3b Quantiative Survey

“Exploring HIV Prevention Communication Among Black Men Who Have Sex with Men in New York City: Project BROTHA”

0920-XXXX

Attachment 3b. ACASI Quantitative Survey Measures

Form Approved

OMB No. 0920-XXXX

Expiration Date XX/XX/20XX

“Exploring HIV Prevention Communication Among Black Men Who Have Sex with Men in New York City: Project BROTHA”

0920-XXXX

ACASI Quantitative Survey Measures

Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-09BC)

One item was created by the PI to measure likelihood to test for HIV:

“If you had the opportunity to get tested for HIV within the next month, how likely is it that you would?”

Intentions for HIV Testing

Adapted from Conner (1999)

IN the next FOUR months	Definitely Do NOT				Definitely DO
1. I plan on getting tested for HIV	1	2	3	4	5
2. I will want to get tested for HIV	1	2	3	4	5
3. I intend to get tested for HIV	1	2	3	4	5

Content and Context of HIV Prevention Interpersonal Communication (Quantitative assessment)

(Nanin, 2008)

1. Thinking about your conversations with various people in your social circle, how often do you have conversations about HIV prevention (for example, about condom use and other safer sex, reduced or no drug or alcohol use, cleaning needles)?

   • Not often at all (0-10% of the time), somewhat often (11-40%), often (41-70%), very often (71-100%)

Sociodemographics Scale for BMSM Study -- FINAL

1a. Age: ____ 1b. Home Zip Code:_________________

Male

Transgender MTF

3. How do you describe yourself? (check all that apply)

 African American	African Caribbean	Mixed
Middle Eastern/Arab	African (native)

3a If you chose “mixed,” which one do you identify with most?____________________________________
(Make sure to answer item #10.)

4. Education (check highest level reached)

Some high school	College degree	 Graduate or professional degree
High school diploma or equivalent	 Some college, but no degree

5. Do you have health insurance? (check one)

 I do not have health insurance  Private insurance  Medicaid  ADAP  Other (write in):______

6. How do you identify yourself? (check one)

 Bisexual	 Gay	 Same-gender Loving
 DL or “down low” NOTE: Other sociodemographic items adapted from CDC PEMS items below.	 Straight	 Other

7. In what month and year were you born? __ __ / __ __ __ __ mm / yyyy

Refuse to Answer (Enter “2098” for Year)

8. Are you… (Choose one)

1 Male

2 Transgender

8 Refuse to Answer

If 8 is not equal to 2, then skip to D4.

9. Are you... (Choose one)

1 Male to Female Transgender (Trans Woman)

2 Female to Male Transgender (Trans Man)

8 Refuse to Answer

10. Do you consider yourself to be Hispanic or Latino?

1Yes

0 No

8 Refused

11. What is the highest level of education you completed? (Choose one)

0 Grade 8 or less

1 Grades 9 through 11

2 Grades 12 or GED

3 Some College, Associate's or Technical Degree

4 Bachelor's Degree

5 Any post graduate studies

8 Refuse to Answer

12. What best describes your current employment status. Are you... (Choose one)

1 Full-time

2 Part-time

3 Unemployed

8 Refuse

13. What was your household income last year from all sources before taxes? Household income refers to the total amount of money from all people living in the household. (Choose one)

00 Less than $10,000

01 $10,000 -19,999

02 $20,000 -29,999

03 $30,000 -39,999

04 $40,000 -49,999

05 $50,000 -59,999

06 $60,000 -69,999

07 $70,000 -79,999

08 $80,000 or more

98 Refuse to Answer

14. Including yourself, how many people depend on this income?

__ __ People including self

98 Refuse to Answer

15. Have you ever spent at least one night in jail (city correctional facility) or prison (federal or state correctional facility)?

1 Yes

0 No (Skip to D13)

8 Refuse to Answer (Skip to D13)

16. Was this in the past 3 months?

1 Yes

0 No

8 Refuse

17. In the last 3 months, were you homeless at any time? That is, you slept in a shelter for homeless people, on the streets, or another place not intended for sleeping.

1 Yes

0 No

8 Refuse

18. In the past 3 months, has a doctor, nurse, or other health care provider given you a new diagnosis of a sexually transmitted infection other than HIV?

