

0 – Exclusively the other sex

1 – Mostly the other sex, infrequently the same sex

2 – Often the other sex, sometimes the same sex

3 – Equally the other sex and the same sex

4 – Often the same sex, sometimes the other sex

5 – Mostly the same sex, infrequently the other sex

6 – Exclusively the same sex


For Categories F and G:

0 – Exclusively heterosexual

1 – Mostly heterosexual, infrequently homosexual

2 – Often heterosexual, sometimes homosexual

3 – Equally heterosexual and homosexual

4 – Often homosexual, sometimes heterosexual

5 – Mostly homosexual, infrequently heterosexual

6 – Exclusively homosexual


A1. In the past, who were you sexually attracted to (males, females, both)?


A2. In the present, who are you sexually attracted to (males, females, both)?


A3. Ideally, who would you be sexually attracted to (males, females, both)?


B1. In the past, with whom did you have sex (males, females, both)?


B2. In the present, with whom do you have sex (males, females, both)?


B3. Ideally, whom would you have sex with (males, females, both)?


C1. In the past, who did you have sexual fantasies about, whether they occurred during masturbation, daydreaming, or as part of your daily life?


C2. In the present, who do you have sexual fantasies about, whether they occur during masturbation, daydreaming, or as part of your daily life?


C3. Ideally, who would you have sexual fantasies about, whether they occur during masturbation, daydreaming, or as part of your daily life?


D1. In the past, who did you feel emotionally close to (males, females, both)?


D2. In the present, who do you feel emotionally close to (males, females, both)?


D3. Ideally, who would you feel emotionally close to (males, females, both)?


E1. In the past, who did you like to hang out with and spend time socially (males, females, both)?


E2. In the present, who do you like to hang out with and spend time socially (males, females, both)?


E3. Ideally, who would you like to hang out with and spend time socially (males, females, both)?


F1. In the past, how did you identify or think about yourself sexually?


F2. In the present, how do you identify or think about yourself sexually?


F3. Ideally, how would you identify or think about yourself sexually?


G1. In the past, where did you tend to spend time and with whom (in the gay and lesbian world, the heterosexual world, both)?


G2. In the present, where do you tend to spend time and with whom (in the gay and lesbian world, the heterosexual world, both)?


G3. Ideally, where would you tend to spend time and with whom (in the gay and lesbian world, the heterosexual world, both)?



Masculine Gender Role Stress Scale


Please rate the following items according to how stressful the situation would be for you…


0 = Not stressful

1

3

4

5

6

7 = Extremely stressful


  1. Feeling that you are not in good physical condition

  2. Not being able to find a sexual partner

  3. Having your lover say that she/he is not satisfied

  4. Being perceived by someone as “gay”

  5. Losing in a sports competition

  6. Being perceived as having feminine traits

  7. Appearing less athletic than a friend

  8. Being compared unfavorably to men

  9. Knowing you cannot hold your liquor as well as others

  10. Telling your spouse that you love her/him

  11. Telling someone that you feel hurt by what he/she said

  12. Admitting that you are afraid of something

  13. Having your children see you cry

  14. Talking with a woman who is crying

  15. Comforting a male friend who is upset

  16. Having a man put his arm around your shoulder

  17. Being outperformed at work by a woman

  18. Having a female boss

  19. Letting a woman take control of the situation

  20. Being married to someone who makes more money that you

  21. Being with a woman who is more successful than you

  22. Being outperformed in a game by a woman

  23. Needing your spouse to work to help support the family

  24. Admitting to your friends that you do housework

  25. Being with a woman who is much taller than you

  26. Having to ask for directions when you are lost

  27. Working with people who seem more ambitious than you

  28. Talking with a “feminist”

  29. Having people say that you are indecisive

  30. Having others say that you are too emotional

  31. Working with people who are brighter than yourself

  32. Staying home during the day with a sick child

  33. Being unemployed

  34. Not making enough money

  35. Finding you lack the occupational skills to succeed

  36. Being unable to perform sexually

  37. Being too tired for sex when your lover initiates it

  38. Being unable to become sexually aroused when you want

  39. Getting passed over for a promotion

  40. Getting fired from your job



Internalized Homophobia Scale


Please choose the number that best describes your response to each item:


1 = strongly agree

2 = moderately agree

3 = slightly agree

4 = neither agree or disagree

5 = slightly disagree

6 = moderately disagree

7 = strongly disagree


  1. Obviously effeminate homosexual men make me feel uncomfortable

  2. I prefer to have anonymous sexual partners

  3. It would not be easier in life to be heterosexual

  4. Most of my friends are homosexual

  5. I do not feel confident about making an advance to another man

  6. I feel comfortable in gay bars

  7. Social situations with gay men make me feel uncomfortable

  8. I don’t like thinking about my homosexuality

  9. When I think about other homosexual men, I think of negative situations

  10. I feel comfortable about being seen in public with an obviously gay person

  11. I feel comfortable discussing homosexuality in a public setting

  12. It is important to me to control who knows about my homosexuality

  13. Most people have negative reactions to homosexuality

  14. Homosexuality is not against the will of God

  15. Society still punishes people for being gay

  16. I object if an anti-gay joke is told in my presence

  17. I worry about becoming old and gay

  18. I worry about becoming unattractive

  19. I would prefer to be more heterosexual

  20. Most people don’t discriminate against homosexuals

  21. I feel comfortable about being homosexual

  22. Homosexuality is morally acceptable

  23. I am not worried about anyone finding out that I am gay

  24. Discrimination against gay people is still common

  25. Even if I could change my sexual orientation, I wouldn’t

  26. Homosexuality is as natural as heterosexuality





























5

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