Form 3 Baseline Interview

“Community-based Organization (CBO) Monitoring and Evaluation
Project of Respect (CMEP-Respect)”

Attachment 5a
Baseline Survey

Form Approved
OMB No. 0920-XXXX
Exp. Date: XX/XX/20XX

“Community-based Organization (CBO) Monitoring and Evaluation Project of Respect
(CMEP-Respect)”

Baseline Survey

Public reporting burden of this collection of information is estimated to average 20 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
Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN:
PRA (0920-XXXX).

CMEP-RESPECT BASELINE DATA COLLECTION: General Information
(To be completed by staff)

The following section should be completed by CMEP-RESPECT staff.

G1. Client ID: ___ ___ ___ ___ [QDS QA Check: This number cannot be longer than 4 digits]
G2. Staff ID: ____________
G3. Data collection date: __ __/__ __/__ __ __ __ [QDS Instructions: drop-down menu]
(MM/DD/YYYY)
G4. Data collection site: _______________
G5. Survey administered by: (Choose one)
Client
Provider (in-person)
Provider (on phone)
G6. Data collection method: (Choose one)
Laptop
Handheld device
Hard copy
G7. In the past 3 months, has the client… (Choose all that apply)
Participated in a face-to-face group discussion about HIV prevention, HIV testing or safer sex
practices
Participated in an on-line discussion about HIV prevention, HIV testing or safer sex practices
Received condoms or a safe sex kit
Received HIV Case Management Services
Received Partner Services
Received written information about HIV/AIDS or STDs
Received other HIV prevention services (if yes, specify ____________________)
Has not participated in discussions or received materials related HIV/AIDS or STDs Decline to
answer
Decline to answer

1

G8. In the past 3 months, has the client participated in any HIV intervention programs? (Choose one)
Yes
No [QDS Skip: Skip to Q1]
Decline to answer
G9. If yes, which one(s)? (Choose all that apply) (Note: These interventions may be called a different
name at each agency)
Clear
Connect
d-up: Defend Yourself!
Focus on Youth + IMPACT
Healthy Relationships
Holistic Health Recovery Program
Many Men, Many Voices
MIP
MPowerment
Nia
Partnership for Health
Popular Opinion Leader
Project Start
PROMISE
RAPP
RESPECT
Safe in the City
Safety Counts
SHIELD
SIHLE
SISTA
Sister to Sister
Street Smart
Together Learning Choices
VOICES/VOCES
WILLOW
Other (specify): _________________________
Decline to answer

2

CMEP-RESPECT DATA COLLECTION: Client-level Data
(To be completed by client)
Thank you for agreeing to participate in this survey. This survey is about your attitudes and behaviors
regarding sex and sexually transmitted diseases (STDs). Many of the questions are very personal. Your
answers will be kept private. Please answer as honestly and openly as you can. Do not hesitate to ask
if you need help figuring out dates or if you don’t understand a question. There are no right or wrong
answers. Let’s get started.

Demographics
The first set of questions asks you to provide some general information about yourself.
1. *(G112) What year were you born? ___ ___ ___ ___ [QDS Instructions: drop-down menu]
2. How old are you? ______ [QDS QA Check: Respondents cannot be younger than 18 at time of data
collection]; QDS QA Check: Q2 = current year minus Q1 OR current year minus (Q1-1)]
3. *(G120) In which state do you currently live? (Choose one)
Hawaii
Oregon
Massachusetts
New York
New Jersey
Connecticut
Other _________________
Decline to answer
4. *(G114) Are you: (Choose one)
Hispanic or Latino
Not Hispanic or Latino
Don’t know
Decline to answer
5. *(G116) What is your race? (Choose all that apply)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander

3

White
Don’t know *QDS QA Check: If any of the first 5 are checked, ‘Don’t know’ should not be
enabled]
Decline to answer [QDS QA Check: If any of the first 6 are checked, ‘Decline to Answer’ should
not be enabled]
6. *(G123) What was your sex at birth? (This is the biological sex on your birth certificate.) (Choose one)
Male
Female
Decline to answer
7. *(G124) How do you currently identify yourself? (Choose one)
Male
Female
Transgender – Male to female
Transgender – Female to male
Other (Specify if your gender is not one of the choices above): _________________
Decline to answer
8. Do you consider yourself to be: (Choose one)
Homosexual (Gay, lesbian, same gender loving, queer, etc.)
Bisexual (Sexually attracted to both men and women)
Heterosexual (Straight)
Questioning (Unsure of your sexual orientation or exploring your sexual orientation)
Other (Specify if you do not consider yourself to be one of the choices above):
___________________
Decline to answer
8a. Are you currently in a primary relationship with someone? (This would be someone you live with
or see a lot, and to whom you have felt a special emotional commitment or call your
boyfriend/girlfriend) (Choose one)
Yes
No [QDS Skip: Skip to Q9]
Decline to answer
8b. How long have you been with this primary partner? (Choose one)
Less than 6 months
6 months to 1 year
1 to 5 years
Longer than 5 years
Decline to answer

4

9. What is the highest level of education that you have completed? (Choose one)
No schooling completed
Bachelor’s degree
th
8 grade or less
Post-graduate (Master’s-level degree)
Some high school
Post-graduate (Doctoral-level degree)
High school graduate/GED
Decline to answer
Some college (including technical school or training)

HIV & STD Testing, Medical Care, and Other HIV Services
The next set of questions is about your history with HIV and STD testing, medical care, and other HIV
services.
10. *(G204) Have you ever been tested for HIV? (Choose one)
Yes
No [QDS Skip: Skip to Q15]
Decline to answer
11. When was your last HIV test?(If you can’t remember then take your best guess) (Choose one)
0-3 months ago
4-12 months ago
More than 12 months (1 year) ago
Decline to answer
12. *(G205) What was the result of your last HIV test? (Choose one)
Negative [QDS Skip: Skip to Q15]
Positive [QDS Skip: If Q12 is positive, skip (do not ask) Q143 and Q145]
Don’t know [QDS Skip: Skip to Q15]
Decline to answer
13. When did you first test positive for HIV? ___ ___/___ ___ ___ ___ (If you do not remember the
month or year, please provide your best estimate.) (QDS Instructions: drop down boxes for month
and year; year must be after 1985 and month and year cannot be greater than current month and
year)
Decline to answer
14. *(G208) Have you seen a primary health care provider (doctor, nurse, etc.) for HIV-related care in
the last 6 months? (Choose one)
Yes
No
Decline to answer