1 Yes

0 No

8 Refuse

19. Have you ever been tested for HIV?

1 Yes

0 No (skip 20 & 21)

8 Refuse

20. What was the result of your most recent HIV test? (Choose one)

0 Negative

1 Positive

2 Indeterminate

3 Did not get result

8 Refuse to Answer

21. When was your most recent HIV test? In what month and year? If you are not sure, enter your best guess.

__ __ / __ __ __ __ (mm / yyyy)

Refuse to Answer (Enter “2098” for Year)

Beliefs about HIV prevention and HIV testing

Response scale:

1 = Strongly Disagree

2 = Slightly disagree

3 = Slightly agree

4 = Strongly agree

1. I believe HIV is preventable.

2. I believe every man in the US should receive an HIV test.

3. I believe every man who has sex with women only should receive an HIV test.

4. I believe every man who has sex with men only should receive an HIV test.

5. I believe every man who has sex with both men and women should receive an HIV test.

6. I believe anal sex (penis into the anus) is a definite way HIV can be transmitted.

7. I believe vaginal sex (penis into vagina) is a definite way HIV can be transmitted.

8. I believe oral sex (penis into mouth) is a definite way HIV can be transmitted.

9. I believe oral sex (vagina in mouth) is a definite way HIV can be transmitted.

10. I believe no matter what I do to protect myself from HIV, I will eventually get HIV.

11. I believe identifying as a gay man puts you at more risk for HIV.

12. I believe identifying as a bisexual man puts you at more risk for HIV.

13. I believe a man on the down low (DL) is at more risk for HIV.

14. I believe not having any type of sex is the best way to avoid getting HIV.

15. I believe having sex in ways that don’t involve someone’s fluids going into someone else’s body is safer.

16. I believe Black men who have sex with other men need to communicate with each other more about HIV prevention.

(Items will be randomly administered during ACASI session.)

Social Engagement Scale (Non-Gay specific)

Kippax et al. (1993)

        Never   Rarely  Not a lot       Sometimes       A lot   All the time
        0       1       2       3       4       5

1.      I go out with my friends to bars.
2.      I get together and hang out with my friends at someone's home.
3.      I go out with my friends to theatre/ballet/opera/shows .
4.      I go to parties with my friends.
5.      I go out with my friends to dance clubs.
6.      I go out with my friends on get away weekends and/or vacations.
7.      I go out with my friends to restaurants/cafes/coffee shops.
8.      I go out with my friends to meetings/seminars/workshops.
9.      I go cruising for sex partners with my friends.
10.     I go out with my friends to bathhouses/sex clubs.
11.     I talk with my friends on the Internet in chatrooms or through email.
12.     I go to parades/rallies with my friends.
13.     I go to sex parties with my friends.
14.     I go places with my friends, like shopping, museums, movies, and other places.
15.     I attend religious services with my friends.

Male Reference Group Identity Dependence Scale (Wade & Gelso, 1998)

Items were answered using a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree).

Taken from Wade, J.C. & Gelso, C. J. (1998). Reference Group Identity Dependence Scale: A measure of male identity. Counseling Psychologist, 26, 384-412.

Global Norms/Normative Beliefs* for HIV Testing

Adapted from Armitage & Conner (1999); Conner (1994); Conner & McMillan (1999)

Please indicate how strongly you agree or disagree with the following statements.	Strongly Disagree	Disagree	neither	Agree	StronglyAgree
1. People who are important to me think I should get tested for HIV	1	2	3	4	5
2. When it comes to testing for HIV I want to do what the people who are important to me think I should do	1	2	3	4	5
3. People who are important to me encourage me to not get tested for HIV	1	2	3	4	5
4. The people who are important to me don’t get tested for HIV.	1	2	3	4	5
5. My closest friends think I should get tested for HIV	1	2	3	4	5
6. When it comes to not testing for HIV, I want to do what my closest friends think I should do	1	2	3	4	5
7. Other people that don’t test for HIV think I should test for HIV	1	2	3	4	5
8. When it comes to not testing for HIV, I want to do what other people who don’t test for HIV think I should do	1	2	3	4	5
9. My friends who practice HIV prevention think I should get tested for HIV	1	2	3	4	5
10. When it comes to using club drugs, I want to do what my friends who practice HIV prevention think I should do	1	2	3	4	5
11. My friends who don’t practice HIV prevention think I should test for HIV	1	2	3	4	5
12. When it comes to not testing for HIV, I want to do what my friends who don’t practice HIV prevention think I should do	1	2	3	4	5
13. My parents think I should get tested for HIV	1	2	3	4	5
14. When it comes to not testing for HIV, I want to do what my parents think I should do
15. My doctor thinks I should get tested for HIV	1	2	3	4	5
16. When it comes to not testing for HIV, I want to do what my doctor thinks I should do	1	2	3	4	5
17. My sexual partner thinks I should get tested for HIV	1	2	3	4	5
18. When it comes to not testing for HIV, I want to do what my sexual partner thinks I should do	1	2	3	4	5

