Round 3 questionnaire

NHBS_Round3_Q-aire_v13_Clean_5Dec11.docx

National HIV Behavioral Surveillance System

SX-51. In the past 12 months, how often have you used the internet to meet or socialize with gay men either for friendship or sex? These could include social network websites (such as Facebook or MySpace), websites directed towards gay men (such as Manhunt or Gay.com), dating websites, or the use of mobile social applications (such as Foursquare or Grindr). Was it: [GIVE RESPONDENT FLASHCARD L. READ CHOICES. CHECK only ONE.]

TX-1b. In the past 12 months, did you try to get into an alcohol treatment program but were unable to?

TX-2b. In the past 12 months, did you try to get into a drug treatment program but were unable to?

HT-8b. Before today, have you ever heard of people who do not have HIV taking antiretroviral medicines, to keep from getting HIV?

HT-9. Before today, have you ever heard of people who do not have HIV taking anti-HIV medicines, to keep from getting HIV?

HEALTH CONDITIONS (HC)

Round 3 questionnaire

OMB: 0920-0770

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0770 can be found here:

Document [docx]

Download: docx | pdf

Form Approved:

OMB No. 0920-0770

Expiration Date: 05/31/2014

National HIV Behavioral Surveillance System: Eligibility Screener

Public reporting burden of this collection of information is estimated to average 5 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, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0770). Do not send the completed form to this address.

National HIV Behavioral Surveillance System: Eligibility Screener

AUTO1. NHBS Round ___ ___ AUTO2. NHBS Cycle ____ (1=MSM; 2=IDU; 3=HET)

AUTO3 Date of Interview: __ __/ __ __ / __ __ __ __ AUTO4. Time Begin __ __:__ __  1AM  2PM

^{(M
M / D D / Y Y Y Y )}

AUTO5. Version ______________________________________

Interviewer Entered Information

INT1. Interviewer ID __ __

INT2. Enter City __ __

INT3. Survey ID ___ ___ ___ ___

If the length of Survey ID is 4 digits and Cycle=1 skip to INT4;

If the Length of Survey ID is 4 digits and Cycle=2 or 3 skip to INT9.

CONF1. Interviewer: The survey ID that you entered was [INT3]. Is this correct?

No………………………………………………  0 Loop back to INT3

Yes……………………………………………...  1

If NHBS-IDU or NHBS-HET (CYCLE=2 or 3), skip to INT9.

INT4. Venue Code ___ ___ ___ ___

INT5. Event Number ___ ___ ___ ___

INT6. Interviewer: Is this interview a “Post Event Appointment”?

No……………………………………  0 Skip to Say Box before ES1

Yes……………………………………………...  1

If INT4 is equal to 0, the skip to Say box before ES1.

P ost Event Appointment

INT7. Enter the field site ID for the location of the interview: ___ ___ ___ ___

INT8. Enter the date of the recruitment event: ___ ___ / ___ ___/ ___ ___ ___ ___

^{M
M / D D / Y Y Y Y}

If NHBS-MSM (CYCLE=) 1, skip to Say Box before ES1.

INT9. Field Site ID ___ ___

CONF2. Interviewer: The field site ID that you entered was [Response to INT9]. Is this correct?

No……….……………….…………..  0 Loop back to INT9

Yes………………………….…….........  1

INT10. Interviewer: Is participant a seed?

No……….……………….…………..  0

Yes………………………….…….........  1

FOR ALL NHBS CYCLES

SAY: I’d like to thank you again for your interest in this health survey. Remember that all information you give me will be kept private and I will not ask for your name. First, I will ask you a few questions about yourself and then the computer will determine if you have been selected to participate in the health survey.

Eligibility Screener Questions

ES1. What is your date of birth?

__ __/ __ __ / __ __ __ __

[Refused = 77/7777, Don't know = 99/9999]^{(M M / D D / Y Y Y Y )}

So, you are [insert calculated age] years old. Is that correct?

No……….……………….………….. 0 Loop back to ES1

Yes………………………….……...... 1

If Respondent is <18 years old, skip to End1

ES2. During 20xx, did you already complete at least part of the health survey that [Insert Project Name] is conducting? It could have been here or at another location.

No………………….……………………………  0

Yes……………………………………………...  1

Known previous participant…………………...  2

Refused to answer………………………………  7

Don't know……………..……………………...  9

ES3. Do you consider yourself to be Hispanic or Latino/a? [Interviewer: If necessary, say “Just tell me Yes or No.”]

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know……………..……………………...  9

If ES3 in (0, 7, 9), skip to ES4.

ES3a. What best describes your Hispanic or Latino ancestry?

[READ CHOICES. CHECK ALL that apply.]

Mexican…………….…..………………………  1

Puerto Rican………..…………………………...  2

Cuban…………...…………………..…………..  3

Dominican……...…………………..…………..  4

Some other ancestry (Specify)………………..... 5

Refused to answer………....……………………  7

Don't know………………………..…………….  9

ES4. [GIVE RESPONDENT FLASHCARD A.] Which racial group or groups do you consider yourself to be in? You may choose more than one option. [READ CHOICES. CHECK ALL THAT APPLY.]

American Indian or Alaska Native……………  1

Asian ..……………………..……………….......  2

Black or African American ……………..……..  3

Native Hawaiian or Other Pacific Islander…….  4

White ……………..…………………………….  5

Refused to answer………....……………………  7

Does not apply ………....……………………  8

Don't know………………………..…………….  9

ES5. What county do you currently live in?_________________________________________

(List of eligible counties on computer)

If “Other” county chosen, specify, then skip to Logic check before ES6.

ES5a. How long have you been living in [project area]? (Interviewer: If response is in months, enter 0 below and then enter the number of months in the next screen.)

Years __ __ [Refused = 777, Don't know = 999]

If ES5a= 1-100, 777, or 999, skip to Logic Check before ES6

ES5b. Number of months: __ __

range of values= 1-11 [Refused = 77, Don't know = 99]

For NHBS-MSM, skip to ES8

For NHBS-IDU, skip to ES9

For NHBS-HET, ask ES6 - ES7a, then skip to ES9

ES6. What zip code do you live in?

[Refused = 77777, Don't know = 99999] __ __ __ __ __

ES7. SHOW RESPONDENT THE MAP. Please take a look at this map. Can you point to the area where you live?

Interviewer: Enter 6-digit census tract #_____________

(Refused= 777777, Don't know= 999999)

ES7a. IF RESPONDENT IS A SEED (INT10=1)

Interviewer: Does participant live in a High Risk Area?

No ………………………………………………… 0

Yes ………………………………………………... 1

Skip to ES9

FOR NHBS-MSM

ES8. What was your sex at birth? [CHECK only ONE]

Male…...……………………………………….  1

Female…....…....……………………………….  2

Intersex/ambiguous………....………………….  3

Refused to answer………....………………  7

Don't know……………..……………………..  9

FOR ALL NHBS CYCLES

ES9. Do you consider yourself to be male, female, or transgender? [CHECK only ONE]

Male…...……………………………………….  1

Female…....…....……………………………….  2

Transgender………………....………………….  3

Refused to answer………....………………  7

Don't know……………..……………………..  9

If NHBS-IDU skip to ES10. If NHBS-HET, skip to Logic check before ES17.

NHBS-MSM behavioral eligibility questions

ES9a. Have you ever had vaginal or anal sex with a woman?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know……………..…………………….....  9

ES9b. Have you ever had oral or anal sex with a man?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know……………..…………………….....  9

FOR NHBS-MSM, skip to SAY Box before ES18

FOR NHBS-IDU, ask ES10 - ES17b, then skip to SAY Box before ES18

FOR NHBS-HET, skip to Logic Check before ES17

NHBS-IDU behavioral eligibility screener questions

ES10. Have you ever in your life shot up or injected any drugs other than those prescribed for you? By shooting up, I mean anytime you might have used drugs with a needle, either by mainlining, skin popping, or muscling.

Shape2 No………………….……………………………  0 Skip to SAY box before ES18

Yes……………………………………………...  1

Shape3 Refused to answer………………………………  7

Don't know……………..…………………….....  9 Skip to SAY box before ES18

ES11. When was the last time you injected any drug? That is, how many days or months or years ago did you last inject? [Interviewer: Enter the number below. If today, enter 0]

Number __ ___ ___

[Refused = 777, Don't know = 999]

If ES11 in (777, 999), skip to ES12.

ES11a. Interviewer: Was this days or months or years? [If today, enter “days”]

Days…………………1

Months.…………….. 2

Years……………….. 3

Refuse to answer….…7

Don’t know……….…9

ES12. Which drug do you inject most often? [READ CHOICES. CHECK ONLY ONE]

Speedball – Heroin and cocaine together ……. 1

Heroin, by itself………………… …………….. 2

Cocaine, by itself……………………………… 3

Crack………………………………………….. 4

Crystal, meth, tina, crank, ice……………………... 5

Something else (Specify________________). 6

Refused to answer………....…………………  7

Don't know………………………..…………  9

ES13. Where on your body do you usually inject? [CHECK ALL THAT APPLY]

[Interviewer: Have participant show ALL injection areas on body. Check for physical signs of injection]

Fresh track marks……………………………… 1

Needle-sized scabs…………………………….. 2

Abscesses……………………………..………. 3

Old track marks or scars...…………………….. 4

Injects in covered area ...………………………. 5

No physical signs...…………………………….. 6

Respondent refused to show…..……………….. 7

If participant has no visible physical signs of current injection, ask ES14-ES16. Otherwise, go to SAY Box before ES18.

ES14. Step-by-step, tell me how you prepare your drugs.

INTERVIEWER:

Description could include:

Mix drugs with water or lemon juice/vinegar

Use cooker /Heat drugs

Use filter

Description OK………………………………… 1

Description Not OK……………………………. 2

ES15. Step-by-step, tell me how you inject your drugs.

INTERVIEWER:

Description could include:

Tie off and find vein (IVDU)

Clean injection site

Description OK……………………………… 1

Description Not OK………………………….. 2

ES16. What type of syringe do you usually inject with?

INTERVIEWER:

Description could include:

Syringe size (in cc’s or units)

Needle size (gauge, length)

Cap (color, number)

(Can also ask where they usually get syringes, what they do with them after injecting, and how they know if they are new or used)

Description OK……………………………… 1

Description Not OK………………………….. 2

If NHBS-IDU, skip to SAY Box before ES18

NHBS-HET behavioral eligibility questions

SAY: The next questions are about having sex. Please remember your answers will be kept private.

IF ES9 is not 1 (male) or 2 (female), then skip to ES17c.

ES17. Have you had sex with a [insert “man” if respondent is female; insert “woman” if respondent is male] in the past 12 months?

No………………………………………………  0

Yes……………………………………………...  1

Refused to answer………....…………………  7

Don't know………………………..…………  9

If ES17 is not 1, skip to SAY box before ES18.

ES17a. Did you have vaginal sex? By vaginal sex, I mean [insert “he put his penis in your vagina” if respondent is female; insert “you put your penis in her vagina” if respondent is male].

No………………………………………………  0

Yes……………………………………………...  1

Refused to answer………....…………………  7

Don't know………………………..…………  9

If ES17a = 1, skip to SAY box before ES18.

ES17b. Did you have anal sex? By anal sex, I mean [insert “he put his penis in your anus (butt)” if respondent is female; insert “you put your penis in her anus (butt)” if respondent is male]

No………………………………………………  0

Yes……………………………………………...  1

Refused to answer………....…………………  7

Don't know………………………..…………  9

If ES17b = 1, skip to SAY box before ES18.

CONF3. Ask the following if ES17=1 AND ES17a=0 AND ES17b=0):

“So, in the last 12 months, you only had oral sex with a [insert “man” if respondent is female; insert “woman” if respondent is male]? Is that correct?

If NOT correct, go back to ES17a.

If CORRECT, go to SAY box before ES18.

ES17c. Have you had sex in the past 12 months?

No………………………………………………  0

Yes……………………………………………...  1

Refused to answer………....…………………  7

Don't know………………………..…………  9

SAY: We’ve finished the first series of questions. Now the computer will determine whether you’ve been selected to participate in the survey.

FOR ALL NHBS CYCLES

ES18. Interviewer: Is this person alert and able to complete the health survey in English or Spanish?

No……………………………………………. 0

Yes……………………………………………. 1

If ES18=0 and NHBS-MSM or NHBS-IDU, display ES18a; then, go to End1.

If ES18=0 and NHBS-HET, display interviewer instruction ES18b; then go to End1.

ES18a. Interviewer: Specify reason person not able to complete the interview [CHECK ALL that apply]:

Not alert………………………………………  1

Not able to complete in English or Spanish…...  2

Thought to be too young…......………………  3

Other (specify _________)………..…………  4

ES18b. Interviewer: Specify reason person not able to complete the interview [CHECK ALL that apply]:

Not alert………………………………………  1

Not able to complete in English or Spanish…...  2

Thought to be too young…...…………………  3

Thought to be too old…...……………………  4

Other (specify _________)………..…………  5

AUTO6. Time Eligibility Screener Ended: __ __:__ __ : __ __ [Military time HH:MM:SS]

Eligibility is calculated based on cycle-specific eligibility criteria defined in the protocol

End 1. If the participant IS NOT ELIGIBLE:

SAY: Thank you for answering these questions. Unfortunately, the computer has not selected you to participate in the health survey. Thank you again for your time.

End Interview.

End 2. If the participant IS ELIGIBLE:

SAY: Congratulations! The computer has selected you to participate in the health survey. Let me tell you about it. [Interviewer: Proceed with the consent process.]

Skip to Consent section.

CONSENT

Interviewer: Conduct the local IRB-approved consent process

CN-1. Do you agree to take part in the survey?

No………………………………………………  0

Yes……………………………………………...  1

If CN-1 = 0, display: Thank the respondent for answering the questions. Then skip to CN-5.

CN-2. Do you agree to HIV counseling and testing?

No………………………………………………  0

Yes……………………………………………...  1

If CN-2=0, display:

Interviewer: You have documented that the person DID NOT consent to HIV counseling and testing. If the person DID consent to HIV testing, please arrow back and re-enter the consent for HIV testing.

If interviewer confirms CN-2=0, and NHBS-MSM, skip to NHBS-MSM Core Intro.

If interviewer confirms CN-2=0, and NHBS-IDU, skip to NHBS-IDU Core Intro.

If interviewer confirms CN-2=0 and NHBS-HET, skip to NHBS-HET Core Intro.

CN-3. Do you agree to have other lab tests (if offered)?

No………………………………………………  0

Yes……………………………………………...  1

Does not apply….………....…………………… 8

CN-4. Do you agree to let us store a sample of your blood for future testing?

No………………………………………………  0

Yes……………………………………………...  1

Does not apply….………....…………………… 8

If CYCLE=MSM, skip to MSM Cycle OMB statement.

If CYCLE=IDU, skip to IDU Cycle OMB statement.

If CYCLE=HET, skip to HET Cycle OMB statement.

CN-5. We're interested in knowing why people do not want to do this study. Would you mind telling me which of the following best describes the reason you do not want to do this study? [READ CHOICES. CHECK ALL that apply.]

You don’t have time…………………….………  1

You don’t want to talk about these topics……....  2

Some other reason…..…....……………….……  3

You’d rather not say why…..………………......  9

Form Approved:

OMB No. 0920-0770

Expiration Date: 05/31/2014

National HIV Behavioral Surveillance System: Core Questionnaire

MSM Cycle OMB Statement

Public reporting burden of this collection of information is estimated to average 30 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, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0770). Do not send the completed form to this address.

Form Approved:

OMB No. 0920-0770

Expiration Date: 05/31/2014

National HIV Behavioral Surveillance System: Core Questionnaire

IDU Cycle OMB Statement

Public reporting burden of this collection of information is estimated to average 54 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, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0770). Do not send the completed form to this address.

Form Approved:

OMB No. 0920-0770

Expiration Date: 05/31/2014

National HIV Behavioral Surveillance System: Core Questionnaire

HET Cycle OMB Statement

Public reporting burden of this collection of information is estimated to average 39 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, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0770). Do not send the completed form to this address.

National HIV Behavioral Surveillance System: Core Questionnaire

AUTO7. Time core questionnaire began: __ __:__ __ : __ __ [Military time HH:MM:SS]

If CYCLE=MSM, skip to MSM Core Intro.

If CYCLE=IDU, skip to IDU Core Intro.

If CYCLE=HET, skip to HET Core Intro.

NHBS-MSM Core Intro:

SAY: “Most people have never been in an interview like this one, so I’m going to describe how it works before we start. I will read you questions exactly as they are written. Some may sound awkward but I need to read them as worded so everyone in the study is asked the same questions. Some questions will ask you to recall if you did something, when you did it, or how often you did it. For others, I’ll read or show you a list of responses to choose from. Please be as accurate as you can.”

Go to the Demographics Section.

NHBS-IDU Core Intro:

Go to the Network Section

NHBS-HET Core Intro:

Go to the Network Section

NETWORK (NS)

If Cycle=HET skip to HET Recruiter Relationship

If Cycle=IDU and R IS a seed (INT10=1), Go to IDU Network Size

If Cycle=HET and R IS a seed (INT10=1), Go to HET Network Size

Recruiter Relationship, NHBS-IDU

SAY:

“I'm going to start by asking you about the person who gave you this coupon and about other people you know in [project area] who inject. Please remember that your answers will be kept private.”

NS-1. [GIVE RESPONDENT FLASHCARD B.1.] Which of the following describes how you know the person who gave you this coupon? You can choose more than one answer. [READ CHOICES. CHECK ALL that apply.]

A relative or family member ……….….……................  1

A person you have sex with............................................  2

A person you use drugs with or buy drugs from ………  3

A friend…………………………………………………  4

An acquaintance (that is, a person you know,

but do not consider a friend)…………….………... 5

A stranger (you don’t know the person/just met them… 6

Refused to answer……………………………………… 77

If NS-1 ≠ 6, go to IDU Network Size. Else, go to CONF4.

Recruiter Relationship, NHBS-HET

SAY:

“I'm going to start by asking you about the person who gave you this coupon and about other people you know in [project area]. Please remember that your answers will be kept private.” [Go to NS-1a.]

