Pre-and Post Surveys Students

Cross-site Evaluation of the Minority Serving Institutions' HIV/AIDS Demonstration Initiative and Capacity Building Project

Pre-and Post- Surveys Items 5-7

Pre-and Post Surveys Students

OMB: 0990-0395

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Form Approved
OMB No. 0990Exp. Date __/__/20__

HIV Risk Assessment among African American College Students
Is this the first time that you have visited this web site and taken this survey?

No / Yes

Section 1: HIV Testing (please select your answer)
1.1

Has a doctor or health care provider ever suggested to you to have an HIV test?
No

1.2

Yes

Do you intend to have an HIV test in the next 6 months?
Absolutely not

Probably not

Not sure

Probably yes

1.3

How many HIV tests have you ever had?
1. None  (skip the rest of section 1 and move to section 2)
2. One
3. Two
4. Three or more

1.4

What was the main reason of your last HIV test?
1. Insurance, hospitalization, surgery, or other requirements
2. Concerns of personal risk
3. Request from my partner
4. Blood donation
5. Other, please specify ____________________

1.5

Where did you have your last HIV test?
1. STD clinic
2. Any University Health Center
3. Community HIV/AIDS center
4. Doctor’s office or hospital
5. Blood center
6. Others, please specify _________________________________

Absolutely yes

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection
of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0990. The time required to complete this information collection is
estimated to average (1 hour) per response, including the time to review instructions, search existing
data resources, gather the data needed, and complete and review the information collection. If you
have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form,
please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W.,
Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

Session 2: Attitudes / Beliefs Towards HIV Testing
The following are a series of statements about HIV testing. For each statement, please indicate
whether you strongly disagree, disagree, not sure, agree, or strongly agree with the
statement.
To what extent do you agree or disagree?
2.1

Knowing my HIV status would make
my life more complicated.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.2

I know where I can get an HIV test.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.3

I am scared to find out if I am
infected with HIV.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.4

I would rather not know if I am HIV
infected.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.5

If I get tested, my friends would
make fun of me if they know about it.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.6

I believe it is not worth of knowing
my HIV status.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.7

I feel HIV testing is not accessible to
young adults.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.8

Early knowledge of an HIV positive
status would help me better taking
care of my partner(s) and myself.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.9

I would not want to let other people
know if I had an HIV test.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.10

Knowing whether I am infected with
HIV is beneficial.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.11

I think there are only limited places
to get an HIV test.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.12

I would be afraid my insurance
company would found out if I had
HIV.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.13

It is likely that I might be infected
with HIV in my lifetime.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.14

I would feel having an HIV test is
humiliating.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

]

2.15

It is important for me to know the
HIV status of my sexual partner(s).

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.16

I feel the availability of HIV testing is
very limited.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.17

Compared with other people my age,
I feel my chance of getting HIV is
higher.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.18

I have no interest in finding out
whether I am HIV infected.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

2.19

I think everyone needs to know their
HIV status.

Strongly
Disagree

Disagree

Not
Sure

Agree

Strongly
agree

Section 3: Sexual behavior (Please circle your answer)
The following questions are about your sexual behavior. You do not have to answer questions
that you are not comfortable with. All information will be kept strictly confidential. No identifying
information will associated with any responses you provide, and your IP address identifier will
be deleted from the secured server immediately after you complete the survey. Your honest
response is important and can help us better understand the issue and develop appropriate
educational programs in the future.
3.1

Have you ever engaged in any of the following sexual activities?
3.11
3.12
3.13

Oral sex
Vaginal sex
Anal sex

No
No
No

Yes
Yes
Yes

(If “no” to all of the activities, then skip the rest of the section and move to section 4)
If yes, how old were you when you had those sexual activities for the first time?
3.14
3.15
3.16
3.2

Oral sex
Vaginal sex
Anal sex

_________ (years old)
_________ (years old)
_________ (years old)

Not applicable
Not applicable
Not applicable

During your life, about how many people have you had the following activities with?
3.21
3.22
3.23

Oral sex
Vaginal sex
Anal sex

1
1
1

2
2
2

3
3
3

more than 3
more than 3
more than 3

never had this activity
never had this activity
never had this activity

3.3

During the past three months, about how many people have you had sex with?
3.31
3.32
3.33

