0920-0222 MMP 2015-2017 Questionnaire v 11.2.3

Attachment 8a
MMP 2015 Interview Questionnaire-English
Medical Monitoring Project
0920-0740

Form Approved
OMB No: 0920-0740
Expiration: XX/XX/XXXX

2015–2017 Questionnaire
Version 11.2.3

Public reporti ng burden of this coll ecti on of i nforma ti on i s es ti ma ted to a vera ge 45 mi nutes per res pons e, i ncl udi ng
the ti me for revi ewi ng i ns tructi ons , s ea rching exi s ting da ta s ources , ga theri ng and ma i nta i ning the da ta needed, and
compl eti ng and revi ewi ng the coll ecti on of i nforma tion. An a gency ma y not conduct or s pons or, and a pers on is not
required to res pond to a coll ecti on of i nforma ti on unl es s it READs a currentl y va l i d OMB control number. Send
comments rega rdi ng this burden es ti ma te or a ny other a s pect of this coll ecti on of i nforma ti on, i ncluding s ugges ti ons
for reduci ng this burden to: CDC, Proj ect Cl ea ra nce Offi cer, 1600 Cl i fton Roa d, MS D–74, Atl anta , GA 30329, ATTN:
PRA (0920–0740). Do not s end the compl eted form to this a ddres s .

Department of Health and Human Services
Public Health Service
Centers for Disease Control and Prevention
Atlanta, GA 30033

Table of Contents
TABLE OF CONTENTS .......... .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. . 1
SURVEY DOCU M E NT AT I O N .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. 4
MS W ORD DOCUMENT KEY ................................ ............................................................... ................................. .............4
VARIABLE NAMING CONVENTIONS ................................ ................................................................ .................................... .4
QDS PROGRAMMING NOTES............................................................... ................................................................ .............5
CALCULATIONS ............................... ................................. ................................................................ ............................. .5
PRELIMINARY INFORMATION (I) ......... .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. . 7
PRIOR TO INTERVIEW (IP) ............................... ................................. ................................................................ ................7
I NTRODUCTION (IN) ................................ ................................................................ ...................................................... .9
ELIGIBILITY CRITERIA (Y) ........... .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. 11
MMP PARTICIPATION (YM) ............................................................... ................................. ......................................... .11
RESIDENCE (YS)................................ ................................................................ ...........................................................11
AGE (YA) ................................ ............................................................... ................................................................ ....21
DIAGNOSIS DATE (YD) ................................ ................................................................ ................................................. .22
BASIC DEMOGRAPHICS (D) ......... .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. 23
EDUCATION (DE) ............................................................... ................................. .........................................................23
RACE-ETHNICITY (DR)................................................................ .................................................................................. .23
GENDER AND SEXUAL ORIENTATION (DG) ............................................................... ................................. ........................ .25
MARRIAGE STATUS (DM) ................................................................ ............................................................... .............. .25
LANGUAGE ABILITY (DL)............................................................... ................................. ............................................... .26
HOMELESS (DH)............................... ................................. ................................................................ ..........................27
I NCARCERATION (DJ) ................................ ............................................................... ................................. ................... .27
DISABILITY (A).... .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. . . .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. . 29
FINANCIAL (F) ......... .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. . 31
EMPLOYMENT (FE) ................................................................ ............................................................... ...................... .31
I NCOME (FI ) ............................... ................................. ................................................................ .............................. .31
FOOD SECURITY (FS) ............................... ................................. ................................................................ ................... .32
PRODUCTIVITY LOSS (FL) ................................ ................................................................ .............................................. .32
HEALTHCARE COVERAGE (FH) ............................... ................................. ................................................................ ....... .36
AFFORDABLE CARE ACT (FC) ................................ ................................................................ ........................................ .39
HIV TESTING EXPERIENCES (X) .......... .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. . 42
NEVER IN CARE (K) .......... .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . . 43
HIV CARE (V) ......... .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. . 52
LINKAGE TO CARE (VL) ................................ ............................................................... ................................. ..................52
RETENTION (VR) ................................................................ ............................................................... ..........................55
HIV CARE QUALITY (VQ) ................................ ................................................................ .............................................. .65
HIV TREATMENT AND ADHERENCE (T) .......... .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. . 66
GENERAL MEDICAL CARE (J)..... . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. 75
ER AND HOSPITALIZATIONS (JH) ............................... ................................. ................................................................ .... .75
O THER CARE (JO) ................................ ................................................................ ....................................................... .75
HEALTH LITERACY (HL) ........... .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. 76

DEPRESSION AND ANXIETY (M) .......... .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. . 77
PHQ-4 SCREENING QUESTIONS (MD) ................................ ............................................................... ..............................77
PHQ-8 DEPRESSION (MA) ................................ ................................................................ ........................................... .78
GAD-7 ANXIETY (MG) ............................... ................................................................ ................................. ................ .79
SEXUAL BEHAVIOR (S).... .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. . . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. 81
TOTAL SEX PARTNERS (ST) ............................................................... ................................. ............................................ .81
EXCHANGE SEX (SE) ............................................................... ................................. .................................................... .83
NAMES OF PARTNERS (SN) ................................ ................................................................ ........................................... .83
PARTNER DEMOGRAPHICS (SP)............................................................... ................................. ...................................... .88
VAGINAL SEX (SV)................................ ............................................................... ................................. ........................97
ANAL SEX (SL)............................... ................................. ................................................................ ...........................106
TRANSGENDER AND UNKNOWN GENDER SEX (SG) ............................... ................................. ............................................131
STATUS (SS) ................................................................ ............................................................... ..............................143
PRE-EXPOSURE PROPHYLAXIS (SR) ............................... ................................. ................................................................149
AGGREGATE INFORMATION (SA)................................................................ ............................................................... ....151
SEROSORTING (SO) ............................................................... ................................. ....................................................152
MSM SEX EVER (ME)............................... ................................................................ ................................. ................153
DISCLOSURE OF SAME SEX ATTRACTION (RC) ................................ ................................................................ .................. .154
PREVENTION ACTIVITIES (PA) ......... .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. . 156
INTIMATE PARTNER VIOLENCE (P) .......... .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. . 158
PHYSICAL VIOLENCE (PV) ................................ ............................................................... ................................. ........... .158
SEXUAL VIOLENCE (PS) ............................... ................................................................ ................................. .............. .159
ALCOHOL, SMOKING, AND DRUG USE (U) ........... .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. . 160
ALCOHOL USE (UA)............................................................... .....................................................................................160
CIGARETTE AND TOBACCO USE (US) ................................ ................................................................ ............................. .161
NON-INJECTION DRUG USE (UN) ............................................................... ................................. ................................. .163
I NJECTION DRUG USE (UI)................................................................ ............................................................... .............169
ACQUISITION RISK BEHAVIORS (B)... .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. . 176
CORE ACQUISITION RISK QUESTIONS (BC) ................................................................ ...................................................... .176
FEMALE HETEROSEXUAL SERIES (BF) ............................... ................................. ............................................................. .178
MALE HETEROSEXUAL SERIES (BM) ............................................................... ................................. ...............................179
ADDITIONAL ACQUISITION RISK QUESTIONS FOR PERSONS BORN PRIOR TO MARCH, 1985 (BA) ..............................................180
MET AND UNMET NEEDS (N) .......... .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. 181
SERVICES AND ASSISTANCE PROGRAMS (ND) ............................................................... ................................. ...................181
O THER DISABILITY (NS) ............................... ................................. ............................................................... ................199
STIGMA AND DISCRIMINATION (R) ......... .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. . 201
STIGMA (RS) ................................ ................................................................ ............................................................201
DISCRIMINATION (RD)................................ ............................................................... ................................. ................203
GYNECOLOGICAL AND REPRODUCTIVE HISTORY (G) ......... .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. . 206
GYNECOLOGICAL CARE (GH) ............................................................... ................................................................ ........ .206
CONTRACEPTION (GC) ................................ ............................................................... ................................. ................206
REPRODUCTIVE HISTORY (GR) ............................... ................................. ................................................................ ..... .209
FOREIGN-BORN AND IMMIGRATION (L) ......... .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. 219
FOREIGN BORN (LF) ................................ ................................................................ ...................................................219

I MMIGRATION STATUS (LI )................................................................................................ ...........................................219
HEALTH CONDITIONS AND PREVENTIVE THERAPY (C)..... .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . 221
HPV (CP) ............................... ................................. ................................................................ ................................221
TUBERCULOSIS (CT) ................................ ................................................................ ...................................................221
I NFLUENZA (CF) ................................ ............................................................... ................................. ........................222
INTERVIEW COMPLETION (E) .......... .. .. .. .. .. .. . .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . 224
END OF I NTERVIEW (EE) ................................ ................................................................ ............................................ .224
DATA VALIDITY (EV) ............................... ................................. ................................................................ ..................224
REFERRALS AND FOLLOW-UP (EO) ................................................................ ................................................................225
2014 CALENDA R . .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . . 226
2015 CALENDA R . .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . . 227
2016 CALENDA R . .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . . 228
2017 CALENDA R . .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. . . 229
RESPONSE CARDS ......... .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. 230

P a ge |4
Survey documentation
MS Word document key
Grey cell

Aqua blue cell

Dark red font
Olive green variable
Grey font
Bold
Underline
Numbering

Table cell width

Grey shaded cells are used to indicate interviewer instructions including skip
patterns.
Color white, background 1, darker 15%.
If “interviewer_note_”, “Skip_”, then shade table cell using the following
color: white, background 1, darker 15%.
Aqua blue shaded cells are used to indicate QDS programming note.
Color aqua, accent 5, and lighter 80%.
If “label_”, “calculation_”, “range_”, “QDS_programming_”, “hard_edit_”,
“soft_edit_”, then shade table cell using the following color: aqua, accent 5,
lighter 80%.
Dark red font indicates a previously used variable.
Color accent 2, darker 50%.
Olive green font indicates a new variable:
Color olive green, accent 3, darker 50%.
Grey font indicates that the interviewer should not read the response set to
respondent.
Bold text indicates time references.
Text that is underlined indicates words that are to be emphasized.
st
1 character is an alpha value indicating each module (e.g., Eligibility Criteria
is Y)
2nd character is an alpha value indicating the question topic (e.g., Age is YA)
3rd character is a numeric value indicating the question number (e.g., YA1)
4th character is a numeric value indicating whether the question is a stem
question (e.g., YA1.0.) or a sub-question (e.g., YA1.1.). 0 denotes that the
question is a stem question and 1, 2, 3… denotes that the question is a subquestion.
7 inches

Variable naming conventions
New variable
convention
Revised variable
convention

Other specify
variable conventions

New variable name will end with the letter N and a number that corresponds
to the data collection cycle. For example TESTN5 would indicate this is a new
variable for the 2015 cycle. This convention was instituted in the 2013 cycle.
At the end of the variable_15 will indicate that the question was revised in
some way during the 2015 cycle.
Example: PIDN3_15
Note that_15 is placed after N3. In order to maintain the integrity of the stem
variable, the person creating the variable may choose to abbreviate_15 to_5.
The_5 denotes the 2015 data collection cycle. This convention was instituted
in the 2009 cycle.
All other specify variables end in OS. A new variable that was changed in a
later cycle with an “other specify” option will read as follows: TEN3_5OS.

P a ge |5
QDS programming notes
Additional programming notes are located throughout the questionnaire.
Standard codes
Intro_[INSERT
VARIABLE NAME]
label_[INSERT
VARIABLE NAME]
range_[INSERT
VARIABLE NAME]
Skip_[INSERT VARIABLE
NAME]
soft_edit_[INSERT
VARIABLE NAME]
hard_edit_[INSERT
VARIABLE NAME]
calculation_[INSERT
VARIABLE NAME]
QDS_programming_[IN
SERT VARIABLE NAME]
Version
Note
Codebook
Codebook

Text limit
Screen setting

Don’t know = 8, Ref = 7, Not applicable = 6.
Use for any Introductory statements prior to a question or section.
Use for all variable labels.
Use for all range values.
Use for Skip logic instructions. Skips are notes for the interviewers, but also
provide coding instructions.
Use for all soft edit checks where the program can advance without a
corrected response.
Use for all hard edit checks where the program does not move forward
without a corrected response.
Use for all calculated variables and explanation of how the variable will be
used.
Use for all other notes not described above.
Use QDS 2.6.1 al ong with most recent patch.
Every question requires a response to move forward in the application
unless else noted.
The QDS codebook should have a brief description of the variable including
all calculated variables.
Label module and topics in the codebook. Use the Table of Contents for
guidance. Modules are under Heading 1 and sections are under Heading 2
in the MS Word version of the questionnaire.
The maximum size of text values is 100 except for ADDCOM1 (additional
comments), which is 200.
Recommended CAPI screen setting of at least 1024 by 768.

Calculations
All date variables

Calculation_AGEIDATE
Label_AGEIDATE
Calculation_CYCYR

Create an automatic variable that is a copy of the date variable. For
example, if the variable for date was called DATE, then the automatic
variable would look like: a. variable name: TXFORM, b. type of date: String
Expression, c. numeric calculation/string expression: DATE.
Calculate the respondent’s age at the time of the interview using DOB_13
(date of birth) and IDATE (date of interview).
Respondent’s age at date of interview.
Calculate data collection cycle using variable name CYCYR.
If the date is May 1, 2015-April 30, 2015, then CYCYR = 2015.
If the date is May 1, 2016-April 30, 2016, then CYCYR = 2016.
If the date is May 1, 2017-April 30, 2017, then CYCYR = 2017.
Follow a similar pattern for subsequent years.

P a ge |6
Label_CYCYR
Calculation_IDATE-12
Label_IDATE-12
Calculation_IDATE-7D
Label_IDATE-7D
Calculation_LANGUAG
Label_LANGUAG
Calculation_LAST YEAR
Label_LASTYEAR
Calculation_PDP_ST

Label_PDP_ST
Calculation_PDP_END

Label_PDP_END
Calculation_ST_ELIGIB
Label_ST_ELIGIB
Calculation_QDSVERN3

Label_QDSVERN3
Calculation_VERSION
Label_VERSION

Interview cycle year.
Calculate the date 12 months prior to IDATE (interview date). Example, if
IDATE is 12/02/2016, then IDATE-12 is 12/02/2015.
12 months prior to interview date.
Calculate the date 7 days prior to IDATE (interview date). Example, if IDATE
is 12/08/2016, then IDATE-7D is 12/01/2016.
7 days prior to interview date.
Distinguish between English (EN) and Spanish (SP) versions of the
questionnaires.
Language of questionnaire.
Calculate last calendar year
LASTYEAR = if (YEAR = '2013', '2012', if (YEAR = '2014', '2013', '9999')).
Last calendar year.
Calculate PDP start date:
If the date is May 1, 2015-April 30, 2016, then the PDP start date is January
1, 2015.
If the date is May 1, 2016-April 30, 2017, then the PDP start date is January
1, 2016.
If the date is May 1, 2017-April 30, 2018, then the PDP start date is January,
2017.
Follow a similar pattern for subsequent years.
Population definition period start date.
If the date is May 1, 2015-April 30, 2016, then the PDP end date is April 30,
2015.
If the date is May 1, 2016-April 30, 2017, then the PDP end date is April 30,
2016.
If the date is May 1, 2017-April 30, 2018, then the PDP end date is April 30,
2017.
Follow a similar pattern for subsequent years.
Population definition period end date.
Calculate start time of eligibility criteria.
Administration start-time for eligibility criteria.
Document the QDS version used to create the QAD file. QDSVERN3 = create
a calculated variable for QDS version number. For the 2015-2017 cycles, the
value is 2.6.1.
QDS software version.
Calculate questionnaire version number using variable name VERSION. This
must be updated every time a change is made in the application. 11.X.X.
QDS file version.

P a ge |7
Preliminary Information (I)
Prior to interview (IP)
Interviewer_note
_IP
IDATE

DISPLAY: Enter the following information prior to interview.

IP.1.0.

Label_IDATE
Calculation_IDATE

Interview date
☐ ☐ /
☐ ☐ /
☐ ☐ ☐ ☐
M M
D
D
Y
Y
Y
Y
Interview date
Automatically calculate IDATE (interview date) in QDS using the date on
the device

Calculation_CALCSDT
IDATE
CALCSDT
June 1, 2015 – May 31, 2016
12/31/2014
June 1, 2016 – May 31, 2017
12/31/2015
June 1, 2017 – May 31, 2018
12/31/2016
Date of sample draw based on date of interview

Label_CALCSDT
SITEID
Label_SITEID
Range_SITEID
QDS_programming
_SITEID
QDS_programming_SJUR

IP.2.1.

Site ID of jurisdiction where person was sampled
Site ID of jurisdiction where person was sampled
0001–9999
4 digits with leading 0s
Name of sampling jurisdiction based on SITEID (Site ID)
SITEID
SJUR
0006
California
1600
Chicago
0010
Delaware
0012
Florida
0013
Georgia
3360
Houston
0017
Illinois
0018
Indiana
0026
Michigan
4480
Los Angeles County
0028
Mississippi
0037
North Carolina
0034
New Jersey
0036
New York
5600
New York City
0041
Oregon
0042
Pennsylvania
6160
Philadelphia
0072
Puerto Rico

P a ge |8
7360
0048
0051
0053
Name of sampling jurisdiction

Label_SJUR
INDID

IP.2.2.

Label_INDID
Range_INDID
QDS_programming
_INDID
Calculation_CYCYR2D

Calculated 2 digit cycle year by taking the last two digits of CYCYR
(interview cycle year)
2 digit interview cycle year
15 to 99
Calculate PARID by combining SITEID + 09 + CYCYR2D + INDID
Participant ID
0000-0000-0001 to 9999-9999-9999
IP.2.3.

The Participant ID is
—
—
. Is that
correct?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Confirmation of PARID
th
Program should read dashes after every 4 number for legibility (e.g.,
“The participant ID is 1111-2222-3333. Is that correct?”)
If IDCONFN3 is 0 (no), then READ, “Interviewer: Please re-enter
participant ID.” Return to IDCONFN3.

IP.3.0.

Interviewer ID

Label_IDCONFN3
QDS_programming
_IDCONFN3
Hard_edit_IDCONFN3

INTID
Label_INTID
Range_INTID
INTSE_12

Respondent ID
Respondent ID
0001-9999
4 digits with leading 0s

Label_CYCYR2D
Range_CYCYR2D
Calculation_PARID
Label_PARID
Range_PARID
IDCONFN3

San Francisco
Texas
Virginia
Washington

Interviewer ID
001–999
IP.4.0.

Interview setting: [SELECT ONLY ONE.]
Outpatient health facility
1
Inpatient health facility
2
Prison or jail facility
3
Community-based
4
organization
Private home
5
Public venue (e.g., coffee
6
shop, library)
Health department
7
Telephone
8

P a ge |9
Other
Refused to answer
Don’t know
Interview setting

Label_INTSE_12
SDTVERN5

IP.5.0.

Based on the current date of [INSERT IDATE], the sampling date for this
data collection cycle is probably [INSERT CALCSDT]. Is that correct?
No
0
Yes
1
Verify sampling date
If SDTVERF (verify sampling date) = 1 (yes), then skip to IJURN5 (Site ID of
jurisdiction completing the interview).
If SDTVERF = 0 (no) then go to SDATE (date sample was drawn).

IP.6.0.

Enter sampling date
☐ ☐ /
☐ ☐ /
☐ ☐ ☐ ☐
M M
D
D
Y
Y
Y
Y
Date sample was drawn
If SDTVERF (verify sampling date) = 1 (yes), then COMBOSDT
(combination sampling date) = CALCSDT (Date of sample draw based on
date of interview). If SDTVERF (verify sampling date) = 0 (no), then
COMBOSDT (combination sampling date) = SDATE (Sampling date).
What is the site ID of the jurisdiction completing the interview?

Label_SDTVERF
Skip_SDATE

SDATEN5

Label_ SDATE
Calculation_COMBOSDT

IJURN5
Label_IJURN5
Range_IJURN5
QDS_programming_
IJURN5

9
77
88

IP.7.0

Site ID of jurisdiction completing the interview
0001–9999
4 digits with leading 0s

Introduction (IN)
Intro_IN

“I’d like to thank you for taking part in this interview. Remember that all
the information you give me will be kept confidential and your name wo
n’ t be recorded in the survey responses. The answers to some
questions may seem obvious to you, but I need to ask you all of the
questions.”

Skip_IN

If INTSE_12 (interview setting) is 8 (telephone interview), then go to
Intro_INTEL; else skip to PARTCPT (ever participation).

Intro_INTEL

“You have chosen to complete the interview over the telephone. Before we
begin, I would like to remind you that there is a set of response cards that I
will ask you to refer to throughout the course of the interview. These
response cards will be needed for some of the questions you will be asked
during the interview. The set of cards contains a calendar, some pictures,
and text to help guide you through the response options for some of the
questions. Each card is labeled. Please keep this set of response cards
nearby so you can use them when needed. I will let you know which
questions require response cards and the label that corresponds to the

P a g e | 10
card that is needed.”

P a g e | 11
Eligibility criteria (Y)
Calculation_ST_INT
Label_ST_INT

Start time of interview. ST_INT = Current time.
Start of Interview

MMP participation (YM)
PARTCPT

YM.1.0.

Have you ever participated in the MMP interview?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever participation
If PARTCPT (ever participation) = 1 (yes), go to PARTIC (date of participation).
If PARTCPT (ever participation) = 0 (no) or 8 (don’t know), then skip to next
topic (DOB_13, age). If PARTCPT (ever participation), is 7 (refused to answer),
READ, “I’m only interviewing people who haven’t already been interviewed
during this data collection year. Thank you very much for your time” and skip
to Calculation_ST_COMPL (end time interview).

YM.1.1.

What month and year did you participate in the MMP interview?
☐ ☐ / ☐ ☐ ☐ ☐
M M
Y Y Y Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date participated in MMP
PARTIC requires a full response for month and year. If the respondent does
not know the month, code the date as Don’t know.
PARTIC cannot be earlier than January 2005 or later than IDATE (interview
date).

YM.1.2.

Interviewer question [DON’T READ TO RESPONDENT]
Was the participant interviewed for MMP during the current data collection
cycle?
No
0
Yes
1
Don’t know
8
Interviewed in current cycle
If CURCYN5 (interviewed in current cycle) is 1 (yes), READ, “I’m only
interviewing people who haven’t already been interviewed during this data
collection year. Thank you very much for your time.” Skip to
Calculation_ST_COMPL (end time interview). If PARTCPT (ever participation) is
0 (no) or 8 (don’t know), then skip to next topic (DOB_13, age).

Label_PARTCPT
Skip_PARTCPT

PARTIC

Label_PARTIC
QDS_programming
_PARTIC
Range_PARTIC

CURCYN5

Label_CURCYN5
Skip_CURCYN5

Residence (YS)
Residence on interview date

P a g e | 12
CURLVN5

YS.1.0.

What state do you currently live in? [DON’T READ RESPONSES. SELECT ONLY
ONE.]
California
1
Delaware
2
Florida
3
Georgia
4
Illinois
5
Indiana
6
Maryland
7
Massachusetts
8
Michigan
9
Mississippi
10
New Jersey
11
New York
12
North Carolina
13
Oregon
14
Pennsylvania
15
Puerto Rico
16
South Carolina
17
Texas
18
Virginia
19
Washington
20
Any other U.S. state or D.C.
21
Outside the United States or in another U.S.
22
territory
Refused to answer
77
Don’t know
88
Current residence
If CURLVN5 (current residence), is 1 (California), 5 (Illinois), 12 (New York), 15
(Pennsylvania), or 18 (Texas), go to MMPCTYN5 (MMP city). If CURLVN5
(current residence) is 77 (refused to answer), or 88 (don’t know), skip to
SAMPLVN5. If CURLVN5 (current residence) is 21 (any other US state or
territory), skip to NONMSTN5 (non-MMP state). If CURLVN5 (current
residence) is 2, 3, 4, 6, 7, 8, 9, 10, 11, 13, 14, 16, 17, 19, or 20, skip to
LONGLVN5 (Time in current residence).

YS.1.1.

What city do you currently live in? [DON’T READ RESPONSES. SELECT ONLY
ONE.]
Chicago
1
Houston
2
Los Angeles County
3
New York City
4
Philadelphia
5
San Francisco
6
Other U.S. city
7
Refused to answer
77
Don’t know
88
MMP city of residence

Label_ CURLVN5
Skip_CURLVN5

MMPCTYN5

Label_ MMPCTYN5

P a g e | 13
Hard_edit_
MMPCTYN5

Only valid combinations for MMPCTYN5 (MMP city of residence) and CURLVN5
(Current residence) are:
CURLVN5 CURLVN5
MMPCTYN5
MMPCTYN5
Description
Description
1
California
3
Los Angeles County
1
California
6
San Francisco
1
California
7
Other U.S. City
1
California
77
Refused
1
California
88
Don’t Know
5
Illinois
1
Chicago
5
Illinois
7
Other U.S. City
5
Illinois
77
Refused
5
Illinois
88
Don’t Know
12
New York
4
New York City
12
New York
7
Other U.S. City
12
New York
77
Refused
12
New York
88
Don’t Know
15
Pennsylvania
5
Philadelphia
15
Pennsylvania
7
Other U.S. City
15
Pennsylvania
77
Refused
15
Pennsylvania
88
Don’t Know
18
Texas
2
Houston
18
Texas
7
Other U.S. City
18
Texas
77
Refused
18
Texas
88
Don’t Know
Else, display text “That city does not match with the state you selected. Please
tell me the city again.” Return to MMPCTYN5 (MMP city of residence).
Skip to LONGLVN5 (Time live in current residence).

Skip_MMPCTYN5
NONMSTN5

YS.1.2.

Interviewer instructions:
Enter the two-character state abbreviation. For reference, the remaining states
are Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR), Colorado (CO),
Connecticut (CT), District of Columbia (DC), Hawaii (HI), Idaho (ID), Iowa (IA),
Kansas (KS), Kentucky (KY), Louisiana (LA), Maine (ME), Minnesota (MN), MO,
Montana (MT), Nebraska (NE), Nevada (NV), New Hampshire (NH), New
Mexico (NM), North Dakota (ND), Ohio (OH), Oklahoma (OK), Rhode Island (RI),
South Dakota (SD), Tennessee (TN), Utah (UT), Vermont (VT), West Virginia
(WV), Wisconsin (WI), Wyoming (WY).
77 = Refused to answer, 88= Don’t know

Label_
NONMSTN5
Hard_edit
_NONMSTN5

Non-MMP state abbreviation
Only valid values for NONMSTN5 (non-MMP state) are:
AL, AK, AZ, AR, CO, CT, HI, ID, IA, KS, KY, LA, ME, MN, MO, MT, NE, NV, NH, NM,
ND, OH, OK, RI, SD, TN, UT, VT, WV, WI, WY, 77, 88.
Else, READ “Incorrect abbreviation, consult list of remaining states.” Return to

P a g e | 14
NONMSTN5.
LONGLVN5

YS.1.3.

How many years and months have you lived there?
_
_ (years)
(months)

Label_LONGLVN5
Calculation_
CURFIPS

Time in current residence
Calculate variable CURFIPS (FIPS code of current residence) as follows:
CURLVN5 Description of
MMPCTYN5 Description of
CURFIPS
State Variable
City Variable
1
California
7
Other U.S. City 0006
1
California
3
Los Angeles
4480
County
1
California
6
San Francisco
7360
2
Delaware
Skipped
0010
3
Florida
Skipped
0012
4
Georgia
Skipped
0013
5
Illinois
7
Other U.S. City 0017
5
Illinois
1
Chicago
1600
6
Indiana
Skipped
0018
7
Maryland
Skipped
0024
8
Massachusetts
Skipped
0025
9
Michigan
Skipped
0026
10
Mississippi
Skipped
0028
11
New Jersey
Skipped
0034
12
New York
7
Other U.S. City 0036
12
New York City
4
New York City
5600
13
North Carolina
Skipped
0037
14
Oregon
Skipped
0041
15
Pennsylvania
7
Other U.S. City 0042
15
Pennsylvania
5
Philadelphia
16
Puerto Rico
Skipped
0072
17
South Carolina
Skipped
7360
18
Texas
7
Other U.S. City 0048
18
Texas
2
Houston
3360
19
Virginia
Skipped
0051
20
Washington
Skipped
0053
Anything Any other code
Skipped
else

Label_ CURFIPS
Skip_edit_
LONGLVN5

FIPS code of current residence
If LONGLVN5 (Time in current residence) ≥ (COMBOSDT – IDATE) and CURLVN5
(current residence) is 22 (Outside the US), READ, “I’m only interviewing people
who lived in the United States on [COMBOSDT]. Thank you very much for your
time” and skip to Calculation_ST_COMPL (end time of interview). If CURFIPS is
equal to SITEID, skip to SAMPLVN5 (residence on sampling date). Else, go to
LVPASN5 (when last lived in project area of sampling).

P a g e | 15
Last residence in project area of sampling
LVPASN5

YS.1.4.

Label_ LVPASN5
QDS_programming
_LVPASN5
Skip_LVPASN5

What month and year did you last live in [INSERT SJUR (project area of
sampling)]?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
When last lived in project area of sampling
Enable “not applicable” option for this question.
If LONGLVN5 (Time in current residence) < (COMBOSDT – IDATE), then go to
SAMPLVN5 (residence on sampling date). Else, if LONGLVN5 (LONGLVN5 (Time
in current residence) < 12 months, skip to SPLV_N5 (residence at start of SP).
Else, skip to next topic (Calculation_ST_BSDEM, start time basic
demographics).

Residence on sampling date
SAMPLVN5

Label_ SAMPLVN5
Skip_SAMPLVN5

YS.2.0.

What state did you live in on [INSERT COMBOSDT]? [DON’T READ RESPONSES.
SELECT ONLY ONE.]
California
1
Delaware
2
Florida
3
Georgia
4
Illinois
5
Indiana
6
Maryland
7
Massachusetts
8
Michigan
9
Mississippi
10
New Jersey
11
New York
12
North Carolina
13
Oregon
14
Pennsylvania
15
Puerto Rico
16
South Carolina
17
Texas
18
Virginia
19
Washington
20
Any other U.S. state or D.C.
21
Outside the United States or in another U.S.
22
territory
Refused to answer
77
Don’t know
88
Residence on sampling date
If SAMPLVN5 (residence on sampling date), is 1 (California), 5 (Illinois), 12 (New

P a g e | 16
York), 15 (Pennsylvania), or 18 (Texas), go to SAMPCTN5 (MMP city of residence
at sampling). If SAMPLVN5 (residence on sampling date) is 22 (outside the US),
77 (refused to answer), or 88 (don’t know) READ, “I’m only interviewing people
who lived in the United States on [COMBOSDT]. Thank you very much for your
time” and Skip to Intro_EE (end of interview). If SAMPLVN5 (residence on
sampling date) is 21, skip to NMSAMPN5 (non-MMP state residence at
sampling abbreviation). If SAMPLVN5 (residence on sampling
date) is 2, 3, 4, 6, 7, 8, 9, 10, 11, 13, 14, 16, 17, 19, or 20 and LONGLVN5 (Time
in current residence) < 12 months, skip to SPLV_N5 (residence at start of SP).
If SAMPLVN5 (residence on sampling date) is 2, 3, 4, 6, 7, 8, 9, 10, 11, 13, 14,
16, 17, 19, or 20 and LONGLVN5 (Time in current residence) ≥ 12 months Skip
to next topic (Calculation_ST_BSDEM, start time basic demographics).
SAMPCTN5

Label_SAMPCTN5
Hard_edit_
SAMPCTN5

YS.2.1.

What city did you live in at that time? [DON’T READ RESPONSES. SELECT ONLY
ONE.]
Chicago
1
Houston
2
Los Angeles County
3
New York City
4
Philadelphia
5
San Francisco
6
Other U.S. city
7
Refused to answer
77
Don’t know
88
MMP city of residence at sampling.
Only valid combinations for SAMPCTN5 (MMP city of residence at sampling)
and SAMPLVN5 (Residence on sampling date) are:
SAMPLVN5 SAMPLVN5
SAMPCTN5
SAMPCTN5 Description
Description
1
California
3
Los Angeles County
1
California
6
San Francisco
1
California
7
Other U.S. City
1
California
77
Refused
1
California
88
Don’t Know
5
Illinois
1
Chicago
5
Illinois
7
Other U.S. City
5
Illinois
77
Refused
5
Illinois
88
Don’t Know
12
New York
4
New York City
12
New York
7
Other U.S. City
12
New York
77
Refused
12
New York
88
Don’t Know
15
Pennsylvania
5
Philadelphia
15
Pennsylvania
7
Other U.S. City
15
Pennsylvania
77
Refused
15
Pennsylvania
88
Don’t Know
18
Texas
2
Houston
18
Texas
7
Other U.S. City

P a g e | 17
18
18

Texas
Texas

77
88

Refused
Don’t Know

Else, display text “That city selection does not match with the state you
selected. Please check the city selection.” Return to [SAMPCTN5].
NMSAMPN5

YS.2.2.

Interviewer instructions:
Enter two-character state abbreviations. For reference, the remaining states
are Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR), Colorado (CO),
Connecticut (CT), District of Columbia (DC), Hawaii (HI), Idaho (ID), Iowa (IA),
Kansas (KS), Kentucky (KY), Louisiana (LA), Maine (ME), Minnesota (MN), MO,
Montana (MT), Nebraska (NE), Nevada (NV), New Hampshire (NH), New
Mexico (NM), North Dakota (ND), Ohio (OH), Oklahoma (OK), Rhode Island (RI),
South Dakota (SD), Tennessee (TN), Utah (UT), Vermont (VT), West Virginia
(WV), Wisconsin (WI), Wyoming (WY).
77 = Refused to answer, 88= Don’t know
Non-MMP state residence at sampling abbreviation.

Label_
NMSAMPN5
Hard_edit_
NMSAMPN5

Only valid values for NMSAMPN5 (non-MMP state) are:
AL, AK, AZ, AR, CO, CT, HI, ID, IA, KS, KY, LA, ME, MN, MO, MT, NE, NV, NH, NM,
ND, OH, OK, RI, SD, TN, UT, VT, WV, WI, WY, 77, 88
Else, display text “Incorrect abbreviation, consult interviewer guide.”
If LONGLVN5 (Time in current residence) < 12 months Skip to SPLV_N5
(residence at start of SP). Else Skip to next topic (Calculation_ST_BSDEM, start
time basic demographics).
If LONGLVN5 (Time in current residence) < 12 months, go to SPLV_N5
(residence at start of SP). Else Skip to next topic (Calculation_ST_BSDEM, start
time basic demographics).

Skip_SAMPCTN5

Skip_NMSAMPN5

SP start date
SPLV_N5

YS.3.0.

What state did you live in on [INSERT IDATE – 12 months]? [DON’T READ
RESPONSES. SELECT ONLY ONE.]
California
1
Delaware
2
Florida
3
Georgia
4
Illinois
5
Indiana
6
Maryland
7
Massachusetts
8
Michigan
9
Mississippi
10
New Jersey
11
New York
12
North Carolina
13
Oregon
14

P a g e | 18
Pennsylvania
15
Puerto Rico
16
South Carolina
17
Texas
18
Virginia
19
Washington
20
Any other U.S. state or D.C.
21
Outside the United States or in another U.S.
22
territory
Refused to answer
77
Don’t know
88
Residence at start of surveillance period (SP)
If SPLV_N5 (residence at start of SP), is 1 (California), 5 (Illinois), 12 (New York),
15 (Pennsylvania), or 18 (Texas), go to SPCTY_N5 (MMP city of residence at
start of SP).
If SPLV_N5 (residence at start of SP) is 21, go to NMMPSPN5 (non-MMP state
residence at start of surveillance period abbreviation).
Else Skip to next topic (Calculation_ST_BSDEM, start time basic demographics).

Label_ SPLV_N5
Skip_SPLV_N5

SPCTY_N5

Label_SPCTY_N5
Hard_edit_SPCITY

YS.3.1.

What city did you live in at that time? [DON’T READ RESPONSES. SELECT ONLY
ONE.]
Chicago
1
Houston
2
Los Angeles County
3
New York City
4
Philadelphia
5
San Francisco
6
Other U.S. city
7
Refused to answer
77
Don’t know
88
MMP city of residence at start of SP
Only valid combinations for to SPCTY_N5 (MMP city of residence at start of SP)
and SPLV_N5 (Residence at start of surveillance period) are:
SPLV_N5
1

SPLV_N5
Description
California

3

1
1
1
1
5
5
5
5
12
12

California
California
California
California
Illinois
Illinois
Illinois
Illinois
New York
New York

6
7
77
88
1
7
77
88
4
7

SPCITY

SPCITY
Description
Los Angeles
County
San Francisco
Other U.S. City
Refused
Don’t Know
Chicago
Other U.S. City
Refused
Don’t Know
New York City
Other U.S. City

P a g e | 19
12
12
15
15
15
15
18
18
18
18

New York
New York
Pennsylvania
Pennsylvania
Pennsylvania
Pennsylvania
Texas
Texas
Texas
Texas

77
88
5
7
77
88
2
7
77
88

Refused
Don’t Know
Philadelphia
Other U.S. City
Refused
Don’t Know
Houston
Other U.S. City
Refused
Don’t Know

Else, display text “That city selection does not match with the state you
selected. Please check the city selection.” Return to [SAMPCTN5].
Calculation
_SPCTY_N5

Calculate FIPS codes for the three sets of residency variables as follows:
State
Variable

Description of
State Variable

City
Variable

Description of
City Variable

1
1

California
California

7
3

1
2
3
4
5
5
6
7
8
9
10
11
12
12
13
14
15
15
16
17
18
18
19
20
Anything

California
Delaware
Florida
Georgia
Illinois
Illinois
Indiana
Maryland
Massachusetts
Michigan
Mississippi
New Jersey
New York
New York City
North Carolina
Oregon
Pennsylvania
Pennsylvania
Puerto Rico
South Carolina
Texas
Texas
Virginia
Washington
Any other code

6

Other U.S. City
Los Angeles
County
San Francisco
Skipped
Skipped
Skipped
Other U.S. City
Chicago
Skipped
Skipped
Skipped
Skipped
Skipped
Skipped
Other U.S. City
New York City
Skipped
Skipped
Other U.S. City
Philadelphia
Skipped
Skipped
Other U.S. City
Houston
Skipped
Skipped
Skipped

7
1

7
4

7
5

7
2

Value
assigned to
FIPS Code
Variable
0006
4480
7360
0010
0012
0013
0017
1600
0018
0024
0025
0026
0028
0034
0036
5600
0037
0041
0042
0072
7360
0048
3360
0051
0053

P a g e | 20
else
The three sets of residency variables are as follows:
Description of
State Variable
City Variable
FIPS Code
set
Variable
Current
CURLVN5
MMPCTYN5
CURFIPS
residence
Residence at
SAMPLVN5
SAMPCTN5
SAMPFIPS
sampling
Residence on SP SPLV_N5
SPCTY_N5
SPFIPS
start date
If CURFIPS not equal to SITEID and SAMPFIPS not equal to SITEID and SPFIPS
not equal to SITEID, then person has never been documented to have lived in
project area of SAMP, go to LVPASN5 (when last lived in project area of
sampling). Else Skip to next topic (Calculation_ST_BSDEM, start time basic
demographics).

Skip_SPCTY_N5

NMMPSPN5

Label_
NMMPSPN5
Hard_edit
_NMSAMPN5

Skip_NMMPSPN5

YS.3.2.

Interviewer instructions:
Enter 2 character state abbreviations. For reference, the remaining states are
Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR), Colorado (CO),
Connecticut (CT), District of Columbia (DC), Hawaii (HI), Idaho (ID), Iowa (IA),
Kansas (KS), Kentucky (KY), Louisiana (LA), Maine (ME), Minnesota (MN), MO,
Montana (MT), Nebraska (NE), Nevada (NV), New Hampshire (NH), New
Mexico (NM), North Dakota (ND), Ohio (OH), Oklahoma (OK), Rhode Island (RI),
South Dakota (SD), Tennessee (TN), Utah (UT), Vermont (VT), West Virginia
(WV), Wisconsin (WI), Wyoming (WY).
77 = Refused to answer, 88= Don’t know
Non-MMP state residence at start of surveillance period abbreviation
Only valid values for NMSAMPN5 (non-MMP state) are:
AL, AK, AZ, AR, CO, CT, HI, ID, IA, KS, KY, LA, ME, MN, MO, MT, NE, NV, NH, NM,
ND, OH, OK, RI, SD, TN, UT, VT, WV, WI, WY, 77, 88. Else, display text “Incorrect
abbreviation, consult interviewer guide.”
If never lived in project area of samp, go to LVPASN5 (when last lived in project
area of sampling). Else Skip to next topic (Calculation_ST_BSDEM, start time
basic demographics).

P a g e | 21

Age (YA)
DOB_13

YA.1.0.

Please tell me the month and year of your date of birth?
☐ ☐ / ☐ ☐ ☐ ☐
M M
Y Y Y Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of birth
DOB_13 (date of birth) requires a response for both the month and year.
Partial date is not accepted.
If respondent is less than 18 years of age (IDATE-DOB_13 < 18*365.25, skip
to AGE_VER1 (age verification). If DOB_13 (date of birth) is 7 (refused to
answer) or 8 (don’t know), or if DOB_13 (date of birth) is 18 years and 0–11
months prior to IDATE (interview date), go to AGE_VER1 (age verification);
Else, skip to POS1S_9 (diagnosis date).
DOB_13 (date of birth) cannot be earlier than January 1, 1900. If date is
earlier than January 1, 1900, then return to DOB_13 (date of birth). DOB_13
(date of birth) cannot be later than the IDATE (interview date). If date is later
than the IDATE (interview date), then return to DOB_13 (date of birth).
Calculate age of respondent using DOB_13 (date of birth). Use the 1st of the
month to calculate age.

YA.1.1.

Are you at least 18 years old today?
No
0
Yes
1
Refused to answer
7
Don’t know
8
age verification
If AGE_VER1 (age verification) is 0 (no), 7 (refused to answer), or 8 (don’t
know), then say, “I am only interviewing people who are 18 years or older.
Thank you very much for your time.” Then Skip to Intro_EE (end of
interview). Else go to POS1S_9 (diagnosis date).

Label_DOB_13
Hard_edit_DOB_13
Skip_DOB_13

Hard_edit_DOB_13

Calculation_DOB_13

AGE_VER1

Label_AGE_VER1
Skip_AGE_VER1

P a g e | 22

Diagnosis date (YD)
POS1S_9

Label_POS1S_9
Hard_edit
_POS1S_9
Soft_edit
_POS1S_9

QDS_programming_
POS1S_9

YD.1.0.

What month and year did you first test positive for HIV? Tell me when you
got your result, not when you got your test.
☐ ☐ / ☐ ☐ ☐ ☐
M M
Y Y Y Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date first tested positive for HIV
POS1S_9 (date first tested positive for HIV) cannot be earlier than DOB_13
(date of birth).
If POS1S_9 (date first tested positive) is earlier than March 1985, confirm
response. If POS1S_9 is earlier than 03/1985, READ, “The date entered is
earlier than 03/1985, the date of the first FDA-approved HIV test. Confirm
date of HIV test.” Program should move forward regardless of date.
Allow a blank response for month.

P a g e | 23
Basic demographics (D)
Calculation_ST
_BSDEM
Label_ST_BSDEM

Start time of basic demographics module
ST_BSDEM = Current time
Start basic demographics

Education (DE)
EDUC

DE.1.0.

What is the highest level of education you completed? [READ RESPONSES.
SELECT ONLY ONE.]
Never attended school
1
Grades 1 through 8
2
Grades 9 through 11
3
Grade 12 or GED
4
Some college, associate’s degree, or technical
5
degree
Bachelor’s degree
6
Any post–graduate studies
7
Refused to answer
77
Don’t know
88
Education

DR.1.0.

Do you consider yourself to be of Hispanic, Latino/a, or Spanish origin?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Hispanic-Latino origin

Label_EDUC
Race-ethnicity (DR)
HISPA_13

Label_HISPA_13
HISN3 series

HISN3A

Which of the following describes your Hispanic, Latino/a, or Spanish origin? You
can choose more than one. [READ RESPONSES. SELECT ALL THAT APPLY.]
DR.1.1.

Label_HISN3A
HISN3B

Label_HISN3B

DR.1.2.

Mexican, Mexican American, or Chicano/a
No
Yes
Refused to answer
Don’t know
Mexican, Mexican American, or Chicano/a origin

0
1
7
8

Puerto Rican
No
Yes
Refused to answer
Don’t know
Puerto Rican origin

0
1
7
8

P a g e | 24
HISN3C

DR.1.3.

Label_HISN3C
HISN3D

DR.1.4.

Label_HISN3D
RACE_9 series

RACE_9A

DR.2.1.

DR.2.2.

Label_RACE_9B
RACE_9C

DR.2.3.

Label_RACE_9C
RACE_9D

DR.2.4.

Label_RACE_9D
RACE_9E

0
1
7
8

Another Hispanic, Latino/a, or Spanish origin
No
Yes
Refused to answer
Don’t know
Another Hispanic, Latino/a, or Spanish origin

0
1
7
8

Which racial group or groups do you consider yourself to be in? You may
choose more than one option. [READ RESPONSES. SELECT ALL THAT APPLY.]

Label_RACE_9A
RACE_9B

Cuban
No
Yes
Refused to answer
Don’t know
Cuban origin

DR.2.5.

American Indian or Alaska Native
No
Yes
Refused to answer
Don’t know
American Indian or Alaska Native race

0
1
7
8

Asian
No
Yes
Refused to answer
Don’t know
Asian race

0
1
7
8

Black or African American
No
Yes
Refused to answer
Don’t know
Black or African American race

0
1
7
8

Native Hawaiian or Other Pacific Islander
No
Yes
Refused to answer
Don’t know
Native Hawaiian or Other Pacific Islander race

0
1
7
8

White
No
Yes

0
1

P a g e | 25
Refused to answer
Don’t know
White race

Label_RACE_9E

7
8

Gender and sexual orientation (DG)
BIRTGEN

DG.1.0.

What was your sex at birth? [READ RESPONSES EXCEPT “Intersex/ambiguous.”
SELECT ONLY ONE.]
Male
1
Female
2
Intersex/ambiguous
3
Refused to answer
7
Don’t know
8
Sex at birth

DG.2.0.

Do you consider yourself to be male, female, or transgender? [DON’T READ
RESPONSES. SELECT ONLY ONE.]
Male
1
Female
2
Transgender
3
Refused to answer
7
Don’t know
8
Gender

DG.3.0.

Do you think of yourself as [READ RESPONSES; SELECT ONLY ONE.]:
Lesbian or gay
1
Straight, that is, not gay
2
Bisexual
3
Something else
4
Refused to answer
7
Don’t know
8
Sexual orientation

Label_BIRTGEN
GENDER

Label_GENDER
SEXOR_N5

Label_SEXOR_N5
Marriage status (DM)
MAR_N5

Label_ MAR_N5

DM.1.0.

The next question is about your current legal marriage status. Are you
currently…? [READ RESPONSES. SELECT ONLY ONE.]
Married
1
In a civil union or domestic partnership
2
Divorced
3
Widowed
4
Separated
5
Never married
6
Refused to answer
7
Don’t know
8
Marital status

P a g e | 26
CLV_N5

DM.1.1.

Label_ CLV_N5

Are you currently living with your husband, wife, boyfriend, girlfriend, or
partner?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Living with partner

Language ability (DL)
LANWL1N3

DL.1.0.

How well do you speak English? [READ RESPONSES. SELECT ONLY ONE.]
Very well
1
Well
2
Not well
3
Not at all
4
Refused to answer
7
Don’t know
8
How well do you speak English?

DL.2.0.

Do you speak a language other than English at home?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Speak a language other than English at home
If LANWL2N3 0 (no), 7 (refused to answer), or 8 (don’t know), then skip to next
topic (Intro_1HOMEL_9A, lived on the street).

DL.2.1.