5

15. *(G213) In the last 12 months (1 year), has a health care provider told you that you have/had any
of the following: (Choose all that apply)
Gonorrhea
Syphilis
Chlamydia
No, I have not been diagnosed with any of these STDs in the last 12 months [QDS Skip: Skip to
Q17; QDS QA Check: If any of the first 3 are checked this response should not be enabled]
Decline to answer *QDS QA Check: If any of the first 4 are checked, ‘Decline to Answer’ should
not be enabled]
16. In the last 3 months (90 days), has a health care provider told you that you have/had any of the
following: (Choose all that apply)
Gonorrhea
Syphilis
Chlamydia
No, I have not been diagnosed with any of these STDs in the last 3 months [QDS QA Check: If any
of the first 3 are checked this response should not be enabled]
Decline to answer *QDS QA Check: If any of the first 4 are checked, ‘Decline to Answer’ should
not be enabled]
17. In the last 3 months (90 days), have you had any of the following STD symptoms: (Choose all that
apply)
Discharge from your genitals
Pain when you urinate (pee)
A sore in your genital area
Rash or redness in your genital area
No, I have not had any of these symptoms in the last 3 months [QDS QA check: If any of the first
4 are checked this response should not be enabled]
Decline to answer*QDS QA Check: if any of the first 5 are checked, ‘Decline to Answer’ should
not be enabled]

Drug Use and Living Situation
The next of set questions are about your experience with drugs and your living situation. Some of the
questions ask about your experience over the last 12 months (1 year) and some will ask you about
your experience over the last 3 months (90 days).
18. *(G211) In the last 12 months (1 year), have you injected drugs? (This includes illegal drugs and
other substances such as silicone, botox, hormones, etc.) (Choose one)
Yes
No [QDS Skip: Skip to Q22]

6

Decline to answer
19. *(G211) In the last 12 months (1 year), have you shared needles, syringes or works? (That is, you
let someone else use your needles, syringes or works, or you borrowed someone else’s needles,
syringes or works to inject drugs.) (Choose one)
Yes
No [QDS Skip: If no, go to Q20 but skip Q21]
Decline to answer
20. In the last 3 months (90 days), have you injected drugs? (This includes illegal drugs and other
substances such as silicone, botox, hormones, etc.) (Choose one)
Yes
No [QDS Skip: Skip to Q22]
Decline to answer
21. In the last 3 months (90 days), when you injected drugs how often did you share needles, syringes
or works with someone else? (That is, you let someone else use your needles, syringes or works, or
you borrowed someone else’s needles, syringes or works to inject drugs. (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
22. In the last 3 months (90 days), were you homeless at any time? (That is, you slept in a shelter for
homeless people, on the streets, in a car, another place not intended for sleeping. In other words,
you didn’t have a permanent address) (Choose one)
Yes
No
Decline to answer
23. In the last 3 months (90 days), were you in jail or prison for more than 24 hours? (Choose one)
Yes
No
Decline to answer

7

Sexual Risk Behaviors with Male Partners
The next series of questions will ask about sex you have had with MALE partners. These questions are
only asking about anal sex you have had with your male partners. They are NOT asking about oral sex
(giving/getting blow jobs or head).
Anal sex is when one partner puts their penis into the other partner’s anus (butt). The anal sex that
you have can be insertive, that is when you put your penis into someone’s anus (butt). This is often
called “topping.” Or it can be receptive, that is when your partner puts their penis in your anus (butt).
This is often called “bottoming.”
Sex with all Male Partners in the Last 12 months (1 year)
The next few questions ask about anal sex you’ve had with your male partners over the last 12
months (1 year).
24. *(G211) In the last 12 months (1 year), have you had anal sex with a male? (Choose one)
Yes
No [QDS Skip: Skip to Q63]
Decline to answer
25. *(G212) In the last 12 months (1 year), did you have anal sex with your male partner(s)... (Choose
all that apply)
Without a condom
While you were drunk or high on drugs
So you could get drugs, money, a place to stay, clothing, or something else you needed
None of the above *QDS QA Check: If any of the first 3 are checked, ‘None of the above’ should
not be enabled]
Decline to answer [QDS QA Check: If any of the first 4 are checked, ‘Decline to Answer’ should
not be enabled]
26. *(G212) In the last 12 months (1 year), were any of your male anal sex partners someone…
(Choose all that apply)
Who has sex with others so he could get drugs, money, a place to stay, clothing, or something
else he needed
Who was an injection drug user (Someone who injected illegal drugs or other substances such as
silicone, botox, hormones, etc.)
Whose HIV status was unknown to you
Who was HIV positive

