Exit Survey

Form Approved:

OMB No. 0920-

Expiration Date:

Critical Thinking and Cultural Affirmation (CTCA): Evaluation of a Locally Developed HIV Prevention Intervention

Attachment 11

Exit Survey

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

Exit Survey

1.	What is your age? (check one) 18 – 24 25-30 31-40 41-50 51 or over
2.	What is your sex or gender (check all that apply):
	Male	Transgender Male/Transman Genderqueer		Other SPECIFY:
3.	Do you now identify as (check all that apply):
	Heterosexual/straight Homosexual/gay Bisexual	Same Gender Loving Queer Pansexual		Other_____________­­­­____ I do not identify with any of these
4.	Was this the first time you volunteered for an HIV research study? Yes No
5.	I decided to participate in this research study because (check all that apply):
	I felt it would help my community I knew someone on the study staff I wanted to get tested I wanted more information about HIV and STDs I was curious about the study I feel this research is important		I would get paid for participating I was asked to join by someone in the study I needed or wanted help finding services in my community I wanted to meet other Black men locally
6.	Before you enrolled in the CTCA study, had you ever taken an HIV test? Yes No
7.	Have you had an HIV test since you started participating in the CTCA study? Yes No
8.	What was the result of your most recent HIV test? Negative Positive I don’t know
8.	Based on your experience with the CTCA study would you say the project was focused on enrolling Black men who are: (check all that apply):
	Any Black man Had never had an HIV test HIV Negative HIV Positive

We want to thank you for your valuable contributions to this study and helping us identify new ways to support the health of African American men who have sex with men. We would like to hear your thoughts about the CTCA: HIV Prevention and Intervention for African American Men who Have Sex With Men study [the CTCA study] and your experience as a participant. All information collected here will be completely confidential and has no impact on your participation. Although we value your feedback, you may choose not to complete this survey.

Please tell us how strongly you agree or disagree with the following statements:		Strongly Agree	Agree	Disagree	Strongly Disagree	Don’t Know	Not Applicable
9.	CTCA has changed the way I think about sex
10.	CTCA helped me get access to services I wanted to find						I did not want help getting services
11.	There was too much talk about HIV in the study
12.	The study appointments were too long
13.	It was hard to find time to participate in the study
14.	The HIV and sexual behavior information was not very useful
15.	I would tell others to join the study
16.	I felt comfortable being around (e.g., talking to) the CTCA research staff
17.	The CTCA study will help stop new HIV infections
18.	The intervention (CTCA) was not very helpful
19.	The cultural & historical content provided through CTCA was helpful						I did not get cultural & historical content

20. Do you have any suggestions on how to improve the CTCA project?

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21. What was your favorite part of the CTCA project?

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22. What was your least favorite part of the CTCA study?

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Thank you for this valuable information. We may wish to follow-up with you to ask you more questions about participating in this project. Your participation in any future follow-up is strictly optional. If you do not wish to be contacted further please indicate so below. However, if you would be willing to speak with a member of the CTCA research staff further about your participation please indicate so below. Again thank you for your valuable feedback.

NO, I do not wish to participate in any further follow-ups regarding CTCA: HIV Prevention and Intervention for African American Men Who Have Sex with Men.

YES, I would be willing to participate in future follow-ups to discuss my participation in CTCA: HIV Prevention and Intervention for African American Men Who Have Sex with Men. You may contact me at the following:

• Telephone:

• E-mail:

• Other: