Form 2 Attachment 1 ACASI Questionnaire English

HIV NOTIFICATION AND COUNSELING_Questionnaire_31_Aug_2014

SECTION A – STUDY DATA

Public reporting burden for this collection of information is estimated to average 40 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX). Do not return the completed form to this address.

OMB #: 0925-XXXX

Expiration Date:

Attachment 1: Follow-up ACASI survey of HIV-positive donors

Appendix 3 Follow-up ACASI survey of HIV-positive donors

HIV NOTIFICATION AND COUNSELING (English)

SECTION A - STUDY DATA

READ AND HEARD: This section is to be completed by the research assistant or other research staff

A1. NOTIFICATION STUDY SUBJECT ID

__ __ __ __ __ __ __

A2. REDS-II /REDS-III RF Subject Study ID:

__ __ __ __ __ __ __

A3. Subject Type (Choose one)

__ Case

A4. Study participation site (Choose one)

31 HEMOPE - Pernambuco

32 FPS - Sao Paulo

33 HEMOMINAS - Minas Gerais

34 HEMORIO-Rio de Janeiro

A5. Month of interview (Choose one)

01 January

02 February

03 March

04 April

05 May

06 June

07 July

08 August

09 September

10 October

11 November

12 December

A6. Year of interview (please enter four numbers)

__ __ __ __ yyyy

A7. Research Assistant Initials: __ __ __ __ __

READ AND HEARD: If study subject is not already sitting at the computer, at this time please make sure the study subject is sitting at the computer and has put the headphones on.

SECTION B - DEMOGRAPHIC DATA

READ AND HEARD: This study has been approved by Ethical Committees in Brazil (CONEP approval #XXXXX) and in the USA (IRB# XXXXX).

This study also has been approved by the Office of Management and Budget; OMB XXXXXXX, OMB approval expires XX, XXXXX, XXXX. 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 clearance number.

READ AND HEARD: The estimated time for collecting the information contained in this questionnaire is 40 minutes, on average, including time for reviewing instructions, responding to questions, and any answer revisions.

READ AND HEARD: The following questions are about your general characteristics. Please, respond as truthful as you can, and keep in mind that your answers are anonymous and will be reported together with all other participants who complete this questionnaire. We know that you have answered some of these questions before. We are asking them again because they will help us understand your current living situation.

READ AND HEARD: From now on, you will be left alone. It means that you will have privacy to answer this survey. Please, if you have any questions call the research assistant for help.

B1. What is your gender?

1 Male

2 Female

7 Don't Know

8 Refuse to Answer

B2. What is your current marital status? (Choose one)

1 Single, never married.

2 Living together, but not legally married.

3 Married.

4 Separated/divorced.

5 Widowed.

7 Don't Know

8 Refuse to Answer

If B2 is not equal to 2 and B2 is not equal to 3, then skip to B4.

B3. If you are married or living with someone, is your spouse/cohabitating partner (Choose one)

0 Male

1 Female

2 Transgender

7 Don't Know

8 Refuse to Answer

B4. What level of education do you have? (Choose one)

00 Never been to school

01 Adult alphabetization

02 Not finished the Elementary school

03 Elementary school

04 High school

05 Technical or professional school

06 College

07 Pos-graduation/ Master/Doctoral

97 Don't Know

98 Refuse to Answer

B5. Are you presently employed? 1 Yes

0 No

7 Don't Know

8 Refuse to Answer

B6. What is your occupation?

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ __ __ __

Section C - Previous donation and HIV testing

READ AND HEARD: The following questions are about blood donation and HIV testing. Please, respond as truthfully as you can. Your answers are anonymous and will be reported together with all other participants who complete this questionnaire.

C1. Since you learned of your HIV test result, have you tried to donate blood at this or another blood center?

1 Yes

0 No Skip to C4

7 Don't Know

8 Refuse to Answer

C2. Since you learned of your HIV test result, how many times have you tried to donate blood at this or at another blood center? (Choose one)

1 1 time

2 2 or more times

7 Don't Know

8 Refuse to Answer

C3. What was the reason for your attempted blood donation? Please check all the boxes for the factors that contributed to your decision to come to a blood center after you learned about your previous HIV test result. When you have selected all of your answers, please touch the "Next Question" box. (Check all that apply)

__ Only place I know of offering tests

__ Testing is free

__ Testing is confidential

__ Testing is more accurate than at other sites

__ Testing is more convenient than at other test sites

__ I wanted to double check the HIV test result

__ I wanted to know about test results other than HIV

__ Other

__ Don't Know

__ Refuse to Answer

C3b. Please specify any other reason for donating blood.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

C4. Since you learned of your HIV test result from the blood center, have you been tested for HIV somewhere else?

1 Yes

0 No Skip to C8

7 Don't Know

8 Refuse to Answer

C5. Since you learned of your HIV test result from the blood center, where have you been tested for HIV? (Choose one)

1 Private lab

2 Counseling and Testing Centers (CTA's)

3 Hospital

4 Public lab

5 Blood bank

6 Other place

7 Don't Know

8 Refuse to Answer

If C5 is not equal to 6, then skip to C5c.

C5b. Please specify the other test site.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

C5c. When was the last time you were tested for HIV? Please tell us the month and year if you can remember.

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

C6. Since you learned of your HIV test result from the blood center, how many times have you been tested for HIV? (Choose one)

1 1 time

2 2 times

3 3 or more times

7 Don't Know

8 Refuse to Answer

C7. Overall, how would you rate your HIV testing experience at locations other than the blood center? (Choose one)

0 Very satisfactory

1 Satisfactory

2 Unsatisfactory

3 Very unsatisfactory

7 Don't Know

8 Refuse to Answer

If C7 is not equal to 2 or C7 is not equal to 3, then skip to C7c.

