Form Approved
OMB No. 0920-New
Expiration Date: XX/XX/XXXX
Understanding Decisions and Barriers about PrEP Use and Uptake Among Men Who Have Sex With Men
Attachment # 3e
Behavioral Assessment
Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)
iQual-PrEP Structured Response, Self-administered Behavioral Assessment
Based on your earlier responses, we are going to ask a few more questions about PrEP, or HIV pre-exposure prophylaxis. PrEP is a pill – sometimes referred to as Truvada – you can take every day and it will help prevent you from becoming infected if exposed to the HIV virus. In studies, it reduces a person’s chance of becoming infected by HIV by up to 92%.
[For those offered PrEP in past 6 months and refused, n=60]
A1. [If refuse…] What was the MAIN reason you refused PrEP in the past 6 months? (Select one)
___ I didn’t want to take a pill every day
___ Taking PrEP creates a bad image or reputation
___ Possible side effects
___ I didn’t believe the pill prevents HIV infection
___ Friends or family didn’t support it
___ I didn’t have enough information at the time
___ Cost
___ Other (specify) _____________________________
A2. [If refuse…] If you were offered PrEP by a provider or counselor now, do you think you would accept it?
☐ Yes ☐ No ☐ Unsure [If “No” or “Unsure,” Skip to A13]
A3. [If yes to A2…] If you agreed to take PrEP now, do you think you would start and continue using it over time?
☐ Yes ☐ No ☐ Unsure [If “No” or “Unsure,” Skip to A13]
A4. [If yes to A3…] What changed your mind about taking PrEP now? (specify) __________________________________________________________________________________
[For those who accepted PrEP in past 6 months but had unsuccessful uptake re algorithm, n=60]
A5. [If unsuccessful uptake via algorithm…] What was the MAIN reason you stopped [did not start] taking PrEP?
___ I didn’t want the hassle of taking a pill every day
___ Taking PrEP creates a bad image or reputation
___ Possible side effects
___ I didn’t believe the pill prevents HIV infection well
___ Friends or family didn’t support it
___ I didn’t have enough information at the time
___ Cost
___ Other (specify) _____________________________
A6. [If nonuptake…] If you were offered PrEP by a provider or counselor now, do you think you would take it?
☐ Yes ☐ No ☐ Unsure [If “No” or “Unsure,” Skip to A13]
A7. [If yes to A6…] If you agreed to take PrEP now, do you think you would start and continue using it over time?
☐ Yes ☐ No ☐ Unsure [If “No” or “Unsure,” Skip to A13]
A8. [If yes to A7…] What changed your mind about taking PrEP now? (specify) __________________________________________________________________________________
[For those not offered PrEP in past 6 months, n=160-180]
A9. Were you ever offered PrEP by a doctor or other health provider?
☐ Yes ☐ No ☐ Unsure [If “No” or “Unsure,” Skip to A13]
A10.. [If yes…] Did you accept a prescription for PrEP from that provider?
☐ Yes ☐ No ☐ Unsure [If “No” or “Unsure,” Skip to A13]
A11. [If yes…] Did you take any pills from a PrEP prescription given by that provider?
☐ Yes ☐ No ☐ Unsure [If “No” or “Unsure,” Skip to A13]
A12. [If yes…] Are you still taking pills now from a PrEP prescription given by that provider?
☐ Yes, always ☐ Yes, sometimes ☐ No ☐ Unsure
[All respondents]
A13. In your opinion, how many of your friends or acquaintances do you think have ever taken PrEP to prevent HIV infection?
__ None
__ A few
__ Some
__ Half
__ Most
__ Almost all
__ All
__ I don’t know
A14. In your opinion, how many gay or bisexual men in your community do you think have ever taken PrEP to prevent HIV infection?
__ None
__ A few
__ Some
__ Half
__ Most
__ Almost all
__ All
__ I don’t know
A15. Have you ever taken anti-HIV medication to prevent HIV infection that was not prescribed to you by a doctor or health provider?
☐ Yes ☐ No ☐ Unsure
A16. Has a friend or sex partner ever given you anti-HIV medication to prevent HIV infection?
☐ Yes ☐ No ☐ Unsure
A17. Which one of the following statements best reflects your current thoughts about PrEP for yourself. (select one)
I plan to never take PrEP
I plan to take PrEP someday
I plan to take PrEP in the next 6-12 months
I plan to take PrEP in the next 2-5 months
I plan to take PrEP within the next month
I don’t know enough about PrEP to answer
A18. Which one of the following statements best reflects your current thoughts about PrEP for gay and bisexual men overall. (select one)
PrEP is not good for any gay or bisexual men to use
PrEP is good for some gay or bisexual men to use
PrEP is good for most gay or bisexual men to use
PrEP is good for all gay or bisexual men to use
I don’t know enough about PrEP to answer
A19. Which one of the following statements best reflects your current thoughts about condom use for yourself. (select one)
I plan to never use condoms
I plan to use condoms someday
I plan to use condoms in the next 6-12 months
I plan to use condoms in the next 2-5 months
I plan to use condoms within the next month
I don’t know enough about condoms to answer
A20. Which one of the following statements best reflects your current thoughts about condom use for gay and bisexual men overall. (select one)
Condoms are not good for any gay or bisexual men to use
Condoms are good for some gay or bisexual men to use
Condoms are good for most gay or bisexual men to use
Condoms are good for all gay or bisexual men to use
I don’t know enough about condoms to answer
A21. If you were to start taking PrEP today, how ready would you be to do each of the following actions.