What is this language? [DON’T READ RESPONSES. SELECT ONLY ONE.]
Spanish
1
French
2
Chinese
3
German
4
Tagalog
5
Vietnamese
6
Italian
7
Korean
8
Russian
9
Polish
10
Other
11
Refused to answer
77
Don’t know
88
What is this language?
If LANWL3N3 is 11 (other), then go t o LANN3_OS. Else skip to next topic
(Intro_1HOMEL_9A).

Label_LANWL1N3
LANWL2N3

Label_LANWL2N3
Skip_LANWL2N3

LANWL3N3

Label_LANWL3N3
Skip_LANWL3N3

LANN3_OS

Specify language

P a g e | 27
Label_LANN3_OS:

Specify other language

Homeless (DH)
Intro_1HOMEL_9
A
QDS_programmin
g_
Intro_HOMEL_9A

“Next I’ll ask about the past 12 months. That is from last year [INSERT IDATE12] to now [INSERT IDATE].”
The QDS program should enter the appropriate dates. EXAMPLE: If IDATE is
11/11/2015, then the program should READ “That is from last year,
11/11/2014 to now 11/11/2015.”

HOMEL_9 series

During the past 12 months, have you done any of the following:

HOMEL_9A

DH.1.1.

Label_HOMEL_9A
HOMEL_9B

DH.1.2.

Label_HOMEL_9B
HOMEL_9C

DH.1.3.

Label_HOMEL_9C
HOMEL_9D

DH.1.4.

Label_HOMEL_9D

…lived on the street?
No
Yes
Refused to answer
Don’t know
lived on the street

0
1
7
8

…lived in a shelter?
No
Yes
Refused to answer
Don’t know
lived in a shelter

0
1
7
8

…lived in a Single Room Occupancy (SRO) hotel?
No
Yes
Refused to answer
Don’t know
lived in a Single Room Occupancy (SRO) hotel

0
1
7
8

…lived in a car?
No
Yes
Refused to answer
Don’t know
lived in a car

0
1
7
8

Incarceration (DJ)
JAIL_N5

Label_ JAIL_N5

DJ.1.0.

During the past 12 months, how many different times were you in jail, detention,
or prison for longer than 24 hours?
[77 = Refused to answer, 88 = Don’t know]
Number of times incarcerated

P a g e | 28
Range_ JAIL_N5
Skip_ JAIL_N5

DYINCN5

0–76
If JAIL_N5 (number of times incarcerated) = 0, then skip to next topic
(Calculation_ST_DISAB, start time disability); else go to DYINCN5 (number of days
incarcerated)

DJ.1.1.

[7777 = Refused to answer, 8888 = Don’t know]
Number of times incarcerated
1–7776

Label_ DYINCN5
Range_
DYINCN5
DTINCN5

Label_ DTINCN5
Hard_edit_
DTINCN5

The last time you were in jail, detention, or prison for longer than 24 hours, how
many days did you spend in jail, detention, or prison?

DJ.1.2.

The last time you were in jail, detention, or prison for longer than 24 hours, what
month and year were you released?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of last release
DTINCN5 (date of last release) cannot be earlier than [IDATE (interview date) – 12
months]. If DTINCN5 (date of last release) is earlier than [IDATE (interview date) –
12 months].then READ, “The release date has to be within the past 12 months
because we are asking about incarcerations that took place in the past 12
months. Please re-enter date.” Do not allow the program to advance.

P a g e | 29
Disability (A)
Start time of disability module
ST_DISAB = Current time
Start disability
“Now, I’m going to ask about different conditions you may or may not have.
Some of these things may seem obvious to you, but please answer the
questions.”

Calculation_ST_DI
SAB
Label_ST_DISAB
Intro_DISDEFN3

DISDEFN3

A.1.0.

No
Yes
Refused to answer
Don’t know
deaf or serious difficulty hearing

Label_DISDEFN3
DISBLNN3

Are you blind or do you have serious difficulty seeing, even when wearing
glasses?
No
0
Yes
1
Refused to answer
7
Don’t know
8
blind or serious difficulty seeing

A.3.0.

Because of a physical, mental, or emotional condition, do you have serious
difficulty concentrating, remembering, or making decisions?
No
0
Yes
1
Refused to answer
7
Don’t know
8
serious difficulty concentrating, remembering, or making decisions

A.4.0.

Do you have serious difficulty walking or climbing stairs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
serious difficulty walking or climbing stairs

A.5.0.

Do you have difficulty dressing or bathing?
No
Yes
Refused to answer
Don’t know
difficulty dressing or bathing

Label_DISCONN3
DISWLKN3

Label_DISWLKN3
DISDRSN3

Label_DISDRSN3

0
1
7
8

A.2.0.

Label_DISBLNN3
DISCONN3

Are you deaf or do you have serious difficulty hearing?

0
1
7
8

P a g e | 30
DISERRN3

Label_DISERRN3

A.6.0.

Because of a physical, mental, or emotional condition, do you have difficulty
doing errands alone such as visiting a doctor's office or shopping?
No
0
Yes
1
Refused to answer
7
Don’t know
8
difficulty doing errands alone

P a g e | 31
Financial (F)
Calculation_ST
_FINAN
Label_ST_FINAN

Start time of financial module
ST_FINAN = Current time
Start financial

Employment (FE)
Intro_WORK_N3

WORK_N3

For the next question, please choose the answer that best describes your
current employment status. Tell me after I’ve read all the choices.”
FE.1.0.

Are you currently…? [READ RESPONSES. SELECT ONLY ONE.]
Employed for wages
1
Self-employed
2
Out of work for more than 1 year
3
Out of work for less than 1 year
4
A homemaker
5
A student
6
Retired
7
Or unable to work
8
Refused to answer
77
Don’t know
88

Label_WORK_N3
Income (FI)
Intro_INCOME_5

INCOME_5

“Now I’d like to ask you some questions about [INSERT LAST YEAR]. That is
from January 1st, [INSERT LAST YEAR] to December 31st, [INSERT LAST YEAR].
For this next question, we will use Response Card A as well as the calendar.”
FI.1.0.

In [INSERT LAST YEAR], what was your combined monthly or yearly household
income from all sources before taxes? When I say “combined household
income,” I mean the total amount of money from all people living in the
household. [DON’T READ RESPONSES.]
Household Monthly Income
Household Yearly Income
a.
$0 to $416 per month
or
$0 to $4,999 per year
b.
$417 to $833 per month
or
$5,000 to $9,999 per year
c.
$834 to $1041 per month
or
$10,000 to $12,499 per year
d.
$1042 to $1249 per month
or
$12,500 to $14,999 per year
e.
$1250 to $1666 per month
or
$15,000 to $19,999 per year
f.
$1667 to $2083 per month
or
$20,000 to $24,999 per year
g.
$2084 to $2499 per month
or
$25,000 to $29,999 per year
h.
$2500 to $2916 per month
or
$30,000 to $34,999 per year
i.
$2917 to $3333 per month
or
$35,000 to $39,999 per year
j.
$3334 to $4166 per month
or
$40,000 to $49,999 per year
k.
$4167 to $4999 per month
or
$50,000 to $59,999 per year
l.
$5000 to $6249 per month
or
$60,000 to $74,999 per year
m.
$6250 or more per month
or
$75,000 or more per year

P a g e | 32
77
Refused to answer
88
Don’t know
Income-monthly and yearly

Label_INCOME_5
DEPND_IN

FI.2.0.

Refused to answer
Don’t know

Including you, how many people depended on this income in [INSERT LAST
YEAR]?
Refused to answer
77
Don’t know
88
Number of dependents
1–49
If DEPND_IN is >1, go to DEPND_N3; else, skip to next topic (FOOD3_N5, food
security-hungry

Label_DEPND_IN
Range_DEPND_IN
Skip_DEPND_IN

DEPND_N3

or
or

FI.2.1.

Of the people who depended on this income in [INSERT LAST YEAR], how
many were less than 18 years old?
Refused to answer
77
Don’t know
88
Number of dependents over 18 years of age
DEPND_N3 must be < DEPND_IN (unless DEPND_N3 is Skipped). If DEPND_N3
≥ DEPND_IN, READ, “The number of people under 18 who depended on your
income in [INSERT LAST YEAR] must be < the total number of people who
depended on your income in [INSERT LAST YEAR].” Do not allow the program
to advance.

Label_DEPND_N3
Hard_edit_DEPND
_N3

Food security (FS)
FOOD3_N5

FS.1.0.

Label_FOOD3_N5

During the past 12 months, were you ever hungry, but didn't eat because
there wasn't enough money for food?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Food security-hungry.

Productivity loss (FL)
Skip_PRLS1_N5

If LWORKN3 (employment) is “employed for wages,” or “self-employed,” then
go to Intro_PRLS1_N5 (work hours scheduled); else Skip to the
Intro_PRL20_N5.

Intro_PRLS1_N5

“Now I’m going to ask you some questions about your work during the past 7
days. That is in the last week from [INSERT IDATE-7D (7 days prior to interview
date)] to now [INSERT IDATE (interview date)].”

PRLS1_N5

FL.1.0.

During the past 7 days, how many hours were you scheduled to work?

P a g e | 33
[777 = Refused to answer, 888 = Don’t know]
Work hours scheduled.
0–168

Label_PRLS1_N5
Range_PRLS1_N5
PRLS2_N5

FL.1.1.

During the past 7 days, how many hours did you actual ly work?
[777 = Refused to answer, 888 = Don’t know]
Work hours actually worked.
0–168
To estimate absenteeism by comparing how many hours someone was
scheduled to work (PRLS1_N5) to how many they actually worked (PRLS2_N5)
during the past 7 days.
Calculating absenteeism in terms of hours lost per 4-week:
Monthly absenteeism due to illness
PRLS3_N5)

Label_PRLS2_N5
Range_PRLS2_N5
Calculation_PRLS1
_
N5+PRLS2_N5

Percent absenteeism due to illness
PRLS3_N5

FL.1.2.

Intro_PRL20_N5

Label_PRL20_N5
Range_PRL20_N5
Calculation_PRL20
_N5

Skip_1PRLS7_N5

During the past 7 days, how many hours of work did you miss because of
problems with your physical or mental health?
[777 = Refused to answer, 888 = Don’t know]
Missed work-physical/mental health.
0–168
PRLS3_N5 (missed work-physical/mental health) cannot be > PRLS1_N5 (work
hours scheduled).
If PRLS3_N5 (missed work-physical/mental health) > PRLS1_N5 (work hours
scheduled), then READ, “The number of hours missed cannot be > the number
of hours scheduled.” Loop back to PRLS1_N5 (work hours scheduled).

Label_PRLS3_N5
Range_PRLS3_N5
Hard_edit_PRLS3_
N5

PRL20_N5

.

“Now I’m going to ask you about householdactivities. Household activities are
things you do to take care of your house, yourself, or your family such as
cooking, cleaning, lawn care, pet care, or childcare. Don’t include activities that
you’re paid for or you do in your free time.”
FL.2.0.

During the past 7 days, about how many fewer hours did you spend on
household activities because of problems with your physical or mental health?
[777 = Refused to answer, 888 = Don’t know]
Fewer hours spent on household activity.
0–168.
To estimate household productivity during the past 7 days.
Calculation (Assume 4-week=1 month):
Productivity loss related to household activities per month = (12.46*
PRL20_N5)*4
Reference: http://www.ncbi.nlm.nih.gov/pubmed/19536021
If WORK_N3 (employment) is “out of work for more than one year,” “out of
work for < one year,” or “unable to work,” then go to PRLS7_N5 (ever
employed). Else Skip to Intro_PRLS9_N5 (yearly individual income).

P a g e | 34

PRLS7_N5

FL.3.0.

Have you ever been employed for wages or self-employed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever employed.
If PRLS7_N5 (ever employed) = 0 (no), 7 (refused to answer), or 8 (don’t know),
then skip to Intro_KINDA_3 (insurance-private health insurance). Else, go to
PRLS8_N5.

FL.3.1.

What month and year did you stop working at your most recent job?
☐ ☐ / ☐ ☐ ☐ ☐
M M
Y Y Y Y
[Month: 77 = Refused to answer, 88= Don’t know; Year: 7777 = Refused to
answer, 8888 = Don’t know]
Date of most recent job.
PRLS8_N5 (date of the most recent job) cannot be earlier than DOB_13
(respondent’s date of birth).
If PRLS8_N5 (date of the most recent job) is earlier than DOB_13 (respondent’s
date of birth), then READ, “The date of your most recent job cannot be earlier
than your date of birth.” Loop back to PRLS8_N5 (date of most recent job).
PRLS8_N5 (date of the most recent job) cannot be later than IDATE (interview
date). If PRLS8_N5 (date of the most recent job) is later than IDATE (interview
date), then READ, “The date of your most recent job cannot be later than
today.” Loop back to PRLS8_N5 (date of most recent job).
To estimate the period of unemployment (months) by comparing PRLS8_N5
(date of the most recent job) to IDATE (interview date).

Label_PRLS7_N5
Skip_2PRLS7_N5

PRLS8_N5

Label_PRLS8_N5
Hard_edit_PRLS8_
N5

Calculation_PRLS8
_N5
Intro_PRLS9_N5

PRLS9_N5

“Next I’m going to ask you about individual income. This is different than
household income, which I asked you about earlier. When I say “individual
income,” I mean the amount of money you earned as a paid employee or from
your own business. Don’t include money earned by another member of your
household or from Supplemental Security Income (SSI) or Social Security
Disability Insurance (SSDI). If you aren’t currently employed or self-employed,
tell me your individual income from the most recent year that you were
employed.”
FL.4.0.

Please take a look at Response Card B and tell me the letter that corresponds
to your individual yearly or monthly income before taxes?
Individual Monthly Income
Individual Yearly Income
a.
$0 to $416 per month
or
$0 to $4,999 per year
b.
$417 to $833 per month
or
$5,000 to $9,999 per year
c.
$834 to $1041 per month
or
$10,000 to $12, 499 per year
d.
$1042 to $1249 per month
or
$12,500 to $14,999 per year
e.
$1250 to $1666 per month
or
$15,000 to $19,999 per year
f.
$1667 to $2083 per month
or
$20,000 to $24,999 per year
g.
$2084 to $2499 per month
or
$25,000 to $29,999 per year

P a g e | 35

Label_PRLS9_N5
Calculation_PRLS9
_N5

h. $2500 to $2916 per month
or
$30,000 to $34,999 per year
i.
$2917 to $3333 per month
or
$35,000 to $39,999 per year
j.
$3334 to $4166 per month
or
$40,000 to $49,999 per year
k.
$4167 to $4999 per month
or
$50,000 to $59,999 per year
l.
$5000 to $6249 per month
or
$60,000 to $74,999 per year
m. $6250 to $8332 per month
or
$75,000 to $99,999 per year
n. $8333 or $12499 per month
or
$100,000 to $149,999 per year
o. $12500 or $16666 per month or
$150,000 to $199,999 per year
p. $16667 or $20832 per month or
$200,000 to $249,999 per year
q. $20833 or more per month
or
$250,000 or more per year
Variable label is individual income
To estimate approximate monetary value of productivity loss due to
absenteeism and unemployment.
Calculation:
*Assume 4-week=1 month;
*Use mid-point of PRLS8_N5 (date of the most recent job) for the $ mount and
plug with $250,000 if the response falls in the category “$250,000 or more.”
Productivity loss due to absenteeism per month =
(
)
Productivity loss due to unemployment per month =
(

P a g e | 36

Healthcare coverage (FH)
Intro_KINDA_5

“I’d like to ask you about all of the types of insurance and other coverage you
have to help you pay for healthcare, medicines prescribed to treat your HIV,
medicines for other conditions, and supportive services like case
management.”

KIND_5 series

During the past 12 months, have you had any of the following types of
insurance or other coverage for any type of healthcare? Please answer “yes”
or “no” to each type. You may answer “yes” to more than one type.

KINDA_5

FH.1.1.

Did you have private health insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-private health insurance
If KINDA_5 is 1 (yes), go to INSEMP_N5, else skip to KINDB_5.

FH.1.1.a.

Was your private health insurance obtained through your employer or a family
member’s employer?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-private-employer

FH.1.1.b.

Did you purchase private health insurance through Healthcare.gov, or the
Health Insurance Marketplace?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-private-marketplace

FH.1.2.

Did you have Medicaid?
No
Yes
Refused to answer
Don’t know
Insurance-Medicaid

Label_KINDA_5
Skip_KINDA_5
INSEMP_N5

Label_INSEMP_
N5
INSMKT_N5

Label_INSMKT_
N5
KINDB_5

Label_KINDB_5
KINDC_5

FH.1.3.

Did you have Medicare?
No

0
1
7
8

0
36

P a g e | 37
Yes
Refused to answer
Don’t know
Insurance-Medicare

Label_KINDC_5
KINDD_15

FH.1.4.

Did you have coverage through Ryan White HIV/AIDS Program or AIDS Drug
Assistance Program, also called ADAP?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-Ryan White or ADAP

FH.1.5.

Did you have Tricare or CHAMPUS/CHAMPVA?
No
Yes
Refused to answer
Don’t know
Insurance-Tricare or CHAMPUS

0
1
7
8

Did you have Veterans Administration coverage?
No
Yes
Refused to answer
Don’t know
Insurance-Veterans Administration coverage

0
1
7
8

Label_KINDD_5
KINDE_5

Label_KINDE_5
KINDF_5

FH.1.6.

Label_KINDF_5
KINDG_5

FH.1.7.

Did you have city, county, state or other publicly funded insurance, not
including Medicaid?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-city, county, state or other publicly funded insurance

FH.1.8.

Did you have free medication or help with payment for medication through
your doctor’s office or clinic, or a compassionate care program. Don’t include
assistance paid for by ADAP or Ryan White.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-clinic or compassionate care

Label_KINDG_N
3
KINDH_N15

Label_KINDH_N
15
KINDI_N15

1
7
8

FH.1.9.

Did you have free medication or help with payment for medication through a
37

P a g e | 38
drug company?
No
Yes
Refused to answer
Don’t know
Insurance-drug company

Label_KINDI_N1
5
KINDJ_5

FH.1.10.

Did you have any other insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-other insurance
If KINDJ_5 is 1 (yes), then go to KINDJ_5OS; else, skip to INS12_9.

FH.1.11.

Please tell me the other type of insurance that you had.

Label_KINDJ_5
Skip_KINDJ_5
KINDJ_5OS

Refused to answer
Don’t know
Insurance-other specify

Label_KINDJ_5O
S
QDS_programmi
ng_KIND_5
series

FH.1.12.

So, during the past 12 months, you had no insurance and no other coverage
for any type of healthcare including medications. Is that correct?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Insurance-no coverage confirmation
If KINDZ_N5 is 0 (no), then repeat KINDA_5 through KINDJ_5. If KINDZ_N5 is
1(yes), then skip to next topic (ACACHNG_N5). If KINDZ_N5 is 7 (refused to
answer) or 8 (don’t know), then go to INS12_9.

FH.2.0.

During the past 12 months, was there a time that you didn’t have any health
insurance or health coverage?
No
0
Yes
1
Refused to answer
7

Label_KINDZ_N5
Skip_KINDZ_N5

INS12_9

7
8

If HTHINS_9 is 1 (yes) at least one of KIND series must be 1 (yes). If HTHINS_9 is
1 (yes), and none of KIND series is 1 (yes), READ, “You said that you had health
insurance or coverage during the past 12 months, but you did not answer 1
(Yes) to any type. Interviewer: confirm response to HTHINS_9. Return to
KINDA_5.
If none of KINDA_5 through KINDJ_5 is 1(yes), then go to KINDZ_N5. Else, skip
to INS12_9.

Skip_KIND_serie
s
KINDZ_N5

0
1
7
8

38

P a g e | 39
Don’t know
8
Gap in insurance or coverage
If INS12_9 is 1 (yes), then ask INSMTH_N5. Else, go back to KINDA_5.

Label_INS12_9
Skip_INS12_9
INSMTH_N5

FH.2.1.

Interviewer_not
e_INSMTH_N5
Label_INSMTH_
N5
Range_INSMTH
_N5

During the past 12 months, about how many months were you without
insurance or other healthcare coverage?

DISPLAY: If INSMTH_N5 is less than one month, round up to “1 month.”
Insurance-months without coverage
0-12

Affordable Care Act (FC)
ACACHNG_N5

FC.1.0.

Label_ACACHNG_
N5
Skip_
ACACHNG_N5
ACAAMT_N5

If ACACHNG_N5 is 1 (yes), then go to ACAAMT_N5 (ACA – change in amount
spent) Else, skip to ACAPAY_N5 (ACA – problems paying).
FC.1.1.

Because of this change in health insurance or coverage, is the amount you
spend on your medical care less, more, or about the same? [DON’T READ
RESPONSES. SELECT ONLY ONE.]
Less
0
More
1
About the same
2
Refused to answer
7
Don’t know
8
ACA – change in amount spent

FC.1.2.

Because of this change in health insurance or coverage, is your access to
supportive services? [DON’T READ RESPONSES. SELECT ONLY ONE.]
Better
0
Worse
1
About the same
2
Refused to answer
7
Don’t know
8
ACA – change in access

Label_
ACAAMT_N5
ACAACS_N5

Label_ACAACS_N5

During the past 12 months, has there been any change in the type of health
insurance or coverage that you have?
No
0
Yes
1
Refused to answer
7
Don’t know
8
ACA – change in type

39

P a g e | 40

Intro_ACAHCARE_N5

“Next I’m going to ask you about outpatient HIV medical care. By that I mean
care from a doctor or other healthcare provider to treat your HIV, not care
when you stay in a hospital overnight, in an emergency room, or urgent care
center.”

ACAHCARE_N5

FC.1.3.

Because of this change in health insurance or coverage, would you say your
outpatient HIV medical care is better, worse, or about the same? [DON’T
READ RESPONSES. SELECT ONLY ONE.]
Better
0
Worse
1
About the same
2
Refused to answer
7
Don’t know
8
ACA – outpatient HIV medical care

FC.1.4.

Because of this change in health insurance or coverage, did your usual
source of outpatient HIV medical care change? [DON’T READ RESPONSES.
SELECT ONLY ONE.]
No
0
Yes
1
Don’t have usual source of outpatient HIV
2
medical care
Refused to answer
7
Don’t know
8
ACA – Usual HIV care change

FC.2.0.

During the past 12 months did you have problems paying or were you
unable to pay any medical bills for your own care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
ACA – problems paying

FC.3.0.

Do you currently have any medical bills for your own care that are being
paid off over time? This could include medical bills being paid off with a
credit card, through personal loans, or bill paying arrangements with
hospitals or other providers. The bills can be from earlier years as well as
this year.
No
0
Yes
1
Refused to answer
7
Don’t know
8
ACA – paying off medical bills over time

Label_ACAHCARE_
N5
ACAUSUAL_N5

Label_ACAUSUAL_
N5
ACAPAY_N5

Label_ACAPAY_N5
ACADEBT_N5

Label_ACADEBT_

40

P a g e | 41
N5

41

P a g e | 42
HIV testing experiences (X)
Calculation_ST_TEST
Label_ST_TEST

Start time of HIV testing experiences module
ST_TEST = Current time
Start HIV testing experiences

Intro_TESSETN5

“Now I’m going to ask you some questions about getting tested for HIV.”

TESSETN5

X.1.0.

When you tested positive in
/
[INSERT POS1S_9 (DATE
FROM FIRST POSITIVE HIV TEST)], in what type of facility were you tested?
[DON’T READ RESPONSES. SELECT ONLY ONE.]
Primary care, non-emergency setting
1
Emergency room or urgent care setting
2
STD clinic
3
Inpatient hospital setting
4
Other clinical setting
5
Dedicated HIV testing, including non-clinical
6
community outreach setting
Self-testing setting
7
Other non-medical setting
8
Refused to answer
77
Don’t know
88
Where were you tested

X.2.0.

When you tested positive in
/
[INSERT POS1S_9 (DATE
FROM FIRST POSITIVE HIV TEST)], what was the main reason you were
tested? [READ RESPONSES. SELECT ONLY ONE.]
You felt sick
1
It was recommended by your provider, but not
2
because you felt sick
It was your own choice, but not because you felt sick 3
You had to, for example, it was a job requirement,
4
part of blood donation, etc.
Because the health department told you one of your 5
partners was infected
Some other reason
6
Refused to answer
7
Don’t know
8
Main reason tested
If MRTESTN5 is 8 (other), then go to MRTN5_OS. Else, skip to next topic
(Calculation_ST_NIC).

Label_TESSETN5
MRTESTN5

Label_MRTESTN5
Skip_MRTESTN5

MRTN5_OS

Please tell me the other reason that you were tested.

Label_MRTN5_OS

Other specify reason tested

42

P a g e | 43
Never in care (K)
Calculation_ST_NIC
Label_ST_NIC
EVERCRN5

K.1.0.

Label_EVERCRN5
Skip_EVERCRN5
Soft_edit_EVERCRN5

Label_ECVERFN5

LNKCRN5

K.1.1.

Label_LNKCRN5
Soft_edit_LNKCRN5

Intro_NICBN5

NICBN1N5

Are you sure that you’ve never seen a doctor, nurse, or other healthcare
worker—not even once—for any sort of outpatient HIV medical care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Confirm never received outpatient HIV medical care
If LNKCRN5 (confirm never in care) = 0 (no), 7 (refused to answer), or 8
(don’t know), then display message: “The respondent did not confirm
never receiving outpatient HIV medical care. Please clarify and correct the
response.”
“I’m going to read you a list of possible reasons people with HIV may not
have gotten outpatient HIV medical care. Please tell me whether or not
each reason applies to you. Is one of the reasons…”

K.1.2.

…because you have a scheduled appointment that hasn’t happened yet?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you have a scheduled appointment that hasn’t
happened yet

K.1.3.

…because you or your healthcare provider didn’t think you needed to?

Label_NICBN1N5

NICBP1N5

Start time of Never in Care module
ST_NIC = Current time
Start Never in Care
Since testing positive for HIV in
/
[INSERT POS1S_9 (date
first tested positive)], have you ever seen a doctor, nurse, or other
healthcare worker for outpatient HIV medical care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever received outpatient HIV medical care
If EVERCRN5 (ever received care) = 1 (yes), 7 (refused to answer), or 8
(don’t know), then skip to Linkage to Care section.
If EVERCRN5 (ever received care) = 0 (no), then display message: “The
respondent reported NEVER receiving outpatient HIV care and will skip the
entire HIV care and HIV treatment sections. If you feel the respondent
misunderstood, please clarify and correct the response.”
Interviewer verification that respondent has NEVER received outpatient
HIV medical care.

43

P a g e | 44
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you or your healthcare provider didn’t think you
needed to

Label_NICBP1N5

NICBP2N5

K.1.4.

…because you’ve been afraid or in denial about being HIV positive?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you’ve been afraid or in denial about being HIV
positive?

K.1.5.

…because you haven’t wanted anyone to know that you have HIV?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you haven’t wanted anyone to know that you have
HIV?

K.1.6.

…because you haven’t liked or trusted healthcare providers?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you haven’t liked or trusted healthcare providers?

K.1.7.

…because of problems with money or health insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because of problems with money or health insurance?

K.1.8.

…because you’ve had other things going on in your life that have made it
difficult?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you’ve had other things going on in your life that
have made it difficult?

K.1.9.

…because you couldn't find an HIV clinic or doctor or you couldn’t find one

Label_NICBP2N5

NICBP3N5

Label_NICBP3N5

NICBP4N5

Label_NICBP4N5
NICBF1N5

Label_NICBF1N5
NICBC1N5

Label_NICBC1N5

NICBS1N5

44

P a g e | 45
that met your needs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you couldn't find an HIV clinic or doctor or you
couldn’t find one that met your needs?

Label_NICBS1N5

NICBS2N5

K.1.10.

…because you’ve had trouble getting transportation to a clinic or doctor?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you’ve had trouble getting transportation to a clinic
or doctor

K.1.11.

…because of some other reason?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because of some other reason?
If NICBOTN5 is 1 (yes), then go to NICBN5OS. Else skip to Intro_NICNN1N5.

Label_NICBS2N5

NICBOTN5

Label_NICBOTN5
Skip_NICBOTN5
NICBN5OS

Please tell me the other reason that you may not have gotten outpatient
HIV medical care.

Label_NICBN5OS
Skip_NICBP1N5

Never in care: Other specify reason
If NICBP1N5 (Never in care: Because you or your healthcare provider didn’t
think you needed to) = 0 (no), 7 (refused to answer), or 8 (don’t know) then
skip to Skip_NICBD1N5 (reasons it was difficult to get outpatient HIV
medical care). Else go to NICNN1N5 (reasons for not seeing a provider
series).

Intro_NICNN1N5

“You mentioned you haven’t received outpatient HIV medical care because
you or your healthcare provider didn’t think you needed to. Is that…”

NICNN1N5

K.2.0.

…because your doctor or other healthcare provider told you that you didn’t
need to?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because your doctor or other healthcare provider told you
that you didn’t need to?

K.2.1.

…because you haven’t felt sick?

Label_NICNN1N5

NICNN2N5

45

P a g e | 46
No
Yes
Refused to answer
Don’t know
Never in care: Because you haven’t felt sick?

Label_NICNN2N5
NICNN3N5

K.2.2.

…because you haven’t believed that HIV medicine will improve your
health?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you haven’t believed that HIV medicine will improve
your health?

K.2.3.

Have you thought you didn’t need to go to a doctor or other healthcare
provider for some other reason?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Other reason you thought you didn’t need to go to a doctor
or other healthcare provider?
If NICNOTN5 is 1 (yes), then go to NICNN5OS. Else skip to Skip_NICBD1N5.

Label_NICNN3N5

NICNN5OS

Label_NICNOTN5
Skip_NICNOTN5

0
1
7
8

NICNN5OS

Please tell me the other reason you thought you didn’t need to go to a
doctor or other healthcare provider.

Label_NICNN5OS

Never in care: Other specify reason you thought you didn’t need to go to a
doctor or other healthcare provider
If the respondent selected “Never in care: Because you or your healthcare
provider didn’t think you needed to”, then the respondent should endorse
one response choice in the NICNNN5 series (reasons for not seeing a
provider series).
If NICNOTN5 (Never in care: Other reason you thought you didn’t need to
go to a doctor or other healthcare provider) = 0 (no) and the reasons for
not seeing a provider series: NICNNIN5 (doctor or other provider told you
that you didn’t need to), NICNN2N5 (you haven’t feel sick), and NICNN3N5
(you haven’t believed that HIV medicine will improve your health) is ‘No’
then READ, “You said you haven’t received outpatient HIV medical care
because your provider didn’t think it was necessary, but didn’t report a
reason. Please confirm.” Return to question NICNOTN5.
If NICBC1N5 (Never in care: Because you’ve had other things going on in
your life that have made it difficult) = 0 (no), 7 (refused to answer), or 8
(don’t know) then skip to Skip_NICM1N5 (Never in care: Because you
couldn’t find any HIV clinic or doctor). Else go to NICBDN5 (Other things
going on in your life series).

Soft_edit_NICNOTN5

Hard_edit_NICNOTN
5

Skip_NICBD1N5

46

P a g e | 47

Intro_NICBDN5

NICBD1N5

“Earlier you said you’ve had other things going on in your life that have
made it difficult to get outpatient HIV medical care. Is it difficult…?”
K.2.4.

…because you’ve been drinking or using drugs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you’ve been drinking or using drugs?

K.2.5.

…because of depression or mental health problems?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because of depression or mental health problems?

K.2.6.

…because you’ve been physically sick or hospitalized?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you’ve been physically sick or hospitalized?

K.2.7.

…because you’ve been in prison or jail?
0
No
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you’ve been in prison or jail?

K.2.8.

Have you found it difficult to get outpatient HIV medical care because of
something else going on in your life?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Have you found it difficult to get outpatient HIV medical care
because of something else going on in your life?
If NICDOTN5 is 1 (yes), then go to NICDN5OS. Else skip to Skip_NICBS1N5.

Label_NICBD1N5
NICBD2N5

Label_NICBD2N5
NICBD3N5

Label_NICBD3N5
NICBD4N5

Label_NICBD4N5
NICDOTN5

Label_NICDOTN5
Skip_NICDOTN5
NICDN5OS

Please tell me what else has been going on in your life that has made it
difficult for you to get outpatient HIV medical care.

Label_NICDN5OS
Soft_edit_NICDOTN5

Never in care: Other specify reason for something else going on in your life
If the participant selected “Never in care: Because you’ve had other things
47

P a g e | 48
going on in your life that have made it difficult”, then the respondent
should endorse one response choice in the NICBDN5 series (other things
going on in your life series).
If NICDOTN5 (other thing going on that made it difficult to get outpatient
HIV medical care) is ‘No’ and the reasons for not getting outpatient HIV
medical care: NICBD1N5 (drinking or using drugs), NICBD2N5 (depression
or mental health problems), NICBD3N5 (physically sick or hospitalized), and
NICBD4N5 (prison or jail) are ‘No’ then READ, “You said you had other
things going on that made it difficult to get outpatient HIV medical care,
but you didn’t report a reason.” Return to question.
If NICBS1N5 (Never in care: Because you couldn't find an HIV clinic or
doctor or you couldn’t find one that met your needs?) = 0 (no), 7 (refused
to answer), or 8 (don’t know) then skip to Skip_NICNM1N5 (Never in care:
Because you couldn’t find any HIV clinic or doctor). Else go to NICBMRN5
(main reason never in care).

Hard_edit_NICDOTN
5

Skip_NICBS1N5

Intro_ NICNM1N5

NICNM1N5

“You mentioned you couldn’t find an HIV clinic or doctor or you couldn’t
find one that met your needs. Is that…”
K.3.1.

…because you couldn’t find any HIV clinic or doctor?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you couldn’t find any HIV clinic or doctor
If NICNM1N5 (Never in care: Because you couldn’t find any HIV clinic or
doctor) = 1 (yes), then skip to Skip_NICBMRN5
Else, go to NICNMN5 (Reason couldn’t find a clinic to meet needs series

K.3.2.

…because the clinic or doctor is too far away?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because the clinic or doctor is too far away?

K.3.3.

…because you haven’t found a clinic or doctor that spoke your language?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Because you haven’t found a clinic or doctor that spoke your
language

K.3.4.

…because you haven’t been able to get an appointment?
No
0
Yes
1

Label_NICNM1N5
Skip_NICNM1N5

NICNM2N5

Label_NICM2N5
NICNM3N5

Label_NICM3N5

NICBM4N5

48

P a g e | 49
Refused to answer
7
Don’t know
8
Never in care: Because you haven’t been able to get an appointment

Label_NICM4N5
NICNMTN5

Label_NICNMTN5
Skip_NICNMTN5

K.3.5.

Have you not found a clinic or doctor that met your needs because of some
other reason?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never in care: Other reason you have not found a clinic or doctor that met
your needs
If NICNMTN5 is 1 (yes), then go to NICNM5OS. Else, skip to
Skip_NICNMTN5.

NICNM5OS

Please tell me the other reason you have not found a clinic or doctor that
met your needs.

Label_NICMN5OS

Never in care: Other specify reason you have not found a clinic or doctor
that met your needs
If the respondent selected “Never in care: Because you couldn’t find any
HIV clinic or doctor”, then the participant should endorse one response
choice. If NICNMTN5 (Never received care: Other reason you have not
found a clinic or doctor that met your needs) = 0 (no) and the reasons for
not finding an HIV clinic or doctor series:
NICNM1N5 (couldn’t find any HIV clinic or doctor),
NICNM2N5 (the clinic or doctor is too far away),
NICNM3N5 (you haven’t found a clinic that spoke your language), and
NICBM4N5 (you haven’t been able to get an appointment) = 0 (no) then
READ, “You said you haven’t received outpatient HIV medical care because
you couldn’t find an HIV clinic or doctor or you couldn’t find one that met
your needs, but you didn’t report a reason.” Return to question
NICNMTN5.
If the respondent indicated only 1 reason for not receiving outpatient HIV
medical care (NICBN1N5, NICBP2N5, NICBP3N5, NICBP4N5, NICBF1N5,
NICBS2N5, NICBOTN5), then skip to SEENMDN5 (have you ever seen a
doctor in any setting for medical care).
Show a list of the options selected in NICBN5 (reasons for not receiving
outpatient HIV medical care), NICNNN5 (reasons for not seeing a provider
series), NICBDN5 (Other things going on in your life series), or NICNMN5
(Reason couldn’t find a clinic to meet needs series) where the selection was
1 (yes). Please exclude NICBP1N5 (you or your healthcare provider didn’t
think you needed to), NICBC1N5 (you’ve had other things going on in your
life that have made it difficult), and NICBS1N5 (you couldn’t find an HIV
clinic or doctor or you couldn’t find one that met your needs) as a main
reason because we want people to select a sub-reason when possible know
the sub-reason.

Hard_edit_NICNMTN
5

Skip_NICNMTN5

QDS_programming_
NICBMRN5

49

P a g e | 50

NICBMRN5

K.4.0.

Of all the reasons you just gave, what is the most important one? [READ
PREVIOUSLY SELECTED RESPONSES. SELECT ONLY ONE.]
Because you have a scheduled appointment that 1
hasn’t happened yet?
Because you’ve been afraid or in denial about
2
being HIV positive?
Because you haven’t wanted anyone to know that 3
you have HIV?
Because you haven’t liked or trusted healthcare
4
providers?
Because of problems with money or health
5
insurance?
Because you’ve had trouble getting
6
transportation to a clinic or doctor?
Because of [INSERT RESPONSE FROM NICBN5OS
7
(other specify reason)]?
Because your doctor or other healthcare provider 8
told you that you didn’t need to?
Because you haven’t felt sick?
9
Because you haven’t believed that HIV medicine
10
will improve your health?
Because of [INSERT RESPONSE FROM NICNN5OS
11
(other specify—reason you thought you didn’t
need to go to a doctor or other healthcare
provider)]?
Because you’ve been drinking or using drugs?
12
Because of depression or mental health
13
problems?
Because you’ve been physically sick or
14
hospitalized?
Because you’ve been in prison or jail
15
Because of [INSERT RESPONSE FROM NICDN5OS
16
(Other specify—reason for something else going
on in your life)]?
Because you couldn't find any HIV clinic or
17
doctor?
Because the clinic or doctor is too far away?
18
Because you haven’t found a clinic or doctor that 19
spoke your language?
Because you haven’t been able to get an
20
appointment?
Because of [INSERT RESPONSE FROM NICMN5OS
21
(other specify—reason you have not found a
clinic or doctor that met your needs)]?
Refused to answer
77
Don’t know
88
50

P a g e | 51
Label_NICBMRN5
SEENMDN5

Label_SEENMDN5
Skip_SEENMDN5

Most important barrier-never in care
K.5.0.

Since testing positive for HIV in [INSERT POS1S_9 (date of first positive
test)], have you seen a doctor, nurse, or other healthcare provider in any
setting for any kind of medical care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Seen a healthcare provider in any setting for any kind of medical care
If SEENMDN5 = 1 (yes), 7 (refused to answer), or 8 (don’t know) then skip
to Intro_HOSPERN5. Else, go to next topic (Calculation_ST_HIV, calculation
start time HIV care).

51

P a g e | 52
HIV Care (V)
Calculation_ST_HIVCA

Start time of HIV care module
ST_ HIVCA = Current time
Start HIV care

Label_ST_HIVCA
Linkage to care (VL)
Intro_PREFN5

PREFN5

“For these next questions, I’ll be asking about the 30 days after you tested
positive for HIV so that is from [INSERT POSIS_9 (date of first positive test)]
to [INSERT ONE MONTH AFTER POSIS_9]”
VL.1.0.

Label_PREFN5
Intro_AREF4N5

AREF4N5

“For the next few questions, I’ll be asking about whether you got help
getting connected to outpatient HIV medical care from a professional. A
professional could be someone like a doctor, nurse, social worker, or
receptionist.”
VL.2.0.

Within 30 days after you got your first positive HIV test, did a professional
help you figure out if you qualified for free or low-cost outpatient HIV
medical care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did a professional help you figure out if you qualified for free or low-cost
outpatient HIV medical care?
If AREF4N5 (did a professional help you figure out if you qualified for free or
low-cost outpatient HIV medical care?) = 1 (yes), then skip to AREF1N5 (did
a professional help you make an appointment for outpatient HIV medical
care?)
If AREF4N5 (did a professional help you figure out if you qualified for free or
low-cost outpatient HIV medical care?) = 7 (refused to answer) or 8 (don’t
know), then skip to KNOWFRN5 (Did you know that free or low-cost
outpatient HIV medical care may be available to those who qualify)
Else, go to AREF4NN5 (Did you want a professional to help you figure out if
you qualified for free or low-cost outpatient HIV medical care).

VL.2.1.

Did you want a professional to help you figure out if you qualified for free

Label_AREF4N5
Skip_AREF4N5

AREF4NN5

Within 30 days after you got your first positive HIV test, did someone ask if
you needed help finding a place to go for outpatient HIV medical care or let
you know where you could go for outpatient HIV medical care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
help finding outpatient HIV medical care

52

P a g e | 53
or low-cost outpatient HIV medical care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did you want a professional to help you figure out if you qualified for free or
low-cost outpatient HIV medical care

Label_AREF4NN5

KNOWFRN5

VL.2.2.

Label_KNOWFRN5
Calculation_KNWCO
N5

Did you know that free or low-cost outpatient HIV medical care may be
available to those who qualify?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did you know that free or low-cost outpatient HIV medical care may be
available to those who qualify
A variable should be calculated that combines AREF4N5 (did a professional
help you figure out if you qualified for free or low-cost care) and
KNOWFRN5 (did you know that free or low-cost outpatient HIV medical
care may be available to those who qualify). Combination variable:
KNWCON5 (Calculated: did you know that free or low-cost outpatient HIV
medical care may be available to those who qualify).
AREF4N5
No

KNWCON5
Value from
KNOWFRN5
Yes
[Skipped]
Yes
Refused
Value from
KNOWFRN5
Don’t Know
Value from
KNOWFRN5
did you know that free or low-cost outpatient HIV medical care may be
available to those who qualify

Label_KNWCON5

AREF1N5

Label_AREF1N5
Skip_AREF1N5

VL.3.0.

KNOWFRN5

Within 30 days after you got your first positive HIV test, did a professional
help you make an appointment for outpatient HIV medical care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did a professional help you make an appointment for outpatient HIV
medical care
If AREF1N5 (did a professional help you make an appointment for
outpatient HIV medical care) = 1 (yes), 7 (refused to answer), or 8 (don’t
know) then skip to AREF2N5 (did a professional help you arrange
transportation to an outpatient HIV medical care appointment).
53

P a g e | 54
AREF1NN5

VL.3.1.

Did you want a professional to help you make an appointment?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did you want a professional to help you make an appointment for
outpatient HIV medical care

VL.4.0.

Within 30 days after you got your first positive HIV test, did a professional
help you arrange transportation to an outpatient HIV medical care
appointment?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did a professional help you arrange transportation to an outpatient HIV
medical care appointment
If AREF2N5 (did a professional help you arrange transportation to an
outpatient HIV medical care appointment) = 1 (yes), 7 (refused to answer),
or 8 (don’t know) then skip to AREF3N5 (did a professional go with you to
your first outpatient HIV medical care appointment?)

VL.4.1.

Did you want a professional to help you arrange transportation?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did you want a professional to help you arrange transportation

VL.5.0.

Within 30 days after you got your first positive HIV test, did a professional
go with you to your first outpatient HIV medical care appointment?
No
0
Yes
1
Refused to answer
7
Don’t know
8
professional go with you to your first appointment
If AREF3N5 (did a professional go with you to your first outpatient HIV
medical care appointment) = 1 (yes), 7 (refused to answer), or 8 (don’t
know) then skip to CARE_9 (date of first outpatient HIV medical care visit).

VL.5.1.

Did you want a professional to go with you?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If EVERCRCN5 (ever received outpatient HIV medical care) = 0 (no), 7
(refused to answer), or 8 (don’t know) then skip to General Medical Care.

Label_AREF1NN5

AREF2N5

Label_AREF2N5
Skip_AREF2N5

AREF2NN5

Label_AREF2NN5
AREF3N5

Label_AREF3N5
Skip_AREF3N5

AREF3NN5

Skip_AREF3NN5

54

P a g e | 55
Else, go to CARE_9 (Date of first care visit).
Did you want a professional to go with you to your first outpatient HIV
medical care appointment

Label_AREF3NN5

CARE_9

VL.6.0.

Label_care_9
Soft_edit_CARE_9

Since testing positive for HIV in [INSERT POS1S_9 (date of first positive
test)], what month and year did you first visit a doctor, nurse, or other
healthcare worker for outpatient HIV medical care?
☐ ☐ / ☐ ☐ ☐ ☐
M M
Y Y Y Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
date of first outpatient HIV medical care visit
If CARE_9 (date of first outpatient HIV medical care visit) is earlier than
POS1S_9 (date first tested positive for HIV), then READ, “The date entered
is earlier than the date first tested positive for HIV care. Please confirm the
date.” Return to CARE_9.
If CARE_9 (date of first outpatient HIV medical care visit) is earlier than
DOB_13 (date of birth), then READ, "The date entered is earlier than your
date of birth. Please confirm the date." Return to CARE_9.

Retention (VR)
LASCA_9

VR.1.0.

When was your most recent visit to a doctor, nurse, or other
healthcare worker for outpatient HIV medical care? Please tell
me the month and year.
☐ ☐/ ☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of most recent outpatient HIV medical care visit
LASCA_9 (date of most recent outpatient HIV medical care visit)
cannot be earlier than CARE_9 (date of first outpatient HIV
medical care visit) or later than IDATE (interview date).
Allow a blank response for month.

VR.2.0.

What is the name of the place you went for most of your outpatie
HIV medical care from ([LASCA_9]-365) to [LASCA_9]?
Interviewer instructions: The name of the usual place of
outpatient care is not recorded in QDS, but will be used in later
questions. This is the name of the location where the medical
record abstraction should be performed.
During the past 2 years, that is between [INSERT TWO YEARS
PRIOR TO IDATE (interview date)] and [INSERT IDATE], have you
seen an HIV care provider for outpatient HIV medical care at any
55

Label_LASCA_9
Hard_edit_
LASCA_9
QDS_Programming_
LASCA_9
USOCN5
QDS_programming_USOCN
5

NYMLTFN5

VR.3.0.

P a g e | 56
facility besides [INSERT NAME OF USUAL SOURCE OF OUTPATIEN
CARE]?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Seen any other outpatient HIV medical care providers past two
years
If NYMLTFN5 (seen any other outpatient HIV medical care provide
past two years) = 0 (no), 7 (refused to answer), or 8
(don’t know) then skip to MSAPPTN5 (Missed any scheduled
outpatient HIV medical care appointments).

Label_NYMLTFN5
Skip_NYMLTFN5

MLTFA1N5

VR.3.1.

[777 = Refused to answer, 888= Don’t know]
A different clinic in the same hospital would be considered a
different facility if different on the sampling frame.
number of outpatient HIV facilities past 2 years
2–99

Interviewer Instructions
Label_MLTFA2N5
Range_MLTFA2N5
MLTFA1N5

VR.3.2.

Hard_edit_MLTFA1N5

Label_MLTFA1N5

Label_MSAPPTN5

During the past 12 months, that is, between [INSERT IDATE-12
months] to [IDATE], at how many total facilities have you
received outpatient HIV medical care? Please include [INSERT
NAME OF USUAL SOURCE OF OUTPATIENT CARE] in the total.
[777 = Refused to answer, 888= Don’t know]
A different clinic in the same hospital would be considered a
different facility if different on the sampling frame.
The number of facilities in MLTFA1N5 (past year) must be ≤ the
number of facilities in MLTFA2N5 (past 2 years). The number of
facilities in [MLTFA1N5] must be between 2 and 99.
number of outpatient HIV facilities past year

Interviewer Instructions

MSAPPTN5

During the past 2 years, at how many total facilities have you
received outpatient HIV medical care? Please include [INSERT
NAME OF USUAL SOURCE OF OUTPATIENT CARE] in the total.

VR.4.0.

During the past 12 months, have you missed ANY scheduled
appointments for outpatient HIV medical care that you didn’t
cancel?
This doesn’t include appointments that were cancelled by the
clinic.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Missed any scheduled outpatient HIV medical care appointments
56

P a g e | 57
NOVSTSN5

VR.5.0.

[777 = Refused to answer, 888= Don’t know]
number of visits with an outpatient HIV medical care provider
0–365

Label_NOVSTSN5
Range_NOVSTSN5
SEEOFTN5

During the past 12 months, how many visits have you had with
any outpatient HIV medical care provider?

VR.6.0.

Label_SEEOFTN5
Skip_SEEOFTN5

Do you think the number of times you saw an outpatient HIV
medical care provider in the past 12 months was… [READ
CHOICES. SELECT ONLY ONE.]
More than you needed
1
About the right number of times
2
Less than you needed
3
Refused to answer
7
Don’t know
8
number of times you saw an outpatient HIV medical care
provider
If SEEOFTN5 (Number of times you saw an outpatient HIV
medical care provider) = 1 (More than you needed to), 2 (About
the right number of times), 7 (refused to answer), or 8 (don’t
know) then skip to REEN5 (Has a provider tried to help you get
more frequent outpatient HIV medical care). Else, go to NOCBN5
Series (Reasons not in care).

Intro_NOCBN5

“I’m going to read you a list of things that can get in the way of
outpatient HIV medical care. Please tell me whether or not each
applies to you. Was one of the reasons that you didn’t see a
provider more often…”

Label_NOCBN5

Not in care series

NOCBN1N5

VR.6.1.

...because your doctor or other healthcare provider didn’t ask
you to come in more often?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because doctor or other healthcare provider didn’t
ask

VR.6.2.

...because you didn’t feel sick?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you didn’t feel sick

Label_NOCBN1N5

NOCBN2N5

Label_NOCBN2N5

57

P a g e | 58
NOCBN3N5

VR.6.3.

...because you didn’t believe that HIV medicine would improve
your health?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you didn’t believe that HIV medicine would
improve your health

VR.6.4.

...because you were afraid or in denial about being HIV positive?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you were afraid or in denial about being HIV
positive

VR.6.5.

...because you didn't want anyone to know that you have HIV?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you didn't want anyone to know that you ha
HIV

VR.6.6.

...because you didn’t like or trust healthcare providers?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you didn’t like or trust healthcare providers

VR.6.7.

...because of problems with money or health insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because of problems with money or health
insurance

VR.6.8.

...because you had other things going on in your life that made
it difficult?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you had other things going on in your life tha

Label_NOCBN3N5

NOCBP1N5

Label_NOCBP1N5

NOCBP2N5

Label_NOCBP2N5

NOCBP3N5

Label_NOCBP3N5
NOCBF1N5

Label_NOCBF1N5

NOCBC1N5

Label_NOCBC1N5

58

P a g e | 59
made it difficult?
NOCBS1N5

VR.6.9.

...because you couldn’t find an HIV clinic or doctor or you
couldn’t find one that met your needs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you couldn’t find an HIV clinic or doctor or y
couldn’t find one that met your needs

VR.6.10.

...because you had trouble getting transportation to a clinic?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you had trouble getting transportation to a
clinic

VR.6.11.

…because of some other reason?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because of some other reason?
If NOCBOTN5 is 1 (yes), then go to NICBN5OS. Else, skip to
Skip_NOCBDN5.

Label_NOCBS1N5

NOCBS2N5

Label_NOCBS2N5

NOCBOTN5

Label_NOCBOTN5
Skip_NOCBOTN5

NICBN5OS

Please tell me the other reason didn’t see a provider more often.

Label_NOCBN5OS

Not in care: Other specify reason didn’t see a provider more
often
If NOCBC1N5 (because you had other things going on in your life
that made it difficult) = 0 (no), 7 (refused to answer), or 8 (don’t
know) then go to Skip_NOCNM1N5. Else go to NOCBDN5 series
(reasons for other things going on that made it difficult).

Skip_NOCBDN5

Intro_NOCBDN5

NOCBD1N5

Label_NOCBD1N5

“Earlier you said you had other things going on that made it
difficult to see an HIV outpatient provider more often. Was it
difficult…?”
VR.7.0.

...because you were drinking or using drugs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you were drinking or using drugs
59

P a g e | 60

NOCBD2N5

VR.7.1.

...because of depression or mental health problems?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because of depression or mental health problems?

VR.7.2.

…because you were physically sick or hospitalized?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you were physically sick or hospitalized?

VR.7.3.

…because you were in prison or jail?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you were in prison or jail

VR.7.4.

Was it difficult to get outpatient HIV medical care more often
because of something else going on in your life?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Something else going in your life that made it difficult
to get care
If NOCDOTN5 is 1 (yes), then go to NOCDN5OS. Else skip to
Skip_NOCNM1N5.

Label_NOCBD2N5
NOCBD3N5

Label_NOCBD3N5
NOCBD4N5

Label_NOCBD4N5
NOCDOTN5

Label_NOCDOTN5
Skip_NOCDOTN5

NOCDN5OS

Please tell me what else has been going on in your life that has
made it difficult for you to get outpatient HIV medical care.

Label_NOCDN5OS

Not in care: Other specify reason for something else going on in
your life that made it difficult to get care
Participant must endorse one sub-reason.
If NOCDOTN5 (Something else going on in your life that made it
difficult to get care) is 0 (no) and the reasons for not getting
outpatient HIV medical care: NOCBD1N5 (you were drinking or
using drugs), NOCBD2N5 (depression or mental health
problems), NOCBD3N5 (you were physically sick or
hospitalized), and NOCBD4N5 (you were in prison) are 0 (no),
then READ, “You said you had other things going on that made
it difficult to get more outpatient HIV medical care, but you

Hard_edit_NOCDOTN5

60

P a g e | 61
didn’t report a reason. Please confirm.” Return to NOCDOTN5
(Something else going on in your life that made it difficult to get
care).
If NOCBS1N5 (Because you couldn’t find an HIV clinic or doctor
or you couldn’t find one that met your needs) = 0 (no), 7
(refused to answer), or 8 (don’t know) then skip to instructions
before NOCBMRN5 (main reason not in care as often as
needed). Else go to NOCNM1N5 (because you couldn’t find any
HIV clinic or doctor).

Skip_NOCNM1N5

NOCNM1N5

VR.8.0.

Label_NOCNM1N5
Skip_NOCM1N5

Intro_NOCNMN5

NOCNM2N5

“Was it…”

VR.8.1.

...because the clinic was too far away?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because the clinic was too far away

VR.8.2.

...because you couldn’t find a clinic that spoke your language?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you couldn’t find a clinic that spoke your
language

VR.8.3.

...because you couldn’t get an appointment?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you couldn’t get an appointment

Label_NOCNM2N5
NOCNM3N5

Label_NOCNM3N5

NOCNM4N5

Label_NOCNM4N5

You mentioned you couldn’t find an HIV clinic or doctor or you
couldn’t find one that met your needs. Was it because you
couldn’t find any HIV clinic or doctor?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Because you couldn’t find any HIV clinic or doctor
If NOCM1N5 (because you couldn’t find any HIV clinic or doctor)
= 1 (yes), then skip to NOCBMRN5 (main reason not in care as
often as needed). Else go to NOCNMN5 series (reason couldn’t
find a doctor or clinic).

61

P a g e | 62

NOCNMTN5

VR.8.4.

Label_NOCNMTN5
Skip_ NOCNMTN5

Have you not found a clinic or doctor that met your needs
because of some other reason?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Not in care: Other reason you have not found a clinic or doctor
If NOCNMTN5 is 1 (yes), then go to NOCMN5OS. Else, skip to
NOCBMRN5.

NOCMN5OS

Please tell me the other reason you have not found a clinic or
doctor.

Label_NOCMN5OS

Not in care: Other specify reason you have not found a clinic or
doctor
Participant must endorse a sub-reason.
If NOCNMTN5 (other reason you couldn’t find a clinic) is 0 (no)
and the reasons you couldn’t find a clinic that met your needs:
NOCNM1N5 (you couldn’t find any HIV clinic or doctor),
NOCNM2N5 (the clinic was too far away), NOCNM3N5 (you
couldn’t find a clinic that spoke your language), and NOCBM4N5
(you couldn’t get an appointment) are 0 (no), then READ, “You
said you couldn’t find any HIV clinic or you couldn’t find one
that met your needs, but you didn’t report a reason. Please
confirm.” Return to question NOCNMTN5 (other reason you
couldn’t find a clinic).
If the respondent indicated only 1 reason in the NOCBN5 series
(Reasons not in care: NOCB1N1N5, NOCBN2N5, NOCBN3N5,
NOCBP1N5, NOCBP2N5, NOCBP3N5, NOCBF1N5, NOCBS2N5)
then skip to Intro_REEN5. Else go to NOCBMRN5 (main reason
not in care as often as needed).
Show a list of the options selected in NOCBN5 (reasons not in
care), NOCBDN5 (reasons you had other things going on that
made it difficult to get outpatient HIV medical care), or
NOCNMN5 (reasons you couldn’t find any clinic or a clinic that
met your needs) where the selection = 1 (yes). Please exclude
NOCBC1N5 (you had other things going on in your life that have
made it difficult), and NOCBS1N5 (you couldn’t find an HIV clinic
or doctor or you couldn’t find one that met your needs) as a
main reason because we want people to select a sub-reason
when possible.

Hard_edit_NOCNMTN5

Skip_NOCBMRN5

QDS_programming_NOCB
MRN5

NOCBMRN5

VR.9.0.

Of all the reasons you just gave, what is the most important
one? [READ PREVIOUSLY SELECTED CHOICES. SELECT ONLY
ONE.]
Because your doctor or other healthcare
1
62

P a g e | 63
provider didn’t ask you to come in more
often?
Because you didn’t feel sick?
Because you didn’t believe that HIV
medicine would improve your health?
Because you were afraid or in denial about
being HIV positive?
Because you didn’t want anyone to know
that you have HIV?
Because you didn’t like or trust healthcare
providers?
Because of problems with money or health
insurance?
Because you had trouble getting
transportation to a clinic?
Because of [response from NOCBN5OS
(other specify reason)]?
Because you were drinking or using drugs?
Because of depression or mental health
problems?
Because you were physically sick or
hospitalized?
Because you were in prison or jail?
Because of [response from NOCDN5OS
(other thing going on that made it difficult
to get outpatient HIV medical care more
often)]?
Because you couldn't find any HIV clinic or
doctor?
Because the clinic was too far away?
Because you couldn’t find a clinic that spoke
your language?
Because you couldn’t get an appointment?
Because of [response from NOCMN5OS
(other reason you couldn’t find a clinic)]?
Refused to answer
Don’t know
Most important barrier-not in care

Label_NOCBMRN5
Intro_REEN5

REEN5

2
3
4
5
6
7
8
9
10
11
12
13
14

15
16
17
18
19
77
88

“For the next question, I’ll be asking about whether you got
help getting connected to outpatient HIV medical care from a
professional. A professional could be someone like a doctor,
nurse, social worker, or receptionist.”
VR.10.0.

During the past 12 months, has a professional tried to help you
get outpatient HIV medical care more often than you are
getting now?
63

P a g e | 64
No
0
Yes
1
Refused to answer
7
Don’t know
8
Has a provider tried to help you get more frequent outpatient
HIV medical care
If the date given in CARE_9 (date of first visit to a provider for
HIV care) is <= 12 months prior to the date given in [LASCA_9]
(date of most recent visit to a provider for HIV care), skip to HIV
care quality. If the date given in [LASCA_9] (date of most recent
visit to a provider for HIV care) >= 12 months prior to IDATE,
skip to HIV care quality.

Label_REEN5
Skip_YRGAPN5

YRGAPN5

VR.10.1.

Since your first visit to an outpatient HIV medical care provider
in [INSERT DATE FROM CARE_N5], has there ever been a time
that you went more than a year without seeing any outpatient
HIV medical care provider?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever had a year gap in care
A variable should be calculated by QDS to combine gaps
suggested by [LASCA_N5] and [YRGAPN5]. If YRGAPN5 (Ever
had a year gap in care) = 1 (yes) OR LASCA_9 (date of most
recent visit to a provider for HIV care) >= 12 months prior to
IDATE (date of interview) then ANYGAPN5 = 1. ELSE ANYGAPN5
=0
Calculated QDS variable: any gap more than a year
If YRGAPN5 (ever had a year gap in care) = 0 (no), 7 (refused to
answer), or 8 (don’t know), then skip to the next topic
(Skip_GESATN5). Else, go to ENDGP_N5 (date returned to a
provider for HIV care).

VR.10.2.

After the last time you went without care for more than a year,
when did you start seeing an outpatient HIV medical care
provider again? Please tell me the month and year.
☐ ☐ / ☐ ☐ ☐ ☐
M M
Y Y Y Y
Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know
date returned to a provider for HIV care after one year gap
If ENDGP_N5 (date returned to a provider for HIV care) is earlier
than CARE_9 (date first visit to a provider for HIV care), then
READ, “The date entered is earlier than the date first received
HIV care. Please confirm date.”
If ENDGP_N5 is later than LASCA_9 (date of most recent visit to

Label_YRGAPN5
Calculation_ANYGAPN5

Label_ANYGAPN5
Skip_ENDGP_N5

ENDGP_N5

Label_ENDGP_N5
Hard_edit_1ENDGP_N5

Hard_edit_2ENDGP_N5

64

P a g e | 65

Hard_edit_3ENDGP_N5

QDS_programming_ENDGP
_N5

a provider for HIV care), then READ, “The date entered is after
the most recent visit to an HIV provider. Please confirm date”.
If ENDGP_N5 is within 12 months of date given in CARE_9 (date
of first visit to a provider for HIV care), then READ, “The date
entered is within 12 months of the first care date. Go back to
previous question to confirm date.”
Allow a blank response for month.

HIV care quality (VQ)
Skip_GESATN5

GESATN5

Skip_1GESATN5

Label_GESATN5

If LASCA_9 (date of most recent visit to a provider for HIV care) is more
than 12 months prior to the IDATE (date of interview), then skip to next
topic (Calculation_ST_GENMD, start time general medical care). Else go to
GESATN5 (General satisfaction with outpatient HIV medical care).
VQ.1.0.

In general, how satisfied are you with the outpatient HIV medical care you
received in the past 12 months? [READ RESPONSES. SELECT ONLY ONE.]
Very satisfied
1
Somewhat satisfied
2
Somewhat dissatisfied
3
Very dissatisfied
4
People who have been out of care for exactly 12 months should be asked 5
(You haven’t had healthcare in the past 12 months.) Else, skip to next topic
(Calculation_ST_GENMD, start time general medical care).
You haven’t had healthcare in the past 12
5
months
Refused to answer
7
Don’t know
8
General satisfaction with outpatient HIV medical care

65

P a g e | 66
HIV treatment and adherence (T)
Calculation_
ST_ADHER
Label_ST_ADHER

Start time of HIV treatment and adherence module
ST_ADHER = Current time.
Start HIV treatment and adherence.

Intro_ EART_N5

“Now I’m going to ask some questions about medicines that you may be taking
for your HIV. These medicines are called HIV medicines, and are also known as
antiretroviral medicines, ART, or HAART. The questions I am going to ask you
are about HIV medicines taken after you tested HIV positive.”

EART_N5

T.1.0.

Label_ EART_N5
Skip_ EART_N5

Have you ever taken any HIV medicines?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever taken ART
If EART_N5 (ever taken ART) is 1 (yes), skip to FART_N5 (Date first took ART).
If EART_N5 (ever taken ART) is 7 (refused to answer) or 8 (don’t know), skip to
P12_N5 (Took prescriptions meds in past 12 months).
Else go to next question.

Intro_ NART1_N5

NART1_N5

“I’m going to read you a list of reasons why some people have not taken HIV
medicines after testing HIV positive. For each reason, please tell me “yes” or
“no” if it applies to your situation. [READ RESPONSES. SELECT ALL THAT
APPLY.]”
T.1.1.

No doctor has ever talked to you about taking HIV medicines.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never ART: No one talked about it

T.1.2.

Your doctor said you should not start taking HIV medicines.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never ART: Dr said not to start

T.1.3.

You have problems paying for or getting insurance or coverage for HIV
medicines.
No
0
Yes
1

Label_ NART1_N5
NART2_N5

Label_ NART2_N5
NART3_N5

66

P a g e | 67
Refused to answer
Don’t know
Never ART: Problems with money or insurance

Label_ NART3_N5
NART4_N5

7
8

T.1.4.

You decided not to take HIV medicines because you don’t think you need
them.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never ART: Don’t think you need them

T.1.5.

You decided not to take HIV medicines because you think they would make
you feel sick or harm you.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never ART: Think would feel sick or may harm

T.1.6.

You decided not to take HIV medicines for some other reason.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Never ART: Other reason
Skip to P12_N5 (Took prescriptions meds in past 12 months).

T.2.0.

Label_ FART_N5
QDS_programmin
g_ FART_N5

When was the first time you ever took any HIV medicines? Please tell me the
month and year.
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
FART_N5 (Date first took ART)
Allow a blank response for month. If month is blank for FART_N5 (date first
took ART), use the year values for the validation.

Hard_edit_
FART_N5

FART_N5 (date first took ART) cannot be earlier than POS1S_9 (date first
tested positive).

Label_ NART4_N5
NART5_N5

Label_ NART5_N5
NART6_N5

Label_ NART6_N5
Skip_ NART6_N5

FART_N5

If FART_N5 (date first took ART) < POS1S_9 (date of first positive test) then
READ, “The date first took HIV medications cannot be earlier than the HIV
diagnosis date. Please re-enter date." Do not allow the program to advance.
FART_N5 (date first took ART) cannot be later than IDATE (interview date).
If FART_N5 (date first took ART) > IDATE (interview date) then READ, “The date
67

P a g e | 68
first took HIV medications cannot be later than interview date. Please re-enter
date." Do not allow the program to advance.
FART_N5 (date first took ART) cannot be earlier than CARE_9 (date first went
to a provider for HIV care).
If FART_N5 (date first took ART) < CARE_9 (date first went to a provider for HIV
care) then READ, “The date first took HIV medications should not be earlier
than the date first went to a provider for HIV care. Please confirm date." Allow
the program to advance.
CART_N5

T.3.0.

Label_ CART_N5
Skip_ CART_N5

Intro_ CART1_N5

CART1_N5

“I’m going to read you a list of reasons why some people are not taking HIV
medicines. For each reason, please tell me “yes” or “no” if it applies to your
situation.”
T.3.1.

No one has talked to you about taking HIV medicines again.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Stopped ART: No one talked about it

T.3.2.

Your doctor said you should not take HIV medicines.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Stopped ART: Dr said not to start

T.3.3.

You have problems paying for or getting insurance or coverage for HIV
medicines.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Stopped ART: Problems with money or insurance

Label_ CART1_N5
CART2_N5

Label_ CART2_N5
CART3_N5

Label_ CART3_N5

Are you currently taking any HIV medicines?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Currently taking ART
If CART_N5 (currently taking ART) is 1 (yes), skip to ADH1_N5 (days missed
taking ART).
If EART_N5 (ever taken ART) is 7 (refused to answer) or 8 (don’t know), skip to
ATMD12_9 (Took ART in past 12 months).
Else go to next question.

68

P a g e | 69

CART4_N5

T.3.4.

You decided not to take HIV medicines because you don’t think you need
them.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Stopped ART: Don’t think you need them

T.3.5.

You decided not to take HIV medicines because you think they would make
you feel sick or harm you.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Stopped ART: Think would feel sick or may harm

T.3.6.

You decided not to take HIV medicines for some other reason.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Stopped ART: Other reason
Skip to P12_N5 (Took prescriptions meds in past 12 months).

Label_ CART4_N5
CART5_N5

Label_ CART5_N5
CART6_N5

Label_ CART6_N5
Skip_ CART6_N5

Intro_ ADH1_N5

ADH1_N5

“Now I am going to ask you about the HIV medicines you are currently taking.
We realize it can be hard for people to take all their medications exactly as
they are supposed to. I’m going to ask you about the past 30 days. That is from
[INSERT IDATE (interview date) - 30 DAYS] to now [INSERT IDATE]. If you have
been taking HIV medicines for less than 30 days, please think about the time
since you started taking them [SHOW RESPONDENT CALENDAR]”
T.4.0.

[77 = Refused to answer, 88 = Don’t know]
Days missed taking ART
0–30

Label_ ADH1_N5
Range_ ADH1_N5
ADH2_N5

In the past 30 days, on how many days did you miss at least one dose of any of
your HIV medicines?

T.4.1.

In the past 30 days, how good a job did you do at taking your HIV medicines in
the way you were supposed to? [READ RESPONSES. SELECT ONLY ONE.]
Very poor
1
Poor
2
Fair
3
Good
4
Very good
5
69

P a g e | 70
Excellent
Refused to answer
Don’t know
How good a job taking ART

Label_ ADH1_N5
ADH3_N5

T.4.2.

During the past 30 days, how often did you take your HIV medicines in the way
you were supposed to? [READ RESPONSES. SELECT ONLY ONE.]
Never
1
Rarely
2
Sometimes
3
Usually
4
Almost always
5
Always
6
Refused to answer
7
Don’t know
8
How often took ART

T.5.0.

For the next question we will use Response Card C. During the past 30 days,
how often were you troubled by side effects from any of your HIV medicines?
[READ RESPONSES. SELECT ONLY ONE.]
Never
1
Rarely
2
About half of the time
3
Most of the time
4
Always
5
Refused to answer
7
Don’t know
8
How often side effects

T.6.0.

How often are you supposed to take your HIV medicines? If you take more
than one pill at the same time, count this as one time. [READ RESPONSES.
SELECT ONLY ONE]
Three times or more a day
1
Twice a day
2
Once a day
3
Less often than once a day—for example, every 4
other day or weekly
Refused to answer
7
Don’t know
8
How often take ART

Label_ ADH3_N5
TRBL_EFT

Label_ TRBL_EFT
OFT_N5

Label_ OFT_N5
Intro_ MIS1_N5

MIS1_N5

6
7
8

“The last time you missed taking your HIV medicines, which of the following
were reasons you missed?”
T.7.0.

You had a problem getting a prescription, a refill, insurance coverage, or
paying for your HIV medicines.
No
0
70

P a g e | 71
Yes
1
Refused to answer
7
Don’t know
8
Missed ART: Problem with prescription, insurance, or money

Label_ MIS1_N5
MIS2_N5

T.7.1.

You were in the hospital or too sick to take your HIV medicines.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Missed ART: Hospitalized or sick

T.7.2.

You fell asleep early or overslept.
No
Yes
Refused to answer
Don’t know
Missed ART: Asleep or overslept

Label_ MIS2_N5
MIS3_N5

Label_ MIS3_N5
MIS4_N5

T.7.3.

You had a change in your daily routine or were out of town.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Missed ART: Change in routine or out of town

T.7.4.

You had side effects from your HIV medicines.
No
Yes
Refused to answer
Don’t know
Missed ART: Side effects

0
1
7
8

You felt depressed or overwhelmed.
No
Yes
Refused to answer
Don’t know
Missed ART: Depressed or overwhelmed

0
1
7
8

You were drinking or using drugs.
No
Yes
Refused to answer
Don’t know
Missed ART: Drinking or using drugs

0
1
7
8

Label_ MIS4_N5
MIS5_N5

Label_ MIS5_N5
MIS6_N5

T.7.5.

Label_ MIS6_N5
MIS7_N5

Label_ MIS7_N5

0
1
7
8

T.7.6.

71

P a g e | 72
MIS8_N5

T.7.7.

Label_ MIS8_N5
MIS9_N5

T.7.8.

Label_ MIS9_N5
Skip_ MIS9_N5
ATMD12_9

T.9.0.

During the past 12 months, did your doctor or other clinic staff ask you
whether you missed taking any doses of your HIV medicines?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Dr asked if missed ART doses

T.9.1.

During the past 12 months, did your doctor or other clinic staff ask you
whether you had problems taking your HIV medicines?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Dr asked if problems taking ART doses
Skip to PRMD1_N5 (Problems with meds: Skipped doses to save money).

T.10.0.

During the past 12 months, have you taken any prescription medicines?
No
0
Yes
1
Refused to answer
7
Don’t know
8

Label_ PROB_N5
Skip_ PROB_N5
P12_N5

0
1
7
8

During the past 12 months, have you taken HIV medicines?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Took ART in past 12 months
If ATMD12_9 (Took ART in past 12 months) is 0 (no), 7 (refused to answer), or
8 (don’t know), skip to P12_N5 (Took prescriptions meds in past 12 months).
Else go to next question (DASK_N5).

Label_ DASK_N5
PROB_N5

You did not feel like taking your HIV medicines.
No
Yes
Refused to answer
Don’t know
Missed ART: Didn’t feel like taking
Skip to DASK_N5 (doctor asked if missed).

0
1
7
8

T.8.0.

Label_ ATMD12_9
Skip_ ATMD12_9

DASK_N5

You forgot to take your HIV medicines.
No
Yes
Refused to answer
Don’t know
Missed ART: Forgot

72

P a g e | 73
Label_ P12_N5
Skip_ P12_N5

Took prescriptions meds in past 12 months
If P12_N5 (Took prescriptions meds in past 12 months) is 0 (no), 7 (refused to
answer), or 8 (don’t know), skip to next topic (Calculation_ST_GENMD,
calculation general medical care start time). Else go to Intro_ PRMD1_N5.

Intro_ PRMD1_N5

“The next questions are about all prescription medicines you have taken in the
past 12 months. Include HIV medicines as well as medicines prescribed for
other conditions. During the past 12 months, are any of the following true for
you?”

PRMD1_N5

T.11.0.

You skipped medication doses to save money.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Problems with meds: skipped doses to save money

T.11.1.

You took less medicine to save money.
No
Yes
Refused to answer
Don’t know
Problems with meds: took less to save money

Label_ PRMD1_N5
PRMD2_N5

Label_ PRMD2_N5
PRMD3_N5

T.11.2.

You delayed filling a prescription to save money.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Problems with meds: delayed filling to save money

T.11.3.

You asked your doctor for a lower-cost medication to save money.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Problems with meds: lower cost med to save money

T.11.4.

You bought prescription drugs from another country to save money.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Problems with meds: bought from another country to save money

T.11.5.

You used alternative therapies to save money.
No

Label_ PRMD3_N5
PRMD4_N5

Label_ PRMD4_N5
PRMD5_N5

Label_ PRMD5_N5
PRMD6_N5

0
1
7
8

0
73

P a g e | 74

Label_ PRMD6_N5
Skip_ PRMD6_N5

Yes
1
Refused to answer
7
Don’t know
8
Problems with meds: alternative therapies to save money
Skip to next topic (Calculation_ST_GENMD, calculation general medical care
start time).

74

P a g e | 75
General medical care (J)
Calculation_ST_GENMD

Start time of General Medical Care module
ST_GENMD = Current time.
Start of General Medical Care

Label_ST_GENMD
ER and hospitalizations (JH)
Intro_HOSPERN5

HOSPERN5

“Now I’m going to ask you about visits to the emergency room or
hospitalizations and general medical care.”
JH.1.0.

During the past 12 months, how many times have you gone to a hospital
emergency room about your own health? This includes emergency room
visits that resulted in a hospital admission.
[777 = Refused to answer, 888= Don’t
know]
Number of times gone to a hospital emergency room
0–776

Label_HOSPERN5
Range_HOSPERN5
HOSPONN5

JH.2.0.

During the past 12 months, were you a patient in a hospital overnight?
Don’t include an overnight stay in the emergency room.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever in a hospital overnight
If HOSPONN5 (ever in a hospital overnight) = 0 (no), 7 (refused to
answer), or 8 (don’t know) then skip to other care
Else go to NUMONN5 (number of times stayed in hospital overnight).

JH.2.1.0.

During the past 12 months, how many different times did you stay in any
hospital overnight or longer?

Label_HOSPONN5
Skip_HOSPONN5

NUMONN5

[777 = Refused to answer, 888= Don’t
know]
Number of time stayed in hospital overnight
1– 365

Label_NUMONN5
Range_
NUMMONN5
Other care (JO)
CLTREC_9

Label_CLTREC_9

75

JO.1.0.

During the past 12 months, have you participated in an HIV clinical trial?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever participated in an HIV clinical trial

P a g e | 76
Health literacy (HL)
Start time of Health Literacy module
ST_ HLLIT = Current time.
Start of health literacy
“For the next question, we will use Response Card C.”

Calculation_ST_
HLLIT
Label_ST_ HLLIT
Intro_HLMF_12
HLMF_12

Label_HLMF_12

76

HL.1.0.

How confident are you filling out medical forms by yourself? [READ
RESPONSES. SELECT ONLY ONE.]
Extremely
1
Quite a bit
2
Somewhat
3
A little bit
4
Not at all
5
Refused to answer
7
Don’t know
8
Health literacy-filling out medical forms by yourself.

P a g e | 77
Depression and Anxiety (M)
Calculation_ST_
MENHL
Label_ST_MENHL

Start time of mental health module
ST_MENHL = Current time
Start mental health

Intro_ANX_DEPA

“Now I’m going to ask you some questions about your mood. When answering,
please think about how often the following has occurred during the past 2
weeks. We will use Response Card D for these questions. We will also use the
calendar to refer to the past 2 weeks.”

PHQ-4 screening questions (MD)
Intro_ANX_DEPA

ANX_DEPA

“Over the past 2 weeks, how often have you been bothered by any of the
following problems?”

Label_ANX_DEPA

MD.1.0. Little interest or pleasure in doing things? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
PHQ little interest

ANX_DEPB

MD.2.0.

Feeling down, depressed, or hopeless? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
PHQ feeling down

MD.3.0.

Feeling nervous, anxious or on edge? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
GAD anxious

MD.4.0.

Not being able to stop or control worrying? [SELECT ONLY ONE. USE RESPONSE
CARD.]

ANX_DEPB
ANXNR_N5

Label_ANXNERN5
ANXSW_N5

77

P a g e | 78
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
GAD not stop worrying
If ANX_DEPA (PHQ little interest) = 3 or 4 or ANX_DEPB = 3 or 4, go to
ANX_DEPC (PHQ sleep trouble); else, skip to the next topic
(Calculation_ST_SEX, start time sexual behavior).

Label_ANXWR_N5
Skip_ANXWR_N5

PHQ-8 depression (MA)
Intro_ANX_DEPC

ANX_DEPC

“Over the past 2 weeks, how often have you been bothered by any of the
following problems?”

Label_ANX_DEPC

MA.1.0. Trouble falling or staying asleep, or sleeping too much? [SELECT ONLY ONE.
USE RESPONSE CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
PHQ sleep trouble

ANX_DEPD

MA.2.0.

Feeling tired or having little energy? [SELECT ONLY ONE. USE RESPONSE CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
PHQ feeling tired

MA.3.0.

Poor appetite or overeating? [SELECT ONLY ONE. USE RESPONSE CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
PHQ poor appetite

MA.4.0.

Feeling bad about yourself—or that you are a failure or have let yourself or
your family down? [SELECT ONLY ONE. USE RESPONSE CARD.]
Not at all
1
Several days
2

Label_ANX_DEPD
ANX_DEPE

Label_ANX_DEPE
ANX_DEPF

78

P a g e | 79
More than half the days
Nearly every day
Refused to answer
Don’t know
PHQ feeling bad about self

Label_ANX_DEPF
ANX_DEPG

MA.5.0.

Trouble concentrating on things, such as reading the newspaper or watching
television? [SELECT ONLY ONE. USE RESPONSE CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
PHQ trouble concentrating

MA.6.0.

Moving or speaking so slowly that other people could have noticed, or the
opposite—being so fidgety or restless that you have been moving around a lot
more than usual? [SELECT ONLY ONE. USE RESPONSE CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
PHQ moving slowly or being fidgety

Label_ANX_DEPG
ANX_DEPH

3
4
7
8

Label_ANX_DEPH
GAD-7 anxiety (MG)
Skip_ANXWR_N5

If ANXNR_N5 (GAD anxious) = 3 or 4 or ANXSW_N5 (GAD not stop worrying) =
3 or 4, go to ANXWR_N5 (GAD worrying too much); else, skip to the next topic
(Calculation_ST_SEX, start time sexual behavior).
“Over the past 2 weeks, how often have you been bothered by any of the
following problems?”

Intro_ANXWR_N5

ANXWR_N5

MG.1.0.

Worrying too much about different things? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
GAD worrying too much

MG.2.0.

Trouble relaxing? [SELECT ONLY ONE. USE RESPONSE CARD.]
Not at all
1
Several days
2

Label_ANXWR_N5
ANXRX_N5

79

P a g e | 80
More than half the days
Nearly every day
Refused to answer
Don’t know
GAD trouble relaxing

Label_ANXRX_N5
ANXRS_N5

MG.3.0.

Being so restless that it’s hard to sit still? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
GAD restless

MG.4.0.

Becoming easily annoyed or irritable? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
GAD irritable

MG.5.0.

Feeling afraid as if something awful might happen? [SELECT ONLY ONE. USE
RESPONSE CARD.]
Not at all
1
Several days
2
More than half the days
3
Nearly every day
4
Refused to answer
7
Don’t know
8
GAD feeling afraid

Label_ANXRS_N5
ANXIR_N5

Label_ANXIR_N5
ANXAF_N5

Label_ANXAF_N5

3
4
7
8

80

P a g e | 81
Sexual behavior (S)
Calculation_ST_SEX

Start time of sexual behavior module
ST_SEX = Current time
Start sexual behavior

Label_ST_SEX
Total sex partners (ST)
Intro_SX_TFPN4

“Next, I'm going to ask you some questions about sex. Please remember that
your answers will be kept confidential and that you don’t have to answer any
questions that you don’t want to. I’ll ask you about the number of people you
had sex with during the past 12 months. When I say “sex,” I mean vaginal or
anal sex. Vaginal sex means penis in the vagina and anal sex means penis in
the anus. When thinking about your answers, please include anyone whom
you had vaginal or anal sex with during the past 12 months. The number of
people could range anywhere from 0 to over a hundred.”

Calculation_SX_GEN

If GENDER=Male and BIRTGEN=Male then SX_GEN=1 (Male).
If GENDER=Female and BIRTGEN=Female then SX_GEN=2 (Female). If
(GENDER=Male and BIRTGEN=Female) or (GENDER=Female and
BIRTGEN=Male) or (GENDER=Transgender and [BIRTGEN=Male, Female,
don’t know, or refused to answer]) then SX_GEN=3 (Transgender).
If BIRTGEN is intersex, then SX_GEN=4 (Indeterminate).
If ([GENDER= refused to answer or don’t know] and [BIRTGEN = Male,
Female, refused to answer, or don’t know], then SX_GEN=4 (Indeterminate).
If BIRTGEN is refused to answer or don’t know, and GENDER is male, female,
refused to answer, or don’t know, then SX_GEN=4 (Indeterminate).
sex gender

Label_SX_GEN

Male

Gender

Male

Female

SX_GEN = 1
male
Female
SX_GEN = 3
transgender
Transgender SX_GEN = 3
transgender
Refused
SX_GEN = 4
Indeterminate
Don’t know SX_GEN = 4
Indeterminate

Skip_SX_TFPN4

SX_TFPN4

BIRTGEN
Intersex

SX_GEN = 3
transgender
SX_GEN = 2
female
SX_GEN = 3
transgender
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate

SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate

Refused to
answer
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate
SX_GEN = 3
transgender
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate

Don’t know
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate
SX_GEN = 3
transgender
SX_GEN = 4
Indeterminate
SX_GEN = 4
Indeterminate

If SX_GEN=2 (Female), skip to SX_TMPN4 (number of male partners).
Else, go to SX_TFPN4 (number of female partners).
ST.1.0.

During the past 12 months, how many females have you had sex with?
81

P a g e | 82

[7777 = Refused to answer, 8888 = Don’t know]
Number of female partners.
0–999

Label_SX_TFPN4
Range_SX_TFPN4
SX_TMPN4

ST.2.0.

[7777 = Refused to answer, 8888 = Don’t know]
Number of male partners.
0–999

Label_SX_TMPN4
Range_SX_TMPN4
SX_TTPN4

Label_SX_TTPN4
Range_SX_TTPN4
Calculation_SX
_TOTN4

Label_SX_TOTN4
Calculation_
SXFMONN4

Label_SXFMONN4
Calculation
_SXMLONN4

Label_SXMLONN4
Calculation_
SXTGONN4

During the past 12 months, how many males have you had sex with?

ST.3.0.

During the past 12 months, how many transgender persons have you had sex
with?
[7777 = Refused to answer, 8888 = Don’t know]
Number of transgender partners.
0–999
Create a calculated variable where the sum of SX_TFPN4 + SX_TMPN4 +
SX_TTPN4 = SX_TOTN4.
If the response to SX_TFPN4 (number of female partners), SX_TMPN4 (number
of male partners), or SX_TTPN4 (number of transgender partners) is 7 (refused
to answer) or 8 (don’t know), then calculate the response as “0.” EXAMPLE: if
SX_TFPN4 = 8 (don’t know) AND SX_TMPN4 = 8 (don’t know), AND SX_TTPN4 =
7 (refused to answer), THEN SX_TOTN4 = 0.
If any of the values are Skipped (.S), then do not include the value in the
calculation. EXAMPLE: if SX_TFPN4 = 2 AND SX_TMPN4 = 8 (don’t know), AND
SX_TTPN4 = Skipped, then SX_TOTN4 = 2.
Variable label for SX_TOTN4 is total number of vaginal and anal sex partners.
Female only partners: create a calculated variable SXFMONN4 (female only
partners) if SX_TMPN4 (number of male partners) = 0, 8 (don’t know), or 7
(refused to answer) AND SX_TTPN4 (number of transgender partners) = 0, 8
(don’t know), or 7 (refused to answer) AND SX_TFPN4 (number of female
partners) ≥ 1, then SXFMONN4 (female only partners) = 1; else SXFMONN4 = 0.
Female only partners.
Male only partners: create a calculated variable SXMLONN4 (male only
partners) if SX_TFPN4 (number of female partners) = 0, 8 (don’t know), or 7
(refused to answer) or .S (skipped) AND SX_TTPN4 (number of transgender
partners) = 0, 8 (don’t know), or 7 (refused to answer) AND SX_TMPN4
(number of male partners) ≥ 1, then SXMLONN4 (male only partners) = 1; else
SXMLONN4 = 0.
Male only partners.
Transgender only partners: create a calculated variable SXTGONN4
(transgender only partners) if SX_TFPN4 (number of female partners) = 0, 8
(don’t know), or 7 (refused to answer) AND SX_TMPN4 (number of male
partners) = 0, 8 (don’t know), or 7 (refused to answer) AND SX_TTPN4 (number
of transgender partners) ≥ 1, then SXTGONN4 (transgender only partners) = 1;
else SXTGONN4 = 0.
82

P a g e | 83
Label_ SXTGONN4
Skip_SX_TWPN4

Transgender only partners.
If SX_GEN=2 (Female), go to Intro_SX_TWPN4 (number of female-female
partners).
If SX_GEN is not 2 (Female) and SX_TOTN4 (total number of sex partners) = 0,
skip to Intro_SEROSRT1 (serosorting).
Else, if SX_GEN is not 2 (Female) and SX_TOTN4 (total number of sex partners)
≥ 1 skip to skip_SX_EXCN4 (exchange sex).

Intro_SX_TWPN4

“Now, I’m going to ask you about sex with women.”

SX_TWPN4

ST.4.0.

During the past 12 months, how many women did you have sex with?
[7777 = Refused to answer, 8888 = Don’t know]
Number of female-female partners
0–999
Female-female only partners: create a calculated variable SXFFONN4 (femalefemale only partners) if SX_TMPN4 (number of male partners) = 0, 8 (don’t
know), or 7 (refused to answer) AND SX_TTPN4 (number of transgender
partners) =0, 8 (don’t know), 7 (refused to answer) AND SX_TWPN4 (number of
female-female partners) ≥ 1, THEN SXFFONN4 (female-female only partners) =
1; ELSE SXFFONN4 = 0.
Female-female only partners
Women who only had sex with women: If SX_GEN=2 AND SX_TMPN4 (number
of male partners) = 0, 7 (refused to answer) or 8 (don’t know), AND SX_TTPN4
(number of transgender partners) = 0, 7 (refused to answer) or 8 (don’t know),
skip to the serosorting section (Intro_SEROSRT1).

Label_SX_TWPN4
Range_SX_TWPN4
Calculation
_SXFFONN4

Label_SXFFONN4
Skip_SX_EXCN4

No vaginal or anal sex partners: If SX_TFPN4 (number of female partners),
SX_TMPN4 (number of male partners), and SX_TTPN4 (number of transgender
partners) are all some combination of 0, 7 (refused to answer) or 8 (don’t
know), then skip to the serosorting section (Intro_SEROSRT1).
Else: Go to SX_EXCN4 (exchange sex).
Exchange sex (SE)
SX_EXCN4

SE.1.0.

Label_SX_EXCN4

During the past 12 months, did you have sex in exchange for things like food,
shelter, transportation, money, or drugs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Exchange sex.

Names of partners (SN)
Skip_1SX_NM1_5

If SX_TOTN4 (total number of sex partners) = 1, go to Intro_1 SX_NM1_5
83

P a g e | 84
(name of partner 1). If SX_TOTN4 ≥ 2, skip to Intro_2SX_NM1_5 (name of
partner 1). If SX_GEN = 2 and SX_TWPN4 (number of female-female sex
partners) ≥ 1 and SX_TMPN4 (number of male sex partners) = 1 then go to
Intro_3SX_NM1N4. If SX_GEN = 2 and SX_TWPN4 (number of female-female
sex partners) ≥ 1 and SX_TMPN4 (number of male sex partners) > 1 then go to
Intro_4SX_NM1N4.
Intro_1
SX_NM1_5

“Now I’m going to ask you some questions about the person that you recently
had sex with during the past 12 months, such as his or her age and race.
Please answer to the best of your knowledge, but it’s okay to tell me that you
don’t know or that you’re unsure. Since I’ll be asking questions about this
person, I need some way to refer to him or her. You may refer to him or her in
any way you want—initials, nickname, or where you met. However, please
don’t provide a last name or any other identifying information.”

Skip_2SX_NM1_5

Skip to SX_NM1_5 (name of partner 1).

Intro_2SX_NM1_
5

“Now I’m going to ask you some questions about the [IF SX_TOTN4 (total
number of sex partners) is 2, 3, or 4, THEN INSERT RESPONSE FROM
SX_TOTN4 (total number of sex partners). IF SX_TOTN4 (total number of sex
partners) ≥5, THEN INSERT “5”] people you recently had sex with during the
past 12 months, such as their age and race. Please answer to the best of your
knowledge, but it’s okay to tell me that you don’t know or that you’re unsure.
Since I’ll be asking questions about each person, I need some way to refer to
them, so that when I ask you follow-up questions, we both know we’re talking
about the same person. You may refer to them in any way you want—initials,
nicknames, or where you met. However, please don’t provide last names or
any other identifying information.”

Skip_3SX_NM1_5

Skip to SX_NM1_5 (name of partner 1).

Intro_3SX_NM1_
5

“Now I’m going to ask you some questions about the male partner that you
recently had sex with during the past 12 months, such as his age and race.
Please answer to the best of your knowledge, but it is okay to tell me that you
don’t know or that you’re unsure. Since I’ll be asking questions about this
person, I need some way to refer to him. You may refer to him in any way you
want—initials, nickname, or where you met. However, please don’t provide a
last name or any other identifying information.”

Skip_4SX_NM1_5

Skip to SX_NM1_5 (name of partner 1).

Intro_4SX_NM1_
5

“Now I’m going to ask you some questions about the male partners that you
recently had sex with during the past 12 months, such as their age and race.
Please answer to the best of your knowledge, but it is okay to tell me that you
don’t know or that you’re unsure. Since I’ll be asking questions about each
person, I need some way to refer to them. You may refer to them in any way
you want—initials, nickname, or where you met. However, please don’t
84

P a g e | 85
provide a last name or any other identifying information.”
SX_NM1_5

SN.1.0.

[7 = Refused to answer]
Name of partner 1
If SX_TOTN4 (total number of sex partners) = 1 AND SX_NM1_5 (name of
partner 1), is 7 (refused to answer), READ the message “Interviewer: remind
the respondent that he or she can provide initials, nicknames, or another
name to identify the partner.” Go back to SX_NM1_5 (name of partner 1). If
SX_NM1_5 (name of partner 1), is still 7 (refused to answer), skip to the
serosorting section (Intro_SEROSRT1).
Character limit = 50.

Label_SX_NM1_5
Skip_SX_NM1_5

Range_SX_NM1_
5
QDS_programmin
g_SX_NM1_5
SX_NM2N4

Open-ended response.
Do not allow an 8 (don’t know) response option.
SN.1.1.

Range_SX_NM2N
4
Hard_edit_SX_N
M2N4

If SX_NM1_5 (name of partner 1) and SX_NM2N4 (name of partner 2) are
identical, then READ, “You gave me the same name for another partner. Can
you please give me another name?” The program should return to SX_NM2N4
(name of partner 2).
Use open-ended response.
Do not allow an 8 (don’t know) response option.

QDS_programmin
g_SX_NM2N4

Skip_SX_NM3N4

What shall we call the 2nd person with whom you had sex during the past 12
months?
[7 = Refused to answer]
Name of partner 2.
If SX_TOTN4 (total number of sex partners) = 2 AND SX_NM1_5 (name of
partner 1) and SX_NM2N4 (name of partner 2) are 7 (refused to answer), skip
to the serosorting section (Intro_SEROSRT1). If SX_TOTN4 (total number of
sex partners) ≥3, go to SX_NM3N4 (name of partner 3). Else, go to SXTOVRN4
(verification of total sex partners).
EXAMPLE: SX_NM1_5 (name of partner 1) is 7 (refused to answer) AND
SX_NM2N4 (name of partner 2) is “John,” then go to SX_NM3N4 (name of
partner 3).
Character limit = 50

Label_SX_NM2N4
Skip_SX_NM2N4

SX_NM3N4

What shall we call the person with whom you most recently had sex during
the past 12 months?

SN.1.2.

What shall we call the 3rd person with whom you had sex during the past 12
months?
[7 = Refused to answer]
If SX_TOTN4 (total number of sex partners) = 3 and SX_NM1_5 (name of
partner 1) and SX_NM2N4 (name of partner 2) and SX_NM3N4 (name of
partner 3) are 7 (refused to answer), skip to the serosorting question
85

P a g e | 86
(Intro_SEROSRT1). If SX_TOTN4 (total number of sex partners) ≥4, go to
SX_NM4N4 (name of partner 4). Else Skip to SXTOVRN4 (verification of total
sex partners).
EXAMPLE: SX_NM1_5 (name of partner 1) is 7 (refused to answer) AND
SX_NM2N4 (name of partner 2) is “John” and SX_NM3N4 (name of partner 3)
is “Jane,” then go to SX_NM4N4 (name of partner 4).
Variable label is name of partner 3.
Character limit = 50.

Label_SX_NM3N4
Range_SX_NM3N
4
Hard_edit_SX_N
M3N4

If either SX_NM1_5 (name of partner 1), SX_NM2N4 (name of partner 2), or
SX_NM3N4 (name of partner 3) are identical, then READ, “You gave me the
same name for another partner. Can you please give me another name?” The
program should return to SX_NM3N4 (name of partner 3).
Use open-ended response.
Do not allow an 8 (don’t know) response option.

QDS_programmin
g_SX_NM3N4
SX_NM4N4

SN.1.3.