C7b. Please check all the boxes for the factors that contributed to your unsatisfactory or very unsatisfactory HIV testing experience. (Check all that apply)

__ Long wait at the testing site

__ The testing site was crowded.

__ The testing site is too close to my house.

__ The testing site is too far away from my house.

__ There is a lack of privacy at the testing site.

__ The counseling session takes too long.

__ The HIV result takes too long of time to get.

__ The HIV test result is not accurate.

__ I unexpectedly met an acquaintance and did not feel comfortable.

__ I am not confident in the quality of the equipment and facilities.

__ The staff at the testing site was not nice to me.

__ Other reason

__ Don't Know

__ Refuse to Answer

If C7bK is not equal to 0, then skip to C8.

C7c. Please specify the other reason for your unsatisfactory or very unsatisfactory HIV testing experience

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

C8. Counseling and Testing Centers (CTA) are health services that provide diagnosis and prevention services for sexually transmitted diseases. At CTA's you can obtain free and confidential testing for HIV, syphilis and hepatitis B and hepatitis C among other services. Have you ever heard about the Counseling and Testing Centers?

1 Yes

0 No Skip to instruction before D1

7 Don't Know

8 Refuse to Answer

If C8 is equal to 0, then skip to instruction before D1.

C9. Have you ever been tested at a Counseling and Testing Centers (CTA)?

1 Yes

0 No Skip to instruction before D1

7 Don't Know

8 Refuse to Answer

C10. When was the last time you were tested at a Counseling and Testing Centers (CTA)? Please specify the month and year.

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

Section D - Sexual History

READ AND HEARD: Now we want to ask about the people you have had sex with or your sexual partners since you learned of your HIV test result. We understand that these questions are about intimate and private matters, which could make you uncomfortable. Please keep in mind that the questions are part of a scientific study. Please answer these questions to the best of your knowledge and as truthfully as you can.

D1. As of today, what do you consider yourself to be? (Choose one)

1 Straight/heterosexual

2 Bisexual

3 Gay/homosexual

4 Transgender

(Transgender definition: People who were assigned a sex, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of their sexual identity)

7 Don't Know

8 Refuse to Answer

READ AND HEARD: The following questions will ask you about your sexual experiences. In these questions, include only those people you have had oral, vaginal, or anal sex with. Do not include people that you have just kissed. Please note: For the next few questions the terms "sexual contact" and "sex" refer to any of the following activities, whether or not a condom or other protection was used: Vaginal sex (vaginal sex is when a man inserts his penis into a woman's vagina), Oral sex (oral sex is when a partner puts his/her mouth on your sex organs or you put your mouth on his/her sex organs), Anal sex (anal sex, when a man inserts his penis into his partner's anus).

D2. (Ask of Men Only) How many different women have you had sex with since you first began having sex?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

D3. (Ask of Men Only) How old were you when you had sex with a woman for the first time?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

D4. (Ask of Men Only) How many different men have you had sex with since you first began having sex?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

D5. (Ask of Men Only) How old were you when you had sex with a man for the first time?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

If D3 is equal to 0 and D4 is equal to 0 and B1 is equal to 1, then skip to instruction before G1.

D2. (Ask of Women Only) How many different men have you had sex with since you first began having sex?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

D3. (Ask of Women Only) How old were you when you had sex with a man for the first time?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

D4. (Ask of Women Only) How many different women have you had sex with since you first began having sex?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

D5. (Ask of Women Only) How old were you when you had sex with a woman for the first time?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

9999 Not Applicable

If D3 is equal to 0 and D4 is equal to 0 and B1 is equal to 2, then skip to instruction before G1.

Section E - Sexual Behavior and Sexual partners risks

READ AND HEARD: Now, we want to ask about the people you have had sex with or your sexual partners. We will also ask you about some of their risks for HIV. Please answer these questions to the best of your knowledge.

E1. When was the last time you have had sex or intercourse with man? (Please tell us the month and year)

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

E2. When was the last time you have had sex or intercourse with woman? (Please tell us the month and year)

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

E3. Since you learned of your HIV test result, how many men have you had sex with? Please include both ongoing sexual partners and one-time encounters. (Choose one)

__ Zero Skip to E4

__ 1

__ 2 to 5

__ More than 5

__ Don't Know

__ Refuse to Answer

If E3 is equal to 0, then skip to E5.

E4. With regard to your ongoing sexual partners and one-time encounters with men, how often did you use condoms when you had sex? (Choose one)

0 Never

1 Sometimes

2 Always

7 Don't Know

8 Refuse to Answer

E5. Since you learned of your HIV test result, how many women have you had sex with? Please include both ongoing sexual partners and one-time encounters. (Choose one)

0 Zero Skip to instruction before E7

1 1

2 2 to 5

3 More than 5

7 Don't Know

8 Refuse to Answer

If E5 is equal to 0, then skip to instruction before E7.

E6. With regard to your ongoing sexual partners and one-time encounters with women, how often did you use condoms when you had sex? (Choose one)

0 Never

1 Sometimes

2 Always

7 Don't Know

8 Refuse to Answer

READ AND HEARD: We are now going to ask you about things that you may have happened to you. No one will know the answers you tell us. If any of these questions make you uncomfortable you may skip them. You may also tell the research assistant if you would like to talk to someone after completing the questionnaire.

E7. Have you ever been physically abused? (Please do not consider sexual abuse when answering this question).