8

Who was anonymous (You do not know the person’s name and have no way to contact the
person again in the future.)
Who was a hemophiliac, recipient of a blood transfusion or a transplant recipient
None of the above[QDS QA Check: If any of the first 6 are checked ‘Decline to Answer’ should
not be enabled]
Decline to answer*QDS QA Check: If any of the first 7 are checked ‘Decline to Answer’ should not
be enabled]
Sex with all Male Partners in the Last 3 months (90 days)
The next questions ask about anal sex you’ve had with your male partners over the last 3 months (90
days). Some of the questions will ask you to report numbers. If your answer is 0 (zero) please enter 0
in the space provided.
27. In the last 3 months (90 days), have you had anal sex with a male? (Choose one)
Yes
No [QDS Skip: Skip to Q63]
Decline to answer
28. In the last 3 months (90 days), how many male partners have you had anal sex with? (Choose one)
______# partners [QDS QA Check: If response = 0 prompt respondent that they answered Yes in
Q27 to having anal sex with a male in the last 3 months; QDS QA Check: If Q28 ≥ 45 ask the
respondent to confirm]
Decline to answer
29. In the last 3 months (90 days), how many times have you had anal sex with your male partner(s)?
(Choose one)
______# times *QDS QA Check: Q29 ≥ Q28. If no, then tell respondent that the number of times
must be greater than or equal to the number of partners and have them verify Q28 and Q29; QDS
QA Check: If response = 0 prompt respondent that they answered Yes in Q27 to having anal sex
with a male in the last 3 months]
Decline to answer
30. Of the (#) [QDS Instructions: Populate with Q29 # response] times you had anal sex with your male
partner(s) during the last 3 months, how many times did you use a condom? (Choose one)
______ # times *QDS QA Check: Q30 ≤ Q29. If no, then tell respondent that the number of times
they used a condom must be less than or equal to the number of times they had sex and have them
verify Q29 and Q30; QDS Skip: If Q30 = Q29 or Q30 = 0, skip (do not ask) Qs
32,35,38,40,42,44,46,48,50,52,54,56,58,60,62]
Decline to answer

9

31. In the last 3 months (90 days), when you had anal sex with your male partner(s) were you ever
the insertive partner? (That is, you put your penis in your partner’s anus *butt+.) (Choose one)
Yes
No [QDS Skip: Skip to Q33]
Decline to answer
32. In the last 3 months (90 days), when you had anal sex with your male partner(s) how often did
you use condoms when you were the insertive partner? (That is, you put your penis in your
partner’s anus *butt+.) (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
33. In the last 3 months (90 days), when you had anal sex with your male partner(s) were you ever
the receptive partner? (That is, your partner put his penis in your anus [butt].) (Choose one)
Yes
No [QDS QA Check: If Q31 = No, Q33 cannot equal No, If it does, ask the client to confirm that
for Q27 they responded that they had anal sex with a male sex partner in the last 3 months. Also
ask the client to confirm Q31 and Q33; QDS Skip: If Q31 = Yes and Q33 = No, skip to Q36]
Decline to answer
34. In the last 3 months (90 days), when you had anal sex with your male partner(s), how often were
you the receptive partner? (That is, your partner put his penis in your anus [butt].) (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time [QDS QA Check: If Q31 = No, Q34 must = All the time. If Q31 = No and Q34 does not
equal All the time, ask the client to confirm Q31; QDS QA Check: If Q31 = Yes and Q33 = Yes, this
value choice should not appear or not be enabled]
Decline to answer
35. In the last 3 months (90 days), when you had anal sex with your male partner(s) how often did
you use condoms when you were the receptive partner? (That is, your partner put his penis in your
anus [butt].) (Choose one)
Never
Less than half the time
Half the time

10

More than half the time
All the time
Decline to answer
36. In the last 3 months (90 days), when you had anal sex with your male partner(s) how often were
you drunk or high on drugs? (Choose one)
Never [QDS Skip: If never, skip to Q39]
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
37. In the last 3 months (90 days), when you had anal sex with your male partner(s) while high or
drunk, which were you using? (Choose all that apply)
Amphetamines, meth, speed, crystal, ice or crank
Heroin (injected, smoked or snorted)
Painkillers (including Oxycontin, Percocet)
Club drugs such as GHB (G), Ketamine (K)
Marijuana
Cocaine (smoked, snorted, or injected)
Crack
Poppers (Amyl nitrate)
Downers (Valium, Ativan, Xanax)
Ecstasy (E)
Hallucinogens such as LSD (acid)
Alcohol
Other: __________________
Decline to answer *QDS QA Check: If any of the first 13 are checked, ‘Decline to Answer’ should
not be enabled]
38. In the last 3 months (90 days), when you had anal sex with your male partner(s) while high or
drunk, how often did you use condoms? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

11

The next questions ask about anal sex with your male primary/main and casual partners.
A primary/main partner is someone you live with, have a special emotional connection with, love,
and/or call your boyfriend/girlfriend/husband/wife.
A casual partner is someone you have had sex with but do not consider to be a primary/main partner.
A casual partner may be someone you have had sex with one time or many times.
Some of the questions in this section will ask you to report numbers. If your answer is 0 (zero) please
enter 0 in the space provided.
39. In the last 3 months (90 days), how many of the (#) [QDS Instructions: Populate with Q28 #
response] men that you have had anal sex with were primary/main partners? (Choose one)
______# primary/main partners [QDS QA Check: Q39 must be less than or equal to Q28. If not,
then tell client that the number of primary/main male partners must be less or equal to the total
number of male and ask them to confirm their answers to Q28 and Q39; QDS QA check: If Q39 ≥
10, refer respondent to the definition of primary/main partner and ask them to confirm the
number of primary/main partners; QDS QA Check: If response = 0 skip to Q41]
Decline to answer
40. In the last 3 months (90 days), how often did you use condoms when having anal sex with your
male primary/main partner(s)? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
41. In the last 3 months (90 days), how many of the (#) [QDS Instructions: Populate with Q28 #
response] men that you have had anal sex with were casual partners? (Choose one)
______# casual partners [QDS QA Check: Q39 + Q41 = Q28. If no, tell client that the number of
primary/main partners plus the number of casual partners must equal the total number of male
partners. Ask client to confirm Q28, 39, and 41l Q DS QA Check: If response = 0 skip to Q43]
Decline to answer
42. In the last 3 months (90 days), how often did you use condoms when having anal sex with your
male casual partner(s)? (Choose one)
Never
Less than half the time
Half the time