NS-1a. [GIVE RESPONDENT FLASHCARD B.2.] Which of the following describes how you know the person who gave you this coupon? You can choose more than one answer. [READ CHOICES. CHECK ALL that apply.]

A relative or family member…………………...............  1

A person you have sex with.............................................  2

A friend ……...................................................................  3

An acquaintance (that is, a person you know,

but do not consider a friend)…………….………... 4

A stranger (you don’t know the person/just met them… 5

Refused to answer……………………………………… 77

If NS-1a ≠ 5, go to NS-3. Else, go to CONF4.

CONF4. Confirmation Message if recruiter = stranger:

IF NS-1 = 6 or NS-1a=5,

Where and when did you first see this person?

Interviewer:

If the respondent indicates that they first saw the recruiter in a situation related to the project (e.g. receiving their coupon, waiting outside the storefront, etc.), then check “Recruiter is a stranger.”

Recruiter is a stranger…………₁ If NHBS-IDU, go to NS-2. If NHBS-HET, go to NS-3.

Recruiter is not a stranger……..₂If NHBS-IDU, go to NS-1 and enter relationship.

If NHBS-HET, go to NS-1a and enter relationship.

Network Size – NHBS-IDU

SAY: I’m going to start by asking you about people you know. Specifically, I’m going to ask you about how many people you know in [insert project area] who inject and whom you have seen in the past 30 days. Remember, we are only interested in those people you have seen in the past 30 days. I will not ask you any questions about any specific person.

NS-2. If R IS a seed (INT10=1):

How many males in [insert project area] do you know who inject and whom you have seen in the past 30 days?

[Refused= 7777, Don’t Know= 9999] ___ ___ ___

If R IS NOT a seed (INT10≠1):

How many males in [insert project area] do you know who inject and whom you have seen in the past 30 days? Please include the person who gave you the coupon if they are male.

[Refused= 7777, Don’t Know= 9999]

NS-2a If R IS a seed (INT10=1):

How many females in [insert project area] do you know who inject and whom you have seen in the past 30 days?

[Refused= 7777, Don’t Know= 9999] ___ ___ ___

If R IS NOT a seed (INT10≠1):

How many females in [insert project area] do you know who inject and whom you have seen in the past 30 days? Please include the person who gave you the coupon if they are female.

[Refused= 7777, Don’t Know= 9999] ___ ___ ___

NS-2b So in the past 30 days you’ve seen _______ [insert sum of NS-2 and NS-2a, if NS-2=7777 or 9999, treat response as ‘0’ in the summation, if NS-2a=7777 or 9999, treat as ‘0’ in the summation] people who you know inject and who live in [insert project area]. Would you say that _______ [insert sum of NS-2 and NS-2a] people is about right?

Yes, about right………….……………………………. 0

No, you actually know less people who inject…… … 1

No, you actually know more people who inject……… 2

Refused to answer…………....……………………….. 7

Don't know……………………………………………. 9

If NS-2b = 1 or 2: Go back to NS-2 (ask network size questions again)

If NS-2b = 0 AND

If sum of NS-2 and NS-2a > 3 AND < 7777 AND NS-2b = 0: Skip to Say Box before DM-1.

If sum of NS-2 and NS-2a = 0: Go to CONF5.

If sum of NS-2 and NS-2a > 0 AND sum of NS-2 and NS-2a < 4: Go to CONF6.

If NS-2 = 7777 or 9999: Skip to Say Box before DM-1

CONF5.

If overall network size is 0 (sum of NS-2and NS-2a = 0),

ASK: “You said you don’t know anyone in [project area] who injects that you have seen in the past 30 days. Is this correct? Did you include the person who gave you the coupon?”

If “NO” (R DOES know other injectors): go back to NS-2 (ask network questions again)

If “YES” (R does NOT know any other injector): go to Say Box before DM-1

CONF6.

If overall network size is 1 – 3 (NS-2 and NS_2a = 1, 2, OR 3)

ASK: “Is there anyone else you know in [project area] who injects that you have seen in the past 30 days? Did you include the person who gave you the coupon?”

If ‘NO,’ (respondent does NOT know any other injectors): Go to Say Box before DM-1

If ‘YES’, (respondent DOES know more injectors): Go back to NS-2

-Ask network size questions again.

-Enter the correct network size.

Skip to Say Box before DM-1.

Network Size – NHBS-HET

SAY: I’m going to start by asking you about people you know. Specifically, I’m going to ask you about how many people you know in [insert project area] who you have seen in the past 30 days. Remember, we are only interested in those people you have seen in the past 30 days. I will not ask you any questions about any specific person.

[GIVE RESPONDENT FLASHCARD C]

NS-3. If R IS a seed (INT10=1):

Please tell me how many male friends, relatives or people you associate with have you seen in the past 30 days, who are at least 18 years old, and live in [insert project area].

[Refused= 7777, Don’t Know= 9999] ___ ___ ___

If R IS NOT a seed (INT10≠1):

How many male friends, relatives, or people you associate with have you seen in the past 30 days, who are at least 18 years old, and live in [insert project area]? Please include the person who gave you the coupon if they are male.

[Refused= 7777, Don’t Know= 9999] ___ ___ ___

NS-3a If R IS a seed (INT10=1):

How many female friends, relatives, or people you associate with have you seen in the past 30 days, who are at least 18 years old, and live in [insert project area]?

[Refused= 7777, Don’t Know= 9999] ___ ___ ___

If R IS NOT a seed (INT10≠1):

How many female friends, relatives, or people you associate with have you seen in the past 30 days, who are at least 18 years old, and live in [insert project area]? Please include the person who gave you the coupon if they are female.

[Refused= 7777, Don’t Know= 9999] ___ ___ ___

NS-3b So in the past 30 days you’ve seen _______ [insert sum of NS-2 and NS-2a, if NS-3=7777 or 9999, treat response as ‘0’ in the summation, if NS-3a=7777 or 9999, treat as ‘0’ in the summation] friends, relatives, or people you associate with that live in [insert project area] and are at least 18 years old. Would you say that _______ [insert sum of NS-2 and NS-2a] people is about right?

Yes, about right………….……………….  0

No, you actually know less people………..  1

No, you actually know more people……….  2

Refused to answer…………....……………  7

Don't know…………………………..……  9

If NS-3b = 1 or 2: Go back to NS-2 (ask network size questions again)

If NS-3b = 0 AND

If sum of NS-3 and NS-3a > 3 AND < 7777 AND NS-3b = 0: Skip to Say Box before DM-1.

If sum of NS-3 and NS-3a = 0: Go to CONF7.

If sum of NS-3 and NS-3a > 0 AND sum of NS-3 and NS-3a < 4: Go to CONF8.

If NS-3b = 7777 or 9999: Skip to Say Box before DM-1

CONF7.

IF overall network size is 0 (sum of NS-3 and NS-3a = 0),

ASK: “You said you haven’t seen anyone in the past 30 days in [insert project area] who is a friend, relative, or someone you associate with who is at least 18 years old. Is this correct? Did you include the person who gave you the coupon?”

If ‘No’: (R DOES know others) go back to NS-3 (ask network questions again)

If ‘Yes’: (R Does NOT know any others) go to Say Box before DM-1.

CONF8.

IF overall network size is 1 – 3 (sum of NS-3 and NS-3a = 1, 2, OR 3)

ASK: “Is there anyone else you know in [insert project area] who is a friend, relative, or someone you associate with who is at least 18 years old who you’ve seen in the past 30 days? Did you include the person who gave you the coupon?”

If ‘NO’ (R Does NOT know any others): go to Say Box before DM-1

If ‘YES’ (R DOES know others): Go back to NS-3

-Ask network size questions again

-Enter the correct network size.

Skip to Say Box before DM-1.

National HIV Behavioral Surveillance System: Core Questionnaire

__________________________________________________

Demographics (DM)

SAY: [If NHBS-MSM, insert “I’d like to start by asking”; otherwise, insert “Next, I’d like to ask you”] some questions about where you live. Please remember your answers will be kept private.”

DM-1. In the past 12 months, that is, since <interview month> of last year, have you been homeless at any time? By homeless, I mean you were living on the street, in a shelter, in a Single Room Occupancy hotel (SRO) , or in a car.

No.………………….…………………………  0

Yes……………………………………………  1

Refused to answer.……………………………  7

Don't know……………..……………………….  9

If NHBS-MSM or NHBS-IDU and DM-1 in (0, 7, 9), skip to DM-2.

If NHBS-HET and DM-1 in (0, 7, 9), skip to DM-3.

DM-1a. Are you currently homeless?

No………………….……………….………….  0

Yes….……………………………….……........  1

Refused to answer………………………..…….  7

Don't know.……………..………………..........  9

If NHBS-HET, skip to DM-3.

DM-2. What zip code do you live in?

[Refused = 77777, Don't know = 99999] __ __ __ __ __

DM-3. Next, I would like to ask you some questions about your background. What country were you born in? [DO NOT read choices. Check only ONE.]

United States….………………….………….  1 Mexico….………………….………….……….  2

Puerto Rico..……………….………….……….  3

Cuba…….………………….………….……….  4

Other (Specify_________________)………...  5

Refused to answer………………………….…..  77

Don't know…….………………………….….....  99

For NHBS-MSM:

If DM-3 in (1, 77, 99), skip to DM-5.

If CITY= San Juan, PR, and DM3=3, skip to DM-5.

For NHBS-IDU and NHBS-HET:

If DM-3 in (1, 77, 99), skip to DM-4.

If CITY= San Juan, PR, and DM3=3, skip to DM-4.

DM-3a. What year did you first come to live in the United States?

[7777 = Refused, 9999 = Don't know] __ __ __ __

^{(Y Y Y Y )}

DM-3b. What language are you most comfortable using with your family and friends? [DO NOT READ CHOICES. CHECK ONLY ONE.]

English  1

Spanish  2

Chinese  3

Tagalog  4

Korean  5

Portuguese  6

Other (Specify:__________________________)  7

Refused to answer  77

Don’t know  99

For NHBS-MSM, skip to DM-5

For NHBS-IDU AND NHBS-HET, ask DM-4 through DM-4a

DM-4. What is your current marital status?

[READ CHOICES. CHECK only ONE.]

Married……...………………………………… 1

Living together as married……………………... 2

Separated…….……….…………………..…….. 3

Divorced…….…….…………………..……….. 4

Widowed….………..…………………………... 5

Never married……...………..………………… 6

Refused to answer……………………………  7

Don't know…..……………..……………….....  9

If DM-4= 2, ask DM-4a. Otherwise, skip to DM-5.

DM-4a. Is your formal marital status separated, divorced, widowed, or never married?

Separated…….……….…………………..…….. 1

Divorced…….…….…………………..……….. 2

Widowed….………..…………………………... 3

Never married……...………..……………… 4

Refused to answer………………………………  7

Don't know….……………..……………….......  9

DM-5. What is the highest level of education you completed?

[DO NOT read choices. CHECK only ONE.]

Never attended school….………………………….  00

Grades 1 through 8….…………………...………..  01

Grades 9 through 11..…………………….…….….  02

Grades 12 or GED...….……..…..…………………  03

Some college, Associate’s Degree, or Technical Degree…….  04

Bachelor’s Degree..………….…………….………  05

Any post graduate studies ………….…………….  06

Refused to answer………………..………………..  77

Don't know……..………………..………………..  99

DM-6. What best describes your employment status? Are you: [READ CHOICES. CHECK only ONE.]

Employed full-time………………….……………………….  01

Employed part-time…………………………………………  02

A homemaker….……….…………………...……………….  03

A full-time student…….…….………………………………  04

Retired….………..……………………………......................  05

Unable to work for health reasons…………………. ……….  06 Unemployed………..………………………….......................  07

Other………..…………………………..................................  08

Refused to answer………………………..……………………  77

Don't know.……………..………………...................................  99

For Respondents who are not currently homeless (DM-1=0 OR DM-1a=0): Say: Next I'd like to ask you some questions about your household income. By "household income," I mean the total amount of money earned and shared by all people living in your household.

For Respondents who are currently homeless (DM-1a=1):

Say: Next I'd like to ask you some questions about your income. By "income," I mean the total amount of money you earn or receive. This includes money other people share with you.

DM-7. What was your [insert household income if DM-1=0 OR DM-1a=0; insert income if DM-1a=1] last year from all sources before taxes?

GIVE RESPONDENT FLASHCARD E. DO NOT read choices.

SAY: Please take a look at this card and tell me the letter that best corresponds to your monthly or yearly income.

Monthly Income Yearly Income

a. 0 to $417……………... a. 0 to $4,999……………….  00

b. $418 to $833………… b. $5,000 to $9,999………..  01

c. $834 to $1041……… c. $10,000 to $12,499..…  02

d. $1042 to $1250……….d. $12,500 to $14,999…….  03

e. $1251 to $1667.……... e. $15,000 to $19,999……..  04

f. $1668 to $2082………. f. $20,000 to $24,999……..  05

g. $2083 to $2500……… g. $25,000 to $29,999……..  06

h. $2501 to $2916……….. h. $30,000 to $34,999……..  07

i $2917 to $3333……… i. $35,000 to $39,999……..  08

j. $3334 to $4167………. j. $40,000 to $49,999……..  09

k. $4168 to $4999………. k. $50,000 to $59,999……..  10

l. $5000 to $6,250……… l. $60,000 to $74,999..…..  11

m. $6251 or more……….. m. $75,000 or more………  12

Shape4 Refused to answer………. ………………………………. 77 Skip to DM-8

Don't know……..………………………………………..... 99

DM-7a. Including yourself, how many people depended on this income? [MUST BE AT LEAST 1.]

[Refused = 77, Don't know = 99] ___ ___

SAY: The next questions are about health insurance. By health insurance, we mean health plans people get through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills.

DM-8. Do you currently have health insurance or health care coverage?

No………………….……………………………  0 Skip to DM-8b

Shape5

Skip to DM-8b

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

DM-8a. [Give participant Flashcard F.] What kind of health insurance or coverage do you currently have? [READ choices. Check ALL that apply.]

A private health plan (through an employer or purchased directly) ……………..……  01

Medicaid (for people with low incomes).………………..…  02

Medicare (for the elderly and people with disabilities)……….…………………..……  03

Some other government plan …………………………  04

TRICARE (CHAMPUS)……………………………...……….….………..…………..  05 Veterans Administration coverage……………………………..………..………..……  06

Some other health care plan (Specify______________)…...……….………  07

Refused to answer……………………………………..……….………………………  77

Don't know……..………………………………………..……………..………………  99

DM-8b. Is there a place that you usually go when you are sick or you need advice about your health? Do not include internet websites or talking with people who are not health care providers.

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

If DM-8b=7 or 9, skip to DM-9

DM-8b.1. Is this because there is no place you go for health care or because there is more than one place?

There is no place………………….……………  1

There is more than one place…………………  2

Refused to answer………………………………  7

Don't know………………..……………………  9

If DM-8b.1 =1, 7, or 9, skip to DM-9.

DM-8c. What kind of place [if DM-8b=1, fill “is it?”; else fill “do you go to most often”] - a clinic, doctor's office, emergency room, or some other place?

Clinic or health center………………….……  1

Doctor's office or HMO………………….……  2

Hospital emergency room………………….….  3

Some other place………………….…………  4

Doesn’t go to one place most often.…………  5

Refused to answer………………………………  7

Don't know……………..………………………  9

DM-9. In the past 12 months, that is, since <interview month> of last year, have you seen a doctor, nurse, or other health care provider?

No………………….……………………………  0 Skip to DM-9b

Shape6

Skip to DM-9b

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

DM-9a. At any of those times you were seen, were you offered an HIV test? An HIV test checks whether someone has the virus that causes AIDS.

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

Skip to DM-9c.

DM-9b. About how long has it been since you last saw a doctor, nurse, or other health care provider about your own health? Would you say it was…[READ CHOICES. CHECK only ONE.]

Within the past 5 years…..…………………..…  1

More than 5 years ago……………………..…....  2

Refused to answer……………………………  7

Don't know………………..……………………  9

DM-9c. During the past 12 months, was there any time when you needed medical care but didn't get it because you couldn't afford it?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

DM-10. Do you consider yourself to be: [READ CHOICES. CHECK only ONE.]

Heterosexual or "Straight"…………….……......  1

Homosexual, Gay, or Lesbian………………….  2

Bisexual………………………………………..  3

Refused to answer…………………..………….  7

Don’t know................……………………….….  9

If Respondent is male (ES9=1) and DM-10 = 2 or 3, ask DM-10a. Otherwise, skip to Say Box before SX-1.

DM-10a. Have you ever told anyone that you are attracted to or have sex with men?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

If DM-10a in (0, 7, 9), skip to DM-11.

DM-10b. I'm going to read you a list of people you may have told. Please tell me which ones apply. Have you told: [READ CHOICES, CHECK NO OR YES FOR EACH ONE.]

No Yes Refused Does not Don’t

to answer Apply know

1. Gay, lesbian, or bisexual friends …... ……………  0… 1….. 7….  8 ….  9

2. Friends who are not gay, lesbian, or bisexual………  0… 1….  7….  8….  9

3. Family members……………………………………  0… 1….  7…. ….  9

FOR NHBS-IDU AND NHBS-HET: ASK DM-10b.4

4. Spouse or partner…………………………………..  0… 1….. 7….  8….  9

5. Health care provider……………………………….  0… 1….. 7….  8….  9

DM-11 . During the past 12 months, have any of the following things happened to you because someone knew or assumed you were attracted to men? [READ CHOICES, CHECK NO OR YES FOR EACH ONE.]

	No	Yes	Refused to answer	Does not apply	Don’t know
You were called names or insulted	0	1	7		9
You received poorer services than other people in restaurants, stores, other businesses or agencies	0	1	7		9
You were treated unfairly at work or school	0	1	7	8	9
You were denied or given lower quality health care	0	1	7	8	9
You were physically attacked or injured	0	1	7		9

DM-12. [Give participant Flashcard G.] Next, I’m going to read you a statement. Please tell me how strongly you agree or disagree with it, using one of the options on this card.

Most people in [insert project area] are tolerant of gays and bisexuals. Do you…[READ choices. CHECK only ONE.]

