Form Approved
OMB No. 0920-1100
Expiration Date: 01/31/2022
Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1100)
Project DETECT: Part 2 Questionnaire
Enrollment Survey B
Description: REDCap Survey to be completed by participants in Part 2/Phase 1 (Enrollment). Study staff will complete the ‘Face page’ questions before the participant begins the survey. These data will serve as a baseline for participants in the longitudinal arm of the study. The answer option “Refuse to answer” will be listed on every question on this survey except: FP-1 through FP-11, CT-1, CT-2, SU-1, SU-2, and SU-3. For free-text fields, the participant will have additional instructions on how to refuse the question (“If you refuse to answer this question, please enter "R".”).
FACE PAGE
_______________
FP-1 UW Part 2 Study ID: _______________
FP-3 Start time: HH:MM:SS
FP-4 Visit Date: MM/DD/YYYY
FP-5: HIV status at start of visit:
HIV-negative/unknown
Established HIV infection – diagnosis >3 months ago
Newly diagnosed HIV infection - diagnosis <=3 months ago
[IF FP-5 ≠ HIV-negative/unknown] FP-7 Referral from:
[UW only] One on One
[UW only] Private Provider
[UW only] PHSKC Sexual Health Clinic
[UW only] DIS
[UW only] UWHIS
[UW only] Madison Clinic
[UW only] ACTU
[JHU only] Baltimore City STD Clinic
[JHU only] JHH ED
[JHU only] Bartlett Specialty Clinic
Other (Write in response)
[IF JHU Site] FP-8 High risk category (check all that apply):
MSM
TG
Screened for STI
Having STI
PWID
Part of high-risk network
Other (Write in response)
[IF FP-5 ≠ HIV-negative/unknown] FP-9 Antiretroviral (ART) history (does not include PrEP or PEP use):
ART naïve
History of ART, currently off ART
Currently on ART
[IF FP-9 = History of ART, currently off ART OR Currently on ART] FP-10 Last ART start date (if day or month is unknown, please enter “99” in its place):
MM/DD/YYYY
[IF FP-9 = History of ART, currently off ART] FP- 11 Last ART end date (if day or month is unknown, please enter “99” in its place):
MM/DD/YYYY
RESEARCH STAFF HANDS COMPUTER TO PARTICIPANT
OMB LANGUAGE
CONSENT
We’ve
already discussed the following two questions with you but would like
to document your answers electronically. If you have any questions
about what we’re asking, please talk to study staff before
responding.
CT-1 Do you agree to take part in the study?
Yes
No
We are asking you to agree to freeze part of your blood and oral fluid specimens at the CDC for future use. We may use these samples for research in the future. Nothing that could be linked to you will be kept with your blood or oral fluid specimens. We are not sure what studies might be done in the future. They might include standard tests as done at hospitals, tests for HIV or other viruses or on your immune system (ability to fight infection). We will not test for genetic problems or use the blood or oral fluid specimens for cloning or commercial purposes.
CT-2 Do you agree to storage of your specimens for future use?
Yes,
I give consent for my blood and oral fluid specimens to be stored at
CDC for the future use as outlined above.
No, I DO NOT give
consent for my blood and oral fluid specimens to be stored at CDC for
future research.
If CT-1 or CT-2 = No, participant has declined participation in the study. Screen will say, “Please pause the survey here and talk to study staff.” Study staff will discuss the responses with the participant and address any questions or concerns. If participant does not want to participate, study staff will end the survey and withdraw participant from the study. If participant does want to participate and responded inaccurately for any reason, study staff will help the participant navigate back to these questions and answer them correctly, so the participant can proceed with the remainder of the survey.
The survey will start once you click the “Next Question” button.
SOCIODEMOGRAPHICS 1
In this first set of questions, we would like to know how you describe yourself.
SU-1 What gender do you consider yourself?
Male
Female
Transgender Male to Female
Transgender Female to Male
Non-binary or Genderqueer
Another gender not listed (Write in response)
SU-2 What was your sex assigned at birth?
Male
Female
SU-3 In the past year, who have you had sex with? Check all that apply. Sex includes any oral, anal or vaginal sex.
Men
Women
Transwomen
Transmen
Non-binary or Genderqueer people
People of another gender not listed (Write in response)
I did not have sex in the past year
SU-4 What is your sexual orientation?
Bisexual
Gay
Lesbian
Queer
Straight or Heterosexual
Another identity not listed (Write in response)
SU-5 What is your age?
SU-6 Do you consider yourself Hispanic or Latinx?
Yes
No
SU-7 Which racial group or groups do you consider yourself to be in? Check all that apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Another group or groups not listed (Write in response)
MEDICAL CARE AND HIV TESTING
The next set of questions will ask you about where you get medical care and where and how often you have been tested for HIV.
HT-1 Do you have a regular health care provider?
Yes
No
[JHU only] No, I use the emergency room for my medical and health-related issues
Don’t know
[If SU-1 = Male, Transgender Male to Female, or Transgender Female to Male AND SU-2 = Males AND HT-1 = “Yes”] HT-2 Does your regular health care provider know that you have sex with men?