*global norms, items 1-4; normative beliefs, items 5-18

Gay Identity Questionnaire

(Brady, 1998)

Directions: Please read each of the following statements carefully and then circle whether you feel the statements are true (T) or false (F) for you at this point in time. A statement is circled as true if the entire statement is true, otherwise it is circled as false.

(starts on next page)

I probably am sexually attracted equally to men and women.

I live a homosexual lifestyle at home, while at work/school I do not want others to know about my lifestyle.

My homosexuality is a valid private identity, that I do not want made public.

I have feelings I would label as homosexual.

I have little desire to be around most heterosexuals.

I doubt that I am homosexual, but still am confused about who I am sexually.

I do not want most heterosexuals to know that I am definitely homosexual.

I am very proud to be gay and make it known to everyone around me.

I don’t have much contact with heterosexuals and can’t say that I miss it.

I generally feel comfortable being the only gay person in a group of heterosexuals.

I’m probably homosexual, even though maintain a heterosexual image in both my personal and public life.

I have disclosed to 1 or 2 people (very few) that I have homosexual feelings, although I’m not sure I’m homosexual.

I am not as angry about treatment of gays because even though I’ve told everyone about my gay ness, they have responded well.

I am definitely homosexual but I do not share that knowledge with most people.

I don’t mind if homosexuals know that I have homosexual thoughts and feelings, but I don’t want others to know.

More than likely I’m homosexual, although I’m not positive about it yet.

I don’t act like most homosexuals do, so I doubt that I’m homosexual.

I’m probably homosexual, but I’m not sure yet.

I am openly gay and fully integrated into heterosexual society.

I don’t think that I’m homosexual.

I don’t feel as if I’m heterosexual or homosexual.

I have thoughts I would label as homosexual.

I don’t want people to know that I may be homosexual, although I’m not sure if I am homosexual or not.

I may be homosexual and I am upset at the thought of it.

The topic of homosexuality does not relate to me personally.

I frequently confront people about their irrational, homophobic (fear of homosexuality) feelings.

Getting in touch with homosexuals is something I feel I need to do, even though I’m not sure I want to.

I have homosexual thoughts and feelings but I doubt that I’m homosexual.

I dread having to deal with the fact that I may be homosexual.

I am proud and open with everyone about being gay, but it isn’t the major focus of my life.

I probably am heterosexual or non-sexual.

I am experimenting with my same sex, because I don’t know what my sexual preference is.

I feel accepted by homosexual friends and acquaintances, even though I’m not sure I’m homosexual.

I frequently express to others, anger over heterosexuals’ oppression of me and other gays.

I have not told most of the people at work that I am definitely homosexual.

I accept but would not say I am proud of the fact that I am definitely homosexual.

I cannot imagine sharing my homosexual feelings with anyone.

Most heterosexuals are not credible sources of help for me.

I am openly gay around heterosexuals.

I engage in sexual behavior I would label as homosexual.

I am not about to stay hidden as gay for anyone.

I tolerate rather than accept my homosexual thoughts and feelings.

My heterosexual friends, family, and associates think of me as a person who happens to be gay, rather than as a gay person.

Even though I am definitely homosexual, I have not told my family.

I am openly gay with everyone, but it doesn’t make me feel all that different from heterosexuals.

Identification and Involvement with the Gay Community Scale

(Rosario et al., 2001; 2004)

Directions: This questionnaire concerns some of your general attitudes and experiences. For each question, circle the response that is most accurate for you personally. Answer the questions quickly, giving your first “gut reaction”.

	D o not agree at all					Strongly agree
It is very important to me that at least some of my friends are bisexual or gay.	1	2	3		4		5
Being gay makes me feel part of a community.	1	2	3		4		5
Being attracted to men is important to my sense of who I am.	1	2	3		4		5
I feel very distant from the gay community.	1	2	3		4		5

For questions 5-7, please think in terms of the last six months or so.