Meet with a doctor or other provider to discuss PrEP.
__ Not at all ready
__ A little ready
__ Somewhat ready
__ Mostly ready
__ Entirely ready
Get tested for HIV infection.
__ Not at all ready
__ A little ready
__ Somewhat ready
__ Mostly ready
__ Entirely ready
Take a PrEP pill every day for the next few months.
__ Not at all ready
__ A little ready
__ Somewhat ready
__ Mostly ready
__ Entirely ready
Attend monitoring appointments with a doctor or other provider every few months.
__ Not at all ready
__ A little ready
__ Somewhat ready
__ Mostly ready
__ Entirely ready
Tell your friends and family you are taking PrEP.
__ Not at all ready
__ A little ready
__ Somewhat ready
__ Mostly ready
__ Entirely ready
Tell your sex partners you are taking PrEP.
__ Not at all ready
__ A little ready
__ Somewhat ready
__ Mostly ready
__ Entirely ready
Continue to use condoms as much as you do now.
__ Not at all ready
__ A little ready
__ Somewhat ready
__ Mostly ready
__ Entirely ready
B1. What is the highest level of education that you have completed?
1 Less than high school
2 High school graduate or obtained GED
3 Some college, Associate’s Degree, or Technical Degree
4 Bachelor’s Degree / College Degree
5 Any post-graduate studies
99 I’d prefer not to answer
B2. Which of the following best describes your employment status? Are you:
1 Employed
full-time
2 Employed part-time
3 On active duty in the U.S. Armed forces, Reserves, or National Guard
4 Full-time Student
X Retired
5 Unable to work for health reasons
6 Unemployed
7 Other [specify below]
77 I don’t know
99 I’d prefer not to answer
B3. [If B2=Other] Please specify what best describes your employment status.
__________________
B4. What was your income last year from all sources before taxes?
1 0 to $4,999
2 $5,000 to $9,999
3 $10,000 to $14,999
4 $15,000 to $19,999
5 $20,000 to $29,999
6 $30,000 to $39,999
7 $40,000 to $49,999
8 $50,000 to $74,999
9 $75,000 or more
77 I don’t know
99 I’d prefer not to answer
B5. Which of the following best represents how you think of yourself?
1 Gay or homosexual
2 Straight or heterosexual
3 Bisexual
4 Other [specify below]
7 I don’t know
B6. [If B5=Other] Please specify ____________________________
B7. Are you currently homeless?
1 Yes
0 No
9 I’d prefer not to answer
B8. Do you currently have health insurance or health care coverage (including Medicare or Medicaid)?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
B8a. What kind of health insurance or coverage do you currently have?
1 A private health plan (through an employer or purchased directly)
2 Medicaid (for people with low incomes)
3 Medicare (for elderly people and people with disabilities)
4 Some other government plan
5 TRICARE (CHAMPUS)
6 Veteran Administration coverage
7 Some other health insurance plan
8 I don’t know
9 I’d prefer not to answer
B9. Have you ever been in jail or prison?
1 Yes
0 No
9 I’d prefer not to answer
We want to ask if you have had a primary male partner in the past 3 months that is since approximately [month and year]. By “primary” partner we mean a man you have lived with or have seen a lot, to whom you have felt a special emotional commitment for at least 3 months.
SX1. Have you had a primary male partner in the past three months?
0 No
1 Yes
Now we want to ask you about all the other men you have had any anal sex with in the past 3 months other than your most recent primary partner.
SX2. In the past 3 months, with how many men other than your most recent primary partner did you have any anal sex? This includes times when you were a top or bottom, used or didn't use a condom, and whether or not there was ejaculation.
____
SX3. [IF SX1=0 AND SEX2=0] You indicated you did not have any sex partners in the past 3 months, is this correct? (Choose one)
1 Yes [SKIP TO NEXT SECTION]
0 No, I want to change my answer [RETURN TO SX1]
SX4. [IF SX1 + SX2≠0] Thanks. So you indicated that in the past 3 months you had a total of [SX1 + SX2] male sex partners, including [SX1] primary partner and [SX2] casual partners. Is that correct?
1 Yes [if No primary partner, skip to p.14, SXCI.1, other male partners]
0 No, I want to change my answer [RETURN to SX1]
SECTION LOGIC FOR SXP1-SXP48: SX1=1; If SX1=0, Skip to SXCL1
SXP1. Throughout this next group of questions, your recent male primary partner will be referred to by his initials. Please put his initials here. Use AZ if you do not know his name.
_ _
SXP2. How old is [Response to SXP1]? If you are not sure, give it your best guess.
____
SXP3. What is [Response to SXP1]’s primary race/ethnicity? If you are not sure, give it your best guess.
1 African American or Black
2 Asian American or Pacific Islander
3 Latino, Hispanic, or Chicano
4 Native American, American Indian, or Alaska Native
5 White or European American
6 Mixed
7 Other [specify below]
99 I’d prefer not to answer
SXP4. [IF SXP3=Other] Please specify [Response to SXP1]’s race/ethnicity.
____________
SXP8. What is [Response to SXP1]’s HIV status?
1 Positive
2 Negative
3 You don’t know / are unsure about his HIV status
99 I’d prefer not to answer
SXP9. Did [Response to SXP1] TELL you his HIV-status?
