MMP Questionnaire 2018

2018

QUESTIONNAIRE | Version 14.1.0

OMB No: 0920-0740 Expiration: XX/XX/XXXX
Public reporting burden of this collection of information is estimated to average 45 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, Project Clearance Officer, 1600 Clifton Road,
MS D–74, Atlanta, GA 30329, ATTN: PRA (0920–0740). Do not send the completed form to this address.
CS270337B

Table of Contents

.............................................................................................................................................................................
PRELIMINARY INFORMATION (I)
1
.............................................................................................................................................................................
Prior to interview (IP)
1
.............................................................................................................................................................................
Introduction (IN)
4
.............................................................................................................................................................................
ELIGIBILITY CRITERIA (Y)
5
.............................................................................................................................................................................
Age (YA)
5
.............................................................................................................................................................................
Residence (YS)
6
.............................................................................................................................................................................
MMP participation (YM)
12
.............................................................................................................................................................................
BASIC DEMOGRAPHICS (D)
13
.............................................................................................................................................................................
Education (DE)
13
.............................................................................................................................................................................
Race-ethnicity (DR)
13
.............................................................................................................................................................................
Gender and sexual orientation (DG)
15
.............................................................................................................................................................................
Language ability (DL)
15
.............................................................................................................................................................................
U.S. born (DF)
16
.............................................................................................................................................................................
Marriage status (DM)
17
.............................................................................................................................................................................
Homeless (DH)
17
.............................................................................................................................................................................
Incarceration (DJ)
18
.............................................................................................................................................................................
DISABILITY (A)
20
.............................................................................................................................................................................
Disability (A)
20
.............................................................................................................................................................................
FINANCIAL (F)
22
.............................................................................................................................................................................
Employment (FE)
22
.............................................................................................................................................................................
Income (FI)
22
.............................................................................................................................................................................
Food security (FS)
23
.............................................................................................................................................................................
Healthcare coverage (FH)
23
.............................................................................................................................................................................
GENERAL MEDICAL CARE (J)
28
.............................................................................................................................................................................
Health and well-being (JW)
28
.............................................................................................................................................................................
ER and hospitalizations (JH)
28
.............................................................................................................................................................................
Influenza (JF)
28
.............................................................................................................................................................................
Prescription medicines (JP)
29
.............................................................................................................................................................................
Health literacy (JL)
30
.............................................................................................................................................................................
HIV CARE (K)
31
.............................................................................................................................................................................
Diagnosis date (KD)
31
.............................................................................................................................................................................
Ever care (KE)
32
.............................................................................................................................................................................
Linkage to care (KL)
32
.............................................................................................................................................................................
Care utilization (KU)
33
.............................................................................................................................................................................
Care satisfaction (KS)
34
.............................................................................................................................................................................
Patient-provider relationship (KB)
35
.............................................................................................................................................................................
Barriers and facilitators to care (KP)
37
.............................................................................................................................................................................
HIV TREATMENT AND ADHERENCE (T)
39
.............................................................................................................................................................................
Ever ART (TE)
39
.............................................................................................................................................................................
Current ART (TC)
40
.............................................................................................................................................................................
Adherence (TA)
42
.............................................................................................................................................................................
HIV treatment as prevention (TB)
45

.............................................................................................................................................................................
SEXUAL BEHAVIOR (S)
46
.............................................................................................................................................................................
Total sex partners (ST)
46
.............................................................................................................................................................................
Exchange sex (SE)
48
.............................................................................................................................................................................
Names of partners (SN)
49
.............................................................................................................................................................................
Partner demographics #1 (SP)
52
.............................................................................................................................................................................
Vaginal sex #1 (SV)
54
.............................................................................................................................................................................
Anal sex #1 (SL)
56
.............................................................................................................................................................................
Transgender and unknown gender sex #1 (SG)
61
.............................................................................................................................................................................
Status #1 (SS)
63
.............................................................................................................................................................................
Pre-exposure prophylaxis #1 (SR)
64
.............................................................................................................................................................................
Partner demographics #2 (SP)
64
.............................................................................................................................................................................
Vaginal sex #2 (SV)
66
.............................................................................................................................................................................
Anal sex #2 (SL)
68
.............................................................................................................................................................................
Transgender and unknown gender sex #2 (SG)
73
.............................................................................................................................................................................
Status #2 (SS)
75
.............................................................................................................................................................................
Pre-exposure prophylaxis #2 (SR)
76
.............................................................................................................................................................................
Partner demographics #3 (SP)
76
.............................................................................................................................................................................
Vaginal sex #3 (SV)
78
.............................................................................................................................................................................
Anal sex #3 (SL)
80
.............................................................................................................................................................................
Transgender and unknown gender sex #3 (SG)
85
.............................................................................................................................................................................
Status #3 (SS)
87
.............................................................................................................................................................................
Pre-exposure prophylaxis #3 (SR)
88
.............................................................................................................................................................................
Partner demographics #4 (SP)
88
.............................................................................................................................................................................
Vaginal sex #4 (SV)
90
.............................................................................................................................................................................
Anal sex #4 (SL)
92
.............................................................................................................................................................................
Transgender and unknown gender sex #4 (SG)
97
.............................................................................................................................................................................
Status #4 (SS)
99
.............................................................................................................................................................................
Pre-exposure prophylaxis #4 (SR)
100
.............................................................................................................................................................................
Partner demographics #5 (SP)
100
.............................................................................................................................................................................
Vaginal sex #5 (SV)
102
.............................................................................................................................................................................
Anal sex #5 (SL)
104
.............................................................................................................................................................................
Transgender and unknown gender sex #5 (SG)
109
.............................................................................................................................................................................
Status #5 (SS)
111
.............................................................................................................................................................................
Pre-exposure prophylaxis #5 (SR)
112
.............................................................................................................................................................................
Aggregate information (SA)
112
.............................................................................................................................................................................
Serosorting (SO)
113
.............................................................................................................................................................................
MSM sex ever (ME)
114
.............................................................................................................................................................................
Disclosure of same sex attraction (RC)
115
.............................................................................................................................................................................
PREVENTION ACTIVITIES (PA)
117
.............................................................................................................................................................................
Prevention messages (PM)
117
.............................................................................................................................................................................
Risk reduction (PR)
118
.............................................................................................................................................................................
VIOLENCE (P)
120
.............................................................................................................................................................................
Physical violence (PV)
120

.............................................................................................................................................................................
Sexual violence (PS)
120
.............................................................................................................................................................................
DEPRESSION AND ANXIETY (M)
122
.............................................................................................................................................................................
PHQ-4 screening questions (MD)
122
.............................................................................................................................................................................
PHQ-8 depression (MA)
123
.............................................................................................................................................................................
GAD-7 anxiety (MG)
124
.............................................................................................................................................................................
ALCOHOL, SMOKING, AND DRUG USE (U)
126
.............................................................................................................................................................................
Alcohol use (UA)
126
.............................................................................................................................................................................
Cigarette and tobacco use (US)
127
.............................................................................................................................................................................
Non-injection drug use (UN)
129
.............................................................................................................................................................................
Injection drug use (UI)
132
.............................................................................................................................................................................
STIGMA AND DISCRIMINATION (R )
136
.............................................................................................................................................................................
Stigma (RS)
136
.............................................................................................................................................................................
Discrimination (RD)
139
.............................................................................................................................................................................
GYNECOLOGICAL AND REPRODUCTIVE HISTORY (G)
142
.............................................................................................................................................................................
Gynecological care (GH)
142
.............................................................................................................................................................................
Contraception (GC)
143
.............................................................................................................................................................................
Reproductive history (GR)
145
.............................................................................................................................................................................
MET AND UNMET NEEDS (N)
154
.............................................................................................................................................................................
Services and assistance programs (ND)
154
.............................................................................................................................................................................
Other disability (NS)
166
.............................................................................................................................................................................
INTERVIEW COMPLETION (E )
168
.............................................................................................................................................................................
End of interview (EE)
168
.............................................................................................................................................................................
Referrals and follow-up (EO)
168
.............................................................................................................................................................................
Data validity (EV)
172
.............................................................................................................................................................................
Local questions (EL)
172
.............................................................................................................................................................................
2016 CALENDAR
A-1
.............................................................................................................................................................................
2017 CALENDAR
B-1
.............................................................................................................................................................................
2018 CALENDAR
C-1
.............................................................................................................................................................................
RESPONSE CARDS
E-1

Page | 1

Module: Preliminary information (I)
Topic: Prior to interview (IP)
Calculation_AGEIDATE

I.1.0.

Label_Calculation_AGEIDATE
Calculation_IDATE7

I.2.0.

Calculate the date 7 days prior to IDATE (interview date). Example, if IDATE is 12/08/2016,
then IDATE7 is 12/01/2016. Coding should take into account leap years.
7 days prior to interview date.

I.3.0.

Calculate the date 12 months prior to IDATE (interview date). Example, if IDATE is
12/02/2016, then IDATE12 is 12/02/2015. Coding should take into account leap years.
12 months prior to interview date

Label_Calculation_IDATE7
Calculation_IDATE12

Label_Calculation_IDATE12
Calculation_IDATE24

I.4.0.

Label_Calculation_IDATE24
Calculation_LANGUAG

Calculate the respondent’s age at the time of the interview using DOB_13 (date of birth)
and IDATE (interview date).
Respondent’s age at date of interview.

I.5.0.

Calculate the date 24 months prior to IDATE (interview date). Example, if IDATE is
12/02/2016, then IDATE24 is 12/02/2014. Coding should take into account leap years.
24 months prior to interview date.

Label_Calculation_LANGUAG

If the English version of the questionnaire is used, then LANGUAG=EN. If the Spanish
version of the questionnaire is used, then LANGUAG=SP.
Language of questionnaire.

Calculation_LASTYEAR
I.6.0.
Label_Calculation_LASTYEAR

Calculate last calendar year: LASTYEAR= (Current year) - 1.
Last calendar year.

Calculation_QDSVERN3

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.

I.7.0

Label_Calculation_QDSVERN3
Calculation_VERSION

I.8.0

Label_Calculation_VERSION
Intro_IDATE
IDATE
Label_IDATE
Soft_edit_IDATE_8

IP.1.0.

QDS_programming_IDATE
Calculation_CLCSDTN5_ IP.1a
8

Label_CLCSDTN5_8
SITEID
Label_SITEID
Hard_edit_8_SITEID

IP.2.1.

QDS_programming_SITEID

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.
“Interviewer note: Enter the following information prior to interview.”
Interview date
Interview date
Display the following message: “Today's date is IDATE. If this is incorrect, fix the date on
your device.” Allow the program to move forward.
Automatically calculate IDATE (interview date) in QDS using the date on the device
IDATE CLCSDTN5_8
June 1, 2017 – May 31, 2018 12/31/2016
June 1, 2018 – May 31, 2019 12/31/2017
June 1, 2019 – May 31, 2020 12/31/2018
June 1, 2020 – May 31, 2021 12/31/2019
June 1, 2021 – May 31, 2022 12/31/2020
Sample draw date based on interview date
Site ID of jurisdiction where person was sampled:
Site ID where person sampled
Valid numbers are as follows: 0006, 1600, 0010, 0012, 0013, 3360, 0017, 0018, 4480,
0026, 0028, 0034, 0036, 5600, 0037, 0041, 0042, 6160, 0072, 7360, 0048, 0051, and 0053.
Else, READ “Site ID is invalid.” Return to SITEID (site ID where person sampled).
4 digits with leading 0s

Page | 2
Calculation_SJURN5_8

IP.2.1.a

Name of sampling jurisdiction based on SITEID (site ID where person sampled).
SITEID SJURN5
0006 California
1600 Chicago
0010 Delaware
0012 Florida
0013 Georgia
3360 Houston
0017 Illinois
0018 Indiana
4480 Los Angeles County
0026 Michigan
0028 Mississippi
0034 New Jersey
0036 New York
5600 New York City
0037 North Carolina
0041 Oregon
0042 Pennsylvania
6160 Philadelphia
0072 Puerto Rico
7360 San Francisco
0048 Texas
0051 Virginia
0053 Washington

Label_Calculation_SJURN5_8

Name of sampling jurisdiction

Calculation_CYGSN5_8

IP.2.1.b.

Calculate cycle year using CYGSN5_8 (cycle year based on date of interview)
If IDATE is June 1, 2017-May 31, 2018, then CYGSN5_8= 2017
If IDATE is June 1, 2018-May 31, 2019, then CYGSN5_8= 2018.
If IDATE is June 1, 2019-May 31, 2020, then CYGSN5_8= 2019.
If IDATE is June 1, 2020-May 31, 2021, then CYGSN5_8= 2020.
If IDATE is June 1, 2021-May 31, 2022, then CYGSN5_8= 2021.
Cycle year based on date of interview

IP.2.2

Respondent ID:
Respondent ID
0001-9999
If number is less than 4 digits, then READ “Number must be four digits.” Return to INDID
(respondent ID).
4 digits with leading 0s

Label_CYGSN5_8
INDID
Label_INDID
Range_INDID
Hard_edit_INDID

QDS_programming_INDID
Calculation_8_PARID

Label_PARID
Range_PARID

IP.2.4a.

Calculate PARID (participant ID) by combining SITEID (side ID where person sampled) and
09 and last two digits of CYGSN5_8 (cycle year based on date of interview) and INDID
(respondent ID).
Participant ID
0000-0000-0001 to 9999-9999-9999

Page | 3
IDCONFN3

IP.2.3

Label_IDCONFN3
Hard_edit_IDCONFN3
QDS_programming_IDCONFN3

[DON'T READ ALOUD] The Participant ID is [Response to IP.2.1]-[CYCYR_ID]-[Response to
IP.2.2]. Is that correct?
0 No
1 Yes
Confirmation of PARID
If IDCONFN3 (confirmation of PARID) is 0 (no), then READ, “Interviewer: Please re-enter
participant ID.” Return to SITEID (site ID where person sampled).
Program should read dashes after every 4th number for legibility (e.g., “The participant ID
is 1111-2222-3333. Is that correct?”)

INTID
Label_INTID
Range_INTID
Hard_edit_INTID

IP.3.0.

Interviewer ID:
Interviewer ID
001–999
If number is less than 3 digits, then READ “Number must be three digits.” Return to INTID
(interviewer ID).

INTSE_12

IP.4.0.

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

IJURN5
Label_IJURN5
Range_IJURN5
Hard_edit_8_IJURN5

IP.6.0.

[DON'T READ ALOUD] What is the site ID of the jurisdiction completing the interview?
Site ID of jurisd. completing interview
0001–9999
Valid numbers are as follows: 0006, 1600, 0010, 0012, 0013, 3360, 0017, 0018, 4480,
0026, 0028, 0034, 0036, 5600, 0037, 0041, 0042, 6160, 0072, 7360, 0048, 0051, and 0053.
Else, READ “The site ID of the jurisdiction completing the interview is invalid.” Return to
IJURN5 (Site ID of jurisd. completing interview).

INTERPN8

IP.7.0

[DON'T READ ALOUD] Are you using a language interpreter for this interview?
0 No
1 Yes
Use of interpreter for interview
If INTERPN8 (use of interpreter for interview)= 0 (no), go to Intro_5_SURVEYIN. Else, skip
to INTLAN8 (language interview conducted in).

Label_INTSE_12

Label_INTERPN8
Skip_INTERPN8

Page | 4
INTLAN8

IP.7.1

[DON'T READ ALOUD] What language is the interpreter using for this interview?
1 Spanish
2 French
3 German
4 Chinese
5 Creole (French or Haitian)
6 American sign language (ASL)
7 Arabic
8 Other
Language interview conducted in
If INTLAN8 (Language interview conducted in) is 8 (other), go to ILAN8_OS (specify other
interpreter language). Else, skip to INTRO_5_SURVEYIN.

IP.7.2

[DON'T READ ALOUD] Please specify what language the interpreter is using for this
interview.
Specify other interpreter language

Label_INTLAN8
Skip_INTLAN8
ILAN8_OS
Label_ILAN8_OS

Topic: Introduction (IN)
Intro_5_SURVEYIN

SURVEYIN
Label_SURVEYIN
Skip_5_SURVEYIN

“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 won’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.”
IN
Introduction for MMP survey
If INTSE_12 (interview setting) is 8 (telephone interview), then go to Intro_5_INTROTEL;
else skip to next topic (Calculation_ST_INTN5).

“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 card that is needed.”

Intro_5_INTROTEL

INTROTEL
Label_INTROTEL

IN
Introduction for telephone interviews

Page | 5

Module: Eligibility criteria (Y)
Topic: Age (YA)
Calculation_ST_INTN5
YA.0.
Label_Calculation_ST_INTN5

ST_INTN5 = Current time.
Start of Interview

Calculation_STELIGIB
YA.0a
Label_Calculation_STELIGIB

Calculate start time of eligibility criteria.
Start time of eligibility criteria.

DOB_13

Please tell me the month and year of your date of birth.
8888 Don't Know
7777 Refused to Answer
Date of birth
01/1900–current
DOB_13 (date of birth) requires a response for both the month and year. Partial date is not
accepted.

YA.1.0.

Label_DOB_13
Range_N6_DOB_13
QDS_programming_DOB_13
Calculation_AGESMPN8 YA.1.0a

Label_AGESMPN8
Skip_AGESMPN8

AGEVER_8

Label_AGEVER_8
Skip_AGEVER_8

Calculate the difference in years between Calculation_CLCSDTN5_8 and DOB_13,
accounting for leap years. Since we do not gather day information for DOB_13, a day will
need to be imputed: the last day of their birth month.
Age at sampling date
If Calculation_AGESMPN8 (Age at sampling date) is < 18 years, then READ, “I am only interviewing
people who were age 18 years or older on [INSERT Calculation_CLCSDTN5_8 (sampling date]]. Thank
you very much for your time.” Then skip to Calculation_EN_INTN5 (End of interview). If DOB_13
(date of birth) is 7 (refused to answer) or 8 (don’t know), or if Calculation_AGESMPN8 (Age at
sampling date) is equal to 18 years, go to AGEVER_8 (Age verification). Else, skip to Intro_RESCURN8
(Current residence as of interview date).

YA.1.1.

Were you at least 18 years old on [Calculation_CLCSDTN5_8]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Age verification

If AGEVER_8 (age verification) is 0 (no), 7 (refused to answer), or 8 (don’t know),
then READ, “I am only interviewing people who were 18 years or older on
[Calculation_CLCSDTN5_8 ]. Thank you very much for your time.” Then skip to
Calculation_EN_INTN5 (end of interview). Else, go to Intro_RESCURN8 (Current
residence as of interview date).

Page | 6

Topic: Residence (YS)
Intro_RESCURN8
RESCURN8

YS.1.0.

“Now I’m going to ask you about where you’ve lived at different times. These questions
may sound similar, but I need to ask all of them.”
What state or territory do you currently live in?
Interviewer instructions [DON’T READ]: Enter the two-character state abbreviation. For
reference, the abbreviations are: Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR),
California (CA), Colorado (CO), Connecticut (CT), Delaware (DE), District of Columbia (DC),
Florida (FL), Georgia (GA), Hawaii (HI), Idaho (ID), Illinois (IL), Indiana (IN), Iowa (IA), Kansas
(KS), Kentucky (KY), Louisiana (LA), Maine (ME), Maryland (MD), Massachusetts (MA),
Michigan (MI), Minnesota (MN), Mississippi (MS), Missouri (MO), Montana (MT), Nebraska
(NE), Nevada (NV), New Hampshire (NH), New Jersey (NJ), New Mexico (NM), New York
(NY), North Carolina (NC), North Dakota (ND), Ohio (OH), Oklahoma (OK), Oregon (OR),
Pennsylvania (PA), Puerto Rico (PR), Rhode Island (RI), South Carolina (SC), South Dakota
(SD), Tennessee (TN), Texas (TX), Utah (UT), Vermont (VT), Virginia (VA), Washington (WA),
West Virginia (WV), Wisconsin (WI), Wyoming (WY), Not currently living in the United
States/Puerto Rico (ZZ).

Label_RESCURN8
Hard_edit_RESCURN8

Skip_RESCURN8

__ __
88 Don't Know
77 Refused to Answer
Current residence as of interview date
If RESCURN8 (Current residence as of interview date) is not one of these values: AL, AK, AZ,
AR, CA, CO, CT, DE, DC, FL, GA, HI,ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO,
MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA,
WA, WV, WI, WY, or ZZ, then READ: “Incorrect abbreviation. Consult list of state or
territory abbreviations.” Return to RESCURN8 (Current residence as of interview date).
If RESCURN8 (Current residence as of interview date) is CA, IL, NY, PA, or TX, then go to
MMPCTYN5 (MMP current city of residence). Else, skip to RESAMPN8 (Residence on
sampling date).

Page | 7
MMPCTYN5

Label_MMPCTYN5
Hard_edit_8_MMPCTYN5

YS.1.1.

What city do you currently live in? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Chicago
2 Houston
3 Los Angeles County
4 New York City
5 Philadelphia
6 San Francisco
7 Other U.S. city
88 Don't Know
77 Refused to Answer
MMP current city of residence
Only valid combinations for MMPCTYN5 (MMP city of residence) and RESCURN8 (Current
residence as of interview date) are:
RESCURN8 and MMPCTYN5
1 California and 3 Los Angeles County
1 California and 6 San Francisco
1 California and 7 Other U.S. City
1 California and 77 Refused
1 California and 88 Don’t Know
5 Illinois and 1 Chicago
5 Illinois and 7 Other U.S. City
5 Illinois and 77 Refused
5 Illinois and 88 Don’t Know
12 New York and 4 New York City
12 New York and 7 Other U.S. City
12 New York and 77 Refused
12 New York and 88 Don’t Know
15 Pennsylvania and 5 Philadelphia
15 Pennsylvania and 7 Other U.S. City
15 Pennsylvania and 77 Refused
15 Pennsylvania and 88 Don’t Know
18 Texas and 2 Houston
18 Texas and 7 Other U.S. City
18 Texas and 77 Refused
18 Texas and 88 Don’t Know
Else, READ “That city does not match with the state you selected. Please tell me the city
again.” Return to MMPCTYN5 (MMP current city of residence).

Page | 8
RESAMPN8

YS.2.0.

What state or territory did you live in on [Calculation_CLCSDTN5_8]?
Interviewer instructions [DON’T READ]: Enter the two-character state abbreviation. For
reference, the abbreviations are: Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR),
California (CA), Colorado (CO), Connecticut (CT), Delaware (DE), District of Columbia (DC),
Florida (FL), Georgia (GA), Hawaii (HI), Idaho (ID), Illinois (IL), Indiana (IN), Iowa (IA), Kansas
(KS), Kentucky (KY), Louisiana (LA), Maine (ME), Maryland (MD), Massachusetts (MA),
Michigan (MI), Minnesota (MN), Mississippi (MS), Missouri (MO), Montana (MT), Nebraska
(NE), Nevada (NV), New Hampshire (NH), New Jersey (NJ), New Mexico (NM), New York
(NY), North Carolina (NC), North Dakota (ND), Ohio (OH), Oklahoma (OK), Oregon (OR),
Pennsylvania (PA), Puerto Rico (PR), Rhode Island (RI), South Carolina (SC), South Dakota
(SD), Tennessee (TN), Texas (TX), Utah (UT), Vermont (VT), Virginia (VA), Washington (WA),
West Virginia (WV), Wisconsin (WI), Wyoming (WY), Not currently living in the United
States/Puerto Rico (ZZ).

Label_RESAMPN8
Hard_edit_RESAMPN8

Skip_RESAMPN8

__ __
88 Don't know
77 Refused to answer
Residence on sampling date
If RESAMPN8 (Residence on sampling date) is not one of these values: AL, AK, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, HI,ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE,
NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV,
WI, WY, or ZZ, then READ: “Incorrect abbreviation. Consult list of state or territory
abbreviations.” Return to RESAMPN8 (Residence on sampling date).
If RESAMPN8 (Residence on sampling date) is CA, IL, NY, PA, or TX, then go to SAMPCTN5
(MMP city of residence at sampling). Else, if RESAMPN8 (Residence on sampling date) is
DE, FL, GA, IN, MI, MS, NJ, NC, OR, PR, VA, or WA, then skip to RES2YN8 (Residence 2 years
before IDATE). Else, READ, "I am only interviewing people who lived in certain states on
[INSERT Calculation_CLCSDTN5_8 (Sampling date)]. Thank you very much for your
time." Then, skip to Calculation_EN_INTN5 (End of interview).

Page | 9
SAMPCTN5

Label_SAMPCTN5
Hard_edit_8_SAMPCTN5

YS.2.1.

What city did you live in at that time? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Chicago
2 Houston
3 Los Angeles County
4 New York City
5 Philadelphia
6 San Francisco
7 Other U.S. city
88 Don't Know
77 Refused to Answer
MMP city of residence at sampling
If the values of RESAMPN8 (Residence on sampling date) and SAMPCTN5 (MMP city of
residence at sampling) result in any of these combinations:
RESAMPN8 and SAMPCTN5
1 California and 3 Los Angeles County
1 California and 6 San Francisco
1 California and 7 Other U.S. City
1 California and 77 Refused
1 California and 88 Don’t Know
5 Illinois and 1 Chicago
5 Illinois and 7 Other U.S. City
5 Illinois and 77 Refused
5 Illinois and 88 Don’t Know
12 New York and 4 New York City
12 New York and 7 Other U.S. City
12 New York and 77 Refused
12 New York and 88 Don’t Know
15 Pennsylvania and 5 Philadelphia
15 Pennsylvania and 7 Other U.S. City
15 Pennsylvania and 77 Refused
15 Pennsylvania and 88 Don’t Know
18 Texas and 2 Houston
18 Texas and 7 Other U.S. City
18 Texas and 77 Refused
18 Texas and 88 Don’t Know,
Then combination is valid. Else READ, "That city does not match with the state you
selected. Please tell me the city again." Return to SAMPCTN5 (MMP city of residence at
sampling).

Page | 10
RES2YN8

YS.3.0.

What state or territory did you live in on [IDATE-2 YEARS]?
Interviewer instructions [DON’T READ]: Enter the two-character state abbreviation. For
reference, the abbreviations are: Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR),
California (CA), Colorado (CO), Connecticut (CT), Delaware (DE), District of Columbia (DC),
Florida (FL), Georgia (GA), Hawaii (HI), Idaho (ID), Illinois (IL), Indiana (IN), Iowa (IA), Kansas
(KS), Kentucky (KY), Louisiana (LA), Maine (ME), Maryland (MD), Massachusetts (MA),
Michigan (MI), Minnesota (MN), Mississippi (MS), Missouri (MO), Montana (MT), Nebraska
(NE), Nevada (NV), New Hampshire (NH), New Jersey (NJ), New Mexico (NM), New York
(NY), North Carolina (NC), North Dakota (ND), Ohio (OH), Oklahoma (OK), Oregon (OR),
Pennsylvania (PA), Puerto Rico (PR), Rhode Island (RI), South Carolina (SC), South Dakota
(SD), Tennessee (TN), Texas (TX), Utah (UT), Vermont (VT), Virginia (VA), Washington (WA),
West Virginia (WV), Wisconsin (WI), Wyoming (WY), Not currently living in the United
States/Puerto Rico (ZZ).

Label_RES2YN8
hard_edit_RES2YN8

Skip_RES2YN8

__ __
88 Don't Know
77 Refused to Answer
Residence 2 years before IDATE
If RES2YN8 (Residence 2 years before IDATE) is not one of these values: AL, AK, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, HI,ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE,
NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV,
WI, WY, or ZZ, then READ: “Incorrect abbreviation. Consult list of state or territory
abbreviations.” Return to RES2YN8 (Residence 2 years before IDATE).
If RES2YN8 (Residence 2 years before IDATE) is CA, IL, NY, PA, or TX, then go to CITY2N8
(MMP city of residence IDATE - 2 years). Else, skip to PARTCPT (Ever participation).

Page | 11
CITY2N8

Label_CITY2N8
Hard_edit_CITY2N8

YS.3.1.

What city did you live in on [IDATE-2 YEARS]? [DON’T READ RESPONSES. SELECT ONLY
ONE.]
1 Chicago
2 Houston
3 Los Angeles County
4 New York City
5 Philadelphia
6 San Francisco
7 Other U.S. city
88 Don't Know
77 Refused to Answer
MMP city of residence IDATE - 2 years
If the values of RES2YN8 (Residence 2 years before IDATE) and CITY2N8 (MMP city of
residence IDATE - 2 years) result in any of these combinations:
RES2YN8 and CITY2N8
1 California and 3 Los Angeles County
1 California and 6 San Francisco
1 California and 7 Other U.S. City
1 California and 77 Refused
1 California and 88 Don’t Know
5 Illinois and 1 Chicago
5 Illinois and 7 Other U.S. City
5 Illinois and 77 Refused
5 Illinois and 88 Don’t Know
12 New York and 4 New York City
12 New York and 7 Other U.S. City
12 New York and 77 Refused
12 New York and 88 Don’t Know
15 Pennsylvania and 5 Philadelphia
15 Pennsylvania and 7 Other U.S. City
15 Pennsylvania and 77 Refused
15 Pennsylvania and 88 Don’t Know
18 Texas and 2 Houston
18 Texas and 7 Other U.S. City
18 Texas and 77 Refused
18 Texas and 88 Don’t Know,
Then combination is valid. Else READ, "That city does not match with the state you
selected. Please tell me the city again." Return to CITY2N8 (MMP city of residence IDATE 2 years).

Page | 12

Topic: MMP participation (YM)
PARTCPT

YM.1.0.

Label_PARTCPT
Skip_8_PARTCPT

Have you ever participated in the MMP interview?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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 Calculation_EN_ELGN5 (end of
eligibility criteria).
If PARTCPT (ever participation) is 7 (refused to answer), then 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_EN_INTN5 (end time interview).

PARTIC

YM.1.1.

QDS_programming_PARTIC

What month and year did you participate in the MMP interview?
8888 Don't Know
7777 Refused to Answer
Date participated in MMP
If CYGSN5_8 (cycle year based on date of interview) =2017 and PARTIC (Date participated
in MMP) >= June 1, 2017 or if CYGSN5_8 (cycle year based on date of interview) =2018 and
PARTIC (Date participated in MMP) >= June 1, 2018 or if CYGSN5_8 (cycle year based on
date of interview) =2019 and PARTIC (Date participated in MMP) >= June 1, 2019 or if
CYGSN5_8 (cycle year based on date of interview) =2020 and PARTIC (Date participated in
MMP) >= June 1, 2020 or if CYGSN5_8 (cycle year based on date of interview) =2021 and
PARTIC (Date participated in MMP) >= June 1, 2021, then 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_En_INTN5 (end time interview). Else, go to
Calculation_EN_ELGN5 (end of eligibility criteria).
Month is not required. Year is required.

Calculation_EN_ELGN5 Y.0.1.
Label_Calculation_EN_ELGN5

EN_ELGN5= Current time.
End of eligibility section

Calculation_TL_ELGN5 Y.0.b
Label_Calculation_TL_ELGN5

Calculate elapsed time between ST_INTN5 and EN_ELGN5 = TL_ELGN5
Total time for eligibility section

Label_PARTIC
Skip_N8_PARTIC

Page | 13

Module: Basic demographics (D)
Topic: Education (DE)
Calculation_STBSDMN5 D.0.
Label_Calculation_STBSDMN5

STBSDMN5 = Current time
Start of basic demographics

EDUC

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

DE.1.0.

Label_EDUC

Topic: Race-ethnicity (DR)
HISPA_13

DR.1.0.

Label_HISPA_13
Skip_HISPA_13
Intro_HISN3_series
HISN3A

DR.1.1.

Label_HISN3A
HISN3B

Label_HISN3C

Which of the following describes your Hispanic, Latino/a, or Spanish origin? You can
choose more than one. [READ RESPONSES.]
Mexican, Mexican American, or Chicano/a
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Mexican, Mexican American, or Chicano/a

DR.1.2.

Puerto Rican
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Puerto Rican origin

DR.1.3.

Cuban
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Cuban origin

Label_HISN3B
HISN3C

Do you consider yourself to be of Hispanic, Latino/a, or Spanish origin?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Hispanic-Latino origin
If HISPA_13 is 1 (yes), then go to HISN3 series. Else, skip to RACE_9 series.

Page | 14
HISN3D

DR.1.4.

Label_HISN3D
Hard_edit_N8_HISN3D

Intro_RACE_9_series
RACE_9A

DR.2.1.

Label_RACE_9A
RACE_9B

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Asian race

DR.2.3.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Black or African American race

DR.2.4.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Native Hawaiian/Other Pacific Islander

DR.2.5.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
White race

Label_RACE_9C
RACE_9D

Label_RACE_9D
RACE_9E

Label_RACE_9E
Soft_edit_N8_RACE_9E

Which racial group or groups do you consider yourself to be in? You may choose more
than one option. [READ RESPONSES.]
American Indian or Alaska Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
American Indian or Alaska Native race

DR.2.2.

Label_RACE_9B
RACE_9C

Another Hispanic, Latino/a, or Spanish origin
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Another Hispanic, Latino/a, or Spanish
If HISPA_13 (Hispanic-Latino origin) = 1 (Yes) and HISN3A (Mexican, Mexican American, or
Chicano/a) = 0 (No) and HISN3B (Puerto Rican origin) = 0 (No) and HISN3C (Cuban origin) =
0 (No) and HISN3D (Another Hispanic, Latino/a, or Spanish) = 0 (No), then READ, “Earlier
you said that you considered yourself to be of Hispanic, Latino/a, or Spanish origin. I'll go
back and read the choices again." Return to HISPA_13 (Hispanic-Latino origin).

If RACE_9A (American Indian or Alaska Native race) = 0 (No), RACE_9B (Asian race) = 0 (No), RACE_
9C (Black or African American race ) = 0 (No), RACE_9D (Native Hawaiian/Other Pacific Islander) = 0
(No), and RACE_9E (White race) = 0 (No), then READ “The respondent did not select any racial
group. Please confirm responses.” Allow the program to move forward.

Page | 15

Topic: Gender and sexual orientation (DG)
BIRTGEN

DG.1.0.

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

DG.2.0.

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

DG.3.0.

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

Label_BIRTGEN
GENDER

Label_GENDER
SEXOR_N5

Label_SEXOR_N5

Topic: Language ability (DL)
LANWL1N3

DL.1.0.

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

DL.2.0.

Do you speak a language other than English at home?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Speak a language other than English
If LANWL2N3 (speak a language other than English) is 0 (no), 7 (refused to answer), or 8
(don’t know), then skip to CO_BORN (country or territory of birth). Else, go to LANWL3N8
(name of language spoken).

Label_LANWL1N3
LANWL2N3

Label_LANWL2N3
Skip_8_LANWL2N3

Page | 16
LANWL3N8

DL.2.1.

What is this language? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Spanish
2 French
3 German
4 Haitian Creole
5 Amharic
6 Tagalog
7 Arabic
8 American Sign Language
9 Chinese
10 Italian
11 Other
88 Don't know
77 Refused to answer
Name of language spoken
If LANWL3N8 (name of language spoken) is 11 (other), then go to LANN3_OS (specify other
language). Else skip to CO_BORN (country or territory of birth).

DL.2.2.

Specify language:
Specify other language

DF.1.0.

In what country or territory were you born? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 United States
2 Puerto Rico
3 Mexico
4 Haiti
5 Dominican Republic
6 Cuba
7 Other
8 Refused to Answer
9 Don't Know
Country or territory of birth
If CO_BORN (country or territory of birth) is 7 (other), then go to OTCTRY (other specifycountry/territory of birth). Else, skip to Skip2_6_CO_BORN.

OTCTRY
Label_OTCTRY
Skip2_6_CO_BORN

DF.1.1.

Specify other country:
Other specify-country/territory of birth
If CO_BORN (country or territory of birth) is 1 (United States), 2 (Puerto Rico), 8 (refused
to answer), or 9 (don’t know), then skip to next topic (CRNLV_N5 [Living with partner]).
Else go to US_YRS (Years living in the US).

US_YRS

DF.1.2.

How many years have you been living in the United States?
888 Don't Know
777 Refused to Answer
Interviewer instructions: If years living in the U.S. are less than 1 year, enter 0.
Years living in the US
US_YRS must be <= AGEIDATE (respondent's age at date of interview). If US_YRS is > then
AGEIDATE (respondent's age at date of interview), 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 (years living in the US).

Label_LANWL3N8
skip_LANWL3N8
LANN3_OS
Label_LANN3_OS

Topic: U.S. born (DF)
CO_BORN

Label_CO_BORN
Skip1_CO_BORN

Interviewer_note_US_YRS
Label_US_YRS
Hard_edit_US_YRS

Page | 17

Topic: Marriage status (DM)
CRNLV_N5

DM.1.0.

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

DM.2.0.

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

Label_CRNLV_N5
MARRI_N5

Label_MARRI_N5

Topic: Homeless (DH)
Intro1_8_HOMEL_9A
Intro2_6_HOMEL_9A
HOMEL_9A

DH.1.1.

Label_HOMEL_9A
QDS_programming_HOMEL_9A

HOMEL_9B

DH.1.2.

…lived in a shelter?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived in a shelter

DH.1.3.

…lived in a Single Room Occupancy (SRO) hotel?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived in a SRO hotel

Label_HOMEL_9B
HOMEL_9C

Label_HOMEL_9C

“Next I’ll ask about the past 12 months. That is from last year [INSERT IDATE-12 MONTHS]
to today.”
During the past 12 months, have you done any of the following:
…lived on the street?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived on the street
The QDS program should enter the appropriate dates. EXAMPLE: If IDATE (interview date)
is 11/11/2015, then the program should READ “That is from last year, 11/11/2014 to now
11/11/2015.”

Page | 18
HOMEL_9D

DH.1.4.

…lived in a car?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived in a car

DH.2.0.

How many times have you moved during the past 12 months?
8888 Don't Know
7777 Refused to Answer
Frequency of moves during past 12 months
0-365

DH.3.0.

During the past 12 months, did you ever move in with other people even for a little while
because of financial problems?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Doubled up in past 12 months

DH.4.0.