Yes
No
Don’t know
HT-3 In the past 12 months, approximately how many times have you seen a health care provider?
0 times
1-4 times
5-9 times
10 times or more
Don't know
[IF FP-5 = HIV-negative/unknown] HT-4 Have you ever had an HIV test before today?
Yes
No
Don’t know
[If HT-4 = Yes] HT-5 How do you usually decide when to test for HIV? Choose the one that best fits how you currently decide to test.
On a regular schedule
After being exposed to HIV
Between sex partners
When I have symptoms of HIV
When I have symptoms of STIs other than HIV
When it’s free and convenient
When recommended by my healthcare provider
I don’t have a reason for testing
Other (Write in response)
[If HT-4 = Yes] HT-6 About how often do you test for HIV?
Every month
Every 3 months
Every 6 months
Once a year
Once every 2 years
No pattern
Other (Write in response)
[IF FP-5 = HIV-negative/unknown] HT-7 What is the main reason you’re getting an HIV test today?
I get tested on a regular schedule and it was time for me to get tested again
I was worried I might have been exposed to HIV
Before having sex with someone new
I had sex with someone new
After stopping having sex with someone
I have symptoms of HIV
I have symptoms of STIs other than HIV
My healthcare provider recommended that I get tested
It is a routine test for any patient
It’s free and convenient
Other (Write in response)
[IF FP-5 = HIV-negative/unknown] HT-8 In the past 12 months, that is, since [insert calculated month and year], how many times have you been tested for HIV? Please enter a number or, if you don’t know, please enter 999.
___ ___ times (0 to N)
[If HT-4=Yes] HT-9 When was the last time you tested for HIV? Please enter a month and year in MM/YYYY format. If you cannot remember the month, please just enter the year.
MM/YYYY
[If HT-4=Yes] HT-10 When you last had an HIV test, what was the result?
Positive (have the infection)
Negative (did not have the infection)
Did not get the results/unknown
[IF HT-10 = Negative OR Did not get the results/unknown] HT-11 Have you ever tested HIV positive?
Yes
No
Don’t know
[If HT-10 = Positive] HT-12 Was that your first positive HIV test?
Yes
No
Don’t know
[HT-12 = No, OR FP-5 ≠ HIV-negative/unknown] HT-13 When did you first test positive for HIV? Please enter a month and year in MM/YYYY format. If you cannot remember the month, please just enter the year.
MM/YYYY
[If HT-10 = Positive OR FP-5 ≠ HIV-negative/unknown] HT-14 Before you were diagnosed with HIV, did you ever have a negative HIV test?
Yes
No
Don’t know
[If HT-14 =Yes] HT-15 When was your last negative HIV test? Please enter a month and year in MM/YYYY format. If you cannot remember the month, please just enter the year.
MM/YYYY
[If HT-10 = Positive OR FP-5 ≠ HIV-negative/unknown] HT-16 Do you currently have a doctor or medical provider for HIV care?
Yes
No
[If HT-16 = No or Refuse to answer] HT-17 Have you ever been to a doctor or medical provider for HIV care?
Yes
No
[If HT-16 = Yes OR HT-17 = Yes] HT-18 When did you last see your doctor or medical provider for HIV care? Please enter a month and year in MM/YYYY format. If you cannot remember the month, please just enter the year.
MM/YYYY
[If HT-10 = Positive OR FP-5 ≠ HIV-negative/unknown] HT-19 What was your last viral load? If you were told that your viral load was undetectable OR detectable but so low that the test cannot tell you the actual number, please choose “Undetectable”.
Undetectable
Detectable
Don’t know
PRE-EXPOSURE PROPHYLAXIS
[Ask section if FP-5 ≠ Established HIV infection – diagnosis >3 months ago.]
This next set of questions is about your experiences taking HIV medicines to prevent yourself from getting HIV. This can also be called Pre-Exposure Prophylaxis or PrEP.
PR-1 In the last 3 months (since [current month/year – 3 months]) have you taken HIV medicines to prevent yourself from getting HIV?
Yes
No
Don’t know
[If PR-1 = Yes AND FP-5 = HIV-negative/unknown] PR-2 Are you currently taking medicines to prevent yourself from getting HIV?
Yes
No
[If PR-1 = Yes] PR-3 When did you last start taking HIV medicines to prevent yourself from getting HIV? Please enter a month and year in MM/YYYY format. If you cannot remember the month, please just enter the year.
MM/YYYY
[If (PR-1 = Yes and PR-2 = No) OR (PR-1 = Yes and FP-5 ≠ HIV-negative/unknown)] PR-4 When did you last stop taking HIV medicines to prevent yourself from getting HIV? Please enter a month and year in MM/YYYY format. If you cannot remember the month, please just enter the year.
MM/YYYY
STD HISTORY
The next set of questions will ask about sexually transmitted infections (STIs) other than HIV that you may have had in the last 3 months.
SD-1 In the last 3 months has a healthcare provider told you that you had an STI other than HIV?
