Motion Comic Post Test Survey

Form Approved

OMB No. 0920-0840

Expiration Date: 02/19/2016

Development of a Motion Comic for HIV/STI Prevention Among Young People – ages 15-24—Phase 2

Attachment 1e.

Participant Post-Test Survey

Public reporting burden of this collection of information is estimated to average 15 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 (0920-0840)

MOTION COMIC POST TEST SURVEY

Study ID No. _____

A. EXPERIENCE AND ATTITUDES ABOUT HIV TESTING

These next set of questions will gauge your attitudes and feelings about HIV testing. You do not have to be sexually active to answer these questions. Please tell us how much you agree or disagree with the following statements.

1. Do you plan to get tested for HIV sometime in the next 3 months (90 days)?

___ Yes ___ No

2. How much do you agree or disagree with the following statements?

a. I am/would be too scared to get an HIV test.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

b. If I was offered a chance to get an HIV test, I would get it.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

c. Everybody who has had unprotected sex should get an HIV test.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

d. I now know where to get an HIV test.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

e. I will continue to or plan on getting tested for HIV regularly.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

f. I get an HIV test before I have sex with a new sex partner.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

g. I will begin to ask or continue to ask all new sex partners when their last HIV test was.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

h. I will begin to ask or continue to ask all new sex partners about the result of their last HIV test.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

h. Everyone regardless of if they are sexually active should get an HIV test.

__ Strongly agree __ Somewhat agree __ Somewhat disagree __ Strongly disagree

B. HIV STIGMA

These next set of questions will gauge your attitudes and feelings about HIV stigma. You do not have to be sexually active to answer these questions. Please tell us how much you agree or disagree with the following statements.

1. I would sit next to an HIV-positive person.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

2. People who got HIV through sex or drug use have gotten what they deserve.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

3. I would be afraid to live with an HIV-positive person.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

4. I would buy fruit from someone who I knew was HIV-positive.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

5. I would not eat in a restaurant if I found out that someone there was HIV-positive.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

6. I would date someone who is HIV positive.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

7. I would live with someone who is HIV positive.

___ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

C. HIV/STI KNOWLEDGE

These next set of questions will gauge your attitudes and feelings about HIV/STI knowledge. You do not have to be sexually active to answer these questions. Please tell us whether you think the following statements are true or false.

1. You can always tell if your partner has as an STI.

___True ___ False

2. All people who have been infected with HIV quickly show serious signs of being infected.

___True ___ False

3. You can’t get HIV by sharing knives, forks, or cups with a person who has HIV.

___True ___ False

4. Wearing a condom correctly will protect you from most STIs.

___True ___ False

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

___True ___ False

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

___True ___ False

7. There is no cure for AIDS.

___True ___ False

8. Having another sexually transmitted disease like Gonorrhea or Herpes increases a person’s risk of becoming infected with HIV.

___True ___ False

9. Having sexual intercourse without a condom increases a person’s risk of becoming infected with HIV/STI.

___True ___ False

10. A person can get HIV by sharing a glass of water with someone who has HIV.

___True ___ False

11. Withdrawal, or pulling out the penis before climax will always prevent HIV/STI transmission.

___True ___ False

12. There is a vaccine (shot) that can prevent people from getting HIV.

___True ___ False

13. There is a vaccine (shot) that can prevent people from getting some STIs.

___True ___ False

14. A person is likely to get HIV by deep kissing (putting their tongue in their partner's mouth) if his/her partner has HIV.

___True ___ False

15. I would have protected sex with someone who is HIV Positive

__True ___False

D. CONDOM ATTITUDES AND KNOWLEDGE

(If you answered no to question B2 in the pre-test, then skip to section F)

1. I know where I can obtain condoms

Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

2. I don’t’ want to buy condoms because I am afraid people will know I am having sex

Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

3. I am embarrassed to purchase condoms at store near where I live because people will know I am having sex

Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

4. I would buy condoms if I could purchase them without anyone knowing/seeing me buy them

Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

5. I would obtain condoms from a clinic if I could so anonymously

Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

6. I am./would be too embarrassed to ask my partner to use a condom.

__Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

7. I will/ would insist on using a condom, even if my partner did not want to use one.

__ Strongly agree __ Agree __ Neither agree or disagree __ Disagree __ Strongly disagree

E. Behavioral Intentions

(If you answered no to question B2 in the pre-test, please go to section F)

1. Thinking of the occasions when you may have sexual intercourse in the next 3 months (90 days), how often do you think you will use condoms?

___ Never ___ Occasionally ___About half the time ___Most times ___Always

___ Not planning to have sex

2. Thinking of the occasions when you may have sexual intercourse in the next 3 months (90 days), how often do you think you will talk with your partner about using condoms during sex?

___ Never ___ Occasionally ___About half the time ___Most times ___Always

___ Not planning to have sex

3. Thinking about the next 90 days how likely is it you will get an HIV Test

___ Likely ___Extremely likely ____ Neutral ___ Extremely unlikely ____ Unlikely

4. Thinking about the next 90 days how likely is it you will get an STI Test

___ Likely ___Extremely likely ____ Neutral ___ Extremely unlikely ____ Unlikely

5. How likely is it that you will remain abstinent in the next 3 months (90 days)

___ Likely ___Extremely likely ____ Neutral ___ Extremely unlikely ____ Unlikely

6. Thinking of the number of sex partners you have had in the last three months, how likely do you think you will reduce the number of partners you will have?

___ Likely ___Extremely likely ____ Neutral ___ Extremely unlikely ____ Unlikely

F. SATISFACTION

1. Do you think that this motion comic about HIV prevention is a good way to reach young people like yourself?

__ Not at all ___ A little ___ Somewhat ___ Very much

2. How interesting was the story portrayed in the motion comic to you?

__ Not at all ___ A little ___ Somewhat ___ Very much

3. How much did you relate to the characters in the motion comic?

__ Not at all ___ A little ___ Somewhat ___ Very much

4. How interested would you be in seeing additional episodes of the motion comic?

__ Not at all ___ A little ___ Somewhat ___ Very much

5. How interested do you think your friends would be in watching the motion comic?

__ Not at all ___ A little ___ Somewhat ___ Very much

6.Would you recommend/share this with your friends?

__ No ___ Maybe ___ Yes

7. Did you learn anything that you did not know about HIV/STI?

__ Yes __No

If yes what did you learn? (open ended)

8. How should this motion comic be distributed? (Check all that apply)

__ Website_ __Podcast __Mobile application (app) __Facebook __ Tumblr __Twitter __

__Youtube __Other