Have you been evicted at any time during the past 12 months?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Eviction during the past 12 months

Label_HOMEL_9D
MOVESN8

Label_MOVESN8
Range_MOVESN8
DOUBLEN8

Label_DOUBLEN8
EVICTN8

Label_EVICTN8

Topic: Incarceration (DJ)
JAIL_N5

Label_JAIL_N5
Range_6_JAIL_N5
Hard_edit_N8_JAIL_N5

Skip_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?
888 Don't Know
777 Refused to Answer
Number of times incarcerated
0-180
If INTSE_12 = 03 (prison or jail facility) and JAIL_N5 = 0, then read, "Interviewer: the
interview setting is a prison or jail facility, but the the respondent said s/he has not been
incacerated during the past 12 months. Please clarify." Return to JAIL_N5.
If JAIL_N5 (number of times incarcerated) = 0, 777 (refused to answer), or 888 (don’t
know), then skip to next topic (Calculation_ENBSDMN5, end time basic demographics);
else go to DYINCN5 (number of days when last incarcerated).

Page | 19
DYINCN5

DJ.1.1.

DTINCN5

DJ.1.2.

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?
8888 Don't Know
7777 Refused to Answer
Label_DYINCN5
Number of days when last incarcerated
Range_DYINCN5
1–7776
Skip_N8_DYINCN5
If INSTE_12 = 03 (prison or jail facility), then skip to next topic (Calculation_ENBSDMN5,
end time basic demographics); else go to DTINCN5 (date of last release).
QDS_programming1_N8__DYINCN IF INTSE_12 (interview setting) = 03 (prison or jail facility), read the question as follows:
5
"How many days have you currently spent in jail, detention, or prison?"
QDS_programming2_N8__DYINCN IF INTSE_12 (interview setting) = 1, 2, 4, 5, 6, 7, 8, 9 AND JAIL_N5 = 1, read the question as
5
follows: "How many days did you spend in jail, detention, or prison?"
The last time you were in jail, detention, or prison for longer than 24 hours, what month
and year were you released?
8888 Don't Know
7777 Refused to Answer
6666 Not Applicable
Label_DTINCN5
Date of last release
Range_N6_DTINCN5
01/1900–current
Hard_edit1_DTINCN5
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. Please re-enter date.” Do
not allow the program to advance. If date is exactly 12 months prior to IDATE, then
message should not pop up. Allow program to advance.
QDS_programming1_N8_DTINCN5 IF INTSE_12 (interview setting) = 1, 2, 4, 5, 6, 7, 8, 9, AND JAIL_N5 = 1, read the question as
follows: "What month and year were you released?"
Calculation_ENBSDMN5 D.0.a.
Label_Calculation_ENBSDMN5

ENBSDMN5 = Current time
End of basic demographics

Calculation_TLBSDMN5 D.0.b.
Label_Calculation_TLBSDMN5

Calculate elapsed time between STBSDMN5 and ENBSDMN5 = TLBSDMN5
Total time for basic demographics

Page | 20

Module: Disability (A)
Topic: Disability (A)
Calculation_STDSABN5 A.0.
Label_Calculation_STDSABN5

STDSABN5 = Current time
Start time of disability

Intro_6_DISDEFN3

“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 I need to ask you all of the questions.”
Are you deaf or do you have serious difficulty hearing?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
deaf or serious difficulty hearing

DISDEFN3

A.1.0.

Label_DISDEFN3
DISBLNN3

A.2.0.

Are you blind or do you have serious difficulty seeing, even when wearing glasses?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Difficulty concentrating, remembering…

A.4.0.

Do you have serious difficulty walking or climbing stairs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Difficulty walking or climbing stairs

A.5.0.

Do you have difficulty dressing or bathing?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
difficulty dressing or bathing

A.6.0.

Label_DISERRN3

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

Calculation_ENDSABN5 A.0.a.
Label_Calculation_ENDSABN5

ENDSABN5 = Current time
End of disability section

Label_DISBLNN3
DISCONN3

Label_DISCONN3
DISWLKN3

Label_DISWLKN3
DISDRSN3

Label_DISDRSN3
DISERRN3

Page | 21
Calculation_TLDSABN5

A.0.b.

Label_Calculation_TLDSABN5

Calculate elapsed time between STDSABN5 (start time of disability) and ENDSABN5 (end of
disability section) = TLDSABN5
Total time for disability section

Page | 22

Module: Financial (F)
Topic: Employment (FE)
Calculation_STFINAN5
F.0.
Label_Calculation_STFINAN5

STFINAN5 = Current time
Start time of financial section

Intro_5_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.”
Are you currently…? [READ RESPONSES. SELECT ONLY ONE.]
1 Employed for wages
2 Self-employed
3 Out of work for more than 1 year
4 Out of work for less than 1 year
5 A homemaker
6 A student
7 Retired
8 Or unable to work
88 Don't Know
77 Refused to Answer
Current employment status

WORK_N3

FE.1.0.

Label_WORK_N3

Topic: Income (FI)
Intro_INCOME_8

INCOME_8

Label_INCOME_8
Skip_INCOME_8

FI.1.0.

“Now I’d like to ask you some questions about [INSERT LASTYEAR]. That is from January
1st, [INSERT LASTYEAR] to December 31st, [INSERT LASTYEAR]. For this next question, we
will use Response Card A as well as the calendar.”
In [INSERT LASTYEAR], what was your combined monthly or yearly family income from all
sources before taxes? When I say “combined family income,” I mean the total amount of
money from all family members living in your household. Please tell me the letter that
matches your income. [DON’T READ RESPONSES.]
1 a. $0 to $416 per month or $0 to $4,999 per year
2 b. $417 to $749 per month or $5,000 to $8,999 per year
3 c. $750 to $916 per month or $9,000 to $10,999 per year
4 d. $917 to $1083 per month or $11,000 to $12,999 per year
5 e. $1084 to $1249 per month or $13,000 to $14,999 per year
6 f. $1250 to $1416 per month or $15,000 to $16,999 per year
7 g. $1417 to $1666 per month or $17,000 to $19,999 per year
8 h. $1667 to $2083 per month or $20,000 to $24,999 per year
9 i. $2084 to $2499 per month or $25,000 to $29,999 per year
10 j. $2500 to $3333 per month or $30,000 to $39,999 per year
11 k. $3334 to $4166 per month or $40,000 to $49,999 per year
12 l. $4167 to $6249 per month or $50,000 to $74,999 per year
13 m. $6250 or more per month or $75,000 or more per year
88 Don't Know
77 Refused to Answer
Income-monthly and yearly
If INCOME_8 (Income-monthly and yearly) is 77 (refused to answer) or 88 (don’t know),
skip to FOOD3_N5 (Food security-hungry). Else, go to DEPND_IN (Number of dependents).

Page | 23
DEPND_IN

FI.2.0.

Including you, how many people depended on this income in [INSERT LAST YEAR]?
88 Don't Know
77 Refused to Answer
Number of dependents
1–49
If DEPND_IN (Number of dependents) is >1, go to DEPND_N3 (number of dependents < 18
years old); else, skip to FOOD3_N5 (food security-hungry).

FI.2.1.

Of the people who depended on this income in [INSERT LAST YEAR], how many were less
than 18 years old?
88 Don't Know
77 Refused to Answer
Number of dependents < 18 years old
0-48
DEPND_N3 (number of dependents < 18 years old) must be < DEPND_IN (number of
dependents) unless DEPND_N3 is skipped. If DEPND_N3 (number of dependents < 18 years
old) >= DEPND_IN (number of dependents), READ, “The number of people under 18 who
depended on your income in [INSERT LAST YEAR] must be less than the total number of
people who depended on your income in [INSERT LAST YEAR].” Do not allow the program
to advance.

Label_DEPND_IN
Range_DEPND_IN
Skip_DEPND_IN
DEPND_N3

Label_DEPND_N3
Range_DEPND_N3
Hard_edit_DEPND_N3

Topic: 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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Food security-hungry

Topic: Healthcare coverage (FH)
Intro_8_KINDA_5

KINDA_5

FH.1.1.

Label_KINDA_5
Skip_KINDA_5
INSEMPN5

Label_INSEMPN5

FH.1.1.a

I'd like to ask you about all of the types of health insurance and coverage you had during
the past 12 months. Please answer "yes" or "no" to each type. You may answer "yes" to
more than one type.
Did you have private health insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-private health insurance
If KINDA_5 (insurance-private health insurance) is 1 (yes), go to INSEMPN5 (insuranceprivate-employer), else skip to KINDB_5 (insurance-Medicaid).
Was your private health insurance obtained through your employer or a family member’s
employer?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-private-employer

Page | 24
INSMKTN5

FH.1.1.b

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

FH.1.2.

Did you have Medicaid?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-Medicaid

FH.1.3.

Did you have Medicare?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-Medicare

FH.1.4.

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

FH.1.5.

Did you have Tricare or CHAMPUS/CHAMPVA?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-Tricare or CHAMPUS

FH.1.6.

Did you have Veterans Administration coverage?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-VA coverage

FH.1.7.

Did you have city, county, state or other publicly funded insurance, not including
Medicaid?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-city/county/st/other public

Label_INSMKTN5
KINDB_5

Label_KINDB_5
KINDC_5

Label_KINDC_5
KINDD_5

Label_KINDD_5
KINDE_5

Label_KINDE_5
KINDF_5

Label_KINDF_5
KINDG_5

Label_KINDG_5

Page | 25
KINDH_N5

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.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-clinic or compassionate care

FH.1.9.

Did you have free medication or help with payment for medication through a drug
company?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-drug company

FH.1.10.

Did you have any other insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-other insurance
If KINDJ_5 (insurance-other insurance) is 1 (yes), then go to KINDOSN5 (insurance-other
specify); else, skip to Skip_KINDOSN5.

FH.1.11.

Please tell me the other type of insurance that you had.
888 Don't Know
777 Refused to Answer
Insurance-other specify
If none of KINDA_5 (Insurance-private health insurance) through KINDJ_5 = 1 (yes), then
go to KINDZ_N5 (insurance-no coverage confirmation). Else, skip to INS12_9 (gap in
insurance or coverage).

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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-no coverage confirmation
If KINDZ_N5 = 0 (no), then repeat KINDA_5 through KINDJ_5. If KINDZ_N5 = 1 (yes), then
skip to PAY_N5. If KINDZ_N5 = 7 (refused to answer) or 8 (don’t know), then skip to
TYPE_N5.

FH.2.0.

During the past 12 months, was there a time that you didn’t have any health insurance or
health coverage?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Gap in insurance or coverage
If INS12_9 (gap in insurance or coverage) is 1 (yes), then ask INSMTHN5 (Insurance-months
without coverage). Else, skip to TYPE_N5 (ACA – change in type).

Label_KINDH_N5
KINDI_N5

Label_KINDI_N5
KINDJ_5

Label_KINDJ_5
Skip_KINDJ_5
KINDOSN5

Label_KINDOSN5
Skip_KINDOSN5

KINDZ_N5

Label_KINDZ_N5
Skip_8_KINDZ_N5

INS12_9

Label_INS12_9
Skip_INS12_9

Page | 26
INSMTHN5

FH.2.1.

During the past 12 months, about how many months were you without insurance or other
healthcare coverage? If it is less than one month, round up to "1 month."
88 Don't Know
77 Refused to Answer
Insurance-months without coverage
1-12

FH.3.0.

During the past 12 months, has there been any change in the type of health insurance or
coverage that you have?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
ACA – change in type
If TYPE_N5 is 1 (yes), then go to AMOUNTN5 (ACA – change in amount spent). Else, skip to
PAY_N5 (ACA – problems paying).

FH.3.1.

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.]
0 Less
1 More
2 About the same
8 Don't Know
7 Refused to Answer
ACA – change in amount spent

FH.3.2.

Because of this change in health insurance or coverage, is your access to supportive
services like case management, transportation, or mental health services better, worse, or
about the same? [DON’T READ RESPONSES. SELECT ONLY ONE.]
0 Better
1 Worse
2 About the same
8 Don't Know
7 Refused to Answer
ACA – change in access

Label_INSMTHN5
Range_6_INSMTHN5
TYPE_N5

Label_TYPE_N5
Skip2_TYPE_N5
AMOUNTN5

Label_AMOUNTN5
ACCESSN5

Label_ACCESSN5
Intro_HCARE_8

HCARE_8

Label_HCARE_8

FH.3.3.

"Next, I'm going to ask you about HIV care. By that, I mean routine care from a doctor,
nurse, or other healthcare worker to treat your HIV, not emergency care when you go to
an urgent care center or emergency room."
Because of this change in health insurance or coverage, would you say your HIV care is
better, worse, or about the same? [DON'T READ RESPONSES. SELECT ONLY ONE.]
0 Better
1 Worse
2 About the same
8 Don't Know
7 Refused to Answer
ACA – outpatient HIV medical care

Page | 27
USUAL_8

FH.3.4.

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

FH.3.5.

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

FH.3.6.

Label_BILLS_N5

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.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
ACA – paying off medical bills over time

Calculation_ENFINAN5 F.0.a.
Label_Calculation_ENFINAN5

ENFINAN5= Current time
End of financial section

Calculation_TLFINAN5
F.0.b.
Label_Calculation_TLFINAN5

Calculate elapsed time between STFINAN5 and ENFINAN5 = TLFINAN5
Total time for financial section

Label_USUAL_8
PAY_N5

Label_PAY_N5
BILLS_N5

Page | 28

Module: General medical care (J)
Topic: Health and well-being (JW)
Calculation_STGNMDN5 J.0.
Label_Calculation_STGNMDN5

STGNMDN5 = Current time.
Start time of General Medical Care

Intro_GENHLTN8
GENHLTN8

“Now I’m going to ask about your health and visits to the emergency room or hospital.”
JW.1.0.

In general, is your health [READ RESPONSES. SELECT ONLY ONE.]:

1 Poor
2 Fair
3 Good
4 Very good
5 Excellent
perception of general health

Label_GENHLTN8

Topic: ER and hospitalizations (JH)
HOSPERN5

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.
888 Don't Know
777 Refused to Answer
Number of times gone to hospital ER
0–776

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.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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 VACFL_8 (influenza vaccination past 12 months). Else go to NUMONN5
(number of times stayed in hospital overnight).

JH.2.1.

During the past 12 months, how many different times did you stay in any hospital
overnight or longer?
888 Don't Know
777 Refused to Answer
Num times stayed in hospital overnight

JF.1.0

During the past 12 months, did you get a flu shot?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Influenza vaccination past 12 months
If VACFL_8 (influenza vaccination past 12 months) = 0 (no), 7 (refused to answer) or 8
(don’t know), go to Intro_8_P12_N5 (took prescription meds past 12 months). Else, skip to
LOCVA_8 (place flu vaccine received).

Label_HOSPERN5
Range_HOSPERN5
HOSPONN5

Label_HOSPONN5
Skip_HOSPONN5_8

NUMONN5

Label_NUMONN5

Topic: Influenza (JF)
VACFL_8

Label_VACFL_8
Skip_VACFL_8

Page | 29
LOCVA_8

JF.1.1

Label_LOCVA_8

Where did you get your most recent flu shot? [READ RESPONSES. SELECT ONLY ONE.]
1 Doctor's office
2 Health department clinic
3 Drugstore or store (e.g., CVS, Walgreens, Target)
4 Workplace
5 Hospital or emergency room
6 Other
8 Don't know
7 Refused to answer
Place flu vaccine received

Topic: Prescription medicines (JP)
Intro_8_P12_N5
P12_N5

JP.1.0.

Label_P12_N5
Skip2_8_P12_N8

Intro_8_PRMD1_N5
PRMD1_N5

JP.2.0.

Label_PRMD1_N5
PRMD2_N5

You took less medicine to save money.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prob. with meds: took less to save money

JP.2.2.

You delayed filling a prescription to save money.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prob. with meds: delayed filling

JP.2.3.

You asked your doctor for a lower-cost medication to save money.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prob. with meds: lower cost med

Label_PRMD3_N5
PRMD4_N5

Label_PRMD4_N5

“During the past 12 months, are any of the following true for you?”
You skipped medication doses to save money.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prob. with meds: skipped to save money

JP.2.1.

Label_PRMD2_N5
PRMD3_N5

"The next questions are about all prescripton medicines you have taken in the past 12
months."
During the past 12 months, have you taken any prescription medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Took prescriptions meds 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 Intro_5_HLMF_12 (health lit: filling out medical forms). Else go to
Intro_8_PRMD1_N5 (Prob. with meds: skipped to save money).

Page | 30
PRMD5_N5

JP.2.4.

You bought prescription drugs from another country to save money.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prob. w/meds: bought from oth. country

JP.2.5.

You used alternative therapies to save money.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prob. with meds: alternative therapies

Label_PRMD5_N5
PRMD6_N5

Label_PRMD6_N5

Topic: Health literacy (JL)

Label_HLMF_12
Skip_8_HLMF_12

“For the next question, we’ll use Response Card H .”
How confident are you filling out medical forms by yourself? [READ RESPONSES. SELECT
ONLY ONE.]
1 Extremely
2 Quite a bit
3 Somewhat
4 A little bit
5 Not at all
8 Don't Know
7 Refused to Answer
Health lit: filling out medical forms
Skip to next topic (Calculation_ENGNMDN5, End of general medical care).

Calculation_ENGNMDN5 J.0.a.
Label_Calculation_ENGNMDN5

ENGNMDN5 = Current time
End of General medical care

Calculation_TLGNMDN5 J.0.b.
Label_Calculation_TLGNMDN5

Calculate elapsed time between STGNMDN5 and ENGNMDN5 = TLGNMDN5
Total time for General medical care

Intro_5_HLMF_12
HLMF_12

JL.1.0.

Page | 31

Module: HIV care (K)
Topic: Diagnosis date (KD)
Calculation_STHVCAN5 K.0.
Label_Calculation_STHVCAN5

STHVCAN5 = Current time
Start time of HIV care

IPERINN3

Were you born with HIV?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Were you born with HIV?
If IPERINN3 (Were you born with HIV?) is 1 (yes) and DOB_13 is earlier than January 1977,
READ, “The date of birth provided is earlier than 1977, the date of the first persons born
with HIV were documented. Confirm date of birth.” Allow program to move forward.
If IPERINN3 = 1, then skip to Intro_EVERCR_8. Else, go to POS1S_9.
For your information only, if IPERINN3 = 1 (yes), then transmission category is perinatal.

KD.1.0.

Label_IPERINN3
Soft_edit_8_IPERINN3

Skip_N8_IPERINN3
QDS_programming_IPERINN3
POS1S_9

KD.2.0.

Label_POS1S_9
Soft_edit_POS1S_9

Hard_edit_POS1S_9

QDS_programming_POS1S_9

What month and year did you first test positive for HIV? Tell me when you got your result,
not when you got your test.
8888 Don't Know
7777 Refused to Answer
Date first tested positive for HIV
If POS1S_9 (date first tested positive for HIV) is earlier than March 1985, confirm response.
If POS1S_9 (date first tested positive for HIV) 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.
POS1S_9 (date first tested positive for HIV) cannot be earlier than DOB_13 (date of birth).
If POS1S_9 (date first tested positive for HIV) is earlier than DOB_13 (date of birth), then
READ, “Date first tested positive cannot be earlier than date of birth.”
Allow a blank response for month.

Page | 32

Topic: Ever care (KE)
Intro_EVERCR_8

EVERCR_8

KE.1.0.

Label_EVERCR_8
soft_edit_EVERCR_8
Skip_EVERCR_8
QDS_programming_EVERCR_8

"Next, I’m going to ask you about HIV care. By that, I mean routine care from a doctor, nurse, or
other healthcare worker to treat your HIV — not emergency care when you go to an urgent care
center, emergency room, or stay in a hospital overnight."
Since testing positive for HIV in __ __/__ __ __ __ [INSERT POS1S_9 (date first tested positive for
HIV)], have you ever seen a doctor, nurse, or other healthcare worker for HIV care?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever recvd. HIV care
If EVERCR_8=0, then read "Are you sure that you have never received HIV care?". If yes,
allow the program to move forward.
If IPERINN3 = 1, then skip to Skip_MSAPPT_8, else, go to Skip_CARE1_8.
If POS1S_9 (date from first positive test) has an unknown month value but a known year
value, then read: “Since testing positive for HIV in [INSERT year from POS1S_9 (date from
first positive HIV test)], have you ever seen a doctor, nurse, or other healthcare worker for
HIV care?” If POS1S_9 (date from first positive HIV test) is 77/7777 (refused to answer) or
88/8888 (don’t know), then EVERCR_8 should read as follows: “Since testing positive for
HIV, have you ever seen a doctor, nurse, or other healthcare worker for HIV care?”

Topic: Linkage to care (KL)
Skip_CARE1_8
Skip2_CARE1_8
CARE1_8

If first positive HIV test < 5 years from IDATE, then GO TO Skip2_CARE1. If first positive HIV
test ≥ 5 years from IDATE, SKIP TO SKIP_ MSAPPT_8.
If EVERCR_8=0, 7, or 8 then skip to Intro_PREF1_8
KL.1.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
1st HIV care visit

Label_CARE1_8
Intro_PREF1_8

PREF1_8

KL.2.0.

Label_PREF2N8

“Next I’ll ask whether you got help getting connected to HIV care from a professional. A professional
could be someone like a doctor, nurse, social worker, patient navigator, or receptionist. If you don’t
remember, it’s okay to answer ‘don’t know’.”
Within 30 days after testing positive, did a professional ask if you needed help finding a place to go
for HIV care?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Offered help finding medical care

Label_PREF1_8
PREF2N8

Within 30 days after testing positive, did you see a doctor, nurse, or other healthcare worker for HIV
care?

KL.3.0.

Within 30 days after testing positive, did a professional tell you where you could go for HIV care?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Told of HIV care

Page | 33
AREF4_8

KL.4.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
linkage free or low cost HIV care

Label_AREF4_8
AREF1_8

KL.5.0.

KL.6.0.

Skip_AREF5N8

If CARE1_8 = 1, then go to AREF5N8. If CARE1_8 = 0, 7, 8, then go to Skip_MSAPPT_8. If
EVERCR_8 = 0, then go to Skip_MSAPPT_8.
KL.7.0.

Within 30 days after testing positive, did anyone contact you to remind you of your first HIV care
appointment?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
linkage appointment reminder

Label_AREF5N8

If CARE1_8 = 0, 7, or 8, then skip to Skip_MSAPPT_8, else go to AREF3_8. If EVERCR_8 = 0,
7, or 8, then skip to MSAPPT_8.

Skip_AREF3_8
AREF3_8

Within 30 days after testing positive, did a professional arrange transportation for you to an HIV
care appointment?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
linkage help arranging transport

Label_AREF2_8

AREF5N8

Within 30 days after testing positive, did a professional make an appointment for you to receive HIV
care?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
linkage making appointment

Label_AREF1_8
AREF2_8

Within 30 days after testing positive, did a professional help you figure out if you qualified for free
or low-cost HIV care?

KL.8.0.

Within 30 days after testing positive, did a professional go with you to your first HIV care
appointment?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
linkage accompany 1st appt

Label_AREF3_8

Topic: Care utilization (KU)
SKIP_ MSAPPT_8
MSAPPT_8

Label_MSAPPT_8

If EVERCR_8 = 1, go to MSAPPT_8. If EVERCR_8 = 0, 7, or 8, then go to Intro_BARRI1N8.

KU.1.0.

During the past 12 months, have you missed any scheduled appointments for HIV care that you
didn’t cancel? Don't include appointments that were cancelled by the clinic.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed appointments

Page | 34
LASCA_8

KU.2.0.

What month and year was your most recent visit to a doctor, nurse, or other healthcare worker for
HIV care?

Label_LASCA_8
Range_6_LASCA_8
QDS_programming_LASCA_8

8888 Don't Know
7777 Refused to Answer
Date most recent outpt. HIV care visit
01/1900–current
Allow a blank response for month.

USOCN5_8

During the past 2 years, what is the name of the place you went for most of your HIV care?

KU.3.0.

Label_USOCN5_8
QDS_programming_USOCN5_8

NYMLTF_8

KU.4.0.

Label_NYMLTF_8
Skip_NYMLTF_8
QDS_programming_NYMLTF_8
MLTFA2_8

KU.4.1.

8 Don't Know
7 Refused to answer
HIV care facility name
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, have you seen a doctor, nurse, or other healthcare worker for HIV care at
any facility besides [USOCN5_8 or "the place you went for most of your care"]?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Other facilities used for HIV care
If NYMLTF_8 = 0, 7, or 8, then skip to Skip_GESAT_8. Else, go to MLTFA2_8.

If USOCN5_8 = 7 or 8, then NYMLTF_8 should read, "During the past 2 years have you seen
a provider for HIV care at any facility besides the place you went for most of your care?"
During the past 2 years, at how many total facilities have you received HIV care? Please include
[INSERT NAME OF USUAL SOURCE OF OUTPATIENT CARE] in the total.

888 Don't Know
777 Refused to Answer
total facilities attended for HIV care
2-99

Label_MLTFA2_8
Range_MLTFA2_8

Topic: Care satisfaction (KS)
SKIP_GESAT_8
GESAT_8

Label_GESAT_8

If LASCA_8 is more than 12 months prior to the IDATE, then skip to HCPROVN8. Else, go to
GESAT_8.
KS.1.0.

In general, how satisfied are you with the HIV care you received in the past 12 months? [READ
RESPONSES. SELECT ONLY ONE.]

1 Very satisfied
2 Somewhat satisfied
3 Somewhat dissatisfied
4 Very dissatisfied
8 Don't Know
7 Refused to Answer
care satisfaction

Page | 35

Topic: Patient-provider relationship (KB)
HCPROVN8

KB.1.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
healthcare provider identified
If HCPROVN8 = 0, 7, or 8, GO TO Intro_BARRI1N8. Else skip to Intro_TRUS1N8.

Label_HCPROVN8
Skip_HCPROVN8
Intro_TRUS1N8
TRUS1N8

"I’m going to read you a few statements to better understand how you feel about that
healthcare provider."
KB.2.0.

KB.3.0.

KB.4.0.

Label_TRUS4N8

My healthcare provider is sincerely interested in me as a person.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: interest

Label_TRUS3N8
TRUS4N8

My healthcare provider is committed to providing the best care possible.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: best care

Label_TRUS2N8
TRUS3N8

How often does your healthcare provider discuss options and choices with you before healthcare
decisions are made?

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: options

Label_TRUS1N8
TRUS2N8

Do you have a healthcare provider such as a doctor or nurse whom you see for most of your HIV
care?

KB.5.0.

My healthcare provider is an excellent listener.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: excellent listener

Page | 36
TRUS5N8

KB.6.0.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: acceptance

Label_TRUS5N8
TRUS6N8

KB.7.0.

KB.8.0.

KB.9.0.

Label_TRUS9N8

My healthcare provider makes me feel that I am worthy of his/her time and effort.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: worthy

Label_TRUS8N8
TRUS9N8

My healthcare provider treats me as an individual.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: individual

Label_TRUS7N8
TRUS8N8

My healthcare provider tells me the complete truth about my health-related problems.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: truthful

Label_TRUS6N8
TRUS7N8

My healthcare provider accepts me for who I am.

KB.10.0.

My healthcare provider takes the time to listen to me during each appointment.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: listens to me

Page | 37
TRUS10N8

KB.11.0.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: personal issues

Label_TRUS10N8
TRUS11N8

KB.12.0.

KB.13.0.

How often do you think about changing to a new healthcare provider?

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: changing HCP

Label_TRUS12N8
TRUS13N8

I feel better after seeing my healthcare provider.

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: feel better

Label_TRUS11N8
TRUS12N8

I feel comfortable talking to my healthcare provider about my personal issues.

KB.14.0.

How often does your healthcare provider consider your need for privacy?

0 None of the time
1 A little of the time
2 About half the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: privacy

Label_TRUS13N8

Topic: Barriers and facilitators to care (KP)
Intro_BARRI1N8
BARRI1N8

Label_BARRI1N8

KP.1.0.

“I want to ask you about things that get in the way of HIV care or help people get care. Please tell
me whether any of these have applied to you, even once.”
During the past 12 months, have problems with money or health insurance made it difficult for you
to get HIV care?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: financial

Page | 38
BARRI2N8

KP.2.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: mental health

Label_BARRI2N8
BARRI3N8

KP.3.0.

KP.4.0.

KP.5.0.

During the past 12 months, have you delayed getting HIV care because you were too busy with
other personal things, such as family or work?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: personal things

Label_BARRI5N8
FACCI1N8

During the past 12 months, have you had trouble getting HIV care because a doctor's office or HIV
clinic was hard to get to?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: lack access

Label_BARRI4N8
BARRI5N8

During the past 12 months, have you delayed getting HIV care because you felt well?

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: felt well

Label_BARRI3N8
BARRI4N8

During the past 12 months, has depression or mental health problems made it difficult for you to
get HIV care?

KP.6.0.

During the past 12 months, was there a doctor's office or HIV clinic that was easy for you to get to?

Label_FACCI1N8

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Facilitators to care: easy access

Calculation_ENHVCAN5 V.0.a.
Label_Calculation_ENHVCAN5

ENHVCAN5 = Current time
End of HIV in care section

Calculation_TLHVCAN5 V.0.b.
Label_Calculation_TLHVCAN5
Skip_Calculation_TLHVCAN5

Calculate elapsed time between STHVCAN5 and ENHVCAN5 = TLHVCAN5
Total time for HIV Care
If EVERCRN8 (ever received outpatient HIV medical care) is 0 (no), 7 (refused to answer),
or 8 (don’t know), then skip to Calculation_ST_SEXN5 (Start time of sexual behavior). Else,
go to Calculation_STADHRN5 (Start HIV treatment and adherence).

Page | 39

Module: HIV treatment and adherence (T)
Topic: Ever ART (TE)
Calculation_STADHRN5 T.0.
Label_Calculation_STADHRN5

STADHRN5 = Current time.
Start HIV treatment and adherence

Skip_8_EART_N5

If EVERCR_8 (ever rcvd HIV care) is 1 (yes), then go to Intro_8_EART_N5.

Intro_8_EART_N5

EART_N5

TE.1.0.

Label_EART_N5
Skip2_8_EART_N5

Intro_8_NART1_N5

NART1_N5

TE.1.1.

Label_NART1_N5
NART2_N5

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

TE.1.3.

You have problems paying for or getting insurance or coverage for HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: Prob. with money/insurance

TE.1.4.

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

Label_NART3_N5
NART4_N5

Label_NART4_N5

“I’m going to read you a list of reasons why some people have not taken HIV medicines
after testing positive for HIV. For each reason, please tell me “yes” or “no” if it applies to
your situation.”
No healthcare provider has ever talked to you about taking HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: No one talked about it

TE.1.2.

Label_NART2_N5
NART3_N5

Else, skip to Skip_TASP1N8 (Aware of treatment as prevention).
“Now I’m going to ask some questions about medicines that you may be taking for your
HIV. These HIV medicines are also known as antiretroviral medicines or ART. The questions
I am going to ask you are about HIV medicines taken after you tested positive for HIV.”
Have you ever taken any HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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 TASP1N8 (treatment as
prevention). Else go Intro_NART1_N5 (Never ART: No one talked about it).

Page | 40
NART5_N5

TE.1.5.

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

TE.1.6.

You decided not to take HIV medicines for some other reason.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: Other reason
If NART1_N5 through NART6_N5 are all “no,” then READ: “The respondent said earlier that
he or she had not taken any HIV medicines after testing positive for HIV. Please confirm
that the respondent has no reason for not taking any HIV medicines.” Allow the program
to advance.
Skip to TASP1N8 (treatment as prevention).

TE.2.0.

When was the first time you ever took any HIV medicines? Please tell me the month and
year.
8888 Don't Know
7777 Refused to Answer
Date first took ART
01/1900–current
FART_N5 (date first took ART) cannot be earlier than POS1S_9 (date first tested positive).
If FART_N5 (date first took ART) was before 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 earlier than DOB_13 (date of birth). If FART_N5
(date first took ART) was before DOB_13 (date of birth), then READ, “The date first took
HIV medications cannot be earlier than the date of birth. Please re-enter date." Do not
allow the program to advance.
Allow a blank response for month. If month is blank for FART_N5 (date first took ART), use
the year values for the validation.

Label_NART5_N5
NART6_N5

Label_NART6_N5
Soft_edit_NART6_N5

Skip_8_NART6_N5
FART_N5

Label_FART_N5
Range_N6_FART_N5
Hard_edit1_FART_N5

Hard_edit2_FART_N5

QDS_programming_FART_N5

Topic: Current ART (TC)
CART_N5

Label_CART_N5
Skip_8_CART_N5

TC.1.0.

Are you currently taking any HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Currently taking ART
If CART_N5 (currently taking ART) is 1 (yes), skip to Intro_ADH1_N5 (days missed taking
ART).
If CART_N5 (currently taking ART) is 0 (no), 7 (refused to answer) or 8 (don’t know), skip to
ATMD12_9 (took ART in past 12 months).

Page | 41
ATMD12_9

TC.2.0.

Label_ATMD12_9
Skip_N8_ATMD12_9

Intro_8_CART1_N5
CART1_N5

TC.2.1.

Label_CART1_N5
CART2_N5

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

TC.2.3.

You have problems paying for or getting insurance or coverage for HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stop ART: Prob. with money or insurance

TC.2.4.

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

TC.2.5.

You decided not to take HIV medicines because you think they would make you feel sick or
harm you.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stop ART: Think would feel sick or harm

Label_CART3_N5
CART4_N5

Label_CART4_N5
CART5_N5

Label_CART5_N5

“I’m going to read you a list of reasons why some people are not currently taking HIV
medicines. For each reason, please tell me “yes” or “no” if it applies to your situation.”
No healthcare provider has talked to you about restarting HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped ART: No one talked about it

TC.2.2.

Label_CART2_N5
CART3_N5

During the past 12 months, have you taken HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Took ART in past 12 months
If CART_N5 (Currently taking ART) is 1 (yes), 7 (refused to answer) or 8 (don't know), then
skip to Skip_8_DASK_N5 (Dr asked if missed ART doses). If CART_N5 (Currently taking ART)
is 0 (no), go to Intro_8_CART1_N5.

Page | 42
CART6_N5

TC.2.6.

Label_CART6_N5
Soft_edit_CART6_N5

Skip_8_CART6_N5

You decided not to take HIV medicines for some other reason.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped ART: Other reason
If CART1_N5 through CART6_N5 are all “no,” then READ: “The respondent said earlier that
he or she is not currently taking HIV medicines. Please confirm that the respondent has no
reason for not taking any HIV medicines.” Allow the program to advance.
Skip to Skip_8_DASK_N5 (dr asked about HIV medicines).

Topic: Adherence (TA)
Intro_ADH1_N5

ADH1_N5

TA.1.0.

Label_ADH1_N5
Range_ADH1_N5
ADH2_N5

TA.1.1.

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.]
1 Very poor
2 Poor
3 Fair
4 Good
5 Very good
6 Excellent
8 Don't Know
7 Refused to Answer
How good a job taking ART

TA.1.2.

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.]
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Almost always
6 Always
8 Don't Know
7 Refused to Answer
How often took ART

Label_ADH2_N5
ADH3_N5

Label_ADH3_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]
In the past 30 days, on how many days did you miss at least one dose of any of your HIV
medicines?
88 Don't Know
77 Refused to Answer
Days missed taking ART
0–30

Page | 43
TRBL_EFT

TA.2.0.

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.]
1 Never
2 Rarely
3 About half of the time
4 Most of the time
5 Always
8 Don't Know
7 Refused to Answer
How often side effects

TA.3.0.

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]
1 Three times or more a day
2 Twice a day
3 Once a day
4 Less often than once a day-for example, every other day or weekly
8 Don't Know
7 Refused to Answer
How often take ART

TA.4.0.

Sometimes, people living with HIV miss taking doses of their HIV medicines. Since starting
your HIV medicines, how often have you missed a dose? [READ RESPONSES. SELECT ONLY
ONE.]
1 Often
2 Sometimes
3 Rarely
4 Never, not even once
8 Don't Know
7 Refused to Answer
How often miss HIV medicine dose
If MISEVRN8 (How often miss HIV medicine dose) is 1 (rarely), 2 (sometimes), or 3 (often),
then go to Intro_MIS1N5_8 (Miss ART: Problem paying). Else, skip to Skip_8_DASK_N5 (Dr
asked if missed ART doses).

Label_TRBL_EFT
OFT_N5

Label_OFT_N5
MISEVRN8

Label_MISEVRN8
Skip_MISEVRN8

Intro_MIS1N5_8
MIS1N5_8

TA.5.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Miss ART: Problem paying

Label_MIS1N5_8
MIS2_N5

Label_MIS2_N5

“The last time you missed taking your HIV medicines, which of the following were reasons you
missed? Please answer 'yes' or 'no' to each reason.”
You had a problem paying for your HIV medicines.

TA.5.1.

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

Page | 44
MIS3_N5

TA.5.2.

You fell asleep early or overslept.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Asleep or overslept

TA.5.3.

You had a change in your daily routine or were out of town.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Miss ART: Change routine or out of town

TA.5.4.

You had side effects from your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Side effects

TA.5.5.

You felt depressed or overwhelmed.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Depressed or overwhelmed

TA.5.6.

You were drinking or using drugs.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Drinking or using drugs

TA.5.7.

You forgot to take your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Forgot

TA.5.8.

You did not feel like taking your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Didn’t feel like taking

TA.5.9.

You had a problem getting a prescription or a refill for your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Problem prescription/refill

Label_MIS3_N5
MIS4_N5

Label_MIS4_N5
MIS5_N5

Label_MIS5_N5
MIS6_N5

Label_MIS6_N5
MIS7_N5

Label_MIS7_N5
MIS8_N5

Label_MIS8_N5
MIS9_N5

Label_MIS9_N5
MIS10_N8

Label_MIS10_N8

Page | 45
Skip_8_DASK_N5

DASK_N5

TA.6.0.

Label_DASK_N5
PROB_N5

TA.7.0.

