Att 3p: HIV Testing Brief Survey Instrument

Form Approved

OMB No: 0920-xxxx

Exp. Date: XX/XX/XXXX

Development of CDC’s Act Against AIDS Social Marketing Campaigns Targeting Consumers

Attachment 3p: HIV Testing

Brief Survey Instrument

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-xxxx).

Attachment 3p: HIV Testing

Brief Survey Instrument

CASE ID_____________

PARTICIPANT SURVEY

We are interested in your opinions about HIV testing. We would also like to get some additional information about you. If you’re not sure, choose an answer that comes closest to what you think might be true for each question. Please remember that your answers are private. You can choose not to answer any question and can stop at any time. Please let the person who checked you in know when you are finished with the survey.

Behaviors

These next questions are about your personal HIV testing behaviors. Please remember that your answers are kept private.

1. Have you ever been tested for HIV? An HIV test checks whether someone has the virus that causes AIDS.

₁ Yes

₂ No [GO TO Q9]

₈₈ Don’t know

₉₉ Prefer not to answer

2. When did you have your first HIV test? DATE (MM/YYYY):__________ [ERROR CHECK: CANNOT BE BEFORE 1985 OR BEYOND CURRENT DATE]

₈₈ Don’t know

₉₉ Prefer not to answer

3. In the past 2 years, that is, since [INSERT CALCULATED MONTH AND YEAR], how many times have you been tested for HIV?

NUMBER __________

₈₈ Don’t know

₉₉ Prefer not to answer

4. How often do you get an HIV test?

₁ Every 0-2 months

₂ Every 3-6 month

₃ Every 7-12 months

₄ Less often than once a year

₅ Other [Specify: ___________________________________________]

₈₈ Don’t know

₉₉ Prefer not to answer

5. What was the result of your most recent HIV test?

₁ I tested positive for HIV [GO TO Q5a]

₂ I tested negative for HIV [GO TO Q5b]

₃ My results were unclear [GO TO Q5b]

₄ I never got my results [GO TO Q5b]

₈₈ Don’t know

₉₉ Prefer not to answer [TERMINATE AND GO TO CLOSING]

1. [IF POSITIVE] When did you test positive for HIV?

DATE (MM/YYYY):__________

₈₈ Don’t know

₉₉ Prefer not to answer

2. [IF NEGATIVE] When did you have your most recent HIV test? DATE (MM/YYYY):__________

₈₈ Don’t know

₉₉ Prefer not to answer

6. Where did you have your last HIV test?

₁ Private doctor

₂ STD or AIDS clinic or testing site

₃ Hospital or emergency room

₄ Public health department

₅ Community health center

₆ At home

₇ Drug treatment facility

₈ Other location

₈₈ Don’t know

₉₉ Prefer not to answer

7. Which of these are the main reasons for your last HIV test? Mark all that apply.

₁ It just seemed like a good idea

₂ It’s something you do every year

₃ Just to find out

₄ Worried that you are infected

₅ A doctor, nurse, or other health care provider asked you to

₆ The health department asked you to

₇ Your sexual partner asked you to

₈ Because of pregnancy

₉ To get birth control

₁₀ You found out your sexual partner cheated

₁₁ Already had an STD

₁₂ You were starting a new relationship

₁₃ You get tested during your yearly exam

₁₄ A family member or friend was diagnosed with HIV

₁₅ Other reason [Specify: __________]

₈₈ Don’t know

₉₉ Prefer not to answer

8. Below is a list of reasons why some people have not been tested for HIV. Which if these best describes the most important reason you have not been tested for HIV in the past [INSERT CALCULATED DATE FROM Q5b] months? Check only one.

₁ I think I am at low risk for HIV infection.

₂ I am afraid of finding out that I have HIV.

₃ I didn’t have time.

₄ Some other reason [Specify: ]

₅ No particular reason

₈₈ Don’t know

₉₉ Prefer not to answer

[GO TO Q10]

9. Below is a list of reasons why some people have not been tested for HIV. Which if these best describes the most important reasons you have not been tested for HIV? Mark all that apply.

₁ I have not been sexually active.

₂ I think I am at low risk for HIV infection.

₃ My doctor never recommended it.

₄ I didn’t have time.

₅ I have not had sex without a condom.

₆ I was afraid to find out if I was HIV positive.

₇ I didn’t want to think about HIV or about being HIV positive.

₈ I don’t like needles or giving blood.

₉ I don’t trust the results to be kept private.

₁₀ I had to wait too long for the results.

₁₁ I didn’t know where to get tested.

₁₂ I trust my sexual partner.

₁₃ I don’t care about the results.

₁₄ I am worried about being labeled as HIV positive.

₁₅ Some other reason [Specify:__________]

₁₆ No particular reason.