12

More than half the time
All the time
Decline to answer
The next set of questions is about the characteristics of the male partners you’ve had anal sex with.
Some of the questions will ask you to report numbers. If your answer is 0 (zero) please enter 0 in the
space provided.
43. In the last 3 months (90 days), did you have anal sex with a male who had an HIV status that was
unknown to you? (Choose one)
Yes
No [QDS Skip: Skip to Q45]
Decline to answer
44. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) whose HIV status was unknown to you? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
45. In the last 3 months (90 days), did you have anal sex with a male who you knew had an HIV status
that was different than yours? (Choose one)
Yes
No [QDS Skip: Skip to Q47]
Decline to answer
46. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) whose HIV status was different than yours? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
47. In the last 3 months (90 days), did you have anal sex with a male only one time? (That is, a onenight stand.) (Choose one)
Yes

13

No [QDS Skip: Skip to Q49]
Decline to answer
48. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) who you had anal sex with only one time? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
49. In the last 3 months (90 days), did you have anal sex with a male who was anonymous? (That is,
you do not know their name and you have no way of contacting them.) (Choose one)
Yes
No [QDS Skip: Skip to Q51]
Decline to answer
50. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
anonymous male partner(s)? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
51. In the last 3 months (90 days), did a male sex partner give you money, drugs, a place to stay,
clothing or something else you needed in exchange for anal sex? (Choose one)
Yes
No [QDS Skip: Skip to Q53]
Decline to answer
52. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) who gave you money, drugs, a place to stay, clothing or something else you
needed in exchange for anal sex? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time

14

Decline to answer
53. In the last 3 months (90 days), did you give a male sex partner money, drugs, a place to stay,
clothing or something else they needed to in exchange for anal sex? (Some common terms for
these men could include ‘sex workers’, ‘prostitutes’,’ hustlers’, etc.) (Choose one)
Yes
No [QDS Skip: Skip to Q55]
Decline to answer
54. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) who you gave money, drugs, a place to stay, clothing or something else they
needed in exchange for anal sex? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
55. In the last 3 months (90 days), did you have anal sex with a male who you knew was an injection
drug user? (That is, they injected illegal drugs or other substances such as silicone, botox, hormones,
etc.) (Choose one)
Yes
No [QDS Skip: Skip to Q57]
Decline to answer
56. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) who injected drugs? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
57. In the last 3 months (90 days), did you have anal sex with a male who you knew had spent more
than 24 hours in jail? (Choose one)
Yes
No [QDS Skip: Skip to Q59]
Decline to answer

15

58. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) who had spent more than 24 hours in jail? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
59. In the last 3 months (90 days), did you have anal sex with a male who had syphilis, Chlamydia or
gonorrhea? (Choose one)
Yes
No [QDS Skip: Skip to Q61]
Decline to answer
60. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partner(s) who had syphilis, Chlamydia or gonorrhea? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
61. In the last 3 months (90 days), did you have anal sex with a male who you knew had one or more
of the following STD symptoms: discharge from the genitals, pain during urination (peeing), sores
in the genital area, rash or redness in the genital area? (Choose one)
Yes
No [QDS Skip: Skip to Q63]
Decline to answer
62. In the last 3 months (90 days), how often did you use condoms when you had anal sex with your
male partners who you knew had one or more of the following STD symptoms: discharge from the
genitals, pain during urination (peeing), sores in the genital area, rash or redness in the genital
area? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

16

Sexual Risk Behaviors with Female Partners
The next series of questions will ask about sex you have had with FEMALE partners. These questions
are only asking about anal or vaginal sex you have had with your female partners. They are NOT
asking about oral sex (giving/getting blow jobs or head). Anal sex means putting your penis into
someone’s anus (butt).
Vaginal sex means putting your penis in someone’s vagina.
Sex with all Female Partners in the Last 12 months (1 year)
The next few questions ask about anal or vaginal sex you’ve had with your female partners over the
last 12 months (1 year).
63. *(G211) In the last 12 months (1 year), have you had anal OR vaginal sex with a female? (Choose
one)
Yes
No [QDS Skip: Skip to Q99]
Decline to answer [QDS Skip: Skip to Q99]
64. *(G212) In the last 12 months (1 year), did you have anal OR vaginal sex with your female
partner(s)…
(Choose all that apply)
Without a condom
While you were drunk or high on drugs
So you could get drugs, money, a place to stay, clothing, or something else you needed
None of the above *QDS QA Check: If any of the first 3 are checked, ‘None of the above’ should
not be enabled]
Decline to answer *QDS QA Check: If any of the first 3 are checked, ‘Decline to Answer’ should
not be enabled]
65. *(G212) In the last 12 months (1 year), were any of your female anal OR vaginal sex partner(s)
someone…
(Choose all that apply)
Who has sex with others so she could get drugs, money, a place to stay, clothing, or something
else she needed
Who was an injection drug user (Someone who injected illegal drugs or other substances such as
silicone, botox, hormones, etc.)
Whose HIV status was unknown to you or different from your own
Who was HIV positive

17

Who was anonymous (You do not know the person’s name and have no way to contact the
person again in the future)
Who was a hemophiliac, recipient of a blood transfusion, or a transplant recipient
None of the above *QDS QA Check: If any of the first 6 are checked ‘None of the above’ should
not be enabled]
Decline to answer [QDS QA Check: If any of the first 6 are checked ‘Decline to Answer’ should
not be enabled]
Sex with all Female Partners in the Last 3 months (90 day)
The next questions ask about anal or vaginal sex you’ve had with your female partners over the last 3
months (90 days). Some of the questions will ask you to report numbers. If your answer is 0 (zero)
please enter 0 in the space provided.
66. In the last 3 months (90 days), have you had anal OR vaginal sex with a female? (Choose one)
Yes
No [QDS Skip: Skip to Q99]
Decline to answer
67. In the last 3 months (90 days), how many female partners have you had anal OR vaginal sex with?
(Choose one)
______# partners [QDS QA Check: If response = 0 prompt respondent that they answered Yes in
Q66 to having anal or vaginal sex with a female in the last 3 month; QDS QA Check: If Q67 ≥ 45 ask
the respondent to confirm]
Decline to answer
68. In the last 3 months (90 days), how many times have you had anal OR vaginal sex with your
female partner(s)?
______# times *QDS QA Check: Q68 ≥ Q67. If no, then tell respondent that the number of times
must be greater than or equal to the number of partners and have them verify Q67 and Q68; QDS
QA Check: If response = 0 prompt respondent that they answered Yes in Q66 to having anal or
vaginal sex with a female in the last 3 months]
Decline to answer
69. Of the (#) [QDS Instructions: Populate with Q68 # response] times you had anal OR vaginal sex with
your female partner(s) during the last 3 months, how many times did you use a condom? (Choose
one)
_______# times (if 0, enter 0) [QDS QA Check: Q69 ≤ Q68. If no, then tell respondent that the
number of times must be greater than or equal to the number of partners and have them verify
Q68 and Q69; QDS QA Skip: If Q69 = Q68 or Q69=0, do not ask Qs
71,73,76,78,80,82,84,86,88,90,92,94,96,98]

