Pilot Test HRRET PRETEST Web-based Survey

11/7/2014

Qualtrics Survey Software

Form Approved
OMB No. 0920-0840
Expiration Date 2/29/16

Consent

Introduction and Purpose:
You have been asked to take part in a research study. The purpose of this study is to learn your opinions about HIV
prevention materials developed by the Centers for Disease Control and Prevention (CDC). RTI International, a
nonprofit research organization in North Carolina, is conducting this CDC-sponsored study.
Procedures:
You will be asked to complete a brief survey so that we can learn more about you. After you complete the survey,
you will be asked to review an online HIV prevention tool developed by CDC. You will then be asked to complete
another brief survey so that we can learn your opinions about the online tool. The study will take about 45 minutes
to complete.
Risks/Discomforts and Right to Refuse or Withdraw:
You might feel embarrassed or upset by some of the survey questions that ask about sexual behavior and alcohol
and drug use or by the content of the tool. You can decline to answer any questions for any reason. You can also
stop reviewing the tool (click the “Quit Exploring” button) or participating in the study (click the “Quit Study” button)
at any time.
Benefits:
There is no direct benefit to you for being in this study. However, you may learn more about ways to prevent getting
or giving someone else HIV.
Privacy
Your responses will be kept private to the extent allowable by law. The survey does ask you for your email address.
The survey vendor will send you a reminder email to complete the study if you stop participating before you finish
the posttest survey. The survey vendor will also record participants’ IP addresses to help make sure people do not
complete the study more than once. Email and IP addresses will be destroyed after all of the data are collected.
Only the survey vendor will know your email and IP address; neither RTI nor CDC will have access to this
information. This means that RTI and CDC cannot link your survey answers to you as an individual.
To help protect your privacy, we suggest that you participate in the study in a private location – either in your home
and/or in a room with a door. Please also close your browser window once you are finished.
Token of Appreciation:
We will give you a $25 Amazon gift card as a token of appreciation. Instructions for redeeming the gift card will be
provided after you complete the second survey.
Persons to Contact:
If you have questions about the study, you can call Jennifer Uhrig at 1-800-334-8571, extension 3311. She can be
reached between 9 a.m. and 5 p.m., Eastern Standard Time, Monday–Friday. If you have questions about your
rights as a participant, you can call RTI’s Office of Research Protection toll-free at 1-866-214-2043.
If you have any questions about HIV, including how to locate services and ways to protect yourself, please contact
CDC Info (http://www.cdc.gov/cdc-info/). To find local HIV testing sites, health centers, and other service providers,
you can also visit AIDS.gov (http://locator.aids.gov/).

Please choose one to continue with the study:

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I have read this consent form and agree to participate in the study.
I have read this consent form and do not want to participate in the study.

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).

Pretest

First, we are going to ask you some questions to get to know you a little bit.

What is the highest grade or year of school you finished?
Never attended school or only attended kindergarten
Grades 1 through 8 (elementary)
Grades 9 through 11 (some high school)
Grade 12 or GED (high school graduate)
College 1 year to 3 years (some college or technical school)
College 4 years or more (college graduate)
Prefer not to answer

Which best describes your total personal income during the past year?
Less than $20,000
$21,000 to $30,000
$31,000 to $40,000
$41,000 to $50,000
$51,000 or more
Prefer not to answer

What is your marital status?
Married, civil union, or domestic partnership

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Unmarried living with a partner or significant other
Divorced
Widowed
Separated
Single, never been married
Prefer not to answer

Pretest 2

Before learning about this study, had you ever heard of CDC or the Centers for Disease Control and Prevention?
Yes
No
Prefer not to answer

Pretest 3

How much do you disagree or agree with the following statement: I trust CDC as a source of information about HIV.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Prefer not to answer

Pretest 4

Using a scale from 1 to 10, where 1=I know nothing and 10=I know everything I need to know, please rate your
overall knowledge of HIV.
1