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E8. Since you learned of your HIV test result, have you been physically abused?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E9. Have you ever been sexually abused or forced to have sex without your consent?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E10. Since you have learned of your HIV test result, have you been sexually abused or forced to have sex without your consent?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E11. Since you learned of your HIV test result, have you had sex with anyone who was an intravenous drug user?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E12. Since you learned of your HIV test result, have you had sex with anyone who tested positive for hepatitis?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E13. Since you learned of your HIV test result, have you had sex with anyone who tested positive for HIV?

1 Yes

0 No Skip to E15

7 Don't Know

8 Refuse to Answer

E14. Since you learned of your HIV test result, how many different HIV positive partners have you had? (Choose one)

0 Zero

1 1

2 2 to 5

3 More than 5

7 Don't Know

8 Refuse to Answer

E15. To the best of your knowledge, if any of your partners were HIV positive, were they taking HIV medications? (Choose one)

0 Yes, all of them

1 Yes, some of them

2 No, none of them

7 Don't Know

8 Refuse to Answer

E16. (Ask of Women Only) Since you learned of your HIV test result, have you had sex with a man who has had sex with another man?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E17. Since you learned of your HIV test result, have you had sex with anyone who received a blood transfusion?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E18. Since you learned of your HIV test result, have you had sex with anyone who was a hemophiliac?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

E19. Since you learned of your HIV test result, have you had sex with anyone who has spent three or more nights in jail, prison, or a detention center?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

9 Not Applicable

E20. Since you learned of your HIV test result, have you had sex with anyone who had a job that involved exposure to blood or other body fluids?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

READ AND HEARD: Now we are going to ask you some general questions regarding sexual behavior and history. We are asking you to respond as truthfully as you can. The answers are anonymous. Your answers will be reported together with all other people who complete the questionnaire.

E21. Since you learned of your HIV test result, have you exchanged (given or received) money or drugs, gifts or trips for sex?

1 Yes

0 No Skip to E23

7 Don't Know

8 Refuse to Answer

E22. When was the last time that you have you exchanged money or drugs, gifts or trips for sex?

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

E23. Since you learned of your HIV test result, have you smoked or snorted illegal drugs? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

E24. Since you learned of your HIV test result, have you used or shot up injection drugs (examples include heroin, cocaine, and amphetamines)? (Choose one)

0 No Skip to E26

1 Yes

7 Don't Know

8 Refuse to Answer

E25. When was the last year you injected drugs?

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

E26. Since you learned of your HIV test result, have you injected any non-prescription substances including vitamins, anabolic steroids, or hormones? (Choose one)

0 No Skip to instruction before E28

1 Yes

7 Don't Know

8 Refuse to Answer

E27. When was the last time you injected non-prescription substances including drug, vitamins, anabolic steroids or hormones?

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

If E24 is equal to 0 and E26 is equal to 0, then skip to E29.

E28. Since you learned of your HIV test result, have you shared needles or syringes with another person?

1 Yes

0 No Skip to instruction before F1

7 Don't Know

8 Refuse to Answer

E29. When was the last time that you shared needles?

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

Section F - Social Matrix

READ AND HEARD: This next set of questions is about sexual experiences you may have had in the 12 months BEFORE today. While some people have had a lot of sexual experience, others have not, so questions may or may not apply to you. Please answer these questions as accurately as possible. Remember that answers that you provide will be combined with those from all other people who complete the questionnaire and we will never disclose individual responses to any question. Specifically, we will ask about sexual activities that include vaginal and anal sex. Please answer these questions to the best of your knowledge and as truthfully as you can.

F1. How many people have you had sex in the last 12 months?

__ __

97 Don't Know

98 Refuse to Answer

If F1 is equal to 0, then skip to F2.

READ AND HEARD: Now we're going to ask you specific questions about your sex partners. If you had more than five partners in the 12 months BEFORE this interview, we are only going to ask you about the five most recent sex partners. Please start with the most recent sex partner or encounter that you had BEFORE this interview and then move back in time. Please be sure to focus on the sex partners you have had after your HIV result. When you answer the questions keep in mind we are asking about your partners after you received your HIV test results.

F2. What is Partner 1's gender? (Check all that apply)

__ Male

__ Female

__ Transgender

__ Don't Know

__ Refuse to Answer

F3. How old is partner 1?

__ __

97 Don't Know

98 Refuse to Answer

F4. What type of partner is partner 1? (Choose one)

1 Anonymous - Did not know, met for sex, never plan to see again

2 One time - Already knew person, but had sex only once

3 Acquaintance - Had sex more than once but not regularly

4 Friend (you socialize with this person) - Had sex more than once but not regularly

5 Main partner - Your spouse or main sex partner

6 Sex worker - Money or other goods were exchanged for sex

7 Don't Know

8 Refuse to Answer

F5. How would you describe partner 1's race or ethnicity? (Choose one)

1 Caucasian

2 Black

3 Asian

4 Mulatto

5 Indian

7 Don't Know

8 Refuse to Answer

If E11 is equal to 0, then skip to F6.

If E11 is equal to 1, then skip to instruction before F7.

F6. Is partner 1 an injection drug user? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

If F2 is equal to 2, then skip to F8.

F7. Is partner 1 a male who has had sex with other males? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

F8. What is partner 1's HIV status? (Choose one)

1 Positive

2 Negative

3 Unknown

8 Refuse to Answer

F9. Where did you first meet partner 1? (Choose one)

01 Bar, cafe, nightclub, restaurant, gym or athletic activity

02 Sex club, bathhouse

03 Street, park, library, public transportation

04 Parties, clubs, political function or church

05 Internet

06 Dating service, newspaper ads

07 Carnival

08 Work

09 Met some other way

97 Don't Know

98 Refuse to Answer

If F9 is not equal to 9, then skip to instruction before F11.