1 Yes, and I have no reason to doubt him
2 Yes, but I have reason to doubt him
0 No
77 I’m not sure
99 I’d prefer not to answer
SXP10. Have you told [Response to SXP1] your current HIV status?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
PAGE LOGIC FOR SXP11-SXP14: SXP8=1
SXP11. Have you ever talked to [Response to SXP1] about whether he is taking antiretroviral medicines to treat his HIV?
1 Yes
0 No [If “No,” “Unsure,” or “I don’t know,” Skip to SXP14]
7 I don’t know
9 I’d prefer not to answer
SXP12. [If SXP11=1] In the past 3 months, that is since [month and year], have you talked to [Response to SXP1] about whether he is taking antiretroviral medicines to treat his HIV?
1 Yes
0 No [If “No,” “Unsure,” or “I don’t know,” Skip to SXP14]
7 I don’t know
9 I’d prefer not to answer
SXP13. [SXP11=1] Has [Response to SXP1] told you he was currently taking antiretroviral medicines to treat his HIV?
1 Yes, and I have no reason to doubt him
2 Yes, but I have reason to doubt him
0 No
7 I don’t know
9 I’d prefer not to answer
SXP14. [IF SXP13=1] Has [Response to SXP1] told you his viral load is undetectable?
1 Yes, and I have no reason to doubt him
2 Yes, but I have some reason to doubt him
0 No
7 I don’t know
9 I’d prefer not to answer
PAGE LOGIC FOR SXP15-SXP17: SXP8=2
SXP15. Have you ever talked to [Response to SXP1] about whether he is taking PrEP to prevent HIV?
1 Yes
0 No [If
“No,” “I don’t know,” or “I
prefer not to answer,” Skip to SXP18]
7 I don’t know
9 I’d prefer not to answer
SXP16. [IF SXP15=1] In the past 3 months, that is since [month and year], have you talked to [Response to SXP1] about whether he is taking PrEP to prevent HIV?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP18]
7 I don’t know
9 I’d prefer not to answer
SXP17. [IF SXP15=1] Has [Response to SXP1] told you he is currently taking PrEP to prevent HIV?
1 Yes, and I have no reason to doubt him
2 Yes, but I have reason to doubt him
0 No
7 I don’t know
9 I’d prefer not to answer
SXP18. In the past 3 months, that is since [month and year], have you had ANY anal sex with [Response to SXP1] in which a condom was not used from start to finish?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP22]
77 I don’t know
99 I’d prefer not to answer
SXP19. [If SXP18=1 Think of the times in the past 3 months that you had anal sex with [Response to SXP1] and did not use a condom from start to finish. Were you the top (you put your penis in his butt), the bottom (he put his penis in your butt), or both?
1 I was always the top
2 I was always the bottom
3 I was both the top and the bottom
7 I don’t know
9 I’d prefer not to answer
SXP20. [IF SXP18=1] Think of the times in the past 3 months that you had anal sex with [Response to SXP1] and did not use a condom from start to finish. Were you ever drunk or buzzed on alcohol within 2 hours before or during sex?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXP21. [IF SXP18=1] Think of the times in the past 3 months that you had anal sex with [Response to SXP1] and did not use a condom from start to finish. Did you ever use non-prescription drugs within 2 hours before or during sex?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
The following questions ask about the last time you had sex with your primary partner.
SXP22. How long ago was the last time you had any anal sex with [Response to SXP1]? That is, with or without a condom, and with or without ejaculation.
1 1 day
2 2 days
3 3 days
4 4 days
5 5 days
6 6 days
7 1 week
8 2 weeks
9 3 weeks
10 1 months
11 2 months
12 3 months
13 More than 3 months
99 I’d prefer not to answer
SXP23. During the most recent time you had anal sex with [Response to SXP1], were you the top (you put your penis in his butt)? This would be with or without a condom and with or without ejaculation.
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXP24. [If SXP24=1] Was a condom used from start to finish when you were the top?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXP25. During the most recent time you had anal sex with [Response to SXP1], were you the bottom (he put his penis in your butt}? This would be with or without a condom and whether or not you ejaculated.
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXP26. [IF SXP26=1] Was a condom used from start to finish when you were the bottom?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
PAGE LOGIC FOR SXP27-SXP29: D12≠1
SXP27. Were you taking PrEP medication to prevent HIV within 24 hours before or after the last time you had sex with [Response to SXP1]?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP30]
7 I don’t know
9 I’d prefer not to answer
SXP28. [IF SXP27=1] Were you taking your PrEP medication once a day as prescribed by your doctor, without missing any doses, in the 7 days before you last had anal sex with [Response to SEX5]?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXP29. [If SXP28=0] You mentioned that you were not taking your PrEP medication once a day as prescribed at the time of your last sexual encounter. In the 7 days before you last had anal sex with [Response to SXP1], on how days did you take your dose of PrEP?
____ (Number of days, up to 7)
PAGE LOGIC FOR SXP30-SXP32: SXP8=2
SXP30. Was [Response to SXP1] taking PrEP medication to prevent HIV within 24 hours before or after the time you last had anal sex?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP33]
7 I don’t know
9 I’d prefer not to answer
SXP31. [IF SXP30=1] To your knowledge, was [Response to SXP1] taking his PrEP medication once a day as prescribed by his doctor, without missing any doses, in the 7 days before you last had anal sex?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXP32. [If SXP31=0] You mentioned that [Response to SXP1] was not taking his PrEP medication once a day as prescribed at the time your last sexual encounter. To your knowledge, in the 7 days before you had anal sex together, on how many days did [Response to SXP1] take his dose of PrEP?