Strongly agree……………......……..………………….  01

Agree…………………………….……….....................  02

Neither agree nor disagree……..…..………….............  03

Disagree…………………………………………….…  04

Strongly disagree……… …..………..…….….............  05

Refused to answer………………………………….…  07

Don’t know……..……… …..………..…….….............  09

SEXUAL BEHAVIOR (SX)

If Cycle=MSM and ES9a in (0, 7, 9), skip to the male sex partner section.

If ES9 =2, skip to the FOR FEMALE RESPONDENTS ONLY section

If ES9 = 3, 7, or 9, skip to the ALCOHOL section

FOR MALE RESPONDENTS ONLY

Female Sex Partners (Male respondent)

SAY: Next, I'm going to ask you some questions about having sex. Please remember your answers will be kept private. GIVE RESPONDENT FLASHCARD H.1

For these questions, "having sex" means oral, vaginal, or anal sex. Oral sex means mouth on the vagina or penis; vaginal sex means penis in the vagina; and anal sex means penis in the anus (butt). I need to ask you all the questions, even if some may not apply to your situation.

Interviewer: Use your discretion in using slang terms for the following sexual behavior questions.

If Cycle=MSM or Cycle=HET, skip to SX-2.

SX-1. Have you ever had vaginal or anal sex with a woman?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

If SX-1 in (0, 7, 9), skip to the male sex partner section.

SX-2. How old were you the first time you had vaginal or anal sex with a woman?

[77 = Refused, 99 = Don't know, 88=Not Applicable] __ __

If SX-2=88, skip to CONF13a.

CONF13a. Het sex confirmation – male participants

If SX-2=88, display:

“Interviewer, you have indicated that the participant has never had vaginal or anal sex with a woman. Is this correct?”

No………………….……………………………  0

Yes……………………………………………...  1

If No, go back to SX-2.

If Yes and NHBS-HET, skip to END of Questionnaire.

If Yes and NHBS-MSM or NHBS-IDU, skip to Say Box before SX-26.

SX-3. In the past 12 months, that is, since <interview month> of last year, with how many different women have you had oral, vaginal, or anal sex?

[Refused = 7777, Don't know = 9999] ___ ___ ____ ____

NHBS-MSM & NHBS-IDU Skip Pattern for # of Female Sex Partners:

If SX-3 =1: Ask SX-4a. (RT column)

If SX-3 > 1: Ask SX-4. (LT column)

If SX-3 = 0, 7777, or 9999: Go to the male sex partner section

NHBS-HET Skip Pattern for # of Female Sex Partners:

If SX-3 =1: Ask SX-4a. (RT column)

If SX-3 > 1: Ask SX-4. (LT column)

If SX-3 = 0, 7777, or 9999: Go to CONF13.

CONF-13b. Sex partner confirmation (NHBS-HET):

If SX-3=0, 7777, or 9999, read:

I would like to clarify your response. You indicated that you haven’t had sex with a woman in the past

12 months. Is that correct?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer……………………………...  7

Don’t know…………………………………...  9

If NO (NOT correct), go to SX-3 (ask it again)

If YES, (correct), Refused, or Don’t know, go to END of Questionnaire.

FOR Multiple Female SEX Partners

[Read Say Box and Questions in this column]

fOR One FEmale SEX Partner

[Read Say Box and Question in this column]

SAY: Now I'm going to ask you to describe these sex partners as either main or casual partners. [GIVE RESPONDENT FLASHCARD I]

By “main partner” I mean a woman you have sex with and who you feel committed to above anyone else. This is a partner you would call your girlfriend, wife, significant other, or life partner. And by “casual partner” I mean a woman you have sex with but do not feel committed to or don't know very well.

Refused = 7777, Don't know = 9999

SAY: Now I'm going to ask you to describe this sex partner as either a main or casual, partner.

[GIVE RESPONDENT FLASHCARD I]

Question

Response

Skip Pattern

Question

SX-4. Of the _____ [insert number from SX-3] women you’ve had oral, vaginal, or anal sex with in the past 12 months, how many of them were main partners?

[_____]

If SX-4= SX-3, skip to Multiple main female partners

SX 4a. Was this woman a main partner or a casual partner?

Main partner……  1 Skip to One main female partner

Casual partner…..  2 Skip to One casual female partner

Shape7 Refused to answer..7

Skip to SX-8

Don't know……….9

SX-5. How many were casual partners?

[_____]

Skip Pattern for Multiple Female Sex Partners:

If SX-4 ≠ 0, 7777, or 9999: Go to Multiple main female partners.

Otherwise, if SX-5 ≠ 0, 7777, or 9999: Go to Multiple casual female partners.

MAIN PARTNERS

Multiple Main Female Partners [Read questions in this column] Refused = 7777, Don't know = 9999			One Main Female Partner [Read questions in this column] No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the _______ [insert number from SX-4] female main sex partners you had in the past 12 months.			SAY: Now I'm going to ask you about the female main sex partner you had in the past 12 months.
Question	Response	Skip Pattern	Question	Response	Skip Pattern
SX-6a. Of your ______ [insert number from SX-4] female main partners in the past 12 months, with how many did you have vaginal sex?	[_____]	If 0, 7777, or 9999, skip to SX-6c. If 1 skip to SX-6b (one).	SX-6a. In the past 12 months, did you have vaginal sex with this woman?	[_____]	If 0, 7, or 9, skip to SX-6c.
SX-6b. In the past 12 months, with how many of these ______ [insert number from SX-6a] women did you have vaginal sex without using a condom?	[_____]		SX-6b. In the past 12 months, did you have vaginal sex with her without using a condom?	[_____]	If SX-4 >1 skip to SX-6c(multi).
SX-6c. Of your ______ [insert number from SX-4] female main partners in the past 12 months, with how many did you have anal sex?	[_____]	If 0, 7777, or 9999, skip to SX-6e. If 1 skip to SX-6d (one).	SX-6c. In the past 12 months, did you have anal sex with this woman?	[_____]	If 0, 7, or 9, skip to SX-6e.
SX-6d. In the past 12 months, with how many of these ______ [insert number from SX-6c] women did you have anal sex without using a condom?	[_____]		SX 6d. In the past 12 months, did you have anal sex with her without using a condom?	[_____]	If SX-4 >1 skip to SX-6e (multi).
SX6e. Of your ____ [insert number from SX-4] female main partners, how many did you have sex with for the very first time in the past 12 months?	[_____]		SX-6e. Think about the very first time you had sex with this woman. Was it within the past 12 months?	[_____]
SX-6f. Of your ______ [insert number from SX-4] female main partners in the past 12 months, how many did you give things like money or drugs in exchange for sex?			SX-6f. In the past 12 months, did you give this woman things like money or drugs in exchange for sex?
SX-6g. Of your ______ [insert number from SX-4] female main partners in the past 12 months, how many gave you things like money or drugs in exchange for sex?			SX-6g. In the past 12 months, did this woman give you things like money or drugs in exchange for sex?

CASUAL PARTNERS

If SX-4 = SX-3: Skip to All Female Partners

If SX-4a=1: Skip to Last Female Partner section

If SX-5=0, 7777, or 9999 Skip to All Female Partners section

If SX-5=1 skip to One casual female partners section

If SX-5 >1 skip to Multiple casual female partners section

Multiple casual Female Partners [Read questions in this column] Refused = 7777, Don't know = 9999			One casual Female Partner [Read questions in this column] No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the _______ [insert number from SX-5] female casual sex partners you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well.			SAY: Now I'm going to ask you about the female casual sex partner you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well.
Question	Response	Skip Pattern	Question	Response	Skip Pattern
SX-7a. Of your ______ [insert number from SX-5] female casual partners in the past 12 months, with how many did you have vaginal sex?	[_____]	If 0, 7777, or 9999, skip to SX-7c. If 1 skip to SX-7b (one).	SX-7a. In the past 12 months, did you have vaginal sex with this woman?	[_____]	If 0, 7, or 9, skip to SX-7c
SX-7b. In the past 12 months, with how many of these ______ [insert number from SX-7a] women did you have vaginal sex without using a condom?	[_____]		SX-7b. In the past 12 months, did you have vaginal sex with her without using a condom?	[_____]	If SX-5 >1 skip to SX-7c(multi).
SX-7c. Of your ______ [insert number from SX-5] female causal partners in the past 12 months, with how many did you have anal sex?	[_____]	If 0, 7777, or 9999, skip to SX-7e. If 1 skip to SX-7d (one).	SX-7c. In the past 12 months, did you have anal sex with this woman?	[_____]	If 0, 7, or 9, skip to SX-7e.
SX-7d. In the past 12 months, with how many of these ______ [insert number from SX-7c] women did you have anal sex without using a condom	[_____]		SX-7d. In the past 12 months did you have anal sex with her without using a condom?	[_____]	If SX-5 >1 skip to SX-7e(multi).
SX-7e. Of your ____ [insert number from SX-5] female casual partners, how many did you have sex with for the very first time in the past 12 months?	[_____]		SX-7e. Think about the very first time you had sex with this woman. Was it within the past 12 months?	[_____]
SX-7f. Of your ______ [insert number from SX-5] female casual partners in the past 12 months, how many did you give things like money or drugs in exchange for sex?			SX-7f. In the past 12 months, did you give this woman things like money or drugs in exchange for sex?
SX-7g. Of your ______ [insert number from SX-5] female casual partners in the past 12 months, how many gave you things like money or drugs in exchange for sex?			SX-7g. In the past 12 months, did this woman give you things like money or drugs in exchange for sex?

ALL FEMALE PARTNERS

If SX-3=1 and SX4a ≠ 7 OR 9, skip to LAST FEMALE PARTNER.

SX-8. In the past 12 months, that is, since < interview month> of last year, did you have vaginal or anal sex without a condom with a woman whose HIV status you didn't know?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX-8a . In the past 12 months did you have vaginal or anal sex without a condom with a woman who was HIV negative?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX-8b . In the past 12 months, did you have vaginal or anal sex without a condom with a woman who was HIV positive?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

Last Female Partner

SX-9. Now I would like you to think about the last time you had sex with a woman. When was the last time you had oral, vaginal, or anal sex with a woman? Just tell me the month and year.

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ _

^{(M
M / Y Y Y Y )}

If SX-9 = 77/7777 or 99/9999, go to CONF14.

CONF14. INTERVIEWER, ask:

Did you have sex with a woman in the past 12 months, that is, since &[AGO_1Y]?

No…………………………………………… ₀

Yes…………………………………………..  ₁

Don’t know…………………………………. ₉

Refuse to answer……………………………. ₇

_{If CONF14 =}0 Loop back to SX-3

If CONF14 = (7,9) skip to SX-26

Skip Pattern:

If SX-3 =1: Go to Logic check before SX-11 .

Otherwise, if SX-3 > 1: Ask SX-10.

SX-10 . [GIVE RESPONDENT FLASHCARD I]. Was the woman you had sex with that last time a main partner or a casual partner? Remember, a main sex partner is someone you feel committed to above anyone else. And a casual sex partner is someone you do not feel committed to or don’t know very well.

Main sex partner………......................................  1

Casual sex partner………....................................  2

Refused to answer................................................  7

Don’t know………..............................................  9

If participant had only one female partner and reported NO exchange with only female partner, skip to SX-12.

If last female partner was main (SX-10=1), and participant reported NO exchange sex with any female main partners (both SX-6f and SX-6g= 0), skip to SX-12.

If last female partner was casual (SX-10=2) and participant reported NO exchange sex with any female casual partners (SX-7f and SX-7g = 0), skip to SX-12.

SX-11. When you had sex that last time, did you give her things like money or drugs in exchange for sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX-11a. When you had sex that last time, did she give you things like money or drugs in exchange for sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX-12. When you had sex that last time, did you have vaginal sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX13. During vaginal sex that last time, did you or your partner use a condom?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX-13a. Did you or your partner use the condom the whole time?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX-14. Did you or your partner use the condom to prevent pregnancy, to prevent infections like HIV or other sexually transmitted diseases, to prevent both, or for some other reason?

Pregnancy ………………….…….….................  1

HIV/STDs…………………… ………………..  2

Both….…………………………………………  3

Other reason…………….…….....……………..  4

Refused to answer…………………..…….…….  7

Don't know……………..……………...…........  9

If participant did not report anal sex with only female partner or did not report anal sex with any female partners of the type identified for last female partner, skip to SX-17.

SX-15. When you had sex that last time, did you have anal sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

If SX-15 in (0, 7, 9), skip to CONF15.

SX-16. During anal sex that last time, did you use a condom?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

If SX-16 in (0, 7, 9), skip to SX-17.

SX-16a. Did you use the condom the whole time?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

CONF-15 Confirmation Message: Ask the following if SX-12 and SX-15 = 0:

"So this means you only had oral sex the last time you had sex?"

If participant says “No,” go back to SX-12.

SX-17. Before or during the last time you had sex with this partner, did you use:

[READ CHOICES. CHECK only ONE.] Alcohol..………………….……………………………  1

Drugs…………………………………………………...  2 Both alcohol and drugs………………………………...  3 Neither one……………………………………………...  4

Refused to answer……...………………………………  7

Don't know…….………………..……………………...  9

If SX-17 in (1, 4, 7, 9), skip to SX-18.

SX-17a. Which drugs did you use? [DO NOT read choices. CHECK ALL that apply.]

Marijuana ….……………..…..…...……….……….  1

Speedballs (heroin and cocaine together) .…………  2

Heroin ….……………..…..…...….…………….….  3

Crack cocaine….……………..…..…...….………...  4

Powdered cocaine ….……………..…..…...….……  5

Crystal meth (tina, crank, ice) ….……………..……  6

X or Ecstasy ….……………..…..…...….………….  7

Special K (ketamine) ….……………..…..…...….…  8

GHB ….……………..…..…...….………………….  9

Painkillers (Oxycontin, Vicodin, Percocet) ….…….  10

Downers (Valium, Ativan, Xanax) ….…………….  11

Hallucinogens (LSD, mushrooms) ….……………...  12

Poppers ….……………..…..…...….………………  13

Other drug ......................................................……..  14

Refused to answer…………………..…….…….......  77

Don't know……………..……………...…..............  99

SX-18. The last time you had sex with this partner, did you know her HIV status?

No………………….……………………………  0 Skip to SX-19

Yes……………………………………………...  1 Refused to answer………………………………  7 Skip to SX-19

SX-18a. What was her HIV status?

HIV-negative……………………………..…......  1

HIV-positive…...….…………………..………..  2

Indeterminate……………………………..…….  3

Refused to answer.……………………………...  7

SX-19. Was this partner younger than you, older than you, or the same age as you?

Younger ….……………..…..…...….………………  0

Older ….……………..…..…...….………………  1

Same age ….……………..…..…...….………………  2

Refused to answer…………………..…….…….......  7

Don't know……………..……………...…..............  9

If SX-19 in (0, 2, 7, 9), skip to SX-19b.

SX-19a. What was her age? ___ ___ ___ [777 = Refused, 999 = Don't know]

SX-19b . Which of the following best describes her racial or ethnic background? [READ choices. Choose one.]

American Indian or Alaska Native..……………  1

Asian .……………………..……………….......  2

Black or African American ……………..……..  3

Hispanic or Latino………………………………  4

Native Hawaiian or Other Pacific Islander…….  5

White….……………..…………………………  6

Refused to answer………………………………  7

Don’t know.……………………………………  ₉

SX-20. [GIVE PARTICIPANT FLASHCARD K] As far as you know, has this partner ever injected drugs like heroin, cocaine, or speed?

Would you say she: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-21. As far as you know, has this partner ever used crack cocaine?

Would you say she: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-22. As far as you know, has this partner ever been in prison or jail for more than 24 hours?

Would you say she: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-23. How long have you been having a sexual relationship with this partner? (Please tell me how many days, months, or years). [Interviewer: If “one night stand,” enter 0]

# of Days: __ __ __

# of Months: __ __ __

# of Years: __ __ __

[Refused = 777, Don't know = 999]

If SX-23 > 12 months, skip to SX-25

If SX-23=0, skip to the male sex partners section.

SX-24. [GIVE PARTICIPANT FLASHCARD K] As far as you know, during the time you were having a sexual relationship with this partner, did she have sex with other people? Would you say she: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-24a. During the time you were having a sexual relationship with this partner, did you have sex with other people?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

If SX-23 ≤ 12 months, skip to the male sex partner section

SX-25. [GIVE PARTICIPANT FLASHCARD K] As far as you know, during the past 12 months when you were having a sexual relationship with this partner, did she have sex with other people? Would you say she: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-25a. During the past 12 months when you were having a sexual relationship with this partner, did you have sex with other people?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

Male Sex Partners (Male respondent)

SAY: Now I'm going to ask you some questions about having sex with other men. I need to ask you these questions even if some don't apply to you. Please remember your answers will be kept private. [GIVE RESPONDENT FLASHCARD H.2]

For these questions, "having sex" means oral or anal sex. Oral sex means he put his mouth on your penis or you put your mouth on his penis. Anal sex means you put your penis in his anus (butt) or he put his penis in your anus (butt).

If Cycle=MSM, skip to SX-27.

SX-26. Have you ever had oral or anal sex with a man?

No………………….………….………………..  0 Skip to alcohol use history section

Yes………………………………..………….....  1

Shape8 Refused to answer……………………………  7 Skip to alcohol use history section

Don't know……………..………….………......  9

SX-27. How old were you the first time you had oral or anal sex with a man?

[77 = Refused, 99 = Don't know, 88=Not Applicable] __ __

If SX-27=88, skip to CONF15b.

CONF15b. MSM sex confirmation

If SX-27=88, display: “Interviewer, you have indicated that the participant said he never had either oral or anal sex with a man. Is this correct?”

No………………….……………………………  0

Yes……………………………………………...  1

If No, go back to SX-27.

If Yes and Cycle=MSM, skip to END Section.

If Yes and Cycle=-IDU or Cycle=HET, skip to the alcohol history use section.

SX-28. In the past 12 months, that is, since <interview month> of last year, with how many different men have you had oral or anal sex?

[Refused = 7777, Don't know = 9999] ___ ___ ___ ___

If SX-28 ≥ 1 and SX-28 < 7777, skip to SX-29.

If SX-28 = 0, ask SX-28a, then skip to the venue attendance section.

SX-28a. Think about the last time you had either oral or anal sex with a man. How many years ago was that?