Label_PROB_N5

If CART_N5 (Currently on ART) is 1 (yes) or if ATMD12_9 (took ART in past 12 months) is 1
(yes), then go to DASK_N5 (dr asked if missed ART doses). Else, skip to TASP1N8
(treatment as prevention).
During the past 12 months, did your doctor or other clinic staff ask you whether you
missed taking any doses of your HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Dr asked if missed ART doses
During the past 12 months, did your doctor or other clinic staff ask you whether you had
problems taking your HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Dr asked if problems taking ART doses

Topic: HIV treatment as prevention (TB)

Label_TASP1N8

If EVERCR_8 (Ever rcvd. HIV care) is 0 (no), 7 (refused), or 8 (don't know), then go to
Intro_TASP1N8 (Aware of treatment as prevention). Else, skip to TASP1N8 (Aware of
treatment as prevention).
“Now I’m going to ask some questions about HIV medicines. These are also known as
antiretroviral medicines or ART.”
Have you heard that if you have an undetectable viral load, you will not pass on HIV to
sexual partners?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware of treatment as prevention

Calculation_ENADHRN5 T.0.a.
Label_Calculation_ENADHRN5

ENADHRN5 = Current time
End of HIV treatment and adherence

Calculation_TLADHRN5 T.0.b.
Label_Calculation_TLADHRN5

Calculate elapsed time between STADHRN5 and ENADHRN5 = TLADHRN5
Total time for HIV tx and adherence

Skip_TASP1N8

Intro_TASP1N8
TASP1N8

TB.1.0.

Page | 46

Module: Sexual behavior (S)
Topic: Total sex partners (ST)
Calculation_ST_SEXN5
S.0.
Label_Calculation_ST_SEXN5

ST_SEXN5 = Current time
Start time of sexual behavior

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, but
don’t include people you only had oral sex with. The number of people could range
anywhere from 0 to over a hundred.”
Calculation_SX_GEN
ST.1.0.a. 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=1 (Male), 2 (Female), 7 (refused to answer), or 8
(don’t know)]), then SX_GEN=3 (Transgender).
If BIRTGEN=intersex, then SX_GEN=4 (Indeterminate).
If ([GENDER=7 (refused to answer) or 8 (don’t know)] and [BIRTGEN = 1 (Male), 2 (Female),
7 (refused to answer), or 8 (don’t know)], then SX_GEN=4 (Indeterminate).
If BIRTGEN=7 (refused to answer) or 8 (don’t know), and GENDER is 1 (male), 2 (female), 7
(refused to answer), or 8 (don’t know), then SX_GEN=4 (Indeterminate).
Label_Calculation_SX_GEN
Sex gender

Skip_SX_TFPN4
SX_TFPN4

ST.1.0.

Label_SX_TFPN4
SX_TMPN4

ST.2.0.

During the past 12 months, how many males have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of male partners

ST.3.0.

During the past 12 months, how many transgender persons have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of transgender partners

Label_SX_TMPN4
SX_TTPN4

Label_SX_TTPN4
Calculation_SX_TOTN4

If SX_GEN=2 (Female), skip to SX_TMPN4 (number of male partners). Else, go to SX_TFPN4
(number of female partners).
During the past 12 months, how many females have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of female partners

ST.3.0.a. Create a calculated variable where the sum of SX_TFPN4 + SX_TMPN4 + SX_TTPN4 =
SX_TOTN4 (total number of sex partners).
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 (total number of sex partners) = 2.
Label_Calculation_SX_TOTN4
Total # of vaginal and anal sex partners

Page | 47
Calculation_SXFMONN4 ST.3.0.b. 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.
Label_Calculation_SXFMONN4
Female only partners
Calculation_SXMLONN4 ST.3.0.c.

Label_Calculation_SXMLONN4

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

Calculation_SXTGONN4

ST.3.0.d. 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.
Label_Calculation_SXTGONN4
Transgender only partners
Skip_SX_TWPN4
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 (Partner +, more likely unprotected sex). 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
SX_TWPN4

ST.4.0.

Label_SX_TWPN4
Calculation_SXFFONN4

ST.4.0a.

Label_Calculation_SXFFONN4
Skip_SX_EXCN4

“Now, I’m going to ask you about sex with women.”
During the past 12 months, how many women did you have sex with?
8888 Don't Know
7777 Refused to Answer
Number of female-female partners
Female-female only partners: create a calculated variable SXFFONN4 (female-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), 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 SXFFONN4=1, skip to Intro_SEROSRT1 (Partner
+, more likely unprotected sex).
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 Intro_SEROSRT1
(Partner +, more likely unprotected sex).
Else: Go to SX_EXCN4 (exchange sex).

Page | 48

Topic: Exchange sex (SE)
SX_EXCN4

Label_SX_EXCN4

SE.1.0.

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

Page | 49

Topic: Names of partners (SN)
Skip_5_1SX_NM1N4

Intro_5_1SX_NM1N4

Skip_5_2SX_NM1N4
Intro_5_2SX_NM1N4

Skip_5_3SX_NM1N4
Intro_5_3SX_NM1N4

Skip_5_4SX_NM1N4
Intro_6_4SX_NM1N4

SX_NM1N4

Label_SX_NM1N4
Skip_SX_NM1N4

SN.1.0.

If SX_TOTN4 (total number of sex partners) = 1, go to Intro_5_1SX_NM1N4 (name of
partner 1). If SX_TOTN4 >= 2, skip to Intro_5_2SX_NM1N4 (name of partner 1). If SX_GEN
= 2 (female) and SX_TMPN4 (number of male sex partners) = 1, then skip to Intro_5_
3SX_NM1N4. If SX_GEN = 2 (female) and SX_TMPN4 (number of male sex partners) > 1,
then skip to Intro_6_4SX_NM1N4.
“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 to SX_NM1N4 (name of partner 1).
“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 to SX_NM1N4 (name of partner 1).
“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’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, so that when I
ask you follow-up questions, we both know we're talking about the same person. 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 to SX_NM1N4 (name of partner 1).
“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”] 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’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, nickname, or
where you met. However, please don’t provide a last name or any other identifying
information.”
What shall we call the person with whom you most recently had sex during the past 12
months?
77 Refused to Answer
Name of partner 1
If SX_TOTN4 (total number of sex partners) = 1 AND SX_NM1N4 (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_NM1N4 (name of partner 1). If SX_NM1N4 (name of partner 1), is still 7 (refused to
answer), skip to Intro_SEROSRT1 (Partner +, more likely unprotected sex). If SX_TOTN4
(total number of sex partners) is >1, go to SX_NM2N4 (name of partner 2). If SX_TOTN4

Page | 50
QDS_programming_SX_NM1N4
SX_NM2N4

SN.1.1.

Label_SX_NM2N4
Soft_edit_7_SX_NM2N4

Hard_edit_SX_NM2N4

Skip_SX_NM2N4

QDS_programming_SX_NM2N4
SX_NM3N4

SN.1.2.

Label_SX_NM3N4
Soft_edit_7_SX_NM3N4

Hard_edit_SX_NM3N4

Skip_SX_NM3N4

QDS_programming_SX_NM3N4

(total number of sex partners) is 1, go to SXTOVRN4 (verification of total partners).
Open-ended response. Do not allow an 8 (don’t know) response option.
What shall we call the 2nd person with whom you had sex during the past 12 months?
77 Refused to Answer
Name of partner 2
If SX_NM2N4 (name of partner 2) 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.” Allow program to move forward.
If SX_NM1N4 (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).
If SX_TOTN4 (total number of sex partners) = 2 AND SX_NM1N4 (name of partner 1) and
SX_NM2N4 (name of partner 2) are 7 (refused to answer), skip to Intro_SEROSRT1 (Partner
+, more likely unprotected sex). If SX_TOTN4 (total number of sex partners) >=3, go to
SX_NM3N4 (name of partner 3). Else, skip to SXTOVRN4 (verification of total sex partners).
EXAMPLE: SX_NM1N4 (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).
Use open-ended response. Do not allow an 8 (don’t know) response option.
What shall we call the 3rd person with whom you had sex during the past 12 months?
77 Refused to Answer
Name of partner 3
If SX_NM3N4 (name of partner 3) 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.” Allow program to move forward.
If either SX_NM1N4 (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).
If SX_TOTN4 (total number of sex partners) = 3 and SX_NM1N4 (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 Intro_SEROSRT1 (Partner +, more likely unprotected sex). 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_NM1N4 (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).
Use open-ended response. Do not allow an 8 (don’t know) response option.

Page | 51
SX_NM4N4

SN.1.3.

Label_SX_NM4N4
Soft_edit_7_SX_NM4N4

Hard_edit_SX_NM4N4

Skip_SX_NM4N4

QDS_programming_SX_NM4N4
SX_NM5N4

SN.1.4.

Label_SX_NM5N4
Soft_edit_7_SX_NM5N4

Hard_edit_SX_NM5N4

Skip_SX_NM5N4

Skip2_SX_NM5N4

QDS_programming_SX_NM5N4

What shall we call the 4th person with whom you had sex during the past 12 months?
77 Refused to Answer
Name of partner 4
If SX_NM4N4 (name of partner 4) 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.” Allow program to move forward.
If either SX_NM1N4 (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).
If SX_TOTN4 (total number of sex partners) = 4 and SX_NM1N4 (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 Intro_SEROSRT1 (Partner +, more
likely unprotected sex). 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_NM1N4 (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).
Use open-ended response. Do not allow for an 8 (don’t know) response option.
What shall we call the 5th person with whom you had sex during the past 12 months?
77 Refused to Answer
Name of partner 5
If SX_NM5N4 (name of partner 5) 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.” Allow program to move forward.
If either SX_NM1N4 (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_NM1N4 (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 (refused to answer), skip to
Intro_SEROSRT1 (Partner +, more likely unprotected sex). Else go to SXTOVRN4
(verification of total sex partners).
If SX_TOTN4 (total number of sex partners) > 5 and SX_NM1N4 (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).
Use open-ended response. Do not allow an 8 (don’t know) response option.

Page | 52
SXTOVRN4

SN.1.5.

Label_SXTOVRN4
Skip_SXTOVRN4

So, the total number of people you had vaginal or anal sex with during the past 12 months
was [INSERT SX_TOTN4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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-bypartner series table. If SXTOVRN4 = 7 (refused to answer), skip to Intro_SEROSRT1 (Partner
+, more likely unprotected sex).

Topic: Partner demographics #1 (SP)
Skip_SXPGN1N4

SXPGN1N4

SP.1.0.

Label_SXPGN1N4
Soft_edit_SXPGN1N4

Skip_SXPGN1N4
QDS_programming_SXPGN1N4
Intro_SXPAG1N4
SXPAG1N4

Label_SXPAG1N4
Skip_SXPAG1N4

SP.2.0.

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, go to Intro_SXPAG1N4 (partner age-partner 1). Else,
go to SXPGN1N4 (partner gender-partner 1).
Is [INSERT SX_NM1N4] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Partner gender-partner 1
If SX_GEN = 2 (female) and SXPGN1N4 (partner gender-partner 1) = female (2), 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 (partner age-partner 1).
If SXPGN1N4=1, 2, 3, 7, or 8, go to SXPAG1N4 (partner age-partner 1).
When question instructions say “insert partner name,” then insert response from
SX_NM1N4 (name of partner 1).
“For the next question we will use Response Card E.”
Which of the following age groups best describes [INSERT SX_NM1N4]? [READ RESPONSES.
SELECT ONLY ONE.]
1 <=24 years old
2 25-29 years old
3 30-34 years old
4 35-39 years old
5 40-44 years old
6 45-49 years old
7 >=50 years old
77 Refused to Answer
88 Don't Know
Partner age-partner 1
For all responses, go to Intro_SXPEN1N4 (partner ethnicity-partner 1).

Page | 53
Intro_SXPEN1N4
SXPEN1N4

SP.3.0.

Label_SXPEN1N4
Skip_SXPEN1N4
SXPR1N4

SP.4.0.

Which of the following racial group or groups best describes [INSERT SX_NM1N4]? Select
all that apply. If you’re not sure, give me your best guess. [READ RESPONSES. SELECT ALL
THAT APPLY.]
race-partner 1
For all responses, go to SXPCM1N4 (commitment-partner 1).

SP.4.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p1: American Indian Alaska Native

SP.4.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 1: Asian

SP.4.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p1: Black or African American

SP.4.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p1: Ntive Hawaiian Othr Pacific

SP.4.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 1: White

Label_SXPR1N4
Skip_SXPR1N4
SXPR1N4A

Label_SXPR1N4A
SXPR1N4B

Label_SXPR1N4B
SXPR1N4C

Label_SXPR1N4C
SXPR1N4D

Label_SXPR1N4D
SXPR1N4E

Label_SXPR1N4E

“The next two questions ask about partners’ race and ethnicity. We’re asking them to
better understand the health of all groups.”
Is [INSERT SX_NM1N4] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give me
your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
partner ethnicity-partner 1
For all responses go to SXPR1N4 (partner race-partner 1).

Page | 54
SXPCM1N4

SP.5.0.

Label_SXPCM1N4
Skip_SXPCM1N4

How would you describe your level of commitment to [INSERT SX_NM1N4]? Are you…
[READ RESPONSES. SELECT ONLY ONE.]
1 Not at all committed
2 Somewhat committed
3 Very committed
4 Committed to above and beyond anyone else
8 Don't Know
7 Refused to Answer
commitment-partner 1
For all responses, go to Skip_SX_VS1N4 (vaginal sex-partner 1).

Topic: Vaginal sex #1 (SV)
Skip_SX_VS1N4

Transgender/unknown gender respondent: If the SX_GEN=3 (transgender) or 4
(indeterminate), then skip to SX_TG1N4 (transgender-partner 1).
Transgender/unknown gender partner: If the SXTGONN4 = 1 (transgender only partner) OR
[SXPGN1N4 (partner gender- partner 1) = 3, 7 (refused to answer), or 8 (don’t know)], then
skip to SX_TG1N4 (transgender partner 1).
Male-male partners: If SX_GEN=1 (male), and SXMLONN4 = 1 (male only partners) OR if
SX_GEN=1 (male) and SXPGN1N4 (partner gender partner 1) =1 (male), then skip to
SXANL1N4 (anal sex-partner1).

SX_VS1N4

SV.1.0.

Label_SX_VS1N4
Skip2_SX_VS1N4
QDS_programming_partnerdemo
1
SV10_1N4

Label_SV10_1N4
Skip_SV10_1N4

SV.1.1.

Else: go to SX_VS1N4 (vaginal sex-partner 1).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM1N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 1
If SX_VS1N4 = 0 (no), 7 (refused), or 8 (don't know), skip to SXANL1N4 (anal sex-partner 1).
Else, if SX_VS1N4 = 1 (yes), go to SV10_1N4 (vaginal10-partner 1).
When question instructions say “insert partner name," then insert response from
SX_NM1N4 (name of partner 1).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM1N4] more than
10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal 10-partner 1
If SV10_1N4 = 0 (no), go to SXVEN1N4 (times vaginal sex-partner 1). Else, if SV10_1N4 = 1
(yes), skip to SXANV1N4 (average number vaginal-partner 1). Else if SV10_1N4 = 7
(refused) or 8 (don't know), skip to SXANL1N4 (anal sex-partner 1).

Page | 55
SXVEN1N4

SV.1.2.

During the past 12 months, please tell me the exact number of times that you had vaginal
sex with [INSERT SX_NM1N4]?
88 Don't Know
77 Refused to Answer
Times vaginal sex-partner 1
1-10
If SXVEN1N4 = 77 (refused) or 88 (don't know), skip to SXANL1N4 (anal sex-partner 1).
Else, skip to Intro_SXVC1AN4 (condom vaginal-partner 1a).

SV.1.3.

On average, how many times did you have vaginal sex with [INSERT SX_NM1N4] per
month?
888 Don't Know
777 Refused to Answer
average number vaginal-partner 1
1-90
For all responses, go to SXMVG1N4 (months vaginal sex-partner 1).

SV.1.4.

During the past 12 months, how many months did you have vaginal sex with [INSERT
SX_NM1N4]?
88 Don't Know
77 Refused to Answer
months vaginal sex-partner 1
1-12
[IF SV10_1N4 (vaginal 10-partner 1) = 1 and the product of SXANV1N4*SXMVG1N4
(average number vaginal-partner 1*months vaginal sex-partner 1) is <=10], then READ,
“You told me you had vaginal sex with [INSERT SX_NM1N4 (name of partner 1)] more than
10 times.” Interviewer instructions: Please re-ask question SV10_1N4 (vaginal sex more
than 10 times-partner 1). The program should go back to SV10_1N4 (vaginal 10-partner
1).
For all responses, go to Intro_SXVC1AN4 (condom vaginal-partner 1a)

Label_SXVEN1N4
range_SXVEN1N4
Skip_SXVEN1N4
SXANV1N4

Label_SXANV1N4
Range_SXANV1N4
Skip_SXANV1N4
SXMVG1N4

Label_SXMVG1N4
Range_SXMVG1N4
Hard_edit_SV10_1N4

Skip_SXMVG1N4
Intro_SXVC1AN4
Skip_SXVC1AN4
SXVC1AN4

Label_SXVC1AN4
Skip2_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.”
If SXVEN1N4 (times vaginal sex-partner 1) = 1, then go to SXVC1AN4 (condom vaginalpartner 1a); else Skip to SXVC1BN4 (condom vaginal-partner 1b).
SV.1.5.a. During the past 12 months, when you had vaginal sex with [INSERT SX_NM1N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom vaginal-partner 1a
For all responses, skip to SXANL1N4 (anal sex-partner 1).

Page | 56
SXVC1BN4

Label_SXVC1BN4
Skip_SXVC1BN4

SV.1.5.b. During the past 12 months, when you had vaginal sex with [INSERT SX_NM1N4] was a
condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom vaginal-partner 1b
For all responses, go to SXANL1N4 (anal sex-partner 1).

Topic: Anal sex #1 (SL)
SXANL1N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM1N4?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal sex-partner 1
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 (partner genderpartner 1) = 1 OR SXMLONN4 (male only partners) = 1] and SXANL1N4 (anal sex-partner 1)
is 0 (no), then READ, “Earlier you told me that you had anal sex with [INSERT SX_NM1N4].
Is this correct?” Interviewer instructions: return to previous questions to correct error.
Allow program to move forward.
If SXANL1N4 = 1 (yes), go to SA10_1N4 (anal 10-partner 1). Else, skip to STATS1N4 (aware
status-partner 1).

SL.1.1.

During the past 12 months, did you have anal sex with [INSERT SX_NM1N4] more than 10
times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal 10-partner 1
If SA10_1N4 = 0 (no), go to SXAEN1N4 (times anal sex-partner 1). Else, if SA10_1N4 = 1
(yes), skip to SXANA1N4 (average number anal-partner 1). Else, skip to STATS1N4 (aware
status-partner 1).

SL.1.2.

During the past 12 months, please tell me the exact number of times that you had anal sex
with [INSERT SX_NM1N4]?
88 Don't Know
77 Refused to Answer
times anal sex-partner 1
1-10
If SXAEN1N4 = 77 (refused) or 88 (don't know), skip to STATS1N4 (aware status-partner 1).
Else, skip to Interviewer Instructions before SXAC1AN4 (Skip_SXAC1AN4).

SL.1.3.

On average, how many times did you have anal sex with [INSERT SX_NM1N4] per month?
888 Don't Know
777 Refused to Answer
average number anal-partner 1
1-90
For all responses, go to SXMAN1N4 (months anal sex-partner 1)

Label_SXANL1N4
Soft_edit_SXANL1N4

Skip_SXANL1N4
SA10_1N4

Label_SA10_1N4
Skip_SA10_1N4

SXAEN1N4

Label_SXAEN1N4
Range_SXAEN1N4
Skip_SXAEN1N4
SXANA1N4

Label_SXANA1N4
Range_SXANA1N4
Skip_SXANA1N4

Page | 57
SXMAN1N4

SL.1.4.

Label_SXMAN1N4
Range_SXMAN1N4
Hard_edit_SA10_1N4

Skip_SXMAN1N4

During the past 12 months, how many months did you have anal sex with [INSERT
SX_NM1N4]?
88 Don't Know
77 Refused to Answer
months anal sex-partner 1
1-12
[IF SA10_1N4 (anal 10-partner 1) = 1 (yes) and the product of SXANA1N4*SXMAN1N4
(average number anal-partner 1*months anal sex-partner 1) is <=10], then READ, “You
told me you had anal sex with [INSERT SX_NM1N4] more than 10 times.” Interviewer
instructions: Please re-ask question SA10_1N4 (anal sex more than 10 times-partner 1).
The program should go back to SA10_1N4 (anal 10-partner 1).
For all responses, go to Interviewer Instructions before SXAC1AN4 (Skip_SXAC1AN4).
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 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 Intro_SXAC1AN4 (condom analpartner 1a).

Skip_SXAC1AN4

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 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 (anal 10-partner 1) = “yes,” then
go to Intro_SXAC1BN4 (condom anal-partner 1b).
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 Intro_SXAC1AN4 (condom analpartner 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 10partner 1) = “yes,” then go to Intro_SXAC1BN4 (condom anal-partner 1b).

Intro_SXAC1AN4
SXAC1AN4

Label_SXAC1AN4
Skip2_SXAC1AN4

SL.1.5.a.

Male-male partner(s): 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], then
skip to interviewer instructions for ABTM1AN4 (receptive anal-partner 1a).
“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 past 12 months, when you had anal sex with [INSERT SX_NM1N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom anal-partner 1a
For all responses, skip to STATS1N4 (aware status-partner 1).

Page | 58
Intro_SXAC1BN4
SXAC1BN4

Label_SXAC1BN4
Skip_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.”
SL.1.5.b. During the past 12 months, when you had anal sex with [INSERT SX_NM1N4] was a
condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 1b
For all responses, skip to STATS1N4 (aware status-partner 1).

Skip_ABTM1AN4

ABTM1AN4

Label_ABTM1AN4
Skip2_ABTM1AN4
ABTM1BN4

Label_ABTM1BN4
Skip_ABTM1BN4

Male-male partner-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 ABTM1AN4 (receptive anal-partner 1a).

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 OR SXMLONN4 (male only
partners) =1] AND the respondent had anal sex with partner 1 more than one time
[SXAEN1N4 (times anal sex-partner 1) >=2 OR SA10_1N4 (anal 10-partner 1) =1] THEN Skip
to ABTM1BN4 (receptive anal-partner 1b).
During the past 12 months, when you had anal sex with [INSERT SX_NM1N4], did you have
anal sex where you were a bottom?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
receptive anal-partner 1a
If ABTM1AN4 = 1 (yes), Skip to Interviewer Instructions before Intro_ABTC1AN4 (Skip2
_ABTC1AN4). Else, Skip to ATP1AN4 (insertive anal-partner 1a).

SL.1.6.b. During the past 12 months, when you had anal sex with [INSERT SX_NM1N4], how often
did you have anal sex where you were a bottom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
receptive anal-partner 1b
If ABTM1BN4 = 1 (never), 7 (refused), or 8 (don't know), skip to ATP1BN4 (insertive analpartner 1b). Else, Skip to Interviewer Instructions before Intro_ABTC1AN4
(Skip_Intro_ABTC1AN4).

Page | 59
Skip_Intro_ABTC1AN4

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 Intro_ABTC1AN4 (condom receptive anal-partner 1a).

Intro_ABTC1AN4
ABTC1AN4

SL.1.7.a.

Label_ABTC1AN4
Skip_ABTC1AN4
Intro_ABTC1BN4

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 [anal 10-partner 1] =1), THEN go
to 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.”
During the past 12 months, when you had anal sex with [INSERT SX_NM1N4] where you
were a bottom, was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Condom receptive anal-partner 1a
For all responses, skip to ATP1AN4 (insertive anal-partner 1a).

Label_ABTC1BN4
Skip_ABTC1BN4

“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.”
SL.1.7.b. During the past 12 months, when you had anal sex with [INSERT SX_NM1N4] where you
were a bottom, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 1b
For all responses, go to ATP1BN4 (insertive anal-partner 1b).

ATP1AN4

SL.1.8.a.

ABTC1BN4

Label_ATP1AN4
Soft_edit_ATP1AN4

Skip_ATP1AN4

During the past 12 months, when you had anal sex with [INSERT SX_NM1N4], did you have
anal sex where you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
insertive anal-partner 1a
If ( (SXANL1N4=1 AND ABTM1AN4=0 AND ATP1AN4=0) ), READ: "Earlier you told me you
had anal sex with [INSERT SX_NM1N4]. Is this correct?" Interviewer instructions: return to
previous question to correct error.
If ATP1AN4 = 1 (yes), Skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4 (Skip2
_ATPC1AN4). Else, Skip to STATS1N4 (aware status-partner 1).

Page | 60
ATP1BN4

Label_ATP1BN4
Soft_edit_ATPC1BN4

Skip_ATP1BN4

SL.1.8.b. During the past 12 months when you had anal sex with [INSERT SX_NM1N4], how often
did you have anal sex where you were a top? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
Insertive anal-partner 1b
If SXANL1N4 (anal sex partner 1) = 1 (yes) and ABTM1AN4 (receptive anal sex partner 1) =
0 (no) and ATP1AN4 (insertive anal sex partner 1) = 0 (no), READ the following: “Earlier
you told me that you had anal sex with [INSERT SX_NM1N4]. Is this correct? Interviewer
instructions: return to previous questions to correct error.” Allow program to move
forward.
If ATP1BN4 = 1 (never), 7 (refused), or 8 (don't know), Skip to STATS1N4 (aware statuspartner 1). Else, Skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4
(Skip_Intro_ATPC1AN4).

Skip_Intro_ATPC1AN4

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 Intro_ATPC1AN4 (condom insertive anal-partner 1a.

Intro_ATPC1AN4
ATPC1AN4

Label_ATPC1AN4
Skip_ATPC1AN4
Intro_ATPC1BN4
ATPC1BN4

Label_ATPC1BN4
Skip_ATPC1BN4

SL.1.9.a.

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
Intro_ATPC1BN4 (condom insertive anal-partner 1b).
“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 past 12 months, when you had anal sex with [INSERT SX_NM1N4], was a
condom used when you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Condom insertive anal-partner 1a
For all responses, skip to STATS1N4 (aware status-partner 1).

“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.”
SL.1.9.b. During the past 12 months, when you had anal sex with [INSERT SX_NM1N4] where you
were a top, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom insertive anal-partner 1b
For all responses, go to STATS1N4 (aware status-partner 1)

Page | 61

Topic: Transgender and unknown gender sex #1 (SG)
SX_TG1N4

SG.1.0.

Label_SX_TG1N4
Soft_edit_SX_TG1N4

Skip_SX_TG1N4
QDS_programming_transgen1
TG10_1N4

SG.1.1.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM1N4]
more than 10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender 10-partner 1
If TG10_1N4 = 1 (yes), skip to TGAN1N4 (average number transgender -partner 1). Else, if
TG10_1N4 = 0 (no), go to TGEN1N4 (times transgender -partner 1). Else, skip to STATS1N4
(aware status- partner 1).

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 SX_NM1N4]?
88 Don't Know
77 Refused to Answer
times transgender -partner 1
1-10
If TGEN1N4=77 (refused) or 88 (don't know), skip to STATS1N4 (aware status-partner 1).
Else, skip to instructions before TGC1AN4 (condom transgender -partner 1a)
(Skip_TGM1N4).

SG.1.3.

On average, how many times did you have vaginal or anal sex with [INSERT SX_NM1N4]
per month?
888 Don't Know
777 Refused to Answer
average number transgender -partner 1
1-90
For all responses, go to TGM1N4 (months transgender partner 1).

Label_TG10_1N4
Skip_TG10_1N4

TGEN1N4

Label_TGEN1N4
Range_TGEN1N4
Skip_TGEN1N4

TGAN1N4

Label_TGAN1N4
Range_TGAN1N4
Skip_TGAN1N4

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM1N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender-partner 1
If SX_TG1N4 (transgender-partner 1) is 0 (no), then READ, “Earlier you told me that you
had vaginal or anal sex with [INSERT SX_NM1N4]. Is this correct? Interviewer instructions:
return to previous questions to correct error." Allow program to move forward.
If SX_TG1N4 = 1 (yes), go to TG10_1N4 (transgender 10-partner 1). Else, skip to STATS1N4
(aware status- partner 1).
When question instructions say “insert partner name,” then insert response from
SX_NM1N4 (name of partner 1).

Page | 62
TGM1N4

Label_TGM1N4
Range_TGM1N4
Hard_edit_TGM1N4

Skip_TGM1N4
Skip_Intro_TGC1AN4

Intro_TGC1AN4
TGC1AN4

Label_TGC1AN4
Skip_TGC1AN4
Skip_Intro_TGC1BN4

Intro_TGC1BN4
TGC1BN4

Label_TGC1BN4
Skip_TGC1BN4

SG.1.4.

During the past 12 months, how many months did you have vaginal or anal sex with
[INSERT SX_NM1N4]?
88 Don't Know
77 Refused to Answer
months transgender-partner 1
1-12
[IF TG10_1N4 (transgender 10-partner 1) = 1 and the product of TGAN1N4*TGM1N4
(average number transgender-partner 1*months transgender-partner 1) is <=10], then
READ, “You told me you had vaginal or anal sex with [INSERT SX_NM1N4] more than 10
times.” Interviewer instructions: Please re-ask question TG10_1N4 (transgender 10partner 1). The program should go back to TG10_1N4 (transgender 10-partner 1).
For all responses, go to interviewer instructions before TGC1AN4 (condom transgender partner 1a) (Skip_Intro_TGC1AN4).
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 transgenderpartner 1) = 1], THEN go to Intro_TGC1AN4 (condom transgender-partner 1a).

Else, go to Interviewer instructions before TGC1BN4 (condom transgender-partner 1b).
“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.”
SG.1.5.a. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM1N4]
was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom transgender-partner 1a
For all responses, skip to STATS1N4 (aware status-partner 1)
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
Intro_TGC1BN4 (condom transgender-partner 1b).
“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.”
SG.1.5.b. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM1N4]
was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom transgender-partner 1b
For all responses, go to STATS1N4 (aware status-partner 1)

Page | 63

Topic: Status #1 (SS)
STATS1N4

SS.1.0.

Label_STATS1N4
Skip2_STATS1N4
QDS_programming_STATS1N4
AWRST1N4

SS.1.1.

During the past 12 months, was [INSERT SX_NM1N4] aware of your status every time you
had sex?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware status every sex -partner 1
For all responses, go to STPRT1N4 (Partner status-partner 1).

SS.2.0.

Do you know [INSERT SX_NM1N4]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 1
If STPRT1N4 = 1 (yes), go to PRTST1N4 (Partner status first sex-partner 1). Else, if
SX_TOTN4 (total number of vaginal and anal sex partners) = 1, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 2, skip
to skip_SXPGN2N4 (partner gender-partner 2).

SS.2.1.

During the past 12 months, what was [INSERT SX_NM1N4]’s HIV status the first time that
you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 1
If PRTST1N4 = 2 (HIV Negative), go to PREP1N4 (PrEP-partner 1). Else, if SX_TOTN4 (total
number of vaginal and anal sex partners)= 1, skip to serosorting section (Intro_SEROSRT1).
If SX_TOTN4 (total number of vaginal and anal sex partners) >=2, skip to skip_SXPGN2N4
(partner gender-partner 2).

Label_AWRST1N4
Skip_AWRST1N4
STPRT1N4

Label_STPRT1N4
Skip_STPRT1N4

PRTST1N4

Label_PRTST1N4
Skip_PRTST1N4

Does [INSERT SX_NM1N4] know your HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
aware status-partner 1
If STATS1N4 = 1 (yes), go to AWRST1N4 (aware status every sex-partner 1). Else, skip to
STPRT1N4 (partner status-partner 1).
When question instructions say “insert partner name,” and the variable is in the Partner 1
column, then insert response from SX_NM1N4(name of partner 1).

Page | 64

Topic: Pre-exposure prophylaxis #1 (SR)
PREP1N4

SR.1.0.

Label_PREP1N4
Skip_PREP1N4

QDS_programming_PREP1N4

Sometimes people who are HIV negative take antiretroviral medicine, such as Truvada, to
prevent them from getting HIV. Was [INSERT SX_NM1N4] taking antiretroviral medicine to
prevent them from getting HIV when you last had sex? If you aren’t sure, that’s okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 1
If SX_TOTN4 (total number of vaginal and anal sex partners) = 1, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >=2, skip to
skip_SXPGN2N4 (partner gender-partner 2).
When question instructions say “insert partner name, then insert response from
SX_NM1N4(name of partner 1).

Topic: Partner demographics #2 (SP)
Skip_SXPGN2N4

SXPGN2N4

SP.1.0.

Label_SXPGN2N4
Soft_edit_SXPGN2N4

Skip_SXPGN2N4
QDS_programming_SXPGN2N4

If SX_TOTN4 = 2 AND respondent provided name for partner 2 (SX_NM2N4 not 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, then skip SXPGN2N4 (partner’s
gender-partner 2) and go to SXPAG2N4 (partner age-partner 2). Else, go to
Intro_SXPGN2N4 (partner gender-partner 2).
Is [INSERT SX_NM2N4] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
partner gender-partner 2
If SX_GEN = 2 (female) and SXPGN2N4 (partner gender-partner 2) = female (2), 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.
If SXPGN2N4=1, 2, 3, 7, or 8, go to SXPAG2N4 (partner age-partner 2).
When question instructions say “insert partner name,” insert response to SX_NM2N4
(name of partner 2).

Page | 65
SXPAG2N4

SP.2.0.

Which of the following age groups best describes [INSERT SX_NM2N4]? [READ
RESPONSES. SELECT ONLY ONE.]
1 <=24 years old
2 25-29 years old
3 30-34 years old
4 35-39 years old
5 40-44 years old
6 45-49 years old
7 >=50 years old
77 Refused to Answer
88 Don't Know
partner age-partner 2
For all responses, go to SXPEN2N4 (partner ethnicity-partner 2).

SP.3.0.

Is [INSERT SX_NM2N4] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give me
your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
partner ethnicity-partner 2
For all responses go to SXPR2N4 (partner race-partner 2).

SP.4.0.

Which of the following racial group or groups best describes [INSERT SX_NM2N4]? Select
all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT ALL
THAT APPLY]
Race-partner 2
For all responses, go to SXPCM2N4 (commitment-partner 2).

SP.4.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p2: American Indian Alaska Native

SP.4.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 2: Asian

SP.4.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p2: Black or African American

Label_SXPAG2N4
Skip_SXPAG2N4
SXPEN2N4

Label_SXPEN2N4
Skip_SXPEN2N4
SXPR2N4

Label_SXPR2N4
Skip_SXPR2N4
SXPR2N4A

Label_SXPR2N4A
SXPR2N4B

Label_SXPR2N4B
SXPR2N4C

Label_SXPR2N4C

Page | 66
SXPR2N4D

SP.4.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p2: Ntive Hawaiian Othr Pacific

SP.4.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 2: White

SP.5.0.

How would you describe your level of commitment to [INSERT SX_NM2N4]? Are you…
[READ RESPONSES. SELECT ONLY ONE.]
1 Not at all committed
2 Somewhat committed
3 Very committed
4 Committed to above and beyond anyone else
8 Don't Know
7 Refused to Answer
commitment-partner 2
For all responses, go to Skip_SX_VS2N4 (vaginal sex-partner 2).

Label_SXPR2N4D
SXPR2N4E

Label_SXPR2N4E
SXPCM2N4

Label_SXPCM2N4
Skip_SXPCM2N4

Topic: Vaginal sex #2 (SV)
Skip_SX_VS2N4

Transgender/unknown gender respondent: If the SX_GEN=3 (transgender) or 4
(indeterminate), then skip to SX_TG2N4 (transgender-partner 2).
Transgender/unknown gender partner: If the SXTGONN4 = 1 (transgender only partner) OR
[SXPGN2N4 (partner gender- partner 2) = 3, 7 (refused to answer), or 8 (don’t know)], then
skip to SX_TG2N4 (transgender partner 2).
Male-male partners: If SX_GEN=1 (male), and SXMLONN4 = 1 (male only partners) OR if
SX_GEN=1 (male) and SXPGN2N4 (partner gender partner 2) =1 (male), then skip to
SXANL2N4 (anal sex-partner 2).

SX_VS2N4

SV.1.0.

Label_SX_VS2N4
Skip2_SX_VS2N4
QDS_programming_partnerdemo
2

Else: go to SX_VS2N4 (vaginal sex-partner 2).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM2N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal sex-partner 2
If SX_VS2N4 = 0 (no), 7 (refused), or 8 (don't know), skip to SXANL2N4 (anal sex-partner 2).
Else, if SX_VS2N4 = 1 (yes), go to SV10_2N4 (vaginal10-partner 2).
When question instructions say “insert partner name,” insert response to SX_NM2N4
(name of partner 2).

Page | 67
SV10_2N4

SV.1.1.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM2N4] more than
10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal 10-partner 2
If SV10_2N4 = 0 (no), go to SXVEN2N4 (times vaginal sex-partner 2). Else, if SV10_2N4 = 1
(yes), skip to SXANV2N4 (average number vaginal-partner 2). Else if SV10_2N4 = 7
(refused) or 8 (don't know), skip to SXANL2N4 (anal sex-partner 2).

SV.1.2.

During the past 12 months, please tell me the exact number of times that you had vaginal
sex with [INSERT SX_NM2N4]?
88 Don't Know
77 Refused to Answer
times vaginal sex-partner 2
1-10
If SXVEN2N4 = 77 (refused) or 88 (don't know), skip to SXANL2N4 (anal sex-partner 2).
Else, skip to Intro_SXVC2AN4 (condom vaginal-partner 2a).

SV.1.3.

On average, how many times did you have vaginal sex with [INSERT SX_NM2N4] per
month?
888 Don't Know
777 Refused to Answer
average number vaginal-partner 2
1-90
For all responses, go to SXMVG2N4 (months vaginal sex-partner 2).

SV.1.4.