Yes
No
Don’t know
[If SD-1 = Yes] SD-2 You said a healthcare provider told you that you had an STI in the last 3 months. Which one(s)? Check all that apply:
Gonorrhea
Chlamydia
Syphilis
Herpes
Trichomonas (“Trich”)
Other (Write in response)
Don’t know
SYMPTOMS
[Ask section if FP-5 ≠ Established HIV infection – diagnosis >3 months ago.]
The next set of questions will ask about symptoms like fever or a sore throat that you may have had in the last 3 months.
SY-1 In the past 3 months (that is, since insert date) have you had any of these symptoms? Check all that apply.
Sore throat
Fever and/or chills
Nausea
Vomiting
Diarrhea
Headache(s)
Fatigue
Soreness or pain in your joints or muscles
Swollen or sore lymph nodes
Body Rash
Sores, bumps, or rashes on your genitals
Changes in hearing or vision
Rash on the palms of your hands or the soles of your feet
Abdominal pain
I haven’t experienced any of these symptoms in the last 3 months
For any checked symptoms:
SY-2a-SY-2n You said that you had [insert symptom] in the past 3 months. Do you have [insert symptom] today?
Yes
No
SY-3a-SY-3n When did you first experience this symptom [insert symptom]? Please enter a day, month and year in MM/DD/YYYY format. If you cannot remember the exact day, please enter just the month and year.
MM/DD/YYYY
[If SY-2a-SY-2n = No] SY-4a-SY4n When did you last experience this symptom [insert symptom]? Please enter a day, month and year in MM/DD/YYYY format. If you cannot remember the exact day, please enter just the month and year.
MM/DD/YYYY
[If SY-1 ≠ I haven’t experienced any of these symptoms in the last 3 months] SY-5 Did you come here today because of your symptom(s)?
Yes
No
[If SY-1 ≠ I haven’t experienced any of these symptoms in the last 3 months] SY-6 Did you go to a doctor or health care provider before today because of your symptom(s)?
Yes
No
[If SY-6 = Yes] SY-7 Did the doctor or another health care provider talk to you about testing for acute HIV infection and the “window period” for HIV tests? The window period is the average length of time from HIV exposure to when a test will give you a positive result for HIV infection.
Yes
No
[If SY-6 = Yes] SY-8 Did you get tested for HIV when you went to the doctor?
Yes
No
Don’t know
[If SY-8 = Yes] SY-9 What type(s) of HIV tests did they do at the doctor’s? Check all that apply.
Rapid test on oral fluid (you got the result when you were still in the office)
Rapid test on finger stick (you got the result when you were still in the office)
Blood draw for another HIV test
Don’t know
[If SY-1 ≠ I haven’t experienced any of these symptoms in the last 3 months] SY-10 Did you miss work or school because of your symptom(s)?
Yes
No
Don’t know
[If SY-6 = Yes] SY-11 Were you hospitalized because of your symptom(s)?
Yes
No
[If SY-5 = No AND SY-6 = No] SY-12 What were the reason(s) you did not go to the doctor for your symptom(s)? Check all that apply.
I didn’t know where to go
I was worried about how much it might cost
I didn’t know my symptoms could be a sign of HIV infection
I thought I had the flu
I thought I had COVID
I was afraid to catch COVID
I wanted to wait to get my regular HIV test
I wanted to wait until after the “window period”
There is no clinic in my neighborhood
I didn’t want to know if it was HIV
Other (Write in response)
SUBSTANCE USE
The next set of questions is about drugs that weren’t prescribed for you by a doctor, sometimes called recreational drugs, that you have taken in the last 3 months.
DU -1 Have you used poppers in the last 3 months?
Yes
No
Don’t know
[If DU-1 ≠ Yes] DU-2 Have you ever used poppers?
Yes
No
Don’t know
DU-3 In the last 3 months have you used cocaine?
Yes
No
Don’t know
[If DU-3 ≠ Yes] DU-4 Have you ever used cocaine?
Yes
No
Don’t know
DU-5 Have you used methamphetamine (meth or crystal) in the last 3 months?
Yes
No
Don’t know
[If DU-5 ≠ Yes] DU-6 Have you ever used methamphetamine (meth or crystal)?
Yes
No
Don’t know
[If SU-1 = “Male”] DU-7 In the last 3 months, have you used Viagra, Cialis or Levitra?
Yes
No
Don’t know
[If DU-7 ≠ Yes] DU-8 Have you ever used Viagra, Cialis or Levitra?
Yes
No
Don’t know
DU-9 In the last 3 months have you injected drugs other than those prescribed by a medical provider?
Yes
No
Don’t know
[If DU-9 ≠ Yes] DU-10 Have you ever injected drugs other than those prescribed by a medical provider?
Yes
No
Don’t know
[If DU-9 = Yes OR DU-10= Yes] DU-11 Which drugs have you injected? Check all that apply
Heroin
Cocaine
Methamphetamine (meth or crystal)
Other (Write in response)
Don’t know
SEXUAL BEHAVIOR
We will now ask you some questions about sexual experiences you've had in the past 3 months. We only want to know about partners you had oral, anal or vaginal sex with since [insert date from 3 months ago].