5. How often do you read a gay or lesbian oriented paper or magazine, such as the Advocate or other local gay/bisexual papers?

A = Never B = Once a month or less C = Several times a month D = About once a week

E = Several times a week or daily

6. How often do you attend any gay or lesbian organizational activities, such as meetings, fund-raisers, political activities, etc.?

A = Never B = Once a month or less C = Several times a month D = About once a week

E = Several times a week or daily

7. How often do you go to a gay bar?

A = Never B = Once a month or less C = Several times a month D = About once a week

E = Several times a week or daily

8. About how many gay men would you call personal friends (as opposed to casual acquaintances)?

A = None B = 1 gay friend C = 2 gay friends D = 3 or 4 gay friends E = 5 or more gay friends

Safer Sex Self-Efficacy Questionnaire

(Parsons et al., 2000a; 2000b)

Confidence for Condom Use

How CONFINDENT would you be to have anal sex WITH a condom with a sex partner . . .	Not at all	Not Very	Somewhat	Very	Extremely
When I really want sex.	1	2	3	4	5
When I really need affection.	1	2	3	4	5
When I am with a really hot guy.	1	2	3	4	5
When he SAYS he does not want to use a condom.	1	2	3	4	5
When I am angry.	1	2	3	4	5
When I think the risk of STD’s is low.	1	2	3	4	5
When I think the risk for HIV (or re-infection) is low.	1	2	3	4	5
When I feel depressed.	1	2	3	4	5
When I THINK that he does not want to use condoms.	1	2	3	4	5
When I am drunk or high on drugs.	1	2	3	4	5
When I think stopping to get a condom will spoil the mood.	1	2	3	4	5
When I am really sexually aroused.	1	2	3	4	5
When I really want to see or be with him again.	1	2	3	4	5

The Condom Fit and Feel Scale

Reece, M., Dodge, B., Herbenick, D., Fisher, C., Satinsky, S., & Alexander, A. (2007). Experiences of condom fit and feel among African-American men who have sex with men. Sexually Transmitted Infections, 454-457.

Response Options:

1. Never applies to me

2. Sometimes applies to me

3. Often applies to me

4. Always applies to me

Scale Items by Subscale (subscale titles provided for information, not to be included in the actual scale when administered).
Condoms Fit Fine
Condoms fit my penis just fine
Condoms feel comfortable once I have them on my penis
Condoms Are Too Long
Condoms are too long for my penis
I have some unrolled condom left at the base of my penis after I unroll it
Condoms Are Too Short
Condoms are too short for my penis
Condoms will not roll down far enough to cover my penis completely
Condoms Feel Too Tight
Condoms are too tight on my penis
Condoms fee too tight along the shaft of my penis
Condoms feel too tight on the head of my penis
Condoms feel too tight around the base of my penis
Condoms Feel Too Loose
Condoms are too loose on my penis
Condoms feel too loose along the shaft of my penis
Condoms feel too loose around the head of my penis
Condoms feel too loose around the base of my penis

Gay-related Stigma Scale

(Frost, Parsons, & Nanin, 2007)

Personalized Stigma subscale

Questions about being Gay/Bi/Trans (G/B/T). . .	Strongly Disagree				StronglyAgree
It is easier to avoid new friendships than worry about telling someone that I’m G/B/T	1	2		3		4
I am very careful who I tell that I’m G/B/T	1	2		3		4
Since realizing that I’m G/B/T, I worry about people discriminating against me	1	2		3		4
I never feel the need to hide the fact that I’m G/B/T	1	2		3		4
I worry that people may judge me when they learn I’m G/B/T	1	2		3		4
I worry that people who know I’m G/B/T will tell others	1	2		3		4
I have told people close to me to keep the fact that I’m G/B/T a secret	1	2		3		4
I have made an effort to make my sexual identity known to others	1	2		3		4
Others are able to tell that I’m G/B/T without my making an effort to make it known to them	1	2		3		4
Stigma Concealment subscale
Questions about being Gay/Bi/Trans (G/B/T). . .	Strongly Disagree				StronglyAgree
I have been hurt by how people reacted to learning I’m G/B/T	1	2		3		4
I regret having told some people that I’m G/B/T	1	2		3		4
Some people who know that I’m G/B/T have grown more distant	1	2		3		4
Since realizing I’m G/B/T, I feel isolated from the rest of the world	1	2		3		4
People who know I’m G/B/T tend to ignore my good points	1	2		3		4
People I care about stopped calling after learning I’m G/B/T	1	2		3		4
Some people close to me are afraid others will reject them if it becomes known that I’m G/B/T	1	2		3		4
I have stopped socializing with some people because of their reactions to my being G/B/T	1	2		3		4
I have lost friends by telling them that I’m G/B/T	1	2		3		4
When people learn you’re G/B/T, they look for flaws in your character	1	2		3		4
Telling someone I’m G/B/T is risky	1	2		3		4

Herek AIDS Stigma Scale

(Herek, 1993)

Feelings Towards Persons with AIDS

People have many different feelings when they think about people who have AIDS. As I read each of the following feelings, please tell me how you personally feel.

1. How about feeling angry at them? Would you say you feel:

(a) very angry,

(b) somewhat,

(c) a little, or

(d) not at all angry at people with AIDS?

2. (How about) afraid of them?.........

3. (How about) disgusted by them?........

Coercive Attitudes and Blame

Now I'm going to read a list of statements people have made. As I read each one, please tell me how much you agree or disagree.

1. How about "people with AIDS should be legally separated from others to protect the public health?" Would you say you:

(a) agree strongly,

(b) agree somewhat,

(c) disagree somewhat, or

(d) disagree strongly?

2. (How about) "The names of people with AIDS should be made public so that others can avoid them?"…..

3. (How about) "People who got AIDS through sex or drug use have gotten what they deserve?"…..

Avoidant Behavioral Intentions

1. Suppose you had a close friend or relative who developed AIDS.

(a) Would you be willing to take care of him/her, or

(b) is that something you would not be willing to do?

IF (b): Is that because

(c) you wouldn't want to take care of someone with AIDS, or

(d) for some other reason?

[supportive response = a; avoidant response = c]

2. And suppose you had a young child who was attending school where one of the students was known to have AIDS. What would you do? Would you:

(a) send your child to another school, or

(b) leave your child in the same school?

IF (b): Would you

(c) encourage your child to be especially nice to the student with AIDS,

(d) discourage your child from contact with him/her, or

(e) encourage your child to treat him/her as always?

[supportive responses = c, e; avoidant responses = a, d]

3. Now suppose you had an office job where one of the men working with you developed AIDS. Would you:

(a) still be willing to work with him,

(b) ask he be assigned someplace else,

(c) or ask to be assigned with someone else.

IF (a): Would you

(d) go out of your way to help him,

(e) try to avoid contact with him, or

(f) treat him the same as always?

[supportive responses = d, f; avoidant responses = b, c, e]

4. Suppose that you found out that the owner of a small neighborhood grocery store where you like to shop had AIDS. Would you:

(a) continue to shop there, or

(b) probably go someplace else to shop?

IF (a): Do you think you would shop there

(c) more often or

(d) less often than you did before you found out the owner had AIDS, or

(e) would you continue to shop there as much as you did before you found out?

[supportive responses = c, e; avoidant responses = b, d]

Casual Contact

These next questions are about the different ways some people think AIDS might be spread. As I read each of the following, please tell me how likely you think it is that a person could get AIDS or AIDS virus infection in that way.

1. How about kissing someone on the cheek who has the AIDS virus? Would you say if someone does that they're:

(a) very likely,

(b) somewhat likely,

(c) somewhat unlikely,

(d) very unlikely to get AIDS, or is it

(e) impossible to get AIDS by kissing someone on cheek?

2. How about sharing a drink out of the same glass with someone who has AIDS?...

3. How about by using public toilets?...

4. How about from being coughed on or sneezed on by someone who has the AIDS virus?...

5. How about from mosquito or other insect bites?...

Transmission through Homosexuality and Drug Use

We're also interested in knowing what you think the chances are that certain types of people will get AIDS in certain types of situations.