[7=Refused to answer]
If SX_TOTN4 (total number of sex partners) = 4 and SX_NM1_5 (name of
partner 1) and SX_NM2N4 (name of partner 2) and SX_NM3N4 (name of
partner 3) and SX_NM4N4 (name of partner 4) are 7 (refused to answer), skip
to the serosorting section (Intro_SEROSRT1). If SX_TOTN4 (total number of
sex partners) ≥5, go to SX_NM5N4 (name of partner 5). Else, skip to
SXTOVRN4 (verification of total sex partners).
EXAMPLE: SX_NM1_5 (name of partner 1) is 7 (refused to answer) AND
SX_NM2N4 (name of partner 2) is “John” and SX_NM3N4 (name of partner 3)
is “Jane” and SX_NM4N4 (name of partner 4) is “JB,” then go to SX_NM5N4
(name of partner 5).
Variable label is name of partner 4.
Character limit = 50.
Use open-ended response.
Do not allow for an 8 (don’t know) response option.
If either SX_NM1_5 (name of partner 1), SX_NM2N4 (name of partner 2),
SX_NM3N4 (name of partner 3), or SX_NM4N4 (name of partner 4) are
identical, then READ, “You gave me the same name for another partner. Can
you please give me another name?” The program should return to SX_NM4N4
(name of partner 4).

Skip_SX_NM4N4

Label_SX_NMN4
Range_SX_NMN4
QDS_programmin
g_SX_NMN4
Hard_edit_SX_N
MN4

SX_NM5N4

Skip_SX_NM5N4

What shall we call the 4th person with whom you had sex during the past 12
months

SN.1.4.

What shall we call the 5th person with whom you had sex during the past 12
months?
[7=Refused to answer]
If SX_TOTN4 (total number of sex partners) = 5 AND SX_NM1_5 (name of
partner 1), SX_NM2N4 (name of partner 2), SX_NM3N4 (name of partner 3),
SX_NM4N4 (name of partner 4), SX_NM5N4 (name of partner 5) are all 7
86

P a g e | 87
(refused to answer), skip to the serosorting section (Intro_SEROSRT1). Else go
to SXTOVRN4 (verification of total sex partners).
Variable label is name of partner 5.
Character limit = 50.

Label_SX_NM5N4
Range_SX_NM5N
4
QDS_programmin
g_SX_NM5N4
Hard_edit_SX_N
M5N4

Use open-ended response.
Do not allow an 8 (don’t know) response option.
If either SX_NM1_5 (name of partner 1), SX_NM2N4 (name of partner 2),
SX_NM3N4 (name of partner 3), SX_NM4N4 (name of partner 4), or
SX_NM5N4 (name of partner 5) are identical, then READ, “You gave me the
same name for another partner. Can you please give me another name?” The
program should return to SX_NM5N4 (name of partner 5).
If SX_TOTN4 (total number of sex partners) > 5 and SX_NM1_5 (name of
partner 1), SX_NM2N4 (name of partner 2), SX_NM3N4 (name of partner 3),
SX_NM4N4 (name of partner 4), and SX_NM5N4 (name of partner 5) are all 8
(don’t know) or 7 (refused to answer), then skip to the aggregate information
section (Intro_SXAGC1N4).

Skip_SX_NM1N4SX_NM2N4SX_NM3N4SX_NM4N4SX_NM5N4
SXTOVRN4

Label_SXTOVRN4
Skip_SXTOVRN4

SN.1.5.

So, the total number of people you had vaginal or anal sex with during the
past 12 months was [INSERT SX_TOTN4]?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Variable label for SXTOVRN4 is verification of total sex partners
If SXTOVRN4 = 0 (no) or 8 (don’t know), return to Skip_SX_TFPN4 (number of
female partners). If SXTOVRN4 = 1 (yes), go to instructions for partner
demographics partner-by-partner series table. If SXTOVRN4 = 7 (refused to
answer), skip to the Serosorting section (Intro_SEROSRT1).

87

P a g e | 88

Partner demographics (SP)
Questions

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name
name
name
name
name
SX_NM1N4]
SX_NM2N4]
SX_NM3N4]
SX_NM4N4]
SX_NM5N4]
Instructions for partner demographics partner-by-partner series table:
The questions and response options are in the far left column of the table. Each question is asked for partners 1–5. Partners 1-5 are
labeled in columns Partner 1, Partner 2, Partner 3, Partner 4, and Partner 5. All Partner 1 questions are asked before moving to
Partner 2 questions. Detailed instructions are provided in each table cell.
QDS_programmi QDS_programmin QDS_programmin QDS_programmin QDS_programmin
ng_partner-byg_partner-byg_partner-byg_partner-byg_partner-bypartner-seriespartner-seriespartner-seriespartner-seriespartner-seriestable1:
table2:
table3:
table4:
table5:
When question
When question
When question
When question
When question
instructions say
instructions say
instructions say
instructions say
instructions say
“insert partner
“insert partner
“insert partner
“insert partner
“insert partner
name,” and
name,” and the
name,” and
name,” and
name,” and
variable is in the
variable is in the
variable is in the
variable is in the
variable is in the
Partner 2 column, same column as
Partner 1
same column as
same column as
insert response to Partner 3, insert
column, then
Partner 4, insert
Partner 5, insert
SX_NM2N4
insert response
response to
response to
response to
(name of partner SX_NM3N4
from
SX_NM4N4
SX_NM5N4
(name of partner (name of partner (name of partner
SX_NM1_5(name 2).
3).
4).
5).
of partner 1).
Skip partner
Skip_SXPGN2N4
Skip_SXPGN3N4
Skip_SXPGN4N4
Skip_SXPGN5N4
gender questions If SX_TOTN4 = 2
If SX_TOTN4 = 3
If SX_TOTN4 = 4
If SX_TOTN4 = 5
if the respondent AND respondent AND respondent AND respondent AND respondent
had sex with only provided name
provided name
provided name
provided name
one gender:
for partner 2
for partner 3
for partner 4
for partner 5
If SXTGONN4
(SX_NM2N4 not
(SX_NM3N4 not
(SX_NM4N4 not
(SX_NM5N4 not
88

P a g e | 89
Questions

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
(transgender only
partners) = 1, OR
SXFMONN4
(female only
partners) = 1 OR
SXMLONN4 (male
only partners) = 1
then skip
SXPGN1N4
(partner’s
gender-partner
1) and go to
Intro_SXPAG1N4
(partner agepartner 1).
Else, go to
SXPGN1N4
(partner genderpartner 1.

Partner 2
[Insert partner
name
SX_NM2N4]
equal to 7
[refused to
answer]), skip to
skip_SXPGN2N4
(partner’s
gender-partner
2). If respondent
refused to
provide name for
partner 2
(SX_NM2N4 = 7),
skip to
serosorting
section
(Intro_SEROSRT1.
Skip partner
gender questions
if the respondent
had sex with only
one gender:
If SXTGONN4
(transgender only
partners) = 1, OR
SXFMONN4
(female only
partners) = 1 OR
SXMLONN4 (male
only partners) = 1

Partner 3
[Insert partner
name
SX_NM3N4]
equal to 7
[refused to
answer]), skip to
skip_SXPGN3N4
(partner’s
gender-partner
3). If respondent
refused to
provide name for
partner 3
(SX_NM3N4 = 7),
skip to
serosorting
section
(Intro_SEROSRT1.
Skip partner
gender questions
if the respondent
had sex with only
one gender:
If SXTGONN4
(transgender only
partners) = 1, OR
SXFMONN4
(female only
partners) = 1 OR
SXMLONN4 (male
only partners) = 1

Partner 4
[Insert partner
name
SX_NM4N4]
equal to 7), skip
to
skip_SXPGN4N4
(partner’s
gender-partner
4). If respondent
refused to
provide name for
partner4
(SX_NM4N4 = 7),
skip to
serosorting
section
(Intro_SEROSRT1.
Skip partner
gender questions
if the respondent
had sex with only
one gender:
If SXTGONN4
(transgender only
partners) = 1, OR
SXFMONN4
(female only
partners) = 1 OR
SXMLONN4 (male
only partners) = 1
then skip

Partner 5
[Insert partner
name
SX_NM5N4]
equal to 7), skip
to
skip_SXPGN5N4
(partner’s
gender-partner
5). If respondent
refused to
provide name for
partner 5
(SX_NM5N4 = 7),
skip to
serosorting
section
(Intro_SEROSRT1.
Skip partner
gender questions
if the respondent
had sex with only
one gender:
If SXTGONN4
(transgender only
partners) = 1, OR
SXFMONN4
(female only
partners) = 1 OR
SXMLONN4 (male
only partners) = 1
then skip
89

P a g e | 90
Questions

SP.1.0.

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]

Partner 3
[Insert partner
name
SX_NM3N4]
then skip
SXPGN3N4
(partner’s
gender-partner 3)
and go to
SXPAG3N4
(partner agepartner 3).
Else, go to
SXPGN3N4
(partner genderpartner 3).
SXPGN3N4

Partner 4
[Insert partner
name
SX_NM4N4]
SXPGN4N4
(partner’s
gender-partner 4)
and go to
SXPAG4N4
(partner agepartner 4).
Else, go to
SXPGN4N4
(partner genderpartner 4.

Partner 5
[Insert partner
name
SX_NM5N4]
SXPGN5N4
(partner’s
gender-partner 5)
and go to
SXPAG5N4
(partner agepartner 5).
Else, go to
SXPGN5N4
(partner genderpartner 5).

SXPGN1N4

Partner 2
[Insert partner
name
SX_NM2N4]
then skip
SXPGN2N4
(partner’s
gender-partner 2)
and go to
SXPAG2N4
(partner agepartner 2).
Else, go to
SXPGN2N4
(partner genderpartner 2).
SXPGN2N4

SXPGN4N4

SXPGN5N4

1
2
3
7
8
Label_SXPGN1N4
Partner genderpartner 1.
Soft_edit_SXPGN

1
2
3
7
8
Label_ SXPGN2N4
Partner genderpartner 2.
Soft_edit_

1
2
3
7
8
Label_ SXPGN3N4
Partner genderpartner 3.
Soft_edit_

1
2
3
7
8
Label_ SXPGN4N4
Partner genderpartner 4.
Soft_edit_

1
2
3
7
8
Label_ SXPGN5N4
Partner genderpartner 5.
Soft_edit_

Is [INSERT PARTNER NAME]
male, female, or
transgender? [READ
RESPONSES. SELECT ONLY
ONE.]
Male
Female
Transgender
Refused to answer
Don’t know

90

P a g e | 91
Questions

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
1N4
If SX_GEN = 2
(female) and
SXPGN1N4 is
female, READ,
“Only include
partners with
whom you had
vaginal or anal
sex. Remember,
for these
questions,
vaginal sex
means penis in
the vagina and
anal sex means
penis in the anus.
Interviewer
instructions:
Return to
previous
question if
necessary.” Allow
survey to move
forward.
Else, go to
Intro_SXPAG1N4.
Skip_SXPGN1N4

Partner 2
[Insert partner
name
SX_NM2N4]
SXPGN2N4
If SX_GEN = 2
(female) and
SXPGN2N4 is
female, READ,
“Only include
partners with
whom you had
vaginal or anal
sex. Remember,
for these
questions, vaginal
sex means penis
in the vagina and
anal sex means
penis in the anus.
Interviewer
instructions:
Return to
previous question
if necessary.”
Allow survey to
move forward.
Else, go to
SXPAG2N4.

Partner 3
[Insert partner
name
SX_NM3N4]
SXPGN3N4
If SX_GEN = 2
(female) and
SXPGN3N4 is
female, READ,
“Only include
partners with
whom you had
vaginal or anal
sex. Remember,
for these
questions, vaginal
sex means penis
in the vagina and
anal sex means
penis in the anus.
Interviewer
instructions:
Return to
previous question
if necessary.”
Allow survey to
move forward.
Else, go to
SXPAG3N4.

Partner 4
[Insert partner
name
SX_NM4N4]
SXPGN4N4
If SX_GEN = 2
(female) and
SXPGN4N4 is
female, READ,
“Only include
partners with
whom you had
vaginal or anal
sex. Remember,
for these
questions, vaginal
sex means penis
in the vagina and
anal sex means
penis in the anus.
Interviewer
instructions:
Return to
previous question
if necessary.”
Allow survey to
move forward.
Else, go to
SXPAG4N4.

Partner 5
[Insert partner
name
SX_NM5N4]
SXPGN5N4
If SX_GEN = 2
(female) and
SXPGN5N4 is
female, READ,
“Only include
partners with
whom you had
vaginal or anal
sex. Remember,
for these
questions, vaginal
sex means penis
in the vagina and
anal sex means
penis in the anus.
Interviewer
instructions:
Return to
previous question
if necessary.”
Allow survey to
move forward.
Else, go to
SXPAG5N4.

Skip_SXPGN2N4

Skip_SXPGN3N4

Skip_SXPGN4N4

Skip_SXPGN5N4
91

P a g e | 92
Questions

SP.2.0.

Which of the following age
groups best describes
[INSERT PARTNER NAME]?
[READ RESPONSES. SELECT
ONLY ONE.]
≤24 years old
25-29 years old
30-34 years old
35-39 years old
40-44 years old
45-49 years old
>=50 years old
Refused to answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
If response is 1,
2, 3, 7, or 8, go to
SXPAG1N4
(partner agepartner 1).
Intro_SXPAG1N4
“For the next
question we will
use Response
Card E.”
SXPAG1N4

1
2
3
4
5
6
7
77
88
Label_SXPAG1N4
Partner agepartner 1.

Partner 2
[Insert partner
name
SX_NM2N4]
If response is 1, 2,
3, 7, or 8, go to
SXPAG2N4
(partner agepartner 2).

Partner 3
[Insert partner
name
SX_NM3N4]
If response is 1, 2,
3, 7, or 8, go to
SXPAG3N4
(partner agepartner 3).

Partner 4
[Insert partner
name
SX_NM4N4]
If response is 1, 2,
3, 7, or 8, go to
SXPAG4N4
(partner agepartner 4).

Partner 5
[Insert partner
name
SX_NM5N4]
If response is 1, 2,
3, 7, or 8, go to
SXPAG5N4
(partner agepartner 5).

SXPAG2N4

SXPAG3N4

SXPAG4N4

SXPAG5N4

1
2
3
4
5
6
7
77
88
Label_SXPAG2N4
partner agepartner 2

1
2
3
4
5
6
7
77
88
Label_SXPAG3N4
partner agepartner 3

1
2
3
4
5
6
7
77
88
Label_SXPAG4N4
partner agepartner 4

1
2
3
4
5
6
7
77
88
Label_SXPAG5N4
partner agepartner 5
92

P a g e | 93
Questions

Intro_SX
PEN1N4

SP.3.0.

Is [INSERT PARTNER NAME]
Hispanic, Latino/a, or of
Spanish origin? If you’re not
sure, give me your best
guess.
No
Yes
Refused to answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
Skip_SXPAG1N4
For all responses,
go to
Intro_SXPEN1N4
(partner
ethnicity-partner
1).

Partner 2
[Insert partner
name
SX_NM2N4]
Skip_SXPAG2N4
For all responses,
go to SXPEN2N4
(partner
ethnicity-partner
2).

Partner 3
[Insert partner
name
SX_NM3N4]
Skip_SXPAG3N4
For all responses,
go to SXPEN3N4
(partner
ethnicity-partner
3).

Partner 4
[Insert partner
name
SX_NM4N4]
Skip_SXPAG4N4
For all responses,
go to SXPEN4N4
(partner
ethnicity-partner
4).

Partner 5
[Insert partner
name
SX_NM5N4]
Skip_SXPAG5N4
For all responses,
go to SXPEN5N4
(partner
ethnicity-partner
5).

“The next two
questions ask
about partners’
race and
ethnicity. We’re
asking them to
better
understand the
health of all
groups.”
SXPEN1N4

SXPEN2N4

SXPEN3N4

SXPEN4N4

SXPEN5N4

0
1
7
8
Label_SXPEN1N4

0
1
7
8
Label_SXPEN2N4

0
1
7
8
Label_SXPEN3N4

0
1
7
8
Label_SXPEN4N4

0
1
7
8
Label_SXPEN5N4
93

P a g e | 94
Questions

SP.4.0.

Which of the following racial
group or groups best
describes [INSERT PARTNER
NAME]? Select all that apply.
If you’re not sure, give me
your best guess. [READ
RESPONSES. SELECT ALL
THAT APPLY.]
American Indian or Alaskan
Native
Asian
Black or African American
Native Hawaiian or Other
Pacific Islander
White
Refused to answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
partner ethnicitypartner 1
Skip_SXPEN1N4
For all responses
go to SXPR1N4
(partner racepartner 1).
SXPR1N4

Partner 2
[Insert partner
name
SX_NM2N4]
partner ethnicitypartner 2
Skip_SXPEN2N4
For all responses
go to SXPR2N4
(partner racepartner 2).
SXPR2N4

Partner 3
[Insert partner
name
SX_NM3N4]
partner ethnicitypartner 3
Skip_SXPEN3N4
For all responses
go to SXPR3N4
(partner racepartner 3).
SXPR3N4

Partner 4
[Insert partner
name
SX_NM4N4]
partner ethnicitypartner 4
Skip_SXPEN4N4
For all responses
go to SXPR4N4
(partner racepartner 4).
SXPR4N4

Partner 5
[Insert partner
name
SX_NM5N4]
partner ethnicitypartner 5
Skip_SXPEN5N4
For all responses
go to SXPR5N4
(partner racepartner 5).
SXPR5N4

1
SXPR1N4A
2
SXPR1N4B
3
SXPR1N4C
4
SXPR1N4D
5
SXPR1N4E
7
8

1
SXPR2N4A
2
SXPR2N4B
3
SXPR2N4C
4
SXPR2N4D
5
SXPR2N4E
7
8

1
SXPR3N4A
2
SXPR3N4B
3
SXPR3N4C
4
SXPR3N4D
5
SXPR3N4E
7
8

1
SXPR4N4A
2
SXPR4N4B
3
SXPR4N4C
4
SXPR4N4D
5
SXPR4N4E
7
8

1
SXPR5N4A
2
SXPR5N4B
3
SXPR5N4C
4
SXPR5N4D
5
SXPR5N4E
7
8
94

P a g e | 95
Questions

SP.5.0.

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
Skip_SXPR1N4
For all responses,
go to SXPCM1N4
(commitmentpartner 1).
Label_ SXPR1N4
race-partner 1
How would you describe your
SXPCM1N4
level of commitment to
[INSERT PARTNER NAME]?
Are you… [READ RESPONSES.
SELECT ONLY ONE.]
Not at all committed
1
Somewhat committed
2
Very committed
3
Committed to above and
4
beyond anyone else
Refused to answer
7
Don’t know
8
Label_SXPCM1N4
commitmentpartner 1
Skip_SXPCM1N4
For all responses,
go to
skip_SX_VS1N4
(vaginal sex-

Partner 2
[Insert partner
name
SX_NM2N4]
Skip_SXPR2N4
For all responses,
go to SXPCM2N4
(commitmentpartner 2).
Label_ SXPR2N4
race-partner 2
SXPCM2N4

Partner 3
[Insert partner
name
SX_NM3N4]
Skip_SXPR3N4
For all responses,
go to SXPCM3N4
(commitmentpartner 3).
Label_ SXPR3N4
race-partner 3
SXPCM3N4

Partner 4
[Insert partner
name
SX_NM4N4]
Skip_SXPR4N4
For all responses,
go to SXPCM4N4
(commitmentpartner 4).
Label_ SXPR4N4
race-partner 4
SXPCM4N4

Partner 5
[Insert partner
name
SX_NM5N4]
Skip_SXPR5N4
For all responses,
go to SXPCM5N4
(commitmentpartner 5).
Label_ SXPR5N4
race-partner 5
SXPCM5N4

1
2
3
4

1
2
3
4

1
2
3
4

1
2
3
4

7
8
Label_SXPCM2N4
commitmentpartner 2
Skip_SXPCM2N4
For all responses,
go to
skip_SX_VS2N4
(vaginal sex-

7
8
Label_SXPCM3N4
commitmentpartner 3
Skip_SXPCM3N4
For all responses,
go to
skip_SX_VS3N4
(vaginal sex-

7
8
Label_SXPCM4N4
commitmentpartner 4
Skip_SXPCM4N4
For all responses,
go to
skip_SX_VS4N4
(vaginal sex-

7
8
Label_SXPCM5N4
commitmentpartner 5
Skip_SXPCM5N4
For all responses,
go to
skip_SX_VS5N4
(vaginal sex95

P a g e | 96
Questions

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
partner 1).

Partner 2
[Insert partner
name
SX_NM2N4]
partner 2).

Partner 3
[Insert partner
name
SX_NM3N4]
partner 3).

Partner 4
[Insert partner
name
SX_NM4N4]
partner 4).

Partner 5
[Insert partner
name
SX_NM5N4]
partner 5).

96

P a g e | 97
Vaginal sex (SV)
Questions

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name
name
name
name
name
SX_NM1N4]
SX_NM2N4]
SX_NM3N4]
SX_NM4N4]
SX_NM5N4]
Instructions for partner demographics partner-by-partner series table:
The questions and response options are in the far left column of the table. Each question is asked for partners 1–5. Partners 1-5 are
labeled in columns Partner 1, Partner 2, Partner 3, Partner 4, and Partner 5. All Partner 1 questions are asked before moving to Partner
2 questions. Detailed instructions are provided in each table cell.
QDS_programmin QDS_programmin QDS_programmin QDS_programmin QDS_programmin
g_partnerdemo1 g_partnerdemo2 g_partnerdemo3 g_partnerdemo4 g_partnerdemo5
When question
When question
When question
When question
When question
instructions say
instructions say
instructions say
instructions say
instructions say
“insert partner
“insert partner
“insert partner
“insert partner
“insert partner
name,” and
name,” and the
name,” and
name,” and
name,” and
variable is in the
variable is in the
variable is in the
variable is in the
variable is in the
Partner 1 column, Partner 2 column, same column as
same column as
same column as
insert response
then insert
Partner 3, insert
Partner 4, insert
Partner 5, insert
to SX_NM2N4
response from
response to
response to
response to
SX_NM1_5(name (name of partner SX_NM3N4
SX_NM4N4
SX_NM5N4
2).
of partner 1).
(name of partner (name of partner (name of partner
3).
4).
5).
Skip_SX_VS1N4-SX_VS2N4-SX_VS3N4-SX_VS4N4-SX_VS5N4
Transgender/unknown gender respondent: If the respondent is transgender (SX_GEN=3) or unknown gender (SX_GEN=4), then skip to
transgender and unknown gender partner-by-partner series table (SX_TG1N4 [transgender partner 1], SX_TG2N4 [transgender partner
2], SX_TG3N4 [transgender partner 3], SX_TG4N4 [transgender partner 4], or SX_TG5N4 [transgender partner 5]).
Transgender/unknown gender partner: If the respondents’ partner(s) is(are) transgender[If SXTGONN4 = 1 (transgender only partner)
OR (SXPGN1N4 (partner 1 gender), SXPGN2N4 (partner 2 gender), SXPGN3N4 (partner 3 gender), SXPGN4N4 (partner 4 gender),
SXPGN5N4 (partner 5 gender) = 3, don’t know, or refused to answer], then skip to transgender and unknown gender partner-bypartner series table (SX_TG1N4 [transgender partner 1], SX_TG2N4 [transgender partner 2], SX_TG3N4 [transgender partner 3],
97

P a g e | 98
Questions

Sexual Partners
Partner 1
Partner 2
[Insert partner
[Insert partner
name
name
SX_NM1N4]
SX_NM2N4]
SX_TG4N4 [transgender partner 4], or SX_TG5N4 [transgender partner 5]).

Partner 3
[Insert partner
name
SX_NM3N4]

Partner 4
[Insert partner
name
SX_NM4N4]

Partner 5
[Insert partner
name
SX_NM5N4]

Male-male partners: If the respondent is male (SX_GEN=1), and he reports only male partners (SXMLONN4 = 1), then skip to anal sex
partner-by-partner series table (SXANL1N4 [anal sex-partner1], SXANL2N4 [anal sex-partner 2], SXANL3N4 [anal sex-partner 3],
SXANL4N4 [anal sex-partner 4], or SXANL5N4 [anal sex-partner 5]).
Female respondent female partner: If the respondent is female (SX_GEN=2) and SX_TOTN4 = 1, skip to serosorting section
(Intro_SEROSRT1). If 2 ≤ SX_TOTN4 ≤ 5, skip to skip_SXPGN2N4 (partner’s gender-partner 2), SXPGN3N4 (partner’s gender-partner 3,
SXPGN4N4 (partner’s gender-partner 4), or SXPGN5N4 (partner’s gender-partner 5). If SX_TOTN4 ≥ 6, skip to serosorting section
(Intro_SEROSRT1).
Else: go to vaginal sex partner-by-partner series table (SX_VS1N4 [vaginal-partner 1], SX_VS2N4 [vaginal-partner 2], SX_VS3N4 [vaginalpartner 3], SX_VS4N4 [vaginal-partner 4], or SX_VS5N4 [vaginal-partner 5]).
SV.1.0.

During the past 12 months, did
you have vaginal sex with
[INSERT PARTNER NAME]?
No

Yes

Refused to answer

SX_VS1N4

SX_VS2N4

SX_VS3N4

SX_VS4N4

SX_VS5N4

0
Skip to SXANL1N4
(anal sex-partner
1)
1
Go to SV10_1N4
(vaginal10partner 1)
7
Skip to SXANL1N4

0
Skip to SXANL2N4
(anal sex-partner
2)
1
Go to SV10_2N4
(vaginal10partner 2)
7
Skip to SXANL2N4

0
Skip to SXANL3N4
(anal sex-partner
3)
1
Go to SV10_3N4
(vaginal10partner 3)
7
Skip to SXANL3N4

0
Skip to SXANL4N4
(anal sex-partner
4)
1
Go to SV10_4N4
(vaginal10partner 4)
7
Skip to SXANL4N4

0
Skip to SXANL5N4
(anal sex-partner
5)
1
Go to SV10_5N4
(vaginal10partner 5)
7
Skip to SXANL5N4
98

P a g e | 99
Questions

Don’t know

SV.1.1.

During the past 12 months, did
you have vaginal sex with
[INSERT PARTNER NAME] more
than 10 times? [READ
RESPONSES. SELECT ONLY ONE.]
No

Yes

Refused to answer

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
(anal sex-partner
1)

Partner 2
[Insert partner
name
SX_NM2N4]
(anal sex-partner
2)

Partner 3
[Insert partner
name
SX_NM3N4]
(anal sex-partner
3)

Partner 4
[Insert partner
name
SX_NM4N4]
(anal sex-partner
4)

Partner 5
[Insert partner
name
SX_NM5N4]
(anal sex-partner
5)

8
Skip to SXANL1N4
(anal sex-partner
1)
Label_SX_VS1N4
Vaginal sexpartner 1.

8
Skip to SXANL2N4
(anal sex-partner
2)
Label_SX_VS2N4
Vaginal sexpartner 2.

8
Skip to SXANL3N4
(anal sex-partner
3)
Label_SX_VS3N4
Vaginal sexpartner 3.

8
Skip to SXANL4N4
(anal sex-partner
4)
Label_SX_VS4N4
Vaginal sexpartner 4.

SV10_1N4

SV10_2N4

SV10_3N4

SV10_4N4

8
Skip to SXANL5N4
(anal sex-partner
5)
Label_SX_VS5N4
SX_VS5N4 is
vaginal sexpartner 5.
SV10 5N4

0
Go to SXVEN1N4
(time vaginal sexpartner 1).
1
Skip to
SXANV1N4
(average number
vaginal-partner
1).
7

0
Go to SXVEN2N4
(time vaginal sexpartner 2).
1
Skip to
SXANV2N4
(average number
vaginal-partner
2).
7

0
Go to SXVEN3N4
(time vaginal sexpartner 3).
1
Skip to
SXANV3N4
(average number
vaginal-partner
3).
7

0
Go to SXVEN4N4
(time vaginal sexpartner 4).
1
Skip to
SXANV4N4
(average number
vaginal-partner
4).
7

0
Go to SXVEN5N4
(time vaginal sexpartner 5).
1
Skip to
SXANV5N4
(average number
vaginal-partner
5).
7
99

P a g e | 100
Questions

Don’t know

SV.1.2.

During the past 12 months,
please tell me the exact number
of times that you had vaginal sex
with [INSERT PARTNER NAME]?

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
Skip to SXANL1N4
(anal sex-partner
1)
8
Skip to SXANL1N4
(anal sex-partner
1)
Label_SV10_1N4
Vaginal 10partner 1.
SXVEN1N4

Skip to Say box
before SXVC1AN4
(condom vaginalpartner 1a)

Partner 2
[Insert partner
name
SX_NM2N4]
Skip to SXANL2N4
(anal sex-partner
2)
8
Skip to SXANL2N4
(anal sex-partner
2).
Label_SV10_2N4
Vaginal 10partner 2.
SXVEN2N4

Skip to
instructions
before SXVC2AN4
(condom vaginalpartner 2a)
77
77
Skip to SXANL1N4 Skip to SXANL2N4
(anal sex-partner (anal sex-partner
1)
2)
88
88
Skip to SXANL1N4 Skip to SXANL2N4

Partner 3
[Insert partner
name
SX_NM3N4]
Skip to SXANL3N4
(anal sex-partner
3)
8
Skip to SXANL3N4
(anal sex-partner
3).
Label_SV10_3N4
Vaginal 10partner 3.
SXVEN3N4

Partner 4
[Insert partner
name
SX_NM4N4]
Skip to SXANL4N4
(anal sex-partner
4)
8
Skip to SXANL4N4
(anal sex-partner
4).
Label_SV10_4N4
Vaginal 10partner 4.
SXVEN4N4

Partner 5
[Insert partner
name
SX_NM5N4]
Skip to SXANL5N4
(anal sex-partner
5)
8
Skip to SXANL5N4
(anal sex-partner
5).
Label_SV10_5N4
Vaginal 10partner 5.
SXVEN5N4

Skip to
instructions
before SXVC3AN4
(condom vaginalpartner 3a)
77
Skip to SXANL3N4
(anal sex-partner
3)
88
Skip to SXANL3N4

Skip to
instructions
before SXVC4AN4
(condom vaginalpartner 4a)
77
Skip to SXANL4N4
(anal sex-partner
4)
88
Skip to SXANL4N4

Skip to
instructions
before SXVC5AN4
(condom vaginalpartner 5a)
77
Skip to SXANL5N4
(anal sex-partner
5)
88
Skip to SXANL5N4
100

P a g e | 101
Questions

SV.1.3.

On average, how many times did
you have vaginal sex with
[INSERT PARTNER NAME] per
month?

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
(anal sex-partner
1)
Label_SXVEN1N4
Times vaginal
sex-partner 1.
Range_SXVEN1N
4
1–10
Hard_edit_SXVEN
1N4
If SXVEN1N4is
out of range,
READ, “Number
too big (if >10) or
too small (if = 0)”
Confirm response
and if necessary
return to
previous
question.”
SXANV1N4

Partner 2
[Insert partner
name
SX_NM2N4]
(anal sex-partner
2)
Label_SXVEN2N4
Times vaginal
sex-partner 2.
Range_SXVEN2N
4
1–10
Hard_edit_SXVEN
2N4
If SXVEN2N4is
out of range,
READ, “Number
too big (if >10) or
too small (if = 0)”
Confirm response
and if necessary
return to
previous
question.”
SXANV2N4

Partner 3
[Insert partner
name
SX_NM3N4]
(anal sex-partner
3)
Label_SXVEN3N4
Times vaginal
sex-partner 3.
Range_SXVEN3N
4
1–10
Hard_edit_SXVEN
3N4
If SXVEN3N4is
out of range,
READ, “Number
too big (if >10) or
too small (if = 0)”
Confirm response
and if necessary
return to
previous
question.”
SXANV3N4

Partner 4
[Insert partner
name
SX_NM4N4]
(anal sex-partner
4)
Label_SXVEN4N4
Times vaginal
sex-partner 4.
Range_SXVEN4N
4
1–10
Hard_edit_SXVEN
4N4
If SXVEN4N4is
out of range,
READ, “Number
too big (if >10) or
too small (if = 0)”
Confirm response
and if necessary
return to
previous
question.”
SXANV4N4

Partner 5
[Insert partner
name
SX_NM5N4]
(anal sex-partner
5)
Label_SXVEN5N4
Times vaginal
sex-partner 5.
Range_SXVEN5N
4
1–10
Hard_edit_SXVEN
5N4
If SXVEN5N4 is
out of range,
READ, “Number
too big (if >10) or
too small (if = 0)”
Confirm response
and if necessary
return to
previous
question.”
SXANV5N4

Go to SXMVG1N4
(months vaginal

Go to SXMVG2N4
(months vaginal

Go to SXMVG3N4
(months vaginal

Go to SXMVG4N4
(months vaginal

Go to SXMVG5N4
(months vaginal
101

P a g e | 102
Questions

SV.1.4.

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
sex-partner 1).
Refused to answer
777
Go to SXMVG1N4
(months vaginal
sex-partner 1)
Don’t know
888
Go to SXMVG1N4
(months vaginal
sex-partner 1).
Label_SXANV1N:
average number
vaginal-partner 1
Range_SXANV1N
4
1–90
During the past 12 months, how
SXMVG1N4
many months did you have
vaginal sex with [INSERT
PARTNER NAME]?
Refused to answer
777
Don’t know
888
For all responses,
go to Say box
before SXVC1AN4
(condom vaginalpartner 1a)

Partner 2
[Insert partner
name
SX_NM2N4]
sex-partner 2).
777
Go to SXMVG2N4
(months vaginal
sex-partner 2)
888
Go to SXMVG2N4
(months vaginal
sex-partner 2).
Label_SXANV2N:
average number
vaginal-partner 2
Range_SXANV2N
4
1–90
SXMVG2N4

Partner 3
[Insert partner
name
SX_NM3N4]
sex-partner 3).
777
Go to SXMVG3N4
(months vaginal
sex-partner 3)
888
Go to SXMVG3N4
(months vaginal
sex-partner 3).
Label_SXANV3N:
average number
vaginal-partner 3
Range_SXANV3N
4
1–90
SXMVG3N4

Partner 4
[Insert partner
name
SX_NM4N4]
sex-partner 4).
777
Go to SXMVG4N4
(months vaginal
sex-partner 4)
888
Go to SXMVG4N4
(months vaginal
sex-partner 4).
Label_SXANV4N:
average number
vaginal-partner 4
Range_SXANV4N
4
1–90
SXMVG4N4

Partner 5
[Insert partner
name
SX_NM5N4]
sex-partner 5).
777
Go to SXMVG5N4
(months vaginal
sex-partner 5)
888
Go to SXMVG5N4
(months vaginal
sex-partner 5).
Label_SXANV5N:
average number
vaginal-partner 5
Range_SXANV5N
4
1–90
SXMVG5N4

777
888
For all responses,
skip to
instructions
before SXVC2AN4
(condom vaginalpartner 2a)

777
888
For all responses,
skip to
instructions
before SXVC3AN4
(condom vaginalpartner 3a)

777
888
For all responses,
skip to
instructions
before SXVC4AN4
(condom vaginalpartner 3a)

777
888
For all responses,
skip to
instructions
before SXVC5AN4
(condom vaginalpartner 3a)
102

P a g e | 103
Questions

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
Label_SXMVG1N
4
months vaginal
sex-partner 1
Range_SXMVG1N
4
1–12
Intro_SXVC1AN4
“The next
question is about
condom use.
Please include
when a condom
was used the
entire time, not
only part of the
time during sex.”
Skip_ SXVC1AN4
If SXVEN1N4
(times vaginal
sex-partner 1) =
1, then go to
SXVC1AN4
(condom vaginalpartner 1a); else
Skip to SXVC1BN4
(condom vaginalpartner 1b).

Partner 2
[Insert partner
name
SX_NM2N4]
Label_SXMVG2N
4
months vaginal
sex-partner 2
Range_SXMVG2N
4
1–12

Partner 3
[Insert partner
name
SX_NM3N4]
Label_SXMVG3N
4
months vaginal
sex-partner 3
Range_SXMVG3N
4
1–12

Partner 4
[Insert partner
name
SX_NM4N4]
Label_SXMVG4N
4
months vaginal
sex-partner 4
Range_SXMVG4N
4
1–12

Partner 5
[Insert partner
name
SX_NM5N4]
Label_SXMVG5N
4
months vaginal
sex-partner 5
Range_SXMVG5N
4
1–12

Skip_ SXVC2AN4
If SXVEN2N4
(times vaginal
sex-partner 2) =
1, then go to
SXVC2AN4
(condom vaginalpartner 2a); else
Skip to SXVC2BN4
(condom vaginalpartner 2b).

Skip _ SXVC3AN4
If SXVEN3N4
(times vaginal
sex-partner 3) =1,
then go to
SXVC3AN4
(condom vaginalpartner 3a); else
Skip to SXVC3BN4
(condom vaginalpartner 3b).

Skip _ SXVC4AN4
If SXVEN4N4
(times vaginal
sex-partner 4) =
1, then go to
SXVC4AN4
(condom vaginalpartner 4a); else
Skip to SXVC4BN4
(condom vaginalpartner 4b).

Skip_ SXVC5AN4
If SXVEN5N4
(times vaginal
sex-partner 5) =
1, then go to
SXVC4AN4
(condom vaginalpartner 5a); else
Skip to SXVC5BN4
(condom vaginalpartner 5b).
103

P a g e | 104
Questions

SV.1.5.a.

SV.1.5.b.

During the past 12 months,
when you had vaginal sex with
[INSERT PARTNER NAME] was a
condom used?
No
Yes
Refused to answer
Don’t know

During the past 12 months,
when you had vaginal sex with
[INSERT PARTNER NAME] was a
condom used...
[READ RESPONSES. SELECT ONLY
ONE.]
Never- not even once
One or more times
Absolutely every time
Refused to answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
SXVC1AN4

Partner 2
[Insert partner
name
SX_NM2N4]
SXVC2AN4

Partner 3
[Insert partner
name
SX_NM3N4]
SXVC3AN4

Partner 4
[Insert partner
name
SX_NM4N4]
SXVC4AN4

Partner 5
[Insert partner
name
SX_NM5N4]
SXVC5AN4

0
1
7
8
Skip_ SXVC1AN4
For all responses,
skip to SXANL1N4
(anal sex-partner
1).
Label_SXVC1AN4
condom vaginalpartner 1a
SXVC1BN4

0
1
7
8
Skip_ SXVC2AN4
For all responses,
skip to SXANL2N4
(anal sex-partner
2).
Label_SXVC2AN4
condom vaginalpartner 2a
SXVC2BN4

0
1
7
8
Skip_ SXVC3AN4
For all responses,
skip to SXANL3N4
(anal sex-partner
3).
Label_SXVC3AN4
condom vaginalpartner 3a
SXVC3BN4

0
1
7
8
Skip_ SXVC4AN4
For all responses,
skip to SXANL4N4
(anal sex-partner
4).
Label_SXVC4AN4
condom vaginalpartner 4a
SXVC4BN4

0
1
7
8
Skip_ SXVC5AN4
For all responses,
skip to SXANL5N4
(anal sex-partner
5).
Label_SXVC5AN4
condom vaginalpartner 5a
SXVC5BN4

1
2
3
7
8

1
2
3
7
8

1
2
3
7
8

1
2
3
7
8

1
2
3
7
8
104

P a g e | 105
Questions

Sexual Partners
Partner 1
[Insert partner
name
SX_NM1N4]
Label_SXVC1BN4
condom vaginalpartner 1b
Skip_SXVC1BN4
For all responses,
go to SXANL1N4
(anal sex-partner
1)

Partner 2
[Insert partner
name
SX_NM2N4]
Label_SXVC2BN4
condom vaginalpartner 2b
Skip_SXVC2BN4
For all responses,
go to SXANL2N4
(anal sex-partner
2)

Partner 3
[Insert partner
name
SX_NM3N4]
Label_SXVC3BN4
condom vaginalpartner 3b
Skip_SXVC3BN4
For all responses,
go to SXANL3N4
(anal sex-partner
3)

Partner 4
[Insert partner
name
SX_NM4N4]
Label_SXVC4BN4
condom vaginalpartner 4b
Skip_SXVC4BN4
For all responses,
go to SXANL4N4
(anal sex-partner
4)

Partner 5
[Insert partner
name
SX_NM5N4]
Label_SXVC5BN4
condom vaginalpartner 5b
Skip_SXVC5BN4
For all responses,
go to SXANL5N4
(anal sex-partner
5)

105

P a g e | 106
Anal sex (SL)
Question

SL.1.0.

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
Instructions for anal partner-by-partner series table: The questions and response options are in the far left column of the
table. Each question is asked for partners 1–5. Partners 1-5 are labeled in columns Partner 1, Partner 2, Partner 3, Partner 4,
and Partner 5. All Partner 1 questions are asked before moving to Partner 2 questions. Detailed instructions are provided in
each table cell.
When question instructions say “insert partner name,” and the variable is in the Partner 1 column, then insert response from
SX_NM1_5(name of partner 1).
When question instructions say “insert partner name,” and variable is in the Partner 2 column, insert response to SX_NM2N4
(name of partner 2).
When question instructions say “insert partner name,” and variable is in the same column as Partner 3, insert response to
SX_NM3N4 (name of partner 3).
When question instructions say “insert partner name,” and variable is in the same column as Partner 4, insert response to
SX_NM4N4 (name of partner 4).
When question instructions say “insert partner name,” and variable is in the same column as Partner 5, insert response to
SX_NM5N4 (name of partner 5).
During the
SXANL1N4
SXANL2N4
SXANL3N4
SXANL4N4
SXANL5N4
past 12
months, did
you have anal
sex with
[INSERT
PARTNER
NAME?
No

0
Skip to STATS1N4
(aware statuspartner 1).

0
Skip to STATS2N4
(aware statuspartner 2).

0
Skip to STATS3N4
(aware statuspartner 3).

0
Skip to STATS4N4
(aware statuspartner 4).

0
Skip to STATS5N4
(aware statuspartner 5).
106

P a g e | 107
Question

Yes

Refused to
answer

Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
1

Partner 2
[Insert partner
name SX_NM2N4]
1

Partner 3
[Insert partner
name SX_NM3N4]
1

Partner 4
[Insert partner
name SX_NM4N4]
1

Partner 5
[Insert partner
name SX_NM5N4]
1

Go to SA10_1N4
(anal 10-partner 1)
7

Go to SA10_2N4
(anal 10-partner 2)
7

Go to SA10_3N4
(anal 10-partner 3)
7

Go to SA10_4N4
(anal 10-partner 4)
7

Go to SA10_5N4
(anal 10-partner 5)
7

Skip to STATS1N4
(aware statuspartner 1)
8

Skip to STATS2N4
(aware statuspartner 2)
8

Skip to STATS3N4
(aware statuspartner 3)
8

Skip to STATS4N4
(aware statuspartner 4)
8

Skip to STATS5N4
(aware statuspartner 5)
8

Skip to STATS1N4
Skip to STATS2N4
Skip to STATS3N4
Skip to STATS4N4
Skip to STATS5N4
(aware status(aware status(aware status(aware status(aware statuspartner 1)
partner 2)
partner 3)
partner 4)
partner 5)
Label_SXANL1N4
Label_SXANL2N4
Label_SXANL3N4
Label_SXANL4N4
Label_SXANL5N4
anal sex-partner 1
anal sex-partner 2 anal sex-partner 3
anal sex-partner 4
anal sex-partner 5
QDS_programming_SXANL1N4 (anal sex-partner 1), SXANL2N4 (anal sex-partner 2), SXANL3N4 (anal sex-partner 3),
SXANL4N4 (anal sex-partner 4), SXANL5N4 (anal sex-partner 5) continued:
No anal sex partners reported among male respondents who previously said they had only male partners:
If SX_GEN (sex gender) = 1 (male) and (If SXPGN1N4 = 1 OR SXMLONN4 (male only partners) = 1) and SXANL1N4 (anal sexpartner 1) is 0 (no), then READ, “Earlier you told me that you had vaginal or anal sex with [INSERT partner name SX_NM1N4].
Is this correct? Interviewer instructions: return to previous questions to correct error.” Allow program to move forward.
If SX_GEN (sex gender) = 1 (male) and (If SXPGN2N4 = 1 OR SXMLONN4 (male only partners) = 1) and SXANL2N4 (anal sexpartner 2) is 0 (no), then READ, “Earlier you told me that you had vaginal or anal sex with [INSERT partner name SX_NM2N4].
Is this correct? Interviewer instructions: return to previous questions to correct error.” Allow program to move forward.
If SX_GEN (sex gender) = 1 (male) and (If SXPGN3N4 = 1 OR SXMLONN4 (male only partners) = 1) and SXANL3N4 (anal sexpartner 3) is 0 (no), then READ, “Earlier you told me that you had vaginal or anal sex with [INSERT partner name SX_NM3N4].
Is this correct? Interviewer instructions: return to previous questions to correct error.” Allow program to move forward.
107

P a g e | 108
Question

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

If SX_GEN (sex gender) = 1 (male) and (If SXPGN4N4 = 1 OR SXMLONN4 (male only partners) = 1) and SXANL4N4 (anal sexpartner 4) is 0 (no), then READ, “Earlier you told me that you had vaginal or anal sex with [INSERT partner name SX_NM4N4].
Is this correct? Interviewer instructions: return to previous questions to correct error.” Allow program to move forward.

SL.1.1.

If SX_GEN (sex gender) = 1 (male) and (If SXPGN5N4 = 1 OR SXMLONN4 (male only partners) = 1) and SXANL5N4 (anal sexpartner 1) is 0 (no), then READ, “Earlier you told me that you had vaginal or anal sex with [INSERT partner name SX_NM5N4].
Is this correct? Interviewer instructions: return to previous questions to correct error.” Allow program to move forward.
During the
SA10_1N4
SA10_2N4
SA10_3N4
SA10_4N4
SA10_5N4
past 12
months, did
you have anal
sex with
[INSERT
PARTNER
NAME] more
than 10
times? [READ
RESPONSES.
SELECT ONLY
ONE.]
No
0
0
0
0
0
Go to SXAEN1N4
Go to SXAEN2N4
Go to SXAEN3N4
Go to SXAEN4N4
Go to SXAEN5N4
(times anal sex(times anal sex(times anal sex(times anal sex(times anal sexpartner 1)
partner 2)
partner 3)
partner 4)
partner 5)
Yes
1
1
1
1
1
Skip to SXANA1N4 Skip to SXANA2N4 Skip to SXANA3N4 Skip to SXANA4N4 Skip to SXANA5N4
(average number
(average number
(average number
(average number
(average number
anal-partner 1)
anal-partner 2)
anal-partner 3)
anal-partner 4)
anal-partner 5)
108

P a g e | 109
Question

Refused to
answer

Don’t know

SL.1.2.

During the
past 12
months,
please tell me
the exact
number of
times that you
had anal sex
with [INSER
PARTNER
NAME]?

Refused to
answer

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
7

Partner 2
[Insert partner
name SX_NM2N4]
7

Partner 3
[Insert partner
name SX_NM3N4]
7

Partner 4
[Insert partner
name SX_NM4N4]
7

Partner 5
[Insert partner
name SX_NM5N4]
7

Skip to STATS1N4
(aware statuspartner 1)
8
Skip to STATS1N4
(aware statuspartner 1)
Label_SA10_1N4
anal 10-partner 1
SXAEN1N4

Skip to STATS2N4
(aware statuspartner 2)
8
Skip to STATS2N4
(aware statuspartner 2)
Label_SA10_2N4
anal 10-partner 2
SXAEN2N4

Skip to STATS3N4
(aware statuspartner 3)
8
Skip to STATS3N4
(aware statuspartner 3)
Label_SA10_3N4
anal 10-partner 3
SXAEN3N4

Skip to STATS4N4
(aware statuspartner 4)
8
Skip to STATS4N4
(aware statuspartner 4)
Label_SA10_4N4
anal 10-partner 4
SXAEN4N4

Skip to STATS5N4
(aware statuspartner 5)
8
Skip to STATS5N4
(aware statuspartner 5)
Label_SA10_5N4
anal 10-partner 5
SXAEN5N4

Skip to
skip_SXAC1AN4
(condom analpartner 1a)
77

Skip to
_skipSXAC2AN4
(condom analpartner 2a)
77

Skip to
_skipSXAC3AN4
(condom analpartner 3a)
77

Skip to
_skipSXAC4AN4
(condom analpartner 4a)
77

Skip to
_skipSXAC5AN4
(condom analpartner 5a)
77
109

P a g e | 110
Question

Don’t know

SL.1.3.