F10. Specify where you met partner 1:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

If B1 is equal to 1 and F2 is equal to 0, then skip to F15.

If B1 is equal to 1 and F2 is equal to 1, then skip to F11.

If B1 is equal to 2 and F2 is equal to 0, then skip to F11.

If B1 is equal to 2 and F2 is equal to 1, then skip to instruction before F19.

F11. Number of times you had vaginal intercourse with partner 1 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F11 is equal to 0, then skip to F13.

F12. When you had vaginal sex, how frequently did you use condoms? (Choose one)

__ never

__ sometimes

__ every time

__ Don't Know

__ Refuse to Answer

F13. Number of times you had anal intercourse with partner 1 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F13 is equal to 0, then skip to instruction before F19.

F14. When you had anal sex, how frequently did you use condoms? (Choose one)

__ never

__ sometimes

__ every time

__ Don't Know

__ Refuse to Answer

Skip to instruction before F19.

F15. (Ask of Men Only) Number of times you had insertive anal intercourse (your penis inserted into your partner's anus) with partner 1 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F15 is equal to 0, then skip to F17.

F16. When you had insertive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every time

__ Don't Know

__ Refuse to Answer

F17. Number of times you had receptive anal intercourse (your partner's penis inserted into your anus) with partner 1 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F17 is equal to 0, then skip to instruction before F19.

F18. When you had receptive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every times

__ Don't Know

__ Refuse to Answer

If F18 is equal to 0, then skip to instruction before F19.

If F1 is equal to 1, then skip to instruction before G1.

READ AND HEARD: The next set of questions is about your second most recent sexual partner in the last year, after you have learned about your HIV positive result.

F19. What is Partner 2's gender? (Check all that apply)

__ Male

__ Female

__ Transgender

__ Don't Know

__ Refuse to Answer

F20. How old is partner 2?

__ __

97 Don't Know

98 Refuse to Answer

F21. What type of partner is partner 2? (Choose one)

1 Anonymous - Did not know, met for sex, never plan to see again

2 One time - Already knew person, but had sex only once

3 Acquaintance - Had sex more than once but not regularly

4 Friend (you socialize with this person) - Had sex more than once but not regularly

5 Main partner - Your spouse or main sex partner

6 Sex worker - Money or other goods were exchanged for sex

7 Don't Know

8 Refuse to Answer

F22. How would you describe partner 2's race or ethnicity? (Choose one)

1 Caucasian

2 Black

3 Asian

4 Mulatto

5 Indian

7 Don't Know

8 Refuse to Answer

If E11 is equal to 0, then skip to F23.

If E11 is equal to 1, then skip to instruction before F24.

F23. Is partner 2 an injection drug user? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

If F19 is equal to 2, then skip to F25.

F24. Is partner 2 a male who has had sex with other males? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

F25. What is partner 2's HIV status? (Choose one)

1 Positive

2 Negative

3 Unknown

8 Refuse to Answer

F26. Where did you first meet partner 2? (Choose one)

01 Bar, cafe, nightclub, restaurant, gym or athletic activity

02 Sex club, bathhouse

03 Street, park, library, public transportation

04 Parties, clubs, political function or church

05 Internet

06 Dating service, newspaper ads

07 Carnival

08 Work

09 Met some other way

97 Don't Know

98 Refuse to Answer

If F26 is not equal to 9, then skip to instruction before F28.

F27. Specify where you met partner 2:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

If B1 is equal to 1 and F19 is equal to 0, then skip to F32.

If B1 is equal to 1 and F19 is equal to 1, then skip to F28.

If B1 is equal to 2 and F19 is equal to 0, then skip to F28.

If B1 is equal to 2 and F19 is equal to 1, then skip to instruction before F36.

F28. Number of times you had vaginal intercourse with partner 2 in past 12 months. (Choose one)

__ none

__ 1 to 3 times.

__ 4 to 10 times.

__ more than 10 times.

__ Don't Know

__ Refuse to Answer

If F28 is equal to 0, then skip to F30.

F29. When you had vaginal sex, how frequently did you use condoms? (Choose one)

__ Never

__ Sometimes

__ Every time

__ Don't Know

__ Refuse to Answer

If F29 is equal to 0, then skip to F30.

F30. Number of times you had anal intercourse with partner 2 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F30 is equal to 0, then skip to instruction before F36.

F31. When you had anal sex, how frequently did you use condoms? (Choose one)

__ never

__ sometimes

__ every time

__ Don't Know

__ Refuse to Answer

Skip to instruction before F36.

F32. (Ask of Men Only) Number of times you had insertive anal intercourse (your penis inserted into your partners anus) with partner 2 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F32 is equal to 0, then skip to F34.

F33. When you had insertive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every time

__ Don't Know

__ Refuse to Answer

F34. Number of times you had receptive anal intercourse (your partner's penis inserted into your anus) with partner 2 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F34 is equal to 0, then skip to instruction before F36.

F35. When you had receptive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every times

__ Don't Know

__ Refuse to Answer

If F35 is equal to 0, then skip to instruction before F36.

If F1 is equal to 2, then skip to instruction before G1.

READ AND HEARD: The next set of questions is about your third most recent sexual partner in the last year, after you have learned about your HIV positive result.

F36. What is Partner 3's gender? (Check all that apply)

__ Male

__ Female

__ Transgender

__ Don't Know

__ Refuse to Answer

F37. How old is partner 3?

