Consent Form (consent is embedded in the screenshots)

1

Development of Messages for the Let’s Stop HIV Together National Campaign

(OMB No. 0920-0920)

Attachment 1: Consent Form Text

Introduction and Purpose: You have been asked to take part in an online survey about HIV-related topics, messages, and ads. If you take part, you will be one of about 1,000 people to do so. RTI International, a nonprofit research organization in North Carolina, is conducting the survey. The survey is sponsored by the Centers for Disease Control and Prevention (CDC).  

Procedures: We will first ask you some questions to find out if you are eligible to participate in this survey which should take about 2 minutes. If you are eligible, we will ask you to complete a 30-minute survey. The survey asks questions about HIV knowledge, attitudes, and beliefs and for your opinions about messages and ads about preventing HIV. Some of the questions are about sensitive topics, including HIV testing, HIV status, sexual orientation, and risk behaviors. It is your choice to participate in the study. You will not be contacted in the future about this study after your participation ends.

Risk/Discomforts: You might feel embarrassed or upset by some of the questions that will be asked. You can decline to answer any questions for any reason, and you can stop participating at any time without penalty.

Benefits: You will not get any personal benefit from taking part in this study. However, your responses are very important because they will help CDC understand how people may respond to potential messages that could be used to prevent HIV.

Token of Appreciation: We will give you the points redeemable for merchandise specified in the invitation you received to participate in this survey.

Privacy and Confidentiality: The privacy and confidentiality of your information is very important to us, and we are committed to maintaining a secure environment in which you can participate. All information collected in this survey will be kept confidential to the extent provided by law. Only Qualtrics knows your name and e‑mail address; RTI and CDC cannot access this information. Only RTI and CDC can access the survey data; Qualtrics cannot access this information. This means that your name and email address cannot be linked to your survey answers.

Qualtrics will record participants’ IP addresses to help make sure that people do not complete the study more than once. IP addresses will be destroyed by Qualtrics and RTI after all data are collected so that they cannot be linked to survey answers. CDC will not have access to IP addresses.

To help protect your privacy, take the survey in a private location, such as your own home and/or in a room with a door, and close your browser window when you are finished or if you decide to stop participating after you already started.

Persons to Contact: If you have questions about the survey, you can call Dr. Jennifer Uhrig at 1-800-334-8571, extension 2-3311. She can be reached between 9 a.m. and 5 p.m., Eastern Standard Time, Monday–Friday. If you have questions about your rights as a participant, you can call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

Consent: I understand that it is my choice to take this survey. I may choose not to take the survey, not to answer any question, or stop taking the survey at any time.

Please choose one:

• I have read this consent form and agree to participate in the survey.

• I have read this consent form and do not want to participate in the survey.