Some questions will ask specifically about your sex partners' HIV status and what you did with partners who were HIV positive, HIV negative, and partners whose HIV status you did not know. We know you can't always be sure of a partner's HIV status. Please try to answer the questions based on what you knew and what your partners told you or did not tell you about their HIV status.
We know that it may be difficult to answer some of these questions if you or one or more of your sex partners do not identify as male or female, or if you or they are transgender. Except where we ask specifically about transgender partners, please include these sex partners in your responses to the questions about sex with either men or women, whichever you think is most appropriate.
We also know that how people refer to their genitals can be unique and personal. The following questions may use words that don’t perfectly fit how you or your partners refer to your bodies. Please answer the questions about specific sex acts the best that you can.
Participants will be asked the appropriate sex partner questions (Female Sex Partners of Men, Male Sex Partners of Women, Other Sex Partners of Men, Male Sex Partners of Men, or none of the sex partner questions) based on their replies to questions SU-1, SU-2, and SU-3.
Female Sex Partners of Men (male sex at birth and female sex partners in the previous year)
The next questions are about women you had vaginal or anal sex with in the past 3 months. Vaginal sex means you put your penis in her vagina. Anal sex means you put your penis in her butt.
FX-1. In the past 3 months, with how many different women did you have vaginal or anal sex?
___ ___ Number of women (0 to N)
FX-2. With how many of these [FX-1] women did you have vaginal or anal sex without using a condom or not using it the whole time?
Number of women (0 to N)
Check to make sure FX-2 ≤ FX-1. If not, then display “The number of women you had sex without using a condom or not using it the whole time cannot be more than the number of women you had vaginal or anal sex with in the past 3 months. Please carefully re-enter your response.”
FX-3. The next three questions are going to ask you about the HIV status (unknown, HIV positive, or HIV negative) of the [FX-2] women with whom you had vaginal or anal sex without using a condom in the past 3 months:
In the past 3 months, how many of these [FX-2] women with whom you had vaginal or anal sex without using a condom were….
partners whose HIV status you didn’t know? ___ Number of women (0 to N)
HIV positive? Number of women (0 to N)
HIV negative? ___ ___ Number of women (0 to N)
Check to make sure that the numbers in FX-3 add up to the total N from FX-2. If not, then display “The number of HIV positive, HIV negative and HIV status unknown partners must add up to [FX-2]. Please carefully re-enter your responses.”
Male Sex Partners of Women (female sex at birth and male sex partners in the previous year)
The next questions are about men you had vaginal or anal sex with in the past 3 months. Vaginal sex means he put his penis in your vagina. Anal sex means he put his penis in your butt.
FM-1. In the past 3 months, with how many different men did you have vaginal or anal sex?
___ ___ Number of men (0 to N)
FM-2. With how many of these [FM-1] men did you have vaginal or anal sex without using a condom or not using it the whole time?
___ ___ Number of men (0 to N)
Check to make sure FM-2 ≤ FM-3. If not, then display “The number of men you had sex without using a condom or not using it the whole time cannot be more than the number of men you had vaginal or anal sex with in the past 3 months. Please carefully re-enter your response.”
FM-3. The next three questions are going to ask you about the HIV status (unknown, HIV positive, or HIV negative) of the [FM-2] men with whom you had vaginal or anal sex without using a condom in the past 3 months:
In the past 3 months, how many of these [FM-2] men with whom you had vaginal or anal sex without using a condom were….
partners whose HIV status you didn’t know? Number of men (0 to N)
HIV positive? ___ ___ Number of men (0 to N)
HIV negative? ___ ___ Number of men (0 to N)
Check to make sure that the numbers in FM-3 add up to the total N from FM-2. If not, then display “The number of HIV positive, HIV negative and HIV status unknown partners must add up to [FM-2]. Please carefully re-enter your responses.”
FM-4. Did any of the [FM-1] men you had sex with in the last 3 months also have sex with men?
Yes
No
Don’t know
Other Sex Partners of Men (male sex at birth and transwomen, transmen, non-binary/genderqueer, and/or other sex partners in the previous year)
The next questions are about people you had sex with in the past 3 months, who you didn’t identify as “Women” or “Men.” For the next few questions we are only interested in persons you had penetrative sex with, and for these questions we will refer to “Vaginal sex” for sex where you put your penis in their vagina (or “front hole”). “Anal sex" means you put your penis in their butt (or “back hole”).
OX-1. In the past 3 months, with how many different people who you would not identify as female or male did you have vaginal or anal sex?
___ ___ Number of people (0 to N)
OX-2. With how many of these [OX-1] people did you have vaginal or anal sex without using a condom or not using it the whole time?
Number of people (0 to N)
Check to make sure OX-1 ≤ OX-2. If not, then display “The number of people you had sex without using a condom or not using it the whole time cannot be more than the number of people you had vaginal or anal sex with in the past 3 months. Please carefully re-enter your response.”