1. First, think of two healthy homosexual men – neither of whom is infected with the AIDS virus. Now suppose they have sexual intercourse. If they use condoms, would you say

that at least one of them is:

(a) almost sure to become infected,

(b) has a fairly strong chance,

(c) has very little chance, or

(d) has no chance of becoming infected

2. Now suppose the same two healthy men have sexual intercourse but this time they do not use condoms….

3. Now think of someone who uses drugs intravenously (and who is not a homosexual). If this person does not share needles, what do you think this person's chances are of

becoming infected with the AIDS virus?...

Ethnic Community Attachment

(Phinney, 1992)

Race/ethnic community questions	Strongly Disagree			Strongly Agree
I am happy that I am a member of the ethnic/racial group I belong to		1	2	3	4
I have a strong sense of belonging to my own ethnic/racial group		1	2	3	4
I have a lot of pride in my ethnic/racial group		1	2	3	4
I feel a strong sense of attachment towards my ethnic/racial group		1	2	3	4
I feel good about my cultural/ethnic/racial background		1	2	3	4

Gay Community Attachment

(adapted from Phinney, 1992)

G/L/B community questions	S trongly Disagree			Strongly Agree
I am happy that I am a member of the G/L/B community		1	2	3	4
I have a strong sense of belonging to the G/L/B community		1	2	3	4
I have a lot of pride in the G/L/B community		1	2	3	4
I feel a strong sense of attachment towards the G/L/B community		1	2	3	4
I feel good about being G/L/B		1	2	3	4

Marlowe-Crowne Social Desirability Scale (long-form)

(Reynolds, 1982)

Before voting I thoroughly investigate the qualifications of all the candidates.

I never hesitate to go out of my way to help someone in trouble.

It is sometimes hard for me to go on with my work if I am not encouraged.

I have never intensely disliked anyone.

On occasion I have had doubts about my ability to succeed in life.

I sometimes feel resentful when I don’t get my way.

I am always careful about my manner of dress.

My table manners at home are as good as when I eat out in a restaurant.

If I could get into a movie without paying and be sure I was not seen I would probably do it.

On a few occasions, I have given up doing something because I thought too little of my ability.

I like to gossip at times.

There have been times when I felt like rebelling against people in authority even though I knew they were right.

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

I can remember “playing sick” to get out of something.

There have been occasions when I took advantage of someone.

I’m always willing to admit it when I make a mistake.

I always try to practice what I preach.

I don’t find it particularly difficult to get along with loud mouthed, obnoxious people.

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

When I don’t know something I don’t at all mind admitting it.

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

At times I have really insisted on having things my own way.

There have been occasions when I felt like smashing things.

I would never think of letting someone else be punished for my wrong-doings.

I never resent being asked to return a favor.

I have never been irked when people expressed ideas very different from my own.

I never make a long trip without checking the safety of my car.

There have been times when I was quite jealous of the good fortune of others.

I have almost never felt the urge to tell someone off.

I am sometimes irritated by people who ask favors of me.

I have never felt that I was punished without cause.

I sometimes think when people have a misfortune they only got what they deserved.

I have never deliberately said something that hurt someone’s feelings.

I have almost never felt the urge to tell someone off.

I am sometimes irritated by people who ask favors for me.

I have never felt that I was punished without cause.

I sometimes think when people have a misfortune they only got what they deserved

I have never deliberately said something that hurt someone’s feelings.

PEMS Risk Profile Questions (questions include value choice answers of “not asked”, “refused to answer”, and “don’t know”)

1. In the past 90 days has the client received income or compensation from engaging in sexual intercourse?

2. The type of living arrangement in which the client has resided in the 90 days prior to data collection.

   1. Permanent housing

   2. Non – permanent housing

   3. Institution

   4. Not asked, refused to answer, other, and don’t know

3. The client self-reports having had at least one prior HIV test before data collection.

4. The client’s self-reported current HIV serostatus.

   1. Positive

   2. Negative

   3. Preliminary positive/indeterminate

   4. Not asked, refused to answer, don’t know

5. The self-reported date of client’s most recent HIV negative Test (only if HIV-)

6. Recent STD (not HIV)-The client’s self-reported or laboratory confirmed status of having being diagnosed with syphilis, gonorrhea, or Chlamydia.