____ (Number of Days up to 7)
7 I don’t know
PAGE LOGIC FOR SXP33-SXP37: SXP8=1
SXP33. Was [Response to SXP1] taking antiretroviral medicines to treat his HIV infection within 24 hours before or after the time you last had anal sex?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP35]
7 I don’t know
9 I’d prefer not to answer
SXP34. [IF SXP33=1] To your knowledge, was [Response to SXP1] taking his HIV medicines exactly as prescribed by his doctor, without missing any doses, in the 7 days before you last had anal sex?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP36]
7 I don’t know
9 I’d prefer not to answer
SXP35. [If SXP33=0] You mentioned that [Response to SXP1] was not taking his HIV medicines exactly as prescribed at the time of your last sexual encounter. To your knowledge, in the 7 days before you last had anal sex, on how days did [Response to SXP1] take all of the doses of his HIV medicines?
____ (Number of Days up to 7)
SXP36. [IF SXP33=1] Did [Response to SXP1] tell you his viral load was undetectable before you last had anal sex?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXP37. [If SXP36=1] When was the last time [Response to SXP1] told you his viral load was undetectable?
1 Less than a week ago
2 More than a week ago but less than a month ago
3 One to three months ago
4 Four to six months ago
5 Seven to twelve months ago
6 More than a year ago
77 I don’t know
99 I’d prefer not to answer
SXP38. Were you drunk or buzzed on alcohol within two hours before or during the most recent time you had anal sex with [Response to SXP1]?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP40]
77 I don’t know
99 I’d prefer not to answer
SXP39. How many drinks did you have? By a drink, I mean a 12 oz. can or glass of beer, a 4 oz. glass of wine, a 1-1/2 oz. shot of liquor, or a mixed drink with that amount of liquor.
____ (number of drinks)
SXP40. Was [Response to SXP1] drunk or buzzed on alcohol within two hours before or during the most recent time you had anal sex?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXP41. Did you use any drug within two hours before or during the most recent time you had anal sex with [Response to SEX5]?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXP45]
77 I don’t know
99 I’d prefer not to answer
SXP42. Which drugs? (Check all that apply)
|
Selected |
Unselected |
Injected Methamphetamine or other amphetamine, injected (meth, speed, crystal, crank, ice) |
1 |
0 |
Methamphetamine or other amphetamine, smoked or snorted (meth, speed, crystal, crank, ice) |
1 |
0 |
Downers (Valium, Ativa, Xanax) |
1 |
0 |
Pain killers (Oxycontin, Percocet) |
1 |
0 |
Hallucinogens (LSD, mushrooms, Peyote, Mescaline) |
1 |
0 |
Ecstacy (E, X, MDMA) |
1 |
0 |
Club drugs (GHB, ketamine, special K) |
1 |
0 |
Marijuana (pot, weed) |
1 |
0 |
Poppers (amyl nitrate) |
1 |
0 |
PCP (angel dust, wet, wicky sticks) |
1 |
0 |
Synthetic marijuana (herbal incense, spice, K2) |
1 |
0 |
Crack, injected |
1 |
0 |
Crack, smoked or snorted |
1 |
0 |
Cocaine, injected |
1 |
0 |
Cocaine, smoked or snorted |
1 |
0 |
Heroin, injected |
1 |
0 |
Heroin, smoked or snorted |
1 |
0 |
Heroin and cocaine injected together (speedballs) |
1 |
0 |
Other |
1 |
0 |
I don’t know |
1 |
0 |
I’d prefer not to answer |
1 |
0 |
SXP43. [IF SXP42=Other] Please specify which other drugs you used.
_________________
SXP44. Did [Response to SXP1] use any drug within two hours before or during the most recent time you had anal sex?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXCL1]
77 I don’t know
99 I’d prefer not to answer
SXP45. Which drugs? (Check all that apply)
|
Selected |
Unselected |
Injected Methamphetamine or other amphetamine, injected (meth, speed, crystal, crank, ice) |
1 |
0 |
Methamphetamine or other amphetamine, smoked or snorted (meth, speed, crystal, crank, ice) |
1 |
0 |
Downers (Valium, Ativa, Xanax) |
1 |
0 |
Pain killers (Oxycontin, Percocet) |
1 |
0 |
Hallucinogens (LSD, mushrooms, Peyote, Mescaline) |
1 |
0 |
Ecstacy (E, X, MDMA) |
1 |
0 |
Club drugs (GHB, ketamine, special K) |
1 |
0 |
Marijuana (pot, weed) |
1 |
0 |
Poppers (amyl nitrate) |
1 |
0 |
PCP (angel dust, wet, wicky sticks) |
1 |
0 |
Synthetic marijuana (herbal incense, spice, K2) |
1 |
0 |
Crack, injected |
1 |
0 |
Crack, smoked or snorted |
1 |
0 |
Cocaine, injected |
1 |
0 |
Cocaine, smoked or snorted |
1 |
0 |
Heroin, injected |
1 |
0 |
Heroin, smoked or snorted |
1 |
0 |
Heroin and cocaine injected together (speedballs) |
1 |
0 |
Other |
1 |
0 |
I don’t know |
1 |
0 |
I’d prefer not to answer |
1 |
0 |
SXP46. [IF SXP47=Other] Please specify which other drugs [Response to SXP1] used.