OX-3. In the past 3 months, how many of these [OX-2] people you had vaginal or anal sex without using a condom were:
HIV positive? Number of people (0 to N)
HIV negative? ___ ___ Number of people (0 to N)
People whose HIV status you did not know? (0 to N)
Check to make sure that the numbers in OX-3 add up to the total N from OX-2. If not, then display “The number of HIV positive, HIV negative and HIV status unknown partners must add up to [OX-2]. Please carefully re-enter your responses.”
Male Sex Partners of Men (male sex at birth and male sex partners in the previous year)
The next questions are about men you had sex with in the past 3 months. Oral sex means you put your penis in his mouth, or he put his penis in your mouth. Anal sex means you put your penis in his butt, or he put his penis in your butt.
SX-1. In the past 3 months, with how many different men did you have oral or anal sex?
Number of men (0 to N)
SX-2. In the past 3 months, with how many different men did you have anal sex?
Number of men (1 to N)
SX-3. In the past 3 months, of the (SX-2) men you had anal sex with, with how many different men did you have anal sex without a condom?
___ ___ Number of men (0 to N)
[IF UW Site AND SX-1>0] The next few questions will ask about times you had sex with more than one man in the same encounter. For these questions, a threesome involves sex with you and two other men. Group sex involves sex with you and at least 3 other men. When the question asks about the number of partners you had during a threesome or group sex, please write the total number of different partners you had across all encounters.
[IF UW Site AND SX-1>0] GS-1: In the past 3 months, how many times did you have sex with more than one man in the same encounter? (Threesome or group sex)
Number of events (times you had sex with more than one man in the same encounter)
[If UW site AND GS-1 > 0:] GS-2: In the past 3 months, how many times did you have sex with only two other men in the same encounter (a threesome)?
____ Number of events (times you had a threesome) (0 to N)
[If UW site AND If GS-2 > 0:] GS-3: In the past 3 months, in these [GS-2] threesomes, with how many different men did you have anal sex?
___ Total number of men with whom you had anal sex during a threesome (0 to N)
[If UW site AND GS-3 > 0:] GS-4: In the past 3 months, of the [GS-3] men you had anal sex with during threesomes, with how many different men did you have anal sex without a condom?
___ Total number of men with whom you had anal sex without a condom (0 to N)
[If UW site AND GS-4 > 0:] GS-5: The next three questions are going to ask you about the HIV status (unknown, HIV positive, or HIV negative) of the [GS-4] men with whom you had anal sex without using a condom during threesomes in the past 3 months:
How many of these [GS-4] men with whom you had anal sex without using a condom during threesomes were….
partners whose HIV status you didn’t know? ___ Number of men (0 to N)
HIV positive? ___ ___ Number of men (0 to N)
HIV negative? _ __ ___ Number of men (0 to N)
Check to make sure that the numbers in GS-5 add up to the total N from GS-4. If not, then display “The number of HIV positive, HIV negative and HIV status unknown partners must add up to [GS-4]. Please carefully re-enter your responses.”
[If UW site AND GS-1 > 0 & GS-2 < GS-1:] GS-6: In the past 3 months, how many times did you have sex with 3 or more other men in the same encounter (group sex)?
____ Number of events (times you had sex with three or more other men) (0 to N)
[If UW site AND GS-6 > 0:] GS-7: In the past 3 months, in these [GS-6] times you had group sex (sex with 3 or more other men), with how many different men did you have anal sex?
___ Total number of men with whom you had anal sex during group sex (0 to N)
[If UW site AND GS-7 > 0:] GS-8: In the past 3 months, of the [GS-7] men you had anal sex with during group sex, with how many different men did you have anal sex without a condom?
___ Total number of men with whom you had anal sex without a condom (0 to N)
[If UW site AND GS-8 > 0:] GS-9: The next three questions are going to ask you about the HIV status (unknown, HIV positive, or HIV negative) of the [GS-8] men with whom you had anal sex without using a condom during group sex in the past 3 months:
How many of these [GS-8] men with whom you had anal sex without using a condom during group sex were….
partners whose HIV status you didn’t know? Number of men (0 to N)
HIV positive? ___ ___ Number of men (0 to N)
HIV negative? ___ ___ Number of men (0 to N)
Check to make sure that the numbers in GS-9 add up to the total N from GS-8. If not, then display “The number of HIV positive, HIV negative and HIV status unknown partners must add up to [GS-8]. Please carefully re-enter your responses.”
In the next section we will ask you more about the SX-2 men you had anal sex with.
[If UW site] Partner-Specific Questions
If SX-2 = 1 ask Partner 1 questions
If SX-2 = 2 ask Partner 1 and Partner 2 questions
If SX-2 = 3 ask Partner 1, Partner 2 and Partner 3 questions
If SX-2 ≥ 4 ask Partner 1, Partner 2, Partner 3 and Questions for ≥ 4 partners
SX-4 Please enter a nickname or initials for the most recent men you had anal sex with since [insert date from 3 months ago].
We do not want to know the names of your partners. Please choose a nickname or initials that you will remember and that will best help you identify that person. If you do not want to enter a nickname or initials, please enter "Partner 1", "Partner 2", and/or "Partner 3".