__ __

97 Don't Know

98 Refuse to Answer

F38. What type of partner is partner 3? (Choose one)

1 Anonymous - Did not know, met for sex, never plan to see again

2 One time - Already knew person, but had sex only once

3 Acquaintance - Had sex more than once but not regularly

4 Friend (you socialize with this person) - Had sex more than once but not regularly

5 Main partner - Your spouse or main sex partner

6 Sex worker - Money or other goods were exchanged for sex

7 Don't Know

8 Refuse to Answer

F39. How would you describe partner 3's race or ethnicity? (Choose one)

1 Caucasian

2 Black

3 Asian

4 Mulatto

5 Indian

7 Don't Know

8 Refuse to Answer

If E11 is equal to 0, then skip to F40.

If E11 is equal to 1, then skip to instruction before F41.

F40. Is partner 3 an injection drug user? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

If F36 is equal to 2, then skip to F42.

F41. Is partner 3 a male who has had sex with other males? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

F42. What is partner 3's HIV status? (Choose one)

1 Positive

2 Negative

3 Unknown

8 Refuse to Answer

F43. Where did you first meet partner 3? (Choose one)

01 Bar, cafe, nightclub, restaurant, gym or athletic activity.

02 Sex club, bathhouse

03 Street, park, library, public transportation

04 Parties, clubs, political function or church

05 Internet

06 Dating service, newspaper ads

07 Carnival

08 Work

09 Met some other way

97 Don't Know

98 Refuse to Answer

If F43 is not equal to 9, then skip to instruction before F45.

F44. Specify where you met partner 3:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

If B1 is equal to 1 and F36 is equal to 0, then skip to F49.

If B1 is equal to 1 and F36 is equal to 1, then skip to F45.

If B1 is equal to 2 and F36 is equal to 0, then skip to F45.

If B1 is equal to 2 and F36 is equal to 1, then skip to instruction before F53.

F45. Number of times you had vaginal intercourse with partner 3 in past 12 months. (Choose one)

__ none

__ 1 to 3 times.

__ 4 to 10 times.

__ more than 10 times.

__ Don't Know

__ Refuse to Answer

If F45 is equal to 0, then skip to F47.

F46. When you had vaginal sex, how frequently did you use condoms? (Choose one)

__ Never

__ Sometimes.

__ Every time.

__ Don't Know

__ Refuse to Answer

F47. Number of times you had anal intercourse with partner 3 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F47 is equal to 0, then skip to instruction before F53.

F48. When you had anal sex, how frequently did you use condoms? (Choose one)

__ never

__ sometimes

__ every time

__ Don't Know

__ Refuse to Answer

Skip to instruction before F53.

F49. (Ask of Men Only) Number of times you had insertive anal intercourse (your penis inserted into your partners anus) with partner 3 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F49 is equal to 0, then skip to F51.

F50. When you had insertive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every time

__ Don't Know

__ Refuse to Answer

F51. Number of times you had receptive anal intercourse (your partners penis inserted into your anus) with partner 3 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F51 is equal to 0, then skip to instruction before F53.

F52. When you had receptive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every times

__ Don't Know

__ Refuse to Answer

If F52 is equal to 0, then skip to instruction before F53.

If F1 is equal to 3, then skip to instruction before G1.

READ AND HEARD: The next set of questions is about your fourth most recent sexual partner in the last year, after you have learned about your HIV positive result.

F53. What is Partner 4's gender? (Check all that apply)

__ Male

__ Female

__ Transgender

__ Don't Know

__ Refuse to Answer

F54. How old is partner 4?

__ __

97 Don't Know

98 Refuse to Answer

F55. What type of partner is partner 4? (Choose one)

1 Anonymous - Did not know, met for sex, never plan to see again

2 One time - Already knew person, but had sex only once

3 Acquaintance - Had sex more than once but not regularly

4 Friend (you socialize with this person) - Had sex more than once but not regularly

5 Main partner - Your spouse or main sex partner

6 Sex worker - Money or other goods were exchanged for sex

7 Don't Know

8 Refuse to Answer

F56. How would you describe partner 4's race or ethnicity? (Choose one)

1 Caucasian

2 Black

3 Asian

4 Mulatto

5 Indian

7 Don't Know

8 Refuse to Answer

If E11 is equal to 0, then skip to F57.

If E11 is equal to 1, then skip to instruction before F58.

F57. Is partner 4 an injection drug user? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

If F53 is equal to 2, then skip to F59.

F58. Is partner 4 a male who has had sex with other male? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

F59. What is partner 4's HIV status? (Choose one)

1 Positive

2 Negative

3 Unknown

8 Refuse to Answer

F60. Where did you first meet partner 4? (Choose one)

01 Bar, cafe, nightclub, restaurant, gym or athletic activity.

02 Sex club, bathhouse

03 Street, park, library, public transportation

04 Parties, clubs, political function or church

05 Internet

06 Dating service, newspaper ads

07 Carnival

08 Work

09 Met some other way

97 Don't Know

98 Refuse to Answer

If F60 is not equal to 9, then skip to instruction before F62.

F61. Specify where you met partner 4:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

If B1 is equal to 1 and F53 is equal to 0, then skip to F66.

If B1 is equal to 1 and F53 is equal to 1, then skip to F62.

If B1 is equal to 2 and F53 is equal to 0, then skip to F62.

If B1 is equal to 2 and F53 is equal to 1, then skip to instruction before F70.

F62. Number of times you had vaginal intercourse with partner 4 in past 12 months. (Choose one)

__ none

__ 1 to 3 times.

__ 4 to 10 times.

__ more than 10 times.

__ Don't Know

__ Refuse to Answer

If F62 is equal to 0, then skip to F64.