_________________
SECTION LOGIC FOR SXCL1-SXCL: SX2 ≥ 1
You will now be asked more detailed questions about the last time you had condomless anal sex within the last THREE months with a man who was not your male primary partner.
That is, not someone you have lived with or have seen a lot, and to whom you have not felt a special emotional commitment. Think about the very last man you had any anal sex with in the last THREE months who was not your primary partner.
SXCL1. Throughout this next group of questions, this man will be referred to by his initials. Please put his initials here. Use AZ if you do not know his name.
_ _
SXCL2. How old is [Response to SXCL1]? If you are not sure, give it your best guess.
____
SXCL3. What is [Response to SXCL1]’s primary race/ethnicity? If you are not sure, give it your best guess.
1 African American or Black
2 Asian American or Pacific Islander
3 Latino, Hispanic, or Chicano
4 Native American, American Indian, or Alaska Native
5 White or European American
6 Mixed
7 Other
99 I’d prefer not to answer
SXCL4. [IF SXCL3=Other] Please specify [Response to SXCL1]’s race/ethnicity
__________
SXCL5. Where did you first meet [Response to SXCL1]?
1 A dating or hookup app/website for gay men, like Grindr or Jack’d
2 A social networking app or website for gay men (not for dating or hooking up)
3 A social networking app or website, like Facebook, Twitter, Instagram or Snapchat
4 Some other app or website
5 Work or school
6 Through family
7 Through a friend
8 A private party or social event
9 A public festival or community event, like Pride
10 A gay commercial venue, like a gay bar or dance club
11 A straight commercial venue, like a straight bar or dance club
12 A commercial sex venue, like a sex club or bath house
13 A public sex venue, like a park, beach, bathroom or tearoom
14 Other [specify below]
99 I’d prefer not to answer
SXCL6. [IF SXCL5=Other] Please specify where you first met [Response to SXCL1].
___________________
SXCL7. Think of the times in the past 3 months that you had anal sex with [Response to SXCL1] and did not use a condom from start to finish. Were you the top (you put your penis in his butt), the bottom (he put his penis in your butt), or both?
1 I was always the top
2 I was always the bottom
3 I was both the top and the bottom
7 I don’t know
9 I’d prefer not to answer
SXCL8. Think of the times in the past 3 months that you had anal sex with [Response to SXCL1] and did not use a condom from start to finish. Were you ever drunk or buzzed on alcohol within 2 hours before or during sex?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL9. Think of the times in the past 3 months that you had anal sex with [Response to SXCL1] and did not use a condom from start to finish. Did you ever use non-prescription drugs within 2 hours before or during sex?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL10. What is [Response to SXCL1]'s HIV status? (Choose one)
1 Positive
2 Negative
3 I don’t know or am unsure about his HIV status
99 I’d prefer not to answer
SXCL11. [IF SXCL10=1] Did [Response to SXCL1] actually TELL you his HIV status?
1 Yes, and I have no reason to doubt him
2 Yes, but I have reason to doubt him
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL12. Did you tell [Response to SXCL1] your current HIV status before the last time you had anal sex together?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL13. How long ago was the last time you had any anal sex with [Response to SXCL1]? That is, with or without a condom, and with or without ejaculation.
1 1 day
2 2 days
3 3 days
4 4 days
5 5 days
6 6 days
7 1 week
8 2 weeks
9 3 weeks
10 1 months
11 2 months
12 3 months
99 I’d prefer not to answer
SXCL14. During the last time you had any anal sex with [Response to SXCL1], where did you have sex? (Select one)
1 Your house or apartment or his house or apartment
2 Someone else's house or apartment
3 Hotel
4 Sex club or bathhouse
5 Bar, night club, or dance club
6 Health club or gym
7 Porn theatre/video arcade
8 Public bathroom
9 Park, woods, street, car or van
10 Other
77 I don’t know
99 I’d prefer not to answer
SXCL15. During the last time you had anal sex with [Response to SXCL1], were you the top (you put your penis in his butt)? This would be with or without a condom and with or without ejaculation.
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL16. [IF SXCL15=1] Was a condom used from start to finish?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL17. During the last time you had anal sex with [Response to SXCL1], were you the bottom (he put his penis in your butt}? This would be with or without a condom and whether or not you ejaculated.
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL18. [If SXCL17=1] Was a condom used from start to finish?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
PAGE LOGIC FOR SXCL19-SXCL21: D12 ≠ 1
SXCL19. Were you taking PrEP medication to prevent HIV within 24 hours before or after the time you last had anal sex with [Response to SXCL1]?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXCL22]
7 I don’t know
9 I’d prefer not to answer
SXCL20. [IF SXCL19=1] Were you taking your PrEP medication once a day as prescribed by your doctor, without missing any doses, in the 7 days before you last had anal sex with [Response to SXCL1]?
1 Yes [If “Yes,” “I don’t know,” or “I’d prefer not to answer,” Skip to SXCL22]
0 No
7 I don’t know
9 I’d prefer not to answer
SXCL21. [If SXCL20=0] You mentioned that you were not taking your PrEP medication once a day as prescribed at the time of your last sexual encounter. In the 7 days before you last had anal sex with [Response to SXCL1], on how days did you take your dose of PrEP?