₈₈ Don’t know

₉₉ Prefer not to answer

THEORETICAL CONSTRUCTS

Knowledge

9. When should you get an HIV test after having sex without a condom with a [woman/man]?

₁ 0–2 months after having sex without a condom

₂ 3–6 months after having sex without a condom

₃ 7–12 months after having sex without a condom

₄ More than 12 months after having sex without a condom

₅ When you start to feel sick

₈₈ Don’t know

₉₉ Prefer not to answer

9. Do you get an HIV test after any situation when you think you might have been exposed to HIV?

₁ Yes

₂ No

₈₈ Don’t know

₉₉ Prefer not to answer

9. Where can you get an HIV test? Mark all that apply.

₁ HIV counseling and testing site

₂ STD or AIDS clinic or testing site

₃ Hospital or emergency room

₄ Community health clinic

₅ Private physician office

₆ Drug treatment program

₇ At home

₈ Correctional facility (jail or prison)

₉ Military

₁₀ Other [Specify: _________________________________________________]

₈₈ Don’t know

₉₉ Prefer not to answer

13. Please tell us how much you agree or disagree with each of the following statements: Someone who is HIV-negative and not taking medicines to prevent HIV (e.g., PrEP/Truvada,) should get tested for HIV every 6 months if they…

	Strongly agree	Agree	Neither agree or disagree	Disagree	Strongly disagree	Don’t know	Prefer not to answer
always have sex with a condom.	1	2	3	4	5	88	99
had vaginal sex without a condom.	1	2	3	4	5	88	99
have had anal insertive sex (topping) without a condom.	1	2	3	4	5	88	99
have had anal receptive sex (bottoming) without a condom.	1	2	3	4	5	88	99
have a sexual partner who is HIV positive.	1	2	3	4	5	88	99
have unprotected [anal/vaginal/oral] sex with a partner whose HIV status they don’t know.	1	2	3	4	5	88	99
have had more than one sexual partner since their last HIV test.	1	2	3	4	5	88	99
exchange sex for drugs.	1	2	3	4	5	88	99

Attitudes and Beliefs

14. On a scale from 1 to 5, where 1 is extremely bad and 5 is extremely good, how would you rate getting tested for HIV at least every [INSERT] months?

Extremely Bad 1	Bad 2	Neither bad or good 3	Good 4	Extremely Good 5	Don’t know	Prefer not to answer
1	2	3	4	5	88	99

14. Please tell us how much you agree with each of the following statements: Getting tested at least every [INSERT] months….

	Strongly agree	Agree	Neither agree or disagree	Disagree	Strongly disagree	Don’t know	Prefer not to answer
is expensive.	1	2	3	4	5	88	99
reassures me that I can get into treatment early if I test positive.	1	2	3	4	5	88	99
is inconvenient.	1	2	3	4	5	88	99
allows me to have sex without a condom with partners who are HIV negative.	1	2	3	4	5	88	99

16. Please tell us your opinion regarding the importance of each of the following statements.

	Very import-ant	Some-what impor-tant	Neither impor-tant nor unimpor-tant	Some-what unimpor-tant	Very unimpor-tant	Don’t know	Prefer not to answer
Having access to free HIV tests is...	1	2	3	4	5	88	99
Having access to confidential HIV tests is...	1	2	3	4	5	88	99
Taking better care of my sexual partner is...	1	2	3	4	5	88	99
Keeping myself healthy is...	1	2	3	4	5	88	99
Doing things to help my future is ...	1	2	3	4	5	88	99
Knowing my HIV status is...	1	2	3	4	5	88	99

16. Please tell us how much you agree or disagree with each of the following statements: Getting tested for HIV…

	Strongly agree	Agree	Neither agree or disagree	Disagree	Strongly disagree	Don’t know	Prefer not to answer
will help me make informed decisions.	1	2	3	4	5	88	99
will help me take better care of my sexual partner.	1	2	3	4	5	88	99
keeps me healthy.	1	2	3	4	5	88	99
will help my future.	1	2	3	4	5	88	99
is free, fast, and confidential.	1	2	3	4	5	88	99
is important for my health.	1	2	3	4	5	88	99
is something everyone should do in their lifetime.	1	2	3	4	5	88	99
is important so that people who test positive can start getting treated right away.	1	2	3	4	5	88	99

16. Please tell us how much you agree or disagree with each of the following statements:

	Strongly agree	Agree	Neither agree or disagree	Disagree	Strongly disagree	Don’t know	Prefer not to answer
Your HIV test result expires every time you have risky sex.	1	2	3	4	5	88	99
Getting an HIV test is free, fast, and confidential.	1	2	3	4	5	88	99
My family/friends are my reasons for getting tested.	1	2	3	4	5	88	99
My reason for getting an HIV test is me.	1	2	3	4	5	88	99
Getting tested for HIV will help me stay strong and informed.	1	2	3	4	5	88	99
Getting tested for HIV will help me take better care of my sexual partner.	1	2	3	4	5	88	99
Getting tested for HIV keeps me healthy.	1	2	3	4	5	88	99
Getting tested for HIV will help my future.	1	2	3	4	5	88	99

Self-Efficacy

16. Please tell us how much you agree or disagree with the following statement: I am confident that I can get an HIV test.