7. The client’s self report of having had sex with someone they met initially on the internet

PEMS Client Sexual and IDU Risk Factors

1. Select the activities the client has been involved in within the last 12 months (also 90 days and /or local recall period) that would place the client at risk of either being exposes to HIV or transmitting HIV. (check all that apply)

   1. Injection drug use – the client has used illicit injection drugs/substances

   2. Sex with transgender – the client has had anal or vaginal intercourse with a transgender person

   3. Sex with female – the client has had anal or vaginal intercourse with a female

   4. Sex with male – the client has had anal or vaginal intercourse with a male.

   5. No risk identified – the client reports no risk factors that may have placed the client at potential risk for HIV exposure and/or transmission

   6. Refused to answer – the client declined or was unwilling to report his/her risk factors

   7. Other – the client reported risk factors other than what is described in the categories described above.

Additional Client Risk Factors

1. If the client risk factors involve sexual activity, select the additional risk factors that further describe the client’s sexual risk for HIV exposure and/or transmission (same recall periods). For each risk factor, indicate whether the vaginal or anal sex was with a male, female and/or transgender. (check all that apply)

   1. No additional risk information specified –

   2. The client participated in sex events in exchange for drugs, money, or something they needed.

   3. The client used alcohol and/or illicit drugs before and/or during sex.

   4. The client has had sex with a person who is an IDU

   5. The client has had sex with a person who is HIV+.

   6. The client has had sex with a person whose HIV status is unknown.

   7. The client has had sex with a person who exchanges sex for drugs or money.

   8. The client is a female and has had sex with a person who has male to male sex.

   9. The client has had sex with a person whose identity was unknown to the client

   10. The client has had sex with a person who has hemophilia or is a transfusion/transplant recipient.

   11. The client had sex without using a condom.

   12. The provider did not ask the client about additional sexual risk factors.

   13. The client declines or is unwilling to report additional sexual risk factors.

2. If the client reports injection drug use, select the additional value choices of:

   1. Whether the client shared drug injection equipment. (check if applicable)

   2. The client’s self-reported drugs/substances that they have injected in the past 12 months (90 days and/or local recall).

      1. Heroin and cocaine together

      2. Heroin alone

      3. Cocaine alone

      4. Crack

      5. Amphetamines, speed, crystal, meth, ice

      6. Other narcotic drugs

      7. Hormones

      8. Steroids

      9. Silicone

      10. Botox

      11. Other medical substances

Table I-Detailed Risk Behavior (variables are optional or for special studies)

1. Number of sex partners with serodiscordant or HIV status unknown

2. Number of HIV status unknown sex partners that were anonymous

3. Total number of sex events

4. Number of sex events with serodiscordant or HIV status unknown partners

5. Number of unprotected sex events

6. Number of unprotected sex events with a serodiscordant or HIV status unknown partner (total/male/female/transgender)

7. Number of unprotected sex events with injection drug user

8. Number of unprotected sex events with partner who exchanged sex for drugs or money

9. Number of unprotected sex events while intoxicated and/or high on non-injection drugs

   1. What drugs

      1. Amphetamine, meth, speed, crystal, crank, etc

      2. Crack

      3. Cocaine

      4. Downers

      5. Pain killers

      6. Hallucinogens such as LSD

      7. Ecstasy

      8. Club drugs such as GHB, ketamine

      9. Heroin (smoked, snorted)

      10. Marijuana

      11. Poppers

      12. Alcohol

      13. Refused to answer

      14. Other

      15. Don’t know

10. Number of Needle sharing events

11. Number of injection drug events with a serodiscordant or HIV status unknown partner

Quantitative Measures of Religiosity and Spirituality for CDC UR1 PS000707

• Behavioral Measure:

  • Religious Background and Behaviors Questionnaire

  • Connors, G., Tonigan, J., & Miller, W. (1996). A measure of religious background and behavior for use in behavior change research. Psychology of Addictive Behaviors, 10 (2), 90-96.

  • This is a 13 item measure that assesses religious activities (current and past). The 1^st question ask participants to identify which best describes their religious beliefs (Atheist, Agnostic, Unsure, Spiritual, Religious). The next 6 questions are on a 8 point Likert scale (Never=1 to More than once a day=8) and ask participants to indicate how often they engage in certain behaviors ( ex: “For the past year, how often have you done the following: Thought about God?”). The last 6 questions ask have participants ever in their life engaged in certain behaviors (ex. Have you ever in your life meditated? Never=1, Yes, in the past but not now=2, or Yes, and I still do=3). The original scale had an alpha of .86. The subscales had alpha’s of .76 (God consciousness) and .81 (formal practices). This scale was updated and adapted for the purposes of the present study.