2

3

4

5

6

7

8

9

10

Tell me how risky you think each behavior is for [getting/transmitting] HIV if a person is not using any form of
protection. Use a scale where 0 is lowest risk and 100 is highest risk. Please assign any number in that range to
each of the behaviors listed. You may skip this question if you do not know or would prefer not to answer.
Deep kissing
Receptive anal sex (“bottom”) with a
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condom
Receptive anal sex (“bottom”) without
a condom
Receptive oral sex (“giving a blow
job”) with a condom
Receptive oral sex (“giving a blow
job”) without a condom
Insertive anal sex (“top”) with a
condom
Insertive anal sex (“top”) without a
condom
Insertive oral sex (“getting a blow job”)
with a condom
Insertive oral sex (“getting a blow job”)
without a condom

Please drag and drop the behaviors below into a box based on how risky you think each behavior is for
[getting/transmitting] HIV. Please assume that a person is not using any form of protection from HIV. You may skip
this question if you do not know or would prefer not to answer.
Items

1 - Little to no risk

Deep kissing
Receptive anal sex (“bottom”)
with a condom
Receptive anal sex (“bottom”)
without a condom
Receptive oral sex (“giving a
blow job”) with a condom
Receptive oral sex (“giving a
blow job”) without a condom

2

Insertive anal sex (“top”) with a
condom
Insertive anal sex (“top”) without
a condom
Insertive oral sex (“getting a blow
job”) with a condom
Insertive oral sex (“getting a blow
job”) without a condom
3

4

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5

6 - High Risk

Please indicate how much you disagree or agree with the following statements.
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Prefer not to
answer

I know all I need to know about HIV.
I know about how to prevent getting or
transmitting HIV.
I know whether and how often I
should be tested for HIV.

Please indicate whether the following statements about HIV are true, false, or if you don’t know the answer.
True

False

Don't Know

Prefer not to
answer

The window period is the time between when a person gets tested for
HIV and when they get back the results.
HIV can be transmitted through tears, saliva, or sweat.
Antiretroviral therapy (ART) reduces the amount of HIV virus in blood
and body fluids.
ART reduces the chance of an HIV positive person transmitting HIV to
a partner who is negative.
When an HIV positive person’s viral load is “undetectable”, they are
cured.
Withdrawal or pulling out is an effective way to prevent HIV.
Heterosexual men who are circumcised are less likely to get HIV from
their female sexual partners compared with men who have not been
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circumcised.
Having a sexually transmitted disease (STD) does NOT increase a
person’s risk for getting or transmitting HIV.
Condoms protect people from every type of sexually transmitted
disease.
Vaginal sex is riskier for transmitting HIV than anal sex.
The chance of getting HIV from oral sex is lower than vaginal sex.
Having anal sex without using a condom is the riskiest type of sex for
getting or transmitting HIV.
People who are HIV negative can take medications (called preexposure prophylaxis or PrEP) to prevent getting infected with HIV if
they have sex with someone who is HIV positive.
A person who has been exposed to HIV can take medications (called
post-exposure prophylaxis or PEP) to lower their chances of getting
HIV. This only works if they take the medication within 72 hours of
being exposed.

Please indicate how much you disagree or agree with the following statements.
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Prefer not to
answer

When you live in a community
where many people have HIV, the
chances of having sex with
someone who has HIV are higher.
Sexually active gay, bisexual and
other men who have sex with men
may benefit from HIV testing every
3 to 6 months.
Having multiple sex partners may
increase a person’s risk for HIV.
All people between the ages of 13
and 64 should get tested for HIV
at least once.
Looking for sexual partners with
the same HIV status as you can
prevent getting or transmitting
HIV.
Using your HIV status and your
partner’s HIV status to determine
which sexual activities (i.e., oral,
vaginal, anal sex) you engage in
can help reduce the risk of getting
or transmitting HIV.
Using your HIV status and your
partner’s HIV status to determine
which sexual roles/positions (i.e.,
insertive/top or receptive/bottom)
you engage in can help reduce
the risk of getting or transmitting
HIV.

Pretest 5

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Next, we are going to ask you some questions about your sexual partners and behaviors.

