HIV Risk Factors Interview Guide

HIV Risk Factors Interview Guide

Qualitative Interview tracking form

To be completed by the interviewer at the beginning of the interview:

Lead Interviewer name
Secondary Interviewer name
Participant provided consent (circle one)	Yes No
Participant ID
How Recruited?
Observed Gender	Male Female
Hispanic or Latino?	Yes No
Observed Race (select all that apply)	White Other: American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Other Pacific Islander

Note – see end of interview guide for other participant characteristics questions

Interviewer Post-Interview Comments:

Complete the following based on the interview [to be used to track diversity in sample and for subsequent recruitment]

Age: ☐ 18-29 ☐30-39 ☐ 40-49 ☐ 50 or older
Preferred Drug of Choice _______________________

Been tested for HIV since you learned of HIV in X County? ☐ Yes ☐No
Been tested for Hep C since you learned of HIV in X County? ☐ Yes ☐No
HIV ☐ Yes ☐No ☐ Don’t Know ☐ Refuse to answer
Hepatitis C ☐ Yes ☐No ☐ Don’t Know ☐ Refuse to answer

Other Comments:

HIV IN THE COMMUNITY MONTH – INTERVIEWEE PERSPECTIVE

Many of our questions will ask you to share your experiences CURRENTLY regarding injection drug use. But we will also ask about your experiences BEFORE you were aware of HIV in X County.

When did you become aware of HIV in X County? What month was that?

Write month: _______________________

Ok, think of that month when we ask you about experiences before or after you learned of HIV in the community. Great, let’s get started with our first question.

Note to Interviewer: You may need to slightly adjust question and probes to account for variations in using experiences [e.g., substitute different names of drugs; adjust between different forms drugs – pills versus powder]; right now the interview guide is written with Opana as the reference drug.

A. Drugs Used, Drugs of Choice

Ok, let’s start by talking about the drugs you use.

QA1. What drugs do you CURRENTLY use, both illegal and prescription [whether prescribed to you or someone else], as well as alcohol and tobacco? And how old were you when you started using any of these drugs?

Probes

• If prescription drugs, are they used how the doctor told you to use them?

• Any used daily? on and off? Together with other drugs?

• What drugs do you like to use the most?

• When used and how much?

• How do you use them? Swallow? Snort? Smoke? Inject?

• How often do you usually inject? – daily, weekly, monthly?

QA2. How has your drug use changed, if at all, since you became aware of the HIV in the community and why [i.e., since – insert month].

B. Last Experience Injecting Opana [ADJUST DRUG IF OPANA IS NOT REGULARLY INJECTED BUT A DIFFERENT DRUG IS]

QB1. Now I would like to know more about your experiences using Opana BOTH before and after you learned of HIV in X County.

Let’s begin by talking about the LAST time you injected Opana.

When was that – day, time, year? _______________

Ok, describe to me your experiences the last time you injected? Walk me through the process – where, when, with who, how?

[Note to interviewer: Let interviewee describe the episode. Listen for answers to each of the following questions below. Once interviewee’s story is told, probe for any questions not answered. Be sure to remind the person to NOT give names when asking who questions; can use pronouns such as myself, or roles such as my friend].

NOTE TO INTERVIEWER: BRING A BOTTLE OF WATER, A FEW PENS, A SODA CAN BOTTOM, A FILTER, ETC AND ASK THEM TO ACTUALLY ILLUSTRATE WHAT HAPPENS

Probes - Content Areas for Drug Injection Narrative:

• Before Using:

  • What was going on that day?
    
    

• Buying/Exchanging/Stealing/Being Prescribed

  • How did you get the drugs?

  • How much drugs? For whom – just you? To be shared?

  • Who got them? Who paid? Who was there?

  • How did you get money for the drugs? Any pooling of money together? If didn’t have money, how did you get your portion?
    
    

• Time, Place and People

  • Nature of place – is it ‘safe’ from police?

  • Who was there? What are your relationships with these people?
    
    

• Nature/Source of Syringe and Injection equipment

  • Describe the syringe you used- what kind was it? Fixed/ vs removable needle?

  • New? Used? Used by whom? How often prior used?

  • Where did you get the needle and other injection equipment [filter, cooker, etc.] and how?
    
    

• Preparing

  • Who prepared the drugs?

  • How were they prepared? [step by step from pill form to ready to use form]

  • If sharing drugs with others, how were they measured and divided? [pills cut before hand? Using ONE syringe to divide up drugs into other syringes? [front or back loading]?

  • What about rinsing syringes? Any rinsed? Rinsed with what? With whom? Any not rinsed with certain folks?
    
    

• Injecting

  • How was the drug injected (self? another person?)

  • How were needles shared, if at all? Who shared with? Relationship with those you shared with? Who went first (second, third, etc.) and why?