On average,
how many
times did you
have anal sex
with [INSERT
PARTNER
NAME] per
month?
Refused to
answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
Skip to STATS1N4
(aware statuspartner 1)
88
Skip to STATS1N4
(aware statuspartner 1)
Label_SXAEN1N4
times anal sexpartner 1
Range_SXAEN1N4
1–10
SXANA1N4

Partner 2
[Insert partner
name SX_NM2N4]
Skip to STATS2N4
(aware statuspartner 2)
88
Skip to STATS2N4
(aware statuspartner 2)
Label_SXAEN2N4
times anal sexpartner 2
Range_SXAEN2N4
1–10
SXANA2N4

Partner 3
[Insert partner
name SX_NM3N4]
Skip to STATS3N4
(aware statuspartner 3)
88
Skip to STATS3N4
(aware statuspartner 3)
Label_SXAEN3N4
times anal sexpartner 3
Range_SXAEN3N4
1–10
SXANA3N4

Partner 4
[Insert partner
name SX_NM4N4]
Skip to STATS4N4
(aware statuspartner 4)
88
Skip to STATS4N4
(aware statuspartner 4)
Label_SXAEN4N4
times anal sexpartner 4
Range_SXAEN4N4
1–10
SXANA4N4

Partner 5
[Insert partner
name SX_NM5N4]
Skip to STATS5N4
(aware statuspartner 5)
88
Skip to STATS5N4
(aware statuspartner 5)
Label_SXAEN5N4
times anal sexpartner 5
Range_SXAEN5N4
1–10
SXANA5N4

777

777

777

777

777

888
For all responses,
go to SXMAN1N4
(months anal sexpartner 1)

888
For all responses,
go to SXMAN2N4
(months anal sexpartner 2)

888
For all responses,
go to SXMAN3N4
(months anal sexpartner 3)

888
For all responses,
go to SXMAN4N4
(months anal sexpartner 4)

888
For all responses,
go to SXMAN5N4
(months anal sexpartner 5)
110

P a g e | 111
Question

SL.1.4.

During the
past 12
months, how
many months
did you have
anal sex with
[INSERT
PARTNER
NAME]?
Refused to
answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
Label_SXANA1N4
average number
anal-partner 1
Range_SXANA1N4
1–90
SXMAN1N4

Partner 2
[Insert partner
name SX_NM2N4]
Label_SXANA2N4
average number
anal-partner 2
Range_SXANA2N4
1–90
SXMAN2N4

Partner 3
[Insert partner
name SX_NM3N4]
Label_SXANA3N4
average number
anal-partner 3
Range_SXANA3N4
1–90
SXMAN3N4

Partner 4
[Insert partner
name SX_NM4N4]
Label_SXANA4N4
average number
anal-partner 4
Range_SXANA4N4
1–90
SXMAN4N4

Partner 5
[Insert partner
name SX_NM5N4]
Label_SXANA5N4
average number
anal-partner 5
Range_SXANA5N4
1–90
SXMAN5N4

77

77

77

77

77

88
For all responses,
go to
skip_SXAC1AN4
(condom analpartner 1a).
Label_SXMAN1N4
months anal sexpartner 1
Range_SXMAN1N4
1–12

88
For all responses,
go to
skip_SXAC2AN4
(condom analpartner 2a).
Label_SXMAN2N4
months anal sexpartner 2
Range_SXMAN2N4
1–12

88
For all responses,
go to
skip_SXAC3AN4
(condom analpartner 3a).
Label_SXMAN3N4
months anal sexpartner 3
Range_SXMAN3N4
1–12

88
For all responses,
go to
skip_SXAC4AN4
(condom analpartner 4a).
Label_SXMAN4N4
months anal sexpartner 4
Range_SXMAN4N4
1–12

88
For all responses,
go to
skip_SXAC5AN4
(condom analpartner 5a).
Label_SXMAN5N4
months anal sexpartner 5
Range_SXMAN5N4
1–12
111

P a g e | 112
Question

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
Interviewer instructions before SXAC1AN4 (condom anal-partner 1a), SXAC2AN4 (condom anal-partner 2a), SXAC2AN4
(condom anal-partner 3a), SXAC2AN4 (condom anal-partner 4a), SXAC2AN4 (condom anal-partner 5a):
Female-male partner #1-anal sex once: If the respondent is female (SX_GEN=2) AND partner 1 is male (SXPGN1N4 [partner’s
gender-partner 1] = 1 [male] or SMLONN4 [male only partners] = 1) AND the respondent had anal sex with partner 1 only one
time (SXAEN1N4 [times anal sex-partner 1] = 1), then go to Say box before SXAC1AN4 (condom anal-partner 1a).
Female-male partner #1-anal sex more than once: If the respondent is female (SX_GEN=2) AND partner 1 is male (SXPGN1N4
[partner’s gender-partner 1] = 1 [male] or SMLONN4 [male only partners]=1) AND the respondent had anal sex with partner
1 more than once (SXAEN1N4 [times anal sex-partner 1] ≥ 2) OR SA10_1N4 (anal 10-partner 1) = “yes,” then go to Say box
before SXAC1BN4 (condom anal-partner 1b).
Female-male partners #2, 3, 4, 5-anal sex once: If the respondent is female (SEX_GEN=2) AND partners 2, 3, 4, or 5 are male
(SXPGN2N4 [partner’s gender-partner 2] = 1 [male], SXPGN3N4 [partner’s gender-partner 3] = 1 [male], SXPGN4N4 [partner’s
gender-partner 4] = 1 [male], SXPGN5N4 [partner’s gender-partner 5] = 1 [male] OR SXMLONN4 [male only partners] = 1) AND
the respondent had anal sex with partners 2, 3, 4, or 5 only one time (SXAEN2N4 [times anal sex-partner 2] = 1, SXAEN3N4
[times anal sex-partner 3] = 1, SXAEN4N4 [times anal sex-partner 4] = 1, SXAEN5N4 [times anal sex-partner 5] =
1), then go to SXAC2AN4 (condom anal-partner 2a), SXAC3AN4 (condom anal-partner 3a), SXAC4AN4 (condom anal-partner
4a), or SXAC5AN4 (condom anal-partner 5a).
Female-male partners #2, 3, 4, 5-anal sex more than once: If the respondent is female (SX_GEN=2) AND partners 2, 3, 4, or 5
are male ( SXPGN2N4 [partner’s gender-partner 2] = 1 [male], SXPGN3N4 [partner’s gender-partner 3] = 1 [male], SXPGN4N4
[partner’s gender-partner 4] = 1 [male], SXPGN5N4 [partner’s gender-partner 5] = 1 [male]) OR SXMLONN4 [male only
partners] = 1) AND the respondent had anal sex with partners 2, 3, 4, or 5 more than once (SXAEN2N4 [times anal sex- partner
2] ≥ 2, SXAEN3N4 [times anal sex-partner 3] ≥ 2, SXAEN4N4 [times anal sex-partner 4] ≥ 2, SXAEN5N4 [times anal sex- partner
5] ≥ 2 OR SA10_2N4 (anal 10-partner 2) = “yes,”, SA10_3N4 (anal 10-partner 3) = “yes,”, SA10_4N4 (anal 10-partner
4) = “yes,”, SA10_5N4 (anal 10-partner 5) = “yes,”, then go to SXAC2BN4 (condom anal-partner 2b), SXAC3BN4 (condom
anal-partner 3b), SXAC4BN4 (condom anal-partner 4b), SXAC5BN4 (condom anal-partner 5b).
112

P a g e | 113
Question

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
Male-female partner #1-anal sex once: If the respondent is male (SX_GEN=1) and partner 1 is female (SXPGN1N4 [partner’s
gender-partner 1] = 2 [female] OR SXFMONN4 [female only partners] =1), AND the respondent had anal sex with partner 1
only one time (SXAEN1N4 [times anal sex-partner 1] = 1), then go to Say box before SXAC1AN4 (condom anal-partner 1a).
Male-female partner #1-anal sex more than once: If the respondent is male (SX_GEN=1) AND partner 1 is female (SXPGN1N4
[partner’s gender-partner 1] = 2 [female] OR SXFMONN4 [female only partners] =1 ), AND the respondent had anal sex with
partner 1 more than once (SXAEN1N4 [times anal sex-partner 1] ≥ 2) OR SA10_1N4 (anal 10-partner 1) = “yes,” then go to Say
box before SXAC1BN4 (condom anal-partner 1b).
Male-female partners # 2, 3, 4, 5-anal sex once: If the respondent is male (SEX_GEN=1) AND partners 2, 3, 4, or 5 are female
(SXPGN2N4 [partner’s gender-partner 2] = 2 [female], SXPGN3N4 [partner’s gender-partner 3] = 2 [female], SXPGN4N4
[partner’s gender-partner 4] = 2 [female], SXPGN5N4 [partner’s gender-partner 5] = 2 [female] OR SXFMONN4 [female only
partners] = 1) AND the respondent had anal sex with partners 2, 3, 4, or 5 only one time (SXAEN2N4 [times anal sex-partner
2] = 1, SXAEN3N4 [times anal sex-partner 3] = 1, SXAEN4N4 [times anal sex-partner 4] = 1, SXAEN5N4 [times anal sex-partner
5] = 1, then go to SXAC2AN4 (condom anal-partner 2a), SXAC3AN4 (condom anal-partner 3a), SXAC4AN4 (condom analpartner 4a), SXAC5AN4 (condom anal-partner 5a).
Male-female partners # 2, 3, 4, 5-anal sex more than once: If the respondent is male (SX_GEN=1) AND partners 2, 3, 4, or 5 are
female ( SXPGN2N4 [partner’s gender-partner 2] = 2 [female], SXPGN3N4 [partner’s gender-partner 3] = 2 [female],
SXPGN4N4 [partner’s gender-partner 4] = 2 [female], SXPGN5N4 [partner’s gender-partner 5] = 2 [female]) OR SXFMONN4
[female only partners] = 1) AND the respondent had anal sex with partners 2, 3, 4, or 5 more than once (SXAEN2N4 [times
anal sex-partner 2] ≥ 2, SXAEN3N4 [times anal sex-partner 3] ≥ 2, SXAEN4N4 [times anal sex-partner 4] ≥ 2, SXAEN5N4 [times
anal sex-partner 5] ≥ 2 OR SA10_2N4 (anal 10-partner 2) = “yes,”, SA10_3N4 (anal 10-partner 3) = “yes,”, SA10_4N4 (anal 10partner 4) = “yes,”, SA10_5N4 (anal 10-partner 5) = “yes,”, then go to SXAC2BN4 (condom anal-partner 2b), SXAC3BN4
(condom anal-partner 3b), SXAC4BN4 (condom anal-partner 4b), SXAC5BN4 (condom anal-partner 5b).
Male-male partner(s): If the respondent is male (SX_GEN=1) and partner is male
(SXPGN1N4 [partner’s gender-partner 1] = 1, SXPGN2N4 [partner’s gender-partner 2] = 1, SXPGN3N4 [partner’s genderpartner 3] = 1, SXPGN4N4 [partner’s gender-partner 4] = 1, SXPGN5N4 [partner’s gender-partner 5] = 1 OR SXMLONN4 [male
113

P a g e | 114
Question

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
only partners] = 1), then skip to skip_ABTM1AN4 (receptive anal-partner 1a), skip_ABTM2AN4 (receptive anal-partner 2a),
skip_ABTM3AN4 (receptive anal-partner 3a), skip_ABTM4AN4 (receptive anal-partner 4a), skip_ABTM5AN4 (receptive analpartner 5a).

SL.1.5.a.

If SA10_1N4 (anal 10-partner 1) = Refused to answer or don’t know, SA10_2N4 (anal 10-partner 2) = Refused to answer or
don’t know, SA10_3N4 (anal 10-partner 3) = Refused to answer or don’t know, SA10_4N4 (anal 10-partner 4) = Refused to
answer or don’t know, SA10_5N4 (anal 10-partner 5) = Refused to answer or don’t know OR if SXAEN1N4 (times anal sexpartner 1) = 0, SXAEN2N4 (times anal sex-partner 2) =0, SXAEN3N4 (times anal sex-partner 3) =0, SXAEN4N4 (times anal sexpartner 4) =0, SXAEN5N4 (times anal sex-partner 5) =0, skip to instructions for partner-by-partner status series table:
STATS1N4 (aware status-partner 1) when answering partner 1 series, STATS2N4 (aware status-partner 2) when answering
partner 2 series, STATS3N4 (aware status-partner 3) when answering partner 3 series, STATS4N4 (aware status-partner 4)
when answering partner 4 series, STATS5N4 (aware status-partner 5) when answering partner 5 series.
Intro_SXAC1AN4
“The next question
is about condom
use. Please include
when a condom
was used the entire
time, not only part
of the time.”
During the
SXAC1AN4
SXAC2AN4
SXAC3AN4
SXAC4AN4
SXAC5AN4
past 12
months, when
you had anal
sex with
INSERT
PARTNER
NAME] was a
condom used?
114

P a g e | 115
Question

No
Yes
Refused to
answer
Don’t know

SL.1.5.b.

During the
past 12
months, when
you had anal
sex with
[PARTNER
NAME] was a
condom

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
0
1
7

Partner 2
[Insert partner
name SX_NM2N4]
0
1
7

Partner 3
[Insert partner
name SX_NM3N4]
0
1
7

Partner 4
[Insert partner
name SX_NM4N4]
0
1
7

Partner 5
[Insert partner
name SX_NM5N4]
0
1
7

8
For all responses,
skip to STATS1N4
(aware statuspartner 1).
Label_SXAC1AN4
condom analpartner 1a
Intro_SXAC1BN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time.”
SXAC1BN4

8
For all responses,
skip to STATS2N4
(aware statuspartner 2).
Label_SXAC2AN4
condom analpartner 2a
Intro_SXAC2BN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time.”
SXAC2BN4

8
For all responses,
skip to STATS3N4
(aware statuspartner 3).
Label_SXAC3AN4
condom analpartner 3a
Intro_SXAC3BN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time.”
SXAC3BN4

8
For all responses,
skip to STATS4N4
(aware statuspartner 4).
Label_SXAC4AN4
condom analpartner 4a
Intro_SXAC4BN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time.”
SXAC4BN4

8
For all responses,
skip to STATS5N4
(aware statuspartner 5).
Label_SXAC5AN4
condom analpartner 5a
Intro_SXAC5BN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time.”
SXAC5BN4

115

P a g e | 116
Question

used… [READ
RESPONSES.
SELECT ONLY
ONE.]
Never – not
even once
One or more
times
Absolutely
every time
Refused to
answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

1

1

1

1

1

2

2

2

2

2

3

3

3

3

3

7

7

7

7

7

8
8
8
8
8
For all responses,
For all responses,
For all responses,
For all responses,
For all responses,
skip to STATS1N4
skip to STATS2N4
skip to STATS3N4
skip to STATS4N4
skip to STATS5N4
(aware status(aware status(aware status(aware status(aware statuspartner 1).
partner 2).
partner 3).
partner 4).
partner 5).
Label_SXAC1BN4
Label_SXAC2BN4
Label_SXAC3BN4
Label_SXAC4BN4
Label_SXAC5BN4
Condom analCondom analCondom analCondom analCondom analpartner 1b.
partner 2b.
partner 3b.
partner 4b.
partner 5b.
Interviewer instructions for ABTM1AN4 (receptive anal-partner 1a), ABTM2AN4 (receptive anal-partner 2a), ABTM3AN4
(receptive anal-partner 3a), ABTM4AN4, (receptive anal-partner 4a), ABTM5AN4 (receptive anal-partner 5a):
Male-male partner-anal sex once: If the respondent is male (SX_GEN=1) and partner is male (SXPGN1N4 [partner’s genderpartner 1] = 1, SXPGN2N4 [partner’s gender-partner 2] = 1, SXPGN3N4 [partner’s gender-partner 3] = 1, SXPGN4N4 [partner’s
gender-partner 4] = 1, SXPGN5N4 [partner’s gender-partner 5] = 1 OR SXMLONN4 [male only partners] = 1), AND the
respondent had anal sex with partners 1, 2, 3, 4, or 5 only one time (SXAEN1N4 [times anal sex-partner 1] = 1, SXAEN2N4
[times anal sex-partner 2] = 1, SXAEN3N4 [times anal sex-partner 3] = 1, SXAEN4N4 [times anal sex-partner 4] = 1, SXAEN5N4
[times anal sex-partner 5] = 1, THEN go to ABTM1AN4 (receptive anal-partner 1a), ABTM2AN4 (receptive anal-partner 2a),
116

P a g e | 117
Question

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
ABTM3AN4 (receptive anal-partner 3a), ABTM4AN4, (receptive anal-partner 4a), ABTM5AN4 (receptive anal-partner 5a).

SL.1.6.a

Male-male partner-anal sex more than once: If the respondent is male (SX_GEN=1) and partner is male (SXPGN1N4 [partner’s
gender-partner 1] = 1, SXPGN2N4 [partner’s gender-partner 2] = 1, SXPGN3N4 [partner’s gender-partner 3] = 1, SXPGN4N4
[partner’s gender-partner 4] = 1, SXPGN5N4 [partner’s gender-partner 5] = 1 OR SXMLONN4 [male only partners]
= 1), AND the respondent had anal sex with partners 1, 2, 3, 4, or 5 more than one time (SXAEN1N4 [times anal sex-partner
1] ≥ 2, SXAEN2N4 [times anal sex-partner 2] ≥ 2, SXAEN3N4 [times anal sex-partner 3] ≥ 2, SXAEN4N4 [times anal sex-partner
4] ≥ 2, SXAEN5N4 [times anal sex-partner 5] ≥ 2 OR SA10_1N4 (anal 10-partner 1) =1, , SA10_2N4 (anal 10-partner 2) =1,
SA10_3N4 (anal 10-partner 3) =1, SA10_4N4 (anal 10-partner 4) =1, SA10_5N4 (anal 10-partner 5) =1 THEN Skip to
ABTM1BN4 (receptive anal-partner 1b), ABTM2BN4 (receptive anal-partner 2b), ABTM3BN4 (receptive anal-partner 3b),
ABTM4BN4, (receptive anal-partner 4b), ABTM5BN4 (receptive anal-partner 5b).
During the
ABTM1AN4
ABTM2AN4
ABTM3AN4
ABTM4AN4
ABTM5AN4
past 12
months, when
you had anal
sex with
INSERT
PARTNER
NAME], did
you have anal
sex where you
were a
bottom?
No
0
0
0
0
0
Skip to ATP1AN4
Skip to ATP2AN4
Skip to ATP3AN4
Skip to ATP4AN4
Skip to ATP5AN4
(insertive anal(insertive anal(insertive anal(insertive anal(insertive analpartner 1a).
partner 2a).
partner 3a).
partner 4a).
partner 5a).
Yes
1
1
1
1
1
Go to
Go to
Go to
Go to
Go to
117

P a g e | 118
Question

Refused to
answer

Don’t know

SL.1.6.b.

During the
past 12
months, when
you had anal
sex with
[INSERT
PARTNER
NAME], how
often did you
have anal sex
where you
were a
bottom?
[READ

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
skip_ABTC1AN4
(condom receptive
anal-partner 1a).
7

Partner 2
[Insert partner
name SX_NM2N4]
skip_ABTC2AN4
(condom receptive
anal-partner 2a).
7

Partner 3
[Insert partner
name SX_NM3N4]
skip_ABTC3AN4
(condom receptive
anal-partner 3a).
7

Partner 4
[Insert partner
name SX_NM4N4]
skip_ABTC4AN4
(condom receptive
anal-partner 4a).
7

Partner 5
[Insert partner
name SX_NM5N4]
skip_ABTC5AN4
(condom receptive
anal-partner 5a).
7

Skip to ATP1AN4
(insertive analpartner 1a).
8
Skip to ATP1AN4
(insertive analpartner 1a).
Label_ABTM1AN4
receptive analpartner 1a
ABTM1BN4

Skip to ATP2AN4
(insertive analpartner 2a).
8
Skip to ATP2AN4
(insertive analpartner 2a).
Label_ABTM2AN4
receptive analpartner 2a
ABTM2BN4

Skip to ATP3AN4
(insertive analpartner 3a).
8
Skip to ATP3AN4
(insertive analpartner 3a).
Label_ABTM3AN4
receptive analpartner 3a
ABTM3BN4

Skip to ATP4AN4
(insertive analpartner 4a).
8
Skip to ATP4AN4
(insertive analpartner 4a).
Label_ABTM4AN4
receptive analpartner 4a
ABTM4BN4

Skip to ATP5AN4
(insertive analpartner 5a).
8
Skip to ATP5AN4
(insertive analpartner 5a).
Label_ABTM5AN4
receptive analpartner 5a
ABTM5BN4

118

P a g e | 119
Question

RESPONSES.
SELECT ONLY
ONE.]
Never

Sometimes

Always

Refused to
answer

Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

1
Skip to ATP1BN4
(insertive analpartner 1b).
2
Go to
skip_ABTC1AN4
condom receptive
anal-partner 1a.
3
Go to
skip_ABTC1AN4
condom receptive
anal-partner 1a.
7

1
Skip to ATP2BN4
(insertive analpartner 2b).
2
Go to
skip_ABTC2AN4
condom receptive
anal-partner 2a.
3
Go to
skip_ABTC2AN4
condom receptive
anal-partner 2a.
7

1
Skip to ATP3BN4
(insertive analpartner 3b).
2
Go to
skip_ABTC3AN4
condom receptive
anal-partner 3a.
3
Go to
skip_ABTC3AN4
condom receptive
anal-partner 3a.
7

1
Skip to ATP4BN4
(insertive analpartner 4b).
2
Go to
skip_ABTC4AN4
condom receptive
anal-partner 4a.
3
Go to
skip_ABTC4AN4
condom receptive
anal-partner 4a.
7

1
Skip to ATP5BN4
(insertive analpartner 5b).
2
Go to
skip_ABTC5AN4
condom receptive
anal-partner 5a.
3
Go to
skip_ABTC5AN4
condom receptive
anal-partner 5a.
7

Skip to ATP1BN4
(insertive analpartner 1b).
8
Skip to ATP1BN4
(insertive analpartner 1b).
Label_ABTM1BN4
receptive anal-

Skip to ATP2BN4
(insertive analpartner 2b).
8
Skip to ATP2BN4
(insertive analpartner 2b).
Label_ABTM2BN4
receptive anal-

Skip to ATP3BN4
(insertive analpartner 3b).
8
Skip to ATP3BN4
(insertive analpartner 3b).
Label_ABTM3BN4
receptive anal-

Skip to ATP4BN4
(insertive analpartner 4b).
8
Skip to ATP4BN4
(insertive analpartner 4b).
Label_ABTM4BN4
receptive anal-

Skip to ATP5BN4
(insertive analpartner 5b).
8
Skip to ATP5BN4
(insertive analpartner 5b).
Label_ABTM5BN4
receptive anal119

P a g e | 120
Question

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
partner 1b
partner 2b
partner 3b
partner 4b
partner 5b
Interviewer instructions for ABTC1AN4 (condom receptive anal-partner 1a), ABTC2AN4 (condom receptive anal-partner 2a),
ABTC3AN4 (condom receptive anal-partner 3a), ABTC4AN4 (condom receptive anal-partner 4a), ABTC5AN4 (condom
receptive anal-partner 5a):
Male-partner #1 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is male
( SXPGN1N4 [partner’s gender-partner 1] = 1 OR SXMLONN4 [male only partners] = 1) AND the respondent had anal sex with
partner #1 only one time (SXAEN1N4 [times anal sex-partner 1] = 1, THEN go to Say box before ABTC1AN4 (condom
receptive anal-partner 1a).
Male-partners #2, 3, 4, 5 male-anal sex once :If the respondent is male (SX_GEN=1) AND the respondent’s partners # 2, 3, 4, or
5 are male (SXPGN2N4 [partner’s gender-partner 2] = 1, SXPGN3N4 [partner’s gender-partner 3] = 1, SXPGN4N4 [partner’s
gender-partner 4] = 1, SXPGN5N4 [partner’s gender-partner 5] = 1) OR SXMLONN4 [male only partners] = 1), AND the
respondent had anal sex with partners #2, 3, 4, or 5 only one time (SXAEN2N4 [times anal sex-partner 2] = 1, SXAEN3N4
[times anal sex-partner 3] = 1, SXAEN4N4 [times anal sex-partner 4] = 1, SXAEN5N4 [times anal sex-partner 5] = 1, THEN go to
ABTC2AN4 (condom receptive anal-partner 2a), ABTC3AN4 (condom receptive anal-partner 3a), ABTC4AN4 (condom
receptive anal-partner 4a), ABTC5AN4 (condom receptive anal-partner 5a).
Male-partner #1 male-anal sex more than once: if the respondent is male (SX_GEN=1) AND partner is male (SXPGN1N4
[partner’s gender-partner 1] OR SXMLONN4 [male only partners] = 1) AND the respondent had anal sex with partner #1more
than once (SXAEN1N4 [times anal sex-partner 1] ≥ 2 or SA10_1N4 [anal 10-partner 1]) =1, THEN go to Say box before
ABTC1BN4 (condom receptive anal-partner 1b).
Male-partner #2, 3, 4, 5, male-anal sex more than once: If the respondent is male (SX_GEN=1)
AND partner is male (SXPGN2N4 [partner’s gender-partner 2] = 1, SXPGN3N4 [partner’s gender-partner 3] = 1, SXPGN4N4
[partner’s gender-partner 4] = 1, SXPGN5N4 [partner’s gender-partner 5] = 1 OR SXMLONN4 [male only partners] = 1), AND
the respondent had anal sex with partners 2, 3, 4, or 5 more than one time (SXAEN1N4 [times anal sex-partner 1] ≥ 2,
SXAEN2N4 [times anal sex-partner 2] ≥ 2, SXAEN3N4 [times anal sex-partner 3] ≥ 2, SXAEN4N4 [times anal sex-partner 4] ≥ 2,
SXAEN5N4 [times anal sex-partner 5] ≥ 2, OR SA10_1N4 (anal 10-partner 1) =1, SA10_2N4 (anal 10-partner 2) =1, SA10_3N4
120

P a g e | 121
Question

SL.1.7.a.

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
(anal 10-partner 3) =1, SA10_4N4 (anal 10-partner 4) =1, SA10_5N4 (anal 10-partner 5) =1, THEN go to ABTC2BN4 (condom
receptive anal-partner 2b), ABTC3BN4 (condom receptive anal-partner 2b), ABTC4BN4 (condom receptive anal-partner 4b),
ABTC5BN4 (condom receptive anal-partner 5b).
Intro_ABTC1AN4
“The next question
is about condom
use. Please include
when a condom
was used the entire
time, not only part
of the time during
sex.”
During the
ABTC1AN4
ABTC2AN4
ABTC3AN4
ABTC4AN4
ABTC5AN4
past 12
months, when
you had anal
sex with
[INSERT
PARTNER
NAME] where
you were a
bottom, was a
condom used?
No
Yes
Refused to
answer
Don’t know

0
1
7

0
1
7

0
1
7

0
1
7

0
1
7

8

8

8

8

8
121

P a g e | 122
Question

Intro_ABTC1
BN4

SL.1.7.b.

During the
past 12
months, when
you had anal
sex with
[INSERT
PARTNER
NAME] where
you were a
bottom, was a

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
For all responses,
skip to
skip_ATP1AN4
(insertive analpartner 1a).
Label_ABTC1AN4
receptive analpartner 1a
Intro_ABTC1BN4
(condom receptive
anal-partner 1b):
“The next question
is about condom
use. Please include
when a condom
was used the entire
time, not only part
of the time during
sex.”
ABTC1BN4

Partner 2
[Insert partner
name SX_NM2N4]
For all responses,
skip to
skip_ATP2AN4
(insertive analpartner 2a).
Label_ABTC2AN4
receptive analpartner 2a

ABTC2BN4

Partner 3
[Insert partner
name SX_NM3N4]
For all responses,
skip to
skip_ATP3AN4
(insertive analpartner 3a).
Label_ABTC3AN4
receptive analpartner 3a

ABTC3BN4

Partner 4
[Insert partner
name SX_NM4N4]
For all responses,
skip to
skip_ATP4AN4
(insertive analpartner 4a).
Label_ABTC4AN4
receptive analpartner 4a

ABTC4BN4

Partner 5
[Insert partner
name SX_NM5N4]
For all responses,
skip to
skip_ATP5AN4
(insertive analpartner 5a).
Label_ABTC5AN4
receptive analpartner 5a

ABTC5BN4

122

P a g e | 123
Question

condom used
… [READ
RESPONSES.
SELECT ONLY
ONE.]
Never – not
even once
One or more
times
Absolutely
every time
Refused to
answer
Don’t know

SL.1.8.a.

During the
past 12
months, when
you had anal
sex with
[INSERT
PARTNER
NAME], did

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

1

1

1

1

1

2

2

2

2

2

3

3

3

3

3

7

7

7

7

7

8
For all responses,
go to ATP1BN4
(insertive analpartner 1b).
Label_ABTC1BN4
condom receptive
anal-partner 1b
ATP1AN4

8
For all responses,
go to ATP2BN4
(insertive analpartner 2b).
Label_ABTC2BN4
condom receptive
anal-partner 2b
ATP2AN4

8
For all responses,
go to ATP3BN4
(insertive analpartner 3b).
Label_ABTC3BN4
condom receptive
anal-partner 3b
ATP3AN4

8
For all responses,
go to ATP4BN4
(insertive analpartner 4b).
Label_ABTC4BN4
condom receptive
anal-partner 4b
ATP4AN4

8
For all responses,
go to ATP5BN4
(insertive analpartner 5b).
Label_ABTC5BN4
condom receptive
anal-partner 5b
ATP5AN4

123

P a g e | 124
Question

you have anal
sex where you
were a top?
No

Yes

Refused to
answer

Don’t know

SL.1.8.b.

During the
past 12
months when
you had anal

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

0
Skip to STATS1N4
(aware statuspartner 1)
1
Skip to
skip_ATPC1AN4
condom insertive
anal-partner 1a
7

0
Skip to STATS2N4
(aware statuspartner 2)
1
Skip to
skip_ATPC2AN4
condom insertive
anal-partner 2a
7

0
Skip to STATS3N4
(aware statuspartner 3)
1
Skip to
skip_ATPC3AN4
condom insertive
anal-partner 3a
7

0
Skip to STATS4N4
(aware statuspartner 4)
1
Skip to
skip_ATPC4AN4
condom insertive
anal-partner 4a
7

0
Skip to STATS5N4
(aware statuspartner 5)
1
Skip to
skip_ATPC5AN4
condom insertive
anal-partner 5a
7

Skip to STATS1N4
(aware statuspartner 1)
8
Skip to STATS1N4
(aware statuspartner 1)
Label_ATP1AN4
insertive analpartner 1a
ATP1BN4

Skip to STATS2N4
(aware statuspartner 2)
8
Skip to STATS2N4
(aware statuspartner 2)
Label_ATP2AN4
insertive analpartner 2a
ATP2BN4

Skip to STATS3N4
(aware statuspartner 3)
8
Skip to STATS3N4
(aware statuspartner 3)
Label_ATP3AN4
insertive analpartner 3a
ATP3BN4

Skip to STATS4N4
(aware statuspartner 4)
8
Skip to STATS4N4
(aware statuspartner 4)
Label_ATP4AN4
insertive analpartner 4a
ATP4BN4

Skip to STATS5N4
(aware statuspartner 5)
8
Skip to STATS5N4
(aware statuspartner 5)
Label_ATP5AN4
insertive analpartner 5a
ATP5BN4

124

P a g e | 125
Question

sex with
[INSERT
PARTNER
NAME], how
often did you
have anal sex
where you
were a top?
[READ
RESPONSES.
SELECT ONLY
ONE.]
Never

Sometimes

Always

Refused to
answer

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

1
Skip to STATS1N4
(aware statuspartner 1)
2
Go to
skip_ATPC1AN4
(condom insertive
anal-partner 1a)
3

1
Skip to STATS2N4
(aware statuspartner 2)
2
Go to
skip_ATPC2AN4
(condom insertive
anal-partner 2a)
3

1
Skip to STATS3N4
(aware statuspartner 3)
2
Go to
skip_ATPC3AN4
(condom insertive
anal-partner 3a)
3

1
Skip to STATS4N4
(aware statuspartner 4)
2
Go to
skip_ATPC4AN4
(condom insertive
anal-partner 4a)
3

1
Skip to STATS5N4
(aware statuspartner 5)
2
Go to
skip_ATPC5AN4
(condom insertive
anal-partner 5a)
3

Go to
skip_ATPC1AN4
(condom insertive
anal-partner 1a)
7

Go to
skip_ATPC2AN4
(condom insertive
anal-partner 2a)
7

Go to
skip_ATPC3AN4
(condom insertive
anal-partner 3a)
7

Go to
skip_ATPC4AN4
(condom insertive
anal-partner 4a)
7

Go to
skip_ATPC5AN4
(condom insertive
anal-partner 5a)
7
125

P a g e | 126
Question

Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
Skip to STATS1N4
(aware statuspartner 1)
8

Partner 2
[Insert partner
name SX_NM2N4]
Skip to
STATS2N4 (aware
status-partner 2)
8

Partner 3
[Insert partner
name SX_NM3N4]
Skip to STATS3N4
(aware statuspartner 3)
8

Partner 4
[Insert partner
name SX_NM4N4]
Skip to STATS4N4
(aware statuspartner 4)
8

Partner 5
[Insert partner
name SX_NM5N4]
Skip to STATS5N4
(aware statuspartner 5)
8

Skip to STATS1N4
(aware statuspartner 1)
Label_ATP1BN4
insertive analpartner 1b
Softedit_ATPC1BN4

Skip to
STATS2N4 (aware
status-partner 2)
Label_ATP2BN4
insertive analpartner 2b
Softedit_ATPC2BN4

Skip to STATS3N4
(aware statuspartner 3)
Label_ATP3BN4
insertive analpartner 3b
Softedit_ATPC3BN4

Skip to STATS4N4
(aware statuspartner 4)
Label_ATP4BN4
insertive analpartner 4b
Softedit_ATPC4BN4

If SXANL2N4 (anal
sex partner 2) = 1
(yes) and
ABTM2AN4
(receptive anal sex
partner 2) = 0 (no)
and ATP2AN4
(insertive anal sex
partner 2) = 0 (no),
READ the
following: “Earlier
you told me that
you had anal sex
with [INSERT
partner name

If SXANL2N4 (anal
sex partner 2) = 1
(yes) and
ABTM2BN4
(receptive anal sex
partner 2) = 1
(Never) and
ATP2BN4 (insertive
anal sex partner 2)
= 1 (Never), READ
the following:
“Earlier you told
me that you had
anal sex with
[INSERT partner

If SXANL3N4 (anal
sex partner 3) = 1
(yes) and
ABTM3BN4
(receptive anal sex
partner 3) = 1
(Never) and
ATP3BN4 (insertive
anal sex partner 3)
= 1 (Never), READ
the following:
“Earlier you told
me that you had
anal sex with
[INSERT partner

If SXANL4N4 (anal
sex partner 4) = 1
(yes) and
ABTM4BN4
(receptive anal sex
partner 4) = 1
(Never) and
ATP4BN4 (insertive
anal sex partner 4)
= 1 (Never), READ
the following:
“Earlier you told
me that you had
anal sex with
[INSERT partner

Skip to STATS5N4
(aware statuspartner 5)
Label_ATP5BN4
insertive analpartner 5b
Softedit_programming
_ATPC5BN4
If SXANL5N4 (anal
sex partner 5) = 1
(yes) and
ABTM5BN4
(receptive anal sex
partner 5) = 1
(Never) and
ATP5BN4 (insertive
anal sex partner 5)
= 1 (Never), READ
the following:
“Earlier you told
me that you had
anal sex with
[INSERT partner
126

P a g e | 127
Question

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4] name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
SX_NM2N4]. Is this name SX_NM2N4]. name SX_NM3N4]. name SX_NM4N4]. name SX_NM5N4].
correct?
Is this correct?
Is this correct?
Is this correct?
Is this correct?
Interviewer
Interviewer
Interviewer
Interviewer
Interviewer
instructions: return instructions: return instructions: return instructions: return instructions: return
to previous
to previous
to previous
to previous
to previous
questions to
questions to
questions to
questions to
questions to
correct error.”
correct error.”
correct error.”
correct error.”
correct error.”
Allow program to
Allow program to
Allow program to
Allow program to
Allow program to
move forward.
move forward.
move forward.
move forward.
move forward.
Interviewer instructions for ATPC1AN4 (condom insertive anal-partner 1a), ATPC2AN4 (condom insertive anal-partner 2a),
ATPC3AN4 (condom insertive anal-partner 3a), ATPC4AN4 (condom insertive anal-partner 4a), ATPC5AN4 (condom insertive
anal-partner 5a):
Male-partner #1 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is male
( SXPGN1N4 [partner’s gender-partner 1] = 1 OR SXMLONN4 [male only partners] = 1) AND the respondent had anal sex with
partner #1 only one time (SXAEN1N4 [times anal sex-partner 1] = 1, THEN go to Say box before ATPC1AN4 (condom insertive
anal-partner 1a).
Male-partners #2, 3, 4, 5 male-anal sex once :If the respondent is male (SX_GEN=1) AND partner is male (SXPGN2N4
[partner’s gender-partner 2] = 1, SXPGN3N4 [partner’s gender-partner 3] = 1, SXPGN4N4 [partner’s gender-partner 4] = 1,
SXPGN5N4 [partner’s gender-partner 5] = 1 OR SXMLONN4 [male only partners] = 1), AND the respondent had anal sex with
partners #2, 3, 4, or 5 only one time (SXAEN2N4 [times anal sex-partner 2] = 1, SXAEN3N4 [times anal sex-partner 3] = 1,
SXAEN4N4 [times anal sex-partner 4] = 1, SXAEN5N4 [times anal sex-partner 5] = 1, THEN go to ATPC2AN4 (condom insertive
anal-partner 2a), ATPC3AN4 (condom insertive anal-partner 3a), ATPC4AN4 (condom insertive anal-partner 4a), ATPC5AN4
(condom insertive anal-partner 5a).
Male-partner #1 male-anal sex more than once: If the respondent is male (SX_GEN=1)
AND partner is male (SXPGN1N4 [partner’s gender-partner 1 OR SXMLONN4 [male only partners] = 1) AND the respondent
had anal sex with partner #1 more than once (SXAEN1N4 [times anal sex-partner 1] ≥ 2 OR SA10_1N4 = 1), THEN go to Say
127

P a g e | 128
Question

Sexual Partners
Partner 1
Partner 2
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4]
box before ATPC1BN4 (condom insertive anal-partner 1b).

SL.1.9.a.

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

Male-partner #2, 3, 4, 5, male-anal sex more than once: If the respondent is male (SX_GEN=1)
AND partner is male (SXMLONN4 [male only partners] = 1 OR SXPGN2N4 [partner’s gender-partner 2] = 1, SXPGN3N4
[partner’s gender-partner 3] = 1, SXPGN4N4 [partner’s gender-partner 4] = 1, SXPGN5N4 [partner’s gender-partner 5] = 1 OR
SXMLONN4 [male only partners] = 1), AND the respondent had anal sex with partners 2, 3, 4, or 5 more than one time
(SXAEN1N4 [times anal sex-partner 1] ≥ 2, SXAEN2N4 [times anal sex-partner 2] ≥ 2, SXAEN3N4 [times anal sex-partner 3] ≥
2, SXAEN4N4 [times anal sex-partner 4] ≥ 2, SXAEN5N4 [times anal sex-partner 5] ≥ 2, SXAEN2N4 [times anal sex-partner 2] ≥
2), OR SA10_1N4 (anal 10-partner 1) =1, SA10_2N4 (anal 10-partner 2) =1, SA10_3N4 (anal 10-partner 3) =1, SA10_4N4 (anal
10-partner 4) =1, SA10_5N4 (anal 10-partner 5) =1, THEN go to ATPC2BN4 (condom insertive anal-partner 2b), ATPC3BN4
(condom insertive anal-partner 2b), ATPC4BN4 (condom insertive anal-partner 4b), ATPC5BN4 (condom insertive analpartner 5b).
Intro_ATPC1AN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time during sex.”
During the
ATPC1AN4
ATPC2AN4
ATPC3AN4
ATPC4AN4
ATPC5AN4
past 12
months, when
you had anal
sex with
[INSERT
PARTNER
NAME], was a
128

P a g e | 129
Question

condom used
when you
were a top?
No
Yes
Refused to
answer
Don’t know

SL.1.9.b.

During the
past 12
months, when
you had anal

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

0
1
7

0
1
7

8
For all responses,
skip to STATS1N4
(aware statuspartner 1)
Label_ATPC1AN4
insertive analpartner 1a
Intro_ATPC1BN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time during sex.”
ATPC1BN4

8
For all responses,
skip to STATS2N4
(aware statuspartner 2)
Label_ATPC2AN4
insertive analpartner 2a

ATPC2BN4

Partner 3
[Insert partner
name SX_NM3N4]

0
1
7
8
For all responses,
skip to STATS3N4
(aware statuspartner 3)
Label_ATPC3AN4
insertive analpartner 3a

ATPC3BN4

Partner 4
[Insert partner
name SX_NM4N4]

0
1
7
8
For all responses,
skip to STATS4N4
(aware statuspartner 4)
Label_ATPC4AN4
insertive analpartner 4a

ATPC4BN4

Partner 5
[Insert partner
name SX_NM5N4]

0
1
7
8
For all responses,
skip to STATS5N4
(aware statuspartner 5)
Label_ATPC5AN4
insertive analpartner 5a

ATPC5BN4

129

P a g e | 130
Question

sex with
[INSERT
PARTNER
NAME] where
you were a
top, was a
condom
used… [READ
RESPONSES.
SELECT ONLY
ONE.]
Never – not
even once
One or more
times
Absolutely
every time
Refused to
answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

1

1

1

1

1

2

2

2

2

2

3

3

3

3

3

7

7

7

7

7

8
For all responses,
go to STATS1N4
(aware statuspartner 1)
Label_ATPC1BN4
insertive analpartner 1b

8
For all responses,
go to STATS2N4
(aware statuspartner 2)
Label_ATPC2BN4
insertive analpartner 2b

8
For all responses,
go to STATS3N4
(aware statuspartner 3)
Label_ATPC3BN4
insertive analpartner 3b

8
For all responses,
go to STATS4N4
(aware statuspartner 4)
Label_ATPC4BN4
insertive analpartner 4b

8
For all responses,
go to STATS5N4
(aware statuspartner 5)
Label_ATPC5BN4
insertive analpartner 5b

130

P a g e | 131
Transgender and unknown gender sex (SG)
Questions

SG.1.0.

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4]
name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
Instructions for transgender sex partner-by-partner series table: The questions and response options are in the far left
column of the table. Each question is asked for partners 1–5. Partners 1-5 are labeled in columns Partner 1, Partner 2,
Partner 3, Partner 4, and Partner 5. All Partner 1 questions are asked before moving to Partner 2 questions. Detailed
instructions are provided in each table cell.
QDS_programming QDS_programming QDS_programming QDS_programming QDS_programming
_transgen1
_transgen2
_transgen3
_transgen4
_transgen5
When question
When question
When question
When question
When question
instructions say
instructions say
instructions say
instructions say
instructions say
“insert partner
“insert partner
“insert partner
“insert partner
“insert partner
name,” and
name,” and the
name,” and
name,” and
name,” and
variable is in the
variable is in the
variable is in the
variable is in the
variable is in the
Partner 2 column,
Partner 1 column,
same column as
same column as
same column as
insert response to
then insert
Partner 3, insert
Partner 4, insert
Partner 5, insert
SX_NM2N4 (name
response from
response to
response to
response to
of partner 2)
SX_NM1_5(name
SX_NM3N4 (name
SX_NM4N4 (name
SX_NM5N4 (name
of partner 1)
of partner 3
of partner 4)
of partner 5)
During the
SX_TG1N4
SX_TG2N4
SX_TG3N4
SX_TG4N4
SX_TG5N4
past 12
months, did
you have
vaginal or anal
sex with
[INSERT
PARTNER
NAME]?
No

0

0

0

0

0
131

P a g e | 132
Questions

Yes

Refused to
answer

Don’t know

Sexual Partners
Partner 1 [Insert
partner name
SX_NM1N4]

Partner 2 [Insert
partner name
SX_NM2N4]

Partner 3 [Insert
partner name
SX_NM3N4]

Partner 4 [Insert
partner name
SX_NM4N4]

Partner 5 [Insert
partner name
SX_NM5N4]

Skip to STATS1N4
(aware statuspartner 1)

Skip to STATS2N4
(aware statuspartner 2)

Skip to STATS3N4
(aware statuspartner 3)

Skip to STATS4N4
(aware statuspartner 4)

Skip to STATS5N4
(aware statuspartner 5)

1
Go to TG10_1N4
(transgender 10partner 1)
7

1
Go to TG10_2N4
(transgender 10partner 2)
7

1
Go to TG10_3N4
(transgender 10partner 3)
7

1
Go to TG10_4N4
(transgender 10partner 4)
7

1
Go to TG10_5N4
(transgender 10partner 5)
7

Skip to STATS1N4
(aware statuspartner 1)
8
Skip to STATS1N4
(aware statuspartner 1)
Label_SX_TG1N4

Skip to STATS2N4
(aware statuspartner 2)
8
Skip to STATS2N4
(aware statuspartner 2)
Label_SX_TG2N4

Skip to STATS3N4
(aware statuspartner 3)
8
Skip to STATS3N4
(aware statuspartner 3)
Label_SX_TG3N4

Skip to STATS4N4
(aware statuspartner 4)
8
Skip to STATS4N4
(aware statuspartner 4)
Label_SX_TG4N4

Skip to STATS5N4
(aware statuspartner 5)
8
Skip to STATS5N4
(aware statuspartner 5)
Label_SX_TG5N4

transgenderpartner 1
QDS_programming
_SX_TGS1N4
If SX_TG1N4
(transgenderpartner 1) is 0 (no),
then READ, “Earlier
you told me that

transgenderpartner 2
QDS_programming
_SX_TGS2N4
If SX_TG2N4
(transgenderpartner 2) is 0 (no),
then READ, “Earlier
you told me that

transgenderpartner 3
QDS_programming
_SX_TGS3N4
If SX_TG3N4
(transgenderpartner 3) is 0 (no),
then READ, “Earlier
you told me that

transgenderpartner 4
QDS_programming
_SX_TGS4N4
If SX_TG4N4
(transgenderpartner 4) is 0 (no),
then READ, “Earlier
you told me that

transgenderpartner 5
QDS_programming
_SX_TGS5N4
If SX_TG5N4
(transgenderpartner 5) is 0 (no),
then READ, “Earlier
you told me that
132

P a g e | 133
Questions

SG.1.1.

During the
past 12
months, did
you have
vaginal or anal
sex with
[INSERT
PARTNER
NAME] more
than 10
times? [READ
RESPONSES.
SELECT ONLY
ONE.]
Yes

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
you had vaginal or
anal sex with
[INSERT partner
name SX_NM1N4].
Is this correct?
Interviewer
instructions: return
to previous
questions to
correct error.”
Allow program to
move forward
TG10_1N4

Partner 2
[Insert partner
name SX_NM2N4]
you had vaginal or
anal sex with
[INSERT partner
name SX_NM2N4].
Is this correct?
Interviewer
instructions: return
to previous
questions to
correct error.”
Allow program to
move forward
TG10_2N4

Partner 3
[Insert partner
name SX_NM3N4]
you had vaginal or
anal sex with
[INSERT partner
name SX_NM3N4].
Is this correct?
Interviewer
instructions: return
to previous
questions to
correct error.”
Allow program to
move forward
TG10_3N4

Partner 4
[Insert partner
name SX_NM4N4]
you had vaginal or
anal sex with
[INSERT partner
name SX_NM4N4].
Is this correct?
Interviewer
instructions: return
to previous
questions to
correct error.”
Allow program to
move forward
TG10_4N4

Partner 5
[Insert partner
name SX_NM5N4]
you had vaginal or
anal sex with
[INSERT partner
name SX_NM5N4].
Is this correct?
Interviewer
instructions: return
to previous
questions to
correct error.”
Allow program to
move forward
TG10_5N4

1
Skip to TGAN1N4
(average number

1
Skip to TGAN2N4
(average number

1
Skip to TGAN3N4
(average number

1
Skip to TGAN4N4
(average number

1
Skip to TGAN5N4
(average number
133

P a g e | 134
Questions

No

Refused to
answer

Don’t know

SG.1.2.