18

Decline to answer
70. In the last 3 months (90 days), have you had vaginal sex with your female partner(s)? (Choose
one)
Yes
No [QDS Skip: Skip to Q72]
Decline to answer
71. In the last 3 months (90 days), when you had vaginal sex with your female partner(s) how often
did you use condoms? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
72. In the last 3 months (90 days), have you had anal sex with your female partner(s)? (Choose one)
Yes
No [QDS QA Check: If Q70 = No, Q72 = No. , ask client to confirm in Q66 that they have had anal
or vaginal sex with a female over the last 3 months. Also ask the client to confirm Q70.] [QDS QA
Check: If Q70 = Yes and Q72 = no, skip to Q74]
Decline to answer
73. In the last 3 months (90 days), when you had anal sex with your female partner(s) how often did
you use condoms? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
74. In the last 3 months (90 days), when you had anal OR vaginal sex with your female partner(s) how
often were you drunk or high on drugs? (Choose one)
Never [QDS Skip: Skip to Q77]
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

19

75. In the last 3 months (90 days), when you had anal OR vaginal sex with your female partner(s)
while high or drunk, which of the following substances were you using? (Choose all that apply)
Amphetamines, meth, speed, crystal, ice or crank
Heroin (injected, smoked or snorted)
Painkillers (including Oxycontin, Percocet)
Club drugs such as GHB (G), Ketamine (K)
Marijuana
Cocaine (smoked, snorted, or injected)
Crack
Poppers (Amyl nitrate)
Downers (Valium, Ativan, Xanax)
Ecstasy (E)
Hallucinogens such as LSD (acid)
Alcohol
Other: __________________
Decline to answer *QDS QA Check: If any of the first 13 are checked, ‘Decline to Answer’ should
not be enabled]
76. In the last 3 months (90 days), when you had anal OR vaginal sex with your female partner(s)
while high or drunk, how often did you use condoms? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
The next questions ask about anal or vaginal sex with your female primary/main and casual partners.
A primary/main partner is someone you live with, have a special emotional connection with, love,
and/or call your boyfriend/girlfriend/husband/wife.
A casual partner is someone you have had sex with but do not consider to be a primary/main partner.
A casual partner may be someone you have had sex with one time or many times.
Some of the questions in this section ask you to report numbers. If your answer is 0 (zero) please
enter 0 in the space provided.

20

77. In the last 3 months (90 days), how many of the (#) [QDS Instructions: Populate with Q67 #
response] women that you have had anal OR vaginal sex with were primary/main partners?
(Choose one)
______# primary/main partners [QDS QA Check: Q77 must be less than or equal to Q67. If not,
then tell client that the number of primary/main female partners must be less or equal to the total
number of female and ask them to confirm their answers to Q67 and Q77; QDS QA Check: If Q77 ≥
10, refer respondent to the definition of primary/main partner and ask them to confirm the
number of primary/main partners; QDS QA check If response = 0 skip to Q79.]
Decline to answer
78. In the last 3 months (90 days), how often did you use condoms when having anal OR vaginal sex
with your female primary/main partner(s)? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
79. In the last 3 months (90 days), how many of the (#) [QDS Instructions: Populate with Q67 #
response] women that you have had anal OR vaginal sex with were casual partners? (Choose one)
______# casual partners (If 0, enter 0) [QDS QA Check: Q77 + Q79 = Q67. If no, tell client that
the number of primary/main partners plus the number of casual partners must equal the total
number of total female partners. Ask client to confirm Q67, 77, and 79. QDS QA Check: If response
= 0 skip to Q81]
Decline to answer
80. In the last 3 months (90 days), how often did you use condoms when having anal OR vaginal sex
with your female casual partner(s)? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
The next set of questions is about the characteristics of the female partners you’ve had anal or vaginal
sex with.
Some of the questions will ask you to report numbers. If your answer is 0 (zero) please enter 0 in the
space provided.

21

81. In the last 3 months (90 days), did you have anal OR vaginal sex with a female who had an HIV
status that was unknown to you? (Choose one)
Yes
No [QDS Skip: Skip to Q83]
Decline to answer
82. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your female partner(s) whose HIV status was unknown to you? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
83. In the last 3 months (90 days), did you have anal OR vaginal sex with a female who you knew had
an HIV status that was different than yours? (Choose one)
Yes
No [QDS Skip: Skip to Q85]
Decline to answer
84. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your female partner(s) whose HIV status was different than yours? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
85. In the last 3 months (90 days), did you have anal OR vaginal sex with a female only one time?
(That is, a one-night stand.) (Choose one)
Yes
No [QDS Skip: Skip to Q87]
Decline to answer
86. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your female partner(s) that you had anal OR vaginal sex with only one time? (Choose one)
Never
Less than half the time
Half the time