Please enter a nickname or initials for Partner 1:
Please enter a nickname or initials for Partner 2:
Please enter a nickname or initials for Partner 3:
SX-5: Now we are going to ask if you had sex with [insert “each of these partners” if SX-2>1 or partner initials if SX=1] during the past month, the month before that (between [insert date from 2 months ago] and [insert date from 1 month ago]), and the month before that [insert date from 3 months ago] and [insert date from 2 months ago]).
Ask the questions below based on how many partners are entered into SX-2.
Did you and [insert partner initials] have sex in the past month, that is since [insert date from 1 month ago]?
Did you and [insert partner initials] have sex 2 months ago, that is between [insert date from 2 months ago] and [insert date from 1 month ago]?
Did you and [insert partner initials] have sex 3 months ago, that is between [insert date from 3 months ago] and [insert date from 2 months ago]?
Ask this question for any partners with overlap in SX-5:
SX-6
You indicated that you had sex with both [partner
X] and
[partner
Y] in
the same month.
Which
of these statements is most correct?
I last had sex with [partner X] before I had sex with [partner Y]
I last had sex with [partner Y] before I had sex with [partner X]
I was having sex with both [partner X] and [partner Y] during the same time period
Don’t know
Thank you for telling us the months in which you had sex with your partners. The next page will ask some questions to help us better understand what you just told us about your sexual partnerships. Click Next to continue
SX-7 Did you have sex with [insert partner initials] once, or more than once during the last 3 months?
Once
More than once
[If had sex “more than once”, then the participant next completes the sections pertaining to dates of first and last sex].
[If had sex “once”, then the participant is skipped to the “One-time partner” section].
“More than once”
SX-8 Do you remember the exact date that you first had anal sex with [insert partner initials]?
[If SX-8 = Yes] SX9. When did you first have anal sex with [insert partner initials]?
Please enter a day, month and year in MM/DD/YYYY format. If you cannot remember the exact day, please enter just the month and year.If the first time you had sex with [insert partner initials] was longer than 3 months ago; we still would like to know the first time you had anal sex with him.
MM/DD/YYYY
[If SX-8 = No] SX-10. About how many years ago you first had sex with [insert partner initials]?
_____ years ago
[If SX-10 <= 2] SX-11. Think back to the time when you first had sex with [insert partner initials]. Perhaps you had sex around a special time of the year such as your birthday, or a holiday like July 4th or Halloween. Maybe you can remember that it was warm outside or it was after a trip you took. Based on what you can recall, try to select what time during the year you first had sex with [insert partner initials]:
January - March
April - June
July - September
October - December
SX-12 What is the date you last had anal sex with [insert partner initials]? Please enter a day, month and year in MM/DD/YYYY format. If you cannot remember the exact day, please enter just the month and year.
MM/DD/YYYY
[For one-time partners:]
SX-13 Do you remember the exact date that you had anal sex with [insert partner initials]?
Yes
No
[If SX-13 = Yes:] SX-14 When did you have anal sex with [insert partner initials]?
MM/DD/YYYY
For Each Partner:
SX-15 Which of the following statements about [insert partner initials]’s age is most true?
He is more than 10 years younger than I am
He is 2-10 years younger than I am
He is within a year of my age
He is 2-10 years older than I am
He is more than 10 years older than I am
Don't know
SX-16 Is [insert partner initials] Hispanic or Latinx?
Yes
No
Don’t know
SX-17 What is [insert partner initials]’s race? Check all that apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Another group or groups not listed [Write in response]
Don’t know
SX-18 Is/was [insert partner initials] someone that you feel or felt committed to (someone you might call your boyfriend, significant other, life partner, or husband)?
Yes
No
Don't know
SX-19 If you had to further describe the type of sex partner [insert partner initials] is/was, which of the following would you choose? Someone who …
is a primary sexual partner
you have sex with on a regular basis, but who is not a main or primary partner
you have had sexual contact with more than once, but not on a regular basis, and who you normally socialize with
you have had sexual contact with more than once, but not on a regular basis, and who you don’t socialize with
you had sexual contact with only 1 time, but could find again if necessary
you had never met before you had had sexual contact and never plan to see again
you gave sex to for money or other goods or someone who gave you sex for money or other goods
SX-20 Where did you first meet [insert partner initials]?
Through friends
School or work
Online or on an app
Circuit party or Rave
At church
Through a personal ad in a newspaper
On a telephone chat line or dating line
Bar/Club
Cruising area
On the street
Adult bookstore
Bath house
Sex club
Sex resort
Private sex party
Sports club or gym
Vacation or cruise
Social organization
Other
[If SX-20 = “Online or on an app”] SX-20b Through which online service or phone app did you first meet [insert partner initials]?
Tik Tok
CraigsList
Adam4Adam
BarebackRT
Manhunt
OkCupid
Plenty of Fish
Grindr
Tinder
Scruff
Jackd
Hornet
Growlr
Skout
BoyAhoy
Other [Write in response] _________________
SX-21 Did you share your HIV status with [insert partner initials] before you first had sex?
Yes
No
Don’t know
SX-22 Did [insert partner initials] share his HIV status with you before you first had sex?