F63. When you had vaginal sex, how frequently did you use condoms? (Choose one)

__ Never

__ Sometimes.

__ Every time.

__ Don't Know

__ Refuse to Answer

If F63 is equal to 0, then skip to F64.

F64. Number of times you had anal intercourse with partner 4 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F64 is equal to 0, then skip to instruction before F70.

F65. When you had anal sex, how frequently did you use condoms? (Choose one)

__ never

__ sometimes

__ every time

__ Don't Know

__ Refuse to Answer

If F65 is equal to 0, then skip to instruction before F70.

Skip to instruction before F70.

F66. (Ask of Men Only) Number of times you had insertive anal intercourse (your penis inserted into your partner's anus) with partner 4 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F66 is equal to 0, then skip to F68.

F67. When you had insertive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every time

__ Don't Know

__ Refuse to Answer

F68. Number of times you had receptive anal intercourse (your partner's penis inserted into your anus) with partner 4 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F68 is equal to 0, then skip to instruction before F70.

F69. When you had receptive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every times

__ Don't Know

__ Refuse to Answer

If F69 is equal to 0, then skip to instruction before F70.

If F1 is equal to 4, then skip to instruction before G1.

READ AND HEARD: The next set of questions is about your fifth most recent sexual partner in the last year, after you have learned about your HIV positive result.

F70. What is Partner 5's gender? (Check all that apply)

__ Male

__ Female

__ Transgender

__ Don't Know

__ Refuse to Answer

F71. How old is partner 5?

__ __

97 Don't Know

98 Refuse to Answer

F72. What type of partner is partner 5? (Choose one)

1 Anonymous - Did not know, met for sex, never plan to see again

2 One time - Already knew person, but had sex only once

3 Acquaintance - Had sex more than once but not regularly

4 Friend (you socialize with this person) - Had sex more than once but not regularly

5 Main partner - Your spouse or main sex partner

6 Sex worker - Money or other goods were exchanged for sex

7 Don't Know

8 Refuse to Answer

F73. How would you describe partner 5's race or ethnicity? (Choose one)

1 Caucasian

2 Black

3 Asian

4 Mulatto

5 Indian

7 Don't Know

8 Refuse to Answer

If E11 is equal to 0, then skip to instruction before F75.

If E11 is equal to 1, then skip to instruction before F75.

F74. Is partner 5 an injection drug user? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

If F70 is equal to 2, then skip to F76.

F75. Is partner 5 a male who has had sex with other males? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

F76. What is partner 5's HIV status? (Choose one)

1 Positive

2 Negative

3 Unknown

8 Refuse to Answer

F77. Where did you first meet partner 5? (Choose one)

01 Bar, cafe, nightclub, restaurant, gym or athletic activity.

02 Sex club, bathhouse

03 Street, park, library, public transportation

04 Parties, clubs, political function or church

05 Internet

06 Dating service, newspaper ads

07 Carnival

08 Work

09 Met some other way

97 Don't Know

98 Refuse to Answer

If F77 is not equal to 9, then skip to instruction before F79.

F78. Specify where you met partner 5:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

If B1 is equal to 1 and F70 is equal to 0, then skip to F83.

If B1 is equal to 1 and F70 is equal to 1, then skip to F79.

If B1 is equal to 2 and F70 is equal to 0, then skip to F79.

If B1 is equal to 2 and F70 is equal to 1, then skip to instruction before G1.

If B1 is equal to 1 and F70 is equal to 0, then skip to F83.

If B1 is equal to 1 and F70 is equal to 1, then skip to F79.

If B1 is equal to 2 and F70 is equal to 0, then skip to F79.

If B1 is equal to 2 and F70 is equal to 1, then skip to F79.

F79. Number of times you had vaginal intercourse with partner 5 in past 12 months. (Choose one)

__ none

__ 1 to 3 times.

__ 4 to 10 times.

__ more than 10 times.

__ Don't Know

__ Refuse to Answer

If F79 is equal to 0, then skip to F81.

F80. When you had vaginal sex, how frequently did you use condoms? (Choose one)

__ Never

__ Sometimes.

__ Every time.

__ Don't Know

__ Refuse to Answer

If F80 is equal to 0, then skip to F81.

F81. Number of times you had anal intercourse with partner 5 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F81 is equal to 0, then skip to instruction before G1.

F82. When you had anal sex, how frequently did you use condoms? (Choose one)

__ never

__ sometimes

__ every time

__ Don't Know

__ Refuse to Answer

If F82 is equal to 0, then skip to instruction before G1.

Skip to instruction before G1.

F83. (Ask of Men Only) Number of times you had insertive anal intercourse (your penis inserted into your partner's anus) with partner 5 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F83 is equal to 0, then skip to F85.

F84. When you had insertive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every time

__ Don't Know

__ Refuse to Answer

F85. Number of times you had receptive anal intercourse (your partner's penis inserted into your anus) with partner 5 in past 12 months. (Choose one)

__ none

__ 1 to 3 times

__ 4 to 10 times

__ more than 10 times

__ Don't Know

__ Refuse to Answer

If F85 is equal to 0, then skip to instruction before G1.

F86. When you had receptive anal sex, how frequently did you use condoms? (Choose one)

__ never

__ some times

__ every times

__ Don't Know

__ Refuse to Answer

If F86 is equal to 0, then skip to instruction before G1.

Section G - Medical History

READ AND HEARD: In the next set of questions we will ask about some medical treatments you may have had.

G1. Since you learned of your HIV test result, have you received a blood transfusion? (Choose one)

0 No Skip to G4

1 Yes

7 Don't Know

8 Refuse to Answer

G2. Since you learned of your HIV test result, how many transfusions have you received?

__ __

97 Don't Know

98 Refuse to Answer

G3. When was the last year you received a transfusion?