3.4

more than 3
more than 3
more than 3

Oral sex
Vaginal sex
Anal sex

0
0
0

1-2
1-2
1-2

3-4
3-4
3-4

5-6
5-6
5-6

7-8
7-8
7-8

someone who has ever used injectable drugs
someone who has more than one sex partner
someone who paid for sex

No
No
No

Oral sex
Vaginal sex
Anal sex

Never
Never
Never

Seldom
Seldom
Seldom

Sometimes
Sometimes
Sometimes

Often
Often
Often

Oral sex
Vaginal sex
Anal sex

Never
Never
Never

Seldom
Seldom
Seldom

Sometimes
Sometimes
Sometimes

Often
Often
Often

Have you ever had a sexually transmitted infection (STI)?
No

3.9

3
3
3

never had this activity
never had this activity
never had this activity

more than 8
more than 8
more than 8

NA
NA
NA

Yes
Yes
Yes

Don’t know
Don’t know
Don’t know

NA
NA
NA

(almost) Always
(almost) Always
(almost) Always

NA
NA
NA

How often do you or your partner use a condom when you have oral sex, vaginal or anal
sex?
3.71
3.72
3.73

3.8

2
2
2

If you ever had oral, vaginal, or anal sex, how often do you drink alcohol before this
behavior?
3.61
3.62
3.63

3.7

1
1
1

Have you ever had sex (oral, vaginal, or anal sex) with someone who uses injectable
drugs, or someone who has more than one sex partner, or someone who is paid for sex?
3.51
3.52
3.53

3.6

0
0
0

During the past 30 days, if you are sexually active, about how many times did you have:
3.41
3.42
3.43

3.5

Oral sex
Vaginal sex
Anal sex

Yes

Don’t know

Have you ever been (or made anyone) pregnant?
No

Yes

Don’t know

(almost) Always
(almost) Always
(almost) Always

NA
NA
NA

Session 4: Knowledge of HIV /AIDS & HIV Testing
The following are statements about HIV testing. Please tell us, for each statement, whether you
think they are “True”, “False” or “Not Sure”.
4.1

HIV/AIDS can be transmitted through mosquito
bites.

True

False

Not Sure

4.2

HIV can be transmitted to me if I donate my blood.

True

False

Not Sure

4.3

A person can get an HIV from oral sex.

True

False

Not Sure

4.4

Taking an HIV test one week after having sex can
tell a person if he/she has HIV.

True

False

Not Sure

4.5

A person can get HIV even if he/she has only one
unprotected sexual encounter with another HIV
infected person.

True

False

Not Sure

4.6

It takes years for HIV to develop into AIDS .

True

False

Not Sure

4.7

HIV testing cannot be done unless you request or
agree to have it done.

True

False

Not Sure

4.8

A person would know if he / she had been infected
with HIV.

True

False

Not Sure

4.9

A person with HIV can look and feel healthy.

True

False

Not Sure

4.10

A pregnant woman with HIV can give the virus to
her unborn baby.

True

False

Not Sure

4.11

It is harder for women to get HIV from men than for
men to get HIV from women.

True

False

Not Sure

4.12

HIV testing is usually anonymous and/or
confidential.

True

False

Not Sure

4.13

Douching after sex will keep a woman from getting
HIV.

True

False

Not Sure

4.14

Anytime when blood is drawn, it is tested for HIV.

True

False

Not Sure

4.15

It takes a couple of weeks or months from infection
with HIV for detection by testing.

True

False

Not Sure

Session 5: Basic Information
5.1

What is your age? ___ ___ (years old)

5.2

What is your gender?

5.3

What is your current relationship status?
1. Single, not in any relationship
2. Single, but has boy or girl friend(s)
3. Friends with benefits
2. Engaged
3. Married
4. Separated or divorced, or other (specify _________ )

5.4

Which of the following best describes you?
1. Heterosexual
2. Bisexual
3. Gay/Lesbian
4. Transgendered or Not sure

5.5

Please choose one that best describes you?
1. African American
2. Hispanic, Asian, or other minority groups
3. White
4. Multi-racial

5.6

Do you personally know someone with HIV or AIDS?
No

5.7

Yes

Don’t know / not sure

Not applicable (NA)