In the past 12 months, have you had oral sex (mouth on the penis or vagina), vaginal sex (penis in the vagina), or
anal sex (penis in the butt)?
Yes
No
Prefer not to answer

Do you currently have a main sexual partner—that is, a partner you would call your boyfriend, girlfriend, spouse,
significant other, or life partner?
Yes
No
Prefer not to answer

How long have you been in a sexual relationship with your main sexual partner?
Male
Female

How long have you been in a sexual relationship with your main sexual partner? You may skip this question if you
do not know or would prefer not to answer.
Month

Day

Year

Please enter start date:

Do you know the HIV status of your main sexual partner?
Yes
No
Prefer not to answer

What is your main sexual partner’s HIV status?
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My main partner is HIV negative.
My main partner is HIV positive.
My main partner has not been tested for HIV.
My main partner has not told me his/her HIV status.
Prefer not to answer

Have you had sex with another person during the time you have been with your current main sexual partner?
Yes
No
Prefer not to answer

Pretest 6

We’d now like to ask you some questions about casual sexual partners. A non-main or casual sexual partner is
someone who you do not consider to be a spouse, significant other, or life partner.
In the past 12 months, how many casual (non-main), sexual partners did you have vaginal, anal or oral sex
with? You may skip this question if you do not know or would prefer not to answer.

Do you know the HIV status of your most recent casual (non-main) sexual partner?
Yes
No
Prefer not to answer

What is the HIV status of your most recent casual (non-main) sexual partner?
My most recent casual (non-main) sexual partner is HIV negative.
My most recent casual (non-main) sexual partner is HIV positive.
My most recent casual (non-main) sexual partner has not been tested for HIV.
My most recent casual (non-main) sexual partner has not told me his/her HIV status.

Pretest 7

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Thinking about the sex you’ve had over the past 12 months, do you consider yourself to be low, medium or high
risk for getting HIV?
Low Risk
Medium Risk
High Risk
Prefer not to answer

In the past 12 months, how often did you use condoms for vaginal or anal sex with your current main sexual
partner?
Always
Usually
Occasionally
Never
Prefer not to answer

In the past 12 months, how often did you use condoms for vaginal or anal sex with casual (non-main) sexual
partners?
Always
Usually
Occasionally
Never
Prefer not to answer

Are you currently taking antiretroviral medicines to treat your HIV infection?
Yes
No
Prefer not to answer

What is the main reason you are not currently taking any antiretroviral medicines?
Not currently going to a health care provider for my HIV infection
CD4 count and viral load are good
Don't have money or insurance for antiretroviral medicines
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Don't want to take antiretroviral medicines
Other [Specify]
Prefer not to answer

Have you ever had an HIV viral load test?
Yes
No
Don't know
Prefer not to answer

What was the result of your most recent viral load test?
Undetectable
Detectable copies/ml
Don’t know
Prefer not to answer

Before today, have you ever heard of people who do not have HIV taking HIV medicines (PrEP or Truvada) before
sex, to keep from getting HIV?
Yes
No
Prefer not to answer

In the past 12 months, have you taken HIV medicines (pre-exposure prophylaxis, PrEP or Truvada) before sex
because you thought it would keep you from getting HIV?
Yes
No
Prefer not to answer

Before today, have you ever heard of people who do not have HIV taking HIV medicines (post-exposure
prophylaxis, nPEP, or PEP) after sex, to keep from getting HIV?
Yes
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No
Prefer not to answer

In the past 12 months, have you taken HIV medicines (post-exposure prophylaxis, nPEP or PEP) after sex because
you thought it would keep you from getting HIV?
Yes
No
Prefer not to answer

Pretest 8

In this section, we are going to ask you some questions about your use of alcohol and illicit drugs.

Think specifically about the past 30 days up to and including today. During the past 30 days, on how many days did
you drink one or more drinks of an alcoholic beverage? A drink is a can or bottle of beer; a wine cooler or a glass of
wine, champagne; a shot of liquor or a mixed drink or cocktail. You may skip this question if you do not know or
would prefer not to answer.
Number of days

On the days that you drank during the past 30 days, how many drinks did you usually have each day? A drink is a
can or bottle of beer; a wine cooler or a glass of wine, champagne; a shot of liquor or a mixed drink or cocktail. You
may skip this question if you do not know or would prefer not to answer.
Number of drinks

Have you ever, even once, used a needle to inject any drug that was not prescribed for you or that you took only
for the experience or feeling it caused?
Yes
No
Don't know
Prefer not to answer

In the past 12 months, have you used a needle to inject any drug that was not prescribed for you or that you took
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only for the experience or feeling it caused?
Yes
No
Don't know
Prefer not to answer