During the past 12 months, how many months did you have vaginal sex with [INSERT
SX_NM2N4]?
88 Don't Know
77 Refused to Answer
months vaginal sex-partner 2
1-12
[IF SV10_2N4 (vaginal 10-partner 2) = 1 and the product of SXANV2N4*SXMVG2N4
(average number vaginal-partner 2*months vaginal sex-partner 2) is <=10], then READ,
“You told me you had vaginal sex with [INSERT SX_NM2N4] more than 10 times.”
Interviewer instructions: Please re-ask question SV10_2N4 (vaginal sex more than 10
times-partner 2). The program should go back to SV10_2N4 (vaginal 10-partner 2).
For all responses, skip to instructions before SXVC2AN4 (condom vaginal-partner 2a).

Label_SV10_2N4
Skip_SV10_2N4

SXVEN2N4

Label_SXVEN2N4
range_SXVEN2N4
Skip_SXVEN2N4
SXANV2N4

Label_SXANV2N4
Range_SXANV2N4
Skip_SXANV2N4
SXMVG2N4

Label_SXMVG2N4
Range_SXMVG2N4
Hard_edit_SV10_2N4

Skip_SXMVG2N4
Skip_SXVC2AN4
SXVC2AN4

Label_SXVC2AN4
Skip2_SXVC2AN4

If SXVEN2N4 (times vaginal sex-partner 2) = 1, then go to SXVC2AN4 (condom vaginalpartner 2a); else Skip to SXVC2BN4 (condom vaginal-partner 2b).
SV.1.5.a. During the past 12 months, when you had vaginal sex with [INSERT SX_NM2N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom vaginal-partner 2a
For all responses, skip to SXANL2N4 (anal sex-partner 2).

Page | 68
SXVC2BN4

Label_SXVC2BN4
Skip_SXVC2BN4

SV.1.5.b. During the past 12 months, when you had vaginal sex with [INSERT SX_NM2N4] was a
condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom vaginal-partner 2b
For all responses, go to SXANL2N4 (anal sex-partner 2).

Topic: Anal sex #2 (SL)
SXANL2N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM2N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal sex-partner 2
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 SXPGN2N4 (partner genderpartner 2) = 1 OR SXMLONN4 (male only partners) = 1] and SXANL2N4 (anal sex-partner 2)
is 0 (no), then READ, “Earlier you told me that you had anal sex with [INSERT SX_NM2N4].
Is this correct?” Interviewer instructions: return to previous questions to correct error.
Allow program to move forward.
If SXANL2N4 = 1 (yes), go to SA10_2N4 (anal 10-partner 2). Else, skip to STATS2N4 (aware
status-partner 2).

SL.1.1.

During the past 12 months, did you have anal sex with [INSERT SX_NM2N4] more than 10
times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal 10-partner 2
If SA10_2N4 = 0 (no), go to SXAEN2N4 (times anal sex-partner 2). Else, if SA10_2N4 = 1
(yes), skip to SXANA2N4 (average number anal-partner 2). Else, skip to STATS2N4 (aware
status-partner 2).

SL.1.2.

During the past 12 months, please tell me the exact number of times that you had anal sex
with [INSERT SX_NM2N4]?
88 Don't Know
77 Refused to Answer
times anal sex-partner 2
1-10
If SXAEN2N4 = 77 (refused) or 88 (don't know), skip to STATS2N4 (aware status-partner 2).
Else, skip to Interviewer Instructions before SXAC2AN4 (Skip_SXAC2AN4).

SL.1.3.

On average, how many times did you have anal sex with [INSERT SX_NM2N4] per month?
888 Don't Know
777 Refused to Answer
average number anal-partner 2
1-90
For all responses, go to SXMAN2N4 (months anal sex-partner 2).

Label_SXANL2N4
Soft_edit_SXANL2N4

Skip_SXANL2N4
SA10_2N4

Label_SA10_2N4
Skip_SA10_2N4

SXAEN2N4

Label_SXAEN2N4
Range_SXAEN2N4
Skip_SXAEN2N4
SXANA2N4

Label_SXANA2N4
Range_SXANA2N4
Skip_SXANA2N4

Page | 69
SXMAN2N4

SL.1.4.

Label_SXMAN2N4
Range_SXMAN2N4
Hard_edit_SA10_2N4

Skip_SXMAN2N4

During the past 12 months, how many months did you have anal sex with [INSERT
SX_NM2N4]?
88 Don't Know
77 Refused to Answer
months anal sex-partner 2
1-12
[IF SA10_2N4 (anal 10-partner 2) = 1 (yes) and the product of SXANA2N4*SXMAN2N4
(average number anal-partner 2*months anal sex-partner 2) is <= 10], then READ, “You
told me you had anal sex with [INSERT SX_NM2N4] more than 10 times.” Interviewer
instructions: Please re-ask question SA10_2N4 (anal sex more than 10 times-partner 2).
The program should go back to SA10_1N4 (anal 10-partner 2).
For all responses, go to Interviewer Instructions before SXAC2AN4 (Skip_SXAC2AN4).
Female-male partner #2-anal sex once: If the respondent is female (SX_GEN=2) AND
partner 2 is male [SXPGN2N4 (partner’s gender-partner 2) = 1 (male) or SXMLONN4 (male
only partners) = 1] AND the respondent had anal sex with partner 1 only one time
[SXAEN2N4 (times anal sex-partner 2) = 1], then go to Intro_SXAC2AN4 (condom analpartner 2a).

Skip_SXAC2AN4

Female-male partner #2-anal sex more than once: If the respondent is female (SX_GEN=2)
AND partner 2 is male [SXPGN2N4 (partner’s gender-partner 2) = 1 (male) or SXMLONN4
(male only partners)=1] AND the respondent had anal sex with partner 2 more than once
[SXAEN2N4 (times anal sex-partner 1) >= 2] OR SA10_2N4 (anal 10-partner 2) = “yes,” then
go to Intro_SXAC2BN4 (condom anal-partner 2b).
Male-female partner #2-anal sex once: If the respondent is male (SX_GEN=1) and partner 2
is female [SXPGN2N4 (partner’s gender-partner 2) = 2 (female) OR SXFMONN4 (female
only partners) =1], AND the respondent had anal sex with partner 2 only one time
[SXAEN2N4 (times anal sex-partner 2) = 1], then go to Intro_SXAC2AN4 (condom analpartner 2a).
Male-female partner #2-anal sex more than once: If the respondent is male (SX_GEN=1)
AND partner 2 is female [SXPGN2N4 (partner’s gender-partner 2) = 2 (female) OR
SXFMONN4 (female only partners) =1 ], AND the respondent had anal sex with partner 1
more than once [SXAEN2N4 (times anal sex-partner 2) >= 2] OR SA10_2N4 (anal 10partner 2) = “yes,” then go to Intro_SXAC2BN4 (condom anal-partner 2b).

SXAC2AN4

Label_SXAC2AN4
Skip2_SXAC2AN4

SL.1.5.a.

Male-male partner(s): If the respondent is male (SX_GEN=1) and partner is male
[SXPGN2N4 (partner’s gender-partner 2) = 1 OR SXMLONN4 (male only partners) = 1], then
skip to interviewer instructions for ABTM2AN4 (receptive anal-partner 2a). If SA10_2N4
(anal 10-partner 2) = Refused to answer or don’t know OR if SXAEN2N4 (times anal sexpartner 2) = 0, skip to STATS2N4 (aware status-partner 2).
During the past 12 months, when you had anal sex with [INSERT SX_NM2N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom anal-partner 2a
For all responses, skip to STATS2N4 (aware status-partner 2).

Page | 70
SXAC2BN4

Label_SXAC2BN4
Skip_SXAC2BN4

SL.1.5.b. During the past 12 months, when you had anal sex with [INSERT SX_NM2N4] was a
condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom anal-partner 2b
For all responses, skip to STATS2N4 (aware status-partner 2).

Skip_ABTM2AN4

ABTM2AN4

Label_ABTM2AN4
Skip2_ABTM2AN4
ABTM2BN4

Label_ABTM2BN4
Skip_ABTM2BN4

Male-male partner-anal sex once: If the respondent is male (SX_GEN=1) and partner is
male [SXPGN2N4 (partner’s gender-partner 2) = 1 OR SXMLONN4 (male only partners) =
1], AND the respondent had anal sex with partner 2 only one time [SXAEN2N4 (times anal
sex-partner 2) = 1], THEN go to ABTM2AN4 (receptive anal-partner 2a).

SL.1.6.a.

Male-male partner-anal sex more than once: If the respondent is male (SX_GEN=1) and
partner is male [SXPGN2N4 (partner’s gender-partner 2) = 1 OR SXMLONN4 (male only
partners) =1] AND the respondent had anal sex with partner 2 more than one time
[SXAEN2N4 (times anal sex-partner 2) >=2 OR SA10_2N4 (anal 10-partner 2) =1] THEN Skip
to ABTM2BN4 (receptive anal-partner 2b).
During the past 12 months, when you had anal sex with [INSERT SX_NM2N4], did you have
anal sex where you were a bottom?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
receptive anal-partner 2a
If ABTM2AN4 = 1 (yes), Skip to Interviewer Instructions before Intro_ABTC2AN4 (Skip2
_ABTC2AN4). Else, Skip to ATP2AN4 (insertive anal-partner 2a).

SL.1.6.b. During the past 12 months, when you had anal sex with [INSERT SX_NM2N4], how often
did you have anal sex where you were a bottom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
receptive anal-partner 2b
If ABTM2BN4 = 1 (never), 7 (refused), or 8 (don't know), skip to ATP2BN4 (insertive analpartner 2b). Else, Skip to Interviewer Instructions before Intro_ABTC2AN4
(Skip_Intro_ABTC2AN4).

Page | 71
Skip_Intro_ABTC2AN4

ABTC2AN4

Male-partner #2 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN2N4 (partner’s gender-partner 2) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #2 only one time [SXAEN2N4 (times anal
sex-partner 2) = 1], THEN go to Intro_ABTC2AN4 (condom receptive anal-partner 2a).

SL.1.7.a.

Label_ABTC2AN4
Skip_ABTC2AN4
ABTC2BN4

Male-partner #2 male-anal sex more than once: if the respondent is male (SX_GEN=1) AND
partner is male (SXPGN2N4 [partner’s gender-partner 2] OR SXMLONN4 [male only
partners] = 1) AND the respondent had anal sex with partner #2 more than once
(SXAEN2N4 [times anal sex-partner 2] >= 2 or SA10_2N4 [anal 10-partner 2] =1), THEN go
to Intro_ABTC2BN4 (condom receptive anal-partner 2b).
During the past 12 months, when you had anal sex with [INSERT SX_NM2N4] where you
were a bottom, was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 2a
For all responses, skip to ATP2AN4 (insertive anal-partner 2a).

Label_ABTC2BN4
Skip_ABTC2BN4

SL.1.7.b. During the past 12 months, when you had anal sex with [INSERT SX_NM2N4] where you
were a bottom, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 2b
For all responses, go to ATP2BN4 (insertive anal-partner 2b).

ATP2AN4

SL.1.8.a.

Label_ATP2AN4
Soft_edit_ATP2AN4

Skip_ATP2AN4

During the past 12 months, when you had anal sex with [INSERT SX_NM2N4], did you have
anal sex where you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
insertive anal-partner 2a
If ( (SXANL2N4=1 AND ABTM2AN4=0 AND ATP2AN4=0) ), READ: "Earlier you told me you
had anal sex with [INSERT SX_NM2N4]. Is this correct?" Interviewer instructions: return to
previous question to correct error.
If ATP2AN4 = 1 (yes), Skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4 (Skip2
_ATPC2AN4). Else, Skip to STATS2N4 (aware status-partner 2).

Page | 72
ATP2BN4

Label_ATP2BN4
Soft_edit_ATPC2BN4

Skip_ATP2BN4

SL.1.8.b. During the past 12 months when you had anal sex with [INSERT SX_NM2N4], how often
did you have anal sex where you were a top? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
insertive anal-partner 2b
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 SX_NM2N4]. Is this correct? Interviewer
instructions: return to previous questions to correct error.” Allow program to move
forward.
If ATP2BN4 = 1 (never), 7 (refused), or 8 (don't know), Skip to STATS2N4 (aware statuspartner 2). Else, skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4
(Skip_Intro_ATPC2AN4).

Skip_Intro_ATPC2AN4

ATPC2AN4

Label_ATPC2AN4
Skip_ATPC2AN4
ATPC2BN4

Label_ATPC2BN4
Skip_ATPC2BN4

Male-partner #2 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN2N4 (partner’s gender-partner 2) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #2 only one time [SXAEN2N4 (times anal
sex-partner 2) = 1], THEN go to Intro_ATPC2AN4 (condom insertive anal-partner 2a).

SL.1.9.a.

Male-partner #2 male-anal sex more than once: If the respondent is male (SX_GEN=1) AND
partner is male [SXPGN2N4 (partner’s gender-partner 2) OR SXMLONN4 (male only
partners) = 1] AND the respondent had anal sex with partner #2 more than once
[SXAEN2N4 (times anal sex-partner 2) >= 2 OR SA10_1N4 = 1], THEN go to
Intro_ATPC2BN4 (condom insertive anal-partner 2b).
During the past 12 months, when you had anal sex with [INSERT SX_NM2N4], was a
condom used when you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 2a
For all responses, skip to STATS2N4 (aware status-partner 2)

SL.1.9.b. During the past 12 months, when you had anal sex with [INSERT SX_NM2N4] where you
were a top, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 2b
For all responses, go to STATS2N4 (aware status-partner 2)

Page | 73

Topic: Transgender and unknown gender sex #2 (SG)
SX_TG2N4

SG.1.0.

Label_SX_TG2N4
Soft_edit_SX_TG2N4

Skip_SX_TG2N4
QDS_programming_transgen2
TG10_2N4

SG.1.1.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM2N4]
more than 10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender 10-partner 2
If TG10_2N4 = 1 (yes), skip to TGAN2N4 (average number transgender -partner 2). Else, if
TG10_2N4 = 0 (no), go to TGEN2N4 (times transgender -partner 2). Else, skip to STATS2N4
(aware status- partner 2).

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 SX_NM2N4]?
88 Don't Know
77 Refused to Answer
times transgender -partner 2
1-10
If TGEN2N4=77 (refused) or 88 (don't know), Skip STATS2N4 (aware status-partner 2). Else,
skip to instructions before TGC2AN4 (condom transgender -partner 2a) (Skip_TGM2N4).

SG.1.3.

On average, how many times did you have vaginal or anal sex with [INSERT SX_NM2N4]
per month?
888 Don't Know
777 Refused to Answer
average number transgender -partner 2
1-90
For all responses, go to TGM2N4 (months transgender partner 2).

Label_TG10_2N4
Skip_TG10_2N4

TGEN2N4

Label_TGEN2N4
Range_TGEN2N4
Skip_TGEN2N4
TGAN2N4

Label_TGAN2N4
Range_TGAN2N4
Skip_TGAN2N4

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM2N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender-partner 2
If SX_TG2N4 (transgender-partner 2) is 0 (no), then READ, “Earlier you told me that you
had vaginal or anal sex with [INSERT SX_NM2N4]. Is this correct? Interviewer instructions:
return to previous questions to correct error.” Allow program to move forward.
If SX_TG2N4 = 1 (yes), go to TG10_2N4 (transgender 10-partner 2). Else, skip to STATS2N4
(aware status- partner 2).
When question instructions say “insert partner name," insert response to SX_NM2N4
(name of partner 2)

Page | 74
TGM2N4

Label_TGM2N4
Range_TGM2N4
Hard_edit_TGM2N4

Skip_TGM2N4
Skip_Intro_TGC2AN4

TGC2AN4

Label_TGC2AN4
Skip_TGC2AN4
Skip_Intro_TGC2BN4

TGC2BN4

Label_TGC2BN4
Skip_TGC2BN4

SG.1.4.

During the past 12 months, how many months did you have vaginal or anal sex with
[INSERT SX_NM2N4]?
88 Don't Know
77 Refused to Answer
months transgender-partner 2
1-12
[IF TG10_2N4 (transgender 10-partner 2) = 1 and the product of TGAN2N4*TGM2N4
(average number transgender-partner 2*months transgender-partner 2) is <=10], then
READ, “You told me you had vaginal or anal sex with [INSERT SX_NM2N4] more than 10
times.” Interviewer instructions: Please re-ask question TG10_2N4 (transgender 10partner 2). The program should go back to TG10_2N4 (transgender 10-partner 2).
For all responses, go to interviewer instructions before TGC2AN4 (condom transgender partner 2a) (Skip_intro_TGC2AN4).
Transgender/Unknown gender sex-any partner #2 vaginal-anal sex once: If the respondent
had vaginal or anal sex with partner #2 only one time [TGEN2N4 (times transgenderpartner 2) = 1], THEN go to Intro_TGC2AN4 (condom transgender-partner 2a).

Else, go to Interviewer instructions before TGC2BN4 (condom transgender-partner 2b).
SG.1.5.a. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM2N4]
was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom transgender-partner 2a
For all responses, skip to STATS2N4 (aware status-partner 2)
Transgender/Unknown gender sex-any partner #2 vaginal-anal sex more than once: If the
respondent had vaginal or anal sex with partner #2 more than once [TGEN2N4 (times
transgender-partner 2) >= 2], OR TG10_2N4 (transgender 10-partner 2) =1 THEN go to
Intro_TGC2BN4 (condom transgender-partner 2b).
SG.1.5.b. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM2N4]
was a condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom transgender-partner 2b
For all responses, go to STATS2N4 (aware status-partner 2)

Page | 75

Topic: Status #2 (SS)
STATS2N4

SS.1.0.

Label_STATS2N4
Skip_STATS2N4
QDS_programming_STATS2N4
AWRST2N4

SS.1.1.

During the past 12 months, was [INSERT SX_NM2N4] aware of your status every time you
had sex?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware status every sex -partner 2
For all responses, go to STPRT2N4 (Partner status-partner 2).

SS.2.0.

Do you know [INSERT SX_NM2N4]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 2
If STPRT2N4 = 1 (yes), go to PRTST2N4 (Partner status first sex-partner 2). Else, if
SX_TOTN4 (total number of vaginal and anal sex partners) = 2, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 3, skip
to skip_SXPGN3N4 (partner gender-partner 3).

SS.2.1.

During the past 12 months, what was [INSERT SX_NM2N4]’s HIV status the first time that
you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 2
If PRTST2N4 = 2 (HIV Negative), Go to PREP2N4 (PrEP-partner 2). Else, If SX_TOTN4 (total
number of vaginal and anal sex partners)= 2, skip to serosorting section (Intro_SEROSRT1).
If SX_TOTN4 (total number of vaginal and anal sex partners) >= 3, skip to skip_SXPGN3N4
(partner gender-partner 3).

Label_AWRST2N4
Skip_AWRST2N4
STPRT2N4

Label_STPRT2N4
Skip_STPRT2N4

PRTST2N4

Label_PRTST2N4
Skip_PRTST2N4

Does [INSERT SX_NM2N4] know your HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
aware status-partner 2
If STATS2N4 = 1 (yes), go to AWRST2N4 (aware status every sex-partner 2). Else, skip to
STPRT2N4 (partner status-partner 2).
When question instructions say “insert partner name," then insert response from
SX_NM2N4 (name of partner 2).

Page | 76

Topic: Pre-exposure prophylaxis #2 (SR)
PREP2N4

SR.1.0.

Label_PREP2N4
Skip_PREP2N4

QDS_programming_PREP2N4

Sometimes people who are HIV negative take antiretroviral medicine, such as Truvada, to
prevent them from getting HIV. Was [INSERT SX_NM2N4] taking antiretroviral medicine to
prevent them from getting HIV when you last had sex? If you aren’t sure, that’s okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 2
If SX_TOTN4 (total number of vaginal and anal sex partners) = 2, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 3, skip
to skip_SXPGN3N4 (partner gender-partner 3).
When question instructions say “insert partner name,” then insert response from
SX_NM2N4 (name of partner 2).

Topic: Partner demographics #3 (SP)
Skip_SXPGN3N4

SXPGN3N4

SP.1.0.

Label_SXPGN3N4
Soft_edit_SXPGN3N4

Skip_SXPGN3N4
QDS_programming_SXPGN5N4

If SX_TOTN4 = 3 AND respondent provided name for partner 3 (SX_NM3N4 not 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, then skip SXPGN3N4 (partner’s
gender-partner 3) and go to SXPAG3N4 (partner age-partner 3). Else, go to
Intro_SXPGN3N4 (partner gender-partner 3).
Is [INSERT SX_NM3N4] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
partner gender-partner 3
If SX_GEN = 2 (female) and SXPGN3N4 (partner gender-partner 3) = female (2), 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.
If SXPGN3N4=1, 2, 3, 7, or 8, go to SXPAG3N4 (partner age-partner 3).
When question instructions say “insert partner name,” insert response to SX_NM3N4
(name of partner 3).

Page | 77
SXPAG3N4

SP.2.0.

Which of the following age groups best describes [INSERT SX_NM3N4]? [READ RESPONSES.
SELECT ONLY ONE.]
1 <=24 years old
2 25-29 years old
3 30-34 years old
4 35-39 years old
5 40-44 years old
6 45-49 years old
7 >=50 years old
77 Refused to Answer
88 Don't Know
partner age-partner 3
For all responses, go to SXPEN3N4 (partner ethnicity-partner 3).

SP.3.0.

Is [INSERT SX_NM3N4] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give me
your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
partner ethnicity-partner 3
For all responses go to SXPR3N4 (partner race-partner 3).

SP.4.0.

Which of the following racial group or groups best describes [INSERT SX_NM3N4]? Select
all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT ALL
THAT APPLY]
Race-partner 3
For all responses, go to SXPCM3N4 (commitment-partner 3).

SP.4.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p3: American Indian Alaska Native

SP.4.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 3: Asian

SP.4.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p3: Black or African American

Label_SXPAG3N4
Skip_SXPAG3N4
SXPEN3N4

Label_SXPEN3N4
Skip_SXPEN3N4
SXPR3N4

Label_SXPR3N4
Skip_SXPR3N4
SXPR3N4A

Label_SXPR3N4A
SXPR3N4B

Label_SXPR3N4B
SXPR3N4C

Label_SXPR3N4C

Page | 78
SXPR3N4D

SP.4.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p3: Ntive Hawaiian Othr Pacific

SP.4.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 3: White

SP.5.0.

How would you describe your level of commitment to [INSERT SX_NM3N4]? Are you…
[READ RESPONSES. SELECT ONLY ONE.]
1 Not at all committed
2 Somewhat committed
3 Very committed
4 Committed to above and beyond anyone else
8 Don't Know
7 Refused to Answer
commitment-partner 3
For all responses, go to Skip_SX_VS3N4 (vaginal sex-partner 3).

Label_SXPR3N4D
SXPR3N4E

Label_SXPR3N4E
SXPCM3N4

Label_SXPCM3N4
Skip_SXPCM3N4

Topic: Vaginal sex #3 (SV)
Skip_SX_VS3N4

Transgender/unknown gender respondent: If the SX_GEN=3 (transgender) or 4
(indeterminate), then skip to SX_TG3N4 (transgender-partner 3).
Transgender/unknown gender partner: If the SXTGONN4 = 1 (transgender only partner) OR
[SXPGN3N4 (partner gender- partner 3) = 3, 7 (refused to answer), or 8 (don’t know)], then
skip to SX_TG3N4 (transgender partner 3).
Male-male partners: If SX_GEN=1 (male), and SXMLONN4 = 1 (male only partners) OR if
SX_GEN=1 (male) and SXPGN3N4 (partner gender partner 3) =1 (male), then skip to
SXANL3N4 (anal sex-partner 3).

SX_VS3N4

SV.1.0.

Label_SX_VS3N4
Skip2_SX_VS3N4
QDS_programming_partnerdemo
3

Else: go to SX_VS3N4 (vaginal sex-partner 3).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM3N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal sex-partner 3
If SX_VS3N4 = 0 (no), 7 (refused), or 8 (don't know), skip to SXANL3N4 (anal sex-partner 3).
Else, if SX_VS3N4 = 1 (yes), go to SV10_3N4 (vaginal10-partner 3).
When question instructions say “insert partner name,” insert response to SX_NM3N4
(name of partner 3).

Page | 79
SV10_3N4

SV.1.1.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM3N4] more than
10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal 10-partner 3
If SV10_3N4 = 0 (no), go to SXVEN3N4 (times vaginal sex-partner 3). Else, if SV10_3N4 = 1
(yes), skip to SXANV3N4 (average number vaginal-partner 3). Else if SV10_3N4 = 7
(refused) or 8 (don't know), skip to SXANL3N4 (anal sex-partner 3).

SV.1.2.

During the past 12 months, please tell me the exact number of times that you had vaginal
sex with [INSERT SX_NM3N4]?
88 Don't Know
77 Refused to Answer
times vaginal sex-partner 3
1-10
If SXVEN3N4 = 77 (refused) or 88 (don't know), skip to SXANL3N4 (anal sex-partner 3).
Else, skip to Intro_SXVC3AN4 (condom vaginal-partner 3a).

SV.1.3.

On average, how many times did you have vaginal sex with [INSERT SX_NM3N4] per
month?
888 Don't Know
777 Refused to Answer
average number vaginal-partner 3
1-90
For all responses, go to SXMVG3N4 (months vaginal sex-partner 3).

SV.1.4.

During the past 12 months, how many months did you have vaginal sex with [INSERT
SX_NM3N4]?
88 Don't Know
77 Refused to Answer
months vaginal sex-partner 3
1-12
[IF SV10_3N4 (vaginal 10-partner 3) = 1 and the product of SXANV3N4*SXMVG3N4
(average number vaginal-partner 3*months vaginal sex-partner 3) is <=10], then READ,
“You told me you had vaginal sex with [INSERT SX_NM3N4] more than 10 times.”
Interviewer instructions: Please re-ask question SV10_3N4 (vaginal sex more than 10
times-partner 3). The program should go back to SV10_3N4 (vaginal 10-partner 3).
For all responses, skip to instructions before SXVC3AN4 (condom vaginal-partner 3a).

Label_SV10_3N4
Skip_SV10_3N4

SXVEN3N4

Label_SXVEN3N4
range_SXVEN3N4
Skip_SXVEN3N4
SXANV3N4

Label_SXANV3N4
Range_SXANV3N4
Skip_SXANV3N4
SXMVG3N4

Label_SXMVG3N4
Range_SXMVG3N4
Hard_edit_SV10_3N4

Skip_SXMVG3N4
Skip_SXVC3AN4
SXVC3AN4

Label_SXVC3AN4
Skip2_SXVC3AN4

If SXVEN3N4 (times vaginal sex-partner 3) =1, then go to SXVC3AN4 (condom vaginalpartner 3a); else Skip to SXVC3BN4 (condom vaginal-partner 3b).
SV.1.5.a. During the past 12 months, when you had vaginal sex with [INSERT SX_NM3N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom vaginal-partner 3a
For all responses, skip to SXANL3N4 (anal sex-partner 3).

Page | 80
SXVC3BN4

Label_SXVC3BN4
Skip_SXVC3BN4

SV.1.5.b. During the past 12 months, when you had vaginal sex with [INSERT SX_NM3N4] was a
condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom vaginal-partner 3b
For all responses, go to SXANL3N4 (anal sex-partner 3).

Topic: Anal sex #3 (SL)
SXANL3N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM3N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal sex-partner 3
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 SXPGN3N4 (partner genderpartner 3) = 1 OR SXMLONN4 (male only partners) = 1] and SXANL3N4 (anal sex-partner 3)
is 0 (no), then READ, “Earlier you told me that you had anal sex with [INSERT SX_NM3N4].
Is this correct?” Interviewer instructions: return to previous questions to correct error.
Allow program to move forward.
If SXANL3N4 = 1 (yes), go to SA10_3N4 (anal 10-partner 3). Else, skip to STATS3N4 (aware
status-partner 3).

SL.1.1.

During the past 12 months, did you have anal sex with [INSERT SX_NM3N4] more than 10
times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal 10-partner 3
If SA10_3N4 = 0 (no), go to SXAEN3N4 (times anal sex-partner 3). Else, if SA10_3N4 = 1
(yes), skip to SXANA3N4 (average number anal-partner 3). Else, skip to STATS3N4 (aware
status-partner 3).

SL.1.2.

During the past 12 months, please tell me the exact number of times that you had anal sex
with [INSERT SX_NM3N4]?
88 Don't Know
77 Refused to Answer
times anal sex-partner 3
1-10
If SXAEN3N4 = 77 (refused) or 88 (don't know), skip to STATS3N4 (aware status-partner 3).
Else, skip to Interviewer Instructions before SXAC3AN4 (Skip_SXAC3AN4).

SL.1.3.

On average, how many times did you have anal sex with [INSERT SX_NM3N4] per month?
888 Don't Know
777 Refused to Answer
average number anal-partner 3
1-90
For all responses, go to SXMAN3N4 (months anal sex-partner 3).

Label_SXANL3N4
Soft_edit_SXANL3N4

Skip_SXANL3N4
SA10_3N4

Label_SA10_3N4
Skip_SA10_3N4

SXAEN3N4

Label_SXAEN3N4
Range_SXAEN3N4
Skip_SXAEN3N4
SXANA3N4

Label_SXANA3N4
Range_SXANA3N4
Skip_SXANA3N4

Page | 81
SXMAN3N4

SL.1.4.

Label_SXMAN3N4
Range_SXMAN3N4
Hard_edit_SA10_3N4

Skip_SXMAN3N4

During the past 12 months, how many months did you have anal sex with [INSERT
SX_NM3N4]?
88 Don't Know
77 Refused to Answer
months anal sex-partner 3
1-12
[IF SA10_3N4 (anal 10-partner 3) = 1 (yes) and the product of SXANA3N4*SXMAN3N4
(average number anal-partner 3*months anal sex-partner 3) is <= 10], then READ, “You
told me you had anal sex with [INSERT SX_NM3N4] more than 10 times.” Interviewer
instructions: Please re-ask question SA10_3N4 (anal sex more than 10 times-partner 3).
The program should go back to SA10_3N4 (anal 10-partner 3).
For all responses, go to Interviewer Instructions before SXAC3AN4 (Skip_SXAC3AN4).
Female-male partner #3-anal sex once: If the respondent is female (SX_GEN=2) AND
partner 3 is male [SXPGN3N4 (partner’s gender-partner 3) = 1 (male) or SXMLONN4 (male
only partners) = 1] AND the respondent had anal sex with partner 1 only one time
[SXAEN3N4 (times anal sex-partner 3) = 1], then go to Intro_SXAC3AN4 (condom analpartner 3a).

Skip_SXAC3AN4

Female-male partner #3-anal sex more than once: If the respondent is female (SX_GEN=2)
AND partner 3 is male [SXPGN3N4 (partner’s gender-partner 3) = 1 (male) or SXMLONN4
(male only partners)=1] AND the respondent had anal sex with partner 3 more than once
[SXAEN3N4 (times anal sex-partner 3) >= 2] OR SA10_3N4 (anal 10-partner 3) = “yes,” then
go to Intro_SXAC3BN4 (condom anal-partner 3b).
Male-female partner #3-anal sex once: If the respondent is male (SX_GEN=1) and partner 3
is female [SXPGN3N4 (partner’s gender-partner 3) = 2 (female) OR SXFMONN4 (female
only partners) =1], AND the respondent had anal sex with partner 3 only one time
[SXAEN3N4 (times anal sex-partner 3) = 1], then go to Intro_SXAC3AN4 (condom analpartner 3a).
Male-female partner #3 -anal sex more than once: If the respondent is male (SX_GEN=1)
AND partner 3 is female [SXPGN3N4 (partner’s gender-partner 3) = 2 (female) OR
SXFMONN4 (female only partners) =1 ], AND the respondent had anal sex with partner 3
more than once [SXAEN3N4 (times anal sex-partner 3) >= 2] OR SA10_3N4 (anal 10partner 3) = “yes,”  then go to Intro_SXAC3BN4 (condom anal-partner 3b).

SXAC3AN4

Label_SXAC3AN4
Skip2_SXAC3AN4

SL.1.5.a.

Male-male partner(s): If the respondent is male (SX_GEN=1) and partner is male
[SXPGN3N4 (partner’s gender-partner 3) = 1 OR SXMLONN4 (male only partners) = 1], then
skip to interviewer instructions for ABTM3AN4 (receptive anal-partner 3a). If SA10_3N4
(anal 10-partner 3) = Refused to answer or don’t know OR if SXAEN3N4 (times anal sexpartner 3) = 0, skip to STATS3N4 (aware status-partner 3).
During the past 12 months, when you had anal sex with [INSERT SX_NM3N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom anal-partner 3a
For all responses, skip to STATS3N4 (aware status-partner 3).

Page | 82
SXAC3BN4

Label_SXAC3BN4
Skip_SXAC3BN4

SL.1.5.b. During the past 12 months, when you had anal sex with [INSERT SX_NM3N4] was a
condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom anal-partner 3b
For all responses, skip to STATS3N4 (aware status-partner 3).

Skip_ABTM3AN4

ABTM3AN4

Label_ABTM3AN4
Skip2_ABTM3AN4
ABTM3BN4

Label_ABTM3BN4
Skip_ABTM3BN4

Male-male partner-anal sex once: If the respondent is male (SX_GEN=1) and partner is
male [SXPGN3N4 (partner’s gender-partner 3) = 1 OR SXMLONN4 (male only partners) =
1], AND the respondent had anal sex with partner 3 only one time [SXAEN3N4 (times anal
sex-partner 3) = 1], THEN go to ABTM3AN4 (receptive anal-partner 3a).

SL.1.6.a.

Male-male partner-anal sex more than once: If the respondent is male (SX_GEN=1) and
partner is male [SXPGN3N4 (partner’s gender-partner 3) = 1 OR SXMLONN4 (male only
partners) =1] AND the respondent had anal sex with partner 3 more than one time
[SXAEN3N4 (times anal sex-partner 3) >=2 OR SA10_3N4 (anal 10-partner 3) =1] THEN Skip
to ABTM3BN4 (receptive anal-partner 3b).
During the past 12 months, when you had anal sex with [INSERT SX_NM3N4], did you have
anal sex where you were a bottom?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
receptive anal-partner 3a
If ABTM3AN4 = 1 (yes), Skip to Interviewer Instructions before Intro_ABTC3AN4 (Skip2
_ABTC3AN4). Else, Skip to ATP3AN4 (insertive anal-partner 3a).

SL.1.6.b. During the past 12 months, when you had anal sex with [INSERT SX_NM3N4], how often
did you have anal sex where you were a bottom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
receptive anal-partner 3b
If ABTM3BN4 = 1 (never), 7 (refused), or 8 (don't know), skip to ATP3BN4 (insertive analpartner 3b). Else, Skip to Interviewer Instructions before Intro_ABTC3AN4
(Skip_Intro_ABTC3AN4).

Page | 83
Skip_Intro_ABTC3AN4

ABTC3AN4

Male-partner #3 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN3N4 (partner’s gender-partner 3) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #3 only one time [SXAEN3N4 (times anal
sex-partner 3) = 1], THEN go to Intro_ABTC3AN4 (condom receptive anal-partner 3a).

SL.1.7.a.

Label_ABTC3AN4
Skip_ABTC3AN4
ABTC3BN4

Male-partner #3 male-anal sex more than once: if the respondent is male (SX_GEN=1) AND
partner is male (SXPGN3N4 [partner’s gender-partner 3]=1 OR SXMLONN4 [male only
partners] = 1) AND the respondent had anal sex with partner #3 more than once
(SXAEN3N4 [times anal sex-partner 3] >= 2 or SA10_3N4 [anal 10-partner 3] =1), THEN go
to Intro_ABTC3BN4 (condom receptive anal-partner 3b).
During the past 12 months, when you had anal sex with [INSERT SX_NM3N4] where you
were a bottom, was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 3a
For all responses, skip to ATP3AN4 (insertive anal-partner 3a).

Label_ABTC3BN4
Skip_ABTC3BN4

SL.1.7.b. During the past 12 months, when you had anal sex with [INSERT SX_NM3N4] where you
were a bottom, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 3b
For all responses, go to ATP3BN4 (insertive anal-partner 3b).

ATP3AN4

SL.1.8.a.

Label_ATP3AN4
Soft_edit_ATP3AN4

Skip_ATP3AN4

During the past 12 months, when you had anal sex with [INSERT SX_NM3N4], did you have
anal sex where you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
insertive anal-partner 3a
If ( (SXANL3N4=1 AND ABTM3AN4=0 AND ATP3AN4=0) ), READ: "Earlier you told me you
had anal sex with [INSERT SX_NM3N4]. Is this correct?" Interviewer instructions: return to
previous question to correct error.
If ATP3AN4 = 1 (yes), Skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4 (Skip2
_ATPC3AN4). Else, Skip to STATS3N4 (aware status-partner 3).

Page | 84
ATP3BN4

Label_ATP3BN4
Soft_edit_ATPC3BN4

Skip_ATP3BN4

SL.1.8.b. During the past 12 months when you had anal sex with [INSERT SX_NM3N4], how often
did you have anal sex where you were a top? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
insertive anal-partner 3b
If SXANL3N4 (anal sex partner 3) = 1 (yes) and ABTM3AN4 (receptive anal sex partner 3) =
0 (no) and ATP3AN4 (insertive anal sex partner 3) = 0 (no), READ the following: “Earlier
you told me that you had anal sex with [INSERT SX_NM3N4]. Is this correct? Interviewer
instructions: return to previous questions to correct error.” Allow program to move
forward.
If ATP3BN4 = 1 (never), 7 (refused), or 8 (don't know), Skip to STATS3N4 (aware statuspartner 3). Else, skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4
(Skip_Intro_ATPC3AN4).

Skip_Intro_ATPC3AN4

ATPC3AN4

Label_ATPC3AN4
Skip_ATPC3AN4
ATPC3BN4

Label_ATPC3BN4
Skip_ATPC3BN4

Male-partner #3 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN3N4 (partner’s gender-partner 3) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #3 only one time [SXAEN3N4 (times anal
sex-partner 3) = 1], THEN go to Intro_ATPC3AN4 (condom insertive anal-partner 3a).

SL.1.9.a.

Male-partner #3 male-anal sex more than once: If the respondent is male (SX_GEN=1) AND
partner is male [SXPGN3N4 (partner’s gender-partner 3) OR SXMLONN4 (male only
partners) = 1] AND the respondent had anal sex with partner #3 more than once
[SXAEN3N4 (times anal sex-partner 3) >= 2 OR SA10_1N4 = 1], THEN go to
Intro_ATPC3BN4 (condom insertive anal-partner 3b).
During the past 12 months, when you had anal sex with [INSERT SX_NM3N4], was a
condom used when you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 3a
For all responses, skip to STATS3N4 (aware status-partner 3)

SL.1.9.b. During the past 12 months, when you had anal sex with [INSERT SX_NM3N4] where you
were a top, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 3b
For all responses, go to STATS3N4 (aware status-partner 3)

Page | 85

Topic: Transgender and unknown gender sex #3 (SG)
SX_TG3N4

SG.1.0.

Label_SX_TG3N4
Soft_edit_SX_TG3N4

Skip_SX_TG3N4
QDS_programming_transgen3
TG10_3N4

SG.1.1.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM3N4]
more than 10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender 10-partner 3
If TG10_3N4 = 1 (yes), skip to TGAN3N4 (average number transgender -partner 3). Else, if
TG10_3N4 = 0 (no), go to TGEN3N4 (times transgender -partner 3). Else, skip to STATS3N4
(aware status- partner 3).

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 SX_NM3N4]?
88 Don't Know
77 Refused to Answer
times transgender -partner 3
1-10
If TGEN3N4 (Times transgender -partner 3) =77 (refused) or 88 (don't know), skip to
STATS3N4 (aware status-partner 3). Else, skip to instructions before TGC3AN4 (condom
transgender -partner 3a) (Skip_TGM3N4).

SG.1.3.

On average, how many times did you have vaginal or anal sex with [INSERT SX_NM3N4]
per month?
888 Don't Know
777 Refused to Answer
average number transgender -partner 3
1-90
For all responses, go to TGM3N4 (months transgender partner 3).

Label_TG10_3N4
Skip_TG10_3N4

TGEN3N4

Label_TGEN3N4
Range_TGEN3N4
Skip_TGEN3N4

TGAN3N4

Label_TGAN3N4
Range_TGAN3N4
Skip_TGAN3N4

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM3N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender-partner 3
If SX_TG3N4 (transgender-partner 3) is 0 (no), then READ, “Earlier you told me that you
had vaginal or anal sex with [INSERT SX_NM3N4]. Is this correct? Interviewer instructions:
return to previous questions to correct error.” Allow program to move forward.
If SX_TG3N4 = 1 (yes), go to TG10_3N4 (transgender 10-partner 3). Else, skip to STATS3N4
(aware status- partner 3).
When question instructions say “insert partner name,” insert response to SX_NM3N4
(name of partner 3

Page | 86
TGM3N4

Label_TGM3N4
Range_TGM3N4
Hard_edit_TGM3N4

Skip_TGM3N4
Skip_Intro_TGC3AN4

TGC3AN4

Label_TGC3AN4
Skip_TGC3AN4
Skip_Intro_TGC3BN4

TGC3BN4

Label_TGC3BN4
Skip_TGC3BN4

SG.1.4.

During the past 12 months, how many months did you have vaginal or anal sex with
[INSERT SX_NM3N4]?
88 Don't Know
77 Refused to Answer
months transgender-partner 3
1-12
[IF TG10_3N4 (transgender 10-partner 3) = 1 and the product of TGAN3N4*TGM3N4
(average number transgender-partner 3*months transgender-partner 3) is <=10], then
READ, “You told me you had vaginal or anal sex with [INSERT SX_NM3N4] more than 10
times.” Interviewer instructions: Please re-ask question TG10_3N4 (transgender 10partner 3). The program should go back to TG10_3N4 (transgender 10-partner 3).
For all responses, go to interviewer instructions before TGC3AN4 (condom transgender partner 3a) (Skip_Intro_TGC3AN4).
Transgender/Unknown gender sex-any partner #3 vaginal-anal sex once: If the respondent
had vaginal or anal sex with partner #3 only one time [TGEN3N4 (times transgenderpartner 3) = 1], THEN go to Intro_TGC3AN4 (condom transgender-partner 3a).

Else, go to Interviewer instructions before TGC3BN4 (condom transgender-partner 3b).
SG.1.5.a. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM3N4]
was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom transgender-partner 3a
For all responses, skip to STATS3N4 (aware status-partner 3)
Transgender/Unknown gender sex-any partner #3 vaginal-anal sex more than once: If the
respondent had vaginal or anal sex with partner #3 more than once [TGEN3N4 (times
transgender-partner 3) >= 2], OR TG10_3N4 (transgender 10-partner 3) =1 THEN go to
Intro_TGC3BN4 (condom transgender-partner 3b).
SG.1.5.b. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM3N4]
was a condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom transgender-partner 3b
For all responses, go to STATS3N4 (aware status-partner 3)

Page | 87

Topic: Status #3 (SS)
STATS3N4

SS.1.0.

Label_STATS3N4
Skip_STATS3N4
QDS_programming_STATS3N4
AWRST3N4

SS.1.1.

During the past 12 months, was [INSERT SX_NM3N4] aware of your status every time you
had sex?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware status every sex -partner 3
For all responses, go to STPRT3N4 (Partner status-partner 3).

SS.2.0.

Do you know [INSERT SX_NM3N4]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 3
If STPRT3N4 = 1 (yes), go to PRTST3N4 (Partner status first sex-partner 3). Else, if
SX_TOTN4 (total number of vaginal and anal sex partners) = 3, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 4, skip
to skip_SXPGN4N4 (partner gender-partner 4).

SS.2.1.

During the past 12 months, what was [INSERT SX_NM3N4]’s HIV status the first time that
you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 3
If PRTST3N4 = 2 (HIV Negative), go to PREP3N4 (PrEP-partner 3). Else, If SX_TOTN4 (total
number of vaginal and anal sex partners) = 3, skip to serosorting section (Intro_SEROSRT1).
If SX_TOTN4 (total number of vaginal and anal sex partners) >= 4, skip to skip_SXPGN4N4
(partner gender-partner 4).

Label_AWRST3N4
Skip_AWRST3N4
STPRT3N4

Label_STPRT3N4
Skip_STPRT3N4

PRTST3N4

Label_PRTST3N4
Skip_PRTST3N4

Does [INSERT SX_NM3N4] know your HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
aware status-partner 3
If STATS3N4 = 1 (yes), go to AWRST3N4 (aware status every sex-partner 3). Else, skip to
STPRT3N4 (partner status-partner 3).
When question instructions say “insert partner name," then insert response from
SX_NM3N4 (name of partner 3).

Page | 88

Topic: Pre-exposure prophylaxis #3 (SR)
PREP3N4

SR.1.0.

Label_PREP3N4
Skip_PREP3N4

QDS_programming_PREP3N4

Sometimes people who are HIV negative take antiretroviral medicine, such as Truvada, to
prevent them from getting HIV. Was [INSERT SX_NM3N4] taking antiretroviral medicine to
prevent them from getting HIV when you last had sex? If you aren’t sure, that’s okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 3
If SX_TOTN4 (total number of vaginal and anal sex partners) = 3, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 4, skip
to skip_SXPGN4N4 (partner gender-partner 4).
When question instructions say “insert partner name,” then insert response from
SX_NM3N4 (name of partner 3).

Topic: Partner demographics #4 (SP)
Skip_SXPGN4N4

SXPGN4N4

SP.1.0.

Label_SXPGN4N4
Soft_edit_SXPGN4N4

Skip_SXPGN4N4
QDS_programming_SXPGN4N4

If SX_TOTN4 = 4 AND respondent provided name for partner 4 (SX_NM4N4 not 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 SXPGN4N4 (partner’s gender-partner 4) and go to
SXPAG4N4 (partner age-partner 4). Else, go to Intro_SXPGN4N4 (partner gender-partner 4.
Is [INSERT SX_NM4N4] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
partner gender-partner 4
If SX_GEN = 2 (female) and SXPGN4N4 (partner gender-partner 4) = female (2), 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.
If SXPGN4N4=1, 2, 3, 7, or 8, go to SXPAG4N4 (partner age-partner 4).
When question instructions say “insert partner name,” insert response to SX_NM4N4
(name of partner 4).

Page | 89
SXPAG4N4

SP.2.0.

Which of the following age groups best describes [INSERT SX_NM4N4]? [READ RESPONSES.
SELECT ONLY ONE.]
1 <=24 years old
2 25-29 years old
3 30-34 years old
4 35-39 years old
5 40-44 years old
6 45-49 years old
7 >=50 years old
77 Refused to Answer
88 Don't Know
partner age-partner 4
For all responses, go to SXPEN4N4 (partner ethnicity-partner 4).

SP.3.0.

Is [INSERT SX_NM4N4] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give me
your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
partner ethnicity-partner 4
For all responses go to SXPR4N4 (partner race-partner 4).

SP.4.0.

Which of the following racial group or groups best describes [INSERT SX_NM4N4]? Select
all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT ALL
THAT APPLY]
Race-partner 4
For all responses, go to SXPCM4N4 (commitment-partner 4).

SP.4.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p4: American Indian Alaska Native

SP.4.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 4: Asian

SP.4.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p4: Black or African American

Label_SXPAG4N4
Skip_SXPAG4N4
SXPEN4N4

Label_SXPEN4N4
Skip_SXPEN4N4
SXPR4N4

Label_SXPR4N4
Skip_SXPR4N4
SXPR4N4A

Label_SXPR4N4A
SXPR4N4B

Label_SXPR4N4B
SXPR4N4C

Label_SXPR4N4C

Page | 90
SXPR4N4D

SP.4.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p4: Ntive Hawaiian Othr Pacific

SP.4.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 4: White

SP.5.0.

How would you describe your level of commitment to [INSERT SX_NM4N4]? Are you…
[READ RESPONSES. SELECT ONLY ONE.]
1 Not at all committed
2 Somewhat committed
3 Very committed
4 Committed to above and beyond anyone else
8 Don't Know
7 Refused to Answer
commitment-partner 4
For all responses, go to Skip_SX_VS4N4 (vaginal sex-partner 4).

Label_SXPR4N4D
SXPR4N4E

Label_SXPR4N4E
SXPCM4N4

Label_SXPCM4N4
Skip_SXPCM4N4

Topic: Vaginal sex #4 (SV)
Skip_SX_VS4N4

Transgender/unknown gender respondent: If the SX_GEN=3 (transgender) or 4
(indeterminate), then skip to SX_TG4N4 (transgender-partner 4).
Transgender/unknown gender partner: If the SXTGONN4 = 1 (transgender only partner) OR
[SXPGN4N4 (partner gender- partner 4) = 3, 7 (refused to answer), or 8 (don’t know)], then
skip to SX_TG4N4 (transgender partner 4).
Male-male partners: If SX_GEN=1 (male), and SXMLONN4 = 1 (male only partners) OR if
SX_GEN=1 (male) and SXPGN4N4 (partner gender partner 4) =1 (male), then skip to
SXANL4N4 (anal sex-partner 4).

SX_VS4N4

SV.1.0.

Label_SX_VS4N4
Skip2_SX_VS4N4
QDS_programming_partnerdemo
4

Else: go to SX_VS4N4 (vaginal sex-partner 4).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM4N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal sex-partner 4
If SX_VS4N4 = 0 (no), 7 (refused), or 8 (don't know), skip to SXANL4N4 (anal sex-partner 4).
Else, if SX_VS4N4 = 1 (yes), go to SV10_4N4 (vaginal10-partner 4).
When question instructions say “insert partner name,” insert response to SX_NM4N4
(name of partner 4).

Page | 91
SV10_4N4

SV.1.1.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM4N4] more than
10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal 10-partner 4
If SV10_4N4 = 0 (no), go to SXVEN4N4 (times vaginal sex-partner 4). Else, if SV10_4N4 = 1
(yes), skip to SXANV4N4 (average number vaginal-partner 4). Else if SV10_4N4 = 7
(refused) or 8 (don't know), skip to SXANL4N4 (anal sex-partner 4).

SV.1.2.

During the past 12 months, please tell me the exact number of times that you had vaginal
sex with [INSERT SX_NM4N4]?
88 Don't Know
77 Refused to Answer
times vaginal sex-partner 4
1-10
If SXVEN4N4 = 77 (refused) or 88 (don't know), skip to SXANL4N4 (anal sex-partner 4).
Else, skip to Intro_SXVC4AN4 (condom vaginal-partner 4a).

SV.1.3.

On average, how many times did you have vaginal sex with [INSERT SX_NM4N4] per
month?
888 Don't Know
777 Refused to Answer
average number vaginal-partner 4
1-90
For all responses, go to SXMVG4N4 (months vaginal sex-partner 4).

SV.1.4.

During the past 12 months, how many months did you have vaginal sex with [INSERT
SX_NM4N4]?
88 Don't Know
77 Refused to Answer
months vaginal sex-partner 4
1-12
[IF SV10_4N4 (vaginal 10-partner 4) = 1 and the product of SXANV4N4*SXMVG4N4
(average number vaginal-partner 4*months vaginal sex-partner 4) is <=10], then READ,
“You told me you had vaginal sex with [INSERT SX_NM4N4] more than 10 times.”
Interviewer instructions: Please re-ask question SV10_4N4 (vaginal sex more than 10
times-partner 4). The program should go back to SV10_4N4 (vaginal 10-partner 1).
For all responses, skip to instructions before SXVC4AN4 (condom vaginal-partner 4a).

Label_SV10_4N4
Skip_SV10_4N4

SXVEN4N4

Label_SXVEN4N4
range_SXVEN4N4
Skip_SXVEN4N4
SXANV4N4

Label_SXANV4N4
Range_SXANV4N4
Skip_SXANV4N4
SXMVG4N4

Label_SXMVG4N4
Range_SXMVG4N4
Hard_edit_SV10_4N4

Skip_SXMVG4N4
Skip_SXVC4AN4
SXVC4AN4

Label_SXVC4AN4
Skip2_SXVC4AN4

If SXVEN4N4 (times vaginal sex-partner 4) = 1, then go to SXVC4AN4 (condom vaginalpartner 4a); else Skip to SXVC4BN4 (condom vaginal-partner 4b).
SV.1.5.a. During the past 12 months, when you had vaginal sex with [INSERT SX_NM4N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom vaginal-partner 4a
For all responses, skip to SXANL4N4 (anal sex-partner 4).

Page | 92
SXVC4BN4

Label_SXVC4BN4
Skip_SXVC4BN4

SV.1.5.b. During the past 12 months, when you had vaginal sex with [INSERT SX_NM4N4] was a
condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom vaginal-partner 4b
For all responses, go to SXANL4N4 (anal sex-partner 4).

Topic: Anal sex #4 (SL)
SXANL4N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM4N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal sex-partner 4
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 SXPGN4N4 (partner genderpartner 4) = 1 OR SXMLONN4 (male only partners) = 1] and SXANL4N4 (anal sex-partner 4)
is 0 (no), then READ, “Earlier you told me that you had anal sex with [INSERT SX_NM4N4].
Is this correct?” Interviewer instructions: return to previous questions to correct error.
Allow program to move forward.
If SXANL4N4 = 1 (yes), go to SA10_4N4 (anal 10-partner 4). Else, skip to STATS4N4 (aware
status-partner 4).

SL.1.1.

During the past 12 months, did you have anal sex with [INSERT SX_NM4N4] more than 10
times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal 10-partner 4
If SA10_4N4 = 0 (no), go to SXAEN4N4 (times anal sex-partner 4). Else, if SA10_4N4 = 1
(yes), skip to SXANA4N4 (average number anal-partner 4). Else, skip to STATS4N4 (aware
status-partner 4).

SL.1.2.

During the past 12 months, please tell me the exact number of times that you had anal sex
with [INSERT SX_NM4N4]?
88 Don't Know
77 Refused to Answer
times anal sex-partner 4
1-10
If SXAEN4N4 = 77 (refused) or 88 (don't know), skip to STATS4N4 (aware status-partner 4).
Else, skip to Interviewer Instructions before SXAC4AN4 (Skip_SXAC4AN4).

SL.1.3.

On average, how many times did you have anal sex with [INSERT SX_NM4N4] per month?
888 Don't Know
777 Refused to Answer
average number anal-partner 4
1-90
For all responses, go to SXMAN4N4 (months anal sex-partner 4).

Label_SXANL4N4
Soft_edit_SXANL4N4

Skip_SXANL4N4
SA10_4N4

Label_SA10_4N4
Skip_SA10_4N4

SXAEN4N4

Label_SXAEN4N4
Range_SXAEN4N4
Skip_SXAEN4N4
SXANA4N4

Label_SXANA4N4
Range_SXANA4N4
Skip_SXANA4N4

Page | 93
SXMAN4N4

SL.1.4.

Label_SXMAN4N4
Range_SXMAN4N4
Hard_edit_SA10_4N4

Skip_SXMAN4N4

During the past 12 months, how many months did you have anal sex with [INSERT
SX_NM4N4]?
88 Don't Know
77 Refused to Answer
months anal sex-partner 4
1-12
[IF SA10_4N4 (anal 10-partner 4) = 1 (yes) and the product of SXANA4N4*SXMAN4N4
(average number anal-partner 4*months anal sex-partner 4) is <= 10], then READ, “You
told me you had anal sex with [INSERT SX_NM4N4] more than 10 times.” Interviewer
instructions: Please re-ask question SA10_4N4 (anal sex more than 10 times-partner 4).
The program should go back to SA10_4N4 (anal 10-partner 4).
For all responses, go to Interviewer Instructions before SXAC4AN4 (Skip_SXAC4AN4).
Female-male partner #4-anal sex once: If the respondent is female (SX_GEN=2) AND
partner 4 is male [SXPGN4N4 (partner’s gender-partner 4) = 1 (male) or SXMLONN4 (male
only partners) = 1] AND the respondent had anal sex with partner 4 only one time
[SXAEN3N4 (times anal sex-partner 4) = 1], then go to Intro_SXAC4AN4 (condom analpartner 4a).

Skip_SXAC4AN4

Female-male partner #4-anal sex more than once: If the respondent is female (SX_GEN=2)
AND partner 4 is male [SXPGN4N4 (partner’s gender-partner 4) = 1 (male) or SXMLONN4
(male only partners)=1] AND the respondent had anal sex with partner 4 more than once
[SXAEN4N4 (times anal sex-partner 4) >= 2] OR SA10_4N4 (anal 10-partner 4) = “yes,” then
go to Intro_SXAC4BN4 (condom anal-partner 4b).
Male-female partner #4-anal sex once: If the respondent is male (SX_GEN=1) and partner 4
is female [SXPGN4N4 (partner’s gender-partner 4) = 2 (female) OR SXFMONN4 (female
only partners) =1], AND the respondent had anal sex with partner 4 only one time
[SXAEN4N4 (times anal sex-partner 4) = 1], then go to Intro_SXAC4AN4 (condom analpartner 4a).
Male-female partner #4 -anal sex more than once: If the respondent is male (SX_GEN=1)
AND partner 4 is female [SXPGN4N4 (partner’s gender-partner 4) = 2 (female) OR
SXFMONN4 (female only partners) =1 ], AND the respondent had anal sex with partner 4
more than once [SXAEN4N4 (times anal sex-partner 4) >= 2] OR SA10_4N4 (anal 10partner 4) = “yes,”  then go to Intro_SXAC4BN4 (condom anal-partner 4b).

SXAC4AN4

Label_SXAC4AN4
Skip2_SXAC4AN4

SL.1.5.a.

Male-male partner(s): If the respondent is male (SX_GEN=1) and partner is male
[SXPGN4N4 (partner’s gender-partner 4) = 1 OR SXMLONN4 (male only partners) = 1], then
skip to interviewer instructions for ABTM4AN4 (receptive anal-partner 4a). If SA10_4N4
(anal 10-partner 4) = Refused to answer or don’t know OR if SXAEN4N4 (times anal sexpartner 4) = 0, skip to STATS4N4 (aware status-partner 4).
During the past 12 months, when you had anal sex with [INSERT SX_NM4N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom anal-partner 4a
For all responses, skip to STATS4N4 (aware status-partner 4).

Page | 94
SXAC4BN4

Label_SXAC4BN4
Skip_SXAC4BN4

SL.1.5.b. During the past 12 months, when you had anal sex with [INSERT SX_NM4N4] was a
condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom anal-partner 4b
For all responses, skip to STATS4N4 (aware status-partner 4).

Skip_ABTM4AN4

ABTM4AN4

Label_ABTM4AN4
Skip_ABTM4AN4
ABTM4BN4

Label_ABTM4BN4
Skip_ABTM4BN4

Male-male partner-anal sex once: If the respondent is male (SX_GEN=1) and partner is
male [SXPGN4N4 (partner’s gender-partner 4) = 1 OR SXMLONN4 (male only partners) =
1], AND the respondent had anal sex with partner 4 only one time [SXAEN4N4 (times anal
sex-partner 4) = 1], THEN go to ABTM4AN4 (receptive anal-partner 4a).

SL.1.6.a.

Male-male partner-anal sex more than once: If the respondent is male (SX_GEN=1) and
partner is male [SXPGN4N4 (partner’s gender-partner 4) = 1 OR SXMLONN4 (male only
partners) =1] AND the respondent had anal sex with partner 4 more than one time
[SXAEN4N4 (times anal sex-partner 4) >=2 OR SA10_4N4 (anal 10-partner 4) =1] THEN Skip
to ABTM4BN4 (receptive anal-partner 4b).
During the past 12 months, when you had anal sex with [INSERT SX_NM4N4], did you have
anal sex where you were a bottom?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
receptive anal-partner 4a
If ABTM4AN4 = 1 (yes), Skip to Interviewer Instructions before Intro_ABTC4AN4 (Skip2
_ABTC4AN4). Else, Skip to ATP4AN4 (insertive anal-partner 4a).

SL.1.6.b. During the past 12 months, when you had anal sex with [INSERT SX_NM4N4], how often
did you have anal sex where you were a bottom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
receptive anal-partner 4b
If ABTM4BN4 = 1 (never), 7 (refused), or 8 (don't know), skip to ATP4BN4 (insertive analpartner 4b). Else, Skip to Interviewer Instructions before Intro_ABTC4AN4
(Skip_Intro_ABTC4AN4).

Page | 95
Skip_Intro_ABTC4AN4

ABTC4AN4

Male-partner #4 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN4N4 (partner’s gender-partner 4) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #4 only one time [SXAEN4N4 (times anal
sex-partner 4) = 1], THEN go to Intro_ABTC4AN4 (condom receptive anal-partner 4a).

SL.1.7.a.

Label_ABTC4AN4
Skip_ABTC4AN4
ABTC4BN4

Male-partner #4 male-anal sex more than once: if the respondent is male (SX_GEN=1) AND
partner is male (SXPGN4N4 [partner’s gender-partner 4] OR SXMLONN4 [male only
partners] = 1) AND the respondent had anal sex with partner #4 more than once
(SXAEN4N4 [times anal sex-partner 4] >= 2 or SA10_4N4 [anal 10-partner 4] =1), THEN go
to Intro_ABTC4BN4 (condom receptive anal-partner 4b).
During the past 12 months, when you had anal sex with [INSERT SX_NM4N4] where you
were a bottom, was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 4a
For all responses, skip to ATP4AN4 (insertive anal-partner 4a).

Label_ABTC4BN4
Skip_ABTC4BN4

SL.1.7.b. During the past 12 months, when you had anal sex with [INSERT SX_NM4N4] where you
were a bottom, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 4b
For all responses, go to ATP4BN4 (insertive anal-partner 4b).

ATP4AN4

SL.1.8.a.

Label_ATP4AN4
Soft_edit_ATP4AN4

Skip_ATP4AN4

During the past 12 months, when you had anal sex with [INSERT SX_NM4N4], did you have
anal sex where you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
insertive anal-partner 4a
If ( (SXANL4N4=1 AND ABTM4AN4=0 AND ATP4AN4=0) ), READ: "Earlier you told me you
had anal sex with [INSERT SX_NM4N4]. Is this correct?" Interviewer instructions: return to
previous question to correct error.
If ATP4AN4 = 1 (yes), Skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4 (Skip2
_ATPC4AN4). Else, Skip to STATS4N4 (aware status-partner 4).

Page | 96
ATP4BN4

Label_ATP4BN4
Soft_edit_ATPC4BN4

Skip_ATP4BN4

SL.1.8.b. During the past 12 months when you had anal sex with [INSERT SX_NM4N4], how often
did you have anal sex where you were a top? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
insertive anal-partner 4b
If SXANL4N4 (anal sex partner 4) = 1 (yes) and ABTM4AN4 (receptive anal sex partner 4) =
0 (no) and ATP4AN4 (insertive anal sex partner 4) = 0 (no), READ the following: “Earlier
you told me that you had anal sex with [INSERT SX_NM4N4]. Is this correct? Interviewer
instructions: return to previous questions to correct error.” Allow program to move
forward.
If ATP4BN4 = 1 (never), 7 (refused), or 8 (don't know), skip to STATS4N4 (aware statuspartner 4). Else, skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4
(Skip_intro_ATPC4AN4).

Skip_Intro_ATPC4AN4

ATPC4AN4

Label_ATPC4AN4
Skip_ATPC4AN4
ATPC4BN4

Label_ATPC4BN4
Skip_ATPC4BN4

Male-partner #4 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN4N4 (partner’s gender-partner 4) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #4 only one time [SXAEN4N4 (times anal
sex-partner 4) = 1], THEN go to Intro_ATPC4AN4 (condom insertive anal-partner 4a).

SL.1.9.a.

Male-partner #4 male-anal sex more than once: If the respondent is male (SX_GEN=1) AND
partner is male [SXPGN4N4 (partner’s gender-partner 4) OR SXMLONN4 (male only
partners) = 1] AND the respondent had anal sex with partner #4 more than once
[SXAEN4N4 (times anal sex-partner 4) >= 2 OR SA10_4N4 = 1], THEN go to
Intro_ATPC4BN4 (condom insertive anal-partner 4b).
During the past 12 months, when you had anal sex with [INSERT SX_NM4N4], was a
condom used when you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 4a
For all responses, skip to STATS4N4 (aware status-partner 4)

SL.1.9.b. During the past 12 months, when you had anal sex with [INSERT SX_NM4N4] where you
were a top, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 4b
For all responses, go to STATS4N4 (aware status-partner 4)

Page | 97

Topic: Transgender and unknown gender sex #4 (SG)
SX_TG4N4

SG.1.0.

Label_SX_TG4N4
Soft_edit_SX_TG4N4

Skip_SX_TG4N4
QDS_programming_transgen4
TG10_4N4

SG.1.1.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM4N4]
more than 10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender 10-partner 4
If TG10_4N4 = 1 (yes), skip to TGAN4N4 (average number transgender -partner 4). Else, if
TG10_4N4 = 0 (no), go to TGEN4N4 (times transgender -partner 4). Else, skip to STATS4N4
(aware status- partner 4).

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 SX_NM4N4]?
88 Don't Know
77 Refused to Answer
times transgender -partner 4
1-10
If TGEN4N4=77 (refused) or 88 (don't know), skip to STATS4N4 (aware status-partner 4).
Else, skip to instructions before TGC4AN4 (condom transgender -partner 4a)
(Skip_TGM4N4).

SG.1.3.

On average, how many times did you have vaginal or anal sex with [INSERT SX_NM4N4]
per month?
888 Don't Know
777 Refused to Answer
average number transgender -partner 4
1-90
For all responses, go to TGM4N4 (months transgender partner 4).

Label_TG10_4N4
Skip_TG10_4N4

TGEN4N4

Label_TGEN4N4
Range_TGEN4N4
Skip_TGEN4N4

TGAN4N4

Label_TGAN4N4
Range_TGAN4N4
Skip_TGAN4N4

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM4N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender-partner 4
If SX_TG4N4 (transgender-partner 4) is 0 (no), then READ, “Earlier you told me that you
had vaginal or anal sex with [INSERT SX_NM4N4]. Is this correct? Interviewer instructions:
return to previous questions to correct error.” Allow program to move forward.
If SX_TG4N4 = 1 (yes), go to TG10_4N4 (transgender 10-partner 4). Else, skip to STATS4N4
(aware status- partner 4).
When question instructions say “insert partner name,” insert response to SX_NM4N4
(name of partner 4).

Page | 98
TGM4N4

Label_TGM4N4
Range_TGM4N4
Hard_edit_TGM4N4

Skip_TGM4N4
Skip_Intro_TGC4AN4

TGC4AN4

Label_TGC4AN4
Skip_TGC4AN4
Skip_Intro_TGC4BN4

TGC4BN4

Label_TGC4BN4
Skip_TGC4BN4

SG.1.4.

During the past 12 months, how many months did you have vaginal or anal sex with
[INSERT SX_NM4N4]?
88 Don't Know
77 Refused to Answer
months transgender-partner 4
1-12
[IF TG10_4N4 (transgender 10-partner 4) = 1 and the product of TGAN4N4*TGM4N4
(average number transgender-partner 4*months transgender-partner 4) is <=10], then
READ, “You told me you had vaginal or anal sex with [INSERT SX_NM4N4] more than 10
times.” Interviewer instructions: Please re-ask question TG10_4N4 (transgender 10partner 4). The program should go back to TG10_4N4 (transgender 10-partner 4).
For all responses, go to interviewer instructions before TGC4AN4 (condom transgender partner 4a) (Skip_Intro_TGC4AN4).
Transgender/Unknown gender sex-any partner #4 vaginal-anal sex once: If the respondent
had vaginal or anal sex with partner #4 only one time [TGEN4N4 (times transgenderpartner 4) = 1], THEN go to Intro_TGC4AN4 (condom transgender-partner 4a).

Else, go to Interviewer instructions before TGC4BN4 (condom transgender-partner 4b).
SG.1.5.a. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM4N4]
was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom transgender-partner 4a
For all responses, skip to STATS4N4 (aware status-partner 4)
Transgender/Unknown gender sex-any partner #4 vaginal-anal sex more than once: If the
respondent had vaginal or anal sex with partner #4 more than once [TGEN4N4 (times
transgender-partner 4) >= 2], OR TG10_4N4 (transgender 10-partner 4) =1 THEN go to
Intro_TGC4BN4 (condom transgender-partner 4b).
SG.1.5.b. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM4N4]
was a condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom transgender-partner 4b
For all responses, go to STATS4N4 (aware status-partner 4)

Page | 99

Topic: Status #4 (SS)
STATS4N4

SS.1.0.

Label_STATS4N4
Skip_STATS4N4
QDS_programming_STATS4N4
AWRST4N4

SS.1.1.

During the past 12 months, was [INSERT SX_NM4N4] aware of your status every time you
had sex?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware status every sex -partner 4
For all responses, go to STPRT4N4 (Partner status-partner 4).

SS.2.0.

Do you know [INSERT SX_NM4N4]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 4
If STPRT4N4 = 1 (yes), go to PRTST4N4 (Partner status first sex-partner 4). Else, if
SX_TOTN4 (total number of vaginal and anal sex partners)= 4, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 5, skip
to skip_SXPGN5N4 (partner gender-partner 5).

SS.2.1.

During the past 12 months, what was [INSERT SX_NM4N4]’s HIV status the first time that
you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 4
If PRTST4N4 = 2 (HIV negative), go to PREP4N4 (PrEP-partner 4). Else, If SX_TOTN4 (total
number of vaginal and anal sex partners) = 4, skip to serosorting section (Intro_SEROSRT1).
If SX_TOTN4 (total number of vaginal and anal sex partners) >= 5, skip to skip_SXPGN5N4
(partner gender-partner 5).

Label_AWRST4N4
Skip_AWRST4N4
STPRT4N4

Label_STPRT4N4
Skip_STPRT4N4

PRTST4N4

Label_PRTST4N4
Skip_PRTST4N4

Does [INSERT SX_NM4N4] know your HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
aware status-partner 4
If STATS4N4 = 1 (yes), go to AWRST4N4 (aware status every sex-partner 4). Else, skip to
STPRT4N4 (partner status-partner 4).
When question instructions say “insert partner name," then insert response from
SX_NM4N4 (name of partner 4).

Page | 100

Topic: Pre-exposure prophylaxis #4 (SR)
PREP4N4

SR.1.0.

Label_PREP4N4
Skip_PREP4N4

QDS_programming_PREP4N4

Sometimes people who are HIV negative take antiretroviral medicine, such as Truvada, to
prevent them from getting HIV. Was [INSERT SX_NM4N4] taking antiretroviral medicine to
prevent them from getting HIV when you last had sex? If you aren’t sure, that’s okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 4
If SX_TOTN4 (total number of vaginal and anal sex partners) = 4, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >=5, skip to
skip_SXPGN5N4 (partner gender-partner 5).
When question instructions say “insert partner name,” then insert response from
SX_NM4N4 (name of partner 4).

Topic: Partner demographics #5 (SP)
Skip_SXPGN5N4

SXPGN5N4

SP.1.0.

Label_SXPGN5N4
Soft_edit_SXPGN5N4

Skip_SXPGN5N4
QDS_programming_SXPGN5N4

If SX_TOTN4 = 5 AND respondent provided name for partner 5 (SX_NM5N4 not 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 SXPGN5N4 (partner’s gender-partner 5) and go to
SXPAG5N4 (partner age-partner 5). Else, go to SXPGN5N4 (partner gender-partner 5).
Is [INSERT SX_NM5N4] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
partner gender-partner 5
If SX_GEN = 2 (female) and SXPGN5N4 (partner gender-partner 5) = female (2), 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_SXPAG5N4 (partner age-partner 5).
If SXPGN5N4=1, 2, 3, 7, or 8, go to SXPAG5N4 (partner age-partner 5).
When question instructions say “insert partner name,” insert response to SX_NM5N4
(name of partner 5).

Page | 101
SXPAG5N4

SP.2.0.

Which of the following age groups best describes [INSERT SX_NM5N4]? [READ RESPONSES.
SELECT ONLY ONE.]
1 <=24 years old
2 25-29 years old
3 30-34 years old
4 35-39 years old
5 40-44 years old
6 45-49 years old
7 >=50 years old
77 Refused to Answer
88 Don't Know
partner age-partner 5
For all responses, go to SXPEN5N4 (partner ethnicity-partner 5).

SP.3.0.

Is [INSERT SX_NM5N4] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give me
your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
partner ethnicity-partner 5
For all responses go to SXPR5N4 (partner race-partner 5).

SP.4.0.

Which of the following racial group or groups best describes [INSERT SX_NM5N4]? Select
all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT ALL
THAT APPLY]
Race-partner 5
For all responses, go to SXPCM5N4 (commitment-partner 5).

SP.4.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p5: American Indian Alaska Native

SP.4.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 5: Asian

SP.4.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p5: Black or African American

Label_SXPAG5N4
Skip_SXPAG5N4
SXPEN5N4

Label_SXPEN5N4
Skip_SXPEN5N4
SXPR5N4

Label_SXPR5N4
Skip_SXPR5N4
SXPR5N4A

Label_SXPR5N4A
SXPR5N4B

Label_SXPR5N4B
SXPR5N4C

Label_SXPR5N4C

Page | 102
SXPR5N4D

SP.4.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-p5 Ntive Hawaiian Othr Pacific

SP.4.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
race-partner 5: White

SP.5.0.

How would you describe your level of commitment to [INSERT SX_NM5N4]? Are you…
[READ RESPONSES. SELECT ONLY ONE.]
1 Not at all committed
2 Somewhat committed
3 Very committed
4 Committed to above and beyond anyone else
8 Don't Know
7 Refused to Answer
commitment-partner 5
For all responses, go to Skip_SX_VS5N4 (vaginal sex-partner 5).

Label_SXPR5N4D
SXPR5N4E

Label_SXPR5N4E
SXPCM5N4

Label_SXPCM5N4
Skip_SXPCM5N4

Topic: Vaginal sex #5 (SV)
Skip_SX_VS5N4

Transgender/unknown gender respondent: If the SX_GEN=3 (transgender) or 4
(indeterminate), then skip to SX_TG5N4 (transgender-partner 5).
Transgender/unknown gender partner: If the SXTGONN4 = 1 (transgender only partner) OR
[SXPGN5N4 (partner gender- partner 5) = 3, 7 (refused to answer), or 8 (don’t know)], then
skip to SX_TG5N4 (transgender partner 5).
Male-male partners: If SX_GEN=1 (male), and SXMLONN4 = 1 (male only partners) OR if
SX_GEN=1 (male) and SXPGN5N4 (partner gender partner 5) =1 (male), then skip to
SXANL5N4 (anal sex-partner 5).

SX_VS5N4

SV.1.0.

Label_SX_VS5N4
Skip2_SX_VS5N4
QDS_programming_partnerdemo
5

Else: go to SX_VS5N4 (vaginal sex-partner 5).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM5N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal sex-partner 5
If SX_VS5N4 = 0 (no), 7 (refused), or 8 (don't know), skip to SXANL5N4 (anal sex-partner 5).
Else, if SX_VS5N4 = 1 (yes), go to SV10_5N4 (vaginal10-partner 5).
When question instructions say “insert partner name,” insert response to SX_NM5N4
(name of partner 5).

Page | 103
SV10_5N4

SV.1.1.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM5N4] more than
10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vaginal 10-partner 5
If SV10_5N4 = 0 (no), go to SXVEN5N4 (times vaginal sex-partner 5). Else, if SV10_5N4 = 1
(yes), skip to SXANV5N4 (average number vaginal-partner 5). Else if SV10_5N4 = 7
(refused) or 8 (don't know), skip to SXANL5N4 (anal sex-partner 5).

SV.1.2.

During the past 12 months, please tell me the exact number of times that you had vaginal
sex with [INSERT SX_NM5N4]?
88 Don't Know
77 Refused to Answer
times vaginal sex-partner 5
1-10
If SXVEN5N4 = 77 (refused) or 88 (don't know), skip to SXANL5N4 (anal sex-partner 5).
Else, skip to Intro_SXVC5AN4 (condom vaginal-partner 5a).

SV.1.3.