____ (Number of days up to 7)
PAGE LOGIC FOR SXCL22-SXCL24: SXCL10=2
SXCL22. Was [Response to SXCL1], taking PrEP medication to prevent HIV within 24 hours before or after the time you last had anal sex?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXCL23. [IF SXCL22=1] To your knowledge, was [Response to SXCL1] taking his PrEP medication once a day as prescribed by his doctor, without missing any doses, in the 7 days before you last had anal sex?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXCL24. [If SXCL23=0] You mentioned that [Response to SXCL1] was not taking his PrEP medication once a day as prescribed at the time of your last sexual encounter. To your knowledge, in the 7 days before you last had anal sex, on how many days did [Response to SXCL1] take his dose of PrEP?
____ (Number of days up to 7)
PAGE LOGIC FOR SXCL25-SXCL29: SXCL10 = 1
SXCL25. Was [Response to SXCL1] taking antiretroviral medicines to treat his HIV infection within 24 hours before or after the time you last had anal sex?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXCL26. [IF SXCL25=1] To your knowledge, was [Response to SXCL1] taking his HIV medicines exactly as prescribed by his doctor, without missing any doses, in the 7 days before you last had anal sex?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXCL27. [If SXCL26=0] You mentioned that [Response to SXCL1] was not taking his HIV medicines exactly as prescribed at the time of your last sexual encounter. To your knowledge, in the 7 days before you last had anal sex, on how many days did [Response to SXCL1] take all of the doses of his HIV medicines?
____ (Number of days up to 7)
SXCL28. [IF SXCL25=1] Did [Response to SXCL1] tell you his viral load was undetectable prior to your last sexual encounter?
1 Yes
0 No
7 I don’t know
9 I’d prefer not to answer
SXCL29. [IF SXCL28=1] When was the last time [Response to SXCL1] told you his viral load was undetectable?
1 Less than a week ago
2 More than a week ago but less than a month ago
3 One to three months ago
4 Four to six months ago
5 Seven to twelve months ago
6 More than a year ago
7 Never
77 I don’t know
99 I’d prefer not to answer
SXCL30. Were you drunk or buzzed on alcohol within two hours before or during the last time you had anal sex with [Response to SXCL1]?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL31. [IF SXCL30=1] How many drinks did you have? By a drink, I mean a 12 oz. can or glass of beer, a 4 oz. glass of wine, a 1-1/2 oz. shot of liquor, or a mixed drink with that amount of liquor.
____
SXCL32. Was [Response to SXCL1] drunk or buzzed on alcohol within two hours before or during the last time you had anal sex?
1 Yes
0 No
77 I don’t know
99 I’d prefer not to answer
SXCL33. Did you use any drug within two hours before or during the last time you had anal sex with [Response to SXCL1]?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXCL36]
77 I don’t know
99 I’d prefer not to answer
SXCL34. [IF SXCL33=1] Which drugs? (Check all that apply)
|
Selected |
Unselected |
Injected Methamphetamine or other amphetamine, injected (meth, speed, crystal, crank, ice) |
1 |
0 |
Methamphetamine or other amphetamine, smoked or snorted (meth, speed, crystal, crank, ice) |
1 |
0 |
Downers (Valium, Ativa, Xanax) |
1 |
0 |
Pain killers (Oxycontin, Percocet) |
1 |
0 |
Hallucinogens (LSD, mushrooms, Peyote, Mescaline) |
1 |
0 |
Ecstacy (E, X, MDMA) |
1 |
0 |
Club drugs (GHB, ketamine, special K) |
1 |
0 |
Marijuana (pot, weed) |
1 |
0 |
Poppers (amyl nitrate) |
1 |
0 |
PCP (angel dust, wet, wicky sticks) |
1 |
0 |
Synthetic marijuana (herbal incense, spice, K2) |
1 |
0 |
Crack, injected |
1 |
0 |
Crack, smoked or snorted |
1 |
0 |
Cocaine, injected |
1 |
0 |
Cocaine, smoked or snorted |
1 |
0 |
Heroin, injected |
1 |
0 |
Heroin, smoked or snorted |
1 |
0 |
Heroin and cocaine injected together (speedballs) |
1 |
0 |
Other [specify below] |
1 |
0 |
I don’t know |
1 |
0 |
I’d prefer not to answer |
1 |
0 |
SXCL35.
[IF SXCL34=Other] Please specify which other drugs.
____________________
SXCL36. Did [Response to SXCL1] use any drug within two hours before or during the most recent time you had sex?
1 Yes
0 No [If “No,” “I don’t know,” or “I prefer not to answer,” Skip to SXW1]
77 I don’t know
99 I’d prefer not to answer
SXCL37. [If SXCL36=1] Which drugs? (Check all that apply)
|
Selected |
Unselected |
Injected Methamphetamine or other amphetamine, injected (meth, speed, crystal, crank, ice) |
1 |
0 |
Methamphetamine or other amphetamine, smoked or snorted (meth, speed, crystal, crank, ice) |
1 |
0 |
Downers (Valium, Ativa, Xanax) |
1 |
0 |
Pain killers (Oxycontin, Percocet) |
1 |
0 |
Hallucinogens (LSD, mushrooms, Peyote, Mescaline) |
1 |
0 |
Ecstacy (E, X, MDMA) |
1 |
0 |
Club drugs (GHB, ketamine, special K) |
1 |
0 |
Marijuana (pot, weed) |
1 |
0 |
Poppers (amyl nitrate) |
1 |
0 |
PCP (angel dust, wet, wicky sticks) |
1 |
0 |
Synthetic marijuana (herbal incense, spice, K2) |
1 |
0 |
Crack, injected |
1 |
0 |
Crack, smoked or snorted |
1 |
0 |
Cocaine, injected |
1 |
0 |
Cocaine, smoked or snorted |
1 |
0 |
Heroin, injected |
1 |
0 |
Heroin, smoked or snorted |
1 |
0 |
Heroin and cocaine injected together (speedballs) |
1 |
0 |
Other [specify below] |
1 |
0 |
I don’t know |
1 |
0 |
I’d prefer not to answer |
1 |
0 |
SXCL38. Please specify which other drugs.