[Refused = 7777, Don't know = 9999] ___ ___ ___ ___ Range: 1 – 99

Skip Pattern for # of Male Sexual Partners: If SX-28 =1, ask SX-29a.

Otherwise, ask SX-29.

FOR Multiple male Partners

[Read Say Box and Questions in this column]

fOR One male Partner

[Read Say Box and Question in this column]

SAY: Now I'm going to ask you to describe these sex partners as either main or casual partners.

[GIVE RESPONDENT FLASHCARD J]

By “main partner” I mean a man you have sex with and who you feel committed to above anyone else. This is a partner you would call your boyfriend, husband, significant other, or life partner. And by “casual partner” I mean a man you have sex with but do not feel committed to or don't know very well.

Refused = 7777, Don't know = 9999

SAY: Now I'm going to ask you to describe this sex partner as either main or casual partners.

[GIVE RESPONDENT FLASHCARD J]

Question

Response

Skip Pattern

Question

SX-29. Of the _____ [insert number from SX-28] men you’ve had oral or anal sex with in the past 12 months, how many of them were main partners?

[_____]

If SX-29 =

SX-28, skip to Multiple main male partners.

SX-29a. Was this man a main partner or a casual partner?

Shape9 Main partner…….... 1 Skip to One main male partner

Shape10 Casual partner…...... 2 Skip to One casual male partner

Shape11 Refused to answer.... 7

Don’t know..…….. ... 9 Last male partner section

SX-30. How many were casual partners?

[_____]

Skip Pattern For Multiple Male Partners:

If SX-29 is not equal to 0, 7777, or 9999, go to Multiple main male partners.

Otherwise, if SX-30 is not equal to 0, 7777, or 9999, go to Multiple casual partners.

MAIN MALE PARTNERS

Multiple Main male Partners [Read questions in this column] Refused = 7777, Don't know = 9999			One Main male Partner [Read questions in this column] No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the _______ [insert number from SX-29] male main sex partners you had in the past 12 months.			SAY: Now I'm going to ask you about the male main sex partner you had in the past 12 months.
Question	Response	Skip Pattern	Question	Response	Skip Pattern
SX-31a. Of your ______ [insert number from SX-29] male main partners in the past 12 months, with how many did you have anal sex?	[_____]	If 0, 7777, or 9999, skip to SX-31c. If 1, skip to SX-31b single.	SX-31a. In the past 12 months, did you have anal sex with this man?	[_____]	If 0, 7, or 9, skip to SX-31c.
SX-31b. In the past 12 months, with how many of these ______ [insert number from SX-31a] men did you have anal sex without using a condom?	[_____]	If 1, skip to SX-31b.1 single.	SX-31b. In the past 12 months, did you have anal sex with him without using a condom?	[_____]	If 0, 7, or 9 and SX-29>1, skip to SX-31c multi.
SX-31b.1. Did you know the HIV status of any of these ___ [insert number from SX-31b] men?	0 = no 1 = yes 7 = Ref	If 0 or 7, skip to SX-31c	SX-31b.1. Did you know his HIV status?	0 = no 1 = yes 7 = Ref	If 0 or 7, skip to SX-31c
SX-31b.2. For how many of these men did you know their HIV status?	[_____]	If 1, ask single partner version of SX-31b.2.	SX-31b.2. What was his HIV status?	HIV-positive…1 HIV-negative…2 Indeterminate…3 Refused……….7	IfSX-29>1, skip to SX-31c multi.
SX-31b.3. Of those ___ [insert number from SX-31b.2] men, how many did you know were HIV-positive?	[_____]
SX-31b.4. How many did you know were HIV-negative?	[_____]
SX-31c. Of your ____ [insert number from SX-29] male main partners, how many did you have sex with for the very first time in the past 12 months?	[_____]		SX-31c. Think about the very first time you had sex with this man. Was it within the past 12 months?	[_____]
SX-31d. Of your ______ [insert number from SX-29] male main partners in the past 12 months, how many did you give things like money or drugs in exchange for sex?			SX-31d. In the past 12 months, did you give this man things like money or drugs in exchange for sex?
SX-31e. Of your ______ [insert number from SX-29] male main partners in the past 12 months, how many gave you things like money or drugs in exchange for sex?			SX-31e. In the past 12 months, did this man give you things like money or drugs, in exchange for sex?		If SX-29a=1, skip to QSX-33.

Skip Pattern for Multiple Male Sex Partners:

If SX-29= SX-28, Skip to SX-33.

Otherwise, if SX-30 is not equal to 0, 7777, or 9999, go to Say Box before SX-32a.

CASUAL PARTNERS

Multiple casual male Partners [Read questions in this column] Refused = 7777, Don't know = 9999			One casual male Partner [Read questions in this column] No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the _______ [insert number from SX-30] male casual sex partners you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well.			SAY: Now I'm going to ask you about the male casual sex partner you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well.
Question	Response	Skip Pattern	Question	Response	Skip Pattern
SX-32a. Of your ______ [insert number fromSX-30] male casual partners in the past 12 months, with how many did you have anal sex?	[_____]	If 0, 7777, or 9999, skip to SX-32c.	SX-32a. In the past 12 months, did you have anal sex with this man?	[_____]	If 0, 7, or 9, skip to SX-32c.
SX-32b. In the past 12 months, with how many of these ______ [insert number from SX-32a] men did you have anal sex without using a condom?	[_____]		SX-32b. In the past 12 months, did you have anal sex without using a condom?	[_____]
SX-32b.1. Did you know the HIV status of any of these ___ [insert number from SX-32b] men?	0 = no 1 = yes 7 = Ref	If 0 or 7, skip toSX-32c.	SX-32b.1. Did you know his HIV status?	0 = no 1 = yes 7 = Ref	If 0 or 7, skip to SX-32c.
SX-32b.2. For how many of these men did you know their HIV status?	[_____]	If 1, ask single partner version of SX-32b.2, then go to SX-32c.	SX-32b.2. What was his HIV status?	HIV-positive…1 HIV-negative…2 Indeterminate…3 Refused……….7
SX-32b.3. Of those ___ [insert number from SX-32b.2] men, how many did you know were HIV-positive?	[_____]
SX-32b.4. How many did you know were HIV-negative?	[_____]
Soft edit check
SX-32c. Of your ____ [insert number from SX-30] male casual partners, how many did you have sex with for the very first time in the past 12 months?	[_____]		SX-32c. Think about the very first time you had sex with this man. Was it within the past 12 months?	[____]
SX-32d. Of your ______ [insert number from SX-30] male casual partners in the past 12 months, how many did you give things like money or drugs in exchange for sex?			SX-32d. In the past 12 months, did you give this man things like money or drugs in exchange for sex?
SX-32e. Of your ______ [insert number from SX-30] male casual partners in the past 12 months, how many gave you things like money or drugs in exchange for sex?			SX-32e. In the past 12 months, did this man give you things like money or drugs, in exchange for sex?

Last Male Partner

SX-33. Now I would like you to think about the last time you had sex with a man. When was the last time you had anal or oral sex with a man? Just tell me the month and year.

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ _

^{(M M / Y Y Y
Y )}

If SX-33 = 77/7777 or 99/9999, go to CONF16.

CONF16. INTERVIEWER:

Did you have sex with a man in the past 12 months, that is, since &[AGO_1Y]?

No…………………………………………… ₀

Yes…………………………………………..  ₁

Don’t know…………………………………. ₉

Refuse to answer……………………………. ₇

_{If CONF16}= (7,9), then skip to SX50

Skip Pattern:

If SX-28=1, go to SX-35.

Otherwise, if SX-28>1, ask SX-34.

SX-34. Was the man you had sex with that last time a main partner or a casual partner? [GIVE RESPONDENT FLASHCARD J]. Remember, a main sex partner is someone you feel committed to above anyone else. And a casual sex partner is someone you do not feel committed to or don’t know very well.

Main sex partner………......................................  1

Casual sex partner………....................................  2

Refused to answer................................................  7

Don’t know………..............................................  9

If participant had one male partner and reported NO exchange with only male partner, skip to SX-36.

If last male partner = main (SX-34 = 1) AND participant reported NO exchange with ANY male main partners, skip to SX-36.

If last male partner = casual (SX-34 = 2) and participant reported NO exchange with ANY male casual partners, skip to SX-36.

SX-35. When you had sex that last time, did you give him things like money or drugs in exchange for sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9

SX-35a. When you had sex that last time, did he give you things like money or drugs in exchange for sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-36. When you had sex that last time, did you have receptive anal sex where he put his penis in your anus (butt)?

No………………….……………………………  0 Skip to SX-38

Shape13 Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9 Skip to SX-38

SX-37. During receptive anal sex that last time, did he use a condom?

No………………….……………………………  0 Skip to SX-38

Shape15 Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know……………..……………………...  9 Skip to SX-38

SX-37a. Did he use the condom the whole time?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-38. When you had sex that last time, did you have insertive anal sex where you put your penis in his anus (butt)?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

If SX-38 in (0, 7, 9), skip to CONF17.

SX-39. During insertive anal sex that last time, did you use a condom?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

If SX-39 in (0, 7, 9), skip to SX-40.

SX-39a. Did you use the condom the whole time?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

CONF17: Ask the following if SX-36 and SX-38 =0:

"So this means you only had oral sex the last time you had sex?"

SX-40. Before or during the last time you had sex with this partner, did you use:

[READ CHOICES. CHECK only ONE.]

Alcohol..………………….……………………………  1

Refused to answer……...………………………………  7

Don't know…….………………..……………………...  9

If SX-40 in (1, 4, 7, 9), skip to SX-41.

SX-40a. Which drugs did you use? [DO NOT read choices. Check ALL that apply.]

Marijuana ….……………..…..…...……….……….  1

Speedballs (heroin and cocaine together) .…………  2

Heroin ….……………..…..…...….…………….….  3

Crack cocaine….……………..…..…...….………...  4

Powdered cocaine ….……………..…..…...….……  5

Crystal meth (tina, crank, ice) ….……………..……  6

X or Ecstasy ….……………..…..…...….………….  7

Special K (ketamine) ….……………..…..…...….…  8

GHB ….……………..…..…...….………………….  9

Painkillers (Oxycontin, Vicodin, Percocet) ….…….  10

Downers (Valium, Ativan, Xanax) ….…………….  11

Hallucinogens (LSD, mushrooms) ….……………...  12

Poppers ….……………..…..…...….………………  13

Other drug ......................................................……..  14

Refused to answer…………………..…….…….......  77

Don't know……………..……………...…..............  99

If participant had one male sex partner in past 12 months, skip to SX-42.

SX-41. The last time you had sex with this partner, did you know his HIV status?

No………………….……………………………  0 Skip to SX-42

Yes……………………………………………...  1 Refused to answer………………………………  7 Skip to SX-42

SX-41a. What was his HIV status?

HIV-negative……………………………..…......  1

HIV-positive…...….…………………..………..  2

Indeterminate……………………………..…….  3

Refused to answer.……………………………...  7

SX-42. Was this partner younger than you, older than you, or the same age as you?

Younger ….….……………..…..…...….………………  0

Older ……….……………..…..…...….………………  1

Same age …….……………..…..…...….………………  2

Refused to answer….…………………..…….…….......  7

Don't know…………………..……………...…..............  9

If SX-42 in (0, 2, 7, 9), skip to SX-42b.

SX-42a. What was his age? ___ ___ ___ [777 = Refused, 999 = Don't know]

SX-42b. Which of the following best describes his racial or ethnic background? [READ choices. Choose one.]

American Indian or Alaska Native..……………  1

Asian .……………………..……………….......  2

Black or African American ……………..……..  3

Hispanic or Latino………………………………  4

Native Hawaiian or Other Pacific Islander…….  5

White….……………..…………………………  6

Refused to answer………………………………  7

Don’t know.……………………………………  ₉

SX-43. [GIVE PARTICIPANT FLASHCARD K] As far as you know, has this partner ever injected drugs like heroin, cocaine, or speed?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-44. As far as you know, has this partner ever used crack cocaine?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-44a. As far as you know, has this partner ever used crystal meth (tina, crank, ice)?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-45. As far as you know, has this partner ever been in prison or jail for more than 24 hours?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-46. How long have you been having a sexual relationship with this partner? (Please tell me how many days, months, or years). [Interviewer: If “one night stand,” enter 0.]

# of Days: __ __ __

# of Months: __ __ __

# of Years: __ __ __

[Refused = 777, Don't know = 999]

If SX-46 > 12 months, 777, or 999, skip to SX-48. If SX-46=0, skip to SX-49.

SX-47. [GIVE PARTICIPANT FLASHCARD K] As far as you know, during the time you were having a sexual relationship with this partner, did he have sex with other people? Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-47a. During the time you were having a sexual relationship with this partner, did you have sex with other people?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

If SX-46≤ 12 months, skip to venue attendance section.

SX-48. As far as you know, during the past 12 months when you were having a sexual relationship with this partner, did he have sex with other people? Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-48a. During the past 12 months when you were having a sexual relationship with this partner, did you have sex with other people?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

If SX-46> or = 3 years or SX-46= Don’t Know or Refused, skip to the venue attendance section

SX-49. Where did you first meet this partner? [DO NOT read choices. Check only ONE.]

Internet…….....….………………..……………  01

Chat line….….................................................  02

Bar/Club..………….............................………...  03

Circuit party or Rave….......................………….  04

Cruising area.………….........................……….  05

Adult bookstore…..…............................………..  06

Bath house, sex club or sex resort….....……….  07

Private sex party……...........................…………  08

Somewhere else.................................…………..  09

Refused to answer…………..….……………….  77

Don't know…..………..……..…………….......  99 Shape16

If NHBS-IDU OR NHBS-HET, skip to SX-52

Venue Attendance

SX-50. In the past 12 months, how often have you gone to a place where gay men hangout, meet or

socialize? These could include bars, clubs, social organizations, parks, gay businesses, bookstores, sex clubs, etc. Was it: [GIVE RESPONDENT FLASHCARD L. READ CHOICES. CHECK only ONE.]

Never More than Once a More than Once More than Once a Less than Refused Don’t

once a day day once a week a week once a month a month once a month to answer Know

 0........ 1……..... 2 .……….. 3……..…. 4..…...… 5……..….. 6.…….… 7…….…77…….. ..99

Never More than Once a More than Once More than Once a Less than Refused Don’t

once a day day once a week a week once a month a month once a month to answer Know

 0........ 1……..... 2 .……….. 3……..…. 4..…... 5……..…….. 6.…….… 7…….… 77……..99

Non-gay identified outness

If DM-10 (Sexual identity)=2 or DM-10=3, skip to the alcohol use history section .

SX-52. The next question is about whether you have told people that you are attracted to or have sex

with men. Have you ever told anyone that you are attracted to or have sex with men?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

If SX-52 in (0, 7, 9), skip to SX-53.

SX-52a. I'm going to read you a list of people you may have told. Please tell me which ones apply. Have you told: [READ CHOICES, CHECK NO OR YES FOR EACH ONE.]

No Yes Refused Does not Don’t

to answer Apply know

1. Gay, lesbian, or bisexual friends …... ……………  0… 1….. 7….  8 ….  9

2. Friends who are not gay, lesbian, or bisexual………  0… 1….  7….  8….  9

3. Family members……………………………………  0… 1….  7…. ….  9

FOR NHBS-IDU AND NHBS-HET: ASK SX-52a.4

4. Spouse or partner…………………………………..  0… 1….. 7….  8….  9

5. Health care provider……………………………….  0… 1….. 7….  8….  9

SX-53. During the past 12 months, have any of the following things happened to you because someone knew or assumed you were attracted to men? [READ CHOICES, CHECK NO OR YES FOR EACH ONE.]

	No	Yes	Refused to answer	Does not apply	Don’t know
You were called names or insulted	0	1	7		9
You received poorer services than other people in restaurants, stores, other businesses or agencies	0	1	7		9
You were treated unfairly at work or school	0	1	7	8	9
You were denied or given lower quality health care	0	1	7	8	9
You were physically attacked or injured	0	1	7		9

SX-53f. [Give participant Flashcard G.] Next, I’m going to read you a statement. Please tell me how strongly you agree or disagree with it, using one of the options on this card.

Most people in [insert project area] are tolerant of gays and bisexuals. Do you…[Read choices. Mark only one.]

Strongly agree……………......……..………………….  01

Agree…………………………….……….....................  02

Neither agree nor disagree……..…..………….............  03

Disagree…………………………………………….…  04

Strongly disagree……… …..………..…….….............  05

Refused to answer………………………………….…  07

Don’t know……..……… …..………..…….….............  09

END OF MALE RESPONDENT SECTION. GO TO the alcohol use history section.

FOR FEMALE RESPONDENTS ONLY

Male Sex Partners (Female respondent)

SX-54. Have you ever had vaginal or anal sex with a man?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

If SX-54 in (0, 7, 9), skip to SX-80.

SX-55. How old were you the first time you had vaginal or anal sex with a man?

[77 = Refused, 99 = Don't know; 88 = Not Applicable] __ __

If SX-55=88, skip to CONF13a.

CONF16b. Het sex confirmation-female participants

If SX-55=88, display:

“Interviewer, you have indicated that the participant has never had either vaginal or anal sex with a man. Is this correct?”

No………………….……………………………  0

Yes……………………………………………...  1

If No, go back to SX-55.

If Yes and NHBS-HET, skip to END of Questionnaire.

If Yes and NHBS-IDU, skip to the alcohol use history section.

SX-56. In the past 12 months, that is, since <interview month> of last year, with how many different men have you had oral, vaginal, or anal sex?

___ ___ ____ ____ [Refused = 7777, Don't know = 9999]

NHBS-IDU Skip Pattern for # of Male Sexual Partners:

If SX-56 =1, ask SX-57a.

If SX-56 >1, ask SX-57.

If 0, 7777, or 9999, skip to SX-80

NHBS-HET Skip Pattern for # of Female Sex Partners:

If SX-56 =1: Ask SX-57a. (RT column)

If SX-56 > 1: Ask SX-57. (LT column)

If SX-56 = 0, 7777, or 9999: Go to CONF18.

FOR Multiple male Partners

[Read Say Box and Questions in this column]

fOR One male Partner

[Read Say Box and Question in this column]

SAY: Now I'm going to ask you to describe the sex partners you've had in the past 12 months as either main or casual partners.

[GIVE RESPONDENT FLASHCARD J]

Refused = 7777, Don't know = 9999

SAY: Now I'm going to ask you to describe this sex partner you've had in the past 12 months as either a main or casual partner.

[GIVE RESPONDENT FLASHCARD J]

Question

Response

Skip Pattern

Question

SX-57. Of the _____ [insert number from SX-56] men you’ve had oral, vaginal, or anal sex with in the past 12 months, how many of them were main partners?

[_____]

If SX-57=

SX-56, skip to Say Box before SX-59a.

SX-57a. Was this man a main partner or a casual partner?

Main partner……. .. 1 Skip to Say Box before SX-59a

Casual partner…..... 2 Skip to Say Box before SX-60a

Shape17 Refused to answer... 7

Skip to SX-61

Don’t know…….. ... 9

SX-58. How many were casual partners?

[_____]

CONF18. Sex partner confirmation:

If SX-56=0, 7777, or 9999, read:

I would like to clarify your response. You indicated that you haven’t had sex with a man in the past 12 months. Is that correct?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer……………………………...  7

Don’t know………..…………………………...  9

If NO (NOT correct), go to SX-56 (ask it again)

If YES, (correct), Refused to answer, or Don’t know, go to End of Questionnaire.

Skip Pattern for Multiple Male Partners:

If SX-57 is not equal to 0, 7777, or 9999, go to Say Box before SX-59a.

Otherwise, if SX-58 is not equal to 0, 7777, or 9999, go to Say Box before SX-60a.

MAIN MALE PARTNERS

Multiple Main male Partners [Read questions in this column] Refused = 7777, Don't know = 9999			One Main male Partner [Read questions in this column] No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the _______ [insert number from SX-57] male main sex partners you had in the past 12 months.			SAY: Now I'm going to ask you about the male main sex partner you had in the past 12 months.
Question	Response	Skip Pattern	Question	Response	Skip Pattern
SX-59a. Of your ______ [insert number fromSX-57] male main partners in the past 12 months, with how many did you have vaginal sex?	[_____]	If 0, 7777, or 9999, skip to SX-59c.	SX-59a. In the past 12 months, did you have vaginal sex with this man?	[_____]	If 0, 7, or 9, skip to SX-59c.
SX-59b. In the past 12 months, with how many of these ______ [insert number from SX-59a] men did you have vaginal sex without using a condom?	[_____]		SX-59b. In the past 12 months, did you have vaginal sex with him without using a condom?	[_____]
SX-59c. Of your ______ [insert number fromSX-57] male main partners in the past 12 months, with how many did you have anal sex?	[_____]	If 0, 7777, or 9999, skip to SX-59e.	SX-59c. In the past 12 months, did you have anal sex with this man?	[_____]	If 0, 7, or 9, skip to SX-59e.
SX-59d. With how many of these ______ [insert number from SX-59c] men did you have anal sex without using a condom?	[_____]		SX-59d. In the past 12 months, did you have anal sex with him without using a condom?	[_____]
SX-59e. Of your ____ [insert number from SX-57] male main partners, how many did you have sex with for the very first time in the past 12 months?	[_____]		SX-59e. Think about the very first time you had sex with this man. Was it within the past 12 months?	[_____]
SX-59f. Of your ______ [insert number from SX-57] male main partners in the past 12 months, how many gave you things like money or drugs in exchange for sex?			SX-59f. In the past 12 months, did this man give you money, drugs, or other things in exchange for sex?
SX-59g. Of your ______ [insert number from SX-57] male main partners in the past 12 months, how many did you give things like money or drugs in exchange for sex?			SX-59g. In the past 12 months, did you give this man things like money or drugs in exchange for sex?		If SX-57a=1, skip to SX-62.

Skip Pattern for Multiple Male Sex Partners:

If SX-57= SX-56, go to SX-62.

Otherwise, if SX-58 is not equal to 0, 7777, or 9999, go to Say Box before SX-60a .

CASUAL PARTNERS

Multiple casual male Partners [Read questions in this column] Refused = 7777, Don't know = 9999			One casual male Partner [Read questions in this column] No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the _______ [insert number from SX-58] male casual sex partners you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well.			SAY: Now I'm going to ask you about the male casual sex partner you had in the past 12 months. Remember, a casual sex partner is someone you do not feel committed to or don't know very well.
Question	Response	Skip Pattern	Question	Response	Skip Pattern
SX-60a. Of your ______ [insert number fromSX-58] male casual partners in the past 12 months, with how many did you have vaginal sex?	[_____]	If 0, 7777, or 9999, skip to SX-60c.	SX-60a. In the past 12 months, did you have vaginal sex with this man?	[_____]	If 0, 7, or 9, skip to SX-60c.
SX-60b. In the past 12 months, with how many of these ______ [insert number from SX-60a] men did you have vaginal sex without using a condom?	[_____]		SX-60b. In the past 12 months, did you have vaginal sex with him without using a condom?	[_____]
SX-60c. Of your ______ [insert number from SX-58] male causal partners in the past 12 months, with how many did you have anal sex?	[_____]	If 0, 7777, or 9999, skip to SX-60e.	SX-60c. In the past 12 months, did you have anal sex with this man?	[_____]	If 0, 7, or 9, skip to SX-60e.
SX-60d. In the past 12 months, with how many of these ______ [insert number from SX-60c] men did you have anal sex without using a condom?	[_____]		SX-60d. In the past 12 months, did you have anal sex with him without a using condom?	[_____]
SX-60e. Of your ____ [insert number from SX-60] male casual partners, how many did you have sex with for the very first time in the past 12 months?	[_____]		SX-60e. Think about the very first time you had sex with this man. Was it within the past 12 months?	[_____]
SX-60f. Of your ______ [insert number fromSX-58] male casual partners in the past 12 months, how many gave you things like money or drugs in exchange for sex?			SX-60f. In the past 12 months, did this man give you money, drugs, or other things in exchange for sex?
SX-60g. Of your ______ [insert number fromSX-58] male casual partners in the past 12 months, how many did you give things like money or drugs in exchange for sex?			SX-60g. In the past 12 months, did you give this man things like money or drugs in exchange for sex?
If SX-56=1 AND SX-57a ≠ 7 OR 9, skip to SX-62.

SX-61. In the past 12 months, that is, since <interview month> of last year, did you have anal or vaginal sex without a condom with a man whose HIV status you didn't know?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-61a. In the past 12 months did you have vaginal or anal sex without a condom with a man who was HIV negative?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-61b. In the past 12 months, did you have vaginal or anal sex without a condom with a man who was HIV positive?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-62. Now I would like you to think about the last time you had sex with a man. When was the last time you had oral, vaginal, or anal sex with a man? Just tell me the month and year.

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ _

^{(M M / Y Y Y
Y )}

If SX-62 = 77/7777 OR 99/9999, go to CONF19.

CONF19. INTERVIEWER:

Did you have sex with a man in the past 12 months, that is, since &[AGO_1Y]?

No…………………………………………… ₀

Yes…………………………………………..  ₁

Don’t know…………………………………. ₉

Refuse to answer……………………………. ₇

If SX-56=1, go to SX-64. Otherwise if SX-56>1, ask SX-63.

SX-63. Was the man you had sex with that last time a main partner or a casual partner? GIVE RESPONDENT FLASHCARD J. Remember, a main sex partner is someone you feel committed to above anyone else. And a casual sex partner is someone you do not feel committed to or don’t know very well.

Main sex partner………......................................  1

Casual sex partner………....................................  2

Refused to answer................................................  7

Don’t know………..............................................  9

If participant had 1 partner and reported NO exchange with only partner, skip to SX-65.

If participant’s last partner was main partner and participant reported NO exchange with ANY main partners, skip to SX-65.

If participant’s last partner was casual and participant reported NO exchange with ANY casual partners, skip to SX-65.

SX-64. When you had sex that last time, did he give you things like money or drugs in exchange for sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-64a. When you had sex that last time, did you give him things like money or drugs in exchange for sex?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-65. When you had sex that last time, did you have vaginal sex?

Shape18

Skip to Logic check before SX-68

No………………….……………………………  0

Shape19

Skip to Logic check before SX-68

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-66. During vaginal sex that last time, did you or your partner use a condom?

Shape20

Skip to Logic check before SX-68

No………………….……………………………  0

Shape21

Skip to Logic check before SX-68

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-66a. Did you or your partner use the condom the whole time?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-67. Did you or your partner use the condom to prevent pregnancy, to prevent infections like HIV or other sexually transmitted diseases, to prevent both, or for some other reason?

Pregnancy ………………….…….…................  1

HIV/STDs…………………… ………………  2

Both….………………………………………  3

Other reason…………….…….....…………….  4

Refused to answer…………………..…….…  7

Don't know……………..……………...…........  9

If participant had 1 male partner and reported NO anal sex with that partner, skip to SX-70.

If participant’s last partner was main and participant reported NO anal sex with ANY main partners, skip to SX-70.

If participant’s last partner was casual and participant reported NO anal sex with ANY casual partners, skip to SX-70.

SX-68. When you had sex that last time, did you have anal sex?

Skip to CONF20.

No………………….……………………………  0

Shape23 Yes……………………………………………...  1 Refused to answer………………………………  7

Skip to CONF20.

Don't know…………..……………………...  9

SX-69. During anal sex that last time, did your partner use a condom?

Shape24

Skip to SX-70

No………………….……………………………  0

Shape25

Skip to SX-70

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-69a. Did he use the condom the whole time?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

CONF20. Ask the following if SX-65 and SX-68=0:

"So this means you only had oral sex the last time you had sex?"

If respondent says “no,” go back to SX-65.

SX-70. Before or during the last time you had sex with this partner, did you use:

[READ CHOICES. CHECK only ONE.]

Alcohol..………………….……………………………  1 Skip to SX-71

Shape26 Drugs…………………………………………………...  2 Both alcohol and drugs………………………………...  3 Neither one……………………………………………...  4

Refused to answer……...………………………………  7 Skip to SX-71.

Don't know…….………………..……………………...  9

SX-70a. Which drugs did you use? [DO NOT read choices. Check that apply.]

Marijuana ….……………..…..…...……….……….  1

Speedballs (heroin and cocaine together) .…………  2

Heroin ….……………..…..…...….…………….….  3

Crack cocaine….……………..…..…...….………...  4

Powdered cocaine ….……………..…..…...….……  5

Crystal meth (tina, crank, ice) ….……………..……  6

X or Ecstasy ….……………..…..…...….………….  7

Special K (ketamine) ….……………..…..…...….…  8

GHB ….……………..…..…...….………………….  9

Painkillers (Oxycontin, Vicodin, Percocet) ….…….  10

Downers (Valium, Ativan, Xanax) ….…………….  11

Hallucinogens (LSD, mushrooms) ….……………...  12

Poppers ….……………..…..…...….………………  13

Other drug ......................................................……..  14

Refused to answer…………………..…….…….......  77

Don't know……………..……………...…..............  99

SX-71. The last time you had sex with this partner, did you know his HIV status?

No………………….……………………………  0 Skip to SX-72

Yes……………………………………………...  1 Refused to answer………………………………  7 Skip to SX-72

SX-71a. What was his HIV status?

HIV-negative……………………………..…......  1

HIV-positive…...….…………………..………..  2

Indeterminate……………………………..…….  3

Refused to answer.……………………………...  7

SX-72. Was this partner younger than you, older than you, or the same age as you?

Y Shape27 ounger ….….……………..…..…...….………………  0 Skip to SX-72b

Older ……….……………..…..…...….………………  1

S Shape28 ame age …….……………..…..…...….………………  2

Refused to answer….…………………..…….…….......  7 Skip to SX-72b

Don't know…………………..……………...…..............  9

SX-72a. What was his age? ___ ___ ___ [777 = Refused, 999 = Don't know]

SX-72b. Which of the following best describes his racial or ethnic background? [READ choices. Choose one.]

American Indian or Alaska Native..……………  1

Asian .……………………..……………….......  2

Black or African American ……………..……..  3

Hispanic or Latino………………………………  4

Native Hawaiian or Other Pacific Islander…….  5

White….……………..…………………………  6

Refused to answer………………………………  7

Don’t know.……………………………………  ₉

SX-73. [GIVE PARTICIPANT FLASHCARD K] As far as you know, has this partner ever injected drugs like heroin, cocaine, or speed?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-74. As far as you know, has this partner ever used crack cocaine?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-75. As far as you know, has this partner ever been in prison or jail for more than 24 hours?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-76. As far as you know, has this partner ever had sex with other men?

Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-77. How long have you been having a sexual relationship with this partner? (Please tell me how many days, months, or years). [Interviewer: If “one night stand,” enter 0.]

# of Days: __ __ __

# of Months: __ __ __

# of Years: __ __ __

[Refused = 777, Don't know = 999]

If SX-77> 12 months, 777, or 999, skip to SX-79. If SX-77≤ 12 months, skip to SX-80.

If SX-77=0, skip to SX-80.

SX-78. [GIVE PARTICIPANT FLASHCARD K] As far as you know, during the time you were having a sexual relationship with this partner, did he have sex with other people? Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-78a. During the time you were having a sexual relationship with this partner, did you have sex with other people?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

SX-79. [GIVE PARTICIPANT FLASHCARD K] As far as you know, during the past 12 months when you were having a sexual relationship with this partner, did he have sex with other people? Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

SX-79a.During the past 12 months when you were having a sexual relationship with this partner, did you have sex with other people?

No………………….……………………………  0

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

Female Sex Partners (Female Respondents)

SX-80. Now I’m going to ask you about having sex with other women. In the past 12 months, with how many different women have you had sex?

[Refused = 7777, Don't know = 9999] ___ ___ ____ ____

ALCOHOL USE HISTORY (AL)

SAY: The next questions are about alcohol use. Please remember your answers will be kept private. For these questions, "a drink of alcohol" means a 12 oz beer, a 5 oz glass of wine, or a 1.5 oz shot of liquor. SHOW RESPONDENT FLASHCARD M (PICTURE OF ALCOHOL DRINK SIZE)

AL-1. In the past 12 months, that is, since <interview month> of last year, did you drink any alcohol such as beer, wine, malt liquor, or hard liquor?

Shape29

Skip to Say Box before ID-1

No………………….……………………………  0

Shape30

Skip to Say Box before ID-1

Yes……………………………………………...  1 Refused to answer………………………………  7

Don't know…………..……………………...  9

AL-2. In the past 12 months, how often did you have 5 or more alcoholic drinks in one sitting? [4 or more drinks if respondent is female.] GIVE RESPONDENT FLASHCARD L. READ CHOICES. CHECK only ONE.

Never….….…………………..………………  0

More than once a day…..………………………  1

Once a day……………………………………  2

More than once a week..…………………….....  3

Once a week.…………………………...............  4

More than once a month.……………………….  5

Once a month…..………………………………  6

Less than once a month.…..……………………  7

Refused to answer………………..……………  77

Don’t know...………..…………………………  99

AL-3. The next questions are about drinking alcohol during the past 30 days, that is, since the [insert day of current month] of last month. During the past 30 days, on how many days did you drink any alcohol?

[77 = Refused, 99 = Don't know] __ __

If AL-3 in (0, 77, 99), skip to Say Box before ID-1.

AL-4. During the past 30 days, on the days when you drank alcohol, how many drinks did you usually

have? (Interviewer: The number of drinks must be greater than 0.)

[77 = Refused, 99 = Don't know] __ __

AL-5. During the past 30 days, how many times did you have 5 or more alcoholic drinks in one sitting? [4 or more drinks if respondent is female.]

[77 = Refused, 99 = Don't know] __ __

DRUG USE HISTORY

Injection Drug Use (ID)

SAY: The next questions are about injection drug use. This means injecting drugs yourself or having someone who isn't a health care provider inject you. Please remember your answers will be kept private.

FOR NHBS-MSM AND NHBS-HET, ASK ID-1

FOR NHBS-IDU, GO TO ID-1a

ID-1. Have you ever in your life shot up or injected any drugs other than those prescribed for you? By shooting up, I mean anytime you might have used drugs with a needle, either by mainlining, skin popping, or muscling.

Shape31 No………………….……………………………  0 Skip to Say Box before ND-1

Shape32 Yes……………………………………………...  1 Refused to answer………………………………  7 Skip to Say Box before ND-1 Don't know…………..……………………...  9

ID-1a. Think back to the very first time you injected any drugs, other than those prescribed for you. How old were you when you first injected any drug?

[77 = Refused, 99 = Don't know] __ __

ID-1bnum. When was the last time you injected any drug? That is, how many days or months or years ago did you last inject? [Interviewer: Enter the number below. If today, enter 000]

Number __ ___ ___

[Refused = 777, Don't know = 999]

ID1b.dmy Interviewer: Was this days or months or years ago that you last injected? [If today, enter “days”]

Days…………………0

Months.…………….. 1

Years……………….. [Refused = 777, Don't know = 999]

If ( ID1b.num=1 and ID1b.dmy=2) or if (ID1b.num=12 and ID1b.dmy=1) or if ID1b.num=365 and ID1b.dmy=0), display:

Interviewer: Was this more than 1 year ago or within the past year?

Within the past year………..

More than 1 year ago………

If last injection was within the past year {need logic with reference number and value}, go to ID-2.

If last injection was more than 1 year ago and CYCLE=1 (MSM) or CYCLE=3(HET), go to Non-Injection Drug Use Section.

If last injection was more than 1 year ago and CYCLE=21 (IDU)), go to End.

If NHBS-MSM or NHBS-HET and ID-1b > 12 months, skip to Say Box before ND-1.

If NHBS-IDU AND ID-1b> 12 months, skip to END of questionnaire.

SAY: The next questions are about injection drug use in the past 12 months, that is, since <interview month> of last year. When I ask you about "needles," I'm talking about needles and syringes.

ID-2. [GIVE RESPONDENT FLASHCARD L] In the past 12 months, on average, how often did you inject? READ CHOICES. CHOOSE only ONE.]

Never..….….…………………..………………  0

More than once a day…..………………………  1

Once a day….…………………………………  2

More than once a week..…………………….....  3

Once a week…………………………...............  4

More than once a month……………………….  5

Once a month…..………………………………  6

Less than once a month…..……………………  7

Refused to answer………………..……………  77

Don’t know..………..…………………………  99

SAY: [GIVE RESPONDENT FLASHCARD L] I'm going to read you a list of drugs. For each drug I mention, please tell me how often you injected it in the past 12 months, that is, since <interview month> of last year.

ID-3. How often did you inject… READ EACH DRUG CHOICE. CHOOSE ONLY ONE RESPONSE PER TYPE OF DRUG

	Never	More than once a day	Once a day	More than once a week	Once a week	More than once a month	Once a month	Less than once a month	Refused to answer
Speedball (heroin & cocaine together)	00	01	02	03	04	05	06	07	77
Heroin, by itself	00	01	02	03	04	05	06	07	77
Powdered cocaine , by itself	00	01	02	03	04	05	06	07	77
Crack cocaine	00	01	02	03	04	05	06	07	77
Crystal meth (tina, crank, or ice)	00	01	02	03	04	05	06	07	77
Oxycontin	00	01	02	03	04	05	06	07	77

ID-3g1. Did you inject any other drugs in the past 12 months?

Shape33 No………………….…………………………  0 Skip to SAY box before ID-4

Shape34 Yes……………………………………………  1 Refused to answer……………………………  7 Skip to SAY box before ID-4

Don't know……………..……………………... 9

Specify other drug _____________________

ID-3g2. How often did you inject [Interviewer: insert other drug specified]:

More More More Less

than than than than

once a Once a once a Once a once a Once a once a Refused Never day day week week month month month to answer

g. (Other drug). .00.. 01…..02…..03…...04…… 05….....06…….07……77

ID-4. [GIVE RESPONDENT FLASHCARD M; READ ALL CHOICES] In the past 12 months when you injected, did you get your needles at any of the following places?

No Yes Refused Don’t

to answer know

a. Pharmacy or drug store ……... …………………………………..  0….  1…  7…. 9

b. Doctor’s office, clinic, or hospital……………………………......  0….  1…  7…. 9

c. Friend, acquaintance, relative, or sex partner………………..…  0….  1…  7…. 9

d. Needle or drug dealer, shooting gallery, hit house, off the street...  0….  1…  7…. 9

e. Needle exchange program………………………………………...  0…  1…  7…. 9

f. Some other place………………………………………………….  0…  1…  7…. 9

(Specify ___________________________)

ID-5. In the past 12 months when you injected, how often did you use a new, sterile needle? By a new, sterile needle, I mean a needle never used before by anyone, even you. [GIVE RESPONDENT FLASHCARD O, READ CHOICES. CHECK only ONE.]

Never...….……….…….…………………..……  0

Rarely..….…………….……………….……..…  1

About half the time..……………………………  2

Most of the time….…..…..……..………………  3

Always…..….……………..……………………  4

Refused to answer……..………………………  7

Don’t know……………..………………………  9

SAY: Next, I'm going to ask you about your injecting behaviors in the past 12 months, that is, since <interview month> of last year.

If ID-5 = 0, 1, 2, OR 3, ask ID-6.

ID-6. In the past 12 months, with how many people did you use a needle after they injected with it?

[Refused = 777, Don't know = 999] __ __ __

ID-7. In the past 12 months, with how many people did you use the same cooker, cotton, or water that they had already used. By “water,” I mean water for rinsing needles or preparing drugs.

[Refused = 777, Don't know = 999] __ __ __

ID-8. In the past 12 months, with how many people did you use drugs that had been divided with a syringe that they had already used?

[Refused = 777, Don't know = 999] __ __ __

If ID-6≥ 1, ask ID-9. If not, skip to instructions before ID-10

ID-9. In the past 12 months, how often did you use needles that someone else had already injected with? [GIVE RESPONDENT FLASHCARD O, READ CHOICES. CHECK only ONE]

Never...….……….…….…………………..……  0

Rarely..….…………….……………….……..…  1

About half the time..……………………………  2

Most of the time….…..…..……..………………  3

Always…..….……………..……………………  4

Refused to answer……..………………………  7

Don’t know……………..………………………  9

For NHBS-IDU, ask ID-10 through ID-12 then skip to ID-14

If ID-7 ≥ 1, ask ID-10– ID-12

ID-10. In the past 12 months when you injected, how often did you use a cooker that someone else had already used? [GIVE RESPONDENT FLASHCARD O, READ CHOICES, CHECK only ONE.]

Never...….……….…….…………………..……  0

Rarely..….…………….……………….……..…  1

About half the time..……………………………  2

Most of the time….…..…..……..………………  3

Always…..….……………..……………………  4

Refused to answer……..………………………  7

Don’t know……………..………………………  9

ID-11. In the past 12 months when you injected, how often did you use a cotton that someone else had already used? [GIVE RESPONDENT FLASHCARD O, READ CHOICES, CHECK only ONE.]

Never...….……….…….…………………..……  0

Rarely..….…………….……………….……..…  1

About half the time..……………………………  2

Most of the time….…..…..……..………………  3

Always…..….……………..……………………  4

Refused to answer……..………………………  7

Don’t know……………..………………………  9

ID-12. In the past 12 months when you injected, how often did you use water that someone else had already used? [GIVE RESPONDENT FLASHCARD O, READ CHOICES, CHECK only ONE]

Never...….……….…….…………………..……  0

Rarely..….…………….……………….……..…  1

About half the time..……………………………  2

Most of the time….…..…..……..………………  3

Always…..….……………..……………………  4

Refused to answer……..………………………  7

Don’t know……………..………………………  9

FOR NHBS-MSM AND NHBS-HET, ASK ID-13

If ID-7 ≥ 1, ask ID-13

ID-13. In the past 12 months when you injected, how often did you use cookers, cottons, or water that someone else had already used? [GIVE RESPONDENT FLASHCARD O, READ CHOICES, CHECK only ONE.]

Never...….……….…….…………………..……  0

Rarely..….…………….……………….……..…  1

About half the time..……………………………  2

Most of the time….…..…..……..………………  3

Always…..….……………..……………………  4

Refused to answer……..………………………  7

Don’t know……………..………………………  9

If ID-8 ≥ 1, ask ID-14

ID-14. In the past 12 months when you injected, how often did you use drugs that had been divided with a syringe that someone else had already injected with? [GIVE RESPONDENT FLASHCARD O, READ CHOICES. CHECK only ONE.]

Never...….……….…….…………………..……  0

Rarely..….…………….……………….……..…  1

About half the time..……………………………  2

Most of the time….…..…..……..………………  3

Always…..….……………..……………………  4

Refused to answer……..………………………  7

Don’t know……………..………………………  9

If ID-6= 0, DK, or REF and

If ID-7= 0, DK, or REF and

If ID-8= 0, DK, or REF

then skip to the non-injection drug use section (ND)

SAY: Now I’d like you to think about the last time you injected with someone.

By “injecting with someone,” I mean you shared drugs or equipment, or both with at least one other person that you were with when you injected.

ID-15. When was the last time you injected with someone?

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __

^{(M M / Y
Y Y Y )}

If ID-15 = 77 skip to ND-1

If ID-16 = 99, the skip to ID-15 conf

ID15conf.

Did you last inject with someone in the past 12 months, that is, since [AGO1Y]?

No……………………………………... 0

Yes……………………………………..1

Don’t know…………………………….7

Refuse to Answer………………………9

If ID-6=0, Skip to ID-16a

ID-16. The last time you injected with someone, did you use a needle after anyone else had already injected with it?

No………………….……………………………  0

Yes……………………………………………...  1 Skip to ID-17

Refused to answer………………………………  7

Don't know…………..……………………...  9

ID-16a. Did you use a new sterile needle to inject?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If ID-7=0, Skip to ID-18

ID-17. The last time you injected with someone, did you use a cooker, cotton, or water that anyone else had already used?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If ID-8=0, Skip to ID-19

ID-18. The last time you injected with someone, did you use drugs that had been divided with a syringe that anyone else had already injected with?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

SAY: The next questions are about this last person you injected with.

ID-19. Is this person male or female?

Male………………………..…………..………  1

Shape35

Skip to ID-21

Female….…………………….……………..…  2

Other (specify______________)………………  3

ID-20. [GIVE RESPONDENT FLASHCARD K] As far as you know, has this person ever had sex with another man? Would you say he: [READ CHOICES. Check only ONE.]

Definitely did not…………………….…………  0

Probably did not..………………………………  1

Probably did...………………………………  2

Definitely did ...………………….…………  3

Refused to answer…………………………..  7

Don't know.……………..………….………....  9

ID-21. The last time you injected with this person, did you know their HIV status?

No………………….……………………………  0 Skip toID-22

Yes……………………………………………...  1

Refused to answer………………………………  7 Skip to ID-22

ID-21a. What was their HIV status?

HIV-negative……………………………..…......  1

HIV-positive…...….…………………..………..  2

Indeterminate……………………………..…….  3

Refused to answer.……………………………...  7

ID-22. The last time you injected with this person, did you know if they had been tested for hepatitis C?

No………………….……………………………  0 Skip to ID-23

Yes……………………………………………...  1

Refused to answer………………………………  7 Skip to ID-23

ID-22a. What was the result of their hepatitis C test?

Negative.……………………………..…......  1

Positive...…...….…………………..………..  2

Refused to answer.………………………...  7

Don't know…………..………….………....  9

ID-23. [GIVE RESPONDENT FLASHCARD O]Which of the following best describes you relationship to this person? Would you say this person was a: READ CHOICES, CHECK only ONE.]

Sex partner ……………………………….……  1

Friend or acquaintance ………………………  2

Relative ………………………………………  3

Needle or drug dealer…………………………..  4

Stranger..........................................……………..  5

Other (specify________________)…………….  6

Refused to answer………………...…………….  7

Don't know……………..……..…..…………..  9

Non-Injection Drug Use (ND)

SAY: Now I’m going to ask you about drugs that you may have used but did not inject. I will refer to these as non-injection drugs. This includes drugs like marijuana, crystal meth, cocaine, crack, club drugs, painkillers, or poppers.

ND-1. In the past 12 months, that is, since <interview month> of last year have you used any non-injection drugs, other than those prescribed for you?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If ES9=2 and ND-1 in (0, 7, 9), skip to Say Box before TX-1.

If ES9=1 and ND-1 in (0, 7, 9), skip to ND-3.

SAY: I'm going to read you a list of drugs. For each drug I mention, please tell me how often you used it in the past 12 months. Do not include drugs you injected or drugs that were prescribed for you. GIVE RESPONDENT FLASHCARD L.

ND-2. How often did you use…READ EACH DRUG CHOICE. CHOOSE ONLY ONE RESPONSE PER TYPE OF DRUG.

More More More Less

than than than than

once a Once a once a Once a once a Once a once a Refused

Never day day week week month month month to answer

a. Marijuana……………… 00……01…… 02……03…... 04……05…........ 06………07………77

b. Crystal meth (tina, crank,

or ice)..…………………… 00……01…… 02……03…... 04……05…........ 06…… 07………77

c. Crack cocaine……………....00……01….... 02……03…... 04……05…....... 06………07………77

d. Powdered cocaine that is smoked

or snorted…………...…… 00…… 01…… 02…… 03…... 04……05…........ 06………07………77

e. Downers (benzos) such as Valium,

Ativan, or Xanax.…… 00……01…….02……03…... 04……05…........ 06………07………77

f. Painkillers such as Oxycontin,

Vicodin, or Percocet, .… 00……01…… 02……03…... 04……05…........ 06………07………77

g. Hallucinogens such as LSD

or mushrooms……….… 00……01…… 02……03…... 04……05…........ 06………07………77

h. X or Ecstasy…………….. 00……01…… 02……03…... 04……05…........ 06………07………77

i. Heroin that is

smoked or snorted…….. 00……01…… 02……03…... 04……05…........ 06………07………77

If NHBS-MSM, ask ND-2j – ND-2l

j. Poppers ( amyl nitrite)... 00……01…… 02……03…... 04……05…........ 06………07………77

k. GHB………………… 00……01……02……03…... 04……05…........ 06………07………77

l. Special K (ketamine)…… 00……01…… 02……03…... 04……05…........ 06………07………77

ND-2m1. In the past 12 months have you used any other non-injection drugs?

Shape36 No………………….……………………………  0 Skip to ND-3

Yes……………………………………………...  1

Shape37 Refused to answer………………………………  7 Skip to ND-3

Don't know…………..……………………...  9

Specify other drug _____________________

ND-2m2. How often did you use:

More More More Less

than than than than

once a Once a once a Once a once a Once a once a Refused Never day day week week month month month to answer

m. (Other drug). .00.. 01…..02…..03…...04…… 05….....06…….07……77

If Respondent is not male (ES9 ≠ 1), skip to Say Box before TX-1.

ND-3. In the past 12 months, have you used Viagra, Levitra or Cialis?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If ND-3 in (0, 7, 9), skip to Say Box before TX-1.

ND-3a. Did you use it to treat erectile dysfunction?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If Respondent is male (ES9 =1) AND ID-3e= 1 through 7 or ND-2b=1 through 7, ask ND-3b. Otherwise, skip to Say Box beforeTX-1.

ND-3b. You told me that you used crystal meth (tina, crank, ice). In the past 12 months, did you use Viagra, Levitra or Cialis at the same time you used crystal meth?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

ALCOHOL AND DRUG TREATMENT (TX)

SAY: Next, I’m going to ask you about alcohol and drug treatment programs. These include out-patient, in-patient, residential, detox, methadone treatment, or 12-step programs.

TX-1. Have you ever participated in an alcohol treatment program?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If TX-1=0, skip to TX-1b. If TX-1 in (7, 9), skip to TX-2.

TX-1a. Have you participated in an alcohol treatment program in the past 12 months?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

TX-2. Have you ever participated in a drug treatment program?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If TX-2=0, skip to TX-2b. If TX-2 in (7, 9), skip to Say Box before HT-1

TX-2a. Have you participated in a drug treatment program in the past 12 months?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

HIV TESTING EXPERIENCES (HT)

SAY: Now I’m going to ask you a few questions about getting tested for HIV. Remember, an HIV test checks whether someone has the virus that causes AIDS.

HT-1. Have you ever been tested for HIV?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If HT-1=0, skip to HT-6.

If HT-1 in (7, 9), Skip to Say Box before HT-9.

HT-2. When did you have your first HIV test?

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __

^{(M M /
Y Y Y Y )}

HT2conf. INTERVIEWER INSTRUCTIONS:

If HT2(y) < 1985, display:

HIV testing was not widely available before 1985. Please confirm the year. Is &[TST1TSTY] correct?

Yes…………………………………………… ₁Go to next question

No……………………………………………  ₀ Loop back to put in the correct year

HT2conf. If HT2 < DOB, display:

“The date of the first test cannot be before your date of birth ([insert month and year of birth based on ES1]).”

Then loop back to HT2.

HT-3. In the past 2 years, that is, since [insert calculated month and year], how many times have you been tested for HIV?

___ ___ ___

[Refused = 777, Don't know = 999] If 0, 777, or 999, skip to HT-4

HT-4. When did you have your most recent HIV test?

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __

^{(M M / Y Y Y Y )}

HT4conf. INTERVIEWER INSTRUCTIONS:

If HT4(y) < 1985, display:

Interviewer: HIV testing was not widely available before 1985. Please confirm the year. Is &[RCNTTSTY] correct?

Yes…………………………………………… ₁Go to next question

No……………………………………………  ₀ Loop back to put in the correct year

If HT-4=DK or HT4(y) = year before calendar year of interview and HT4(m)=DK, ask HT4conf2. Otherwise, go to logic check before HT4a to determine if participant should be asked HT4a – HT4b.

HT4conf2.

Was your most recent HIV test in the past 12 months, that is, since [AGO1Y]?

Yes…………………………………………… ₁

No……………………………………………  ₀

HT2conf. If HT4 < HT2, display:

“The date of the most recent HIV test cannot be before the date of your first test ever ([insert response to HT2]) .”

Then loop back to HT4.

Otherwise, if (HT2=DK or Ref) and HT4 < DOB, display:

“The date of the most recent HIV test cannot be before your date of birth ([insert month and year of birth based on ES1]).”

Then loop back to HT4.

HT2conf. If HT3=0 and date of last HIV test is fewer than 2 years before interview date, display:

You said that you did not have any HIV tests in the past 2 years. However, your most recent HIV test is within the past 2 years. Please correct the number of HIV tests that you had in the past 2 years.

Then loop back to HT3.

If Auto3 - HT-4 is > 5 years ago or if time since last HIV test cannot be determined based on HT4 or HT4conf2, skip to HT-4c.

HT-4a. When you got tested in ____/____ [insert date from HT-4, if date is known, otherwise, insert “that last time”], where did you get tested?

Testing Site:________________________________________________________

[Write down the site name and classify it from the list of choices below. Probe with additional questions if necessary. DO NOT read choices. Choose only ONE site type.]

HIV counseling and testing site……..………………  01

HIV/AIDS street outreach program/Mobile Unit…  02

Drug treatment program………………..…………….  04

Needle exchange program.…...……..……………….  05

Correctional facility (jail or prison)………………….…  6

Family planning or obstetrics clinic……………..........  07

Public health clinic/ Community health center ………..  09

Private doctor’s office (including HMO)……………..  11

Emergency room………….……...…………………….  12

Hospital (inpatient)……………...….………………..…  13

At home…………..……………………………………  14

Other………..………………………….………………  15

Refused………………………………………...............  77

Don’t know……….....……..…………………….........  99

HT-4b. When you got tested in ____/____ [insert date from HT-4, if date is known, otherwise, insert “that last time”], was it a rapid test where you could get your results within a couple of hours?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

HT-4c. What was the result of your most recent HIV test? [DO NOT Read choices, check only ONE.]

Negative…………….………………….…………………..  1 Positive………………………….……………….…..........  2

Never obtained results……………………………...….......  3

Indeterminate…………..……………..……………………  4

Refused to answer…………...….…………………………..  7

Don't know…...…………………………............................  9

If HT-4c=2, skip to HT-7.

If HT-4c=1 or HT-4c=Ref, go to Logic check before HT-6 to evaluate time since last HIV test.

Otherwise, if HT4c=3, 4, or DK, ask HT-5.

HT-5. Before your test in ____/_____ [insert date from HT-4, if date is known, otherwise, insert “that last time”], did you ever test positive for HIV?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If HT-5=1, skip to HT-7a. Otherwise, go to Logic check before HT-6 to evaluate time since last HIV test.