  • How about other injection equipment? Anything else shared such as water, cookers, filters, etc.? Can you tell me more about that?

    • Probe for each individually – start with cookers, then filters, then water

    • Probe for whether these sources vary by whom they may share with [e.g., partner versus other]

• Number of times injected per day

During the last day you injected, can you tell me about the number of times you injected, how often, when, with whom, etc.?

• HIV/HCV

  • Was HIV or HCV discussed with anyone who was with you that last time? Did they bring it up with you? Or was anyone’s Hep C or HIV status already known to you or others? Was Your HIV/Hep C status known? Sharing partner’s status? Others who were there whom you did not share with? If so, how and when?

  • How did knowing or not knowing your own or others’ status in the room affect injecting drugs that time?

  • Did you or anyone else do anything specifically to make it less likely for someone who is HIV or Hep C positive to be passed to someone who is negative? What did you or someone else do? If affected by doing things to reduce risk, probe what kinds of things, if any, to reduce risk were done?
    
    

C. Typical Current Experiences Injecting Opana [ADJUST DRUG IF NEEDED]

QC1. How, in any way, was the LAST time you injected different from your usual experience injecting in the past few weeks? Is what you described above your usual experience NOW? If not usual, can you elaborate on what is different?

D. Experiences Injecting Opana before HIV in the Community

QD1. Ok, now I want to shift to your experiences BEFORE you were aware of HIV in X County? How is your usual experience injecting Opana NOW similar to or different from your usual experience THEN? How so?

Probes – especially for these content areas from the above narrative:

• Before Using

• Buying/Exchanging/Stealing/Being Prescribed

• Time, place and people

• Nature of Syringe

• Preparing

• Injecting

• HIV/HCV

• Number of times injected per day

E. Experiences Injecting other Drugs

QE1. Tell me how you prepare and inject any other drugs, such as heroin, differently from how you prepare and inject Opana? Please explain the differences and similarities?

Probes

• Any differences over time? That is, BEFORE you were aware of HIV in the community as compared to NOW?

F. Transition from Non-Injection to Injection Drug Use

QF1. Ok, tell me about your experiences on when you started to inject drugs, how old were you, where were you, how did you start injecting? About when was the very first time? What were you using?

Probes

• Why did you start using?

• How old were you?

• What drug injected when first time injecting?

• When was the first time using Opana? Have you ever injected any other painkillers? What are they? [how old? month, year?] First time injecting [how old? month, year?] Where you got the drug? Have you ever been prescribed Opana by a Doctor? How did you initially start using Opana? What made you use it differently?

• Describe how using Opana increased over time. ; can explore if used different types of prescription opioids over time/other substances as well as order of use.

• Explore preparing and injection practices to see if risk started immediately upon first injection.Have you changed how you inject Opana from the first time you used to now? How have you changed your practices?

G. Experiences With Needle Exchange Program

QG1. Tell me about your experiences using the needle exchange program? Probe for Use? Not used? How are those services working for you? What are your concerns about services?

BRING A TYPICAL BAG THAT IS GIVEN AT THE NEP WHEN THEY FIRST ENROLL AND ASK THEM TO TELL YOU ABOUT THE ITEMS – WHATS USFUL, WHATS NOT?

Probes for “folks who have used”

• Probe about context and content of program (If any are problematic, ask why and what could be done better to meet their needs):

  • use of NEW CENTER versus Mobile van

  • location of new center

  • location of the mobile van

  • type of needles and amount of needles given out

  • type of filters provided [probe about cotton, whether they think cig filters are safe; size]

  • time it takes to get the needles

  • hours of operation of the mobile van? Or the NEP

  • people providing the needles

  • police presence

  • community perceptions

  • stigma and discrimination
    

• Do you give or sell needles to anyone? If yes, can you tell me about that? How does this affect your needle supply, if at all?

Probes if “Never used”:

• Why not? What are some reasons? Prompts - Anything to do with?

  • location

  • hours of operation

  • police presence

  • community perceptions

• What would need to change for you to attend the needle exchange program?

Note To Interviewer: Do A Time Check, And ONLY Ask The Sex Questions If You Think You Can Get Through Everything. If Not, Skip I, OR JUST ASK QI3, And Go To J.

H. Sexual Risk Behaviors

Now I would like to ask some personal questions about sex. We realize that this is a very personal subject, but your answers are very important to our investigation. Your answers will remain private and remember names will not be attached to any of this information.

QH1. I would like to talk about the last time you had sex with someone that included vaginal or anal sex WITHOUT a condom. Note: This includes if a condom broke or came off during sex. When was that? [if always use condoms, skip to QH2].

Date [month/year]_________________

Ok, think back now and try to remember as much as you can about that time, and tell me: What is your relationship with this person? What you were doing? Why did you have sex with them? Were others there in the house? Other having sex together? How did injecting drugs fit in, if at all?