During the
past 12
months,
please tell me
the exact
number of
times that you
had vaginal or
anal sex with
[INSERT
PARTNER

Sexual Partners
Partner 1 [Insert
partner name
SX_NM1N4]
transgender partner 1)
0
Go to TGEN1N4
(times transgender
-partner 1)
7

Partner 2 [Insert
partner name
SX_NM2N4]
transgender partner 2)
0
Go to TGEN2N4
(times transgender
-partner 2)
7

Partner 3 [Insert
partner name
SX_NM3N4]
transgender partner 3)
0
Go to TGEN3N4
(times transgender
-partner 3)
7

Partner 4 [Insert
partner name
SX_NM4N4]
transgender partner 4)
0
Go to TGEN4N4
(times transgender
-partner 4)
7

Partner 5 [Insert
partner name
SX_NM5N4]
transgender partner 5)
0
Go to TGEN5N4
(times transgender
-partner 5)
7

Skip to STATS1N4
(aware statuspartner 1)
8
Skip to STATS1N4
(aware statuspartner 1)
Label_TG10_1N4
transgender 10partner 1
TGEN1N4

Skip to STATS2N4
(aware statuspartner 2)
8
Skip to STATS2N4
(aware statuspartner 2)
Label_TG10_2N4
transgender 10partner 2
TGEN2N4

Skip to STATS3N4
(aware statuspartner 3)
8
Skip to STATS3N4
(aware statuspartner 3)
Label_TG10_3N4
transgender 10partner 3
TGEN3N4

Skip to STATS4N4
(aware statuspartner 4)
8
Skip to STATS4N4
(aware statuspartner 4)
Label_TG10_4N4
transgender 10partner 4
TGEN4N4

Skip to STATS5N4
(aware statuspartner 5)
8
Skip to STATS5N4
(aware statuspartner 5)
Label_TG10_5N4
transgender 10partner 5
TGEN5N4

134

P a g e | 135
Questions

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

Skip to Say box
before TGC1AN4
(condom
transgender partner 1a)
77

Skip to instructions
before TGC2AN4
(condom
transgender partner 2a)
77

Skip to instructions
before TGC3AN4
(condom
transgender partner 3a)
77

Skip to instructions
before TGC4AN4
(condom
transgender partner 4a)
77

Skip to instructions
before TGC5AN4
(condom
transgender partner 5a)
77

Skip STATS1N4
(aware statuspartner 1)
88
Skip STATS1N4
(aware statuspartner 1)
Label_TGEN1N4
times transgender partner 1
Range_TGEN1N4
1–10
TGAN1N4

Skip STATS2N4
(aware statuspartner 2)
88
Skip STATS2N4
(aware statuspartner 2)
Label_TGEN2N4
times transgender partner 2
Range_TGEN2N4
1–10
TGAN2N4

Skip STATS3N4
(aware statuspartner 3)
88
Skip STATS3N4
(aware statuspartner 3)
Label_TGEN3N4
times transgender partner 3
Range_TGEN3N4
1–10
TGAN3N4

Skip STATS4N4
(aware statuspartner 4)
88
Skip STATS4N4
(aware statuspartner 4)
Label_TGEN4N4
times transgender partner 4
Range_TGEN4N4
1–10
TGAN4N4

Skip STATS5N4
(aware statuspartner 5)
88
Skip STATS5N4
(aware statuspartner 5)
Label_TGEN5N4
times transgender
-partner 5
Range_TGEN5N4
1–10
TGAN5N4

NAME]?

Refused to
answer

Don’t know

SG.1.3.

On average,
how many
times did you
have vaginal
or anal sex
with [INSERT
PARTNER

135

P a g e | 136
Questions

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]

Partner 2
[Insert partner
name SX_NM2N4]

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

NAME] per
month?
Refused to
answer

Don’t know

777

777

777

777

777

Go to TGM1N4
(months
transgender partner 1).

Go to TGM2N4
(months
transgender partner 2).

Go to TGM3N4
(months
transgender partner 3).

Go to TGM4N4
(months
transgender partner 4).

Go to TGM5N4
(months
transgender partner 5).

888
Go to TGM1N4
(months
transgender
partner 1).
Label_TGAN1N4
average number
transgender partner 1
Range_TGAN1N4
1-90

888
Go to TGM2N4
(months
transgender partner 2).
Label_TGAN2N4
average number
transgender partner 2
Range_TGAN2N4
1-90

888
Go to TGM3N4
(months
transgender partner 3).
Label_TGAN3N4
average number
transgender partner 3
Range_TGAN3N4
1-90

888
Go to TGM4N4
(months
transgender partner 4).
Label_TGAN4N4
average number
transgender partner 4
Range_TGAN4N4
1-90

888
Go to TGM5N4
(months
transgender partner 5).
Label_TGAN5N4
average number
transgender partner 5
Range_TGAN5N4
1-90

Hard_edit_TGAN1
N4
If TGAN1N4
(average number
transgender partner 1) is > 90,

Hard_edit_TGAN2
N4
If TGAN2N4
(average number
transgender partner 2) is > 90,

Hard_edit_TGAN3
N4
If TGAN3N4
(average number
transgender partner 3) is > 90,

Hard_edit_TGAN4N
4
If TGAN4N4
(average number
transgender partner 4) is > 90,

Hard_edit_TGAN5
N4
If TGAN5N4
(average number
transgender partner 5) is > 90,
136

P a g e | 137
Questions

SG.1.4.

During the
past 12
months, how
many months
did you have
vaginal or anal
sex with
[INSERT
PARTNER
NAME]?
Refused to
answer
Don’t know

Sexual Partners
Partner 1
[Insert partner
name SX_NM1N4]
then READ,
“Number too large.
Interviewer
instructions:
confirm response.”
TGM1N4

77
88
For all responses,
go to instructions
before TGC1AN4
(condom
transgender partner 1a)
Label_TGM1N4
months
transgenderpartner 1

Partner 2
[Insert partner
name SX_NM2N4]
then READ, “Out of
range. Interviewer
instructions:
confirm response.”
TGM2N4

Partner 3
[Insert partner
name SX_NM3N4]
then READ,
“Number too large.
Interviewer
instructions:
confirm response.”
TGM3N4

Partner 4
[Insert partner
name SX_NM4N4]
then READ,
“Number too large.
Interviewer
instructions:
confirm response.”
TGM4N4

Partner 5
[Insert partner
name SX_NM5N4]
then READ,
“Number too large.
Interviewer
instructions:
confirm response.”
TGM5N4

77

77

77

77

88
For all responses,
skip to instructions
before TGC2AN4
(condom
transgender partner 2a)
Label_TGM2N4
months
transgenderpartner 2

88
For all responses,
skip to instructions
before TGC3AN4
(condom
transgender partner 3a)
Label_TGM3N4
months
transgenderpartner 3

88
For all responses,
skip to instructions
before TGC4AN4
(condom
transgender partner 4a)
Label_TGM4N4
months
transgenderpartner 4

88
For all responses,
skip to instructions
before TGC5AN4
(condom
transgender partner 5a)
Label_TGM5N4
months
transgenderpartner 5
137

P a g e | 138
Questions

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4]
name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
Range_TGM1N4
Range_TGM2N4
Range_TGM3N4
Range_TGM4N4
Range_TGM5N4
1-12
1-12
1-12
1-12
1-12
Hard_edit_TGM1N Hard_edit_TGM2N Hard_edit_TGM3N Hard_edit_TGM4N Hard_edit_TGM5N
4
4
4
4
4
If TGM1N4
If TGM2N4
If TGM3N4
If TGM4N4 (months If TGM5N4
(months
(months
(months
transgender(months
transgendertransgendertransgenderpartner 4) is >12,
transgenderpartner 1) is “0,”
partner 2) is >12,
partner 3) is >12,
then READ,
partner 5) is >12,
then READ, “You
then READ,
then READ,
“Number too large. then READ,
told me that you
“Number too large. “Number too large. Interviewer
“Number too large.
had vaginal or anal Interviewer
Interviewer
instructions:
Interviewer
sex with this
instructions:
instructions:
confirm response.” instructions:
confirm response.”
partner during the
confirm response.” confirm response.”
past 12 months.
Interviewer
instructions:
confirm.
If the response to
TGM1N4 (months
transgenderpartner 1) is >12,
then READ,
“Number too large.
Interviewer
instructions:
confirm response.”
Interviewer instructions before TGC1AN4 (condom transgender-partner 1a), TGC2AN4 (condom transgender-partner 2a),
TGC3AN4 (condom transgender-partner 3a), TGC4AN4 (condom transgender-partner 4a), TGC5AN4 (condom transgenderpartner 5a):
138

P a g e | 139
Questions

Sexual Partners
Partner 1
Partner 2
Partner 3
Partner 4
Partner 5
[Insert partner
[Insert partner
[Insert partner
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4]
name SX_NM3N4]
name SX_NM4N4]
name SX_NM5N4]
Transgender/Unknown gender sex-any partner #1 vaginal-anal sex once: If the respondent had vaginal or anal sex with
partner #1 only one time (TGEN1N4 [times transgender-partner 1] = 1), THEN go to Say box before TGC1AN4 (condom
transgender-partner 1a).
Transgender/Unknown gender sex-any partner #2, 3, 4, 5 vaginal-anal sex once :If the respondent had vaginal or anal sex
with partners #2, 3, 4, or 5 only one time (TGEN2N4 [times transgender-partner 2]) = 1, (TGEN3N4 [times transgenderpartner 3]) = 1, (TGEN4N4 [times transgender-partner 4]) = 1, (TGEN5N4 [times transgender-partner 5]) = 1, THEN go to
TGC2AN4 (condom transgender-partner 2a), TGC3AN4 (condom transgender-partner 3a), TGC4AN4 (condom transgenderpartner 4a), TGC5AN4 (condom transgender-partner 5a).

SG.1.5.a.

Else, go to Interviewer instructions before TGC1BN4 (condom transgender-partner 1b), TGC2BN4 (condom transgenderpartner 2b), TGC3BN4 (condom transgender-partner 3b), TGC4BN4 (condom transgender-partner 4b), TGC5BN4 (condom
transgender-partner 5b).
Intro_TGC1AN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time during sex.”
During the
TGC1AN4
TGC2AN4
TGC3AN4
TGC4AN4
TGC5AN4
past 12
months, when
you had
vaginal or anal
sex with
[INSERT
139

P a g e | 140
Questions

PARTNER
NAME] was a
condom used?
No
Yes
Refused to
answer
Don’t know

Sexual Partners
Partner 1 [Insert
partner name
SX_NM1N4]

0
1
7

Partner 2 [Insert
partner name
SX_NM2N4]

0
1
7

Partner 3 [Insert
partner name
SX_NM3N4]

0
1
7

Partner 4 [Insert
partner name
SX_NM4N4]

0
1
7

Partner 5 [Insert
partner name
SX_NM5N4]

0
1
7

8
8
8
8
8
For all responses,
For all responses,
For all responses,
For all responses,
For all responses,
skip to STATS1N4
skip to STATS2N4
skip to STATS3N4
skip to STATS4N4
skip to STATS5N4
(aware status(aware status(aware status(aware status(aware statuspartner 1)
partner 2)
partner 3)
partner 4)
partner 5)
Label_TGC1AN4
Label_TGC2AN4
Label_TGC3AN4
Label_TGC4AN4
Label_TGC5AN4
condom
condom
condom
condom
condom
transgendertransgendertransgendertransgendertransgenderpartner 1a
partner 2a
partner 3a
partner 4a
partner 5a
Interviewer instructions before TGC1BN4 (condom transgender-partner 1b), TGC2BN4 (condom transgender-partner 2b),
TGC3BN4 (condom transgender-partner 3b), TGC4BN4 (condom transgender-partner 4b), TGC5BN4 (condom transgenderpartner 5b):
Transgender/Unknown gender sex-any partner #1 vaginal-anal sex more than once: If the respondent had vaginal or anal sex
with partner #1 more than once (TGEN1N4 [times transgender-partner 1]) ≥ 2, OR TG10_1N4 (transgender 10-partner 1) =1
THEN go to Say box before TGC1BN4 (condom transgender-partner 1b).
Transgender/Unknown gender sex-any partner #2, 3, 4, 5, vaginal-anal sex more than once: If the respondent had vaginal or
anal sex with partners #2, 3, 4, or 5 more than one time (TGEN2N4 [times transgender sex-partner 2]) ≥ 2, (TGEN3N4 [times
transgender sex-partner 3]) ≥ 2, (TGEN3N4 [times transgender sex-partner 3]) ≥ 2, (TGEN5N4 [times transgender sex-partner
5]) ≥ 2, OR TG10_2N4 (transgender 10-partner 2) =1, TG10_3N4 (transgender 10-partner 3) =1, TG10_4N4 (transgender 10partner 4) =1, TG10_5N4 (transgender 10-partner 5) =1, THEN go to TGC2BN4 (condom transgender-partner 2b), TGC3BN4
(condom transgender-partner 3c), TGC4BN4 (condom transgender-partner 4b), TGC5BN4 (condom transgender-partner 5b).
140

P a g e | 141
Questions

SG.1.5.b.

During the
past 12
months, when
you had
vaginal or anal
sex with
[INSERT
PARTNER
NAME] was a
condom
used...
[READ
RESPONSES.
SELECT ONLY
ONE.]
Never- not
even once
One or more
times
Absolutely

Sexual Partners
Partner 1
Partner 2
[Insert partner
[Insert partner
name SX_NM1N4]
name SX_NM2N4]
Intro_TGC1BN4
“The next question
is about condom
use. Please include
times when a
condom was used
the entire time, not
only part of the
time during sex.”
TGC1BN4
TGC2BN4

Partner 3
[Insert partner
name SX_NM3N4]

Partner 4
[Insert partner
name SX_NM4N4]

Partner 5
[Insert partner
name SX_NM5N4]

TGC3BN4

TGC4BN4

TGC5BN4

1

1

1

1

1

2

2

2

2

2

3

3

3

3

3
141

P a g e | 142
Questions

every time
Refused to
answer
Don’t know

Sexual Partners
Partner 1 [Insert
partner name
SX_NM1N4]
7
8
For all responses,
go to STATS1N4
(aware statuspartner 1)
Label_TGC1BN4
condom
transgenderpartner 1b

Partner 2 [Insert
partner name
SX_NM2N4]
7
8
For all responses,
go to STATS1N4
(aware statuspartner 1)
Label_TGC2BN4
condom
transgenderpartner 2b

Partner 3 [Insert
partner name
SX_NM3N4]
7
8
For all responses,
go to STATS1N4
(aware statuspartner 1)
Label_TGC3BN4
condom
transgenderpartner 3b

Partner 4 [Insert
partner name
SX_NM4N4]
7
8
For all responses,
go to STATS1N4
(aware statuspartner 1)
Label_TGC4BN4
condom
transgenderpartner 4b

Partner 5 [Insert
partner name
SX_NM5N4]
7
8
For all responses,
go to STATS1N4
(aware statuspartner 1)
Label_TGC5BN4
condom
transgenderpartner 5b

142

P a g e | 143
Status (SS)
Questions

Sexual partners
Partner 1 [INSERT
Partner 2 [INSERT
Partner 3 [INSERT
Partner 4 [INSERT
Partner 5 [INSERT
partner name
partner name
partner name
partner name
partner name
SX_NM1N4]
SX_NM2N4]
SX_NM3N4]
SX_NM4N4]
SX_NM5N4]
Instructions for status partner-by-partner series table: The questions and response options are in the far left column of the
table. Each question is asked for partners 1–5. Partners 1-5 are labeled in columns Partner 1, Partner 2, Partner 3, Partner 4,
and Partner 5. All Partner 1 questions are asked before moving to Partner 2 questions. Detailed instructions are provided in
each table cell.

SS.1.0.

When question instructions say “insert partner name,” and the variable is in the Partner 1 column, then insert response from
SX_NM1_5(name of partner 1).
When question instructions say “insert partner name,” and variable is in the Partner 2 column, insert response to SX_NM2N4
(name of partner 2).
When question instructions say “insert partner name,” and variable is in the same column as Partner 3, insert response to
SX_NM3N4 (name of partner 3).
When question instructions say “insert partner name,” and variable is in the same column as Partner 4, insert response to
SX_NM4N4 (name of partner 4).
When question instructions say “insert partner name,” and variable is in the same column as Partner 5, insert response to
SX_NM5N4 (name of partner 5).
Does [INSERT
STATS1N4
STATS2N4
STATS3N4
STATS4N4
STATS5N4
PARTNER
NAME] know
your HIV
status?
No
0
0
0
0
0
Skip to STPRT1N4
Skip to STPRT2N4
Skip to STPRT3N4
Skip to STPRT4N4
Skip to STPRT5N4
(partner status(partner status(partner status(partner status(partner statuspartner 1).
partner 2).
partner 3).
partner 4).
partner 5).
Yes
1
1
1
1
1
Go to AWRST1N4 Go to AWRST2N4
Go to AWRST3N4
Go to AWRST4N4
Go to AWRST5N4
(aware status every (aware status every (aware status every (aware status every (aware status every
143

P a g e | 144
Questions

Refused to
answer

Don’t know

SS.1.1.

During the
past 12
months, was
[INSERT
PARTNER
NAME] aware
of your status
every time
you had sex?
No
Yes
Refused to
answer
Don’t know

Sexual partners
sex-partner 1).
7
Skip to STPRT1N4
(partner statuspartner 1).
8
Skip to STPRT1N4
(partner statuspartner 1).
Label_STATS1N4
aware statuspartner 1
AWRST1N4

0
1
7
8
For all responses,
go to STPRT1N4
(Partner status-

sex-partner 2).
7
Skip to STPRT2N4
(partner statuspartner 2).
8
Skip to STPRT2N4
(partner statuspartner 2).
Label_STATS2N4
aware statuspartner 2
AWRST2N4

0
1
7
8
For all responses,
go to STPRT2N4
(Partner status-

sex-partner 3).
7
Skip to STPRT3N4
(partner statuspartner 3).
8
Skip to STPRT3N4
(partner statuspartner 3).
Label_STATS3N4
aware statuspartner 3
AWRST3N4

0
1
7
8
For all responses,
go to STPRT3N4
(Partner status-

sex-partner 4).
7
Skip to STPRT4N4
(partner statuspartner 4).
8
Skip to STPRT4N4
(partner statuspartner 4).
Label_STATS4N4
aware statuspartner 4
AWRS41N4

0
1
7
8
For all responses,
go to STPRT4N4
(Partner status-

sex-partner 5).
7
Skip to STPRT5N4
(partner statuspartner 5).
8
Skip to STPRT5N4
(partner statuspartner 5).
Label_STATS5N4
aware statuspartner 5
AWRST5N4

0
1
7
8
For all responses,
go to STPRT5N4
(Partner status144

P a g e | 145
Questions

SS.2.0.

Do you know
[INSERT
PARTNER
NAME]’s HIV
status?
No

Yes

Refused to
answer

Sexual partners
partner 1).
Label_AWRST1N4
Aware status every
sex -partner 1
STPRT1N4

partner 2).
Label_AWRST2N4
Aware status every
sex -partner 2
STPRT2N4

partner 3).
Label_AWRST3N4
Aware status every
sex -partner 3
STPRT3N4

partner 4).
Label_AWRST4N4
Aware status every
sex -partner 4
STPRT4N4

partner 5).
Label_AWRST5N4
Aware status every
sex -partner 5
STPRT5N4

0
If SX_TOTN4 = 1,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 2,
skip to
skip_SXPGN2N4
(partner’s genderpartner 2).
1
Go to PRTST1N4
(Partner status first
sex-partner 1).
7

0
If SX_TOTN4 = 2,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 3,
skip to
skip_SXPGN3N4
(partner’s genderpartner 3).
1
Go to PRTST2N4
(Partner status first
sex-partner 2).
7

0
If SX_TOTN4 = 3,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN4N4
(partner’s genderpartner 4).
1
Go to PRTST3N4
(Partner status first
sex-partner 3).
7

0
If SX_TOTN4 = 4,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN5N4
(partner’s genderpartner 5).
1
Go to PRTST4N4
(Partner status first
sex-partner 4).
7

0
If SX_TOTN4 = 5,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 5,
skip to aggregate
information
section.

If SX_TOTN4 = 1,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 2,

If SX_TOTN4 = 2,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 3,

If SX_TOTN4 = 3,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,

If SX_TOTN4 = 4,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,

If SX_TOTN4 = 5,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 5,

1
Go to PRTST5N4
(Partner status first
sex-partner 5).
7

145

P a g e | 146
Questions

Don’t know

SS.2.1.

During the
past 12
months, what
was [INSERT
PARTNERS’
NAME]’s HIV
status the first
time that you
had sex?
[DON’T READ
RESPONSES.
SELECT ONLY

Sexual partners
skip to
skip_SXPGN2N4
(partner’s genderpartner 2).
8
If SX_TOTN4 = 1,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 2,
skip to
skip_SXPGN2N4
(partner’s genderpartner 2).
Label_STPRT1N4
Partner statuspartner 1

skip to
skip_SXPGN3N4
(partner’s genderpartner 3).
8
If SX_TOTN4 = 2,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 3,
skip to
skip_SXPGN3N4
(partner’s genderpartner 3).
Label_STPRT2N4
Partner statuspartner 2

skip to
skip_SXPGN4N4
(partner’s genderpartner 4).
8
If SX_TOTN4 = 3,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN4N4
(partner’s genderpartner 4).
Label_STPRT3N4
Partner statuspartner 3

skip to
skip_SXPGN5N4
(partner’s genderpartner 5).
8
If SX_TOTN4 = 4,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN5N4
(partner’s genderpartner 5).
Label_STPRT4N4
Partner statuspartner 4

PRTST1N4

PRTST2N4

PRTS31N4

PRTST4N4

skip to aggregate
information
section.
8
If SX_TOTN4 = 5,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 5,
skip to aggregate
information
section.
Label_STPRT5N4
Partner statuspartner 5

PRTST5N4

146

P a g e | 147
Questions
ONE.]
HIV Positive

HIV Negative

Refused to
answer

Don’t know

Sexual partners
1
If SX_TOTN4 = 1,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 2,
skip to
skip_SXPGN2N4
(partner’s genderpartner 2).
2
Go to PREP1N4
(PrEP-partner 1).
7

1
If SX_TOTN4 = 2,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 3,
skip to
skip_SXPGN3N4
(partner’s genderpartner 3).
2
Go to PREP2N4
(PrEP-partner 2).
7

1
If SX_TOTN4 = 3,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN4N4
(partner’s genderpartner 4).
2
Go to PREP3N4
(PrEP-partner 3).
7

1
If SX_TOTN4 = 4,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN5N4
(partner’s genderpartner 5).
2
Go to PREP4N4
(PrEP-partner 4).
7

1
If SX_TOTN4 = 5,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 5,
skip to aggregate
information
section.

If SX_TOTN4 = 1,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 2,
skip to
skip_SXPGN2N4
(partner’s genderpartner 2).
8
If SX_TOTN4 = 1,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 2,
skip to

If SX_TOTN4 = 2,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 3,
skip to
skip_SXPGN3N4
(partner’s genderpartner 3).
8
If SX_TOTN4 = 2,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 3,
skip to

If SX_TOTN4 = 3,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN4N4
(partner’s genderpartner 4).
8
If SX_TOTN4 = 3,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to

If SX_TOTN4 = 4,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN5N4
(partner’s genderpartner 5).
8
If SX_TOTN4 = 4,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to

If SX_TOTN4 = 5,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 5,
skip to aggregate
information
section.

2
Go to PREP5N4
(PrEP-partner 5).
7

8
If SX_TOTN4 = 5,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 5,
skip to aggregate
147

P a g e | 148
Questions

Sexual partners
skip_SXPGN2N4
(partner’s genderpartner 2).
Label_PRTST1N4
Partner status first
sex-partner 1

skip_SXPGN3N4
(partner’s genderpartner 3).
Label_PRTST2N4
Partner status first
sex-partner 2

skip_SXPGN4N4
(partner’s genderpartner 4).
Label_PRTST3N4
Partner status first
sex-partner 3

skip_SXPGN5N4
(partner’s genderpartner 5).
Label_PRTST4N4
Partner status first
sex-partner 4

information
section.
Label_PRTST5N4
Partner status first
sex-partner 5

148

P a g e | 149
Pre-exposure prophylaxis (SR)
Questions

SR.1.0. Sometimes people
who are HIV negative
take antiretroviral
medicine, such as
Truvada, to prevent
them from getting
HIV. Was [INSERT
PARTNER NAME]
taking antiretroviral
medicine to prevent
them from getting
HIV when you last
had sex? If you aren’t
sure, that’s okay.
No
Yes
Refused to answer
Don’t know

Sexual partners
Partner 1 [INSERT
partner name
SX_NM1N4]
PREP1N4

Partner 2 [INSERT
partner name
SX_NM2N4]
PREP2N4

Partner 3 [INSERT
partner name
SX_NM3N4]
PREP3N4

Partner 4 [INSERT
partner name
SX_NM4N4]
PREP4N4

Partner 5 [INSERT
partner name
SX_NM5N4]
PREP5N4

0
1
7

0
1
7

0
1
7

0
1
7

0
1
7

8
If SX_TOTN4 = 1,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 2,
skip to
skip_SXPGN2N4
(partner’s genderpartner 2).

8
If SX_TOTN4 = 2,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 3,
skip to
skip_SXPGN3N4
(partner’s genderpartner 3).

8
If SX_TOTN4 = 3,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN4N4
(partner’s genderpartner 4).

8
If SX_TOTN4 = 4,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 4,
skip to
skip_SXPGN5N4
(partner’s genderpartner 5).

8
If SX_TOTN4 = 5,
skip to serosorting
section
(Intro_SEROSRT1).
If SX_TOTN4 ≥ 6,
skip to aggregate
information
section.

P a g e | 150
Questions

Sexual partners
Label_PREP1N4
PrEP-partner 1

Label_PREP2N4
PrEP-partner 2

Label_PREP3N4
PrEP-partner 3

Label_PREP4N4
PrEP-partner 4

Label_PREP5N4
PrEP-partner 5

P a g e | 151
Aggregate information (SA)
Skip_SXAGC1N4
Skip_SXAGC2N4
Intro_SXAGC1N4

SXAGC1N4

If respondent reported 6 partners (SX_TOTN4=6), go to SXAGC1N4 (aggregate condom
use- 6 partners).
If respondent reported 7 or more sex partners (SX_TOTN4 ≥ 7), then skip to SXAGC2N4
(aggregate condom use-more than 6 partners).
“We just talked about the five people you most recently had sex with. Now I’d like to
ask you about the other partner(s) with whom you had sex with during the past 12
months. For these next questions, please don’t include partners you have already
discussed.”
SA.1.0.

No
Yes
Refused to answer
Don’t know
aggregate condom use-6 partners

Label_SXAGC1N4
SXAGP1N4

During the past 12 months, was a condom always used when you had vaginal
or anal sex with your other partner?

SA.1.1.

0
1
7
8

Label_SXAGP1N4

Was your other partner HIV positive?
No
Yes
Refused to answer
Don’t know
aggregate partner status-6 partners

Skip_ SXAGP1N4

Skip to the serosorting section (Intro_SEROSRT1).

SXAGC2N4

Label_ SXAGC2N4
Range_ SXAGC1N4
Hard_edit_SXAGC2
N4

Calculation_SXAGU
PN4

Label_SXAGUPN4
Skip_SXAGC2N4

SA.1.2.

0
1
7
8

During the past 12 months, with how many of these [INSERT SX_TOTN4-5]
other partners was a condom always used when you had vaginal or anal sex?
Refused to answer
7777
Don’t know
8888
aggregate condom use-more than 6 partners
0-999
If SXAGC2N4 (aggregate condom use-more than 6 partners) is > SX_TOTN4-5
then READ the following: “The number of additional partners with whom you
used a condom cannot be greater than [insert value from SX_TOTN4-5].
Confirm Answer.” Go back to SXAGC2N4 (aggregate condom use-more than 6
partners.
Create a calculated variable to indicate the aggregate number of partners
with whom the respondent had unprotected sex. If SX_TOTN4 is > 5, then
create SXAGUPN4 where (SX_TOTN4-5)-SXAGC2N4. (If SXAGC2N4 is don’t
know or refuse, assign it a 7777 if refused or 8888 if don’t know.)
aggregate number of condomless sex partners
If SXAGC2N4 (aggregate condom use more than 6 partners) = SX_TOTN4

P a g e | 152
(total number of partners), 7 (refused to answer) or 8 (don’t know), then skip
to the serosorting section (Intro_SEROSRT1). Else, go to SXAGC3N4
(aggregate condom use-more than 6 partners).
SXAGC3N4

SA.1.3.

So, you had unprotected sex with [INSERT RESPONSE FROM SXAGUPN4] of
these other partners?
No
0
Yes
1
Refused to answer
7
Don’t know

8

Label_SXAGC3N4

aggregate condomless sex-more than 6 partners

Skip_SXAGC3N4

If SXAGC3N4 (aggregate unprotected sex-more than 6 partners is 0 (no), 7
(refused to answer) or 8 (don’t know), then return to SXAGC2N4 (aggregate
condom use-more than 6 partners).

SXAGP2N4

SA.1.4.

How many of those [INSERT RESPONSE FROM SXAGUPN4] other partners
were HIV positive?

Label_SXAGC3N4

Refused to answer
7777
Don’t know
8888
aggregate concordant partners-more than 6 partners

Range_SXAGC3N4

0-999

Hard_edit_SXAGC3
N4

SXAGP2N4 cannot be greater than SXAGUPN4. If SXAGP2N4 > SXAGUPN4,
then READ, “The response is out of range” and return to SXAGP2N4
(aggregate concordant partners-more than 6 partners).

Serosorting (SO)
Intro_SEROSRT1

SEROSRT1

Label_SEROSRT1

“For these next questions, I will read you a statement and then I’ll ask you to
tell me how strongly you disagree or agree with the statement. Some of the
statements may not apply to your situation; however, tell me whether you
think you would disagree or agree. When I say unprotected sex, I mean anal or
vaginal sex where a condom was not used at all or was only used part of the
time. We’ll use Response Card F for these four questions.”
SO.1.0.

If my partner tells me he or she is HIV positive, I’m more likely to have
unprotected sex with him or her. [READ RESPONSES. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
If partner is positive I’m more likely to have unprotected sex

P a g e | 153

SEROSRT2

SO.2.0.

If my partner tells me he or she is HIV positive, we don’t have to worry about
using condoms. [READ RESPONSES. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
If partner is positive we don’t have to worry about using condoms

SO.3.0.

If I have an undetectable HIV viral load, I am more likely to have unprotected
sex. [READ RESPONSES. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
If I have an undetectable VL, I’m more likely to have unprotected sex

SO.4.0.

Having an undetectable HIV viral load means I can worry less about having to
use condoms. [READ RESPONSES. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
If I have an undetectable VL, I worry less about using condoms

Label_SEROSRT2
SEROSRT3

Label_SEROSRT3
SEROSRT4

Label_SEROSRT3
MSM Sex Ever (ME)
Skip_MSMEVRN5

MSMEVRN5

ME.1.0.

If SX_GEN (sex gender) is 1 (male) and SXMLONN4 (male only partners) is 0
(no), then go to MSMEVRN5 (ever had sex with a male).
Else, skip to Calculation_ST_PREVN (start time prevention activities).
Have you ever had sex with a male?
No
0
Yes
1
Refused to answer
7
Don’t know

Label_MSMEVRN5

ever had sex with a male

8

P a g e | 154
Disclosure of same sex attraction (RC)
Skip_Intro_
OUTMAN5

If MSMEVRN5 (ever had sex with a male) is 1 (yes), then go to Intro_OUTMAN5.
If SX_GEN (sex gender) is 1 (Male) and SEXOR_N5 (sexual orientation) is 1
(Lesbian or gay) or 2 (bisexual) and SX_TOTN4 (total number of vaginal and anal
sex partners) is 0, then go to Intro_OUTMAN5. Else Skip to next topic
(Calculation_EN_SEXN5, end of sexual behavior).

Intro_OUTMAN
5

“For the next questions, tell me whether the answer is yes, no, or doesn’t apply
to your situation.”

OUTMN5 series

Do any of the following people know that you’ve had sex with men:

OUTMAN5

RC.1.1.

Label_OUTMAN
5
OUTMBN5

RC.1.2.

Label_OUTMBN
5
OUTMCN5

RC.1.3.

Label_OUTMCN
5
OUTMDN5

Label_OUTMDN
5

RC.1.4.

Family members?
No
Yes
Not applicable
Refused to answer
Don’t know
Disclose male-male sex to family members

0
1
6
7
8

Friends?
No
Yes
Not applicable
Refused to answer
Don’t know
Disclose male-male sex to friends

0
1
6
7
8

Work associates?
No
Yes
Not applicable
Refused to answer
Don’t know
Disclose male-male sex to work associates

0
1
6
7
8

Doctors, nurses, or other healthcare workers?
No
Yes
Not applicable
Refused to answer
Don’t know
Disclose male-male sex to healthcare workers

0
1
6
7
8

P a g e | 155
Skip_OUTMEN5

OUTMEN5

If SX_TFPN4 (number of female partners) is ≥1, go to OUTMEN5 (disclose malemale sex to female sex partner); else Skip to OUTMFN5 (disclose male-male sex
to religious leaders).
RC.1.5.

Label_OUTMEN
5
OUTMFN5

Label_OUTMFN
5

RC.1.6.

Female sex partners?
No
Yes
Not applicable
Refused to answer
Don’t know
Disclose male-male sex to female sex partners

0
1
6
7
8

Religious leaders?
No
Yes
Not applicable
Refused to answer
Don’t know
Disclose male-male sex to religious leaders

0
1
6
7
8

P a g e | 156
Prevention activities (PA)
Calculation_ST_
PREVN
Label_ST_
PREVEN

Start time of prevention activities module
ST_PREVEN = Current time
Start prevention activities

Intro_COND12_9

“Next I'd like to ask you some questions about HIV prevention.”

COND12_9

PA.1.0.

During the past 12 months, have you gotten any free condoms, not counting
those given to you by a friend, relative, or sex partner?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Gotten any free condoms.

PA.2.0.

During the past 12 months, have you seen or received any
informational/educational materials such as posters, leaflets, pamphlets, or
videos that tell you how to protect you or your partners from HIV or other
STDs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Received informational/educational materials.

Label_COND12_9

HIVINFN3

Label_HIVINFN3
Intro_CNTLK

CNTLK_N5

“During the past 12 months, not including when you may have been tested for
HIV, have you had a one-on-one conversation with any of the following people
about ways to protect yourself or your partners from getting HIV or other
STDs…”
PA.3.1.

An outreach worker, counselor, or prevention program worker?
No
0
Yes
1
Refused to answer
7
Don’t know
8
One-on-one conversation with an outreach worker, counselor, or prevention
program worker.

PA.3.2.

A doctor, nurse, or other healthcare worker
No
0
Yes
1
Refused to answer
7
Don’t know
8
One-on-one conversation with a doctor, nurse, or other healthcare worker.

Label_CNTLK_N5

PRTLK_N5

Label_PRTLK_N5

P a g e | 157
GROU1_12

Label_GROU1_12

PA.3.3.

During the past 12 months, not including when you may have been tested for
HIV, have you participated in an organized session involving a small group of
people to discuss ways to protect yourself or your partners from getting HIV or
other sexually transmitted diseases?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Participated in an organized session involving a small group of people to
discuss ways to protect yourself or your partners.

P a g e | 158
Intimate partner violence (P)
Physical violence (PV)

Intro_IPVPH1N5

IPVPH1N5

“Next I’ll ask about experiences you may have had with romantic or sexual
partners. When I ask about romantic or sexual partners, I want you to think
about anybody you’ve been involved with romantically or sexually, which might
include spouses, boyfriends, girlfriends, people you’ve dated, people you were
seeing, or people you hooked up with.“
PV.1.0.

[Don’t know=7777; Refused to answer=8888]
Ever IPV physical violence

Label_
IPVPH1N5
Range_
IPVPH1N5
Skip_IPVPH1N5

IPVPH2N5

Label_
IPVPH2N5

How many of your romantic or sexual partners have ever slapped, punched,
shoved, kicked, choked or otherwise physically hurt you?

0-999
If IPVPH1N5= 1-999, then go to IPVPH2N5; else Skip to next topic
(Calculation_ST_DRUG, start time alcohol, smoking, and drug use).
PV.1.1.

During the past 12 months, has a partner slapped, punched, shoved, kicked,
choked, or otherwise physically hurt you?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Last year IPV physical violence

P a g e | 159

Sexual violence (PS)
Intro_IPVSX1N5

IPVSX1N5

“Some people may experience unwanted and uninvited sexual situations by
strangers or people they know well, such as a romantic or sexual partner,
friend, teacher, coworker, supervisor, or family member.”
PS.1.0.

[Don’t know=7777; Refused to answer=8888]
Ever IPV sexual violence.

Label_
IPVSX1N5
Range_
IPVSX1N5
Skip_IPVSX1N5
IPVSX2N5

Label_
IPVSX2N5

Some people are threatened with harm or physically forced to have sex when
they don’t want to, for example, by being pinned or held down, or by the use of
violence. How many people have ever threatened or forced you to have
vaginal, anal, or oral sex when you did not want to?

0-999
If IPVSX1N5 = 1-999, then go to IPVSX2N5; else Skip to IPVPH1N5.
PS.1.1.

During the past 12 months, have you been threatened or forced to have
vaginal, anal, or oral sex when you did not want to?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Last year IPV sexual violence.

P a g e | 160
Alcohol, smoking, and drug use (U)
Calculation_ST
_DRUG
Label_ST_DRUG

Start time of alcohol, smoking, and drug use module
ST_DRUG = Current time
Start alcohol, smoking, and drug use

Alcohol use (UA)
Intro_ALCOHO_9

ALCOHO_9

“Now I’m going to ask you about any alcohol that you may have had. We
will use Response Card G.”
UA.1.0.

During the past 12 months, how often did you drink alcohol? [SELECT
ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Less than monthly
3
Never
4
Refused to answer
7
Don’t know
8
How often drank alcohol in past 12 months
If ALCOHO_9 (how often drank alcohol in past 12 months) is 5 (Never), 7
(refused to answer), 8 (don’t know), then skip to next topic
(Intro_CIGEVRN5).
If SX_TOTN4 (total number of sex partners) ≥1 OR if SXFFONN4 (femalefemale partners only) =1, go to ALCOHOL1. Else, skip to Intro_DRINK_9.

UA.2.0.

During the past 12 months, did you drink alcohol before or duri ng sex?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Drank alcohol before or during sex

Label_ALCOHO_9
Skip_ALCOHO_9

Skip_ALCOHOL1

ALCOHOL1

Label_ALCOHOL1
Intro_DRINK_9

DRINK_9

Label_DRINK_9
Range_DRINK_9
Skip_DRINK_9

Intro_NDRINK_9

“Now I’m going to ask you some questions about your alcohol use. We’ll
use the calendar to refer to the past 30 days.”
UA.3.0.

During the past 30 days, on how many days did you have an alcoholic
drink?
[Refused to answer = 77, Don’t know = 88]
Number of days drank past 30 days
0–30
If DRINK_9 (number of days consumed alcohol during the past 30 days) is
“0,” Refused to answer (77), or Don’t know (88), skip to next topic
(Intro_CIGEVRN5).

“We’ll use the Alcohol Response Card for the next questions. For these

P a g e | 161
questions a drink of alcohol is a 12 oz. beer, a 5 oz. glass of wine, or a 1.5
oz. shot of liquor.”
NDRINK_9

UA.4.0.

[Refused to answer = 77, Don’t know = 88]
Number of drinks in typical day past 30 days
1–30
If BIRTGEN (gender at birth) is 2 (Female) or 3 (Intersex/ambiguous), skip
to DRINK4_9 (number of days had 4 or more drinks in past 30 days)

Label_NDRINK_9
Range_NDRINK_9
Skip_NDRINK_9

DRINK5_9

UA.5.0.

During the past 30 days, on how many days did you have 5 or more
alcoholic drinks in one sitting?
[Refused to answer = 77, Don’t know = 88] Label_DRINK5_9
Number of days had 5 or more drinks in past 30 days.
If DRINK5_9 (number of days had 5 or more drinks in past 30 days) >
DRINK_9 (number of days drank in past 30 days) then READ, “The
number of days during the past 30 days that you had 5 or more drinks
cannot be > the number of days you had a drink in the last 30 days."
Return to DRINK_9.
DRINK5_9 (number of days had 5 or more drinks during the past 30 days)
must be ≤ 30 and ≤ DRINK_9 (number of days had a drink during the past
30 days).
Skip to next topic (Intro_CIGEVRN5).

Hard_edit_1DRINK5_9

Hard_edit_2DRINK5_9

Skip_DRINK5_9
DRINK4_9

During the past 30 days, how many alcoholic drinks did you have on a
typical day when you were drinking?

UA.6.0.

During the past 30 days, on how many days did you have 4 or more
alcoholic drinks in one sitting?

[Refused to answer = 77, Don’t know = 88] Label_DRINK4_9 Number
of days had 4 or more drinks in past 30 days Hard_edit_DRINK4_9 DRINK4_9 (number of days had 4 or more
drinks during the past 30 days)
must be ≤ 30 and ≤ DRINK_9 (number of days had a drink during the past
30 days).
Hard_edit
If DRINK4_9 (number of days had 4 or more drinks in past 30 days) >
_DRINK4_9
DRINK_9 (number of days drank in past 30 days) then READ, "The
number of days during the past30 days that you had 4 or more drinks
cannot be > the number of days you had a drink in the last 30 days.”
Return to DRINK_9.
Cigarette and tobacco use (US)
Intro_CIGEVRN5
CIGEVRN5

“The next questions are about smoking cigarettes.”
US.1.0.

Have you smoked at least 100 cigarettes, equal to 5 packs of cigarettes, in
your entire life?
No
0

P a g e | 162
Yes
1
Refused to answer
7
Don’t know
8
Ever smoked cigarettes
If CIGEVRN5 (ever smoked cigarettes) is 0 (no), 7 (refused to answer), or 8
(don’t know), then skip to Intro_CIGARN5.

Label_CIGEVRN5
Skip_CIGEVRN5

“Now we will use Response Card G.”

Intro_CIG_OFT
CIG_OFT

US.1.1.

Label_CIG_OFT
Intro_CIGARN5

CIGARN5

“The next questions ask about tobacco products you might smoke other
than cigarettes, specifically cigars, cigarillos and little filtered cigars.
Cigarillos are medium cigars that sometimes are sold with plastic or
wooden tips. Some common brands are Black and Mild’s, Swisher Sweets,
Dutch Masters and Phillies Blunts. Cigarillos are usually sold individually or
in packs of 5 or 8. In contrast, little filtered cigars look like cigarettes and
are usually brown in color. Like cigarettes, little filtered cigars have a
spongy filter and are sold in packs of 20. Some common brands are Prime
Time and Winchester.”
US.2.0.

Have you smoked cigars, cigarillos, or little filtered cigars at least 50 times
in your entire life?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever smoked cigars, cigarillos, or little filtered cigars
If CIGARN5 (ever smoked cigars, cigarillos, or little filtered cigars) is 0 (no),
7 (refused to answer), or 8 (don’t know), then skip to Intro_CIGELCN5.

US.2.1.

Do you now smoke cigars, cigarillos, or little filtered cigars every day,
some days, rarely, or not at all? [SELECT ONE RESPONSE.]
Every day
1
Some days
2
Rarely
3
Not at all
4
Refused to answer
7
Don’t know
8
Current use cigars, cigarillos, or little filtered cigars

Label_CIGARN5
Skip_CIGARN5

CIGARFN5

Label_CIGARFN5

How often do you smoke cigarettes now? [SELECT ONLY ONE. USE
RESPONSE CARD.]
Daily
1
Weekly
2
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Current use cigarettes

P a g e | 163

Skip_ CIG_QTN5

If CIGARFN5 is 4 (not at all) and CIG_OFT is 5 (never), then skip to
Intro_CIGELCN5. Else, go to Intro_CIG_QTN5.

Intro_CIG_QTN5

“The next questions ask about quitting smoking. By smoking, I mean
smoking cigarettes, cigars, cigarillos, or little filtered cigars.”

CIG_QTN5

US.3.0.

During the past 12 months, have you stopped smoking for one day or
longer because you were trying to quit?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Stopped smoking one day or longer

US.4.0.

During the past 12 months, has a doctor, nurse, or other healthcare
professional advised you to quit smoking?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Doctor advised to quit smoking

Label_CIG_QTN5
CIG_DQN5

Label_CIG_DQN5
Intro_CIGELCN5

CIGELCN5

“The next set of questions is about electronic cigarettes. Electronic
cigarettes, or e-cigarettes, are battery-operated devices that simulate
smoking a cigarette, but don’t involve the burning of tobacco. The heated
vapor produced by an e-cigarette often contains nicotine.”
US.5.0.

Have you ever used an e-cigarette, even just one time in your entire life?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever used electronic cigarettes
If CIGELCN5 (ever used electronic cigarettes) is 0 (no), 7 (refused to
answer), or 8 (don’t know), then skip to next topic (Intro_ANID12_9).

US.5.1.

Have you used e-cigarettes during the past 30 days?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Used electronic cigarettes past 30 days

Label_CIGELCN5
Skip_CIGELCN5

CIGELFN5

Label_CIGELFN5

Non-injection drug use (UN)
Intro_ANID12_9

“Now I’m going to ask you about times when you may have used drugs, but did

P a g e | 164
not inject them. This includes times when you may have smoked, snorted,
inhaled or ingested drugs like marijuana, methamphetamine, cocaine, or crack.
I will refer to these as non-injection drugs.”
ANID12_9

UN.1.0.

Label_ANID12_9
Skip_ANID12_9

During the past 12 months, did you use any non-injection drugs?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Used non-injection drugs in past 12 months
If ANID12_9 (used non-injection drugs in past 12 months) is 1 (yes), then go to
Intro_MARIJU_9; else Skip to next topic (Intro_EVRINJN5).

Intro_MARIJU_9

“I’m going to read you a list of non-injection drugs. For each drug I mention,
please tell me how often you used it during the past 12 months. Don’t include
drugs you injected or drugs that were used for medical purposes. We’ll use
Response Card G for these questions.”

Interviewer_not
e_MARIJU_9

DISPLAY: If the respondent’s drug use was sporadic during the past 12 months,
ask the respondent to choose the response option that best characterizes his
or her use.

MARIJU_9

UN.1.1.

During the past 12 months, how often did you use marijuana? [SELECT ONLY
ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used marijuana
If MARIJU_9 (used marijuana) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less than
monthly) and [SX_TOTN4 (total number of sex partners) ≥1 OR if SXFFONN4
(female-female partners only) =1] then go to MARI_SN5 (marijuana before sex);
else go to CRACK1_9 (used crack).

UN.1.2.

Did you use marijuana before or duri ng sex?

Label_MARIJU_9
Skip_MARIJU_9

MARI_SN5

No
Yes
Refused to answer
Don’t know
Use marijuana before sex.

Label_MARI_SN
5
CRACK1_9

UN.2.0.

0
1
7
8

During the past 12 months, how often did you use crack? [SELECT ONLY ONE.
USE RESPONSE CARD.]

P a g e | 165
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used crack
If CRACK1_9 (used crack) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less than
monthly) and [SX_TOTN4 (total number of sex partners) ≥1 OR if SXFFONN4
(female-female partners only) =1] then go to CRACKSN5 (used crack before
sex); else go to COCSMO_9 (used cocaine).

Label_CRACK1_9
Skip_CRACK1_9

CRACKSN5

UN.2.1.