22

More than half the time
All the time
Decline to answer
87. In the last 3 months (90 days), did you have anal OR vaginal sex with a female who was
anonymous? (Choose one) (That is, you do not know their name and you have no way of contacting
them.)
Yes
No [QDS Skip: Skip to Q89]
Decline to answer
88. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your anonymous female partner(s)? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
89. In the last 3 months (90 days), did a female sex partner give you money, drugs, a place to stay,
clothing or something else you needed in exchange for anal OR vaginal sex? (Choose one)
Yes
No [QDS Skip: Skip to Q91]
Decline to answer
90. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your female partner(s) that gave you money, drugs, a place to stay, clothing or something
else you needed in exchange for anal OR vaginal sex? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
91. In the last 3 months (90 days), did you give a female sex partner money, drugs, a place to stay,
clothing or something else they needed in exchange for anal OR vaginal sex? (Choose one)
Yes
No [QDS Skip: Skip to Q93]
Decline to answer

23

92. In the last 3 months (90 days), how often did you use condoms with your female partner(s) that
you gave money, drugs, a place to stay, clothing or something else they needed in exchange for
anal OR vaginal sex? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
93. In the last 3 months (90 days), did you have anal OR vaginal sex with a female who you knew was
an injection drug user? (Choose one) (That is, they injected illegal drugs or other substances such as
silicone, botox, hormones, etc.)
Yes
No [QDS Skip: Skip to Q95]
Decline to answer
94. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your female partner(s) who injected drugs? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
95. In the last 3 months (90 days), did you have anal OR vaginal sex with a female who had syphilis,
Chlamydia or gonorrhea? (Choose one)
Yes
No [QDS Skip: Skip to Q97]
Decline to answer
96. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your female partner(s) who had syphilis, Chlamydia or gonorrhea? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

24

97. In the last 3 months (90 days), did you have anal OR vaginal sex with a female who you knew had
one or more of the following STD symptoms: discharge from the genitals, pain during urination
(peeing), sores in the genital area, rash or redness in the genital area? (Choose one)
Yes
No [QDS Skip: Skip to Q99]
Decline to answer
98. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your female partner(s) who you knew had one or more of the following STD symptoms:
discharge from the vagina, pain during urination (peeing), sores in the genital area, rash or
redness in the genital area? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

Sexual Risk Behaviors with Transgender Partners
The next series of questions will ask about sex you have had with TRANSGENDER partners. These
questions are only asking about anal or vaginal sex you have had with your transgender partners.
They are NOT asking about oral sex (giving/getting blow jobs or head).
Anal sex is when one partner puts their penis into the other partner’s anus (butt). The anal sex that
you have can be insertive, that is when you put your penis into someone’s anus (butt). This is often
called “topping.” Or it can be receptive, that is when your partner puts their penis in your anus (butt).
This is often called “bottoming. “ Vaginal sex means putting your penis in someone’s vagina.
Sex with all Transgender Partners in the Last 12 months (1 year)
The next few questions ask about anal or vaginal sex you’ve had with your transgender partners over
the last 12 months (1 year).
99. *(G211) In the last 12 months (1 year), have you had anal OR vaginal sex with a transgender
partner? (Choose one)
Yes
No [QDS Skip: Skip to Q141]
Decline to answer

25

100. *(G212) In the last 12 months (1 year), did you have anal OR vaginal sex with a transgender
partner(s)… (Choose
all that apply)
Without a condom
While you were drunk or high on drugs
So you could get drugs, money, a place to stay, clothing, or something else you needed
None of the above *QDS QA Check: If any of the first 3 are checked, ‘None of the above’ should
not be enabled]
Decline to answer*QDS QA Check: If any of the first 3 are checked, ‘Decline to answer’ should
not be enabled]
101. *(G212) In the last 12 months (1 year), were any of your transgender anal OR vaginal sex
partner(s) someone… (Choose all that apply)
Who has sex with others so they could get drugs, money, a place to stay, clothing, or something
else he needed
Who was an injection drug user (Someone who injected illegal drugs or other substances such as
silicone, botox, hormones, etc.)
Whose HIV status was unknown to you
Who was HIV positive
Who was anonymous (You do not know the person’s name and have no way to contact the
person again in the future)
Who was a hemophiliac, recipient of a blood transfusion or a transplant recipient
None of the above *QDS QA Check: If any of the first 6 are checked, ‘None of the above’ should
not be enabled]
Decline to answer[QDS QA Check: If any of the first 6 are checked, ‘Decline to answer’ should
not be enabled]
Sex with all Transgender Partners in the Last 3 Months (90 days)
The next questions ask about anal or vaginal sex you’ve had with your transgender partners over the
last 3 months (90 days). Some of the questions will ask you to report numbers. If your answer is 0
(zero) please enter 0 in the space provided.
102. In the last 3 months (90 days), have you had anal OR vaginal sex with a transgender partner?
(Choose one)
Yes
No [QDS Skip: Skip to Q141]
Decline to answer

26

103. In the last 3 months (90 days), how many transgender sex partners have you had anal OR vaginal
sex with? (Choose one)
______# partners [QDS QA Check: If response = 0 prompt respondent that they answered Yes in
Q102 to having anal or vaginal sex with a transgender in the last 3 months; QDS QA Check: If Q103
≥ 45 ask the respondent to confirm+
Decline to answer
104. In the last 3 months (90 days), how many times have you had anal OR vaginal sex with your
transgender partner(s)? (Choose one)
______# times *QDS Check: Q104 ≥ Q103. If no, then tell respondent that the number of times
must be greater than or equal to the number of partners and have them verify Q103 and Q104; Q
DS QA Check: If response = 0 prompt respondent that they answered Yes in Q102 to having anal or
vaginal sex with a transgender partner in the last 3 months]
Decline to answer
105. Of the (#) [QDS Instructions: Populate with Q29 # response] times you had anal OR vaginal sex
with your transgender partner(s) during the last 3 months, how many times did you use a
condom?
______ # times *QDS QA Check: Q105 ≤ 104. If not, tell respondent that the number of times
that the number of times they used a condom must be less than or equal to the number of times
they have had sex and ask them to confirm Q104 and Q105; Q DS QA Skip: If Q105 = Q104 or
Q105=0, skip (do not ask) Qs 107,110,113,116,118,120,122,124,126,128,130,132,134,136,138,140]
Decline to answer
106. In the last 3 months (90 days), have you had vaginal sex with your transgender partner(s)?
(Choose one)
Yes
No [QDS Skip: Skip to Q108]
Decline to answer
107. In the last 3 months (90 days), when you had vaginal sex with your transgender partner(s) how
often did you use
condoms? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
108. In the last 3 months (90 days), have you had anal sex with your transgender partner(s)? (Choose
one)