Have you ever asked a partner about his/her HIV status?
No

5.8

Male / Female

Yes

Don’t know / not sure

Not applicable (NA)

Has a partner ever asked you about your HIV status?
No

Yes

Don’t know / not sure

5.9

How many of your close friends would you estimate have engaged in sexual activities of
any kind (oral sex, vaginal or anal intercourse)?
5.111 Oral sex
None
Few
Some
Most
All
5.112 Vaginal sex
None
Few
Some
Most
All
5.113 Anal sex
None
Few
Some
Most
All

5.10

How much do your religious beliefs play a part of your sexual values?
Very little

Somewhat

Moderately

Quite a bit

Very much

5.11

Please rate your perceived risk of getting HIV during your college life compared with
other students of your age.
Much lower

5.12

Higher

Much higher

Low

Medium

High

Very high

How would you rate your knowledge specifically related to HIV testing?
Very low

5.14

About the same

How would you rate your knowledge about HIV / AIDS in general?
Very low

5.13

Lower

Low

Medium

High

Very high

Please tell us any comments you have about this survey (length, clarity, overall
appearance, etc.). Or anything that could help us better understand HIV prevention
issues.

Thank you very much. This is the end of the survey.

Citation Sources:
1. Hou, S. (2008). Using an online survey to assess knowledge of HIV in general and testing
specifically - Do black and white college students score differently? J Natl Med Assoc,
100(7), 826-832. Available at:
http://www.nmanet.org/images/uploads/Publications/OC826.pdf
2. Hou, S. (2009). Extending the use of the web-based HIV Testing Belief Inventory (wHITBI)
to students attending Historically Black Colleges and Universities (HBCUs): An examination
of reliability and validity. AIDS Education & Prevention, 21(1), 80-90.
3. Hou, S. (2009). HIV-related behaviors among black students attending Historically Black
Colleges and Universities (HBCUs) versus white students attending a Traditionally White
Institution (TWI). AIDS Care, 21(8), 1050-1057.
4. Hou, S. (2007). Alternative modes of measuring self-report on HIV-related behaviors among
college students: Web-delivered mode versus paper-pencil mode. American Journal of
Health Education, 38(1), 9-15.

Form Approved
OMB No. 0990Exp. Date __/__/20__

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0990. The time required to
complete this information collection is estimated to average (1 hour) per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning
the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human
Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

21. A doctor may inform, without consent of the HIV/AIDS patient, a sexual SA A N D SD
partner that he or she is at risk of HIV infection.
22. Only unfit mothers have children with HIV or AIDS. SA A N D SD
23.HIV and AIDS can be prevented by taking proper procedures. SA A N D SD
24. Research on HIV and AIDS should be a priority for governmental funding. SA A N D SD
25. I often read and listen to information about HIV. SA A N D SD
Please answer the following items using a true or false format. Circle T if you believe the statement is
TRUE and F if you believe it’s False.
1.Hemophiliacs can get HIV. T/TRUE F/FALSE
2.AIDS is an epidemic. T/TRUE F/FALSE
3.Only homosexuals get HIV. T/TRUE F/FALSE
4.The virus that causes AIDS is called Human Immunodeficiency Virus T/TRUE F/FALSE
5. The AIDS virus can remain infectious outside the body for up to ten T/TRUE F/FALSE
if is at room temperature.
6. One can get HIV by sharing a meal with a person who has HIV or AIDS. T/TRUE F/FALSE
7. People who have AIDS do not develop cancer. T/TRUE F/FALSE
8. Today’s blood supply in hospitals and blood donation centers is T/TRUE F/FALSE
screened for AIDS virus.
9. Impaired memory and concentration and motor deficits may occur T/TRUE F/FALSE
in some people who have AIDS.
10. One can get HIV by sharing drug needles. T/TRUE F/FALSE
11. AIDS virus may live in the human body for years before T/TRUE F/FALSE
symptoms appear.
12. The medically regulated blood supply in the U.S. is safe from the T/TRUE F/FALSE
AIDS virus.
13. By using a condom when having sex, one is always safe from T/TRUE F/FALSE
contracting HIV.
14. The HIV test is a test which can tell if a person has AIDS. T/TRUE F/FALSE
15. There is a cure for AIDS. T/TRUE F/FALSE
16. Some people living with HIV may show extreme tiredness, night T/TRUE F/FALSE
sweats, fever, weight loss, diarrhea, etc.
17. One can get HIV by having sexual intercourse with an infected person. T/TRUE F/FALSE
18. HIV is spread by sneezing, coughing, or touching. T/TRUE F/FALSE
19. AZT is the only drug approved by the U.S. Food and Drug Administration T/TRUE F/FALSE
for the treatment of AIDS.
20. One can get HIV by having sex with someone who uses intravenous drugs. T/TRUE F/FALSE
21. HIV can be spread by having contact with towels or bed linens used by T/TRUE F/FALSE
a person with HIV or AIDS.
22. An HIV infected mother can give the AIDS virus to the baby during T/TRUE F/FALSE
pregnancy and/or through breast feeding.
23. About 900,000 people in the United States are infected with the AIDS virus. T/TRUE F/FALSE
24. Blacks and Hispanics show higher incidence rates of AIDS than other T/TRUE F/FALSE
Other population groups in the United States.
25. More women than men have been infected by the AIDS virus in the T/TRUE F/FALSE
United States.
Goh, D.S.(1993). The Development and Reliability of the Attitudes toward AIDS Scale. College Student Journal, 27(2), 208‐214.

A-36

Form Approved
OMB No. 0990Exp. Date __/__/20__

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0990. The time
required to complete this information collection is estimated to average (15 minutes) per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you
have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S.
Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201,
Attention: PRA Reports Clearance Officer
1

4. Did you think the message is an important one for motivating African American female college
students to get tested for HIV?
____ It is very important
____ It is somewhat important
____ It is not at all important
5. Did you think the message encouraged African American female college students to get the
results of a HIV test?
_____ The message was highly encouraging
_____ The message was somewhat encouraging
_____ The message was not at all encouraging
6. Have you heard other African American female students talking about the posters/post card?
____ Yes
____ No
7. Have you heard any male students talking about the posters?
_____ Yes
_____ No
8. Have you talked about the posters with any of the following?
Yes
a.
b.
c.
d.

Female friends
Boyfriend/partner
Female classmates
Other females on campus

9. Do you think the posters were helpful in getting African American female college students to
get tested for HIV?
____ Yes, helpful to a lot of female students
____ Yes, helpful to some female students
____ No
10. Do you think the posters were helpful in getting African American female college students to
know their HIV status?
____ Yes, helpful to a lot of female students
____ Yes, helpful to some female students
____ No

11. How do you think the posters were helpful? (or why do you think they were not helpful?)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
12. Any other comments or suggestions about the posters?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
C. Demographics:
What is your age? ________
How would you describe your race/ethnicity?
____ African American/Black
____ Hispanic/Latino
____ American Indian
____Asian/Pacific Islander
____ Other, please specify: _________________________________________________
College Classification:
_____ Freshman
_____ Sophomore
_____ Junior
_____ Senior

Form Approved
OMB No. 0990Exp. Date __/__/20__

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0990. The time required to complete this
information collection is estimated to average (1 hours) per response, including the time to review instructions, search existing data
resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the
time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200
Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

A-1

4. Did you think the message is an important one for motivating African American female
college students to get tested for HIV?
____ It is very important
____ It is somewhat important
____ It is not at all important
5. Did you think the message encouraged African American female college students to get the
results of a HIV test?
_____ The message was highly encouraging
_____ The message was somewhat encouraging
_____ The message was not at all encouraging
6. Have you heard other African American female students talking about the posters/post card?
____ Yes
____ No
7. Have you heard any male students talking about the posters?
_____ Yes
_____ No
8. Have you talked about the posters with any of the following?
Yes

N
o

a.
b.
c.
d.

Female friends
Boyfriend/partner
Female classmates
Other females on campus

A-2

11. How do you think the posters were helpful? (or why do you think they were not helpful?)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
12. Any other comments or suggestions about the posters?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
C. Demographics:
What is your age? ________
How would you describe your race/ethnicity?
____ African American/Black
____ Hispanic/Latino
____ American Indian
____Asian/Pacific Islander
____ Other, please specify: _________________________________________________
College Classification:
_____ Freshman
_____ Sophomore
_____ Junior
_____ Senior

A-3

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Author	robinsonm
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File Created	2012-02-14