Yes
No
Don’t know
[If SX-22 = Yes:] SX-23 What was [insert partner initials]’s HIV status at that time?
HIV-negative
HIV-positive
[If SX-23 ≠ “HIV-positive”] SX-24 To the best of your knowledge, what is [insert partner initials]'s HIV status today?
HIV-negative
HIV-positive
Don’t know
[If SX-24 = “HIV-negative”] SX-25 To the best of your knowledge, is [insert partner initials] currently taking medicine to prevent himself from getting HIV? This might also be known as Pre-Exposure Prophylaxis or PrEP.
Yes
No
I don’t know
[If SX-23 = “HIV-positive” OR SX-24 = “HIV-positive”]SX-26 To the best of your knowledge, is [insert partner initials] currently taking medicines for HIV?
Yes
No
I don’t know
[If SX-23 = “HIV-positive” OR SX-24 = “HIV-positive”]SX-27 To the best of your knowledge, does [insert partner initials] have an undetectable viral load?
Yes
No
I don’t know
For all partners:
SX-28 In the past 3 months (since [current month - 3]), how many times did you and [insert partner initials] have anal sex?
___ ___ Number of times (0 to N)
[If SX-28 = 1:] SX-29 When you had anal sex with [partner initials] did you have anal sex without using a condom or not using it the whole time?
Yes
No
[If SX-28 > 1:] SX-30 In the past 3 months (since [current month - 3]), how many times did you and [partner initials] have anal sex without using a condom or not using it the whole time?
___ ___ Number of times (0 to N)
[If SX-29 = Yes or SX-30 >0:] SX-31 In the past 3 months (since [current month - 3]), when you and [insert partner initials] had anal sex without a condom were you the top (your penis in his butt), bottom (his penis in your butt) or both? Check only one.
Both top and bottom
Top only
Bottom only
[For repeat partners:]
SX-32 In the last 3 months (since [current month - 3]), during the time you were having sex with [insert partner initials], did [insert partner initials] have sex with anyone else?
Yes
No
Don't know
SX-33 Was [insert partner initials] diagnosed with an STI in the last 3 months (since [current month - 3])?
Yes
No
Don’t know
The next few questions will ask about times you and [partner initials] had sex with at least one other man together in the same encounter. For these questions, a threesome involves sex with you, [partner initials], and one other man (a total of 3 men). Group sex involves sex with you, [partner initials], and at least 2 other men (a total of 4 or more men). When the question asks about the number of partners you had during a threesome or group sex, please write the total number of different partners you had across all encounters.
SX-34 In the last 3 months (since [current month - 3]), did you and [insert partner initials] ever have sex with other people in the same encounter (Threesome or group sex)?
Yes
No
Don't know
[If SX-34 = “Yes”:] GS-10: In the past 3 months how many times did you and [partner initials] have sex with only one other man in the same encounter (threesome)?
___ Number of times (encounters involving sex with this partner and 1 other man)
[If GS=10 > 0:] GS-11: Think of the most recent time you had a threesome with [partner initials]. Did anyone have anal sex during this threesome?
Yes
No
[If GS-11=”Yes”] GS-12 Did anyone have anal sex without a condom during the most recent threesome with [partner initials]?
Yes
No
[If GS-12 =”Yes”] GS-13 Who had anal sex without a condom with each other in the most recent threesome with [partner initials]? Mark all that apply.
I had anal sex without a condom with this partner
I had anal sex without a condom with the 3rd partner
This partner had anal sex without a condom with the 3rd partner.
[If GS-12 =”Yes”] GS-14 What was the HIV status of the 3rd Partner?
HIV-Positive
HIV-Negative
Didn’t know his HIV status
[If SX-34 = “Yes”:] GS-15: In the past 3 months how many times did you and [partner initials] have sex with 2 or more other men in the same encounter (group sex)?
___ Number of times (encounters involving sex with you, this partner and 2+ other men)
[If GS-15 > 0:] GS-16: Think of the most recent time you had group sex with [partner initials] and at least two other men. How many men took part in this group sex encounter? Include [partner initials], but not yourself.
___ Total number of men your last group sex encounter with this partner
[If GS-16 > 0:] GS-17: The next three questions are going to ask you about the HIV status (unknown, HIV positive, or HIV negative) of the [GS-16] men involved the last time you had group sex with [insert partner initials]:
How many of these [GS-16] men involved the last time you had group sex with [insert partner initials] were….
partners whose HIV status you didn’t know? Number of men (0 to N)
HIV positive? ___ ___ Number of men (0 to N)
HIV negative? ___ ___ Number of men (0 to N)
[If GS-16 > 0..] GS-18: Questions asking about condom use (“Did X and Y have anal sex without a condom during your most recent group sex encounter that included [insert partner initials]?”) will be asked using the number of group sex partners from question GS-16 and following the table below for reference of which partnerships should be asked about.
|
Partner initials |
3rd |
4th |
Up to GS-16+1 |
You |
|
|
|
|
Partner initials |
|
|
|
|
3rd |
|
|
|
|
4th |
|
|
|
|
Up to GS-16 + 1 |
|
|
|
|
If two partners are reported, SX-35a will be asked. If three partners are reported, SX-35a – SX-35c will be asked.
