Information Sheet - English

Attachment 6

Information for Participants

Who is carrying out this study?

This study is being funded by the Centers for Disease Control and Prevention (CDC). The CDC is working together with John Snow, Inc. (JSI), a public health consulting company located in Boston, Massachusetts, and with [insert local site name here].

The Principal Investigators (study leaders) at JSI are Dr. Jeremy Holman, PhD, and Dr. Matthew Mimiaga, ScD.

What is the purpose of this study?

The purpose of this study is to try out short health messages about HIV among black and Latino men who have sex with men. We want to hear your ideas about these messages. This will help CDC develop better health information messages for black and Latino men who have sex with men.

What happens in this study?

If you decide to be in this study, you will fill out a survey on a computer. This will take 45 minutes to one hour. The survey will ask questions about you and your activities, including sex and drug use. You will also be asked to read some HIV health messages and answer questions about them.

At the end of the survey, you may get information about other services at [insert local site name]. Using any of those services is up to you, and is not part of this study.

What is the risk of being in this study?

There are few risks. The survey asks questions about sex and drugs. Some of these questions may make you feel uncomfortable. You can choose not to answer any question. All of your answers will be kept private.

What are the benefits of being in this study?

There is no direct benefit to you. Yet, the answers you give today will help CDC better understand how to create health information messages that will be useful to people like you.

Will I be paid for my time?

If you complete the survey, you will receive a $40 gift card to [insert local merchant here] as a token of appreciation.

How will my information be kept private?

Your survey answers are anonymous, meaning they cannot be linked to you. Your name will not be used. CDC and JSI will not know who you are. Your answers will be grouped with answers from other people who take the survey. All information will be kept on a computer that is protected by coded passwords and stored in a locked room. Any contact information you gave to [insert local site name] to schedule today’s appointment has been kept on a different computer, and will not be connected to what you say on the survey. Your contact information will not be given to anyone at CDC or JSI, and will be destroyed at the end of this study.

If you choose to get other services at [insert local site name], any information you share to get those services will not be linked with this survey. The study team will only count how many men get these services after hearing about them in the study.

There is a rare exception to this privacy statement. The law says that the study team must tell local authorities if: (1) a person says that he intends to harm himself or others, (2) an elderly person or dependent adult is being physically or sexually abused, or (3) someone under age 18 is being physically or sexually abused. This includes consenting sexual contact with an adult if the person is 17 in Illinois, 18 in Florida, or 17 in Missouri (16 in Kansas). [Include only the relevant state for each site.]

Who should I call if I have questions?

This study is directed by Jeremy Holman, PhD, Senior Consultant for HIV/AIDS at JSI. You may call him at (617) 482‐9485 if you have questions about this study. If you have questions about your rights as a participant or if you feel you have been harmed, call Dr. Laurie Kunches, PhD, Chair of JSI Institutional Review Board at (617) 482-9485.

Can I refuse to be part of the study?

Being in the study is up to you. You can say “no” now, or leave the study at any time later. You can skip any question on the survey. Your decision to be in the study or not won’t affect your care or services at [insert local site name].

How do I agree to be in the study?

Before you take the survey, this information form will appear on your computer screen. You will be asked if you agree with what you have read. If you check “yes, I agree,” that means you have agreed to be in this study.

Grade level: 7.1