27

Yes
No [QDS QA Check: If Q106 = No, and Q108=No. If and Q106, ask client to confirm in Q 102 that
they have had anal or vaginal sex with a transgender over the last 3 months. Also ask the client to
confirm Q106. Also ask the client to confirmQ106 and Q108; QDS Skip: If Q106 = Yes and Q108 =
No, skip to Q114]
Decline to answer
109. In the last 3 months (90 days), when you had anal sex with your transgender partner(s) were you
ever the insertive partner? (That is, you put your penis in your partner’s anus *butt+.) (Choose one)
Yes
No [QDS Skip: Skip to Q111]
Decline to answer
110. In the last 3 months (90 days), when you had anal sex with your transgender partner(s) how
often did you use condoms when you were the insertive partner? (That is, you put your penis in
your partner’s anus *butt+.) (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
111. In the last 3 months (90 days), when you had anal sex with your transgender partner(s) were you
ever the receptive partner? (That is, your partner put their penis in your anus [butt].) (Choose one)
Yes
No [QDS Check: If Q109 = No, and Q111 = No, ask the client to confirm that for Q108 they
responded that they had anal sex with a transgender partner in the last 3 months. Also ask the
client to confirm Q109 and Q111; QDS Skip: If Q109 = Yes and Q111 = No, skip to 114]
Decline to answer
112. In the last 3 months (90 days), when you had anal sex with your transgender partner(s) how
often were you the receptive partner? (That is, your partner put their penis in your anus [butt].)
(Choose one)
Less than half the time
Half the time
More than half the time
All the time [QDS QA Check: If Q109 = No, Q112 must = All the time. If Q109 = No and Q112 does
not equal All the time, ask the client to confirm Q109; QDS QA Check: If Q109 = Yes and Q111 = Yes,
this value choice should not appear or not be enabled]
Decline to answer

28

113. In the last 3 months (90 days), when you had anal sex with your transgender partner(s) how
often did you use condoms when you were the receptive partner? (That is, your partner put his
penis in your anus [butt].) (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
114. In the last 3 months (90 days), when you had anal OR vaginal sex with your transgender
partner(s) how often were you drunk or high on drugs? (Choose one)
Never [QDS Skip: Skip to Q117]
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
115. In the last 3 months (90 days), when you had anal OR vaginal sex with your transgender
partner(s) while high or drunk, which of the following substances were you using? (Choose all that
apply)
Amphetamines, meth, speed, crystal, ice or crank
Heroin (injected, smoked or snorted)
Painkillers (including Oxycontin, Percocet)
Club drugs such as GHB (G), Ketamine (K)
Marijuana
Cocaine (smoked, snorted, or injected)
Crack
Poppers (Amyl nitrate)
Downers (Valium, Ativan, Xanax)
Ecstasy (E)
Hallucinogens such as LSD (acid)
Alcohol
Other: __________________
Decline to answer [QDS QA Check: If any of the first 13 are checked, ‘Decline to answer’ should
not be enabled]

29

116. In the last 3 months (90 days), when you had anal OR vaginal sex with transgender partner(s)
while high or drunk, how often did you use condoms? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
The next questions ask about anal or vaginal sex with your transgender primary/main and casual
partners.
A primary/main partner is someone you live with, have a special emotional connection with, love,
and/or call your boyfriend/girlfriend/husband/wife.
A casual partner is someone you have had sex with but do not consider to be a primary/main partner.
A casual partner may be someone you have had sex with one time or many times.
Some of the questions in this section ask you to report numbers. If your answer is 0 (zero) please
enter 0 in the space provided.
117. In the last 3 months (90 days), how many of the (#) [QDS Instructions: Populate with Q103 #
response] transgender partners that you have had anal OR vaginal sex with were primary/main
partners? (Choose one)
______# primary/main partners [QDS QA check: Q117 must be less than or equal to Q103. If
not, tell client that the number of primary/male transgender partners must be less than or equal to
the total number of transgender and ask them to confirm their answers to Q103 and Q117; QDS
check: If Q117 ≥ 10, refer respondent to the definition of primary/main partner and ask them to
confirm the number of primary/main partners.; QDS QA Check: If response = 0 skip to Q119]
Decline to answer
118. In the last 3 months (90 days), how often did you use condoms when having anal OR vaginal sex
with your transgender primary/main partner(s)? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

30

119. In the last 3 months (90 days), how many of the (#) [QDS Instructions: Populate with Q103 #
response] transgender partners that you have had anal OR vaginal sex with were casual partners?
(Choose one)
______# casual partners (If 0, enter 0) [QDS QA Check: Q117 + Q119 = Q103 If no, tell client that
the number of primary/main partners plus the number of casual partners must equal the total
number of total transgender partners. Ask client to confirm Q103, Q117, and Q121; Q DS QA
Check: If response = 0 skip to Q81]
Decline to answer
120. In the last 3 months (90 days), how often did you use condoms when having anal OR vaginal sex
with your transgender casual partner(s)? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
The next set of questions is about the characteristics of the transgender partners you’ve had anal or
vaginal sex with.
Some of the questions will ask you to report numbers. If your answer is 0 (zero) please enter 0 in the
space provided.
121. In the last 3 months (90 days), did you have anal OR vaginal sex with a transgender partner who
had an HIV status that was unknown to you? (Choose one)
Yes
No [QDS Skip: Skip to Q123]
Decline to answer
122. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal
sex with your transgender partner(s) whose HIV status was unknown to you? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