Religious Background and Behaviors Questionnaire

Adapted from:

Conners, G., Tonigan, J., & Miller, W. (1996). A measure of religious background and behavior for use in behavior change research. Psychology of Addictive Behavior, 10(2), 90-96.

1. Which of the following best describes you at the present time? (Check one)

(For the purposes of these questions, please think about “Higher power” as God or any other divine being that a person may worship.)

_____Atheist I do not believe in a Higher Power.

_____Agnostic I believe we can't really know about a Higher Power.

_____Unsure I don't know what to believe about Higher Power.

_____Spiritual I believe in a Higher Power, but I'm not religious.

_____Religious I believe in Higher Power and practice religion.

2. For the past year, how often have you done the following?

	Never	Rarely	Once a month	Twice a month	Once a week	Twice a week	Almost daily	More than once a day
Thought about a Higher Power	1	2	3	4	5	6	7	8
Prayed	1	2	3	4	5	6	7	8
Meditated	1	2	3	4	5	6	7	8
Attended worship service	1	2	3	4	5	6	7	8
Read-studied scriptures, holy writings	1	2	3	4	5	6	7	8
Had direct experiences with a Higher Power	1	2	3	4	5	6	7	8

3. Have you ever in your life:

	Never	Yes, in the past but not now	Yes, and I still do
Believe in a Higher Power?	1	2	3
Prayed?	1	2	3
Mediated?	1	2	3
Attended worship services regularly?	1	2	3
Read scriptures or holy writings regularly?	1	2	3
Had direct experiences with a Higher Power?	1	2	3

• Cognitive/Affective Measure:

  • Spiritual Well-Being Scale

  • This instrument consists of 20 items which measure religious and existential well-being. These two subscales summed give an overall spiritual well-being score. The items are measured on a 7 point Likert scale (Strongly Agree=1 to Strongly Disagree=7). The original subscales reached alphas of .96 for religious well-being, .86 for existential well-being and .93 for overall spiritual well being. This scale has been used on multiple groups making it a great scale to use on BMSM with an intersection of identities and social groups. In the adaptation, the word “God” was replaced with “Higher Power” so as to be inclusive of many spiritualities.

Spiritual Well-Being Scale

Adapted from:

Ellison, C. (1983). Spiritual well-being: conceptualization and measurement. Journal of Psychology and Theology, 11(4), 330-340.

(For the purposes of these questions, please think about “Higher power” as God or any other divine being that a person may worship.)

For each of the following statements, please check the choice that best indicates the extent of your agreement or disagreement as it describes your personal experience:

1: Strongly Agree 4: Disagree

2: Moderately Agree 5: Moderately Disagree

3. Agree 6: Strongly Disagree

	SA	MA	A	D	MA	SD
I don't find much satisfaction in private prayer with a Higher Power.	1	2	3	4	5	6
I don't know who I am, where I came from, or where I'm going.	1	2	3	4	5	6
I believe that a Higher Power loves me and cares about me.	1	2	3	4	5	6
I feel that life is a positive experience.	1	2	3	4	5	6
I believe that a Higher Power is impersonal and not interested in my daily situations.	1	2	3	4	5	6
I feel unsettled about my future.	1	2	3	4	5	6
I have a personally meaningful relationship with a Higher Power.	1	2	3	4	5	6
I feel very fulfilled and satisfied with life.	1	2	3	4	5	6
I don't get much personal strength and support from my Higher Power.	1	2	3	4	5	6
I feel a sense of well-being about the direction my life is headed in.	1	2	3	4	5	6
I believe that a Higher Power is concerned about my problems.	1	2	3	4	5	6
I don't enjoy much about life.	1	2	3	4	5	6
I don't have a personally satisfying relationship with a Higher Power.	1	2	3	4	5	6
I feel good about my future.	1	2	3	4	5	6
My relationship with a Higher Power helps me not to feel lonely.	1	2	3	4	5	6
I feel that life is full of conflict and unhappiness.	1	2	3	4	5	6
I feel most fulfilled when I'm in a close communion with a Higher Power.	1	2	3	4	5	6
Life doesn't have much meaning.	1	2	3	4	5	6
My relation with a Higher Power contributes to my sense of well-being.	1	2	3	4	5	6
I believe there is some real purpose for my life.	1	2	3	4	5	6