__ __ __ __

9997 Don't Know

9998 Refuse to Answer

G4. Since you learned of your HIV test result, have you had minor or major medical surgery, tooth extraction, or another dental procedure? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

G5. Since you learned of your HIV test result, have you had endoscopy or colonoscopy? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

G6. Since you learned of your HIV test result, have you taken antiretroviral therapy (ART) ? (Choose one)

0 No Skip to instruction before H1

1 Yes

7 Don't Know

8 Refuse to Answer

G7. If yes, in what year did you start taking ART?

__ __ __ __ yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

G8. Are you currently taking ART?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

9 Not Applicable

G9. What ART are you currently taking? A list and pictures of available therapies are provided to help you recall. (Check all that apply)

__ Abacavir

__ Didanosine

__ Estavudine

__ Lamivudine

__ Tenofovir

__ Zidovudine

__ Efavirenz

__ Nevirapine

__ Etravirine

__ Atazanavir

__ Danunavir

__ Fosamprenavir

__ Indinavir

__ Lopinavir

__ Nelfinavir

__ Ritonavir

__ Saquinavir

__ Tipranavir

__ Enfuvintide

__ Raltegravir

__ Don't Know

__ Refuse to Answer

Section H- General Activities or Exposures

READ AND HEARD: The next set of questions we will focus on other exposures you may have had.

H1. Since you learned of your HIV test result, have you spent three or more nights in jail, prison, or a detention center? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

H2. Since you learned of your HIV test result, have you had acupuncture treatments? (Choose one)

0 No

1 Yes

7 Don't Know

8 Refuse to Answer

H3. Since you learned of your HIV test result, have you had a new tattoo or had one re-applied? (Choose one)

0 No Skip to H5

1 Yes

7 Don't Know

8 Refuse to Answer

H4. Since you learned of your HIV test result, where did you get your most recent tattoo? (Choose one)

1 Tattoo parlor

2 At home, a friends place, or at parties/raves

3 Jail

4 Other

7 Don't Know

8 Refuse to Answer

H5. Since you learned of your HIV test result, have you had new ear or body piercings? (Choose one)

0 No Skip to H7

1 Yes

7 Don't Know

8 Refuse to Answer

H6. Since you learned of your HIV test result, where did you get your most recent piercing? (Choose one)

1 Pharmacy or medical clinic

2 Tattoo/piercing parlor

3 At home, a friends place, or at parties/raves

4 Jail

5 Other

7 Don't Know

8 Refuse to Answer

H7. Since you learned of your HIV test result, have you had a manicure or pedicure or had a shave at a barber shop? (Choose one)

0 No Skip to instruction before H9

1 Yes

7 Don't Know

8 Refuse to Answer

H8. Since you learned of your HIV test result, how many times have you had manicures or pedicures or shaves at a barbershop? (Choose one)

1 1 time

2 2 to 5 times

3 5 or more times

7 Don't Know

8 Refuse to Answer

READ AND HEARD: Now, we would like to know about any personal contact you have had with persons who either have AIDS or have tested positive for HIV. In each question, please include only family members, personal friends or acquaintances.

H9. How many people do you personally know who do NOT have AIDS, but have HIV, the virus that causes AIDS? Please do not include yourself when answering this question (Choose one)

0 0 (none)

1 1

2 2 to 4

3 5 or more

7 Don't Know

8 Refuse to Answer

H10. How many people do you personally know who currently have AIDS? Please do not include yourself when answering this question. (Choose one)

0 0 (none)

1 1

2 2 to 4

3 5 or more

7 Don't Know

8 Refuse to Answer

Section I - Counseling and Notification

READ AND HEARD: The next set of questions we will focus on Counseling and Notification, since you learned your HIV test result.

I1. When did you first learn about your HIV test result? Type month and year

__ __ / __ __ __ __ mm / yyyy

2097 Don't Know (Year)

2098 Refuse to Answer (Year)

2099 Not Applicable (Year)

I2. Where did you first learn about your HIV test result? (Choose one)

0 At the Blood Center

1 At a Counseling and Testing Center (CTA)

2 At a Private lab

3 At a Public lab

4 Other place

7 Don't Know

8 Refuse to Answer

If I2 is not equal to 0, then skip to I4.

I3. How do you rate your confidence level in the blood bank physician during your HIV counseling and notification? (Choose one)

0 Very confident

1 Confident

2 Somehow confident

3 Not confident

7 Don't Know

8 Refuse to Answer

I4. How do you rate the counseling skills of the blood bank physician during your HIV test result notification? (Choose one)

0 Very Satisfactory

1 Satisfactory

2 Unsatisfactory

3 Very Unsatisfactory

7 Don't Know

8 Refuse to Answer

I5. How do you rate the importance of the blood bank counseling physician in your decision to seek health care? (Choose one)

0 Very Important

1 Important

2 Somehow important

3 Not important at all

7 Don't Know

8 Refuse to Answer

I6. After the blood bank physician notification and counseling, did you go to seek health care somewhere else?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

If I6 is not equal to 1, then skip to I10.

I7. After the blood bank physician notification and counseling, where did you go to seek health care? (Choose one)

0 Volunteer Counseling and Testing site

1 Private Hospital

2 Public Hospital

3 My physician's office

4 Other

7 Don't Know

8 Refuse to Answer

If I7 is not equal to 4, then skip to I9.