Refer to HT-4 and HT4conf2. LAST HIV TEST WAS DONE (Check one):

< 12 months ago................................... SAY Box before HT-9

> 12 months ago................................... Go to next question

Cannot determine if last HIV test in past 12 months … Go to SAY Box before HT-9

[PERSONS WHO HAVE NEVER TESTED HIV+ AND HAVE NOT TESTED FOR HIV IN THE PAST 12 MONTHS]

HT-6 I’m going to read you a list of reasons why some people have not been tested for HIV. Which of these best describes the most important reason you have not been tested for HIV in the past 12 months? [READ CHOICES. CHOOSE only ONE. ]

You think you are at low risk for HIV infection?………  1

You were afraid of finding out that you had HIV?..……  2

You didn’t have time?................................……………  3

Some other reason?........................................…………  4

No particular reason…...................................…………  5

Refused to answer.......................................…………  7

Don’t know…...................................…………  9

If HT-6 ≠ 4, go to Say Box before HT-9.

HT-6a. What was the most important reason you have not been tested for HIV in the past 12 months?

_______________________________________________

Go to Say Box before HT-9.

[PERSONS WHO HAVE TESTED HIV POSITIVE]

HT-7. Was your test in ____/_____ [insert date from HT-4, if date is known, otherwise, insert “that last time”] your first positive test?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………...  9

If HT7=0, go to HT7a. Otherwise, skip to HT7b.

HT-7a. When did you first test positive? (Please tell me the month and year.)

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __

^{(M M / Y Y Y Y )}

HT7conf. INTERVIEWER INSTRUCTIONS:

If HT7a(y) < 1985, display:

Interviewer: HIV testing was not widely available before 1985. Please confirm the year. Is &[POS1STDY] correct?

Yes……………………………………… ₁Go to next question

No………………………………………  ₀ Loop back to put in the correct year

HT7aconf.

If HT7a < HT2, display:

The date of your first positive test cannot be before the date of your first test ever ([insert response to HT2]). Then loop back to HT7a.

Otherwise, if (HT2=DK or Ref) and HT7a < ES1 {date of birth}, display:

“The date of the first positive HIV test cannot be before your date of birth ([insert month and year of birth based on ES1]).” Then loop back to HT7a.

HT-7b. After you tested positive, were you asked by someone from the health department or your health care provider to give the names of your sex or drug use partners so they could be notified that they may have been exposed to HIV?

No…….……………….……………………………  0

Yes…..……………………………………………...  1

Refused to answer…..………………………………  7

Don't know…………………..……………………...  9

If HT-7b in (0, 7, 9), skip to HT-7d.

HT-7c. Did you give the names or contact information of any of your partners when asked?

No…….……………….……………………………  0

Yes…..……………………………………………...  1

Refused to answer…..………………………………  7

Don't know…………………..……………………...  9

HT-7d. Before your first positive test in _____ / ______ [insert date from HT-4 or HT-7a, if date is known, otherwise, insert “that time”], did you ever have a negative HIV test? (By negative HIV test, I mean the test showed you did not have HIV infection.)

No…….……………….……………………………  0

Yes…..……………………………………………...  1

Refused to answer…..………………………………  7

Don't know…………………..……………………...  9

If HT-7d in (0, 7, 9), skip to HT-7e.

HT-7d.1 What was the month and year that you got your last negative HIV test? Tell me when you got your last test, not when you got your results.

[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __

^{(M M /
Y Y Y Y )}

HT7d.1conf. INTERVIEWER INSTRUCTIONS:

If HT7d.1(y) < 1985, display:

Interviewer: HIV testing was not widely available before 1985. Please confirm the year. Is [response to HT7d.1(y)] correct?

Yes……………………………………… ₁Go to next question

No………………………………………  ₀ Loop back to put in the correct year

HT7d1conf.

If HT7d.1 < date of 1^st positive test (when HT7=1, first positive date=HT4; otherwise, first positive test date is from HT7a) display:

The date of your last negative HIV test cannot be after your first positive test.

Then loop back to HT7d.1.

Otherwise, if date of 1^st positive test is unknown (HT4 or HT7a=DK or Ref), and (HT7d.1 < ES1 {date of birth}), display:

The date of the last negative HIV test cannot be before the date of birth. Then loop back to HT7d.1.

HT-7e. In the 2 years before your first positive test in _____ / ______ [insert date from HT-4 or HT-7a, if date is known, otherwise, insert “that time”], how many times did you get tested for HIV? Don't include your first positive test in that total number.

[Refused = 7777, Don't know = 9999] ___ ___ ___ ___

HT-7f. Have you ever been seen by a doctor, nurse, or other health care provider for a medical evaluation or care related to your HIV infection?

No…….……………….……………………………  0

Yes…..……………………………………………...  1

Refused to answer…..………………………………  7

Don't know…………………..……………………...  9

If HT-7f = 1, skip to HT-7g.

If HT-7f in (7, 9), skip to Say Box before HT-8b.

HT-7f.1. What is the main reason you have never gone to a health care provider for a medical evaluation or care related to your HIV infection? [DO NOT read choices. Choose only ONE reason.]

Feel good, don't need to go …………………..……………………  01

Don't want to think about being HIV positive/Denial……………  02

Didn’t have money or insurance…..………….……………………..  03

Inconvenient (location/hours/time, etc.)....…………………………  04

Forgot to go/Missed appointment……………..……………………  05

Drinking or using drugs………….……………...............................  06

Appointment pending..………..…………………………………  07

Other……………………..…………………………………………  08

Refused.…………………………………………………………  77

Don’t know……………………..…………………........................  99

If HT-7f.1=8, ask HT-7f.2. Otherwise, skip to Say Box before HT-8b.

HT-7f.2. Interviewer: Type in other reason Respondent never sought HIV care. _____________________

Skip to Say Box before HT-8b.

HT-7g. When did you first go to your health care provider after learning you had HIV?

[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __

^{(M M / Y
Y Y Y )}

HT7aconf.

If HT7g < date of first positive test (either HT4 or HT7a), display:

The date you first saw your health care provider about your positive serostatus should not be before your first positive test. Then loop back to HT7g.

Otherwise, if date of first positive test is unknown (either HT4 or HT7a=DK or Ref) and (HT7g < ES1 {date of birth}), display:

The date you first saw your health care provider about your positive serostatus should not be before your date of birth ([insert month and year of birth based on ES1]).” Then loop back to HT7a.

If HT-g=DK, ask HT-7g.1. Otherwise, skip to HT-7h.

HT7g.1.

Did you first go to your health care provider for HIV care more than 3 months after learning you had HIV?

Yes…………………………………………… ₁

No……………………………………………  ₀

DK…………………………………………… ₉

Ref……………………………………………  ₇

INTERVIEWER INSTRUCTIONS: Refer to date of first positive HIV test (HT-4or HT-7a) and response to HT7g or HT7g.1.

< 3 months before first provider visit Skip to HT-7i

> 3 months before first provider visit Go to next question

Interval cannot be determined (date missing and HT7g.1=DK or Ref) Skip to HT-7i

If first positive test result was > 3 years before [date of interview], skip to HT-7i

HT-7h. Some people go to a health care provider soon after learning they are positive; others do not. What is the main reason you didn’t go to a health care provider soon after you learned of your HIV infection? [DO NOT read choices. Choose only ONE reason.]

Felt good, didn't need to go ……..…………………..…………………  01

Didn't want to think about being HIV positive/Denial…………………  02

Didn’t have money or insurance……..………….……………………..  03

Inconvenient (location/hours/time, etc.)…....………………………….  04

Forgot to go/Missed appointment………….………..…………………  05

Drinking or using drugs……………...……………................................  06

Unable to get an earlier appointment……….…………………………  07

Other…….…………………..………………………………………….  08

Refused…………………………………………………………………  77

Don’t know…..……………………..…………………..........................  99

If HT-7h = 8, ask HT-7h.1. Otherwise, go to HT-7i.

HT-7h.1 Interviewer: Type in other reason Respondent did not seek HIV care soon after diagnosis:

_________________________________

HT-7i. When did you last go to your health care provider for HIV care?

[77/7777=Refused, 99/9999 = Don't know] __ __/ __ __ __ __

^{(M M / Y Y Y
Y )}

HT7i.1.

Was your last visit for HIV care in the past 6 months?

Yes…………………………………………… ₁

No……………………………………………  ₀

DK…………………………………………… ₉

Ref……………………………………………  ₇

INTERVIEWER INSTRUCTIONS: Refer to date of last visit based on HT-7i and HT7i.1.

< 6 months since last provider visit Skip to HT-8

> 6 months since last provider visit Go to next question

Interval cannot be determined (date missing and HT7i.1=DK or Ref) Skip to HT-8

Shape39 HT-7j. What is the main reason you have not gone to a health care provider for HIV care in the past 6 months? [DO NOT Read reason types. Choose only ONE reason.]

Felt good, didn't need to go…………………………..…………………  01

Don't want to think about being HIV positive/Denial…….……………  02

Didn’t have money or insurance….…..………….…………………….  03

Inconvenient (location/hours/time, etc.).........…………………………  04

Forgot to go/Missed appointment…….…………..……………………  5

Drinking or using drugs……..……….……………................................  06

Appointment pending…….….…………………………………………  07

Other……………….………..………………………………………….  08

Refused…………………………………………………………………  77

Don’t know……...………………..…………………..........................  99

If HT-7j = 8, ask HT-7j.1. Otherwise, go to HT-8.

HT-7j.1. Interviewer: Type in other reason Respondent has not sought HIV care in past 6 months:

_________________________________

HT-8. Are you currently taking antiretroviral medicines to treat your HIV infection?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If HT-8 in (1, 7, 9), skip to Say Box before HT-8b.

HT-8a. What is the main reason you are not currently taking any antiretroviral medicines? [DO NOT read reason types. Choose only ONE reason.]

Feel good, don’t need them……….......……..………………….  01

CD4 count and viral load are good……….……….....................  02

Doctor advised to delay treatment…………..………….............  03

Don't want to think about being HIV positive./Denial…………  04

Worried about side effects …………..………..…….….............  05

Don't have money or insurance……………….…………....…..  06

Drinking or using drugs…………………..…..…….…………..  07

Recently into medical care……..……………………………...  08

Other……………………………..……………………..............  09

Refused…………………………………………………………  77

Don’t know……………………………….……………….........  99

If HT-8a = 9, ask HT-8a.1. Otherwise, go to Say Box before HT-8b.

HT-8a.1 Interviewer: Type in other reason Respondent is not currently taking ARVs:

____________________________

SAY: Researchers are studying whether antiretroviral medicines could possibly be taken to prevent HIV infection.

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If participant answers 0, 7 or 9, skip to Say Box before HT-14.

HT-8c. In the past 12 months, have you given your antiretroviral medicines to a sex partner who was HIV-negative because you thought it might keep them from getting HIV?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

Skip to SAY Box before HT-14

FOR PARTICIPANTS WHO HAVE NOT PREVIOUSLY TESTED HIV+:

SAY: Researchers are studying whether anti-HIV medicine (also called antiretrovirals)-- a pill -- could possibly be taken to prevent HIV infection.

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If participant answers 0, 7 or 9, skip to HT-13.

HT-10. In the past 12 months, have you taken anti-HIV medicines after sex because you thought it would keep you from getting HIV?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

HT-11. In the past 12 months, have you taken anti-HIV medicines before sex because you thought it would keep you from getting HIV?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If participant has not taken PEP or PrEP in the past 12 months, skip to HT-13.

HT-12. Please tell me if you got any of the anti-HIV medicines you took from the following people or places. Did you get them from…[GIVE RESPONDENT FLASHCARD Q. READ ALL CHOICES.]

HT-12d.1. Interviewer: Type in other specified place ______________________________.

HT11 does NOT equal 1, ask HT12d.1. Otherwise, if HT-11 DOES equal 1, skip to HT-14.

HT-13. Would you be willing to take anti-HIV medicines every day to lower your chances of getting HIV?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

FOR ALL PARTICIPANTS:

SAY: Now I’m going to read you some statements. Please tell me how strongly you agree or disagree with each statement, using the options on this card. [Give participant Flashcard G ]

HT-14. The first statement is… Most people in [insert project area] would discriminate against someone with HIV. Do you…[READ choices. Mark only one.]

Strongly agree..……………......……..…………  01

Agree……………………………………...........  02

Neither agree nor disagree…….…..…..……….  03

Disagree…………….……………………….…  04

Strongly disagree…………… …..…….............  05

Refused to answer…….…………………….…  07

Don’t know……..…..…… …..……….............  09

HT-15. Most people in [insert project area] would support the rights of a person with HIV to live and work wherever they wanted to. Do you…[READ choices. Mark only one.]

Strongly agree..……………......……..…………  01

Agree……………………………………...........  02

Neither agree nor disagree…….…..…..……….  03

Disagree…………….……………………….…  04

Strongly disagree…………… …..…….............  05

Refused to answer…….…………………….…  07

Don’t know……..…..…… …..……….............  09

HT16. Most people in [insert project area] would not be friends with someone with HIV. Do you…[ READ choices. Mark only one.]

Strongly agree..……………......……..…………  01

Agree……………………………………...........  02

Neither agree nor disagree…….…..…..……….  03

Disagree…………….……………………….…  04

Strongly disagree…………… …..…….............  05

Refused to answer…….…………………….…  07

Don’t know……..…..…… …..……….............  09

HT-17. Most people in [insert project area] think that people who got HIV through sex or drug use have gotten what they deserve. Do you…[READ choices. Mark only one.]

Strongly agree..……………......……..…………  01

Agree……………………………………...........  02

Neither agree nor disagree…….…..…..……….  03

Disagree…………….……………………….…  04

Strongly disagree…………… …..…….............  05

Refused to answer…….…………………….…  07

Don’t know……..…..…… …..……….............  09

Refused to answer

Don’t know

Doctor or other health care provider

Sex partner, friend, relative, or acquaintance

Some other place (Specify ______________)

HT12d=1, ask HT12d.1. Otherwise, skip to HT-14.

SAY: Next, I'd like to ask you some questions about your health.

If Respondent is Male (ES9 =1), ask HC-1

HC-1. Have you been circumcised?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

SAY: The next questions are about hepatitis, an infection of the liver.

HC-2. Has a doctor, nurse or other health care provider ever told you that you had hepatitis?

Skip to HC-5

Shape40 No………………….……………………………  0

Yes……………………………………………...  1

Skip to HC-5

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

HC-2a. What type or types of hepatitis have you had? [CHECK ALL THAT APPLY.]

Hepatitis A……….…………………………….  0

Hepatitis B………………….………….............  1

Hepatitis C……………………………..............  2

Other……………..…………….………………  3

If Other: Specify__________________

Refused to answer………………………………  7

Don't know……………..……………...............  9

If HC-2a=1, ask HC-3.

HC-3. Have you ever taken medicine to treat your hepatitis B infection?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If HC-2a=2, ask HC-4a through HC-4c. Else, skip to HC-5.

HC-4a. When were you told you had hepatitis C? [READ CHOICES. CHECK ONE.]

6 months ago or less.………………………………….  0

More than 6 months, but less than 1 year ago.…….  1

At least 1 year but less than 5 years ago ………  2

At least 5 years but less than 10 years ago……..………  3

10 years ago or more…...……………..……………….  4

Refused to answer…………………..…………………  7

Don't know……………..…………...…………………  9

HC-4b. Have you ever taken medicine to treat your hepatitis C infection?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If HC-4b= 0, 7, OR 9, skip to HC-5.

HC-4c. Did your doctor tell you that you were cured of your hepatitis C infection after you finished taking medicine for hepatitis C?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

SAY: Now I'm going to ask you about getting tested for hepatitis.

HC-5. Have you ever had a blood test to check for hepatitis C infection?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If HC-5 in (0, 7, 9), skip to HC-5b.

HC-5a. When did you have your most recent hepatitis C test? [READ CHOICES. CHECK only ONE]

6 months ago or less……..…………………..…  0

More than 6 months ago, but less than 1 year….  1

1 year ago or more……………………………  2

Refused to answer…..…………………..………  7

Don't know….……………..…………...………  9

HC-5b. Have you ever had a blood test to check for hepatitis B?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If HC-5b in (0,7,9), skip to HC-6.

HC-5c. When did you have your most recent hepatitis B test? [READ CHOICES. CHECK only ONE]

6 months ago or less.…………………..………  0

More than 6 months ago, but less than 1 year…  1

1 year ago or more……………………………  2

Refused to answer…………………..…………  7

Don't know……………..…………...…………  9

HC-6. There are vaccines or shots that can prevent some types of hepatitis. Have you ever had a hepatitis vaccine?

Shape42

Skip to

Say box before HC-7

No………………….……………………………  0

Yes……………………………………………...  1

Shape43

Skip to

Say box before HC-7

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

HC-6a. What type or types of hepatitis vaccine have you had? [READ CHOICES. CHECK only ONE]

Hepatitis A vaccine..…………………………  1

Hepatitis B vaccine……………………………  2

Both Hepatitis A and B vaccines……………  3

Refused to answer..………………..…………  7

Don't know………………..…………..............  9

SAY: Now, I’m going to ask you some questions about sexually transmitted diseases, or STDs, other than HIV and hepatitis.

Has a doctor or other health care provider ever told you that you had any of the following: [READ choices. CHECK YES or NO for each one.]

No Yes Refused Don’t

to answer Know

HC-7. Genital herpes?………..………………  0......…  1…….. 7………… 9

HC-8. Genital warts?…………...............……  0......…  1…….. 7……..….. 9

HC-9. Human papillomavirus or HPV?………  0........  1……. 7……..….. 9

HC-10. In the past 12 months, that is, since (__/____), were you tested by a doctor or other health care provider for a sexually transmitted disease like gonorrhea, chlamydia, or syphilis? Do NOT include tests for HIV or hepatitis.

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If HC-10 = 0, DK, or Ref, skip to HC-12.

HC-11. In the past 12 months, that is, since (__/____), were you tested for… [READ choices. CHECK YES or NO for each one.]