On average, how many times did you have vaginal sex with [INSERT SX_NM5N4] per
month?
888 Don't Know
777 Refused to Answer
average number vaginal-partner 5
1-90
For all responses, go to SXMVG5N4 (months vaginal sex-partner 5).

SV.1.4.

During the past 12 months, how many months did you have vaginal sex with [INSERT
SX_NM5N4]?
88 Don't Know
77 Refused to Answer
months vaginal sex-partner 5
1-12
[IF SV10_5N4 (vaginal 10-partner 5) = 1 and the product of SXANV5N4*SXMVG5N4
(average number vaginal-partner 5*months vaginal sex-partner 5) is <=10], then READ,
“You told me you had vaginal sex with [INSERT SX_NM5N4] more than 10 times.”
Interviewer instructions: Please re-ask question SV10_5N4 (vaginal sex more than 10
times-partner 5). The program should go back to SV10_5N4 (vaginal 10-partner 5).
For all responses, skip to instructions before SXVC5AN4 (condom vaginal-partner 5a).

Label_SV10_5N4
Skip_SV10_5N4

SXVEN5N4

Label_SXVEN5N4
range_SXVEN5N4
Skip_SXVEN5N4
SXANV5N4

Label_SXANV5N4
Range_SXANV5N4
Skip_SXANV5N4
SXMVG5N4

Label_SXMVG5N4
Range_SXMVG5N4
Hard_edit_SV10_5N4

Skip_SXMVG5N4
Skip_SXVC5AN4
SXVC5AN4

Label_SXVC5AN4
Skip2_SXVC5AN4

If SXVEN5N4 (times vaginal sex-partner 5) = 1, then go to SXVC5AN4 (condom vaginalpartner 5a); else Skip to SXVC5BN4 (condom vaginal-partner 5b).
SV.1.5.a. During the past 12 months, when you had vaginal sex with [INSERT SX_NM5N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom vaginal-partner 5a
For all responses, skip to SXANL5N4 (anal sex-partner 5).

Page | 104
SXVC5BN4

Label_SXVC5BN4
Skip_SXVC5BN4

SV.1.5.b. During the past 12 months, when you had vaginal sex with [INSERT SX_NM5N4] was a
condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom vaginal-partner 5b
For all responses, go to SXANL5N4 (anal sex-partner 5).

Topic: Anal sex #5 (SL)
SXANL5N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM5N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal sex-partner 5
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 SXPGN5N4 (partner genderpartner 5) = 1 OR SXMLONN4 (male only partners) = 1] and SXANL5N4 (anal sex-partner 5)
is 0 (no), then READ, “Earlier you told me that you had anal sex with [INSERT SX_NM5N4].
Is this correct?” Interviewer instructions: return to previous questions to correct error.
Allow program to move forward.
If SXANL5N4 = 1 (yes), go to SA10_5N4 (anal 10-partner 5). Else, skip to STATS5N4 (aware
status-partner 5).

SL.1.1.

During the past 12 months, did you have anal sex with [INSERT SX_NM5N4] more than 10
times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
anal 10-partner 5
If SA10_5N4 = 0 (no), go to SXAEN5N4 (times anal sex-partner 5). Else, if SA10_5N4 = 1
(yes), skip to SXANA5N4 (average number anal-partner 5). Else, skip to STATS5N4 (aware
status-partner 5).

SL.1.2.

During the past 12 months, please tell me the exact number of times that you had anal sex
with [INSERT SX_NM5N4]?
88 Don't Know
77 Refused to Answer
times anal sex-partner 5
1-10
If SXAEN5N4 = 77 (refused) or 88 (don't know), skip to STATS5N4 (aware status-partner 5).
Else, skip to Interviewer Instructions before SXAC5AN4 (Skip_SXAC5AN4).

SL.1.3.

On average, how many times did you have anal sex with [INSERT SX_NM5N4] per month?
888 Don't Know
777 Refused to Answer
average number anal-partner 5
1-90
For all responses, go to SXMAN5N4 (months anal sex-partner 5).

Label_SXANL5N4
Soft_edit_SXANL5N4

Skip_SXANL5N4
SA10_5N4

Label_SA10_5N4
Skip_SA10_5N4

SXAEN5N4

Label_SXAEN5N4
Range_SXAEN5N4
Skip_SXAEN5N4
SXANA5N4

Label_SXANA5N4
Range_SXANA5N4
Skip_SXANA5N4

Page | 105
SXMAN5N4

SL.1.4.

Label_SXMAN5N4
Range_SXMAN5N4
Hard_edit_SA10_5N4

Skip_SXMAN5N4

During the past 12 months, how many months did you have anal sex with [INSERT
SX_NM5N4]?
88 Don't Know
77 Refused to Answer
months anal sex-partner 5
1-12
[IF SA10_5N4 (anal 10-partner 5) = 1 (yes) and the product of SXANA5N4*SXMAN5N4
(average number anal-partner 5*months anal sex-partner 5) is <= 10], then READ, “You
told me you had anal sex with [INSERT SX_NM5N4] more than 10 times.” Interviewer
instructions: Please re-ask question SA10_5N4 (anal sex more than 10 times-partner 5).
The program should go back to SA10_5N4 (anal 10-partner 5).
For all responses, go to Interviewer Instructions before SXAC5AN4 (Skip_SXAC5AN4).
Female-male partner #5-anal sex once: If the respondent is female (SX_GEN=2) AND
partner 5 is male [SXPGN5N4 (partner’s gender-partner 5) = 1 (male) or SXMLONN4 (male
only partners) = 1] AND the respondent had anal sex with partner 5 only one time
[SXAEN5N4 (times anal sex-partner 5) = 1], then go to Intro_SXAC5AN4 (condom analpartner 5a).

Skip_SXAC5AN4

Female-male partner #5-anal sex more than once: If the respondent is female (SX_GEN=2)
AND partner 5 is male [SXPGN5N4 (partner’s gender-partner 5) = 1 (male) or SXMLONN4
(male only partners)=1] AND the respondent had anal sex with partner 5 more than once
[SXAEN5N4 (times anal sex-partner 5) >= 2] OR SA10_4N4 (anal 10-partner 5) = “yes,” then
go to Intro_SXAC5BN4 (condom anal-partner 5b).
Male-female partner #5-anal sex once: If the respondent is male (SX_GEN=1) and partner 5
is female [SXPGN5N4 (partner’s gender-partner 5) = 2 (female) OR SXFMONN4 (female
only partners) =1], AND the respondent had anal sex with partner 5 only one time
[SXAEN5N4 (times anal sex-partner 5) = 1], then go to Intro_SXAC5AN4 (condom analpartner 5a).
Male-female partner #5 -anal sex more than once: If the respondent is male (SX_GEN=1)
AND partner 5 is female [SXPGN5N4 (partner’s gender-partner 5) = 2 (female) OR
SXFMONN4 (female only partners) =1 ], AND the respondent had anal sex with partner 5
more than once [SXAEN5N4 (times anal sex-partner 5) >= 2] OR SA10_5N4 (anal 10partner 5) = “yes,” then go to Intro_SXAC5BN4 (condom anal-partner 5b).

SXAC5AN4

Label_SXAC5AN4
Skip2_SXAC5AN4

SL.1.5.a.

Male-male partner(s): If the respondent is male (SX_GEN=1) and partner is male
[SXPGN5N4 (partner’s gender-partner 5) = 1 OR SXMLONN4 (male only partners) = 1], then
skip to interviewer instructions for ABTM5AN4 (receptive anal-partner 5a). If SA10_5N4
(anal 10-partner 5) = Refused to answer or don’t know OR if SXAEN5N4 (times anal sexpartner 5) = 0, skip to STATS5N4 (aware status-partner 5).
During the past 12 months, when you had anal sex with [INSERT SX_NM5N4] was a
condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom anal-partner 5a
For all responses, skip to STATS5N4 (aware status-partner 5).

Page | 106
SXAC5BN4

Label_SXAC5BN4
Skip_SXAC5BN4

SL.1.5.b. During the past 12 months, when you had anal sex with [INSERT SX_NM5N4] was a
condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom anal-partner 5b
For all responses, skip to STATS5N4 (aware status-partner 5).

Skip_ABTM5AN4

ABTM5AN4

Label_ABTM5AN4
Skip2_ABTM5AN4
ABTM5BN4

Label_ABTM5BN4
Skip_ABTM5BN4

Male-male partner-anal sex once: If the respondent is male (SX_GEN=1) and partner is
male [SXPGN5N4 (partner’s gender-partner 5) = 1 OR SXMLONN4 (male only partners) =
1], AND the respondent had anal sex with partner 5 only one time [SXAEN5N4 (times anal
sex-partner 5) = 1], THEN go to 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 [SXPGN5N4 (partner’s gender-partner 5) = 1 OR SXMLONN4 (male only
partners) =1] AND the respondent had anal sex with partner 5 more than one time
[SXAEN5N4 (times anal sex-partner 5) >;=2 OR SA10_5N4 (anal 10-partner 5) =1] THEN
Skip to ABTM5BN4 (receptive anal-partner 5b).
During the past 12 months, when you had anal sex with [INSERT SX_NM5N4], did you have
anal sex where you were a bottom?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
receptive anal-partner 5a
If ABTM5AN4 = 1 (yes), Skip to Interviewer Instructions before Intro_ABTC5AN4 (Skip2
_ABTC5AN4). Else, Skip to ATP5AN4 (insertive anal-partner 5a).

SL.1.6.b. During the past 12 months, when you had anal sex with [INSERT SX_NM5N4], how often
did you have anal sex where you were a bottom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
receptive anal-partner 5b
If ABTM5BN4 = 1 (never), 7 (refused), or 8 (don't know), skip to ATP5BN4 (insertive analpartner 5b). Else, Skip to Interviewer Instructions before Intro_ABTC5AN4
(Skip_Intro_ABTC5AN4).

Page | 107
Skip_Intro_ABTC5AN4

ABTC5AN4

Male-partner #5 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN5N4 (partner’s gender-partner 5) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #5 only one time [SXAEN5N4 (times anal
sex-partner 5) = 1], THEN go to Intro_ABTC5AN4 (condom receptive anal-partner 5a).

SL.1.7.a.

Label_ABTC5AN4
Skip_ABTC5AN4
ABTC5BN4

Male-partner #5 male-anal sex more than once: if the respondent is male (SX_GEN=1) AND
partner is male (SXPGN5N4 [partner’s gender-partner 54] OR SXMLONN4 [male only
partners] = 1) AND the respondent had anal sex with partner #5 more than once
(SXAEN5N4 [times anal sex-partner 5] >= 2 or SA10_5N4 [anal 10-partner 5] =1), THEN go
to Intro_ABTC5BN4 (condom receptive anal-partner 5b).
During the past 12 months, when you had anal sex with [INSERT SX_NM5N4] where you
were a bottom, was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 5a
For all responses, skip to ATP5AN4 (insertive anal-partner 5a).

Label_ABTC5BN4
Skip_ABTC5BN4

SL.1.7.b. During the past 12 months, when you had anal sex with [INSERT SX_NM5N4] where you
were a bottom, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom receptive anal-partner 5b
For all responses, go to ATP5BN4 (insertive anal-partner 5b).

ATP5AN4

SL.1.8.a.

Label_ATP5AN4
Soft_edit_ATP5AN4

Skip_ATP5AN4

During the past 12 months, when you had anal sex with [INSERT SX_NM5N4], did you have
anal sex where you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
insertive anal-partner 5a
If ( (SXANL5N4=1 AND ABTM5AN4=0 AND ATP5AN4=0) ), READ: "Earlier you told me you
had anal sex with [INSERT SX_NM5N4]. Is this correct?" Interviewer instructions: return to
previous question to correct error.
If ATP5AN4 = 1 (yes), Skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4 (Skip2
_ATPC5AN4). Else, Skip to STATS5N4 (aware status-partner 5).

Page | 108
ATP5BN4

Label_ATP5BN4
Soft_edit_ATPC5BN4

Skip_ATP5BN4

SL.1.8.b. During the past 12 months when you had anal sex with [INSERT SX_NM5N4], how often
did you have anal sex where you were a top? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Sometimes
3 Always
8 Don't Know
7 Refused to Answer
insertive anal-partner 5b
If SXANL5N4 (anal sex partner 5) = 1 (yes) and ABTM5AN4 (receptive anal sex partner 5) =
0 (no) and ATP5AN4 (insertive anal sex partner 5) = 0 (no), READ the following: “Earlier
you told me that you had anal sex with [INSERT SX_NM5N4]. Is this correct? Interviewer
instructions: return to previous questions to correct error.” Allow program to move
forward.
If ATP5BN4 = 1 (never), 7 (refused), or 8 (don't know), skip to STATS5N4 (aware statuspartner 5). Else, skip to Interviewer instructions for ATPC1AN4 thru ATPC5AN4
(Skip_intro_ATPC5AN4).

Skip_Intro_ATPC5AN4

ATPC5AN4

Label_ATPC5AN4
Skip_ATPC5AN4
ATPC5BN4

Label_ATPC5BN4
Skip_ATPC5BN4

Male-partner #5 male-anal sex once: If the respondent is male (SX_GEN=1) AND partner is
male [SXPGN5N4 (partner’s gender-partner 5) = 1 OR SXMLONN4 (male only partners) = 1]
AND the respondent had anal sex with partner #5 only one time [SXAEN5N4 (times anal
sex-partner 5) = 1], THEN go to Intro_ATPC5AN4 (condom insertive anal-partner 5a).

SL.1.9.a.

Male-partner #5 male-anal sex more than once: If the respondent is male (SX_GEN=1) AND
partner is male [SXPGN5N4 (partner’s gender-partner 5) OR SXMLONN4 (male only
partners) = 1] AND the respondent had anal sex with partner #4 more than once
[SXAEN5N4 (times anal sex-partner 5) >= 2 OR SA10_5N4 = 1], THEN go to
Intro_ATPC5BN4 (condom insertive anal-partner 5b).
During the past 12 months, when you had anal sex with [INSERT SX_NM5N4], was a
condom used when you were a top?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 5a
For all responses, skip to STATS5N4 (aware status-partner 5)

SL.1.9.b. During the past 12 months, when you had anal sex with [INSERT SX_NM5N4] where you
were a top, was a condom used… [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom insertive anal-partner 5b
For all responses, go to STATS5N4 (aware status-partner 5)

Page | 109

Topic: Transgender and unknown gender sex #5 (SG)
SX_TG5N4

SG.1.0.

Label_SX_TG5N4
Soft_edit_SX_TG5N4

Skip_SX_TG5N4
QDS_programming_transgen5
TG10_5N4

SG.1.1.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM5N4]
more than 10 times? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender 10-partner 5
If TG10_5N4 = 1 (yes), skip to TGAN5N4 (average number transgender -partner 5). Else, if
TG10_5N4 = 0 (no), go to TGEN5N4 (times transgender -partner 5). Else, skip to STATS5N4
(aware status- partner 5).

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 SX_NM5N4]?
88 Don't Know
77 Refused to Answer
times transgender -partner 5
1-10
If TGEN5N4=77 (refused) or 88 (don't know), skip to STATS5N4 (aware status-partner 5).
Else, skip to instructions before TGC5AN4 (condom transgender -partner 5a)
(Skip_TGM5N4).

SG.1.3.

On average, how many times did you have vaginal or anal sex with [INSERT SX_NM5N4]
per month?
888 Don't Know
777 Refused to Answer
average number transgender -partner 5
1-90
For all responses, go to TGM5N4 (months transgender partner 5).

Label_TG10_5N4
Skip_TG10_5N4

TGEN5N4

Label_TGEN5N4
Range_TGEN5N4
Skip_TGEN5N4

TGAN5N4

Label_TGAN5N4
Range_TGAN5N4
Skip_TGAN5N4

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM5N4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
transgender-partner 5
If SX_TG5N4 (transgender-partner 5) 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.
If SX_TG5N4 = 1 (yes), go to TG10_5N4 (transgender 10-partner 5). Else, skip to STATS5N4
(aware status- partner 5).
When question instructions say “insert partner name,” insert response to SX_NM5N4
(name of partner 5)

Page | 110
TGM5N4

Label_TGM5N4
Range_TGM5N4
Hard_edit_TGM5N4

Skip_TGM5N4
Skip_Intro_TGC5AN4

TGC5AN4

Label_TGC5AN4
Skip_TGC5AN4
Skip_Intro_TGC5BN4

TGC5BN4

Label_TGC5BN4
Skip_TGC5BN4

SG.1.4.

During the past 12 months, how many months did you have vaginal or anal sex with
[INSERT SX_NM5N4]?
88 Don't Know
77 Refused to Answer
months transgender-partner 5
1-12
[IF TG10_5N4 (transgender 10-partner 5) = 1 and the product of TGAN5N4*TGM5N4
(average number transgender-partner 5*months transgender-partner 5) is <=10], then
READ, “You told me you had vaginal or anal sex with [INSERT SX_NM5N4] more than 10
times.” Interviewer instructions: Please re-ask question TG10_5N4 (transgender 10partner 5). The program should go back to TG10_5N4 (transgender 10-partner 5).
For all responses, go to interviewer instructions before TGC5AN4 (condom transgender partner 5a) (Skip_Intro_TGC5AN4).
Transgender/Unknown gender sex-any partner #5 vaginal-anal sex once: If the respondent
had vaginal or anal sex with partner #5 only one time [TGEN5N4 (times transgenderpartner 5) = 1], THEN go to Intro_TGC5AN4 (condom transgender-partner 5a).

Else, go to Interviewer instructions before TGC5BN4 (condom transgender-partner 5b).
SG.1.5.a. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM5N4]
was a condom used?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
condom transgender-partner 5a
For all responses, skip to STATS5N4 (aware status-partner 5)
Transgender/Unknown gender sex-any partner #5 vaginal-anal sex more than once: If the
respondent had vaginal or anal sex with partner #5 more than once [TGEN5N4 (times
transgender-partner 5) >= 2], OR TG10_5N4 (transgender 10-partner 5) =1 THEN go to
Intro_TGC5BN4 (condom transgender-partner 5b). 
SG.1.5.b. During the past 12 months, when you had vaginal or anal sex with [INSERT SX_NM5N4]
was a condom used... [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 One or more times
3 Absolutely every time
8 Don't Know
7 Refused to Answer
condom transgender-partner 5b
For all responses, go to STATS5N4 (aware status-partner 5)

Page | 111

Topic: Status #5 (SS)
STATS5N4

SS.1.0.

Label_STATS5N4
Skip_STATS5N4
QDS_programming_STATS5N4
AWRST5N4

SS.1.1.

During the past 12 months, was [INSERT SX_NM5N4] aware of your status every time you
had sex?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware status every sex -partner 5
For all responses, go to STPRT5N4 (Partner status-partner 5).

SS.2.0.

Do you know [INSERT SX_NM5N4]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 5
If STPRT5N4 = 1 (yes), go to PRTST5N4 (Partner status first sex-partner 5). Else, if
SX_TOTN4 (total number of vaginal and anal sex partners) = 5, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 6, skip
to aggregate information section.

SS.2.1.

During the past 12 months, what was [INSERT SX_NM5N4]’s HIV status the first time that
you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 5
If PRTST5N4 = 2 (HIV negative), Go to PREP5N4 (PrEP-partner 5). Else, If SX_TOTN4 (total
number of vaginal and anal sex partners) = 5, skip to serosorting section (Intro_SEROSRT1).
If SX_TOTN4 (total number of vaginal and anal sex partners) >= 6, skip to aggregate
information section.

Label_AWRST5N4
Skip_AWRST5N4
STPRT5N4

Label_STPRT5N4
Skip_STPRT5N4

PRTST5N4

Label_PRTST5N4
Skip_PRTST5N4

Does [INSERT SX_NM5N4] know your HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
aware status-partner 5
If STATS5N4 = 1 (yes), go to AWRST5N4 (aware status every sex-partner 5). Else, skip to
STPRT5N4 (partner status-partner 5).
When question instructions say “insert partner name," then insert response from
SX_NM5N4 (name of partner 5).

Page | 112

Topic: Pre-exposure prophylaxis #5 (SR)
PREP5N4

SR.1.0.

Label_PREP5N4
Skip_PREP5N4

QDS_programming_PREP5N4

Sometimes people who are HIV negative take antiretroviral medicine, such as Truvada, to
prevent them from getting HIV. Was [INSERT SX_NM5N4] taking antiretroviral medicine to
prevent them from getting HIV when you last had sex? If you aren’t sure, that’s okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 5
If SX_TOTN4 (total number of vaginal and anal sex partners) = 5, skip to serosorting section
(Intro_SEROSRT1). If SX_TOTN4 (total number of vaginal and anal sex partners) >= 6, skip
to aggregate information section.
When question instructions say “insert partner name,” then insert response from
SX_NM5N4 (name of partner 5).

Topic: Aggregate information (SA)
Intro_SXAGC1N4

Skip2_6_SXAGC1N4

SXAGC1N4

SA.1.0.

Label_SXAGC1N4
SXAGP1N4

SA.1.1.

Was your other partner HIV positive?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
aggregate partner status-6 partners
All responses skip to the serosorting section (Intro_SEROSRT1).

SA.1.2.

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?
8888 Don't Know
7777 Refused to Answer
Aggregate: # partners condom always used
If SXAGC2N4 (Aggregate: # partners condom always used) is > [SX_TOTN4 (total number of
vaginal and anal sex partners)] - (minus) 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 (total number of vaginal and anal sex partners)) - (minus) 5]. Confirm
Answer.” Go back to SXAGC2N4 (Aggregate: # partners condom always used).

Label_SXAGP1N4
Skip_SXAGP1N4
SXAGC2N4

Label_SXAGC2N4
Hard_edit_SXAGC2N4

“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.”
If respondent reported 6 partners (SX_TOTN4 (total number of vaginal and anal sex
partners) = 6), go to SXAGC1N4 (aggregate condom use-6 partners). If respondent
reported 7 or more sex partners (SX_TOTN4 (total number of vaginal and anal sex
partners) >= 7), then skip to SXAGC2N4 (Aggregate: # partners condom always used).
During the past 12 months, was a condom always used when you had vaginal or anal sex
with your other partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
aggregate condom use-6 partners

Page | 113
Calculation_SXAGUPN4

SA.1.2a.

Label_Calculation_SXAGUPN4
Skip_SXAGC2N4

SXAGC3N4

SA.1.3.

So, you had unprotected sex with [INSERT RESPONSE FROM SXAGUPN4] of these other
partners?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aggregate: confirm # of unprt partners
If SXAGC3N4 (aggregate: confirm # of unprt partners) is 0 (no), 7 (refused to answer) or 8
(don’t know), then READ, “The number of unprotected sex partners does not compute.
Please verify the response.” Return to SXAGC2N4 (Aggregate: # partners condom always
used).

SA.1.4.

How many of those [INSERT RESPONSE FROM SXAGUPN4] other partners were HIV
positive?
8888 Don't Know
7777 Refused to Answer
Aggregate: # of concordant partners
SXAGP2N4 (Aggregate: # of concordant partners) cannot be greater than SXAGUPN4
(Aggregate # condomless sex partners). If SXAGP2N4 (Aggregate: # of concordant
partners) > SXAGUPN4 (Aggregate # condomless sex partners), then READ, “The response
is out of range” and return to SXAGP2N4 (Aggregate: # of concordant partners).

Label_SXAGC3N4
Hard_edit_6_SXAGC3N4

SXAGP2N4

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 (total number of vaginal and anal sex partners)] - (minus) 5] - SXAGC2N4). (If
SXAGC2N4 is don’t know or refuse, assign it a 7777 if refused or 8888 if don’t know.)
Aggregate # condomless sex partners
If SXAGC2N4 (Aggregate: # partners condom always used) = SX_TOTN4 (total number of
vaginal and anal sex partners), 7 (refused to answer) or 8 (don’t know), then skip to the
serosorting section (Intro_SEROSRT1). Else, go to SXAGC3N4 (aggregate: confirm # of
unprt partners).

Label_SXAGP2N4
Hard_edit_SXAGP2N4

Topic: Serosorting (SO)
Intro_SEROSRT1

SEROSRT1

Label_SEROSRT1

SO.1.0.

“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.”
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.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Partner +, more likely unprotected sex

Page | 114
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.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
If partner is +, don't worry 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.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Undet VL, more likely have unprotect 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.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Undet VL, worry less about condoms

Label_SEROSRT2
SEROSRT3

Label_SEROSRT3
SEROSRT4

Label_SEROSRT4

Topic: MSM sex ever (ME)
Skip_MSMEVRN5

MSMEVRN5

Label_MSMEVRN5

ME.1.0.

If SX_GEN (sex gender) is 1 (male) and SX_TMPN4 (number of male partners) is 0, 7777
(refused to answer), or 8888 (don’t know), then go to MSMEVRN5 (ever had sex with a
male). Else, skip to Skip_Intro_OUTMAN5.
Have you ever had sex with a male?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
ever had sex with a male

Page | 115

Topic: Disclosure of same sex attraction (RC)
Skip_Intro_OUTMAN5

Intro_OUTMAN5
OUTMAN5

RC.1.1.

Label_OUTMAN5
OUTMBN5

RC.1.2.

Friends?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
6 Not Applicable
Disclose male-male sex to friends

RC.1.3.

Work associates?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
6 Not Applicable
Disclose M-M sex to coworkers

RC.1.4.

Doctors, nurses, or other healthcare workers?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
6 Not Applicable
Disclose M-M sex to health workers

Label_OUTMBN5
OUTMCN5

Label_OUTMCN5
OUTMDN5

Label_OUTMDN5
Skip_OUTMEN5
OUTMEN5

Label_OUTMEN5

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 3
(bisexual), then go to Intro_OUTMAN5. If SX_GEN (sex gender) = 1 (male) and SX_TMPN4
(number of male partners) is >= 1, then go to Intro_OUTMAN5. Else Skip to next topic
(Calculation_EN_SEXN5, end of sexual behavior).
“For the next questions, tell me whether the answer is yes, no, or doesn’t apply to your
situation. Do any of the following people know that you’ve had sex with men:”
Family members?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
6 Not Applicable
Disclose male-male sex to family members

RC.1.5.

If SX_TFPN4 (number of female partners) is >=1, go to OUTMEN5 (Disclose M-M sex to
female partners); else Skip to OUTMFN5 (Disclose M-M sex to religious leaders).
Female sex partners?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
6 Not Applicable
Disclose M-M sex to female partners

Page | 116
OUTMFN5

RC.1.6.

Label_OUTMFN5

Religious leaders?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
6 Not Applicable
Disclose M-M sex to religious leaders

Calculation_EN_SEXN5 S.0.a.
Label_Calculation_EN_SEXN5

EN_SEXN5 = Current time
End of sexual behavior

Calculation_TL_SEXN5
S.0.b.
Label_Calculation_TL_SEXN5

Calculate elapsed time between ST_SEXN5 and EN_SEXN5 = TL_SEXN5
Total time for sexual behavior

Page | 117

Module: Prevention activities (PA)
Topic: Prevention messages (PM)
Calculation_STPREVN5 PA.0.
Label_Calculation_STPREVN5

STPREVN5 = Current time
Start prevention activities

Intro_INFTX1N8
INFTX1N8

Next I'd like to ask you some questions about HIV information.
PM.1.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever looked for care & treatment info
If INFTX1N8 = 1 (Yes), go to INFTX2N8 (Recent search for HIV care & treatment info); else
skip to HTWCMPN8 (Exposure to HTW campaign).

Label_INFTX1N8
Skip_INFTX1N8
INFTX2N8

PM.1.1.

Intro_INFT3N8A

"In general, how much would you trust information about HIV care or treatment
from each of the following sources:"
PM.2.1.

A doctor, nurse, or other health care worker
0 Not at all
1 Somewhat
2 A great deal
Trust provider for HIV info

PM.2.2.

Family or friend
0 Not at all
1 Somewhat
2 A great deal
Trust family or friend for HIV info

PM.2.3.

Centers for Disease Control and Prevention or CDC
0 Not at all
1 Somewhat
2 A great deal
Trust CDC for HIV info

PM.2.4.

State or local health department
0 Not at all
1 Somewhat
2 A great deal
Trust health department for HIV info

Label_INFT3N8A
INFT3N8B

Label_INFT3N8B
INFT3N8C

Label_INFT3N8C
INFT3N8D

Label_INFT3N8D

The most recent time that you looked for information about HIV care and treatment, what source
did you use first? [READ RESPONSES. SELECT ONLY ONE.]

1 Internet
2 Brochures or pamplets
3 Magazines
4 Doctor, nurse, or other healthcare worker
5 Family or friend
6 Other source
Recent search HIV care & treatment info

Label_INFTX2N8

INFT3N8A

Have you ever looked for information about HIV care and treatment from any source?

Page | 118
INFT3N8E

PM.2.5.

Community-based organization
0 Not at all
1 Somewhat
2 A great deal
Trust CBO for HIV info

PM.2.6.

Religious organization
0 Not at all
1 Somewhat
2 A great deal
Trust religious orgs for HIV info

PM.3.0.

During the past 12 months, have you seen or heard the campaign slogan or message “HIV
Treatment Works?”

Label_INFT3N8E
INFT3N8F

Label_INFT3N8F
HTWCMPN8

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Exposure to HTW campaign

Label_HTWCMPN8

Topic: Risk reduction (PR)
Intro_5_COND12_9
COND12_9

PA.1.0.

Label_COND12_9
Intro_TALK_5_SERIES

TALK_5A

PA.2.0

Label_TALK_5A
QDS_programming_TALK_5A

TALK_5B

Label_TALK_5B

PA.2.1.

“Next I'd like to ask you some questions about HIV prevention.”
During the past 12 months, have you gotten any free condoms, not counting those given
to you by a friend, relative, or sex partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Gotten any free condoms
“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…”
An outreach worker, counselor, or prevention program worker?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Conversation with an outreach worker…
If POS1S_9 (date first tested positive for HIV) is greater than 12 months from IDATE
(interview date) then display the text as follows: “During the past 12 months, 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…”
A doctor, nurse, or other healthcare worker?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Conversation with a doctor, nurse…

Page | 119
GROU1_12

PA.3.0.

Label_GROU1_12
QDS_programming_8_GROU1_12

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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Organized group session to discuss HIV
If POSIS_9 (date first tested positive for HIV) is greater than 12 months from IDATE
(interview date), then display the question text as follows: "During the past 12 months,
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?"

Calculation_ENPREVN5 PA.3.3a.
Label_Calculation_ENPREVN5

ENPREVN5 = Current time
End of prevention activities

Calculation_TLPREVN5 PA.3.3b.
Label_Calculation_TLPREVN5

Calculate elapsed time between STPREVN5 and ENPREVN5 = TLPREVN5
Total time for prevention activities

Page | 120

Module: Violence (P)
Topic: Physical violence (PV)
Calculation_STIPVN5
P.0.
Label_Calculation_STIPVN5

STIPVN5 = Current time
Start time intimate partner violence

Intro_IPVPH1N5_8

"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. I
would again like to remind you that your answers will be kept confidential, and that you
do not have to answer any questions that you do not want to."
How many of your romantic or sexual partners have ever slapped, punched, shoved,
kicked, choked or otherwise physically hurt you?
8888 Don't Know
7777 Refused to Answer
Ever IPV physical violence
0-999
If IPVPH1N5 (ever IPV physical violence) = 1-999, then go to IPVPH2N5 (last year IPV
physical violence); else skip to Intro_IPVSX1N5 (Intro ever IPV sexual violence).

IPVPH1N5

PV.1.0.

Label_IPVPH1N5
Range_IPVPH1N5
Skip_IPVPH1N5
IPVPH2N5

PV.1.1.

Label_IPVPH2N5

During the past 12 months, has a partner slapped, punched, shoved, kicked, choked, or
otherwise physically hurt you?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Last year IPV physical violence

Topic: Sexual violence (PS)
Intro_IPVSX1N5

IPVSX1N5

PS.1.0.

Label_IPVSX1N5
Range_IPVSX1N5
Skip_IPVSX1N5
IPVSX2N5

PS.1.1.

“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.”
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?
8888 Don't Know
7777 Refused to Answer
Ever IPV sexual violence
0-999
If IPVSX1N5 (ever IPV sexual violence) = 1-999, then go to IPVSX2N5 (last year IPV sexual
violence); else skip to next topic (Calculation_ENIPVN5, End of intimate partner violence).

Label_IPVSX2N5

During the past 12 months, have you been threatened or forced to have vaginal, anal, or
oral sex when you did not want to?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Last year IPV sexual violence

Calculation_ENIPVN5
P.0.a.
Label_Calculation_ENIPVN5

ENIPVN5 = Current time
End of intimate partner violence

Page | 121
Calculation_TLIPVN5
P.0.b.
Label_Calculation_TLIPVN5

Calculate elapsed time between STIPVN5 and ENIPVN5 = TLIPVN5
Total time for intimate partner violence

Page | 122

Module: Depression and anxiety (M)
Topic: PHQ-4 screening questions (MD)
Calculation_STMNHLN5 M.0.
Label_Calculation_STMNHLN5

STMNHLN5 = Current time
Start time mental health

Intro_5_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’ll use
Response Card D for these questions. We’ll also use the calendar to refer to the past 2
weeks.”
“Over the past 2 weeks, how often have you been bothered by any of the following
problems?”
Little interest or pleasure in doing things? [USE RESPONSE CARD D. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ little interest

Intro_1ANX_DEPA
ANXDEPA8

MD.1.0

Label_ANXDEPA8
ANXDEPB8

MD.2.0

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

MD.3.0

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

MD.4.0

Not being able to stop or control worrying? [USE RESPONSE CARD D. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD not stop worrying

Label_ANXDEPB
ANXNR_8

Label_ANXNR_8
ANXSW_8

Label_ANXSW_8
Calculation_PHQ2N8

MD.4.0a Create a calculated where the sum of ANXDEPA8 + ANXDEPB8=PHQ2N8. If the response to
ANXDEPA8 or ANXDEPB8= 7 (refused to answer) or 8 (don’t know), then calculate the
response as 0.
Label_Calculation_PHQ2N8
PHQ2 score

Page | 123
Calculation_GAD2N8

MD.4.0b Create a calculated variable where the sum of ANXNR_8 + ANXSW_8= GAD2N8. If the
response to ANXNR_8 or ANXSW_8= 7(refused to answer) or 8 (don’t know), then
calculate the response as 0.
Label_Calculation_GAD2N8
GAD2 score
Skip_Calculation_GAD2N8
If PHQ2N8 (PHQ2 score) =>3, go to ANXDEPC8 (PHQ sleep trouble). Else, skip to
Skip_ANXWR_8 (GAD worrying too much).

Topic: PHQ-8 depression (MA)
ANXDEPC8

MA.1.0

Trouble falling or staying asleep, or sleeping too much? [USE RESPONSE CARD D. SELECT
ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ sleep trouble

MA.2.0

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

MA.3.0

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

MA.4.0

Feeling bad about yourself—or that you are a failure or have let yourself or your family
down? [USE RESPONSE CARD D. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ feeling bad about self

Label_ANXDEPC8
ANXDEPD8

Label_ANXDEPD8
ANXDEPE8

Label_ANXDEPE8
ANXDEPF8

Label_ANXDEPF8

Page | 124
ANXDEPG8

MA.5.0

Trouble concentrating on things, such as reading the newspaper or watching television?
[USE RESPONSE CARD D. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
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? [USE
RESPONSE CARD D. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ moving slowly or being fidgety

Label_ANXDEPG8
ANXDEPH8

Label_ANXDEPH8

Topic: GAD-7 anxiety (MG)
Skip_ANXWR_8
ANXWR_8

MG.1.0

Label_ANXWR_8
ANXRX_8

MG.2.0

Trouble relaxing? [USE RESPONSE CARD D. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD trouble relaxing

MG.3.0

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

Label_ANXRX_8
ANXRS_8

Label_ANXRS_8

If GAD2N8 (GAD2 score) >=3, go to ANXWR_8 (GAD worrying too much). Else, skip to
Calculation_ENMNHLN5 (end of mental health).
Worrying too much about different things? [USE RESPONSE CARD D. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD worrying too much

Page | 125
ANXIR_8

MG.4.0

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

MG.5.0

Label_ANXAF_8

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

Calculation_ENMNHLN5 M.0.a.
Label_Calculation_ENMNHLN5

ENMNHLN5 = Current time
End of mental health

Calculation_TLMNHLN5 M.0.b.
Label_Calculation_TLMNHLN5

Calculate elapsed time between STMNHLN5 and ENMNHLN5 = TLMNHLN5
Total time for mental health

Label_ANXIR_8
ANXAF_8

Page | 126

Module: Alcohol, smoking, and drug use (U)
Topic: Alcohol use (UA)
Calculation_STDRUGN5 U.0.
Label_Calculation_STDRUGN5

STDRUGN5 = Current time
Start time of alcohol, smoking, drug use

Intro_8_ALCOHO_9

“These next questions are about drinking alcohol. Included are beer, wine, wine coolers,
and liquor, such as whiskey or gin, and any other type of alcohol. We will use Response
Card G.”
During the past 12 months, how often did you drink alcohol? [USE RESPONSE CARD G.
SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
How often drank alcohol in past 12 mos
If ALCOHO_9 (how often drank alcohol in past 12 mos) is 5 (never), 7 (refused to answer),
8 (don’t know), then skip to Intro_CIGEVRN5 (Ever smoked cigarettes).

ALCOHO_9

UA.1.0.

Label_ALCOHO_9
Skip_ALCOHO_9
Intro_8_NDRINK_9

NDRINK_9

UA.2.0.

Label_NDRINK_9
Range_NDRINK_9
DRINK_9

Label_DRINK_9
Range_DRINK_9
Skip_DRINK_9

UA.3.0.

“We’ll use the Alcohol Response Card for the next questions. For these questions a drink of
alcohol is a 12 oz. beer, a 5 oz. glass of wine, or a 1.5 oz. shot of liquor. We'll use the
calendar to refer to the past 30 days.”
During the past 30 days, how many alcoholic drinks did you have on a typical day when
you were drinking?
88 Don't Know
77 Refused to Answer
# drinks/day typical day past 30 days
1-30
During the past 30 days, on how many days did you have an alcoholic drink?
88 Don't Know
77 Refused to Answer
Number of days drank past 30 days
0–30
If DRINK_9 (number of days drank past 30 days) is 0 (no), 77 (refused to answer), or 88
(don’t know), then skip to Intro_CIGEVRN5.

Page | 127
BINGE_8

UA.4.0.

Label_BINGE_8
Range_BINGE_8
Hard_edit_BINGE_8

QDS_programming_note_BINGE_
8

During the past 30 days, on how many days did you have [5 or 4] or more alcoholic drinks
in one sitting?
88 Don't Know
77 Refused to Answer
# binge drink days past 30 days
BINGE_8 (# binge drink days past 30 days) must be <= 30 and <= DRINK_9 (number of days
drank past 30 days).
If BINGE_8 (# binge drink days past 30 days) > DRINK_9 (number of days drank in past 30
days), then READ, “The number of days that you had any drink should be equal to or larger
than the number of days you had [5 or 4] or more drinks.” Return to DRINK_9 (number of
days drank past 30 days).
Tokens may be used to alter how this question appears based on respondent’s sex. If
BIRTGEN (sex at birth) = 2 (female), 3 (intersex/ambiguous), then question should read,
“During the past 30 days, on how many days did you have 4 or more alcoholic drinks in
one sitting?” If BIRTGEN (sex at birth) = 1 (male), 7 (refused), or 8 (don’t know), then
question should read, “During the past 30 days, on how many days did you have 5 or more
alcoholic drinks in one sitting?” The same substitution tokens apply to Hard_edit_BINGE_

Topic: Cigarette and tobacco use (US)
Intro_CIGEVRN5
CIGEVRN5

US.1.0.

Label_CIGEVRN5
Skip_CIGEVRN5
Intro_CIG_OFT
CIG_OFT

US.1.1.

Label_CIG_OFT
CIGARN5

Label_CIGARN5
Skip_CIGARN5

US.2.0.

“The next questions are about smoking cigarettes.”
Have you smoked at least 100 cigarettes, equal to 5 packs of cigarettes, in your entire life?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever smoked cigarettes
If CIGEVRN5 (ever smoked cigarettes) is 0 (no), 7 (refused to answer), or 8 (don’t know),
then skip to CIGARN5 (ever smoked cigars, etc.). Else, go to Intro_CIG_OFT.
“Now we will use Response Card G.”
How often do you smoke cigarettes now? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Current use cigarettes
Have you smoked cigars, cigarillos, or little filtered cigars at least 50 times in your entire
life?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever smoked cigars, etc.
If CIGARN5 (ever smoked cigars, etc.) is 0 (no), 7 (refused to answer), or 8 (don’t know),
then skip to Skip_CIG_QTN5 (Stopped smoking one day or longer). Else, go to CIGARFN5
(current use cigars, etc.)

Page | 128
CIGARFN5

US.2.1.

Label_CIGARFN5
Skip_CIG_QTN5

Intro_CIG_QTN5
CIG_QTN5

US.3.0.

Label_CIG_QTN5
CIG_DQ_8

US.4.0.

Label_CIG_DQ_8
Intro_CIGELCN5

CIGELCN5

US.5.0.

Label_CIGELCN5
Skip_CIGELCN5
CIGELFN5

Label_CIGELFN5

US.5.1.

Do you now smoke cigars, cigarillos, or little filtered cigars every day, some days, rarely, or
not at all? [SELECT ONE RESPONSE.]
1 Every day
2 Some days
3 Rarely
4 Not at all
8 Don't Know
7 Refused to Answer
Current use cigars, etc.
If CIG_OFT (current use cigarettes) = 1 (Daily), 2 (Weekly), 3 (Monthly), or 4 (Less than
monthly) or if CIGARFN5 (current use cigars, etc.) = 1 (every day), 2 (some days), or 3
(rarely), then go to Intro_CIG_QTN5. Else, skip to Intro_CIGELCN5.
“The next questions ask about quitting smoking. By smoking, I mean smoking cigarettes,
cigars, cigarillos, or little filtered cigars.”
During the past 12 months, have you stopped smoking for one day or longer because you
were trying to quit?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped smoking one day or longer
During the past 12 months, has a doctor, nurse, or other healthcare worker advised you to
quit smoking?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Doctor advised to quit smoking
“The next set of questions is about electronic cigarettes. Electronic cigarettes, or ecigarettes, 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.”
Have you ever used an e-cigarette, even just one time in your entire life?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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 Intro_ANID12_9 (Used non-injection drugs in past 12 mos).
Have you used e-cigarettes during the past 30 days?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Used electronic cigarettes past 30 days

Page | 129

Topic: Non-injection drug use (UN)
Intro_ANID12_9

ANID12_9

UN.1.0.

Label_ANID12_9
Skip_ANID12_9
Intro_MARIJU_9

MARIJU_9

UN.2.0.

Label_MARIJU_9
CRACK1_9

Label_COCSMO_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.”
During the past 12 months, how often did you use marijuana? [USE RESPONSE CARD G.
SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used marijuana

UN.3.0.

During the past 12 months, how often did you use crack? [USE RESPONSE CARD G. SELECT
ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used crack

UN.4.0.

During the past 12 months, how often did you use cocaine that is smoked or snorted?
[USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used cocaine

Label_CRACK1_9
COCSMO_9

“Now I’m going to ask you about times when you may have used drugs, but didn’t inject
them. This includes times when you may have smoked, snorted, inhaled or ingested drugs
like marijuana, methamphetamine, cocaine, crack, or certain prescription drugs. I will refer
to these as non-injection drugs.”
During the past 12 months, did you use any non-injection drugs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Used non-injection drugs in past 12 mos
If ANID12_9 (used non-injection drugs in past 12 mos) is 1 (yes), then go to Intro_MARIJU_
9 (used marijuana). Else, skip to Intro_EVRINJN5 (ever injected drugs).

Page | 130
METHN5

UN.5.0.

During the past 12 months, how often did you use any methamphetamines, such as crystal
meth, tina, crank, or ice? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used methamphetamines

UN.6.0.

During the past 12 months, how often did you use amphetamines, such as speed, bennies,
or uppers? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used amphetamines

UN.7.0.

During the past 12 months, how often did you use heroin or opium that is smoked or
snorted? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used non-injected heroin

UN.8.0.

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 (also called Liquid Ecstasy)? [USE RESPONSE
CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used club drugs

Label_METHN5
AMPHEN5

Label_AMPHEN5
HEROIN_9

Label_HEROIN_9
CLUBN5

Label_CLUBN5

Page | 131
POPPER_9

Label_POPPER_9
Intro_PAINKN5
PAINKN5

Label_PAINKN5
TRANQN5

Label_TRANQN5
Soft_edit_8_TRANQN5

UN.9.0.

During the past 12 months, how often did you use poppers, also called amyl nitrite? [USE
RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used poppers

“The next few questions are about medications that require a prescription. I’ll first ask you
about prescription pain relievers.”
UN.10.0. 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? [USE RESPONSE CARD G. SELECT ONLY
ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used painkillers
UN.11.0. During the past 12 months, how often did you take a prescription tranquilizer, such 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? [USE RESPONSE CARD G. SELECT ONLY
ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used tranquilizers
If ANID12_9 (used non-injection drugs) is 1 (yes) and [MARIJU_9, CRACK1_9, COCSMO_9,
METHN5, AMPHEN5, CLUBN5, POPPER_9, PAINKN5, and TRANQN5] are all 5 (never), then
READ, “The respondent said that he/she didn’t use any of the specific drugs that you asked
about. Verify that the respondent used non-injection drugs during the past 12 months.”
Allow the program to move forward.

Page | 132

Topic: Injection drug use (UI)
Intro_EVRINJN5
EVRINJN5

UI.1.0.

Label_EVRINJN5
Skip_EVRINJN5

INJECTN5

UI.1.1.

Label_INJECTN5
Skip_INJECTN5
Intro_COCINJN5

COCINJN5

UI.2.0.

Label_COCINJN5
HERINJN5

Label_HERINJN5

UI.3.0.

“The next questions are about injection drug use. This means injecting drugs yourself or
having someone else inject you.”
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.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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 Calculation_ENDRUGN5 (End of alcohol, smoking, and
drug use).
During the past 12 months, have you shot up or injected any drugs that weren’t used for
medical purposes?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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 Calculation_ENDRUGN5 (End of alcohol, smoking, and drug use).
“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.”
During the past 12 months, how often did you inject powder cocaine? [USE RESPONSE
CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected powder cocaine
During the past 12 months, how often did you inject heroin? [USE RESPONSE CARD G.
SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected heroin

Page | 133
SPDBALN5

UI.4.0.

During the past 12 months, how often did you inject heroin and cocaine together, also
called speedball? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected speedball

UI.5.0.

During the past 12 months, how often did you inject methamphetamines, such as crystal
meth, tina, crank or ice? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected methamphetamines

UI.6.0.

During the past 12 months, how often did you inject amphetamines, such as speed,
bennies, or uppers? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected amphetamines

UI.7.0.

During the past 12 months, how often did you inject painkillers, such as Oxycontin,
oxycodone, or hydrocodone? [USE RESPONSE CARD G. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected painkillers
If INJECTN5 (used injection drugs past 12 months) is 1 (yes) and [COCINJN5, HERINJN5,
SPDBALN5, METINJN5, AMPINJN5, or PKINJN5] are all 5 (Never), then READ, “The
respondent said that he/she didn’t inject any of the specific drugs that you asked about.
Verify that the respondent injected drugs during the past 12 months.” Allow the program
to move forward.

Label_SPDBALN5
METINJN5

Label_METINJN5
AMPINJN5

Label_AMPINJN5
PKINJN5

Label_PKINJN5
Soft_edit_PKINJN5

Page | 134
Intro_SHRNDLN5
SHRNDLN5

UI.8.0.

Label_SHRNDLN5
SHR_WRKS

UI.9.0.

Label_SHR_WRKS
Intro_GETNDAN5
GETNDAN5

UI.10.0.

Label_GETNDAN5
GETNDBN5

UI.10.2.

A doctor’s office, clinic, or hospital?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needles Dr. office, clinic, hospital

UI.10.3.

A friend, relative, or sex partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
A friend, relative, or sex partner

UI.10.4.

A needle or drug dealer, shooting gallery, or off the street?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needle dealer, shooting gallery, st.

Label_GETNDDN5
GETNDEN5

Label_GETNDEN5

“During the past 12 months when you injected, did you get your needles at any of the
following places:”
A needle exchange program?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needles at needle exchange
A pharmacy or drug store?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needles at pharmacy

Label_GETNDCN5
GETNDDN5

When you injected during the past 12 months, did someone use the same cookers, cotton,
or rinse water after you used it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Shared injection works

UI.10.1.

Label_GETNDBN5
GETNDCN5

“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.”
When you injected during the past 12 months, did someone use the same needle after
you used it to either inject drugs or divide drugs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Shared needles

Page | 135
Calculation_ENDRUGN5 U.0.a.
Label_Calculation_ENDRUGN5

ENDRUGN5 = Current time
End of alcohol, smoking, and drug use

Calculation_TLDRUGN5 U.0.b.
Label_8_Calculation_TLDRUGN5

Calculate elapsed time between STDRUGN5 and ENDRUGN5 = TLDRUGN5
Total time - Alcohol, smoking, drug use

Page | 136

Module: Stigma and discrimination (R )
Topic: Stigma (RS)
Calculation_STSTIGN5
R.0.
Label_Calculation_STSTIGN5

STSTIGN5 = Current time
Start time stigma and discrimination

Intro_8_STIGMAN5

“Next, I’ll read you a few statements that some people living with HIV have said they feel.
We’re asking you 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.
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’ll use
Response Card F for these questions.”
I have been hurt by how people reacted to learning I have HIV. [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Hurt by people reacting to my HIV

STIGMAN5

RS.1.0.

Label_STIGMAN5
STIGMBN5

RS.2.0.

I have stopped socializing with some people because of their reactions to my HIV status.
[USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
No socialize w. some people b/c of HIV

RS.3.0.

I have lost friends by telling them I have HIV. [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Lost friends telling of my HIV

RS.4.0.

I am very careful who I tell that I have HIV. [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Careful who I tell I have HIV

Label_STIGMBN5
STIGMCN5

Label_STIGMCN5
STIGMDN5

Label_STIGMDN5

Page | 137
STIGMEN5

RS.5.0.

I worry that people who know I have HIV will tell others. [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
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.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Not as good a person as others

RS.7.0.

Having HIV makes me feel unclean. [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Having HIV makes me feel unclean

RS.8.0.

Having HIV makes me feel that I’m a bad person. [USE RESPONSE CARD. SELECT ONLY
ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Feel I’m a bad person

RS.9.0.

Most people think that a person with HIV is disgusting. [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
HIV is disgusting

Label_STIGMEN5
STIGMFN5

Label_STIGMFN5
STIGMGN5

Label_STIGMGN5
STIGMHN5

Label_STIGMHN5
STIGMIN5

Label_STIGMIN5

Page | 138
STIGMJN5

RS.10.0.

Label_STIGMJN5
Intro_STGA12N8
STGA12N8

RS.11.0.

Label_STGA12N8
STGB12N8

Label_STGC12N8

"The statements I just read were about experiences since you tested positive for HIV. Now,
I'd like you to focus specifically on the past 12 months."
During the past 12 months, I have been hurt by how people reacted to learning I have HIV.
[USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Stigma – hurt by people p12m

RS.12.0.

During the past 12 months, I have stopped socializing with some people because of their
reactions to my HIV status. [USE RESPONSE CARD.SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Stigma – stopped socializing p12m

RS.13.0.

During the past 12 months, I have lost friends by telling them I have HIV. [USE RESPONSE
CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Stigma – lost friends p12m

Label_STGB12N8
STGC12N8

Most people with HIV are rejected when others find out. [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Most people with HIV are rejected

Page | 139

Topic: Discrimination (RD)
If EVERCR_8 is 0 (no), 8 (don't know), or 7 (refused), then skip to Calculation_ENSTIGN5.

Skip_DISC1N8

Intro_DISC1N8

DISC1N8

RD.1.0.

Label_DISC1N8
DISC2N8

RD.2.0.

During the past 12 months, how often were you treated with less respect than other
people? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – treated less respect

RD.3.0.

During the past 12 months, how often have you received poorer service than others? [USE
RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – poorer service

RD.4.0.

During the past 12 months, how often has a doctor or nurse acted as if he or she thought
you were not smart? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – not smart

Label_DISC2N8
DISC3N8

Label_DISC3N8
DISC4N8

Label_DISC4N8

If EVERCR_8 is 1 (yes) and LASCA_8 <= 12 months from IDATE, go to Intro_DISC1N8. Else,
skip to Calculation_ENSTIGN5.
“Now, I’m going to ask you about things that may have happened when you got HIV care
at a doctor’s office or a clinic. Please tell me how often the following things happened to
you in the past 12 months. We are going to use Response Card I.”
During the past 12 months, how often were you treated with less courtesy than other
people? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – treated less courtesy

Page | 140
DISC5N8

RD.5.0.

During the past 12 months, how often has a doctor or nurse acted as if he or she was
afraid of you? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – provider afraid

RD.6.0.

During the past 12 months, how often has a doctor or nurse acted as if he or she was
better than you? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination - provider better

RD.7.0.

During the past 12 months, how often have you felt like a doctor or nurse was not
listening to what you were saying? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination - provider not listening

Label_DISC5N8
DISC6N8

Label_DISC6N8
DISC7N8

Label_DISC7N8
Skip_STIGMA_8

Intro_DISHIV_8

DISHIV_8

Label_DISHIV_8

RD.8.0.

If DISC1N8 (Discrimination – treated less courtesy) or DISC2N8 (Discrimination – treated
less respect) or DISC3N8 (Discrimination – poorer service) or DISC4N8 (Discrimination –not
smart) or DISC5N8 (Discrimination – provider afraid) or DISC6N8 (Discrimination - provider
thinks they are better) or DISC7N8 (Discrimination - provider not listening) is 2 (rarely), 3
(sometimes), 4 (most of the time), or 5 (always), then go to Intro_DISHIV_8 (Your HIV
infection). Else, skip to Calculation_ENSTIGN5 (End of stigma and discrimination).
“Based on your responses to the questions I’ve just asked, you may have experienced
discrimination when getting HIV care in the past 12 months. In the past 12 months, did the
discrimination occur because…”
…of your HIV infection?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your HIV infection

Page | 141
DISGEN_8

RD.9.0.

…of your gender?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your gender

RD.10.0

…of your sexual orientation or sexual practices?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
our sexual orientation and practices

Label_DISGEN_8
DISSEX_8

Label_DISSEX_8
DISRAC_8

Label_DISRAC_8
DISINCN8

Label_DISINCN8
Skip_DISINCN8
DISDRG_8

Label_DISDRG_8

RD.11.0. …of your race or ethnicity?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your race or ethnicity
RD.12.0. …of your income or social class?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your income or social class
If EVRINJN5 (ever used injection drugs) is 1 (yes), then go to DISDRG_8 (your drug injecting
habit). Else, skip to Calculation_ENSTIGN5 (End of stigma and discrimination).
RD.13.0. …someone at your doctor's office or clinic thought you injected drugs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Someone thought they injected drugs

Calculation_ENSTIGN5 R.0.a.
Label_Calculation_ENSTIGN5

ENSTIGN5 = Current time
End of stigma and discrimination

Calculation_TLSTIGN5
R.0.b.
Label_Calculation_TLSTIGN5

Calculate elapsed time between STSTIGN5 and ENSTIGN5 = TLSTIGN5
Total time for stigma and discrimination

Page | 142

Module: Gynecological and reproductive history (G)
Topic: Gynecological care (GH)
Skip_PLV_EX_9

Calculation_STOBGYN5 G.0.
Label_Calculation_STOBGYN5

If BIRTGEN (sex at birth) and GENDER (gender) = 2 (female), then go to
Calculation_STOBGYN5 (start gynecological and reproductive history); else, skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive history).
STOBGYN5 = current time
Start time gyn and reproductive history

Skip_PLV_EX_9

If BIRTGEN (sex at birth) and GENDER (gender) = 2 (female), then go to Calculation_STOBGYN5 (start
gynecological and reproductive history); else, skip to Calculation_ENOBGYN5 (End of gynecological
and reproductive history).

Intro_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.”
During the past 12 months, have you had a pelvic examination?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Pelvic exam

PLV_EX_9

GH.1.0.

Label_PLV_EX_9
PAP_EX_8

GH.2.0.

Label_PAP_EX_8
QDS_programming_PAP_EX_8

[During the past 3 years or Since testing positive for HIV], have you had a Pap smear?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Pap smear
If POS1S_9 (HIV diagnosis date) <3 years prior to interview date, then question should read
as "Since testing positive for HIV, have you had a Pap smear?". If POS1S_9 (HIV diagnosis
date) ≥3 years ago, then question should read as "During the past 3 years, have you had a Pap
smear?"

POSTMEN8

GH.3.0.

Are you post-menopausal, meaning you don’t have periods anymore?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Post menopausal

GH.4.0.

Have you had a tubal ligation, also known as having your “tubes tied”?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Tubal ligation

Label_POSTMEN8
Skip_POSTMEN8
TUBLIGN8

Label_TUBLIGN8
Skip_TUBLIGN8

Page | 143
HYSTERN8

GH.5.0

Label_HYSTERN8
Skip_HYSTERN8

Have you had a hysterectomy? A hysterectomy is when all or some of your uterus is
removed.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Hysterectomy
If POSTMEN8 (post menopausal) is 1 (yes) or TUBLIGN8 (tubal ligation) is 1 (yes) or
HYSTERN8 (Hysterectomy) is 1 (yes), then go to PREG_9 (number of pregnancies); else skip
to Skip_BIRCOAN3.

Topic: Contraception (GC)
Skip_BIRCOAN3

If SX_TMPN4 (number of male partners) is >= 1, then go to Intro1_BIRCOAN3; else, skip
to PREG_9 (number of times pregnant).

Intro1_8_BIRCOAN3

“I’m going to read a list of ways that people prevent pregnancy. As I read each one, tell me if you or
your partner(s) used it during the past 12 months. Answer 'Yes' even if you’ve only used it once.”

BIRCOAN3

GC.1.1.

Male condom, also called a “rubber”
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Male condom, also called a "rubber"

GC.1.2.

Female condom
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Female condom

GC.1.3.

Diaphragm, cervical cap, or cervical sponge
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Diaphragm, cervical cap

GC.1.4.

Spermicidal foam or jelly
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Spermicidal foam or jelly

GC.1.5.

An injection, such as Depo-Provera®
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Depo-Provera®, which is an injection

Label_BIRCOAN3
BIRCOBN3

Label_BIRCOBN3
BIRCOCN3

Label_BIRCOCN3
BIRCODN3

Label_BIRCODN3
BIRCOE_8

Label_BIRCOE_8

Page | 144
BIRCOF_8

GC.1.6.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Hormonal implants-Implanon®/Nexplanon®

Label_BIRCOF_8
BIRCOGN3

GC.1.7.

Birth control pills
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Birth control pills

GC.1.8.

Contraceptive patch, for example, Ortho Evra®
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Contraceptive patch Ortho Evra®

GC.1.9.

Contraceptive ring, for example NuvaRing®
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Contraceptive ring-NuvaRing®

Label_BIRCOGN3
BIRCOHN3

Label_BIRCOHN3
BIRCOIN3

Label_BIRCOIN3
BIRCOJ_8

Hormonal implant, which is a small rod inserted under the skin of your upper arm, such as
Implanon® or Nexplanon®

GC.1.10. Intrauterine device or IUD, which is a “T” shaped piece of plastic inserted into your uterus, such as
Mirena® or ParaGard®

Label_BIRCOJ_8
BIRCOKN3

Label_BIRCOKN3
BIRCOLN3

Label_BIRCOLN3

0 No
1 Yes
8 Don't Know
7 Refused to Answer
use of IUDs
GC.1.11. Emergency contraception or “morning after pill”
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Emergen contraception-morning after pill
GC.1.12. Withdrawal, also called “pulling out”
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Withdrawal, also called “pulling out”

Page | 145
BIRCOMN3

Label_BIRCOMN3
BIRCOPN3

Label_BIRCOPN3

GC.1.13. Abstinence, which is not having sex
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Abstinence, which is not having sex
GC.1.16. Partner’s vasectomy
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner’s vasectomy

Topic: Reproductive history (GR)
INTENTN8

GR.1.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Currently trying to get pregnant

Label_INTENTN8
PREG_9

GR.1.0.

Label_PREG_9
Skip_INTNT1N3

QDS_programming_PREG_9

Skip_Intro1_INTNT1N3

Intro1_5_INTNT1N3
Skip_Intro2_INTNT1N3
Intro2_5_INTNT1N3
INTNT1N3

Label_INTNT1N3

Are you currently trying to get pregnant?

GR.2.0.

Since testing positive for HIV in [INSERT POS1S_9 (date of first positive test)], how many
times have you been pregnant?
888 Don't Know
777 Refused to Answer
Number of times pregnant
If PREG_9 (number of times pregnant) = 0, 777 (refused to answer), or 888 (don’t know),
then skip to Calculation_ENOBGYN5 (End of gynecological and reproductive history); else
go to Skip_Intro1_INTNT1N3 (1st pregnancy trying to get pregnant).
If POS1S_9 (date first tested positive for HIV) is 77/7777 (refused to answer) or 88/8888
(don’t know), then PREG_9 (number of times pregnant) should read as follows: Since
testing positive for HIV, how many times have you been pregnant?
If PREG_9 (number of times pregnant) = 1, then skip to INTNT1N3 (1st pregnancy trying to
get pregnant). If PREG_9 (number of times pregnant) = 2–5, then go to Intro1_5
_INTNT1N3 (1st pregnancy trying to get pregnant). Else, skip to Intro2_5_INTNT1N3 (1st
pregnancy trying to get pregnant).
“Now I’d like to ask you about all of your pregnancies since testing positive for HIV,
starting with your first one.”
If PREG_9 (number of times pregnant) = 2-5, then go to INTNT1N3 (1st pregnancy trying to
get pregnant).
“Now I’d like to ask you about your first 5 pregnancies since testing positive for HIV,
starting with your first one.”
For your 1st pregnancy since testing positive for HIV, were you trying to get pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
1st pregnancy trying to get pregnant

Page | 146
OUTCM1N3

GR.2.1.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY ONE.]
1 Currently pregnant
2 Live birth
3 Stillbirth
4 Miscarriage
5 Abortion
8 Don't Know
7 Refused to Answer
First pregnancy outcome
If PREG_9 (number of times pregnant) > 1, then OUTCM1N3 (first pregnancy outcome)
cannot be 1 (currently pregnant). If PREG_9 (number of times pregnant)> 1 and
OUTCM1N3 (first pregnancy outcome) is 1 (currently pregnant), then READ “I am asking
about the outcome of the very first pregnancy you had.” Return to OUTCM1N3 (first
pregnancy outcome).
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?
8888 Don't Know
7777 Refused to Answer
Date of first pregnancy outcome
PDTE1N3 (date of first pregnancy outcome) cannot be earlier than POS1S_9 (date first
tested positive for HIV). If PDTE1N3 (date of first pregnancy outcome) < POS1S_9 (date
first tested positive for HIV), 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). If OUTCM1N3 (first pregnancy outcome) = 3 (stillbirth), 4
(miscarriage), 5 (abortion), 7 (refused to answer), or 8 (don’t know), skip to
Skip_INTNT2N3 (2nd pregnancy trying to get pregnant).
Allow a blank response for month. If month is blank for PDTE1N3 (date of first pregnancy
outcome), use the year values for the validation.

Label_OUTCM1N3
Hard_edit_OUTCM1N3

Skip_OUTCM1N3
PDTE1N3

Label_PDTE1N3
Hard_edit_PDTE1N3

Skip_PDTE1N3

QDS_programming_PDTE1N3
KID1HVN3

Label_KID1HVN3
Skip_KID1HVN3

GR.2.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
2 Indeterminate
8 Don't Know
7 Refused to Answer
First pregnancy vertical transmission
Skip to Skip_INTNT2N3 (2nd pregnancy trying to get pregnant).

Page | 147
DUDT1N3

GR.2.4.

Label_DUDT1N3
Range_N6_DUDT1N3
Hard_edit1_DUDT1N3

Hard_edit2_DUDT1N3

Hard_edit3_DUDT1N3

Skip_INTNT2N3

INTNT2N3

GR.3.0.

Label_INTNT2N3
OUTCM2N3

Label_OUTCM2N3
Hard_edit_OUTCM2N3

Skip_OUTCM2N3

GR.3.1.

What is your due date?
8888 Don't Know
7777 Refused to Answer
First pregnancy due date
01/01/1980–later
DUDT1N3 (first pregnancy due date) cannot be earlier than DOB_13 (date of birth). If
DUDT1N3 (first pregnancy due date) < DOB_13 (date of birth), then READ, “The due date
cannot be earlier than the respondent's date of birth. Please re-enter date.” Do not allow
the program to advance.
DUDT1N3 (first pregnancy due date) cannot be earlier than POS1S_9 (date first tested
positive for HIV). If DUDT1N3 (first pregnancy due date) < POS1S_9 (date first tested
positive for HIV), 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.
DUDT1N3 (first pregnancy due date) cannot be more than 10 months after the IDATE
(interview date). If DUDT1N3 (first pregnancy due date) > 10 months after IDATE
(interview date), then READ, “The due date cannot be more than 10 months after [INSERT
IDATE (interview date)]. Please re-enter date.” Do not allow the program to advance.
If PREG_9 (number of times pregnant) >1, go to INTNT2N3 (2nd pregnancy trying to get
pregnant); else, skip to Calculation_ENOBGYN5 (End of gynecological and reproductive
history).
For the 2nd pregnancy since testing positive for HIV, were you trying to get pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
2nd pregnancy trying to get pregnant
What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY ONE.]
1 Currently pregnant
2 Live birth
3 Stillbirth
4 Miscarriage
5 Abortion
8 Don't Know
7 Refused to Answer
2nd pregnancy outcome
If PREG_9 (number of times pregnant) > 2, then OUTCM2N3 (2nd pregnancy outcome)
cannot be 1 (currently pregnant). If PREG_9 (number of times pregnant) > 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 (2nd pregnancy outcome).
If OUTCM2N3 (2nd pregnancy outcome) = 1 (currently pregnant), then skip to DUDT2N3
(2nd pregnancy due date); else go to PDTE2N3 (date of second pregnancy outcome).

Page | 148
PDTE2N3

GR.3.2.

Label_PDTE2N3
Hard_edit_PDTE2N3

Skip_PDTE2N3

QDS_programming_PDTE2N3
KID2HVN3

GR.3.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
2 Indeterminate
8 Don't Know
7 Refused to Answer
Second pregnancy vertical transmission
Skip to Skip_INTNT3N3 (3rd pregnancy trying to get pregnant).

GR.3.4.

What is your due date?
8888 Don't Know
7777 Refused to Answer
2nd pregnancy due date
01/01/1980–later
DUDT2N3 (2nd pregnancy due date) cannot be earlier than DOB_13 (date of birth). If
DUDT2N3 (2nd pregnancy due date) < DOB_13 (date of birth), 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.
DUDT2N3 (2nd pregnancy due date) cannot be earlier than POS1S_9 (date first tested
positive for HIV). If DUDT2N3 (2nd pregnancy due date) < POS1S_9 (date first tested
positive for HIV), 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.
DUDT2N3 (2nd pregnancy due date) cannot be more than 10 months after the IDATE
(interview date). If DUDT2N3 (2nd pregnancy due date) > 10 months after IDATE
(interview date), 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.

Label_KID2HVN3
Skip_KID2HVN3
DUDT2N3

Label_DUDT2N3
Range_N6_DUDT2N3
Hard_edit1_DUDT2N3

Hard_edit2_DUDT2N3

Hard_edit3_DUDT2N3

In what month and year did this outcome occur?
8888 Don't Know
7777 Refused to Answer
Date of second pregnancy outcome
PDTE2N3 (date of second pregnancy outcome) cannot be earlier than PDTE1N3 (date of
first pregnancy outcome). If PDTE2N3 (date of second pregnancy outcome) < PDTE1N3
(date of first pregnancy outcome), then READ, “The outcome date cannot be earlier than
the date of the first pregnancy outcome. Please re-enter date.” Do not allow the program
to advance.
If OUTCM2N3 (2nd pregnancy outcome) = 2 (live birth), then go to KID2HVN3 (2nd
pregnancy vertical transmission). If OUTCM2N3 (2nd pregnancy outcome) = 3 (stillbirth), 4
(miscarriage), 5 (abortion), 7 (refused to answer), or 8 (don’t know), skip to
Skip_INTNT3N3 (3rd pregnancy trying to get pregnant).
Allow a blank response for month. If month is blank for PDTE2N3 (date of second
pregnancy outcome), use the year values for the validation.

Page | 149
Skip_INTNT3N3

INTNT3N3

GR.4.0.

Label_INTNT3N3
OUTCM3N3

GR.4.1.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY ONE.]
1 Currently pregnant
2 Live birth
3 Stillbirth
4 Miscarriage
5 Abortion
8 Don't Know
7 Refused to Answer
3rd pregnancy outcome
If PREG_9 (number of times pregnant) > 3, then OUTCM3N3 (3rd pregnancy outcome)
cannot be 1 (currently pregnant). If PREG_9 (number of times pregnant) > 3 and
OUTCM3N3 (3rd pregnancy outcome) is 1 (currently pregnant), then READ “I am asking
about the outcome of the third pregnancy that you had.” Return to OUTCM3N3 (3rd
pregnancy outcome).
If OUTCM3N3 (3rd pregnancy outcome) = 1 (currently pregnant), then skip to DUDT3N3
(3rd pregnancy due date). Else, go to PDTE3N3 (date of third pregnancy outcome).

GR.4.2.

In what month and year did this outcome occur?
8888 Don't Know
7777 Refused to Answer
Date of third pregnancy outcome
PDTE3N3 (date of third pregnancy outcome) cannot be earlier than PDTE2N3 (date of
second pregnancy outcome). If PDTE3N3 (date of third pregnancy outcome) < PDTE2N3
(date of second pregnancy outcome), then READ, “The outcome date cannot be earlier
than the date of the second pregnancy outcome. Please re-enter date.” Do not allow the
program to advance.
If OUTCM3N3 (3rd pregnancy outcome) = 2 (live birth), then go to KID3HVN3 (third
pregnancy vertical transmission). If OUTCM3N3 (third pregnancy outcome) = 3 (stillbirth),
4 (miscarriage), 5 (abortion), 7 (refused to answer), or 8 (don’t know), skip to
Skip_INTNT4N3 (4th pregnancy trying to get pregnant).
Allow a blank response for month. If month is blank for PDTE3N3 (date of third pregnancy
outcome), use the year values for the validation.

Label_OUTCM3N3
Hard_edit_OUTCM3N3

Skip_OUTCM3N3
PDTE3N3

Label_PDTE3N3
Hard_edit_PDTE3N3

Skip_PDTE3N3

QDS_programming_PDTE3N3
KID3HVN3

Label_KID3HVN3
Skip_KID3HVN3

If PREG_9 (number of times pregnant) >2, go to INTNT3N3 (3rd pregnancy trying to get
pregnant); else, skip to Calculation_ENOBGYN5 (End of gynecological and reproductive
history).
For the 3rd pregnancy since testing positive for HIV, were you trying to get pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
3rd pregnancy trying to get pregnant

GR.4.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
2 Indeterminate
8 Don't Know
7 Refused to Answer
Third pregnancy vertical transmission
Skip to Skip_INTNT4N3 (4th pregnancy trying to get pregnant).

Page | 150
DUDT3N3

GR.4.4.

Label_DUDT3N3
Range_N6_DUDT3N3
Hard_edit1_DUDT3N3

Hard_edit2_DUDT3N3

Hard_edit3_DUDT3N3

Skip_INTNT4N3

INTNT4N3

GR.5.0.

Label_INTNT4N3
OUTCM4N3

Label_OUTCM4N3
Hard_edit_OUTCM4N3

Skip_OUTCM4N3

GR.5.1.

What is your due date?
8888 Don't Know
7777 Refused to Answer
3rd pregnancy due date
01/01/1980–later
DUDT3N3 (3rd pregnancy due date) cannot be earlier than DOB_13 (date of birth). If
DUDT3N3 (3rd pregnancy due date) < DOB_13 (date of birth), 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.
DUDT3N3 (3rd pregnancy due date) cannot be earlier than POS1S_9 (date first tested
positive for HIV). If DUDT3N3 (3rd pregnancy due date) < POS1S_9 (date first tested
positive for HIV), 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.
DUDT3N3 (3rd pregnancy due date) cannot be more than 10 months after IDATE
(interview date). If DUDT3N3 (3rd pregnancy due date) > 10 months after IDATE (interview
date), 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 Calculation_ENOBGYN5 (End of gynecological and reproductive
history).
For the 4th pregnancy since testing positive for HIV, were you trying to get pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
4th pregnancy trying to get pregnant
What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY ONE.]
1 Currently pregnant
2 Live birth
3 Stillbirth
4 Miscarriage
5 Abortion
8 Don't Know
7 Refused to Answer
4th pregnancy outcome
If PREG_9 (number of times pregnant) > 4, then OUTCM4N3 (4th pregnancy outcome)
cannot be 1 (currently pregnant). If PREG_9 (number of times pregnant) > 4 and
OUTCM4N3 (4th pregnancy outcome) is 1 (currently pregnant), then READ “I am asking
about the outcome of the fourth pregnancy that you had.” Return to OUTCM4N3 (4th
pregnancy outcome).
If OUTCM4N3 (4th pregnancy outcome) is 1 (currently pregnant), then skip to DUDT4N3
(4th pregnancy due date). Else, go to PDTE4N3 (date of fourth pregnancy outcome).

Page | 151
PDTE4N3

GR.5.2.

Label_PDTE4N3
Hard_edit_PDTE4N3

Skip_PDTE4N3

QDS_programming_PDTE4N3
KID4HVN3

GR.5.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
2 Indeterminate
8 Don't Know
7 Refused to Answer
4th pregnancy vertical transmission
Skip to Skip_INTNT5N3 (5th pregnancy trying to get pregnant).

GR.5.4.

What is your due date?
8888 Don't Know
7777 Refused to Answer
4th pregnancy due date
01/01/1980–later
DUDT4N3 (4th pregnancy due date) cannot be earlier than DOB_13 (date of birth). If
DUDT4N3 (4th pregnancy due date) < DOB_13 (date of birth), 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.
DUDT4N3 (4th pregnancy due date) cannot be earlier than POS1S_9 (date first tested
positive for HIV).
If DUDT4N3 (4th pregnancy due date) < POS1S_9 (date first tested positive for HIV), 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.
DUDT4N3 (4th pregnancy due date) cannot be > 10 months after IDATE (interview date).
If DUDT4N3 (4th pregnancy due date) > 10 months after IDATE (interview date), then
READ, “The due date cannot be more than 10 months after the interview date. Please reenter date.” Do not allow the program to advance.

Label_KID4HVN3
Skip_KID4HVN3
DUDT4N3

Label_DUDT4N3
Range_N6_DUDT4N3
Hard_edit1_DUDT4N3

Hard_edit2_DUDT4N3

Hard_edit3_DUDT4N3

In what month and year did this outcome occur?
8888 Don't Know
7777 Refused to Answer
Date of fourth pregnancy outcome
PDTE4N3 (date of fourth pregnancy outcome) cannot be earlier than PDTE3N3 (date of
third pregnancy outcome). If PDTE4N3 (date of fourth pregnancy outcome) < PDTE3N3
(date of third pregnancy outcome), then READ, “The outcome date cannot be earlier than
the date of the third pregnancy outcome. Please re-enter date.” Do not allow the program
to advance.
If OUTCM4N3 (4th pregnancy outcome) = 2 (live birth), then go to KID4HVN3 (4th
pregnancy vertical transmission). If OUTCM4N3 (4th pregnancy outcome) = 3 (stillbirth), 4
(miscarriage), 5 (abortion), 7 (refused to answer), or 8 (don’t know), skip to
Skip_INTNT5N3 (5th pregnancy trying to get pregnant).
Allow a blank response for month. If month is blank for PDTE4N3 (date of fourth
pregnancy outcome), use the year values for the validation.