_________________
SXW1. In the past 3 months, that is since [month and year] with how many women have you had sex? Include only women with whom you had vaginal or anal sex, with or without a condom, and with or without ejaculation.
___ [IF 0 SKIP to C1]
SXW2. Of the [Response to SXW1] women you have had sex with in the past three months, with how many did you have any sex in which a condom was not used from start to finish?
____
SXW3. Have you been in a primary relationship with a woman in the last three months? This would be a woman you have lived with or have seen a lot, and to whom you have felt a special emotional commitment in the last three months.
1 Yes
0 No [If “No,” or “I prefer not to answer,” Skip to SXW5]
99 I’d prefer not to answer
SXW4. Are you still in this primary relationship with your most recent primary female partner?
1 Yes
0 No
99 I’d prefer not to answer
SXW5. What is her HIV status? (Choose one)
1 Positive
2 Negative [If “No,” “I don’t know…,” or “I prefer not to answer,” Skip to C1]
3 I don’t know or am unsure about her HIV status
99 I’d prefer not to answer
SXW6. [IF SXw5=1] Did she actually TELL you her HIV status?
1 Yes, and I have no reason to doubt her
2 Yes, but I have reason to doubt her
0 No
77 I don’t know
99 I’d prefer not to answer--------------------------------------------
C. Future Prevention Methods
Condoms
C1. How likely are you to use condoms to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
Oral PrEP
C2. How likely are you to use PrEP to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
On Demand PrEP
Researchers are also working on a form of PrEP that you would take only around the times you have sex. You would take two pills within 24 hours before sex and then two separate one-pill doses in the two days after sex.
C3. How likely would you be to use this type of PrEP that is taken only around the time you have sex?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
Injectable PrEP
Researchers are working on a form of PrEP that a doctor would give as a shot into your arm. You would need to get the shot every 1 to 3 months to reduce your risk of getting HIV.
C4. How likely would you be to use this injectable form of PrEP to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
Gel PrEP
Researchers are also working on a form of PrEP that is a gel you would apply to the penis (like lubricant or lube) or put into the rectum with an applicator before and/or after sex to reduce the risk of getting HIV.
C5. How likely would you be to use a gel form of PrEP that you apply to your penis like lube before having insertive anal sex (topping) to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
C6. How likely would you be to use a gel form of PrEP that you apply to your penis like lube after having insertive anal sex (topping) to reduce the risk of getting HIV?
__Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
C7. How likely would you be to use a gel form of PrEP that you squeeze into your rectum using an applicator before receptive sex (bottoming) to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
C8. How likely would you be to use a gel form of PrEP that you squeeze into your rectum using an applicator after receptive sex (bottoming) to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
Rectal Suppository PrEP
Researchers are also working on a form of PrEP that you would put in your rectum as a suppository. The suppository would be the size of a daily vitamin pill. You would have to put it in your rectum at least 30 minutes before having receptive anal sex (bottoming) to be sure it dissolved in time to reduce the risk of getting HIV.
C9. How likely would you be to use a suppository form of PrEP that you insert into your rectum to dissolve 30 minutes before having receptive anal sex (bottoming) to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
C10. How likely would you be to use a suppository form of PrEP that you insert into your rectum to dissolve within three hours after having receptive anal sex (bottoming) to reduce the risk of getting HIV?
__ Very likely
__ Somewhat likely
__ Neither likely or unlikely
__ Somewhat unlikely
__ Very unlikely
Prevention Method Preferences
C11. Below is a list of prevention methods that includes the currently available daily PrEP pill, condoms, and all the other forms of PrEP that researchers are working on. Please rank them in your order of preference, from 1 (first choice) to 8 (last choice). Drag each method to the second column to show your order of preference.
__ Daily PrEP (a pill that you take every day)
__ Event-level PrEP (two pills before sex and one pill for two days after sex)
__ Injectible PrEP (a shot you receive every 1-3 months)
__ Rectal suppository PrEP that is used before sex (a pill-size dose you put in your rectum)
__ Rectal suppository PrEP that is used after sex (a pill-size dose you put in your rectum)
__ Rectal gel PrEP before sex (a gel that you squeeze into your rectum with an applicator)
__ Rectal gel PrEP after sex (a gel that you squeeze into your rectum with an applicator)
__ Condoms
Ranking of Prevention Method Characteristics
C12. Listed below are general qualities of prevention methods. Please rank them in your order of the qualities most important to you, from 1 (most important) to 7 (least important). Drag each quality to the second column to show your order of importance.
__ Effective against HIV
__ Effective against other STDs
__ Doesn’t reduce physical pleasure
__ Doesn’t break the mood of sex
__ You control it, not your partner
__ Your partner controls it, not you
__ Recommended by experts
Risk Compensation
C13. If you had a choice of using condoms during anal sex or taking a pill every day to prevent HIV infection, both at no cost, which would you choose?