No Yes Refused Don’t

to answer Know

a. Gonorrhea?…………..…………..  0......…  1……..  7………… 9

b. Chlamydia?…………....................  0......…  1……..  7……..….. 9

c. Syphilis?…………… ……………  0........  1…….  7……..….. 9

d. Some other STD (except HIV)?….  0......…  1……..  7……..….. 9

d.1 If Yes: Specify__________________

In the past 12 months, has a doctor or other health care provider told you that you had . . . [READ choices. CHECK YES or NO for each one.]

No Yes Refused Don’t

to answer Know

HC-12. Gonorrhea?…………..…………..  0......…  1…….. 7………… 9

HC-13. Chlamydia?…………....................  0......…  1…….. 7……..….. 9

HC-14. Syphilis?…………… ……………  0........  1……. 7……..….. 9

HC-15. Some other STD (except HIV)?….  0......…  1…….. 7……..….. 9

HC-15. If Yes: Specify__________________

HC-16. A vaccine to prevent HPV infection is available and is called the HPV shot, cervical cancer vaccine, GARDASIL®, or CERVARIX®. Have you ever received the HPV shot or cervical cancer vaccine?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If HC-16 in (0, 7, 9), skip to JT-1.

HC-17. How old were you when you received your first dose of the HPV vaccine?

[77= Refused, 99= Don’t know] __ __ Range=5 – 46years.

HIV TESTING IN JAIL (JT)

SAY: Now I will ask about experiences you may have had with the criminal justice system. Please remember your answers will be kept private.

JT-1. Have you ever been held in a detention center, jail, or prison for more than 24 hours?

Shape44

Skip to Say Box PA-1

No………………….……………………………  0

Yes……………………………………………...  1

Shape45

Skip to Say Box PA-1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

JT-1a. During the past 12 months, that is, since <interview month> of last year have you been held in a detention center, jail, or prison, for more than 24 hours??

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If JT-1a in (0, 7, 9), skip to Say Box before PA-1.

JT-2. During the past 12 months, when you were in detention, jail, or prison, did you get a test for HIV?

Shape46

Skip to JT-3

No………………….……………………………  0

Yes……………………………………………...  1

Shape47

Skip to JT-3

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

JT-2a. During the past 12 months, how many times did you get tested for HIV in detention, jail, or prison?

[77 = Refused, 99 = Don't know] __ __

JT-2b. [If JT-2a > 1 and < 77, autofill with “Think of the last time you were tested for HIV in detention, jail, or prison.”] Did you get the results of that HIV test?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

JT-3. During the past 12 months, when you were in detention, jail, or prison, did you get a test for hepatitis C?

Shape48

Skip to Say Box before PA-1

No………………….……………………………  0

Yes……………………………………………...  1

Shape49

Skip to Say Box before PA-1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

JT-3a. During the past 12 months, how many times did you get tested for hepatitis C in detention, jail, or prison?

[77 = Refused, 99 = Don't know] __ __

JT-3b. [If JT-3a > 1 and < 77, autofill with “Think of the last time you were tested for hepatitis C in detention, jail, or prison.”] Did you get the results of that hepatitis C test?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

ASSESSMENT OF PREVENTION ACTIVITIES (PA)

Say: Next I'd like to ask you about HIV prevention activities that happen around here.

PA-1. In the past 12 months, have you gotten any free condoms, not counting those given to you by a friend, relative, or sex partner?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If PA-1 in (0, 7, 9) AND participant injected in past 12 months, skip to PA-2.

Else, if PA-1 in (0, 7, 9) AND participant did NOT inject in past 12 months, skip to PA-4.

If PA-1=1AND NHBS-MSM, go to PA-1a.

Else, if PA-1=1 AND NHBS-IDU, skip to PA-1b.

Else if PA-1=1 AND NHBS-HET, skip to PA-1c.

PA-1a. [GIVE RESPONDENT FLASHCARD R.] Which place or places on this list did you get free condoms from? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

GLBTQ organization or community health center……  2

Health center or clinic……………………….………  3

Bar, club, bookstore, or other business..……………  4

Some other place ……………………………………  5

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

Skip to PA-1d.

PA-1b. [GIVE RESPONDENT FLASHCARD S.] Which place or places on this list did you get free condoms from? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

Needle or syringe exchange program……………….  2

IDU outreach program……………………….………  3

Health center or clinic………………...………………  4

Drug or alcohol treatment program……………………  5

Some other place ……………………………………  6

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

Skip to PA-1d.

PA-1c. [GIVE RESPONDENT FLASHCARD T.] Which place or places on this list did you get free condoms from? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization..…  1

Health center or clinic………………………….………  2

Bar, club, bookstore, or other business…..……………  3

Drug or alcohol treatment program……………………  4

Some other place………………………………………  5

Refused to answer..……………………….…...............  7

Don’t know….………..………….……………………  9

PA-1d. Have you used any of the free condoms you received?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If injected drugs in past 12 months, go to PA-2. Otherwise, skip to PA-4.

PA-2. In the past 12 months, that is, since <interview month> of last year have you gotten any new sterile needles for free, not including those given to you by a friend, relative, or sex partner?

Shape50

Skip to PA-3

No………………….……………………………  0

Yes……………………………………………...  1

Shape51

Skip to PA-3

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

PA-2a. [GIVE RESPONDENT FLASHCARD S.] Which place or places on this list did you get the free sterile needles from? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

Needle or syringe exchange program……………….  2

IDU outreach program……………………….………  3

Health center or clinic………………...………………  4

Drug or alcohol treatment program……………………  5

Some other place ……………………………………  6

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

PA-2b. Have you used any of the free sterile needles you received?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

PA-3. In the past 12 months, have you gotten any new cookers, cotton, or water for free, not including those given to you by a friend, relative, or sex partner?

Shape52

Skip to PA-4

No………………….……………………………  0

Yes……………………………………………...  1

Shape53

Skip to PA-4

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

PA-3a. [GIVE RESPONDENT FLASHCARD S.] Which place or places on this list did you get those free items from? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

Needle or syringe exchange program……………….  2

IDU outreach program……………………….………  3

Health center or clinic………………...………………  4

Drug or alcohol treatment program……………………  5

Some other place ……………………………………  6

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

PA-3b. Have you used the free cookers, cotton, or water that you received?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

PA-4. In the past 12 months, have you had a one-on-one conversation with an outreach worker, counselor, or prevention program worker about ways to prevent HIV? Don’t count the times when you had a conversation as part of an HIV test.

Shape54 No………………….……………………………  0 Skip to PA-5

Yes……………………………………………...  1

Shape55 Refused to answer………………………………  7 Skip to PA-5

Don't know…………..……………………... ….  9

If PA-4 in (0, 7, 9), skip to PA-5.

If PA-4=1AND NHBS-MSM, go to PA-4a.

Else, if PA-4=1 AND NHBS-IDU, skip to PA-4b.

Else if PA-4=1 AND NHBS-HET, skip to PA-4c.

PA-4a. [GIVE RESPONDENT FLASHCARD R.] Which type of organization did they work for? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

GLBTQ organization or community health center……  2

Health center or clinic……………………….………  3

Bar, club, bookstore, or other business..……………  4

Some other place ……………………………………  5

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

Skip to PA-4d.

PA-4b. [GIVE RESPONDENT FLASHCARD S.] Which type of organization did they work for? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

Needle or syringe exchange program……………….  2

IDU outreach program……………………….………  3

Health center or clinic………………...………………  4

Drug or alcohol treatment program……………………  5

Some other place ……………………………………  6

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

Skip to PA-4d.

PA-4c. [GIVE RESPONDENT FLASHCARD T.] Which type of organization did they work for? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization..…  1

Health center or clinic………………………….………  2

Bar, club, bookstore, or other business…..……………  3

Drug or alcohol treatment program……………………  4

Some other place………………………………………  5

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

PA-4d. During those one-on-one conversation(s), did you: [ASK EACH QUESTION, MARK NO OR YES FOR EACH] No Yes Refused Don't

to answer Know

1. Discuss ways to talk to a partner about safe sex?....  0…  1 …  7………. 9

If yes, ask:

2. Practice ways to talk to a partner about safe sex?........  0....  1…  7………. 9

3. Discuss ways to effectively use condoms?…...……..  0…  1…  7………. 9

If yes, ask:

4. Practice ways to effectively use condoms?.................. 0…  1….. 7………. 9

[If injected drugs in past 12 months, ask:]

5. Discuss how to prepare for safe injections?…...…….  0… 1….. 7………. 9

If yes, ask:

6. Practice safe drug-injecting practices?……….....…… 0… 1….. 7………. 9

PA-5. In the past 12 months have you been a participant in any organized session(s) involving a small group of people to discuss ways to prevent HIV? Don't include discussions you had with a group of friends.

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  7

Don't know…………..……………………... ….  9

If PA-5 in (0, 7, 9), skip to INT11.

If PA-5=1 AND NHBS-MSM, go to PA-5a.

Else, if PA-5=1 AND NHBS-IDU, skip to PA-5b.

Else if PA-5=1 AND NHBS-HET, skip to PA-5c.

PA-5a. [GIVE RESPONDENT FLASHCARD R.] Which type of organization sponsored those sessions? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

GLBTQ organization or community health center……  2

Health center or clinic……………………….………  3

Bar, club, bookstore, or other business..……………  4

Some other place ……………………………………  5

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

Skip to PA-5d.

PA-5b. [GIVE RESPONDENT FLASHCARD S.] Which type of organization sponsored those sessions? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization…  1

Needle or syringe exchange program……………….  2

IDU outreach program……………………….………  3

Health center or clinic………………...………………  4

Drug or alcohol treatment program……………………  5

Some other place ……………………………………  6

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

Skip to PA-5d.

PA-5c. [GIVE RESPONDENT FLASHCARD T.] Which type of organization sponsored those sessions? [READ CHOICES. MARK ALL THAT APPLY.]

HIV/AIDS-focused community-based organization..…  1

Health center or clinic………………………….………  2

Bar, club, bookstore, or other business…..……………  3

Drug or alcohol treatment program……………………  4

Some other place………………………………………  5

Refused to answer……………………….…...............  7

Don’t know…………..………….……………………  9

PA-5d. During those organized group session(s), did you: [ASK EACH QUESTION, MARK NO OR YES FOR EACH.]

No Yes Refused Don't

to answer Know

1. Discuss ways to talk to a partner about safe sex?....  0…  1 …  7………. 9

If yes, ask:

2. Practice ways to talk to a partner about safe sex?........  0....  1…  7………. 9

3. Discuss ways to effectively use condoms?…...……..  0…  1…  7………. 9

If yes, ask:

4. Practice ways to effectively use condoms?..................  0…  1…  7………. 9

[If injected drugs in past 12 months, ask:]

5. Discuss how to prepare for safe injections?…...…….  0… 1…  7………. 9

If yes, ask:

6. Practice safe drug-injecting practices?……….....…… 0… 1…  7………. 9

BEFORE BEGINNING THE LOCAL QUESTIONS, THE INTERVIEWER ANSWERS THE FOLLOWING QUESTION. DO NOT READ THIS QUESTION TO THE RESPONDENT.

INT11. How confident are you of the validity of the respondent’s answers?

Confident….…………………..………………  1

Some doubts………………………..…………  2

Not confident at all…………………..…..........  3

If response is 2 or 3, please explain why you are not confident in the respondent's answers:

__________________________________________________________________________

Auto8. Time core questionnaire ended: __ __:__ __  1 AM  2 PM

END SECTION

INTERVIEWER INSTRUCTIONS:

Please confirm. Did the person complete the survey?

No (did not complete the survey)……………………………… ₀

Yes (did complete the survey)…………………………………..  ₁

If consent for HIV test not recorded (CN-2 = 0), go to CONF23.

CONF23. INTERVIEWER INSTRUCTIONS:

SAY: My records reflect that you did not agree to HIV testing when asked earlier during the interview. Before I close out the survey, I’d like to ask you again about whether or not you would like an HIV test. Did you want the HIV test that is part of today’s survey?

Yes (respondent DOES want the test)…………………….… ₁

No (respondent DOES NOT want the test)……………...….  ₀

If CONF23 =1, go to CN-2.

CN-2. Do you agree to HIV counseling and testing?

No………………………………………………  0

Yes……………………………………………...  1

If CN-2=0, display:

If interviewer confirms CN-2=0, and NHBS-MSM, skip to Interviewer Comments Section.

If interviewer confirms CN-2=0, and NHBS-IDU, skip to Interviewer Comments Section.

If interviewer confirms CN-2=0 and NHBS-HET, skip to Interviewer Comments Section.

CN-3. Do you agree to have other lab tests (if offered)?

No………………………………………………  0

Yes……………………………………………...  1

Does not apply….………....…………………… 8

CN-4. Do you agree to let us store a sample of your blood for future testing?

No………………………………………………  0

Yes……………………………………………...  1

Does not apply….………....…………………… 8

FOR NHBS-IDU

Message about Eligibility to Receive Coupons:

If COMPLETE=1 AND VALIDITY ≠ 3:

"This respondent is ELIGIBLE to recruit others and receive coupons."

Message about not being eligible to receive coupons:

If VALIDITY = 3 OR COMPLETE=0:

“This respondent is NOT eligible to recruit others or receive coupons.”

FOR NHBS-HET

Message about Eligibility to Receive Coupons:

Non-seeds:

If participant met HET definition {at/below poverty OR low education AND gender=male or female AND no IDU in past 12 mos.}, AND COMPLETE=1 AND (VALIDITY =1 or 2);

Seeds:

If participant met recruiter criteria for non-seed AND HRA=1 AND EVRINJ=0;

"This respondent is ELIGIBLE to recruit others and receive coupons."

Message about not being eligible to receive coupons:

Non- seeds:

If participant did NOT meet HET definition OR VALIDITY = 3 OR COMPLETE = 0

Seeds:

If participant did NOT meet HET definition OR VALIDITY = 3 OR COMPLETE = 0 OR participant does NOT live in an HRA OR participant ever injected;

“This respondent is NOT eligible to recruit others or receive coupons.”

To the Interviewer: Do you have any additional comments to add?

If yes, enter comments below:

Interviewer Comments

LOCAL USE QUESTIONS FOLLOW

After completing the local questions say:

Do you have any questions about the issues we've talked about?

Thank the respondent for their time and end the interview.

National HIV Behavioral Surveillance System: Flashcards

FLASHCARD A

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

FLASHCARD B.1

A relative or family member

A person you have sex with

A person you use drugs with or buy drugs from

A friend

An acquaintance

A stranger

FLASHCARD B.2

A relative or family member
A person you have sex with
A friend
An acquaintance
A stranger

FLASHCARD C

How many people do you know who are:

Friends, relatives, or other people you associate with, AND
Who are at least 18 years old, AND
Who live in [insert project area]

FLASHCARD E

	MONTHLY INCOME	OR		YEARLY INCOME
A.	$0 to $417		A.	$0 to $4,999
B.	$418 to $833		B.	$5,000 to $9,999
C.	$834 to $1,041		C.	$10,000 to $12,499
D.	$1,042 to $1,250		D.	$12,500 to $14,999
E.	$1,251 to $1,667		E.	$15,000 to $19,999
F.	$1,668 to $2,082		F.	$20,000 to $24,999
G.	$2,083 to $2,500		G.	$25,000 to $29,999
H.	$2,501 to $2,916		H.	$30,000 to $34,999
I.	$2,917 to $3,333		I.	$35,000 to $39,999
J.	$3,334 to $4,167		J.	$40,000 to $49,999
K.	$4,168 to $4,999		K.	$50,000 to $59,999
L.	$5,000 to $6,250		L.	$60,000 to $74,999
M.	$6,251 or more		M.	$75,000 or more

FLASHCARD F

Private health plan
Medicaid
Medicare
Some other government plan
TRICARE (CHAMPUS)
Veterans Administration coverage
Some other health care plan

FLASHCARD G

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

FLASHCARD H.1

Definition of "Having Sex"

Oral, vaginal, or anal sex.

Oral sex means mouth on the vagina or penis

Vaginal sex means penis in the vagina

Anal sex means penis in the anus (butt)

FLASHCARD H.2

Definition of "Having Sex"

Oral or anal sex.

Oral sex means mouth on the penis

Anal sex means penis in the anus (butt)

FLASHCARD I

Female Sex Partners

Main partner:

A woman you have sex with and who you feel committed to above anyone else. This is a partner you would call your girlfriend, wife, significant other, or life partner.

Casual partner:

A woman you have sex with but do not feel committed to or don't know very well.

FLASHCARD J

Male Sex Partners

Main partner:

A man you have sex with and who you feel committed to above anyone else. This is a partner you would call your boyfriend, husband, significant other, or life partner.

Casual partner:

A man you have sex with but do not feel committed to or don't know very well.

FLASHCARD K

Definitely did not

Probably did not

Probably did

Definitely did

Refused to answer

Don't know

FLASHCARD L

Never

More than once a day

Once a day

More than once a week

Once a week

More than once a month

Once a month

Less than once a month

FLASHCARD M

FOR USE WITH ALCOHOL QUESTIONS

1 Shot of Liquor 1 Regular Beer 1 Glass of Wine
(Whisky, Vodka, Gin, etc.) 12 oz. 5 oz.
1.5 oz.

FLASHCARD N

Pharmacy or drug store

Doctor’s office, clinic, or hospital

Friend, acquaintance, relative, or sex partner

Needle or drug dealer, shooting gallery, hit house, off the street

Needle exchange program

FLASHCARD O

Never

Rarely

About half the time

Most of the time

Always

FLASHCARD P

Sex partner

Friend or acquaintance

Relative

Needle or drug dealer

Stranger

FLASHCARD Q

Doctor or other health care provider

Sex partner, friend, relative, or acquaintance

Internet

Some other place

FLASHCARD R

HIV/AIDS-focused community-based organization

GLBTQ organization or community health center

Health center or clinic

Bar, club, bookstore, or other business

Some other place

FLASHCARD S

HIV/AIDS-focused community-based organization

Needle or syringe exchange program

IDU outreach program

Health center or clinic

Drug or alcohol treatment program

Some other place

FLASHCARD T

HIV/AIDS-focused community-based organization

Health center or clinic

Bar, club, bookstore, or other business

Drug or alcohol treatment program

Some other place

NHBS Round 3 Questionnaire, v. 13 – Clean 97

December 5, 2011

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Brittani Robinson
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File Created	2021-01-31