Page | 152
Skip_INTNT5N3

INTNT5N3

GR.6.0.

Label_INTNT5N3
OUTCM5N3

GR.6.1.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY ONE.]
1 Currently pregnant
2 Live birth
3 Stillbirth
4 Miscarriage
5 Abortion
8 Don't Know
7 Refused to Answer
5th pregnancy outcome
If PREG_9 (number of times pregnant) > 5, then OUTCM5N3 (5th pregnancy outcome)
cannot be 1 (currently pregnant). If PREG_9 (number of times pregnant) > 5 and
OUTCM5N3 (5th pregnancy outcome) is 1 (currently pregnant), then READ “I am asking
about the outcome of the fifth pregnancy that you had.” Return to OUTCM5N3 (5th
pregnancy outcome).
If OUTCM5N3 (5th pregnancy outcome) = 1 (currently pregnant), then skip to DUDT5N3
(5th pregnancy due date). Else, go to PDTE5N3 (date of fifth pregnancy outcome).

GR.6.2.

In what month and year did this outcome occur?
8888 Don't Know
7777 Refused to Answer
Date of fifth pregnancy outcome
PDTE5N3 (date of fifth pregnancy outcome) cannot be earlier than PDTE4N3 (date of 4th
pregnancy outcome). If PDTE5N3 (date of fifth pregnancy outcome) < than PDTE4N3 (date
of fourth pregnancy outcome), then READ, “The outcome date cannot be earlier than the
date of the 4th pregnancy outcome. Please re-enter date.” Do not allow the program to
advance.
If OUTCM5N3 (5th pregnancy outcome) = 2 (live birth), then go to KID5HVN3 (5th
pregnancy vertical transmission). If OUTCM5N3 (5th pregnancy outcome) = 3 (stillbirth), 4
(miscarriage), 5 (abortion), 7 (refused to answer), or 8 (don’t know), skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive history).
Allow a blank response for month. If month is blank for PDT53N3 (date of fifth pregnancy
outcome), use the year values for the validation.

Label_OUTCM5N3
Hard_edit_OUTCM5N3

Skip_OUTCM5N3
PDTE5N3

Label_PDTE5N3
Hard_edit_PDTE5N3

Skip_PDTE5N3

QDS_programming_PDTE5N3
KID5HVN3

Label_KID5HVN3
Skip_KID5HVN3

If PREG_9 (number of times pregnant) >4, go to INTNT5N3 (5th pregnancy trying to get
pregnant); else, skip to Calculation_ENOBGYN5 (End of gynecological and reproductive
history).
For the 5th pregnancy since testing positive for HIV, were you trying to get pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
5th pregnancy trying to get pregnant

GR.6.3.

Was the child diagnosed with HIV? [READ RESPONSES. SELECT ONLY ONE.]
0 No
1 Yes
2 Indeterminate
8 Don't Know
7 Refused to Answer
5th pregnancy vertical transmission
Skip to Calculation_ENOBGYN5 (End of gynecological and reproductive history).

Page | 153
DUDT5N3

GR.6.4.

Label_DUDT5N3
Range_N6_DUDT5N3
Hard_edit1_DUDT5N3

Hard_edit2_DUDT5N3

Hard_edit3_DUDT5N3

What is your due date?
8888 Don't Know
7777 Refused to Answer
5th pregnancy due date
01/01/1980–later
DUDT5N3 (5th pregnancy due date) cannot be earlier than DOB_13 (date of birth). If
DUDT5N3 (5th pregnancy due date) < DOB_13 (date of birth), 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.
DUDT5N3 cannot be earlier than POS1S_9 (date first tested positive for HIV).
If DUDT5N3 (5th pregnancy due date) < POS1S_9 (date first tested positive for HIV), 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.
DUDT5N3 (5th pregnancy due date) cannot be > 10 months after IDATE (interview date). If
DUDT5N3 (5th pregnancy due date) > 10 months after IDATE (interview date), 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.

Calculation_ENOBGYN5 G.0.a.
Label_Calculation_ENOBGYN5

ENOBGYN5 = Current time
End of gynecological and reproductive hi

Calculation_TLOBGYN5 G.0.b.
Label_Calculation_TLOBGYN5

Calculate elapsed time between STOBGYN5 and ENOBGYN5 = TLOBGYN5
Total time for gyn and reproductive hist

Page | 154

Module: Met and unmet needs (N)
Topic: Services and assistance programs (ND)
Calculation_STNEEDN5 N.0.
Label_Calculation_STNEEDN5

STNEEDN5 = Current time
Start time met and unmet needs

Intro_8_CSMNA_5

“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 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.”
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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get HIV case management services
If CSMNA_5 (get HIV case management services) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to CSMNB_5 (needed HIV case management services); else, skip to Skip1_
6_TKMDA_5 (get help taking meds on time/correctly).

CSMNA_5

ND.1.0.

Label_CSMNA_5
Skip_6_CSMNA_5

CSMNB_5

ND.1.1.

Label_CSMNB_5
Skip_6_CSMNB_5

Intro_CSMNC_5
CSMNC_5

ND.1.2.

Label_CSMNC_5
CSMNE_5

Label_CSMNF_5

“Were you not able to get this service for any of the following reasons:”
...because you didn't have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-HIV case management

ND.1.3.

…because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-HIV case management

ND.1.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-HIV case management

Label_CSMNE_5
CSMNF_5

During the past 12 months, have you needed HIV case management services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed HIV case management services
If CSMNA_5 (needed HIV case management services) is 1 (yes), go to Intro_CSMNC_5
(barrier-financial-HIV case management); else, skip to Skip1_6_TKMDA_5 (get help taking
meds on time/correctly).

Page | 155
CSMND_5

ND.1.5.

Label_CSMND_5
Skip1_6_TKMDA_5

TKMDA_5

ND.2.0.

Label_TKMDA_5
Skip2_6_TKMDA_5
TKMDB_5

ND.2.1.

Label_TKMDB_5
Skip_TKMDB_5
Intro_TKMDC_N5
TKMDC_N5

ND.2.2.

Label_TKMDC_N5
TKMDE_N5

Label_TKMDF_N5

If CART_N5 (currently taking ART) = 1 (yes) or ATMD12_9 (took ART in past 12 months) = 1
(yes), then go to TKMDA_5 (Get help taking meds on time/correctly); else, skip to
Skip_NEDADA_5.
During the past 12 months, did you get professional help on how to take your HIV
medicines on time or correctly?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get help taking meds on time/correctly
If TKMDA_5 (get help taking meds on time/correctly) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to TKMDB_5; else, skip to Skip_NEDADA_5 (needed ADAP).
During the past 12 months, have you needed professional help on how to take your HIV
medicines on time or correctly?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need help taking meds on time/correctly
If TKMDB_5 (need help taking meds on time/correctly) is 1 (yes), go to Intro_TKMDC_N5
(barrier-financial- help taking HIV meds); else, skip to Skip_NEDADA_5 (ADAP).
“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-help taking HIV meds

ND.2.3.

…because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-struct. 1-help taking HIV meds

ND.2.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-struct. 2-help taking HIV meds

Label_TKMDE_N5
TKMDF_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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-HIV case management

Page | 156
TKMDD_N5

ND.2.5.

Label_TKMDD_N5
Skip_NEDADA_5
NEDADA_5

ND.3.1.

Label_NEDADA_5
Skip2_NEDADA_5
Intro_ADAPC_N5
ADAPC_N5

ND.3.2.

Label_ADAPC_N5
ADAPD_N5

Label_ADAPB_N5

If KINDD_5 (insurance-Ryan White or ADAP) is 0 (no), go to NEDADA_5 (needed ADAP).
Else, skip to Intro_PATNAVN5 (get patient navigation).
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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed ADAP
If NEDADA_5 (needed ADAP) is 1 (yes), go to Intro_ADAPC_N5 (barrier-structural 1—
ADAP); else, skip to Intro_PATNAVN5 (patient navigation).
“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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-ADAP

ND.3.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-ADAP

ND.3.4.

…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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-ADAP

Label_ADAPD_N5
ADAPB_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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-help taking HIV meds

Page | 157
Intro_PATNAVN5

PATNAVN5

ND.4.0.

Label_PATNAVN5
Skip_PATNAVN5

PATNABN5

ND.4.1.

Label_PATNABN5
Skip_PATNABN5
Intro_PATNACN5
PATNACN5

ND.4.2.

Label_PATNACN5
PATNAEN5

Label_PATNADN5

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-patient navigation
…because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-patient navigation

ND.4.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-patient navigation

ND.4.5.

…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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-patient navigation

Label_PATNAFN5
PATNADN5

During the past 12 months, have you needed patient navigation services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed patient navigation services
If PATNABN5 (needed patient navigation services) is 1 (yes), go to Intro_PATNACN5
(barrier-financial-patient navigation); else, skip to GET_GRP (get peer group support).

ND.4.3.

Label_PATNAEN5
PATNAFN5

“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.”
During the past 12 months, did you get patient navigation services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get patient navigation services
If PATNAVN5 (get patient navigation services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to PATNABN5 (needed patient navigation services); else, skip to GET_GRP (get
peer group support).

Page | 158
GET_GRP

ND.5.0.

During the past 12 months, did you get HIV peer group support?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get HIV peer group support
If GET_GRP (get HIV peer group support) is 0 (no), 7 (refused to answer), or 8 (don’t know),
go to NED_GRP (needed HIV peer group support); else, skip to DENS12_9 (get dental care).

ND.5.1.

During the past 12 months, have you needed HIV peer group support?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed HIV peer group support
If NED_GRP (needed HIV peer group support) is 1 (yes), go to Intro_RSGRPCN5 (barrierstructural 1-HIV peer support); else, skip to DENS12_9 (get dental care).

Label_GET_GRP
Skip_GET_GRP
NED_GRP

Label_NED_GRP
Skip_NED_GRP
Intro_RSGRPCN5
RSGRPCN5

ND.5.2.

Label_RSGRPCN5
RSGRPDN5

ND.5.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-HIV peer support

ND.5.4.

…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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-HIV peer group support

ND.6.0.

During the past 12 months, did you get dental care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get dental care
If DENS12_9 (get dental care) is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
DENSER_9 (needed dental care); else, skip to GET_SUBU (get drug and alcohol).

Label_RSGRPDN5
RSGRPBN5

Label_RSGRPBN5
DENS12_9

Label_DENS12_9
Skip_DENS12_9

“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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-HIV peer support

Page | 159
DENSER_9

ND.6.1.

Label_DENSER_9
Skip_DENSER_9
Intro_DENSA_N5
DENSA_N5

ND.6.2.

Label_DENSA_N5
DENSC_N5

…because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-dental care

ND.6.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-dental care

ND.6.5.

…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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-dental care

ND.7.0.

During the past 12 months, did you get drug or alcohol counseling or treatment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get drug/alcohol counseling or treatment
If GET_SUBU (get drug/alcohol counseling or treatment) is 0 (no), 7 (refused to answer), or
8 (don’t know), go to NED_SUBU (Need drug/alcohol counsel or treatment); else, skip to
MENTA_5 (get mental health).

Label_DENSD_N5
DENSB_N5

Label_DENSB_N5
GET_SUBU

Label_GET_SUBU
Skip_GET_SUBU

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-dental care

ND.6.3.

Label_DENSC_N5
DENSD_N5

During the past 12 months, have you needed dental care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed dental care
If DENSER_9 (needed dental care) is 1 (yes), go to Intro_DENSA_N5 (barrier-financialdental care); else, skip to GET_SUBU (get drug and alcohol).

Page | 160
NED_SUBU

ND.7.1.

Label_NED_SUBU
Skip_NED_SUBU
Intro_SUBUA_N5
SUBUA_N5

ND.7.2.

Label_SUBUA_N5
SUBUB_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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-drug/alcohol TX

ND.7.4.

…because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-drug/alcohol TX

ND.7.5.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-drug/alcohol TX

ND.8.0.

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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get mental health counsel or treatment
If MENTA_5 (get mental health counsel or treatment) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to MENTB_5 (need mental health counsel or treatment); else, skip to
TRAS12_9 (get transportation).

Label_SUBUC_N5
SUBUD_N5

Label_SUBUD_N5
MENTA_5

Label_MENTA_5
Skip_MENTA_5

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-drug/alcohol TX

ND.7.3.

Label_SUBUB_N5
SUBUC_N5

During the past 12 months, have you needed drug or alcohol counseling or treatment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need drug/alcohol counsel or treatment
If NED_SUBU (Need drug/alcohol counsel or treatment) is 1 (yes), go to Intro_SUBUA_N5
(Barrier-financial-drug/alcohol TX); else, skip to MENTA_5 (get mental health).

Page | 161
MENTB_5

ND.8.1.

Label_MENTB_5
Skip_MENTB_5
Intro_MENTC_5
MENTC_5

ND.8.2.

Label_MENTC_5
MENTE_5

…because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-mental health TX

ND.8.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-mental health TX

ND.8.5.

…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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-mental health TX

ND.9.0.

During the past 12 months, did you get transportation assistance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
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_5.

Label_MENTF_5
MENTD_5

Label_MENTD_5
TRAS12_9

Label_TRAS12_9
Skip_TRAS12_9

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-mental health TX

ND.8.3.

Label_MENTE_5
MENTF_5

During the past 12 months, have you needed to see or talk to a mental health professional
about your health?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need mental health counsel or treatment
If MENTB_5 (need mental health counsel or treatment) is 1 (yes), go to Intro_MENTC_5
(barrier-financial-mental health TX); else, skip to TRAS12_9 (get transportation).

Page | 162
TRASAS_9

ND.9.1.

Label_TRASAS_9
Skip_TRASAS_9
Intro_TRANC_N5
TRANC_N5

ND.9.2.

Label_TRANC_N5
TRAND_N5

Label_TRANB_N5
SHLTA_5

Label_SHLTA_5
Skip_SHLTA_5

SHLTB_5

Label_SHLTB_5
Skip_SHLTB_5

“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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-transportation

ND.9.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-transportation

ND.9.4.

…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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-transportation

Label_TRAND_N5
TRANB_N5

During the past 12 months, have you needed transportation assistance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed transportation assistance
If TRASAS_9 is 1 (yes), go to Intro_TRANC_N5 (barrier-structural 1-transportation); else,
skip to SHLTA_5 (get shelter or housing services).

ND.10.0. 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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get shelter or housing services
If SHLTA_5 (get shelter or housing services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to SHLTB_5 (needed shelter or housing services); else, skip to FOODA_N5 (get
food assistance).
ND.10.1. During the past 12 months, have you needed shelter or housing services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed shelter or housing services
If SHLTB_5 (needed shelter or housing services) is 1 (yes), go to Intro_SHLTC_N5 (barrierstructural 1-shelter/hous service); else, skip to FOODA_N5 (get food assistance).

Page | 163
Intro_SHLTC_N5
SHLTC_N5

Label_SHLTC_N5
SHLTD_N5

Label_SHLTD_N5
SHLTE_N5

Label_SHLTE_N5
FOODA_N5

Label_FOODA_N5
Skip_FOODA_N5

FOODB_N5

Label_FOODB_N5
Skip_FOODB_N5
Intro_FOODE_N5
FOODE_N5

Label_FOODE_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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-shelter/hous servic
ND.10.3. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-shelter/hous servic
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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-shelter or housing
ND.11.0. During the past 12 months, did you get food assistance or food stamps from SNAPSupplemental Nutrition Assistance Program or WIC-The Special Supplemental Nutrition
Program for Women, Infants, and Children?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get food assistance
If FOODA_N5 (get food assistance) is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
FOODB_N5 (needed food assistance); else, skip to Intro_N5_MLSF12_9 (get meal or food
services).
ND.11.1. During the past 12 months, have you needed food assistance or food stamps?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed food assistance
If FOODB_N5 (needed food assistance) is 1 (yes), go to Intro_FOODE_N5 (Barrier-structural
1—food assistance); else, skip to Intro_N5_MLSF12_9 (get meal or food services).

“Were you not able to get this service for any of the following reasons:”
ND.11.2. …because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-food assistance

Page | 164
FOODF_N5

Label_FOODF_N5
FOODD_N5

Label_FOODD_N5
Intro_N5_MLSF12_9

MLSF12_9

Label_MLSF12_9
Skip_MLSF12_9

MLSFOD_9

Label_MLSFOD_9
Skip_MLSFOD_9
Intro_MEALA_N5
MEALA_N5

Label_MEALA_N5
MEALC_N5

Label_MEALC_N5

ND.11.3. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-food assistance
ND.11.4. …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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-food assistance

“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.12.0. During the past 12 months, did you get meal or food services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get meal or food services
If MLSF12_9 (get meal or food services) is 0 (no), 7 (refused to answer), or 8 (don’t know),
go to MLSFOD_9 (needed meal or food services); else, skip to GET_DOMS (get domestic
violence services).
ND.12.1. During the past 12 months, have you needed meal or food services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed meal or food services
If MLSFOD_9 is 1 (yes), go to Intro_MEALA_N5; else, skip to GET_DOMS (get domestic
violence services).

“Were you not able to get this service for any of the following reasons:”
ND.12.2. ...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-meal or food services
ND.12.3. …because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-meal/food services

Page | 165
MEALD_N5

Label_MEALD_N5
MEALB_N5

Label_MEALB_N5
GET_DOMS

Label_GET_DOMS
Skip_GET_DOMS
NED_DOMS

Label_NED_DOMS
Skip_NED_DOMS
Intro_DOMSA_N5
DOMSA_N5

Label_DOMSA_N5
DOMSC_N5

Label_DOMSC_N5

ND.12.4. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-meal/food services
ND.12.5. …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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-meal or food services
ND.13.0. During the past 12 months, did you get domestic violence services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get domestic violence services
If GET_DOMS (get domestic violence services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to NED_DOMS (needed domestic violence services); else, skip to Intro_SSIA_N8.
ND.13.1. During the past 12 months, have you needed domestic violence services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed domestic violence services
If NED_DOMS (needed domestic violence services) is 1 (yes), go to Intro_DOMSA_N5
(barrier-financial-domestic violence); else, skip to Intro_SSIA_N8.

“Were you not able to get this service for any of the following reasons:”
ND.13.2. ...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-domestic violence
ND.13.3. …because you couldn’t find the information you needed to get the service or didn’t know
it existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-domestic violence

Page | 166
DOMSD_N5

Label_DOMSD_N5
DOMSB_N5

Label_DOMSB_N5

ND.13.4. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-domestic violence
ND.13.5. …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?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-domestic violence

Topic: Other disability (NS)
Intro_SSIA_N8

SSIA_N8

NS.1.0.

label_SSIA_N8
skip_SSIA_N8
DSSSIN8

NS.1.1.

label_DSSSIN8
range_DSSSIN8
hard_edit_DSSSIN8

qds_programming_DSSSIN8
intro_SSDIA_N8
SSDIA_N8

Label_SSDIA_N8
skip_SSDIA_N8

NS.2.0.

"The next question is about Supplemental Security Income or SSI. SSI is a federal program
that provides money for food, clothing, and shelter for older persons or persons with
disabilities."
During the past 12 months, did you get SSI?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get SSI
If SSIA_N8 is 1 (yes), go to DSSSIN8; else, skip to intro_SSDIA_N8.
When did you first get SSI? Please tell me the month and year.
8888 Don't Know
7777 Refused to Answer
Date received SSI
01/1900–current
DSSSIN8 (date received SSI) cannot be earlier than DOB_13 (date of birth). If DSSSIN8 (date
received SSI) is earlier than DOB_13 (date of birth), then READ, “The date that the
respondent received SSI cannot be earlier than the respondent’s date of birth.” Return to
DSSSIN8 (date received SSI).
Allow an unknown month value.
"Now I’m going to ask about Social Security Disability Insurance or SSDI. SSDI is a federal
insurance program that provides income to people unable to work because of a disability."
During the past 12 months, did you get SSDI?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get SSDI
If SSDIA_N8 is 1 (yes), go to DSSDIN8; else, skip to next topic.

Page | 167
DSSDIN8

NS.2.1.

qds_programming_DSSDIN8

When did you first get SSDI? Please tell me the month and year.
8888 Don't Know
7777 Refused to Answer
Date received SSDI
01/1900–current
DSSDIN8 (date received SSDI) cannot be earlier than DOB_13 (date of birth). If DSSDIN8
(date received SSDI) is earlier than DOB_13 (date of birth), then READ, “The date that the
respondent received SSDI cannot be earlier than the respondent’s date of birth.” Return to
DSSDIN8 (date received SSI).
Allow an unknown month value.

Calculation_ENNEEDN5 N.0.a.
Label_Calculation_ENNEEDN5

ENNEEDN5 = Current time
End of met and unmet needs

Calculation_TLNEEDN5 N.0.b.
Label_Calculation_TLNEEDN5

Calculate elapsed time between STNEEDN5 and ENNEEDN5 = TLNEEDN5
Total time for met and unmet needs

label_DSSDIN8
range_DSSDIN8
hard_edit_DSSDIN8

Page | 168

Module: Interview completion (E )
Topic: End of interview (EE)
Calculation_EN_INTN5 E.0.
Label_Calculation_EN_INTN5

EN_INTN5 = Current time
End of interview

Calculation_TL_TIMN5 E.0.a.
Label_Calculation_TL_TIMN5

Calculate elapsed time between ST_INTN5 and EN_INTN5 = TL_TIMN5.
Total interview time

Intro_RECCOMP_8

“Thank you again for taking part in this interview. Please remember that all the
information you have given me will be kept confidential. Now we are going to talk about
services you may need or want. ”
Interview end date:
Interview end date
Automatically calculate RECCOMP (interview end date) in QDS using the date on the
device

RECCOMP
EE.1.0.
Label_RECCOMP
QDS_programming_RECCOMP

Topic: Referrals and follow-up (EO)
Skip_RFLKPN8

RFLKPN8

EO.1.0

Label_RFLKPN8
RFLKA1N8

EO.1.1

[DON'T READ ALOUD] Did you offer to refer the respondent to a provider or HIV agency for
appropriate HIV medical services or treatment?
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Active referral: provider or HIV agency

EO.1.2

[DON'T READ ALOUD] Did you offer to make a medical appointment for the respondent for
HIV medical services or treatment?
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Active referral make appt

EO.2.0

[DON'T READ ALOUD] Did you offer the respondent HIV prevention materials such as palm
cards, pamphlets, or videos?
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Offered prevention materials

Label_RFLKA1N8
RFLKA2N8

Label_RFLKA2N8
PREV_N8

Label_PREV_N8

If EVERCRN8 (ever rcvd. HIV care) is 0 (no), go to RFLKPN8 (passive referral for LTC or reengagement). If LASCA_9 (Date most recent outpt. HIV care visit) is > 12 months prior to
IDATE (Interview date), go to RFLKPN8 (passive referral for LTC or re-engagement). Else,
skip to PREV_N8 (offered prevention materials).
[DON'T READ ALOUD] Did you offer the respondent information about a provider or HIV
agency they can go to for HIV medical services or treatment? This includes offering them
written or verbal information such as a contact name, location, phone number, or hours of
operation of a provider or agency.
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Passive referral: LTC or re-engagement

Page | 169
Skip_SMOKCEN8

If CIG_OFT (current use cigarettes) is 1 (daily), 2 (weekly), 3 (monthly) or 4 (less than
monthly), go to SMOKCEN8 (need smoking cessation). If CIGARFN5 (current use cigars,
etc.) is 1 (every day), 2 (some days) or 3 (rarely), go to SMOKCEN8 (need smoking
cessation). Else, skip to RFANS_8(referrals for ancillary services).
SMOKCEN8
EO.3.0
Earlier, you said that a healthcare professional has not advised you to quit smoking in the
past 12 months. Would you like any assistance, information, or additional advice to help
you quit smoking?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
label_SMOKCEN8
need smoking cessation
QDS_programming_note_SMOKCE Tokens may be used to alter how this question appears based on the respondent’s answer
SN8
to CIG_DQN5 (doctor advised to quit smoking). If CIG_DQN5 (doctor advised to quit
smoking) is 0 (no), then question should read, “Earlier, you said that a healthcare
professional has not advised you to quit smoking in the past 12 months. Would you like
any assistance, information, or advice to help you quit smoking?” If CIG_DQN5 (doctor
advised to quit smoking) is 1 (yes), then question should read, “Earlier, you said that a
healthcare professional advised you to quit smoking in the past 12 months. Would you like
any assistance, information, or additional advice to help you quit smoking?” If CIG_DQN5
is 7 (don’t know) or 8 (Refused), the question should read “Earlier, we asked you if a
healthcare professional has advised you to quit smoking in the past 12 months. Would you
like any assistance, information, or additional advice to help you quit smoking?”

Page | 170
RFANS_8

EO.4.0

Label_RFANS_8
QDS_programming_note_RFANSN
8

RFANSN5A

HIV case management services
0 No
1 Yes
refs ancillary services: HIV case mgmt

EO.2.0.

Adherence counseling
0 No
1 Yes
refs ancillary services: Adhere counsel

EO.2.0.

ADAP
0 No
1 Yes
refs ancillary services: ADAP

Label_RFANSN5B
RFANSN5C

Label_RFANSN5C

[Resources previously indicated as “needed” by the respondent are flagged with an
asterisk (*)]
Referrals for ancillary services
If CSMNB_5 (needed HIV case management services)=1 then show asterisk next to
RFANSN5A (referrals for ancillary services: HIV case management services)
If TKMDB_5 (needed help taking meds on time/correctly) =1 then show asterisk next to
RFANSN5B (referrals for ancillary services: adherence counseling)
If NEDADA_5 (needed ADAP) =1 then show asterisk next to RFANSN5C (referrals for
ancillary services: ADAP)
If PATNABN5 (needed patient navigation services) =1 then show asterisk next to
RFANSN5D (referrals for ancillary services: patient navigation)
If NED_GRP (needed HIV peer group support) =1 then show asterisk next to RFANSN5E
(referrals for ancillary services: HIV peer group support)
If DENSER_9 (needed dental care) =1 then show asterisk next to RFANSN5F (referrals for
ancillary services: dental care)
If NED_SUBU (need drug/alcohol counsel or treatment) =1 then show asterisk next to
RFANSN5G (referrals for ancillary services: drug or alcohol counseling or treatment)
If MENTB_5 (need mental health counsel or treatment) =1 then show asterisk next to
RFANSN5H (referrals for ancillary services: mental health services)
If TRASAS_9 (needed transportation assistance) =1 then show asterisk next to RFANSN5I
(referrals for ancillary services: transportation)
If SHLTB_5 (needed shelter or housing) =1 then show asterisk next to RFANSN5J (referrals
for ancillary services: shelter or housing services)
If FOODB_N5 (needed food assistance) =1 then show asterisk next to RFANSN5M (referrals
for ancillary services: food assistance)
If MLSFOD_9 (needed meal or food services) =1 then show asterisk next to RFANSN5N
(referrals for ancillary services: meal or food services)
If NED_DOMS (needed domestic violence services)=1 then show asterisk next to
RFANSN5O (referrals for ancillary services: domestic violence services)
If SMOKCEN8 (need smoking cessation)=1 then show asterisk next to RFANSN5R (tobacco
cessation services)

EO.2.0.

Label_RFANSN5A
RFANSN5B

[DON'T READ ALOUD] Which of the following additional resources were or will be offered
to the respondent? [SELECT ALL THAT APPLY.]

Page | 171
RFANSN5D

EO.2.0.

Patient navigation
0 No
1 Yes
refs ancillary services: Pt navigation

EO.2.0.

HIV peer group support
0 No
1 Yes
refs ancillary services: HIV grp support

EO.2.0.

Dental care
0 No
1 Yes
refs ancillary services: Dental

EO.2.0.

Drug or alcohol counseling or treatment
0 No
1 Yes
refs ancillary services: Drug alcohol tx

EO.2.0.

Mental health services
0 No
1 Yes
refs ancillary services: Mental hlth tx

EO.2.0.

Transportation
0 No
1 Yes
refs ancillary services: Transportation

EO.2.0.

Shelter or housing services
0 No
1 Yes
refs ancillary services: Shltr or house

EO.2.0.

Food assistance
0 No
1 Yes
refs ancillary services: Food assist

EO.2.0.

Meal or food services
0 No
1 Yes
refs ancillary services: Meal services

EO.2.0.

Domestic violence services
0 No
1 Yes
refs ancillary services: Dom violence

EO.2.0.

Tobacco cessation services
0 No
1 Yes
Refs ancillary service: Smoke cessation

Label_RFANSN5D
RFANSN5E

Label_RFANSN5E
RFANSN5F

Label_RFANSN5F
RFANSN5G

Label_RFANSN5G
RFANSN5H

Label_RFANSN5H
RFANSN5I

Label_RFANSN5I
RFANSN5J

Label_RFANSN5J
RFANSN5M

Label_RFANSN5M
RFANSN5N

Label_RFANSN5N
RFANSN5O

Label_RFANSN5O
RFANSN5R

Label_RFANSN5R

Page | 172
RFANSN5S

EO.2.0.

Label_RFANSN5S
Hard_edit_RFANSN5

No referrals provided
0 No
1 Yes
Refs ancillary services: None provided
If RFANSN5A, RFANSN5B, RFANSN5C, RFANSN5D, RFANSN5E, RFANSN5F, RFANSN5G,
RFANSN5H, RFANSN5I, RFANSN5J, RFANSN5K, RFANSN5L, RFANSN5M, RFANSN5N,
RFANSN5O, RFANSN5P, RFANSN5Q or RFANSN5R is selected AND RFANSN5S is selected,
then READ: “You cannot select a referral and also select that no referral was offered.
Correct the error.” Else, do not show RFANSN5S.

Topic: Data validity (EV)
CONF

EV.1.0.

[DON'T READ ALOUD] How confident are you of the validity of the respondent’s answers?
1 Confident
2 Some doubts
3 Not confident at all
Interviewer instructions: 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.
Validity confidence

EV.2.0.

[DON'T READ ALOUD] 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.
666 Not Applicable
Additional comments
Include a 6 (not applicable) response option. Character limit is 250 words.

Interviewer_note_EE_8

Label_CONF
ADDCOM1

Label_ADDCOM1
QDS_programming_ADDCOM1

Topic: Local questions (EL)
LOCSURN6

Label_LOCSURN6

EL.1.0.

Local Questions:
Interviewer instructions: Does your project area ask local questions? If yes, press "Yes" to
continue to local questions. If not, press "No" to end.
0 No
1 Yes
Local survey verification question

A|1

Medical Monitoring Project Calendar

2016
January 16
Mo Tu We Th Fr

Sa

Su

February 16
Mo Tu We Th Fr

1

2

3

1

2

3

4

5

Sa

Su

6

7

March 16
Mo Tu We Th Fr

Sa

Su

1

2

3

4

5

6

4

5

6

7

8

9

10

8

9

10

11

12 13

14

7

8

9

10

11 12

13

11

12 13

14

15 16

17

15

16 17

18

19 20

21

14

15 16

17

18 19

20

18

19 20

21

22 23

24

22

23 24

25

26 27

28

21

22 23

24

25 26

27

25

26 27

28

29 30

31

29

28

29 30

31

May 16
Mo Tu We Th Fr

April 16
Mo Tu We Th Fr

Sa

Su

1

2

3

Sa

Su

June 16
Mo Tu We Th Fr

Sa

Su

1

1

2

3

4

5

4

5

6

7

8

9

10

2

3

4

5

6

7

8

6

7

8

9

10 11

12

11

12 13

14

15 16

17

9

10 11

12

13 14

15

13

14 15

16

17 18

19

18

19 20

21

22 23

24

16

17 18

19

20 21

22

20

21 22

23

24 25

26

25

26 27

28

29 30

23

24 25

26

27 28

29

27

28 29

30

30

31

Sa

Su

September 16
Mo Tu We Th Fr Sa

Su

July 16
Mo Tu We Th Fr

Sa

Su

August 16
Mo Tu We Th Fr

1

2

3

1

2

3

4

5

6

7

1

2

3

4

4

5

6

7

8

9

10

8

9

10

11

12 13

14

5

6

7

8

9

10

11

11

12 13

14

15 16

17

15

16 17

18

19 20

21

12

13 14

15

16 17

18

18

19 20

21

22 23

24

22

23 24

25

26 27

28

19

20 21

22

23 24

25

25

26 27

28

29 30

31

29

30 31

26

27 28

29

30

Sa

Su

November 16
Mo Tu We Th Fr Sa

1

2

October 16
Mo Tu We Th Fr

Su

1

2

3

4

5

6

December 16
Mo Tu We Th Fr Sa

Su

1

2

3

4

3

4

5

6

7

8

9

7

8

9

10

11 12

13

5

6

7

8

9

10

11

10

11 12

13

14 15

16

14

15 16

17

18 19

20

12

13 14

15

16 17

18

17

18 19

20

21 22

23

21

22 23

24

25 26

27

19

20 21

22

23 24

25

24

25 26

27

28 29

30

28

29 30

26

27 28

29

30 31

31

B|1

Medical Monitoring Project Calendar

2017
January 17
Mo Tu We Th Fr

Sa

Su

February 17
Mo Tu We Th Fr

Sa

Su

March 17
Mo Tu We Th Fr

Sa

Su

1

1

2

3

4

5

1

2

3

4

5

2

3

4

5

6

7

8

6

7

8

9

10 11

12

6

7

8

9

10 11

12

9

10 11

12

13 14

15

13

14 15

16

17 18

19

13

14 15

16

17 18

19

16

17 18

19

20 21

22

20

21 22

23

24 25

26

20

21 22

23

24 25

26

23

24 25

26

27 28

29

27

28

27

28 29

30

31

30

31

Sa

Su

May 17
Mo Tu We Th Fr

1

2

1

2

3

4

5

April 17
Mo Tu We Th Fr

Sa

Su

6

7

June 17
Mo Tu We Th Fr

Sa

Su

1

2

3

4

3

4

5

6

7

8

9

8

9

10

11

12 13

14

5

6

7

8

9

10

11

10

11 12

13

14 15

16

15

16 17

18

19 20

21

12

13 14

15

16 17

18

17

18 19

20

21 22

23

22

23 24

25

26 27

28

19

20 21

22

23 24

25

24

25 26

27

28 29

30

29

30 31

26

27 28

29

30

Sa

Su

August 17
Mo Tu We Th Fr

1

2

July 17
Mo Tu We Th Fr

Sa

Su

1

2

3

4

5

6

September 17
Mo Tu We Th Fr Sa

Su

1

2

3

3

4

5

6

7

8

9

7

8

9

10

11 12

13

4

5

6

7

8

9

10

10

11 12

13

14 15

16

14

15 16

17

18 19

20

11

12 13

14

15 16

17

17

18 19

20

21 22

23

21

22 23

24

25 26

27

18

19 20

21

22 23

24

24

25 26

27

28 29

30

28

29 30

31

25

26 27

28

29 30

Su

November 17
Mo Tu We Th Fr Sa

31

October 17
Mo Tu We Th Fr

Sa

1

Su

1

2

3

4

5

December 17
Mo Tu We Th Fr Sa

Su

1

2

3

2

3

4

5

6

7

8

6

7

8

9

10 11

12

4

5

6

7

8

9

10

9

10 11

12

13 14

15

13

14 15

16

17 18

19

11

12 13

14

15 16

17

16

17 18

19

20 21

22

20

21 22

23

24 25

26

18

19 20

21

22 23

24

23

24 25

26

27 28

29

27

28 29

30

25

26 27

28

29 30

31

30

31

Medical Monitoring Project Calendar

C|1

2018
January 18
Mo Tu We Th Fr
4

5

Sa

Su

6

7

1

2

3

8

9

10 11 12 13 14

February 18
Mo Tu We Th Fr
5

6

7

Sa

Su
4

1

2

3

8

9

10 11

March 18
Mo Tu We Th Fr
5

6

7

Sa

Su
4

1

2

3

8

9

10 11

15 16 17 18 19 20 21

12 13 14 15 16 17 18

12 13 14 15 16 17 18

22 23 24 25 26 27 28

19 20 21 22 23 24 25

19 20 21 22 23 24 25

29 30 31

26 27 28

26 27 28 29 30 31

April 18
Mo Tu We Th Fr

Sa

Su

May 18
Mo Tu We Th Fr

1
4

5

6

7

8

7

4

Sa

Su

June 18
Mo Tu We Th Fr

Sa

Su

5

6

1

2

3

8

9

10

1

2

3

8

9

10 11 12 13

2

3

4

5

6

7

9

10 11 12 13 14 15

14 15 16 17 18 19 20

11 12 13 14 15 16 17

16 17 18 19 20 21 22

21 22 23 24 25 26 27

18 19 20 21 22 23 24

23 24 25 26 27 28 29

28 29 30 31

25 26 27 28 29 30

Su

August 18
Mo Tu We Th Fr

Sa

Su

September 18
Mo Tu We Th Fr Sa

Su

1

1

2

3

4

5

1

2

8

9

10 11 12

8

9

30

July 18
Mo Tu We Th Fr
4

5

6

Sa

2

3

7

8

6

7

3

4

5

6

7

9

10 11 12 13 14 15

13 14 15 16 17 18 19

10 11 12 13 14 15 16

16 17 18 19 20 21 22

20 21 22 23 24 25 26

17 18 19 20 21 22 23

23 24 25 26 27 28 29

27 28 29 30 31

24 25 26 27 28 29 30

November 18
Mo Tu We Th Fr Sa

Su

December 18
Mo Tu We Th Fr Sa

Su

4

1

2

8

9

30 31

October 18
Mo Tu We Th Fr
4

5

Sa

Su

6

7

1

2

3

8

9

10 11 12 13 14

5

6

7

1

2

3

8

9

10 11

3

4

5

6

7

15 16 17 18 19 20 21

12 13 14 15 16 17 18

10 11 12 13 14 15 16

22 23 24 25 26 27 28

19 20 21 22 23 24 25

17 18 19 20 21 22 23

29 30 31

26 27 28 29 30

24 25 26 27 28 29 30
31



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