Label_CRACKSN
5
COCSMO_9

UN.3.0.

Label_COCSMO_
9
Skip_COCSMO_
9

COC_SN5

0
1
7
8

During the past 12 months, how often did you use cocaine that is smoked or
snorted? [SELECT ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used cocaine
If COCSMO_9 (used cocaine) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less than
monthly) and [SX_TOTN4 (total number of sex partners) ≥1 OR if SXFFONN4
(female-female partners only) =1] then go to COCSMO_SN5 (used cocaine
before sex); else go to METHN5 (used methamphetamines).

UN.3.1.

Label_COC_SN5
METHN5

Did you use crack before or duri ng sex?
No
Yes
Refused to answer
Don’t know
Used crack before sex

UN.4.0.

Did you use cocaine before or duri ng sex?
No
Yes
Refused to answer
Don’t know
Cocaine before or during sex

0
1
7
8

During the past 12 months, how often did you use any methamphetamines,
such as crystal meth, tina, crank, or ice? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Daily
1

P a g e | 166
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used methamphetamines
If METHN5 (used methamphetamines) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less
than monthly) and [SX_TOTN4 (total number of sex partners) ≥1 OR if
SXFFONN4 (female-female partners only) =1] then go to METH_SN5 (used
methamphetamines before sex); else go to AMPHEN5 (used amphetamines).

Label_METHN5
Skip_METHN5

METH_SN5

UN.4.1.

Label_METH_SN
5
AMPHEN5

During the past 12 months, how often did you use amphetamines, such as
speed, bennies, or uppers? [SELECT ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used amphetamines
If AMPHEN5 (used amphetamines) is 1,2,3,4 (Daily, Weekly, Monthly, Less than
monthly) and [SX_TOTN4 (total number of sex partners) ≥1 or if SXFFONN4
(female-female partners only) =1] then go to AMPH_SN5 (used amphetamines
before sex); else go to CLUBN5 (used club drugs).

UN.5.1.

Did you use amphetamines before or duri ng sex?
No
Yes
Refused to answer
Don’t know
Used amphetamines before sex

Label
AMPH_SN5
CLUBN5

0
1
7
8

UN.5.0.

Label AMPHEN5
Skip_AMPHEN5

AMPH_SN5

Did you use methamphetamines before or duri ng sex?
No
Yes
Refused to answer
Don’t know
Used methamphetamines before sex

UN.6.0.

0
1
7
8

During the past 12 months, how often did you use club drugs such as Ecstasy
(also called X), ketamine (also called Special K) or GHB? [SELECT ONLY ONE. USE
RESPONSE CARD.]
Daily
1
Weekly
2

P a g e | 167
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used club drugs
If CLUBN5 (used club drugs) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less than
monthly) and [SX_TOTN4 (total number of sex partners) ≥1 OR if SXFFONN4
(female-female partners only) =1] then go to CLUB_SN5 (used club drugs
before sex); else go to POPPER_9 (used poppers).

Label_CLUBN5
Skip_CLUBN5

CLUB_SN5

UN.6.1.

Label_CLUB_SN
5
POPPER_9

UN.7.0.

Label_POPPER_
9
Skip_POPPER_9

POPP_SN5

0
1
7
8

During the past 12 months, how often did you use poppers, also called amyl
nitrite? [SELECT ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used poppers
If POPPER_9 (used poppers) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less than
monthly) and SX_TOTN4 (total number of sex partners) ≥1 or if SXFFONN4
(female-female partners only) =1, then go to POPP_SN5 (used poppers before
sex); else go to PAINKN5 (used painkillers).

UN.7.1.

Label POPP_SN5
Intro_PAINKN5

PAINKN5

Did you use any club drugs before or during sex?
No
Yes
Refused to answer
Don’t know
Used club drugs before sex

Did you use poppers before or duri ng sex?
No
Yes
Refused to answer
Don’t know
Used poppers before sex

0
1
7
8

“The next few questions are about medications that require a prescription. I’ll
first ask you about prescription pain relievers.”
UN.8.0.

During the past 12 months, how often did you take a prescription pain reliever,
such as oxycodone, hydrocodone, Percocet, or Vicodin that was not prescribed
to you, or was prescribed to you but you took more than directed? [SELECT

P a g e | 168
ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used painkillers
If PAINKN5 (used painkillers) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less than
monthly) and [SX_TOTN4 (total number of sex partners) ≥1 or if SXFFONN4
(female-female partners only) =1] then go to PAIN_SN5 (used painkillers before
sex); else go to Skip_DOWNER_9.

Label_PAINKN5
Skip_PAINKN5

PAIN_SN5

UN.8.1.

Label_PAIN_SN5
TRANQN5

Label_TRAQ_SN
5
Skip_EDMEDN5

0
1
7
8

UN.9.0.

During the past 12 months, how often did you take a prescription tranquilizer, su
as Valium, Ativan, Xanax, downers, or nerve pills, that was not prescribed to you
or was prescribed to you but you took more than directed? [SELECT ONLY ONE. U
RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Don’t know
8
Used tranquilizers
If TRANQN5 (used tranquilizers) is 1, 2, 3, 4 (Daily, Weekly, Monthly, Less than
monthly) and [SX_TOTN4 (total number of sex partners) ≥1 OR if SXFFONN4
(female-female partners only) =1] then go to TRAQ_SN5 (used tranquilizers befor
sex); else go to Skip_EDMD_SN5.

UN.9.1.

Did you use tranquilizers before or duri ng sex?
No
Yes
Refused to answer
Don’t know
Used tranquilizers before sex

Label_TRANQ5
Skip_TRANQN5

TRAQ_SN5

Did you use painkillers before or duri ng sex?
No
Yes
Refused to answer
Don’t know
Used painkillers before sex

0
1
7
8

If SX_GEN (sex gender) = 1 (Male) and SX_TOTN4 (total number of sex partners)
≥1, then go to EDMD_SN5 (used erectile dysfunction drugs before sex); else
Skip to next topic (Intro_EVRINJN5).

P a g e | 169

EDMD_SN5

UN.10.0.

Label_EDMD_SN
5
Hard_edit_ANID
12_9

During the past 12 months, did you use erectile dysfunction drugs, such as
Viagra, Levitra, or Cialis?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Used erectile dysfunction drugs
If ANID12_9 (used non-injection drugs) is 1 (yes) and [MARIJU_9, CRACK1_9,
COCSMO_9, METHN5, AMPHEN5, CLUBN5, POPPER_9, PAINKN5, TRANQN5
and EDMD_SN5] are all 0 (no), and then READ, “You said that you used noninjection drugs during the past 12 months. Please tell me the name of the drug
you used during the past 12 months.” Return to Intro_MARIJU_9.

Injection drug use (UI)

Intro_EVRINJN5

EVRINJN5

“The next questions are about injection drug use. This means injecting
drugs yourself or having someone else inject you.”
UI.1.0.

Have you ever shot up or injected any drugs that weren’t used for
medical purposes? By shooting up, I mean anytime a needle was used to
inject drugs in your veins, under the skin or in the muscle.
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever used injection drugs
If EVRINJN5 (ever used injection drugs) is 1 (yes), then go to INJECTN5
(used injection drugs past 12 months); else Skip to next topic
(QDS_Programming_ST_ACQU, start time acquisition risk).

UI.1.1.

During the past 12 months, have you shot up or injected any drugs that
weren’t used for medical purposes?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Used injection drugs past 12 months
If INJECTN5 (used injection drugs past 12 months) is 1 (yes) then go to
Intro_COCINJN5; else Skip to next topic (QDS_Programming_ST_ACQU,
start time acquisition risk).

Label_EVRINJN5
Skip_EVRINJN5

INJECTN5

Label_INJECTN5
Skip_INJECTN5

Intro_COCINJN5

“Now I'm going to read you a list of drugs. For each drug I mention,
please tell me how often you injected it during the past 12 months. We’ll
use Response Card G for these questions.”

P a g e | 170
Interviewer_note
_COCINJN5
COCINJN5

UI.2.0.

Label_COCINJN5
HERINJN5

UI.3.0.

During the past 12 months, how often did you inject heroin? [SELECT
ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Injected heroin

UI.4.0.

During the past 12 months, how often did you inject heroin and cocaine
together, also called speedballs? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Injected speedballs

UI.5.0.

During the past 12 months, how often did you inject
methamphetamines, such as crystal meth, tina, crank or ice? [SELECT
ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Injected methamphetamines

Label_HERINJN5

SPDBALN5

Label SPDBALN5

METINJN5

Label_METINJN5

DISPLAY: If the respondent’s drug use was sporadic during the past 12
months, ask the respondent to choose the response option that best
characterizes his or her use.
During the past 12 months, how often did you inject powder cocaine?
[SELECT ONLY ONE. USE RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Injected powder cocaine

P a g e | 171
AMPINJN5

UI.6.0.

During the past 12 months, how often did you inject amphetamines,
such as speed, bennies, or uppers? [SELECT ONLY ONE. USE RESPONSE
CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Injected amphetamines

UI.7.0

During the past 12 months, how often did you inject painkillers, such as
Oxycontin, oxycodone, or hydrocodone? [SELECT ONLY ONE. USE
RESPONSE CARD.]
Daily
1
Weekly
2
Monthly
3
Less than monthly
4
Never
5
Refused to answer
7
Injected painkillers
If INJECTN5 (injected drugs past 12 months) is 1 (yes) and [COCINJN5,
HERINJN5, SPDBALN5, METINJN5, AMPNINJ5, or PKINJN5] are all 5
(Never), then READ, “You said that you injected drugs during the past 12
months. Please tell me the name of the drug you injected during the past
12 months.” Return to Intro_ COCINJN5.
If COCINJN5, HERINJN5, SPDBALN5, METINJN5, AMPINJN5 or PKINJN5 is
1, 2, 3, or 4 (daily, weekly, monthly, less than monthly), then go to
INJSEXN5 (injected any drugs before or during sex); else go to next topic
(QDS_Programming_ST_ACQU, start time acquisition risk).

UI.8.0.

During the past 12 months, did you inject drugs before or duri ng sex?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Injected any drug before sex

Label_AMPINJN5

PKINJN5

Label_PKINJN5
Hard_edit_INJEC
TN5

Skip_INJSEXN5

INJSEXN5

Label INJSEXN5
Intro_SHRNDLN5

SHRNDLN5

“Now I am going to ask you some questions about sharing needles and
other injection equipment. When I ask you about needles, I’m talking
about needles and syringes.”
UI.9.0.

When you injected during the past 12 months, did someone use the
same needle af ter you used it to either inject drugs or divide drugs?
No
0
Yes
1
Refused to answer
7

P a g e | 172
Don’t know
8
Shared needles
If SHRNDLN5 (shared needles) is 1 (yes) then skip to SHRNUMN5
(number of people who shared needles with); else go to SHR_WRKS
(shared injection works).

Label_SHRNDLN5
Skip_SHRNDLN5

SHRNUMN5

UI.9.1.

Refused to answer
777
Don’t know
888
Number of people who shared needles with

Label_SHRNUMN
5
Range_SHRNUM
N5
Skip_SHR1SXN5

SHR1SXN5

0-300
If SHRNUMN5 (number of people who shared needles with) = 0, go to
SHR_WRKS (shared injection works); if SHRNUMN5 = 1 (number of
people who shared needles with), = 1, go to SHR1SXN5 (had sex with
shared needle partner); if SHRNUMN5 (number of people who shared
needles with) > 1, go to SHRSEXN5 (number of needle partners had sex
with.
UI.9.2.

During the past 12 months, did you have also have sex with this person
who used the same needle after you?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Had sex with shared needle partner

UI.9.3.

During the past 12 months, with how many of these [insert number from
SHRNUMN5 (number of people who shared needles with)] people did
you also have sex?

Label_SHR1SXN5
SHRSEXN5

Refused to answer
777
Don’t know
888
Number of needle partners had sex with
0-300
If SHRNUMN5 (number of people who shared needle with) = 0, go to
Intro_GETNDAN5; if SHRNUMN5 (number of people who shared needle
with) = 1, go to SHR1PON5 (needle partner was HIV positive); if
SHRNUMN5 (number of people who shared needle with) >1, go to
SHRPOSN5 (number of needle partners who were HIV positive)

Label_SHRSEXN5
Range_SHRSEXN5
Skip_SHR1PON5

SHR1PON5

During the past 12 months, how many different people used the same
needle after you used it to either inject drugs or divide drugs?

UI.9.4.

During the past 12 months, was this person who used the same needle
after you HIV positive?
No
0

P a g e | 173
Yes
Refused to answer
Don’t know
Needle partner was HIV positive

Label_SHR1PON5
SHRPOSN5

UI.9.5.

Label_SHRPOSN5
Range_SHRPOSN
5
SHR_WRKS

UI.10.0.

Label_SHR_WRKS
Intro_GETNDAN5

GETNDAN5

UI.10.1.

UI.10.2.

Label_GETNDBN5
GETNDCN5

When you injected during the past 12 months, did someone use the
same cookers, cotton, or rinse water after you used it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Shared injection works

A needle exchange program?
No
Yes
Refused to answer
Don’t know
Get needles at needle exchange

0
1
7
8

A pharmacy or drug store?
No
Yes
Refused to answer
Don’t know
Get needles at pharmacy

0
1
7
8

UI.10.3.

A doctor’s office, clinic, or hospital?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get needles at doctor’s office, clinic, hospital

UI.10.4.

A friend, relative, or sex partner?
No

Label_GETNDCN5
GETNDDN5

During the past 12 months, how many of these people [insert number
from SHRNUMN5 (number of people who shared needles with)] were
HIV positive?
Refused to answer
777
Don’t know
888
Number of needle partners who were HIV positive
1-300

“During the past 12 months when you injected, did you get your needles
at any of the following places?”

Label_GETNDAN5
GETNDBN5

1
7
8

0

P a g e | 174
Yes
Refused to answer
Don’t know
A friend, relative, or sex partner?

Label_GETNDDN
5
GETNDEN5

1
7
8

UI.10.5.

A needle or drug dealer, shooting gallery, or off the street?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get needles from needle or drug dealer, shooting gallery, off the street

Intro_USENDAN5

U.11.
series

“During the past 12 months after you injected, what did you do with the
used needles?”

USENDBN5

UI.11.1.

Threw it away, for example in the trash, on the street, or in a container
that is not a medical waste disposal container?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Put in trash, street, other container

UI.11.2.

Kept it to re-use it?
No
Yes
Refused to answer
Don’t know
Kept it to re-use

Label_GETNDEN5

Label_USENDBN
5
USENDCN5

Label_USENDCN
5
USENDDN5

UI.11.3.

Gave it or sold it to someone else to use it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Gave or sold to someone else

UI.11.4.

Put it in a medical waste disposal container – a Red Box?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Put in a red box

Label_USENDD
N5
USENDAN5

Label_USENDAN
5

0
1
7
8

P a g e | 175

USENDEN5

UI.11.5.

Label_USENDEN
5
DRUGTXN5

Label_DRUGTXN
5

UI.12.0.

Took it to a needle exchange program?
No
Yes
Refused to answer
Don’t know
Took to needle exchange

0
1
7
8

During the past 12 months, were you enrolled in an opiate replacement
program such as a methadone clinic?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Enrolled in opiate replacement program

P a g e | 176
Acquisition risk behaviors (B)
Start time of Acquisition risk behaviors module
ST_ACQU = Current time.
Start of acquisition risk behaviors

Calculation_ST_
ACQU
Label_ST_ACQU

Core acquisition risk questions (BC)
QDS_Programming
_ST_ACQU

The intent of this section is to classify people by HIV acquisition risk
behaviors into “transmission categories.” This calculation will be performed
in SAS in post-processing, and does not need to be addressed in QDS
programming. Notes on transmission category are for information only and
don’t affect QDS programming.
“Next I'd like to ask you some questions about how you might have gotten
HIV. Some questions may ask you to remember things that happened a long
time ago or ask for information about your past partners’ behaviors.”

Intro_IPERINN3

IPERINN3

BC.1.0.

Label_IPERINN3
QDS_programming
_IPERINN3
Calculate_AGEDX
Soft_edit_AGEX

Skip_IPERINN3

Were you born with HIV?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Were you born with HIV?
For your information only, if IPERINN3 = 1 (yes), then transmission category
is perinatal.
Create a calculated variable for age at HIV diagnosis called AGEX and =
POS1S_9-DOB_13.
If IPERINN3=1 (yes) and AGEDX>=13 years then show alert. “This person’s
calculated age at diagnosis was [AGEDX] years old, but you indicated that
the person was born with HIV. Please verify the response.”
If IPERINN3 = 1 (yes), then skip to next topic (Intro_CSMNA_15). Else, go to
Intro_IIDUN3_5.

Intro_IIDUN3_5

“Now I’m going to ask you about things you did between 1977—around
when HIV was recognized in the United States—and when you tested
positive for HIV on [INSERT POS1S_9 (date of first positive test)].”

Skip1_IIDUN3_5

If EVERINJ (ever took injection drugs) is 1 (yes) then person may have
injected drugs prior to HIV diagnosis. Go to IIDUN3_5. Else if BIRTGEN
(gender at birth) is 3 (Intersex/ambiguous), 8 (don’t know) or 7 (refused to
answer) and DOB_13 (date of birth) is later than March 1985, then none of
the other acquisition risk questions apply and person has no identified risk
and. Skip to next topic (Intro_CSMNA_15). Else, skip to ICLOTN3.

IIDUN3_5

BC.2.0.

Before you first tested positive for HIV, did you ever use needles to inject
heroin, cocaine, steroids, or any other drug that was not prescribed by a
doctor?
No
0

P a g e | 177
Yes
1
Refused to answer
7
Don’t know
8
Since testing positive for HIV, ever use needles to inject
If BIRTGEN (gender at birth) is 2 (Female), 3 (Intersex/ambiguous), 8 (don’t
know) or 7 (refused to answer) and IIDUN3_5 is 1 (yes) then transmission
category is IDU. Skip to next topic (Intro_CSMNA_15).

Label_IIDUN3_5
Skip2_IIDUN3_5

Else if BIRTGEN (gender at birth) is 1 (Male) and MSMEVRN5 is 0 (no) and
IIDUN3_5 is 1 (yes) then transmission category is IDU. Skip to next topic
(Intro_CSMNA_15).
Else if BIRTGEN (gender at birth) is 1 (Male) and MSMEVRN5 is 0 (no), go to
Intro_ICLOTN3.
Else if BIRTGEN (gender at birth) is 1 (Male) or BIRTGEN (gender at birth) is 2
(Female), then go to ISEXMA_5.
Else if DOB_13 (date of birth) is later than March 1985, then respondent has
no identified risk. Skip to next topic (Intro_CSMNA_15).
ISEXMA_5

BC.3.0.

Before you first tested positive for HIV, did you ever have sex with a male?
No
0
Yes
1
Refused to answer
7
Don’t know
8

Label_ISEXMA_5
Skip_ISEXMA_5

Since testing positive for HIV, ever have sex with a male
If BIRTGEN (gender at birth) = 1 (Male) and ISEXMA_5= 1 (yes) then
transmission category is either MSM or MSM-IDU. Skip to next topic
(Intro_CSMNA_15). Else if IIDUN3_5 = 1 (yes) then transmission category is
IDU. Skip to next topic (Intro_CSMNA_15). Else if the DOB_13 (Date of Birth)
is later than March 1985 AND the person was female at birth (BIRTGEN=2)
AND had sex with a man ISEXMA_5=1 then clotting factor question does not
apply, but person could be heterosexual risk. Go to IFSXHIN3. Else if the
Date of Birth [DOB_13] is later than March 1985 AND the person was female
at birth (BIRTGEN=2) and did not have sex with a man (ISEXMAN3 ≠ 1) then
none of the other risk questions apply and person has no identified risk. Skip
to next topic (Intro_CSMNA_15). Else if the Date of Birth [DOB_13] is later
than March 1985 AND the person was male at birth (BIRTGEN=1), then
clotting factor question does not apply, but person could be heterosexual

Intro_ICLOTN3

“People who have blood clotting problems like hemophilia sometimes need
to get treated with something to prevent bleeding called clotting factor.”

ICLOTN3

BC.4.0.

Before you first tested positive for HIV, did you ever receive clotting factor?
No
0
Yes
1

P a g e | 178
Refused to answer
7
Don’t know
8
Since testing positive for HIV, ever receive clotting factor

Label_ICLOTN3
ICLO85N3

BC.4.1.

Did you ever receive clotting factor before March, 1985?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Did you ever receive clotting factor before March, 1985
If ICLO85N3= 1 (yes) then person’s transmission risk category is other (adult
receipt of clotting factor). Skip to next topic (Intro_CSMNA_15). Else if the
person was female at birth (BIRTGEN =2) and had sex with a man
(ISEXMA_5=1) then person may be female heterosexual risk. Go to
IFSXHIN3. Else if the person was male at birth (BIRTGEN=1), then person
may be male heterosexual risk. Go to ISEXFEN3. Else if the Date of Birth
(DOB_13) is later than March 1985, then none of the other risk questions
apply and person is no identified risk. Skip to next topic (Intro_CSMNA_15).
Else go to ITRANN3.

BC.5.0.

Before you first tested positive for HIV, did you have sex with a female?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Before you first tested positive for HIV, did you have sex with a female
If ISEXFEN3 = 1 (yes) then person may have male heterosexual risk. Go to
IMSXHIN3. Else if the Date of Birth (DOB_13) is later than March 1985, then
none of the other risk questions apply and person is no identified risk. Skip
to next topic (Intro_CSMNA_15). Else, skip to ITRANN3.

Label_ICLO85N3
Skip_ ICLO85N3

ISEXFEN3

Label_ISEXFEN3
Skip_ ISEXFEN3

Female heterosexual series (BF)
IFSXHIN3

BF.1.0.

Before you first tested positive for HIV, did any of your male sex partners
have HIV or AIDS?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If IFSXHIN3 = 1 (yes) then transmission category is heterosexual. Skip to next
topic (Intro_CSMNA_15).

BF.2.0.

Before you first tested positive for HIV, did any of your male sex partners
use needles to inject heroin, cocaine, steroids, or any other drug that was
not prescribed by a doctor?
No
0
Yes
1
Refused to answer
7

Skip_ IFSXHIN3

IFSXID_5

P a g e | 179
Don’t know
8
If IFSXID_5= 1 (yes) then transmission category is heterosexual. Skip to next
topic (Intro_CSMNA_15).

Skip_ IFSXID_5

IFSXHE_5

BF.3.0.

Before you first tested positive for HIV, did any of your male sex partners
have hemophilia or another blood clotting problem?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If IFSXHE_5= 1 (yes) then transmission category is heterosexual. Skip to next
topic (Intro_CSMNA_15).

BF.4.0.

Before you first tested positive for HIV, did any of your male sex partners
have sex with other men?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If [IFSXBIN3] = 1 (yes) then transmission category is heterosexual. Skip to
next topic (Intro_CSMNA_15).
Else if person was born later than March 1985 (Date of Birth [DOB_13] is
later than March 1985) then none of the other risk questions apply and
person has no identified risk. Skip to next topic (Intro_CSMNA_15).
Else Skip to. ITRANN3.

Skip_IFSXHE_5

IFSXBIN3

Skip_ IFSXBIN3

Male heterosexual series (BM)
IMSXHIN3

BM.1.0.

Before you first tested positive for HIV, did any of your female sex partners
have HIV or AIDS?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If [IMSXHIN3] = 1 (yes) then transmission category is heterosexual. Skip to
next topic (Intro_CSMNA_15).

BM.2.0.

Before you first tested positive for HIV, did any of your female sex partners
use needles to inject heroin, cocaine, steroids, or any other drug that was
not prescribed by a doctor?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If IMSXIDN3= 1 (yes) then transmission category is heterosexual. Skip to next
topic (Intro_CSMNA_15).

BM.3.0.

Before you first tested positive for HIV, did any of your female sex partners

Skip_ IMSXHIN3

IMSXIDN3

Skip_ IMSXIDN3

IMSXHEN5

P a g e | 180
have hemophilia or another blood clotting problem?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If IMSXHEN5= 1 (yes) then transmission category is heterosexual. Skip to
next topic (Intro_CSMNA_15).

Skip_ IMSXHEN5

Additional Acquisition Risk Questions for Persons Born Prior to March, 1985 (BA)
Intro_ ITRANN3

ITRANN3

“The next question asks about whether you have ever had a transfusion of
blood products. By this I mean something made from someone else’s
blood—such as blood, red blood cells, plasma, or platelets—that was given
to you by IV.”
BA.1.0.

Before you first tested positive for HIV, did you ever receive a transfusion of
blood products besides clotting factor?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If ITRANN3= 1 (yes) then go to ITRA85N3. Else, skip to ITRPLTN3.

BA.1.1.

Did you ever receive a transfusion of blood products before March, 1985?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If ITRA85N3=1 (yes) then transmission category is other (transfusion). Skip to
next topic (Intro_CSMNA_15).

BA.2.0.

Before you first tested positive for HIV, did you receive an organ or tissue
transplant or artificial insemination?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If ITRPLTN3 = 1 (yes) then go to ITRP85N5. Else, skip to next topic
(Intro_CSMNA_15).

BA.2.1.

Did you receive an organ or tissue transplant or artificial insemination
before March, 1985?
No
0
Yes
1
Refused to answer
7
Don’t know
8
If ITRP85N5=1 (yes) then transmission category is other (transplant). Skip to
next topic (Intro_CSMNA_15).

Skip_ ITRANN3
ITRA85N3

Skip_ ITRA85N3

ITRPLTN3

Skip_ ITRPLTN3

ITRP85N5

Skip_ ITRP85N5

P a g e | 181
Met and unmet needs (N)
Start time of met and unmet need module
ST_NEED = Current time
Start met and unmet need

Calculation_
ST_NEED:
Label_ST_NEED

Services and assistance programs (ND)
HIV case management
Intro_CSMNA_15

CSMNA_15

“For these next questions, I’m going to ask about services you used or
needed during the past 12 months. First I'll ask whether you got the service
and then if you didn’t, I'll ask whether you needed it. These questions might
sound similar, but I need to ask you all of them.”
ND.1.0.

The first question is about HIV case management services. A case manager is
a professional who helps you to get care and other services that you or your
family may need. During the past 12 months, did you get HIV case
management services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get HIV case management services
If CSMNA_15 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
CSMNB_15 (needed case management services); else, skip to TKMDA_15
(adherence counseling).

ND.1.1.

During the past 12 months, have you needed HIV case management
services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed HIV case management services
If CSMNA_15 is 1 (yes), go to CSMNC_15; else, skip to TKMDA_15 (adherence
counseling).

Label_CSMNA_15
Skip_CSMNA_15

CSMNB_15

Label_CSMNB_15
Skip_CSMNB_15

Intro_CSMNC_15
CSMNC_15

Label_CSMNC_15

“Were you not able to get this service for any of the following reasons”
ND.1.2.

...because you didn't have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial-HIV case management

P a g e | 182
CSMNE_15

ND.1.3.

Label_CSMNE_15
CSMNF_15

ND.1.4.

Label_CSMNF_15
CSMND_15

ND.1.5.

Label_CSMND_15

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1--HIV case management
…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2--HIV case management
…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal-HIV case management

Adherence counseling
TKMDA_15

ND.3.0.

During the past 12 months, did you get professional help on how to take
your HIV medicines on time or correctly?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get professional help on how to take your HIV medicines on time or correctly
If TKMDA_15 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
TKMDB_15; else, skip to Skip_NEDADA_5 (ADAP).

ND.3.1.

During the past 12 months, have you needed professional help on how to
take your HIV medicines on time or correctly?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed professional help on how to take your HIV medicines on time or
correctly
If TKMDB_15 is 1 (yes), go to TKMDC_N5; else, skip to Skip_NEDADA_5
(ADAP).

Label_TKMDA_15
Skip_TKMDA_15

TKMDB_15

Label_TKMDB_15
Skip_TKMDB_15

Intro_TKMDC_N5

“Were you not able to get this service for any of the following reasons”

P a g e | 183

TKMDC_N5

ND.3.2.

...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial- professional help on how to take your HIV medicines on
time or correctly

ND.3.3.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- professional help on how to take your HIV medicines on
time or correctly

ND.3.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2--professional help on how to take your HIV medicines on
time or correctly

ND.3.5.

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- professional help on how to take your HIV medicines on
time or correctly

Label_TKMDC_N5

TKMDE_N5

Label_TKMDE_N5

TKMDF_N5

Label_TKMDF_N5

TKMDD_N5

Label_TKMDD_N5

ADAP
Skip_NEDAD_5

NEDADA_5

If KINDD_15 (Insurance-Ryan White or ADAP) is 0 (no), go to NEDADA_5. Else,
skip to Intro_PATNAVN5 (patient navigation).
ND.4.1.

Earlier you told me that during the past 12 months, you did not have Ryan
White or ADAP coverage. During the past 12 months, have you needed to get
medicine through ADAP?
No
0
Yes
1
Refused to answer
7
Don’t know
8

P a g e | 184
Label_ NEDADA_5
Skip_NEDADA_5

Needed ADAP
If NEDADA_5 is 1 (yes), go to ADAPA_N5; else, skip to Intro_PATNAVN5
(patient navigation).

Intro_ADAPA_N5

“Were you not able to get this service for any of the following reasons”

ADAPC_N5

ND.4.2.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- ADAP

ND.4.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- ADAP

ND.4.4.

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- ADAP.

Label_ADAPC_N5
ADAPD_N5

Label_ADAPD_N5
ADAPB_N5

Label_ADAPB_N5
Patient navigation
Intro_PATNAVN5

PATNAVN5

“The next question is about patient navigation services. This is someone
whose job it is to help you get the best medical care for you. For example, a
patient navigator might help you talk to your doctor about your care or go
with you to your medical appointments.”
ND.5.0.

During the past 12 months, did you get patient navigation services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get patient navigation services.
If PATNAVN5 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
PATNABN5; else, skip to GET_GRP (peer group support).

ND.5.1.

During the past 12 months, have you needed patient navigation services?
No
0

Label_PATNAVN5
Skip_PATNAVN5

PATNABN5

P a g e | 185
Yes
1
Refused to answer
7
Don’t know
8
Needed patient navigation services
If PATNABN5 is 1 (yes), go to PATNACN5; else, skip to GET_GRP (peer group
support).

Label_PATNABN5
Skip_PATNABN5

Intro_PATNACN5
PATNACN5

ND.5.2.

Label_PATNACN5
PATNAEN5

ND.5.3.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- patient navigation services

ND.5.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- patient navigation services

Label_PATNAEN5
PATNAFN5

Label_PATNAFN5
PATNADN5

“Were you not able to get this service for any of the following reasons”
...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial- patient navigation services

ND.5.5.

Label_PATNADN5

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- patient navigation services

Peer group support
GET_GRP

Label_GET_GRP
Skip_GET_GRP

ND.6.0.

During the past 12 months, did you get HIV peer group support?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get HIV peer group support
If GET_GRP is 0 (no), 7 (refused to answer), or 8 (don’t know), go to

P a g e | 186
NED_GRP; else, skip to DENS12_9 (dental care).
NED_GRP

ND.6.1.

Label_NED_GRP
Skip_NED_GRP
Intro_RSGRPAN5
RSGRPCN5

ND.6.2.

Label_RSGRPCN5
RSGRPDN5

ND.6.3.

Label_RSGRPDN5
RSGRPBN5

ND.6.4.

Label_RSGRPBN5

During the past 12 months, have you needed HIV peer group support?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed HIV peer group support
If NED_GRP is 1 (yes), go to RSGRPAN5; else, skip to DENS12_9 (dental care).
“Were you not able to get this service for any of the following reasons”
…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1--HIV peer group support
…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2--HIV peer group support
…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- HIV peer group support

Dental care
DENS12_9

ND.7.0.

During the past 12 months, did you get dental care?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get dental care
If DENS12_9 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
DENSER_9; else, skip to GET_SUBU (drug and alcohol).

ND.7.1.

During the past 12 months, have you needed dental care?
No
0

Label_DENS12_9
Skip_DENS12_9

DENSER_9

P a g e | 187
Yes
1
Refused to answer
7
Don’t know
8
Needed dental care
If DENSER_9 is 1 (yes), go to DENSA_N5; else, skip to GET_SUBU (drug and
alcohol).

Label_DENSER_9
Skip_DENSER_9

Intro_DENSA_N5
DENSA_N5

“Were you not able to get this service for any of the following reasons”
ND.7.2.

...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial-dental care

ND.7.3.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- dental care

ND.7.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- dental care

Label_DENSA_N5
DENSC_N5

Label_DENSC_N5
DENSD_N5

Label_DENSD_N5
DENSB_N5

ND.7.5.

Label_DENSB_N5

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- dental care.

Drug and alcohol
GET_SUBU

ND.8.0.

During the past 12 months, did you get drug or alcohol counseling or
treatment?
No
0
Yes
1
Refused to answer
7
Don’t know
8

P a g e | 188
Label_GET_SUBU
Skip_GET_SUBU

NED_SUBU

Get drug or alcohol counseling or treatment
If GET_SUBU is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
NED_SUBU; else, skip to MENTA_15 (mental health).
ND.8.1.

Label_NED_SUBU
Skip_NED_SUBU

Intro_SUBUA_N5
SUBUA_N5

“Were you not able to get this service for any of the following reasons”
ND.8.2.

...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial- drug or alcohol counseling or treatment

ND.8.3.

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- drug or alcohol counseling or treatment

ND.8.4.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- drug or alcohol counseling or treatment

ND.8.5.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- drug or alcohol counseling or treatment

Label_SUBUA_N5
SUBUB_N5

Label_SUBUB_N5
SUBUC_N5

Label_SUBUC_N5
SUBUD_N5

Label_SUBUD_N5

During the past 12 months, have you needed dr ug or alcohol counseling or
treatment?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed drug or alcohol counseling or treatment
If NED_SUBU is 1 (yes), go to SUBUA_N5; else, skip to MENTA_15 (mental
health).

P a g e | 189
Mental health
MENTA_15

ND.9.0.

During the past 12 months, have you seen or talked to a mental health
professional such as a psychologist, psychiatrist, psychiatric nurse, or clinical
social worker about your health?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get mental health counseling or treatment
If MENTA_15 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
MENTB_15; else, skip to TRAS12_9 (transportation).

ND.9.1.

During the past 12 months, have you needed to see or talk to a mental
health professional about your health?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed mental health counseling or treatment
If MENTB_15 is 1 (yes), go to MENTC_15; else, skip to TRAS12_9
(transportation).

Label_MENTA_15
Skip_MENTA_15

MENTB_15

Label_MENTB_15
Skip_MENTB_15

Intro_MENTC_15
MENTC_15

“Were you not able to get this service for any of the following reasons”
ND.9.2.

...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial- mental health counseling or treatment

ND.9.4.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1- mental health counseling or treatment

ND.9.5.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2- mental health counseling or treatment

Label_MENTC_15

MENTE_15

Label_MENTE_15
MENTF_15

Label_MENTF_15

P a g e | 190
MENTD_15

ND.9.3.

Label_ MENTD_15

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- mental health counseling or treatment

Transportation
TRAS12_9

ND.10.0.

Label_TRAS12_9
Skip_TRAS12_9

TRASAS_9

Label_TRASAS_9
Skip_TRASAS_9

ND.10.1. During the past 12 months, have you needed transportation assistance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed transportation assistance
If TRASAS_9 is 1 (yes), go to TRANA_N5; else, skip to SHLTA_15.

Intro_TRANA_N5
TRANC_N5

“Were you not able to get this service for any of the following reasons”
ND.10.2.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- transportation assistance

ND.10.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- transportation assistance

Label_TRANC_N5
TRAND_N5

Label_TRAND_N5
TRANB_N5

During the past 12 months, did you get transportation assistance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get transportation assistance
If TRAS12_9 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
TRASAS_9; else, skip to SHLTA_15.

ND.10.4.

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?

P a g e | 191
No
Yes
Refused to answer
Don’t know
Barrier-personal- transportation assistance

Label_TRANB_N5

0
1
7
8

Shelter or housing
SHLTA_15

ND.11.0.

During the past 12 months, did you get shelter or housing services where you
got help with temporary or long-term housing including section 8 vouchers?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get shelter or housing services
If SHLTA_15 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
SHLTB_15; else, skip to SSIA_N5.

ND.11.1.

Label_SHLTB_15
Skip_SHLTB_15

During the past 12 months, have you needed shelter or housing services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed shelter or housing services
If SHLTB_15 is 1 (yes), go to SHLTA_N5; else, skip to SSIA_N5.

Intro_SHLTA_N5

“Were you not able to get this service for any of the following reasons”

Label_SHLTA_15
Skip_SHLTA_15

SHLTB_15

SHLTC_N5

Label_SHLTC_N5

ND.11.2. …because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- shelter or housing services

SHLTD_N5

ND.11.3.

Label_SHLTD_N5
SHLTB_N5

ND.11.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- shelter or housing services
…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1

P a g e | 192
Refused to answer
Don’t know
Barrier-personal- shelter or housing services.

Label_SHLTB_N5

7
8

SSI
SSIA_N5

ND.12.0.

Label_SSIA_N5
Skip_SSIA_N5

SSIB_N5

Label_SSIB_N5
Skip_SSIB_N5

ND.12.1. During the past 12 months, have you needed SSI?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed SSI
If SSIB_N5 is 1 (yes), go to SSIC_N5; else, skip to SSDIA_N5.

Intro_SSIC_N5
SSIC_N5

“Were you not able to get this service for any of the following reasons”
ND.12.2.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1--SSI

ND.12.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- SSID_N5

Label_SSIC_N5
SSID_N5

Label_SSID_N5
SSID_N5

Label_SSIC_N5

During the past 12 months, did you get Supplemental Security Income or SSI?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get SSI
If SSIA_N5 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to SSIB_N5;
else, skip to SSDIA_N5.

ND.12.4.

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal-SSI

P a g e | 193

SSDI
SSDIA_N5

ND.13.0.

During the past 12 months, did you get Social Security Disability Insurance or
SSDI?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get SSDI
If SSDIA_N5 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
SSDIB_N5; else, skip to FOODA_N5.

ND.13.1.

Label_SSDIB_N5
Skip_SSDIB_N5

During the past 12 months, have you needed SSDI?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed SSDI
If SSDIB_N5 is 1 (yes), go to SSDIC_N5; else, skip to FOODA_N5.

Intro_SSDIC_N5

“Were you not able to get this service for any of the following reasons”

Label_SSDIA_N5
Skip_SSDIA_N5

SSDIB_N5

SSDIE_N5

Label_SSDID_N5

ND.13.2. …because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1--SSDI

SSDIF_N5

ND.13.3.

Label_SSDIF_N5
SSDID_N5

Label_SSDID_N5

ND.13.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2--SSDI
…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal-SSDI

P a g e | 194
Food assistance
FOODA_N5

ND.14.0.

No
0
Yes
1
Refused to answer
7
Don’t know
8
Get food assistance
If FOODA_N5 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
FOODB_N5; else, skip to Intro_MLSF12_9.

Label_FOODA_N5
Skip_FOODA_N5

FOODB_N5

During the past 12 months, did you get food assistance or food stamps from
SNAP—Supplemental Nutrition Assistance Program or WIC—The Special
Supplemental Nutrition Program for Women, Infants, and Children?

Label_FOODB_N5
Skip_FOODB_N5

During the past 12 months, have you needed food assistance or food
stamps?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed food assistance
If FOODB_N5 is 1 (yes), go to FOODC_N5; else, skip to Intro_MLSF12_9.

Intro_FOODC_N5

“Were you not able to get this service for any of the following reasons”

FOODE_N5

ND.14.1.

ND.14.2.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1—food assistance

ND.14.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2—food assistance

Label_FOODE_N5
FOODF_N5

Label_FOODF_N5
FOODD_N5

Label_FOODD_N5

ND.14.4.

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal-food assistance

P a g e | 195

Meal of food services
Intro_MLSF12_9

MLSF12_9

Label_MLSF12_9
Skip_MLSF12_9

MLSFOD_9

“Next I’m going to ask about meal or food services. This is different from food
assistance, which I just asked you about. Meal or food services include
services such as soup kitchens, food pantries, food banks, church dinners, or
food delivery services.”
ND.15.0. During the past 12 months, did you get meal or food services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get meal or food services
If MLSF12_9 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
MLSFOD_9; else, skip to NUTRA_15.

Label_MLSFOD_9
Skip_MLSFOD_9

ND.15.1. During the past 12 months, have you needed meal or food services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed meal or food services
If MLSFOD_9 is 1 (yes), go to MEALA_N5; else, skip to NUTRA_15.

Intro_MEALA_N5
MEALA_N5

ND.15.2.

Label_ MEALA_N5
MEALC_N5

“Were you not able to get this service for any of the following reasons”
...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial- meal or food services

Label_ MEALC_N5

ND.15.3. …because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-- meal or food services

MEALD_N5

ND.15.4.

Label_MEALD_N5

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2-- meal or food services

P a g e | 196
MEALB_N5

ND.15.5.

Label_ MEALB_N5

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- meal or food services

Domestic violence
GET_DOMS

ND.16.0.

During the past 12 months, did you get domestic violence services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get domestic violence services
If GET_DOMS is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
NED_DOMS; else, skip to GET_INTS (interpreter).

ND.16.1.

During the past 12 months, have you needed domestic violence services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed domestic violence services
If NED_DOMS is 1 (yes), go to DOMSA_N5; else, skip to GET_INTS
(interpreter).

Label_GET_DOMS
Skip_GET_DOMS

NED_DOMS

Label_NED_DOMS
Skip_NED_DOMS

Intro_DOMSA_N5
DOMSA_N5

“Were you not able to get this service for any of the following reasons”
ND.16.2.

...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial- domestic violence services

ND.16.3.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1-domestic violence services

ND.16.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0

Label_DOMSA_N5
DOMSC_N5

Label_DOMSC_N5
DOMSD_N5

P a g e | 197
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2- domestic violence services

Label_DOMSD_N5
DOMSB_N5

ND.16.5.

Label_DOMSB_N5

…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- domestic violence services

Interpreter
Skip_1GET_INTS
GET_INTS

Label_GET_INTS
Skip_2GET_INTS

NED_INTS

If LANWL1N3 = 1 (Very well), then go to GET_INTS; else, skip to GET_LAN3.
ND.17.0. During the past 12 months, did you get interpreter services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get interpreter services
If GET_INTS is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
NED_INTS; else, skip to GET_LAN3 (legal).

Label_NED_INTS
Skip_NED_INTS

During the past 12 months, have you needed interpreter services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed interpreter services
If NED_INTS is 1 (yes), go to INTEA_N5; else, skip to GET_LAN3 (legal).

Intro_INTEA_N5

“Were you not able to get this service for any of the following reasons”

INTEA_N5

ND.17.1.

ND.17.2.

...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial-interpreter services

ND.17.3.

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1

Label_INTEA_N5
INTEC_N5

P a g e | 198
Refused to answer
Don’t know
Barrier-structural 1- interpreter services.

Label_INTEC_N5
INTED_N5

ND.17.4.

Label_ INTED_N5
INTEB_N5

ND.17.5.

Label_INTEB_N5

7
8

…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2—interpreter services.
…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- interpreter services.

Legal
GET_LAN3

ND.18.0.

During the past 12 months, did you get a lawyer or legal services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Get a lawyer or legal services.
If GET_LAN3 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
NED_LAN3; else, skip to MENTA_15.

ND.18.1.

Label_NED_LAN3
Skip_NED_LAN3

During the past 12 months, have you needed a lawyer or legal services?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Needed a lawyer or legal services.
If NED_LAN3 is 1 (yes), go to LAWYA_N5; else, skip to MENTA_15.

Intro_ LAWYA_N5

“Were you not able to get this service for any of the following reasons”

Label_GET_LAN3
Skip_GET_LAN3

NED_LAN3

LAWYA_N5

Label_LAWYA_N5

ND.18.2. ...because you didn’t have enough money or insurance?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-financial- lawyer or legal services.

P a g e | 199

LAWYC_N5

ND.18.3.

Label_LAWYB_N5
LAWYC_N5

ND.18.4.

Label_LAWYC_N5
LAWYB_N5

ND.18.5.

Label_LAWYB_N5

…because you couldn’t find the information you needed to get the service or
didn’t know it existed?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 1- lawyer or legal services.
…because the service didn’t meet your needs or you weren’t eligible for it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-structural 2- lawyer or legal services.
…because of personal reasons such as you were afraid or embarrassed to get
the service or you had other things going on in your life that made it difficult
to get it?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Barrier-personal- lawyer or legal services.

Other disability (NS)
Skip_ DISSSIN5

DISSSIN5

If SSIA_N5 (Social Security Income) = 1 (yes), then go to DISSSIN5; else Skip to
Skip_DISSDIN5.
NS.1.0.

M
M
/
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date received Supplemental Security Income (SSI).
Allow an unknown month value.

Label_DISSSIN5
QDS_programming
_DISSSIN5
Skip_DISSDIN5

DISSDIN5

Earlier you told me that during the past 12 months you got Supplemental
Security Income or SSI. When did you first get SSI? Please tell me the month
and year.
Y

Y

If SSDIA_N5 (Social Security Disability Insurance [SSDI]) = 1 (yes), then go to
DISSDIN5; else Skip to next topic (Intro_STIGMAN5).
NS.2.0.

Earlier you told me that during the past 12 months you got Social Security
Disability Insurance or SSDI. When did you first get SSDI? Please tell me the
month and year.
M

M

/

Y

Y

Y

Y

P a g e | 200

Label_DISBENN5
QDS_programming
_DISBENN5

[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date received Social Security Disability Insurance (SSDI).
Allow an unknown month value.

P a g e | 201
Stigma and discrimination (R)
Calculation_ST_STIG
Label_ST_STIG

Start time of stigma and discrimination module
ST_STIG = Current time
Start stigma and discrimination.

Stigma (RS)
Intro_STIGMAN5

STIGMAN5

“Next, I’d like to read you a few statements that some people living with HIV
have said they sometimes feel. We’re asking you these questions to better
understand how often people living with HIV experience these negative
feelings. These statements are not things that I or anyone in this project
thinks about people with HIV. These statements may be uncomfortable for
you to answer. Please remember that you don’t have to answer any
question you don’t want to. For each statement that I read, please tell me
how strongly you disagree or agree. We will use Response Card F for these
questions.”
RS.1.0.

I have been hurt by how people reacted to learning I have HIV. [USE
RESPONSE CARD. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
Hurt by people reacting to my HIV

RS.2.0.

I have stopped socializing with some people because of their reactions to
my HIV status. [USE RESPONSE CARD. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
Stopped socializing with some people because of my HIV

RS.3.0.

I have lost friends by telling them I have HIV. [USE RESPONSE CARD. SELECT
ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7

Label_STIGMAN5
STIGMBN5

Label_STIGMBN5
STIGMCN5

201

P a g e | 202
Don’t know
Lost friends telling of my HIV

Label_STIGMCN5
STIGMDN5

RS.4.0.

I am very careful who I tell that I have HIV. [USE RESPONSE CARD. SELECT
ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
Careful who I tell I have HIV

RS.5.0.

I worry that people who kno w I have HIV will tell others. [USE RESPONSE
CARD. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
Worry people will tell others

RS.6.0.

I feel that I am not as good a person as others because I have HIV. [USE
RESPONSE CARD. SELECT ONLY ONE.]
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
Not as good a person as others

RS.7.0.

Having HIV makes me feel unclean. [USE RESPONSE CARD. SELECT ONLY
ONE].
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
Having HIV makes me feel unclean

RS.8.0.

Having HIV makes me feel that I’m a bad person. [USE RESPONSE CARD.

Label_STIGMDN5
STIGMEN5

Label_STIGMEN5
STIGMFN5

Label_STIGMFN5
STIGMGN5

Label_STIGMGN5
STIGMHN5

202

8

P a g e | 203
SELECT ONLY ONE].
Strongly disagree
Somewhat disagree
Neutral
Somewhat agree
Strongly agree
Refused to answer
Don’t know
Feel I’m a bad person

Label_STIGMHN5
STIGMIN5

RS.9.0.