31

123. In the last 3 months (90 days), did you have anal OR vaginal sex with a transgender partner who
you knew had an HIV status that was different than yours? (Choose one)
Yes
No [QDS Skip: Skip to Q125]
Decline to answer
124. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your transgender partner(s) whose HIV status was different than yours? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
125. In the last 3 months (90 days), did you have anal OR vaginal sex with a transgender partner only
one time? (That is, a one-night stand.) (Choose one)
Yes
No [QDS Skip: Skip to Q127]
Decline to answer
126. In the last 3 months (90days), how often did you use condoms when you had anal OR vaginal sex
with your transgender partner(s) that you had anal OR vaginal sex with only one time? (Choose
one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
127. In the last 3 months (90 days), did you have anal OR vaginal sex with a transgender partner who
was anonymous? (That is, you do not know their name and you have no way of contacting them.)
(Choose one)
Yes
No [QDS Skip: Skip to Q129]
Decline to answer
128. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your anonymous transgender partner(s)? (Choose one)
Never

32

Less than half the time
Half the time
More than half the time
All the time
Decline to answer
129. In the last 3 months (90 days), did a transgender sex partner give you money, drugs, a place to
stay, clothing or something else you needed in exchange for anal OR vaginal sex? (Choose one)
Yes
No [QDS Skip: Skip to Q131]
Decline to answer
130. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal
sex with your transgender partner(s) that gave you money, drugs, a place to stay, clothing or
something else you needed in exchange for anal OR vaginal sex? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
131. In the last 3 months (90 days), did you give a transgender sex partner money, drugs, a place to
stay, clothing or something else they needed in exchange for anal OR vaginal sex? (Some common
terms for these individuals could include ‘sex workers’, ‘prostitutes’, etc.) (Choose one)
Yes
No [QDS Skip: Skip to Q133]
Decline to answer
132. In the last 3 months (90 days), how often did you use condoms with transgender partner(s) that
you gave money, drugs, a place to stay, clothing or something else they needed in exchange for
anal OR vaginal sex? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

33

133. In the last 3 months (90 days), did you have anal OR vaginal sex a transgender partner who you
knew was an injection drug user? (That is, they injected illegal drugs or other substances such as
silicone, botox, insulin, hormones, etc.) (Choose one)
Yes
No [QDS Skip: Skip to Q135]
Decline to answer
134. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal
sex with your transgender partner(s) who injected drugs? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
135. In the last 3 months (90 days), did you have anal OR vaginal sex with a transgender partner who
you knew had spent more than 24 hours in jail? (Choose one)
Yes
No [QDS Skip: Skip to Q137]
Decline to answer
136. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal
sex with your transgender partner(s) who had spent more than 24 hours in jail? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer
137. In the last 3 months (90 days), did you have anal OR vaginal sex with a transgender partner who
had syphilis, Chlamydia or gonorrhea? (Choose one)
Yes
No [QDS Skip: Skip to Q139]
Decline to answer
138. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal
sex with your transgender partner(s) who had syphilis, Chlamydia or gonorrhea? (Choose one)
Never
Less than half the time

34

Half the time
More than half the time
All the time
Decline to answer
139. In the last 3 months (90 days), did you have anal OR vaginal sex with a transgender partner who
you knew had one or more of the following STD symptoms: discharge from the penis or vagina,
pain during urination (peeing), sores in the genital area, rash or redness in the genital area?
(Choose one)
Yes
No [QDS Skip: Skip to Q141]
Decline to answer
140. In the last 3 months (90 days), how often did you use condoms when you had anal OR vaginal sex
with your transgender partner(s) who you knew had one or more of the following STD symptoms:
discharge from the penis or vagina, pain during urination (peeing), sores in the genital area, rash
or redness in the genital area? (Choose one)
Never
Less than half the time
Half the time
More than half the time
All the time
Decline to answer

Correct Condom Use
[QDS Skip: If Q30=0 and Q69=0 and Q105=0, skip to Q143]
This section will ask you about your experience using condoms over the last 3 months (90 days) when
you were having vaginal or anal sex.
141. In the last 3 months (90 days) how often did the condom break or slip off either during sex or
while you (or your partner) were pulling out? (Choose one)
Never
Sometimes
Always
Don’t know
Decline to answer
142. In the last 3 months (90 days), how often did you or your partner put the condom on after you
had started having sex or take the condom off before you had finished having sex? (Choose one)

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Never
Sometimes
Always
Don’t know
Decline to answer

Perceived HIV Risk
The next set of questions is about how likely you think it is that you will get HIV/STDs or give
HIV/STDs to someone else.
143. What do you think is your chance of getting HIV/AIDS in the future if you do not use condoms
every time you have sex? (Choose one)
No chance
Unlikely
Likely
Certain to happen
Decline to answer
144. What do you think is your chance of getting an STD in the future if you do not use condoms
every time you have sex? (Choose one)
No chance
Unlikely
Likely
Certain to happen
Decline to answer
145. What do you think is your chance of getting HIV/AIDS in the future if you share needles,
syringes, or works when you inject drugs? (Choose one)
No chance
Unlikely
Likely
Certain to happen
Decline to answer
146. If you currently have a STD or were to get an STD, what do you think is your chance of giving an
STD to your partner(s) in the future if you do not use condoms every time you have sex? (Choose
one)
No chance
Unlikely
Likely

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Certain to happen
Decline to answer
147. If you are currently HIV-positive or were to become HIV-positive, what do you think is your
chance of giving HIV/AIDS to your partner(s) in the future if you do not use condoms every time
you have sex? (Choose one)
No chance
Unlikely
Likely
Certain to happen
Decline to answer
148. If you are currently HIV-positive or were to become HIV-positive, what do you think is your
chance of giving HIV/AIDS to your partner(s) in the future if you share needles, syringes or works
when you inject drugs? (Choose the one answer that best describes your chance)
No chance
Unlikely
Likely
Certain to happen
Decline to answer

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