[Interviewer note: Let interviewee describe the episode. Listen for answers to each of the following questions below. Once interviewee’s story is told, probe for any questions not answered. Be sure to remind the person to NOT give names when asking who questions; can use pronouns such as myself, or roles such as my boyfriend]. Only select areas are covered here for sake of time]

Probes Select Content Areas for Sexual Interactions:

• Partner characteristics (age, gender)

  • Relationship with this partner (duration and nature of relationship, where/when/how met partner; main, casual, paying or exchange)

  • Have you ever had sex with them previously? How often? Past sexual experiences with this partner, whether condoms used.

  • Did you want to have sex with this person? Can you tell me more about that?

• Sexual Events/Condom Use

  • What determined the kinds of sex you had? [foreplay/touching, plating; Intercourse; oral or whatever]

  • Do you typically have sex with this person?

  • Why did you decide to NOT use a condom?/why didn’t you use condoms?
    
    

• Using Drugs

  • Did you and/or your partner use before/during/after sex? Did you and/or your partner use alcohol before/during, after sex? Drugs or alcohol used by you or this sex partner before, during or after having sex (Injected drugs/non-injected drugs/alcohol; levels of intoxication).
    
    

• HIV

  • Have you ever talked about HIV with your sex partner(s)? (Your status? Partner’s status? If so, how? Before or after sex?)

  • If not discussed, then what did you believe (or assume)? Before or after sex?

  • How did knowing or not knowing your partner’s HIV status affect having sex this time.

QH2. Thinking about when you have sex in general, have you ever used a condom with sex? What makes it easier to use condoms/protection with partners? What are some of the reasons you haven’t used condoms/protection?

QH3. Have you ever had sex with someone and they gave you something for it? Have they ever given you money? How about drugs? What about something else like food or a place to sleep? Can you tell me more about that both before and after you learned about HIV in X County?

Probes:

• How often? With whom? Where do the folks [clients] come from?

• What about condoms? Used, not used? Why?

I. HIV Testing and Care & Treatment Experiences

Now I have some questions about HIV testing.

QI.1. Have you ever been tested for HIV before- why or why not? tell me about your experiences, , being tested for HIV? Test? No Test? How many times? Where? When [before/after you knew about HIV in the community]?

Probes if “Never tested”

• Why not? What has kept you from getting tested?

• What would make it more likely or easier for you to get tested?

Probes if “Tested”

• When were you last tested (month and year)?

• How, if at all, did that testing change how you inject drugs or prepare them to be used?

• Have you changed how you use condoms when having sex? Change? No change? How so?

How about use of the needle exchange program? Did it affect your use of the program? Increase? Decrease? How so?

• Did you get your HIV test results? If not, why not? If yes, what were they? If you don’t feel comfortable telling me, you don’t have to.

IF PARTICIPANT IS HIV POSITIVE

QI2. Tell me what that has been like for you to be diagnosed positive? How you are doing with this? What have your experiences with HIV doctors been like? Taking HIV meds?

Probes:

• If not in care, why not? What would it take to get you into care? What would make you want to be in care?

IF PARTICIPANT IS HIV NEGATIVE

QI3. Ask about retesting experiences –tell me how often people who share needles or other works or have sex without a condom should get retested for HIV?[interviewer should also be aware of PreP and TasP when probing here as those are effective prevention measures as well]?

Probes:

• If they seem to have accurate knowledge but are not retesting, ask why? What would make it more likely for you to get tested again for HIV?

QI4. Is there anything that you know of that can help prevent HIV? Have you heard about any medications that prevent HIV? Can you tell me what you have heard? Would you be interested in taking it?

Probes if no: Why not? What are your concerns? What would make you want to take the pill?

Q14a. IS there anything you have heard about people who are HIV positive taking medications that can prevention transmission to others [TasP]? Can you tell me what you have heard?

QI.5. Many folks who inject drugs in [City X] have tested positive for HIV but others have not tested positive.  Why do you think some people tested HIV+ and others have not? What keeps some people negative?

J. Hepatitis C Testing and Care & Treatment Experiences

J.1. What about your experiences being tested for Hepatitis C? Test? No Test? Tell me about that? What happened? What were the results? What happened afterwards?

Probes if “Never tested”:

• Why not? What would it take to get you tested? What would make it easier for people to test for Hep C?

Probes if “positive”:

• Can you tell me what that has been like for you? How you are doing? What have your experiences with HCV care providers been like?

• If not in care, why not? What would it take for you to get care? What would make it easier to get into care?

K. FINAL QUESTION

We are trying to understand the risk for HIV and other health problems in your community and how to help prevent disease. What else do you think is important for me to know that I haven’t already asked about? Maybe something we have or haven’t covered?

WRAP UP AND REFER

• THANK THEM

• PROVIDE RESOURCE BAG AND REFER IF NEEDED

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