I8. Please specify other place __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

I9. After the blood bank physician notification and counseling, how long did it take for you to seek health care somewhere else? (Choose one)

0 Within 2 weeks

1 2 - 4 weeks

2 1 - 3 months

3 4 - 6 months

4 More than 6 months

7 Don't Know

8 Refuse to Answer

I10. After you learned about your HIV test result, have you disclosed your result to someone else? (Choose one)

0 No Skip to I12

1 Yes

7 Don't Know

8 Refuse to Answer

I11. To whom have you disclosed your HIV test result? (Check all that apply)

__ My partner/spouse

__ Best friend

__ Several friends

__ Family

__ Co-worker(s)

__ Priest or other religious leader

__ Health care provider

__ Other

__ Don't Know

__ Refuse to Answer

I12. What are the reasons for not disclosing your HIV test result? (Check all that apply)

__ I'm afraid of discrimination

__ I feel ashamed/embarrassed

__ I believe this is my personal/private information

__ Other reason

__ Don't Know

__ Refuse to Answer

If I12 is not equal to 6, then skip to I13.

I12b. Please specify the other reason

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

I13. Have you felt discriminated against because of your HIV test result? (Choose one)

0 Not at all Skip to instruction before J1

1 A little

2 Somewhat

3 A lot

7 Don't Know

8 Refuse to Answer

I14. Can you tell us more about why you feel discrimination? Did something occur that you felt was discrimination? (Check all that apply)

__ Have you been discriminated against by coworkers or classmates because of your HIV test result.

__ Someone has made fun of you because of your HIV test result.

__ Someone has offended you because of your HIV test result.

__ You have been harassed because of your HIV test result.

__ All above

__ Other

__ Don't Know

__ Refuse to Answer

Section J- Impact of Your Test Result

READ AND HEARD: In the following section we are going to ask you some questions related to how you may behave and think, and how others may behave and think in regard to HIV. We understand this is a very sensitive topic. Please read the questions carefully and answer as honestly as you can.

J1. In the place where you work are people friends with other people who have HIV?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

J2. Are you concerned you might give HIV to someone else? (Choose one)

0 not at all Skip to J3

1 a little

2 a fair amount

3 a great deal

7 Don't Know

8 Refuse to Answer

J2a. In what ways are you concerned of transmitting HIV? (Check all that apply)

__ Using bathrooms, public showers, gyms

__ Shaking hands, touching, hugging people

__ Sharing dishes, glasses, spoons, forks, etc

__ Kissing other people

__ Protected sex (with condoms)

__ Unprotected sex (without condoms)

__ Pregnancy

__ Breastfeeding

__ Other

__ Don't Know

__ Refuse to Answer

If J2a is not equal to 9, then skip to J3.

J2c. Could you please, specify other ways of transmission?

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

J3. Do you feel that people avoid you because of your HIV test result? (Choose one)

0 not at all

1 at little

2 a fair amount

3 a great deal

7 Don't Know

8 Refuse to Answer

J4. Has anyone forced you to move out of a place you lived because of your HIV test result?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

J5. Have you been refused housing because people suspect you might have HIV?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

READ AND HEARD: Please read the questions carefully and answer as honestly as you can about how you perceive health care workers act towards people who are HIV positive.

J6. Has a health care provider made you feel bad because of your HIV test result?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

J7. Has a health care provider refused to touch you because of your HIV test result?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

J8. Have you been refused medical care or denied hospital services because of your HIV test result?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

READ AND HEARD: The next set of questions are about your opinions which can help us to make blood transfusion safer.

J9. To help us to make blood safer, what would you recommend for improving the donor selection process? Any thoughts or ideas you have are good, please type as much or little as you would like to write.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

J10. What could we do to get blood donors to disclose risk behaviors? Any thoughts or ideas you have are good, please type as much or little as you would like to write.

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

J11. Would you be more comfortable during the donation interview if the blood center staff was: (Check all that apply)

__ Same sex as you

__ Same age as you

__ Same sexual orientation as you

__ Open minded and accepting; gay friendly

__ More engaged and interactive

__ Other

__ Don't Know

__ Refuse to Answer

If J11 is not equal to 6, then skip to J13.

J12. Could you please, specify other

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

J13. Would you be willing to answer more detailed and specific behavioral risk questions during the donor screening process, if the interview: (Check all that apply)

__ Took place in a private booth

__ Used an electronic interview (like this one)

__ Gave you more time to answer to the questions

__ Included more explanation of the questions you are asked

__ Other

__ Don't Know

__ Refuse to Answer

If J13 is not equal to 5, then skip to instruction before J15.

J14. Could you please, specify other?

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

READ AND HEARD: The next questions are about any volunteer work or paid work to support individuals living with HIV/AIDS that you are doing or have done since you learned of your HIV test result. Please read carefully and answer as honestly as you can.

J15. Since you learned of your HIV test result, have you considered volunteering or working with organizations that provide support or services to individuals living with HIV/AIDS?

1 Yes

0 No Skip to end of questionnaire

7 Don't Know

8 Refuse to Answer

J16. Do you currently do volunteer or paid work with organizations that provide support or services to individuals living with HIV/AIDS?

1 Yes

0 No Skip to J18

7 Don't Know

8 Refuse to Answer

9 Not Applicable Skip to J18

J17. What kind of organization are you currently doing volunteer or paid work with?

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

J18. Would you consider volunteering or doing paid work in the future?

1 Yes

0 No

7 Don't Know

8 Refuse to Answer

READ AND HEARD: Thank you for taking the time to complete this questionnaire. If you have any questions or concerns, please talk to the research assistant or nurse. You can also contact the medical director at our blood bank.

READ AND HEARD: You have finished the questionnaire. From now on, DO NOT touch the screen. Please, talk to the research assistant, the person who assisted you at the beginning of this questionnaire. This assistant will close the screen and acknowledge you for your participation in this study.

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