₁ Strongly agree

₂ Agree

₃ Neither agree nor disagree

₄ Disagree

₅ Strongly disagree

₈₈ Don’t know

₉₉ Prefer not to answer

16. How sure are you that you could get an HIV test at least every [INSERT] months if you…

	Very sure I could not	Somewhat sure I could not	Slightly sure I could	Somewhat sure I could	Very sure I could	Don’t know	Prefer not to answer
wanted to get an HIV test?	1	2	3	4	5	88	99
could find a free testing site?	1	2	3	4	5	88	99
had to travel far to find a free testing site?	1	2	3	4	5	88	99
could get the results of your HIV test within [INSERT TIMEFRAME]?	1	2	3	4	5	88	99
knew that your results would be kept confidential?	1	2	3	4	5	88	99
could find an HIV test provider that spoke your language (e.g., English, Spanish)?	1	2	3	4	5	88	99
could find a provider that you feel comfortable with and trust?	1	2	3	4	5	88	99
could use a home-based testing kit?	1	2	3	4	5	88	99

Norms

16. Please tell us how much you agree or disagree with each of the following statements.

	Strongly agree	Agree	Neither agree or disagree	Disagree	Strongly disagree	Don’t know	Prefer not to answer
Most people who are important to me think I should get tested for HIV at least every [INSERT #] months. (By “important to me”, we mean people like friends, family, and anyone else who is an important part of your life.)	1	2	3	4	5	88	99
Most people in my community think HIV testing is important.	1	2	3	4	5	88	99
Most of my sexual partners get tested for HIV at least every [INSERT #] months.	1	2	3	4	5	88	99
Most [men/women] I know get tested for HIV at least every [INSERT #] months.	1	2	3	4	5	88	99
Most people in my community would be supportive of someone living with HIV.	1	2	3	4	5	88	99
Most people in my community would be supportive of a [gay/transgender] family member or friend.	1	2	3	4	5	88	99

Behavioral Intentions

22. Please tell us how likely you are to do the following:

	Very likely	Some-what likely	Neither likely nor unlikely	Some-what unlikely	Very unlikely	Don’t know	Prefer not to answer
I plan to get an HIV test in the next [INSERT #] months.	1	2	3	4	5	88	99
I plan to get an HIV test before sex with a new sexual partner	1	2	3	4	5	88	99
I plan to get tested with a sexual partner.	1	2	3	4	5	88	99

INFORMATION SEEKING

22. In the last [INSERT #] months, how often have you…

	Very often	Often	Some-times	Rarely	Never	Don’t know	Prefer not to answer
a. looked for information about HIV testing?	1	2	3	4	5	88	99
b. searched online for a location to get an HIV test?	1	2	3	4	5	88	99
c. called an HIV testing hotline?	1	2	3	4	5	88	99
d. texted your zip code for a location to get an HIV test?	1	2	3	4	5	88	99
e. talked about HIV testing?	1	2	3	4	5	88	99
f. visited a Centers for Disease Control website for HIV information?	1	2	3	4	5	88	99

COMMUNICATION BEHAVIORS

24. Do you currently have a main sexual partner?

₁ Yes

₂ No [GO TO Q27]

₈₈ Don’t know

₉₉ Prefer not to answer [GO TO Q27]

24. In the past [INSERT #] months, how often have you had one-on-one conversations with your current main sexual partner about HIV testing?

₁ Very often

₂ Often

₃ Sometimes

₄ Rarely

₅ Never

₈₈ Don’t know

₉₉ Prefer not to answer

24. In the past [INSERT #] months, how often have you discussed the following topics with your current main sexual partner?

	Very often	Often	Some-times	Rarely	Never	Don’t know	Prefer not to answer
Your last HIV test and test results	1	2	3	4	5	88	99
Your partner’s last HIV test and test results	1	2	3	4	5	88	99
Getting tested for HIV	1	2	3	4	5	88	99
Getting tested for HIV together	1	2	3	4	5	88	99

24. Do you currently have a [casual/non-main] sexual partner?

₁ Yes

₂ No [GO TO CLOSING]

₈₈ Don’t know

₉₉ Prefer not to answer [GO TO CLOSING]

24. In the past [INSERT #] months, how often have you had one-on-one conversations with a current [casual/non-main] sexual partner about ways to prevent HIV?

₁ Very often

₂ Often

₃ Sometimes

₄ Rarely

₅ Never

₈₈ Don’t know

₉₉ Prefer not to answer

24. In the past [INSERT #] months, how often have you discussed the following topics with a current [casual/non-main] sexual partner?

	Very often	Often	Some-times	Rarely	Never	Don’t know	Prefer not to answer
Your last HIV test and test results	1	2	3	4	5	88	99
Your partner’s last HIV test and test results	1	2	3	4	5	88	99
Getting tested for HIV	1	2	3	4	5	88	99
Getting tested for HIV together	1	2	3	4	5	88	99

The End

Thank you for answering these questions. Please place the survey in the envelope provided. Give the survey and your consent form to the interviewer when you go into the interview room. The interviewer will not see your responses to these questions.

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