Most people think that a person with HIV is disgusting. [USE RESPONSE
CARD. SELECT ONLY ONE].
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
HIV is disgusting

RS.10.0.

Most people with HIV are rejected when others find out. [USE RESPONSE
CARD. SELECT ONLY ONE].
Strongly disagree
1
Somewhat disagree
2
Neutral
3
Somewhat agree
4
Strongly agree
5
Refused to answer
7
Don’t know
8
Most people with HIV are rejected

Label_STIGMIN5
STIGMJN5

1
2
3
4
5
7
8

Label_STIGMJN5
Discrimination (RD)
Intro_STIGMAN5

STIGMA2A

“People with HIV sometimes sense discrimination from healthcare
providers in different ways. Has anyone in the healthcare system done
any of the following to you since testing positive for HIV?
RD.1.0.

Exhibited hostility or a lack of respect toward you?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Exhibited hostility or lack of respect.

RD.2.0.

Given you less attention than other patients?
No
Yes

Label_STIGMA2A:
STIGMA2B

203

0
1

P a g e | 204
Refused to answer
Don’t know
Given you less attention.

Label_STIGMA2B:
STIGMA2C

RD.3.0.

Refused you service?
0
No
Yes
1
Refused to answer
7
Don’t know
8
Refused you service.
If STIGMA2A (exhibited hostility or lack of respect), STIGMA2B (given you
less attention), or STIGMA2C (refused you service) are 1 (yes), then go to
STIGMA3A (your HIV infection). Else, skip to next topic (Skip_PLV_EX_9).

RD.4.0.

Did the discrimination occur because of your HIV infection?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Your HIV infection.

RD.5.0.

Did the discrimination occur because of your gender?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Your gender.

RD.6.0.

Did the discrimination occur because of your sexual orientation or sexual
practices?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Your sexual orientation and practices.

RD.7.0.

Did the discrimination occur because of your race or ethnicity?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Your race or ethnicity.
If EVERINJ (ever used injection drugs) is 1 (yes), then go to STIGMA3E.
Else, skip to next topic (Skip_PLV_EX_9).

RD.8.0.

Did the discrimination occur because of your drug injecting habit?
No
0
Yes
1

Label_STIGMA2C:
Skip_STIGMA2A,
2B, 2C:

STIGMA3A

Label_STIGMA3A:
STIGMA3B

Label_STIGMA3B:
STIGMC_5

Label_STIGMA3C:
STIGMA3D

Label_STIGMA3D:
Skip_STIGMA3E:

STIGMA3E

204

7
8

P a g e | 205

Label_STIGMA3E:

205

Refused to answer
Don’t know
Your drug injecting habit.

7
8

P a g e | 206
Gynecological and reproductive history (G)
Skip_PLV_EX_9

If BIRTGEN (sex at birth) and GENDER (gender) = 2 (Female), then go to
Calculation_ST_OBGYN; else, skip to next topic (CO_BORN).
Start time of gynecological and reproductive history module
ST_OBGYN = current time.
Start gynecological and reproductive history

Calculation_ST_
OBGYN
Label_ST_OBGYN
Gynecological care (GH)
Intro_PLV_EX_9

PLV_EX_9

“I’m now going to ask some questions about pelvic exams and Pap smears. A
pelvic exam is a vaginal examination. A Pap smear, also called a cervical cancer
test or Pap test, is a test used to check for cancer of the cervix. Often a pelvic
exam and Pap smear are performed at the same time.”
GH.1.0.

During the past 12 months, have you had a pelvic examination?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Pelvic exam

GH.2.0.

During the past 12 months, have you had a Pap smear?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Pap smear

Label_PLV_EX_9
PAP_EX_9

Label_PAP_EX_9
Contraception (GC)
Skip_GC.1.0.series

If SX_TMPN4 (number of male partners) is ≥ 1, then go to BIRCOAN3; else,
skip to next topic (CO_BORN).
“I’m going to read a list of ways that people prevent pregnancy. As I read each
one, tell me if you’ve used it during the past 12 months. Answer “Yes” even if
you’ve only used it once.”

Intro1_BIRCOAN3

Intro2_BIRCOAN3

GC.1.
series

“Have you used this method to prevent pregnancy during the past 12
months?”

BIRCOAN3

GC.1.1.

Male condom, also called a “rubber”
No
Yes
Refused to answer
Don’t know
Male condom, also called a "rubber"

Label_BIRCOAN3

206

0
1
7
8

P a g e | 207
BIRCOBN3

GC.1.2.

Label_BIRCOBN3
BIRCOCN3

Diaphragm, cervical cap, or cervical sponge
No
0
Yes
1
Refused to answer
7
Don’t know
8
Diaphragm, cervical cap, or cervical sponge

GC.1.4.

Spermicidal foam or jelly
No
Yes
Refused to answer
Don’t know
Spermicidal foam or jelly

0
1
7
8

Depo-Provera,® which is an injection
No
Yes
Refused to answer
Don’t know
Depo-Provera,® which is an injection

0
1
7
8

Label_BIRCODN3
BIRCOEN3

GC.1.5.

Label_BIRCOEN3
BIRCOFN3

GC.1.6.

Hormonal implants such as Implanon® or Nexplanon®
No
0
Yes
1
Refused to answer
7
Don’t know
8
Hormonal implants such as Implanon® or Nexplanon®

GC.1.7.

Birth control pills
No
Yes
Refused to answer
Don’t know
Birth control pills

Label_BIRCOFN3
BIRCOGN3

Label_BIRCOGN3
BIRCOHN3

Label_BIRCOHN3

207

0
1
7
8

GC.1.3.

Label_BIRCOCN3
BIRCODN3

Female condom
No
Yes
Refused to answer
Don’t know
Female condom

GC.1.8.

0
1
7
8

Contraceptive patch, for example, Ortho Evra®)
No
0
Yes
1
Refused to answer
7
Don’t know
8
Contraceptive patch, for example, Ortho Evra®

P a g e | 208

BIRCOIN3

GC.1.9.

Contraceptive ring, for example NuvaRing®
0
No
Yes
1
Refused to answer
7
Don’t know
8
Contraceptive ring, for example NuvaRing®

GC.1.10.

Intrauterine device or IUD, which comes as a coil or loop, for example,
Mirena® or Paraguard®
No
0
Yes
1
Refused to answer
7
Don’t know
8
Intrauterine device or IUD, which comes as a coil or loop, for example,
Mirena® or Paraguard®

GC.1.11

Emergency contraception or “morning after pill”
No
0
Yes
1
Refused to answer
7
Don’t know
8
Emergency contraception or “morning after pill”

GC.1.12.

Withdrawal, also called “pulling out”
No
Yes
Refused to answer
Don’t know
Withdrawal, also called “pulling out”

0
1
7
8

Abstinence, which is not having sex
No
Yes
Refused to answer
Don’t know
Abstinence, which is not having sex

0
1
7
8

Label_BIRCOIN3
BIRCOJN3

Label_BIRCOJN3

BIRCOKN3

Label_BIRCOKN3
BIRCOLN3

Label_BIRCOLN3
BIRCOMN3

GC.1.13.

Label_BIRCOMN3
BIRCONN3

GC.1.14.

Post-menopausal, meaning that you don’t have periods anymore
No
0
Yes
1
Refused to answer
7
Don’t know
8
Post-menopausal, meaning that you don’t have periods anymore

GC.1.15.

Tubal sterilization, which is having your “tubes tied,” or a
hysterectomy, which is having your uterus removed
No
0

Label_BIRCONN3
BIRCOON3

208

P a g e | 209
Yes
1
Refused to answer
7
Don’t know
8
Tubal sterilization, which is having your “tubes tied,” or a hysterectomy,
which is having your uterus removed

Label_BIRCOON3

BIRCOPN3

GC.1.16.

Label_BIRCOPN3

Partner’s vasectomy
No
Yes
Refused to answer
Don’t know
Partner’s vasectomy

0
1
7
8

Reproductive history (GR)
Number of pregnancies
Skip_PREG_9

PREG_9

If POS1S_9 (date first tested positive) is 7 (refused to answer) or 8 (don’t know),
then skip Intro_PREG_9 (number of times pregnant) AND PREG_9 (number of
times pregnant) READ, “Since testing positive for HIV, how many times have
you been pregnant?”
GR.1.0.

Since testing positive for HIV in
/
[INSERT POS1S_9 (date of
first positive test)], how many times have you been pregnant?
[777 = Refused to answer, 888 = Don’t know]
Number of times pregnant
0–100
If PREG_9 (number of times pregnant) = 0, 777 (refused to answer), or 888
(don’t know), then skip to next topic (Calculation_ST_FRBRN); else go to
Intro_1INTNT1N3.

Label_PREG_9
Range_PREG_9
Skip_INTT1N3

First pregnancy
Skip_Intro_1INTN
T1N3

If PREG_9 (number of times pregnant) = 1, then skip to INTNT1N3. If PREG_9
(number of times pregnant) = 2–5, then go to Intro_1INTNT1N3. Else, skip
toIntro_2INTNT1N3.

Intro_1INTNT1N3

“Now I’d like to ask you about all of your pregnancies since testing positive for
HIV, starting with your first one.”

Intro_2INTNT1N3

“Now I’d like to ask you about your first 5 pregnancies since testing positive for
HIV, starting with your first one.”

INTNT1N3

209

GR.2.0.

st

For your 1 pregnancy since testing positive for HIV, were you trying to get
pregnant?
No
0
Yes
1

P a g e | 210
Refused to answer
Don’t know
1st pregnancy trying to get pregnant.

Label_INTNT1N3
OUTCM1N3

GR.2.1.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY
ONE.]
Currently pregnant
1
Live birth
2
Stillbirth
3
Miscarriage
4
Abortion
5
Refused to answer
7
Don’t know
8
First pregnancy outcome.
If PREG_9 (number of times pregnant) > 1, then OUTCM1N3 cannot be 1
(currently pregnant). If PREG_9 > 1 and OUTCM1N3 is 1 (currently pregnant),
then READ “I am asking about the outcome of the very first pregnancy you
had.” Return to OUTCM1N3.
If OUTCM1N3 (first pregnancy outcome) = 1 (Currently pregnant), then skip to
DUDT1N3 (first pregnancy due date). Else, go to PDTE1N3 (date of first
pregnancy outcome).

GR.2.2.

In what month and year did this outcome occur?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of first pregnancy outcome.
Allow a blank response for month. If month is blank for PDTE1N3 (date of first
pregnancy outcome), use the year values for the validation.
PDTE1N3 (date of first pregnancy outcome) cannot be earlier than POS1S_9
(date first tested positive).
If PDTE1N3 (date of first pregnancy outcome) < POS1S_9 (date of first positive
test) then READ, “The outcome date cannot be earlier than the date of
respondent's first positive HIV test. Please re-enter date." Do not allow the
program to advance.
If OUTCM1N3 (first pregnancy outcome) = 2 (Live birth), then go to KID1HVN3
(first pregnancy vertical transmission); else Skip to INTNT2N3 (second
pregnancy trying to get pregnant).

GR.2.3.

Was the child diagnosed with HIV?
No
0
Yes
1
Indeterminate
2
Refused to answer
7
Don’t know
8
First pregnancy vertical transmission.
If PREG_9 (number of times pregnant) >1 Skip to INTNT2N3 (2nd pregnancy

Label_OUTCM1N3
Hard_edit_OUTC
M1N3

Skip_OUTCM1N3

PDTE1N3

Label_PDTE1N3
QDS_programmin
g_PDTE1N3
Hard_edit_PDTE1
N3

Skip_PDTE1N3

KID1HVN3

Label_KID1HVN3
Skip_KID1HVN3

210

7
8

P a g e | 211
trying to get pregnant); else, skip to next topic (CO_BORN).
DUDT1N3

GR.2.4.

What is your due date?
☐ ☐ / ☐
☐ /
☐ ☐ ☐ ☐
M M
D
D
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Day: 777 = Refused to answer, 888= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
First pregnancy due date
DUDT1N3 cannot be earlier than DOB_13 (date of birth) or earlier than
POS1S_9 (date first tested positive) or > 10 months after IDATE (interview
date).
If DUDT1N3 < POS1S_9 (date first tested positive) then READ, “The due date
cannot be earlier than the date of respondent's first positive HIV test. Please
re-enter date." Do not allow the program to advance.
If DUDT1N3 > 10 months after IDATE then READ, “The due date cannot be
more than 10 months after IDATE (interview date). Please re-enter date.” Do
not allow the program to advance.
If PREG_9 (number of times pregnant) >1 Skip to INTNT2N3 (2nd pregnancy
trying to get pregnant), else Skip to next topic (CO_BORN).

GR.3.0.

For the 2nd pregnancy since testing positive for HIV, were you trying to get
pregnant?
No
0
Yes
1
Refused to answer
7
Don’t know
8
2nd pregnancy trying to get pregnant.

GR.3.1.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY
ONE.]
Currently pregnant
1
Live birth
2
Stillbirth
3
Miscarriage
4
Abortion
5
Refused to answer
7
Don’t know
8
2nd pregnancy outcome.
If PREG_9 (number of times pregnant) > 2, then OUTCM2N3 cannot be 1
(currently pregnant). If PREG_9 > 2 and OUTCM2N3 is 1 (currently pregnant),
then READ “I am asking about the outcome of the second pregnancy that you
had.” Return to OUTCM2N3.
If OUTCM2N3 is 1 (Currently pregnant), then skip to DUDT2N3 (first pregnancy
due date); else go to PDTE2N3 (date of second pregnancy outcome).

Label_DUDT1N3
Hard_edit_DUDT1
N3

Skip_INTNT2N3

Second pregnancy
INTNT2N3

Label_INTNT2N3
OUTCM2N3

Label_OUTCM2N3
Hard_edit_OUTC
M2N3

Skip_1PDTE2N3

211

P a g e | 212
PDTE2N3

GR.3.2.

In what month and year did this outcome occur?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of second pregnancy outcome.
If OUTCM2N3 (2nd pregnancy outcome) is 2 (Live birth), then go to KID2HVN3
(2nd pregnancy vertical transmission); else Skip to DUDT2N3 (2nd pregnancy
due date).
Allow a blank response for month.
If month is blank for PDTE2N3 (date of second pregnancy outcome), use the
year values for the validation.
PDTE2N3 (date of second pregnancy outcome) cannot be earlier than DOB_13
(date of birth) or earlier than POS1S_9 (date first tested positive).
If PDTE2N3 (date of second pregnancy outcome) < DOB_13 (date of birth) then
READ, “The outcome date cannot be earlier than respondent's date of birth.
Please re-enter date.” Do not allow the program to advance.
If PDTE2N3 (date of second pregnancy outcome) < POS1S_9 (date first tested
positive) then READ, “The outcome date cannot be earlier than the date of
respondent's first positive HIV test. Please re-enter date." Do not allow the
program to advance.

GR.3.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
No
0
Yes
1
Indeterminate
2
Refused to answer
7
Don’t know
8
Second pregnancy vertical transmission.
If PREG_9 (number of times pregnant) >2 Skip to INTNT3N3 (3rd pregnancy
trying to get pregnant), else Skip to next topic (CO_BORN).

GR.3.4.

What is your due date?

Label_PDTE2N3
Skip_2PDTE2N3

QDS_prorgammin
g_KID2HVN3
Hard_edit_KID2H
VN3

KID2HVN3

Label_KID2HVN3
Skip_KID2HVN3

DUDT2N3

Label_DUDT2N3
Skip_DUDT2N3
Hard_edit_DUDT2
N3

212

☐ ☐ / ☐
☐ /
☐ ☐ ☐ ☐
M M
D
D
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Day: 777 = Refused to answer, 888= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
2nd pregnancy due date
If PREG_9 (number of times pregnant) > 2 go to INTNT3N3 (3rd pregnancy
trying to get pregnant), else Skip to next topic (CO_BORN).
DUDT2N3 cannot be earlier than DOB_13 or earlier than POS1S_9 (date first
tested positive) or > 10 months after IDATE (interview date).
If DUDT2N3 < DOB_13 then READ, “The due date cannot be earlier than
respondent's date of birth. Please re-enter date." Do not allow the program to
advance.
If DUDT2N3 < POS1S_9 then READ, “The due date cannot be earlier than the

P a g e | 213
date of respondent's first positive HIV test. Please re-enter date." Do not allow
the program to advance.
If DUDT2N3 > 10 months after IDATE then READ, “The due date cannot be
more than 10 months after the interview date. Please re-enter date." Do not
allow the program to advance.
Third pregnancy
INTNT3N3

GR.4.0.

For the 3rd pregnancy since testing positive for HIV, were you trying to get
pregnant?
No
0
Yes
1
Refused to answer
7
Don’t know
8
3rd pregnancy trying to get pregnant.

GR.4.1.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY
ONE.]
Currently pregnant
1
Live birth
2
Stillbirth
3
Miscarriage
4
Abortion
5
Refused to answer
7
Don’t know
8
3rd pregnancy outcome.
If PREG_9 (number of times pregnant) > 3, then OUTCM3N3 cannot be 1
(currently pregnant). If PREG_9 > 3 and OUTCM3N3 is 1 (currently pregnant),
then READ “I am asking about the outcome of the third pregnancy that you
had.” Return to OUTCM3N3.
If OUTCM3N3 = 1 (Currently pregnant), then skip
to DUDT3N3.

GR.4.2.

In what month and year did this outcome occur?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of third pregnancy outcome.
Allow a blank response for month.
If month is blank for PDTE3N3 (date of third pregnancy outcome), use the year
values for the validation.
PDTE3N3 (date of third pregnancy outcome) cannot be earlier than DOB_13
(date of birth) or earlier than POS1S_9 (date first tested positive).
If PDTE3N3 (date of third pregnancy outcome) < DOB_13 (date of birth) then
READ, “The outcome date cannot be earlier than respondent's date of birth.
Please re-enter date.” Do not allow the program to advance.
If PDTE3N3 (date of third pregnancy outcome) < POS1S_9 (date of first positive

Label_INTNT3N3
OUTCM3N3

Label_OUTCM3N3
Hard_edit_OUTC
M3N3

Skip_OUTCM3N3

PDTE3N3

Label_PDTE3N3
QDS_programmin
g_PDTE3N3
Hard_edit_PDTE3
N3

213

P a g e | 214
test) then READ, “The outcome date cannot be earlier than the date of
respondent's first positive HIV test. Please re-enter date.” Do not allow the
program to advance.
If OUTCM1N = 2 (Live birth), then go to KID3HVN3; else Skip to INTNT4N3 (4th
pregnancy trying to get pregnant). If PREG_9 (number of times pregnant) > 3,
then skip to next topic (CO_BORN). If PREG_9 (number of times pregnant) = 3,
then skip to INTNT4N3.

Skip_PDTE3N3

KID3HVN3

GR.4.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
No
0
Yes
1
Indeterminate
2
Refused to answer
7
Don’t know
8
Third pregnancy vertical transmission.
If PREG_9 (number of times pregnant) > 3, go to INTNT4N3 (4th pregnancy
trying to get pregnant), else Skip to next topic (CO_BORN).

GR.4.4.

What is your due date?
☐ ☐ / ☐
☐ /
☐ ☐ ☐ ☐
M M
D
D
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Day: 777 = Refused to answer, 888= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
3rd pregnancy due date
DUDT3N3 cannot be earlier than DOB_13 (date of birth) or earlier than
POS1S_9 (date first tested positive) or > 10 months after IDATE (interview
date).
If DUDT3N3 < DOB_13 then READ, “The due date cannot be earlier than
respondent's date of birth. Please re-enter date.” Do not allow the program to
advance.
If DUDT3N3 < POS1S_9 (date first tested positive) then READ, “The due date
cannot be earlier than the date of respondent's first positive HIV test. Please
re-enter date.” Do not allow the program to advance.
If DUDT3N3 > 10 months after IDATE then READ, “The due date cannot be
more than 10 months after the interview date. Please re-enter date.” Do not
allow the program to advance.
If PREG_9 (number of times pregnant) > 3, go to INTNT4N3 (4th pregnancy
trying to get pregnant), else Skip to next topic (CO_BORN).

GR.5.0.

For the 4th pregnancy since testing positive for HIV, were you trying to get
pregnant?
No
0
Yes
1
Refused to answer
7
Don’t know
8

Label_KID3HVN3
Skip_KID3HVN3

DUDT3N3

Label_DUDT3N3
Hard_edit_DUDT3
N3

Skip_DUDT3N3

Fourth pregnancy
INTNT4N3

214

P a g e | 215
Label_INTNT4N3
OUTCM4N3

4th pregnancy trying to get pregnant.
GR.5.1.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY
ONE.]
Currently pregnant
1
Live birth
2
Stillbirth
3
Miscarriage
4
Abortion
5
Refused to answer
7
Don’t know
8
4th pregnancy outcome
If PREG_9 (number of times pregnant) > 4, then OUTCM4N3 cannot be 1
(currently pregnant). If PREG_9 > 4 and OUTCM4N3 is 1 (currently pregnant),
then READ “I am asking about the outcome of the fourth pregnancy that you
had.” Return to OUTCM4N3.
If OUTCM4N3 is 1 (Currently pregnant), then
skip to DUDT4N3. Else, go to PDTE4N3 (date of
fourth pregnancy outcome).

GR.5.2.

In what month and year did this outcome occur?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of fourth pregnancy outcome
Allow a blank response for month.
If month is blank for PDTE4N3 (date of fourth pregnancy outcome), use the
year values for the validation.
PDTE4N3 (date of fourth pregnancy outcome) cannot be earlier than DOB_13
(date of birth) or earlier than POS1S_9 (date first tested positive).
If PDTE4N3 (date of fourth pregnancy outcome) < DOB_13 (date of birth), then
READ, “The outcome date cannot be earlier than respondent's date of birth.
Please re-enter date.” Do not allow the program to advance.
If PDTE4N3 (date of fourth pregnancy outcome) < POS1S_9 (date first tested
positive) then READ, “The outcome date cannot be earlier than the date of
respondent's first positive HIV test. Please re-enter date." Do not allow the
program to advance.
If OUTCM4N3] was 2 (Live birth), then go to KID4HVN3; else Skip to INTNT5N3
(5th pregnancy trying to get pregnant). If Preg_9 (number of times pregnant) >
3, skip to next topic (CO_BORN).

GR.5.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
No
0
Yes
1
Indeterminate
2
Refused to answer
7
Don’t know
8

Label_OUTCM4N3
Hard_edit_OUTC
M4N3

Skip_OUTCM4N3

PDTE4N3

Label_PDTE4N3
QDS_programmin
g_PDTE4N3
Hard_edit_PDTE4
N3

Skip_PDTE4N3

KID4HVN3

215

P a g e | 216
Label_KID4HVN3
Skip_KID4HVN3

DUDT4N3

4th pregnancy vertical transmission.
If Preg_9 (number of times pregnant)>3 go to INTNT5N3 (5th pregnancy trying
to get pregnant), else Skip to next topic (CO_BORN).
GR.5.4.

What is your due date?
☐ ☐ / ☐
☐ /
☐ ☐ ☐ ☐
M M
D
D
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Day: 777 = Refused to answer, 888= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
4th pregnancy due date
DUDT4N3 cannot be earlier than DOB_13 (date of birth) or earlier than
POS1S_9 (date first tested positive) or > 10 months after IDATE (interview
date).
If DUDT4N3 < DOB_13 then READ, “The due date cannot be earlier than
respondent's date of birth. Please re-enter date.” Do not allow the program to
advance.
If DUDT4N3 < POS1S_9 (date first tested positive) then READ, “The due date
cannot be earlier than the date of respondent's first positive HIV test. Please
re-enter date.” Do not allow the program to advance.
If DUDT4N3 > 10 months after IDATE then READ, “The due date cannot be
more than 10 months after the interview date. Please re-enter date.” Do not
allow the program to advance.
If Preg_9 (number of times pregnant)>3 go to INTNT5N3 (5th pregnancy trying
to get pregnant), else Skip to next topic (CO_BORN).

GR.6.0.

For the 5th pregnancy since testing positive for HIV, were you trying to get
pregnant?
No
0
Yes
1
Refused to answer
7
Don’t know
8
5th pregnancy trying to get pregnant

GR.6.1.

What was the outcome of this pregnancy?
Currently pregnant
1
Live birth
2
Stillbirth
3
Miscarriage
4
Abortion
5
Refused to answer
7
Don’t know
8
5th pregnancy outcome
If PREG_9 (number of times pregnant) > 5, then OUTCM5N3 cannot be 1
(currently pregnant). If PREG_9 > 5 and OUTCM5N3 is 1 (currently pregnant),
then READ “I am asking about the outcome of the fifth pregnancy that you

Label_DUDT4N3
Hard_edit_DUDT4
N3

Skip_DUDT4N3

Fifth pregnancy
INTNT5N3

Label_INTNT5N3
OUTCM5N3

Label_OUTCM5N3
Hard_edit_OUTC
M5N3

216

P a g e | 217
had.” Return to OUTCM5N3.
If OUTCM5N3 is 1 (Currently pregnant), then skip to next topic (CO_BORN).
Else, go to PDTE5N3 (date of fifth pregnancy outcome).

Skip_OUTCM4N3

PDTE5N3

GR.6.2.

Label_PDTE5N3
QDS_programmin
g_PDTE5N3
Hard_edit_PDTE5
N3

PDTE5N3 (date of fifth pregnancy outcome) cannot be earlier than DOB_13
(date of birth) or earlier than POS1S_9 (date first tested positive).
If PDTE5N3 (date of fifth pregnancy outcome) < DOB_13 (date of birth) then
READ, “The outcome date cannot be earlier than respondent's date of birth.
Please re-enter date.” Do not allow the program to advance.
If PDTE5N3 (date of fifth pregnancy outcome) < POS1S_9 (date first tested
positive) then READ, “The outcome date cannot be earlier than the date of
respondent's first positive HIV test. Please re-enter date.” Do not allow the
program to advance. If month is blank for PDT53N3 (date of fifth pregnancy
outcome), use the year values for the validation.
If OUTCM5N3] was 2 (Live birth), then go to KID5HVN3; else Skip to next topic
(CO_BORN). If Preg_9 (number of times pregnant)>3 or Skip to next topic
(CO_BORN) if Preg_9 (number of times pregnant) = 3.

Skip_PDTE5N3

KID5HVN3

GR.6.3.

Was the child diagnosed with HIV?
No
0
Yes
1
Indeterminate
2
Refused to answer
7
Don’t know
8
5th pregnancy vertical transmission.
If Preg_9 (number of times pregnant)>3 go to next topic (CO_BORN), else Skip
to next topic (CO_BORN).

GR.6.4.

What is your due date?
☐ ☐ / ☐
☐ /
☐ ☐ ☐ ☐
M M
D
D
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Day: 777 = Refused to answer, 888= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
5th pregnancy due date
DUDT5N3 cannot be earlier than DOB_13 (date of birth) or earlier than
POS1S_9 (date first tested positive) or > 10 months after IDATE (interview
date).
If DUDT5N3 < DOB_13 then READ, “The due date cannot be earlier than
respondent's date of birth. Please re-enter date.” Do not allow the program to

Label_KID5HVN3
Skip_KID5HVN3

DUDT5N3

Label_DUDT5N3
Hard_edit_DUDT5
N3

217

In what month and year did this outcome occur?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y
Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of fifth pregnancy outcome
Allow a blank response for month.

P a g e | 218
advance.
If DUDT5N3 < POS1S_9 (date first tested positive) then READ, “The due date
cannot be earlier than the date of respondent's first positive HIV test. Please
re-enter date.” Do not allow the program to advance.
If DUDT5N3 > 10 months after IDATE then READ, “The due date cannot be
more than 10 months after the interview date. Please re-enter date.” Do not
allow the program to advance.

218

P a g e | 219

Foreign-born and immigration (L)
Start time of foreign-born and language ability module
ST_FRBRN = Current time
Start foreign-born and language ability.

Calculation_ST_
FRBRN
Label_ST_FRBR
N
Foreign born (LF)
Intro_CO_BORN
CO_BORN

“Now I’m going to ask you about where you were born.”
LF.1.0.

Label_CO_BORN
Skip_1CO_BORN

In what country or territory were you born? [DON’T READ RESPONSES. SELECT
ONLY ONE.]
United States
1
Puerto Rico
2
Mexico
3
Cuba
4
Other
5
Refused to answer
7
Don’t know
8
Country or territory of birth
If CO_BORN is 5 (other), then go to OTCTRY. Else, skip to Skip_2CO_BORN

OTCTRY

Specify other country

Label_OTCTRY
Skip_2CO_BORN

Other specify-country or territory of birth
If CO_BORN is 1 (United States), 7 (refused to answer), or 8 (don’t know), then
skip to Health conditions and preventive therapy (Calculation_ST_HLTCN). Else
go to US_YRS.

US_YRS

F.1.1.

Label_US_YRS
Interviewer_not
e_US_YRS
Range_US_YRS
Hard_edit_US_Y
RS

How many years have you been living in the United States?
[Years: 777 = Refused to answer, 888 = Don’t know]
Years living in the US
DISPLAY: If years living in the U.S. are less than 1 year, enter 0.
0–110.
US_YRS must be ≤ AGEIDATE (respondent’s age at the date of the interview). If
US_YRS is > than AGEIDATE, then READ, “The number of years you have been
living in the United States cannot be greater than your age.” The program
should return to US_YRS.

Immigration status (LI)
Intro_CIT_N5

“The next questions are about United States citizenship and permanent
residency status. These questions don’t determine if someone is in the country
legally. Your personal information will not be shared with anyone.”

P a g e | 220

CIT_N5

LI.1.0.

Label_ CIT_N5
Skip_ CIT_N5

GC_N5

Label_ GC_N5

LI.1.1.

Are you currently a United States citizen?
No
Yes
Refused to answer
Don’t know
US citizenship.
If CIT_N5= 1 (yes), then skip to next topic
(Intro_HPV_EVR).

0
1
7
8

Are you a permanent resident, that is, do you have a green card?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Permanent resident

P a g e | 221
Health conditions and preventive therapy (C)
Start time of health conditions and preventive therapy module
ST_ HLTCN = Current time
Start health conditions and preventive therapy.

Calculation_ST_
HLTCN
Label_ST_
HLTCN
HPV (CP)
Intro_HPV_EVR

HPV_EVR

“Now I’m going to ask about vaccinations. To begin, I’m going to ask about the
human papillomavirus or HPV vaccine. Other names for this vaccine are
Gardasil and Cervarix.”
CP.1.0.

Label_HPV_EVR

Have you ever had a vaccine for HPV?
No
Yes
Refused to answer
Don’t know
Ever had vaccine for HPV.

0
1
7
8

Tuberculosis (CT)
Intro_TESTPN13
TESTPN13

“Now I am going to ask you about tuberculosis, also called TB.”
CT.1.0.

Have you ever had a skin test for TB, sometimes called a PPD, or a blood test for
TB?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever had TB skin or blood test.
If TESTPN13 = 0 (no), 7 (refused to answer), or 8 (don’t know), then skip to next
topic (VACFL_10). Else, go to PPDMYN3.

CT.1.1.

What month and year did you have your most recent TB skin or blood test?
☐ ☐ /
☐ ☐ ☐ ☐
M M
Y
Y Y
Y
[Month: 77 = Refused to answer, 88= Don’t know;
Year: 7777 = Refused to answer, 8888 = Don’t know]
Date of most recent TB test.

Label_TESTPN13
Skip_TESTPN13

PPDMYN3

Label_PPDMYN
3
QDS_programmi
ng_PPDMYN3
Hard_edit_PPD
MYN3

Allow a blank response for month.
PPDMYN3 (date of most recent TB test) cannot be earlier than DOB_13 (date of
birth) or later than the IDATE (date of interview).
If PPDMYN3 (date of most recent TB test) is earlier than DOB_13 (date of birth),
then READ, “Your most recent TB test cannot be earlier than your date of

P a g e | 222
birth.” Return to PPDMYN3.
If PPDMYN3 (date of most recent TB test) is later than the IDATE (date of
interview), then READ, “Your most recent TB test cannot be later than today.”
Return to PPDMYN3.
PP_PSN13

CT.1.2.

Label_PP_PSN1
3
Intro_ACTVTBN
3

ACTVTBN3

Have you ever had a positive skin test or blood test for TB?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Ever had a positive TB skin or blood test.

“TB can live in the body for a long time without making a person sick, and the
only way we might know about it is through a skin or blood test. When TB does
make a person sick, we call it active TB."
CT.1.3.

Label_ACTVTBN
3

Have you ever been diagnosed with active TB?
No
Yes
Refused to answer
Don’t know
Diagnosed with active TB.

0
1
7
8

Influenza (CF)
VACFL_10

CF.1.0.

During the past 12 months, did you get a vaccine or shot to protect you from
seasonal flu?
No
0
Yes
1
Refused to answer
7
Don’t know
8
Influenza vaccination past 12 months.
If VACFL_10 = 0 (no), 7 (refused to answer) or 8 (don’t know), then skip to next
topic (Intro_EE). Else, go to LOCVA_10.

CF.1.1.

Where did you get your most recent seasonal flu vaccine? [READ RESPONSES.
SELECT ONLY ONE.]
Doctor’s office
1
Health department clinic
2
Drugstore or store (i.e. CVS, Walgreens, Target) 3
Employer
4
Other
5
Refused to answer
7
Don’t know
8
Type of place influenza vaccination received.

Label_VACFL_10
Skip_VACFL_10

LOCVA_10

Label_LOCVA_1
0

Page

Skip_LOCVA_lO

If LOCVA_lO is 5 (other), then go to LOC_lOOS. Else, skip to next topic
(Calculation_ST_COMPL).

LOC lOOS

Please tell me the type of place where you got your influenza vaccination.

Label LOC 100

Other specify-type of place influenza vaccination received.

s

I 223

P a g e | 224
Interview completion (E)
End time of interview
ST_COMP = Current time
End interview

Calculation_ST_
COMPL
Label_ST_COMP
End of Interview (EE)
Intro_EE

“Thank you again for taking part in this interview. Please remember that all the
information you have given me will be kept confidential.”
DISPLAY: Offer assistance with information and resources, according to local
protocol, but please be sure to record this information below.
Don’t pay the respondent if the respondent already participated in an MMP
interview during the [INSERT CYCLE YEAR] data collection cycle OR the
respondent is < 18 years old.
Pay the respondent if the interview was partially or fully completed.

Interviewer_not
e_EE

Data Validity (EV)
CONF

EV.1.0.

Label_CONF
ADDCOM1

Label_ADDCOM
1
QDS_programmi
ng_ADDCOM1

EV.2.0.

How confident are you of the validity of the respondent’s answers?
Confident
1
Some doubts
2
Not confident at all
3
Refused to answer
7
Don’t know
8
Validity confidence
Record any additional comments, including disruptions that might have taken
place during the interview, reason the interview might have been stopped, or
why the respondent’s answers may not have been reliable.
Additional comments
Include a 6 (not applicable) response option.

P a g e | 225
Referrals and follow-up (EO)
RFLNK_N5

EO.1.0.

Label_RFLNK_N
5
Skip_RFLNK_N5

If RFLNK_N5 is 8 (other), then go to RFLNOSN5. Else, skip to RFANS_N5
(referrals for ancillary services).

RFLNOSN5

RFANS_N5

Label_RFANS_N
5

Which of the following resources were or will be offered to the respondent to
facilitate linkage or re-engagement in care?
Give written information about HIV care
1
providers
Make appointment for respondent
2
Arrange transportation to appointment for
3
respondent
Arrange for someone to accompany respondent 4
to care appointment
Refer to case manager
5
Refer to patient navigator
6
Refer to other partner
7
Other
8
No intervention offered
9
Referrals for care linkage or re-engagement

Specify referrals for care linkage or re-engagement

EO.2.0.

Which of the following additional resources were or will be offered to the
respondent? [SELECT ALL THAT APPLY.]
HIV case management services
1
Adherence counseling
2
ADAP
3
Patient navigation
4
HIV peer group support
5
Dental care
6
Drug or alcohol counseling or treatment
7
Mental health services
8
Transportation
9
Shelter or housing services
10
SSI
11
SSDI
12
Food assistance
13
Meal or food services
14
Domestic violence services
15
Interpreter services
16
A lawyer or legal services
17
Tobacco cessation services
18
No referrals provided
19
referrals for ancillary services

P a g e | 226

2014 Calendar
January
S

M

T

5
12
19
26

6
13
20
27

7
14
21
28

April
S
M
6
13
20
27

7
14
21
28

July
S
M
6
13
20
27

7
14
21
28

T
1
8
15
22
29
T
1
8
15
22
29

W
1
8
15
22
29

W
2
9
16
23
30
W
2
9
16
23
30

R
2
9
16
23
30

R
3
10
17
24

R
3
10
17
24
31

F
3
10
17
24
31

F
4
11
18
25

F
4
11
18
25

S
4
11
18
25

S
5
12
19
26

S
5
12
19
26

October
S

M

T

5
12
19
26

6
13
20
27

7
14
21
28

W
1
8
15
22
29

R
2
9
16
23
30

F
3
10
17
24
31

S
4
11
18
25

March

February
S
M T

W

R

F

2
9
16
23

5
12
19
26

6
13
20
27

7
14
21
28

3
10
17
24

4
11
18
25

May
S
M

T

W

4
11
18
25

6
13
20
27

7
14
21
28

5
12
19
26

August
S
M
3
10
17
24
31

4
11
18
25

3
10
17
24

F
2
9
16
23
30

T

W

R

5
12
19
26

6
13
20
27

7
14
21
28

F
1
8
15
22
29

W

R

F

5
12
19
26

6
13
20
27

7
14
21
28

November
S
M T
2
9
16
23
30

R
1
8
15
22
29

4
11
18
25

S

M

T

W

R

F

2
9
16
23
30

3
10
17
24
31

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

S
1
8
15
22
29

S
3
10
17
24
31

June
S
1
8
15
22
29

M
2
9
16
23
30

T
3
10
17
24

W
4
11
18
25

R
5
12
19
26

F
6
13
20
27

S
7
14
21
28

S
2
9
16
23
30

September
S
M T
1
2
7
8
9
14 15 16
21 22 23
28 29 30

W
3
10
17
24

R
4
11
18
25

F
5
12
19
26

S
6
13
20
27

S
1
8
15
22
29

S
1
8
15
22

December
S
7
14
21
28

M
1
8
15
22
29

T
2
9
16
23
30

W
3
10
17
24
31

R
4
11
18
25

F
5
12
19
26

S
6
13
20
27

P a g e | 227
2015 Calendar
January
S

M

T

W

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

R
1
8
15
22
29

F
2
9
16
23
30

S
3
10
17
24
31

April
S

M

T

5
12
19
26

6
13
20
27

7
14
21
28

W
1
8
15
22
29

R
2
9
16
23
30

F
3
10
17
24

S
4
11
18
25

July
S

M

T

5
12
19
26

6
13
20
27

7
14
21
28

W
1
8
15
22
29

R
2
9
16
23
30

F
3
10
17
24
31

S
4
11
18
25

February
S
M
1
2
8
9
15 16
22 23

May
S
M

March
T
3
10
17
24

W
4
11
18
25

R
5
12
19
26

T

W

R

3
4
10 11
17 18
24 25
31
August
S
M

5
12
19
26

6
13
20
27

T

2
9
16
23
30

3
10
17
24
31

F
6
13
20
27

S
7
14
21
28

7
14
21
28

F
1
8
15
22
29

S
2
9
16
23
30

W

R

F

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

S
1
8
15
22
29

T
3
10
17
24

W
4
11
18
25

R
5
12
19
26

F
6
13
20
27

S
7
14
21
28

November

October
S

M

T

W

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

R
1
8
15
22
29

F
2
9
16
23
30

S
3
10
17
24
31

S
1
8
15
22
29

M
2
9
16
23
30

S
1
8
15
22
29

M
2
9
16
23
30

T
3
10
17
24
31

W
4
11
18
25

R
5
12
19
26

F
6
13
20
27

S
7
14
21
28

June
S
M
1
7
8
14 15
21 22
28 29

T
2
9
16
23
30

W
3
10
17
24

R
4
11
18
25

F
5
12
19
26

S
6
13
20
27

T
1
8
15
22
29

W
2
9
16
23
30

R
3
10
17
24

F
4
11
18
25

S
5
12
19
26

T
1
8
15
22
29

W
2
9
16
23
30

R
3
10
17
24
31

F
4
11
18
25

S
5
12
19
26

September
S

M

6
13
20
27

7
14
21
28

December
S

M

6
13
20
27

7
14
21
28

P a g e | 228

2016 Calendar
January
S
M

T

W

R

3
4
10 11
17 18
24 25
31
April
S
M

5
12
19
26

6
13
20
27

7
14
21
28

T

W

R

3
10
17
24

5
12
19
26

6
13
20
27

7
14
21
28

4
11
18
25

July
S
M

F
1
8
15
22
29

F
1
8
15
22
29

T

W

R

3
4
10 11
17 18
24 25
31
October
S
M

5
12
19
26

6
13
20
27

7
14
21
28

T

W

R

F

2
9
16
23
30

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

3
10
17
24
31

F
1
8
15
22
29

S
2
9
16
23
30

February
S
M
1
7
8
14 15
21 22
28 29

S
2
9
16
23
30

May
S
1
8
15
22
29

M
2
9
16
23
30

T
3
10
17
24
31

W
4
11
18
25

R
5
12
19
26

F
6
13
20
27

S
7
14
21
28

S
2
9
16
23
30

August
S
M
1
7
8
14 15
21 22
28 29

T
2
9
16
23
30

W
3
10
17
24
31

R
4
11
18
25

F
5
12
19
26

S
6
13
20
27

S
1
8
15
22
29

November
S
M T
1
6
7
8
13 14 15
20 21 22
27 28 29

T
2
9
16
23

W
3
10
17
24

R
4
11
18
25

F
5
12
19
26

S
6
13
20
27

March
S
M

T
1
8
15
22
29

W
2
9
16
23
30

R
3
10
17
24
31

F
4
11
18
25

S
5
12
19
26

June
S
M

T

5
12
19
26

7
14
21
28

W
1
8
15
22
29

R
2
9
16
23
30

F
3
10
17
24

S
4
11
18
25

September
S
M T

W

4
11
18
25

6
13
20
27

7
14
21
28

R
1
8
15
22
29

F
2
9
16
23
30

S
3
10
17
24

R
1
8
15
22
29

F
2
9
16
23
30

S
3
10
17
24
31

6
13
20
27

7
14
21
28

6
13
20
27

5
12
19
26

December
W
2
9
16
23
30

R
3
10
17
24

F
4
11
18
25

S
5
12
19
26

S

M

T

W

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

P a g e | 229

2017 Calendar
January
S
1
8
15
22
29

M
2
9
16
23
30

April
S
M
2
9
16
23
30

3
10
17
24

July
S
M
2
9
16
23
30

3
10
17
24
31

T
3
10
17
24
31

W
4
11
18
25

R
5
12
19
26

F
6
13
20
27

T

W

R

F

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

T

W

R

F

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

S
7
14
21
28

S
1
8
15
22
29

S
1
8
15
22
29

October
S
1
8
15
22
29

M
2
9
16
23
30

February
S
M T
5
12
19
26

6
13
20
27

May
S
M
1
7
8
14 15
21 22
28 29
August
S
M
6
13
20
27

7
14
21
28

7
14
21
28

T
2
9
16
23
30

T
1
8
15
22
29

March
W
1
8
15
22

W
3
10
17
24
31

W
2
9
16
23
30

R
2
9
16
23

R
4
11
18
25

R
3
10
17
24
31

F
3
10
17
24

F
5
12
19
26

F
4
11
18
25

S
4
11
18
25

S
6
13
20
27

S
5
12
19
26

November
T
3
10
17
24
31

W
4
11
18
25

R
5
12
19
26

F
6
13
20
27

S
7
14
21
28

S

M

T
7
14
21
28

W
1
8
15
22
29

R
2
9
16
23
30

F
3
10
17
24
31

S
4
11
18
25

5
12
19
26

6
13
20
27

June
S
M

T

W

4
11
18
25

6
13
20
27

7
14
21
28

R
1
8
15
22
29

F
2
9
16
23
30

S
3
10
17
24

September
S
M T

W

R

3
10
17
24

5
12
19
26

6
13
20
27

7
14
21
28

F
1
8
15
22
29

S
2
9
16
23
30

F
1
8
15
22
29

S
2
9
16
23
30

5
12
19
26

4
11
18
25

December

S

M

T

5
12
19
26

6
13
20
27

7
14
21
28

W
1
8
15
22
29

R
2
9
16
23
30

F
3
10
17
24

S
4
11
18
25

S

M

T

W

R

3
10
17
24
31

4
11
18
25

5
12
19
26

6
13
20
27

7
14
21
28

P a g e | 230

Response cards

Response Cards
Response Card A
Monthly Household Income

Yearly Household Income

a.

$0 to $416 per month

or

$0 to $4,999 per year

b.

$417 to $833 per month

or

$5,000 to $9,999 per year

c.

$834 to $1041 per month

or

$10,000 to $12,499 per year

d.

$1042 to $1249 per month

or

$12,500 to $14,999 per year

e.

$1250 to $1666 per month

or

$15,000 to $19,999 per year

f.

$1667 to $2083 per month

or

$20,000 to $24,999 per year

g.

$2084 to $2499 per month

or

$25,000 to $29,999 per year

h.

$2500 to $2916 per month

or

$30,000 to $34,999 per year

i.

$2917 to $3333 per month

or

$35,000 to $39,999 per year

j.

$3334 to $4166 per month

or

$40,000 to $49,999 per year

k.

$4167 to $4999 per month

or

$50,000 to $59,999 per year

l.

$5000 to $6249 per month

or

$60,000 to $74,999 per year

m.

$6250 or more per month

or

$75,000 or more per year

Response Card B
Individual Monthly Income

Individual Yearly Income

a.

$0 to $416 per month

or

$0 to $4,999 per year

b.

$417 to $833 per month

or

$5,000 to $9,999 per year

c.

$834 to $1041 per month

or

$10,000 to $12,499 per year

P a g e | 231

d.

$1042 to $1249 per month

or

$12,500 to $14,999 per year

e.

$1250 to $1666 per month

or

$15,000 to $19,999 per year

f.

$1667 to $2083 per month

or

$20,000 to $24,999 per year

g.

$2084 to $2499 per month

or

$25,000 to $29,999 per year

h.

$2500 to $2916 per month

or

$30,000 to $34,999 per year

i.

$2917 to $3333 per month

or

$35,000 to $39,999 per year

j.

$3334 to $4166 per month

or

$40,000 to $49,999 per year

k.

$4167 to $4999 per month

or

$50,000 to $59,999 per year

l.

$5000 to $6249 per month

or

$60,000 to $74,999 per year

m.

$6250 to $8332 per month

or

$75,000 to $99,999 per year

n.

$8333 or $12499 per month

or

$100,000 to $149,999 per year

o.

$12500 or $16666 per month

or

$150,000 to $199,999 per year

p.

$16667 or $20832 per month

or

$200,000 to $249,999 per year

q.

$20833 or more per month

or

$250,000 or more per year

Response Card C
Never
Rarely
About half the time
Most of the time
Always

P a g e | 232
Response Card D
Not at all
Several days
More than half the days
Nearly every day
Response Card E
≤24 years old
25-29 years old
30-34 years old
35-39 years old
40-44 years old
45-49 years old
>=50 years old
Response Card F
Strongly disagree
Somewhat disagree
Neutral
Somewhat agree
Strongly agree

Response Card G
Daily
Weekly
Monthly
Less than monthly

Page 1233
Never
AlcoholResponse Card

12 floz of
regular beer

about 5%
alcohol

-

8-9 floz of
malt liquor
(shown in a
12 oz glass)

about 7%
alcohol

5 fl oz of
table wine

about 12%
alcohol

1.5 floz shot of
80-proof spirits
("hard liquor"whiskey, gin, rum,
vodka, tequila, etc.)

about 40%
alcohol

The percent of "pure" alcohol, expressed here as alcohol by volume (alc/vol), varies by beverage.