SX-35a: Do you know if [insert partner 1 initials] and [insert partner 2 initials] had sex with each other in the past 3 months, or think that they probably have?
Yes
No
Don’t know
SX-35b: Do you know if [insert partner 1 initials] and [insert partner 3 initials] had sex with each other in the past 3 months, or think that they probably have?
Yes
No
Don’t know
SX-35c: Do you know if [insert partner 2 initials] and [insert partner 3 initials] had sex with each other in the past 3 months, or think that they probably have?
Yes
No
Don’t know
Thank you for telling us about [Partner X].
Next, we'd like to ask you about [Partner X+1].
Partner 1 section replicated for partners 2 and 3, but excluded here for brevity.
[If UW site] Questions for ≥ 4 male sex partners
The next questions are about the [(SX-2) – 3] men you had anal sex with in the past 3 months other than [insert nicknames from SX-4].
SX-36 Were any of the [(SX-2)-3] men you had anal sex with in the past 3 months someone that you feel or felt committed to (someone you might call your boyfriend, significant other, life partner, or husband)?
Yes
No
Don't know
[If SX-36 = Yes:] SX-37 How many of the men you had anal sex with in the past 3 months were someone that you feel or felt committed to (someone you might call your boyfriend, significant other, life partner, or husband)?
____ Number of partners
SX-38 Thinking about the [(SX-2)-3] men you had anal sex with in the past 3 months other than [insert initials of Partner 1, Partner 2, and Partner 3], how would you describe your relationship with each of them? Please describe each partner with only one category.
Of these [(SX-2)-3] men, how many….If none, please enter 0.
would you describe as a primary sexual partner?
would you describe as someone you have sex with on a regular basis, but who is not a main or primary partner?
did you have sexual contact with more than once, but not on a regular basis, and who you normally socialize with?
did you have sexual contact with more than once, but not on a regular basis, and who you don’t socialize with?
did you have sexual contact with only 1 time, but could find again if necessary?
had you never met before you had had sexual contact and never plan to see again?
did you give sex to for money or other goods or gave you sex for money or other goods?
Check to make sure that the numbers in SX-38 add up to (SX-2) - 3. If not, then display “The number of partners must add up to [(SX-2) - 3]. Please carefully re-enter your responses.”,
SX-39. With how many of these [(SX-2) – 3] men did you have anal sex without using a condom or not using it the whole time?
___ ___ Number of men (0 to N)
Check to make sure SX-39 ≤ (SX-2) – 3. If not, then display “The number of other men you had anal sex without using a condom cannot be more than the total number of men you had anal sex with in the past 3 months. Please carefully re-enter your response.”
SX-40. The next three questions are going to ask you about the HIV status (unknown, HIV positive, or HIV negative) of the [(SX-2)-3] men with whom you had anal sex without using a condom in the past 3 months.
How many of these [(SX-2)-3] men with whom you had anal sex without using a condom in the past 3 months were….
partners whose HIV status you didn’t know? Number of men (0 to (SX-2)-3)
HIV positive? ___ ___ Number of men (0 to (SX-2)-3)
HIV negative? ___ ___ Number of men (0 to (SX-2)-3)
Check to make sure that the numbers in SX-40 add up to the total N from SX-40. If not, then display “The number of HIV positive, HIV negative and HIV status unknown partners must add up to [SX-40]. Please carefully re-enter your responses.”
DEMOGRAPHICS 2
This next section will ask a few last questions about your work, income, and housing situation.
DE-1 What is the highest grade in school you completed?
Less than high school
Some high school
High school diploma or GED
Some college, Associate’s degree, or Technical degree
College graduate
Post graduate or professional school
The next question is about your household income last year from all sources before taxes. That is, the total amount of money earned and shared by all people living in your household.
DE-2 Please choose if you would like to answer in terms of monthly income or yearly income:
$ per month
$ per year
DE-3 What was your household income last year from all sources before taxes?
0 to $1667 per month
$1668 to $3333 per month
$3334 to $6250 per month
$6251 or more per month
Don't know
DE-4 What was your household income last year from all sources before taxes?
0 to $19,999 per year
$20,000 to $39,999 per year
$40,000 to $74,999 per year
$75,000 or more per year
Don't know
DE-5 In the past 12 months, have you been homeless at any time? By homeless, I mean you were living on the street, in a shelter, a Single Room Occupancy hotel (SRO), temporarily staying with friends or relatives, or living in a car?
Yes
No
Don't know
[If DE-5 = Yes] DE-6 Are you currently homeless?
Yes
No
Don't know
DE-7 Do you currently have health insurance? This includes Medicare, Medicaid, Apple Health, and others.
Yes
No
Don't know
This is the end of the survey. Please hand the computer back to the research team member. Thank you for your time!
[completed by study staff] End time: HH:MM:SS
Part 2 –1/15/2021
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Katz, David |
| File Modified | 0000-00-00 |
| File Created | 2021-03-29 |