In the past 12 months, have you been drunk or high during sex?
Yes
No
Prefer not to answer

Pretest 9

In the past 12 months, how often have you looked for information about…
Very often

Often

Sometimes

Rarely

Never

Prefer not to
answer

HIV?
HIV risk of different sexual
activities (i.e., oral, vaginal, anal
sex)?
HIV testing?
condoms?
taking medicines to treat HIV
infection (e.g., antiretroviral
therapy or ART)?
taking medicines daily to reduce
the chance of being HIV infected
(e.g., Truvada, pre-exposure
prophylaxis, or PrEP)?
taking medicines after sex to
reduce the chance of being HIV
infected (e.g., post-exposure
prophylaxis, nPEP or PEP)?
how to talk to my sexual partner(s)
about HIV?

In the past 12 months, how often have you…
Very often

Often

Sometimes

Rarely

Never

Prefer not to
answer

Daily

searched online for HIV
information?
called an HIV hotline?
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texted your zip code for a location
to get an HIV test?
visited a Centers for Disease
Control website for HIV
information?

Pretest 10

Please tell us how strongly you agree or disagree with the following statements.
Most of my friends and other people close to me…
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Prefer not to
answer

Agree

Strongly
Agree

Prefer not to
answer

talk to someone they are thinking
about having sex with about using
condoms.
always use condoms with their sex
partners.
talk to someone they are thinking
about having sex with about different
options to prevent HIV
talk with someone they are thinking
about having sex with about sexually
transmitted infections (STIs)
talk to someone they are thinking
about having sex with about number
of prior sex partners
tell someone they are thinking about
having sex with their HIV status
ask someone they are thinking about
having sex with about their HIV status
get tested for HIV as often as they
should.
take their HIV medication (ART)
correctly as prescribed by their doctor

Pretest 11

Please tell us how strongly you agree or disagree with the following statements.
I am confident that I can…
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

talk to someone I’m thinking about
having sex with about using condoms.
always use condoms correctly with my
sex partners.
talk to someone I’m thinking about
having sex with about different options
to prevent HIV
talk with someone I’m thinking about
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having sex with about sexually
transmitted diseases
talk to someone I’m thinking about
having sex with about my number of
prior sex partners
tell someone I’m thinking about
having sex with my HIV status
ask someone I’m thinking about
having sex with about their HIV status
get tested for HIV as often as I should.
take my HIV medication (ART)
correctly as prescribed by my doctor

How confident are you that you can…
Not at all confident

Somewhat confident

Very confident

Prefer not to answer

Find information about the risks of
different sexual behaviors for getting
and transmitting HIV
Understand how risky different sexual
behaviors are for getting and
transmitting HIV
Use information about HIV risk to
make decisions about how to protect
yourself from getting or transmitting
HIV
Use information about HIV risk to
make decisions about how to protect
your partner from getting or
transmitting HIV
Find information about the HIV
prevention options available to you
Find information about the benefits of
each HIV prevention option available
to you
Find information about the risks of
each HIV prevention option available
to you
Understand HIV information enough to
choose the prevention option that best
suits you
Handle unwanted pressure from
others in choosing an HIV prevention
option

Pretest 12

Next, we will ask you a few questions about your plans to do or discuss doing various things.

Please tell us how strongly you agree or disagree with the following statements.
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I plan to…
Strongly
Disagree

Disagree

Neither Agree
nor Disagree

Agree

Strongly
Agree

Prefer not to
answer

Talk to someone I’m thinking about
having sex with about using condoms.
Always use condoms correctly with my
sex partners.
Talk to someone I’m thinking about
having sex with about different options
to prevent HIV
Talk with someone I’m thinking about
having sex with about sexually
transmitted diseases (STDs)
Tell someone I’m thinking about
having sex with my HIV status
Ask someone I’m thinking about
having sex with about their HIV status
Get tested for HIV as often as I should.
Take my HIV medication (ART)
correctly as prescribed by my doctor
Find information about the risks of
different sexual behaviors
Use information about the risks of
different sexual behaviors to protect
myself from getting or transmitting HIV
Use information about the risks of
different sexual behaviors to protect
my partner from getting or transmitting
HIV

In what zip code do you currently live?

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