___ Condoms only
___ Daily pill only
___ Both condoms and daily pill
___ Neither (specify why) __________________________________
___ Refused
Hypothetical Context: Event-level PrEP vs. Condom
C14. Now we want you to think about a specific situation. Imagine you just met a hot guy and you both want to have anal sex right now, but you haven’t talked about HIV status. If there was a pill you could take -- only once before and after sex -- that was as effective as using a condom, which would you use?
___ A pill once before and after anal sex
___ A condom during anal sex
___ Both a pill and condom
___ Neither (specify why) _____________________________________
___ Refused
D. Psychosocial Covariates
Perceived HIV Disease Severity
Please answer the next questions by indicating how much you agree with each statement. Answer on a scale from 1 to 5 where '1' indicates you do not agree at all and '5' indicates that you strongly agree.
|
1 |
2 |
3 |
4 |
5 |
8 |
|
Strongly Disagree |
Somewhat Disagree |
Neither |
Somewhat Agree |
Strongly Agree |
Refuse to Answer |
D1. [HIV-] Because of medication to treat HIV, I am less concerned about becoming infected with HIV. (Choose one) |
|
|
|
|
|
|
Condom Use Perceived Norms & Self Efficacy
D2. A lot of my friends use condoms. (Choose one) |
|
|
|
|
|
|
D3. I can choose condom use with a man I have sex with regularly. (Choose one) |
|
|
|
|
|
|
D4. Someone can talk me out of using condoms by persuading me they are the same HIV status as me. (Choose one) |
|
|
|
|
|
|
D5. If I ever did something sexually risky, I am confident that I would go back to using condoms right away. (Choose one) |
|
|
|
|
|
|
D6. I am confident that I can use condoms even if my partner really doesn't want to. (Choose one) |
|
|
|
|
|
|
D7. Most gay men do not use condoms anymore. (Choose one) |
|
|
|
|
|
|
D8. Most gay men I meet only use condoms still. (Choose one) |
|
|
|
|
|
|
D9. A lot of gay men just will not have sex with you if you insist on a condom. (Choose one) |
|
|
|
|
|
|
Generic Medication Adherence
D10. Have you ever been prescribed any other medicine by a doctor or other health provider?
__ Yes __ No __ Unsure [If “No” or “Unsure,” Skip to D15]
For the next 4 questions, think about times when you were prescribed medicine by a doctor or other health provider when you were sick or for an ongoing condition.
D11. Do you ever forget to take your medicine?
1 Yes
2 No
8 Refused to answer
D12. Do you ever have problems taking your medicine?
1 Yes
2 No
8 Refused to answer
D13. When you feel better, do you sometimes stop taking your medicine before you should?
1 Yes
2 No
8 Refused to answer
D14. Sometimes if you feel worse when you take your medicine, do you stop taking it?
1 Yes
2 No
8 Refused to answer
Difficulty Communicating with Doctor
READ: For the next four questions, you will be asked about your visits with your doctor. Please indicate how much you AGREE or DISAGREE with the following statements.
|
1 |
2 |
3 |
4 |
8 |
|
Agree a lot |
Agree a little |
Disagree a little |
Disagree a lot |
Refuse to Answer |
D15. Sometimes I don’t ask my doctor questions. |
|
|
|
|
|
D16. Sometimes I don’t understand my doctor’s instructions. |
|
|
|
|
|
D17. Sometimes I don’t remember my doctor’s instructions. |
|
|
|
|
|
D18. Sometimes I don’t tell my doctor personal information. |
|
|
|
|
|
D19. Sometimes I don’t ask my doctor for help if I need it. |
|
|
|
|
|
Engagement in Care/Testing
D20. In the past two years, that is since [mm/yyyy], how often have you seen a doctor or a nurse for healthcare?
__ At least once every 3 months
__ At least once every 6 months, but not every 3 months
__ At least once a year, but not every 6 months
__ Less than once a year
__ I haven’t been to a provider in the past 2 years [skip to D24]
D21. In the past two years [since date], when you saw a doctor or a nurse, were they:
__ The same doctor or nurse every time
__ A different doctor or nurse every time
__ I try to see the same one, but they are not always available
D22. In the past two years [since date}, when you needed healthcare, have you:
__ Gone to the same place for healthcare, e.g. a hospital, clinic, or urgent care setting
__ Gone to a different place each time
__ I try to go to the same place, but sometimes that isn’t possible
D23. In the past two years [since date], when you have seen a doctor or nurse, what did you see them for?
__ A regularly scheduled check-up
__ An emergency illness/accident
__ A combination of regularly scheduled check-up and emergency illnesses
D24. Do you trust doctors and nurses to have your best interest at heart?
__ Yes, I trust my doctors and nurses
__ I trust some of my doctors and nurses, but not others
__ No, I do not trust doctors and nurses
D25. In the past two years [since date], how often have you gotten tested for HIV?
__ At least every 3 months
__ At least every 6 months, but not every 3 months
__ At least once a year, but not every 6 months
__ Less than once a year
__ I haven’t gotten tested for HIV in the past 2 years [skip to D27]
D26. In the past two years [since date], when you have gotten tested for HIV, do you go to:
__ The same HIV testing location every time
__ A different location every time
__ Sometimes the same/sometimes different locations
D27. Do you trust the HIV test counselors to have your best interest at heart?
__ Yes, I trust my HIV test counselors
__ I trust some of my HIV test counselors, but not others
__ No, I do not trust HIV test counselors
Thank you for your valuable input on this survey!
####
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ptomey, Natasha (CDC/OID/NCHHSTP) (CTR) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |