Quantitative Core Survey (English)

National HIV Behavioral Surveillance: Brief HIV Bio-behavioral Assessment (NHBS-BHBA)

Att 3c_Quantitative Core Survey_Eng_20230426_clean

OMB: 0920-1398

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National HIV Behavioral Surveillance System - Brief Biobehavioral HIV Assessments (NHBS-BHBA)

Attachment #3c (English)

Quantitative Core Survey (English)

















Public reporting burden of this collection of information is estimated to average 10 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 30329; Attn: OMB-PRA (0920-XXXX)





CONSENT INFORMATION



If base eligibility = yes and population eligibility = MSM, HET, PWID


Question: Do you agree to take part in the interview?


Variable: CONSENTA


Response: Consent to survey


No…0


Yes…1




If CONSENTA = yes


Question: Do you agree to HIV counseling and testing?


Variable: CONSENTB


Response: Consent to HIV testing


No…0


Yes…1




(INTERVIEWER: if you did NOT offer the person hepatitis testing, enter ‘not offered”)


Question: Do you agree to hepatitis testing?


Variable: CNSTHEP1


Response: Consent to hepatitis testing


No…0


Yes…1


Not offered…2




(INTERVIEWER: if you did NOT offer the person STI testing, enter ‘not offered”)


Question: Do you agree to STD testing?


Variable: CNSTSTI1


Response: Consent to STD testing


No…0


Yes…1


Not offered…2




If CONSENTB = yes or CNSTHEP1 = yes or CNSTSTI1 = yes


Question: Do you agree to let us store some of your test sample(s) for future testing?


Variable: CNSTSTORE


Response: Consent to specimen storage


No…0


Yes…1

DEMOGRAPHICS


Question Set Intro: Now I am going to ask you questions about yourself. [Variable: qsintro_c]



Question: What is the highest level of education you completed? [Do NOT read choices]



Variable: SCHOOL



Response: Education



Never attended school…1



Grades 1 through 8…2



Grades 9 through 11…3



Grade 12 or GED…4



Some college, Associate's Degree, or Technical Degree…5



Bachelor's Degree…6



Any post graduate studies…7



Don’t Know…(.D)



Refuse to Answer…(.R)






Question: Do you currently have health insurance or health care coverage?



Variable: CURRHLTH1



Response: Currently insured



No…0



Yes…1



Don’t Know…(.D)



Refuse to Answer…(.R)






If CURRHLTH1=yes



Question: What kind of health insurance or health care coverage do you currently have? You may choose more than one option. [Give respondent Flashcard B] [Read choices. Check all that apply]



Variable: TYPE_INS



Response: Type of health insurance



A private health plan- purchased through an employer or purchased directly…0



Medicaid- for people with low incomes…1



Medicare- for the elderly and people with disabilities ….2



Indian Health Service…3



TRICARE/CHAMPUS…4



Veterans Administration coverage…5



Some other government plan…6



Some other health insurance…7



Don’t Know…(.D)



Refuse to Answer…(.R)






Question: In the past 12 months, that is, since [fill with interview month] of last year, have you seen a doctor, nurse, or other health care provider?


Variable: VISITMD12


Response: Health care visit, past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




Question: During the past 12 months, was there any time when you needed medical care but didn't get it because you couldn't afford it?


Variable: HCAFF


Response: Lacked health care due to cost


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




Introduction: The next questions are about your overall health. [Variable: qsintro_d]



Question: Are you deaf or do you have serious difficulty hearing?



Variable: DISDEAF



Response: Disability- Hearing



No…0



Yes…1



Don’t Know…(.D)



Refuse to Answer…(.R)






Question: Are you blind or do you have serious difficulty seeing, even when wearing glasses?



Variable: DISBLND



Response: Disability- Vision



No…0



Yes…1



Don’t Know…(.D)



Refuse to Answer…(.R)






Question: Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?



Variable: DISCOGN



Response: Disability- Cognition



No…0



Yes…1



Don’t Know…(.D)



Refuse to Answer…(.R)






Question: Do you have serious difficulty walking or climbing stairs?



Variable: DISWALK



Response: Disability- Ambulation



No…0



Yes…1



Don’t Know…(.D)



Refuse to Answer…(.R)






Question: Do you have difficulty dressing or bathing?



Variable: DISCARE



Response: Disability- Self-care



No…0



Yes…1



Don’t Know…(.D)



Refuse to Answer…(.R)






Question: Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone, such as visiting a doctor's office or shopping?



Variable: DISERND



Response: Disability- Errands



No…0



Yes…1



Don’t Know…(.D)



Refuse to Answer…(.R)





SEX BEHAVIORS


Intro: The next questions are about having sex. Please remember your answers will be kept private.


If SEX12=yes and SXGENDER=men and GEND=male


QUESTION: “In the past 12 months, that is, since [fill with interview month] of last year, with how many different men have you had oral or anal sex?” [variable: intro_sbm]



If SEX12=yes and SXGENDER=men and GEND=female


QUESTION: “In the past 12 months, that is, since [fill with interview month] of last year, with how many different men have you had oral, vaginal or anal sex?” [variable: intro_sbf]


Variable: SEX12_M


Response: Number of male sex partners, past 12 mos.


Range…1-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SXGENDER=women


Question: In the past 12 months, that is, since [fill with interview month] of last year, with how many different women have you had oral, vaginal, or anal sex?


Variable: SEX12_F


Response: Number of female sex partners, past 12 mos.


Range…1-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.



If SEX12=yes and SEX12_M=1


Intro: Now I'm going to ask you about the 1 male sex partner you had in the past 12 months. [intro_mm]


If SEX12=yes and SEX12_M=1 and GEND=female


Question: In the past 12 months, did you have vaginal sex with him?


Variable: F_VS_M1


Response: VS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=1 and GEND=female and F_VS_M1=Yes


Question: In the past 12 months, did you have vaginal sex with him without using a condom?


Variable: F_UVS_M1


Response: UVS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=1


Question: In the past 12 months, did you have anal sex with him?


Variable: AS_M1


Response: AS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=1 and AS_M1=yes


Question: In the past 12 months, did you have anal sex with him without using a condom?


Variable: UAS_M1


Response: UAS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=1


Question: In the past 12 months, did this man give you money, drugs, or some other type of payment or trade to have sex with him?


Variable: EXCH_R_M1


Response: Single exchange received (M sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=1


Question: In the past 12 months, did you give this man money, drugs, or some other type of payment or trade in exchange for having sex with you?


Variable: EXCH_G_M1


Response: Single exchange give (M sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)



If SEX12=yes and SEX12_M=2 or more


Intro: Now I'm going to ask you about the [fill with #] male sex partners you had in the past 12 months. [intro_mms]


If SEX12=yes and SEX12_M=2 or more and GEND=female


Question: In the past 12 months, with how many of these [fill with # male sex partners] men did you have vaginal sex?


Variable: F_VS_M


Response: Number of VS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_M=2 or more and GEND=female and F_VS_M=2 or more


Question: In the past 12 months, with how many of these [fill with # male vaginal sex partners] men did you have vaginal sex without using a condom?


Variable: F_UVS_M


Response: Number of UVS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_M=2 or more and GEND=female and F_VS_M=1


Question: In the past 12 months, did you have vaginal sex with him without using a condom?


Variable: F_UVS_M1A


Response: UVS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=2 or more


Question: In the past 12 months, with how many of these [fill with # male sex partners] men did you have anal sex?


Variable: AS_M


Response: Number of AS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_M=2 or more and AS_M=2 or more


Question: In the past 12 months, with how many of these [fill with # male anal sex partners] men did you have anal sex without using a condom?


Variable: UAS_M


Response: Number of UAS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_M=2 or more and AS_M=1


Question: In the past 12 months, did you have anal sex with him without using a condom?


Variable: UAS_M1A


Response: UAS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=2 or more


Question: Of your [fill with # male sex partners] male sex partners in the past 12 months, did any of them give you money, drugs, or some other type of payment or trade to have sex with them?


Variable: EXCH_R_M


Response: Multiple exchange received (M sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=2 or more


Question: Of your [fill with # male sex partners] male sex partners in the past 12 months, did you give any of them money, drugs, or some other type of payment or trade in exchange for having sex with you?


Variable: EXCH_G_M


Response: Multiple exchange give (M sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)



If SEX12=yes and SXGENDER=women and GEND=male


Intro: Now I'm going to ask you about the [fill with #] female sex partners you had in the past 12 months. (ASK ONLY MALE RESPONDENTS) [variable: intro_ff]


If SEX12=yes and SEX12_F=1


Question: In the past 12 months, did you have vaginal sex with her?


Variable: VS_F1    


Response: VS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=1 and VS_F1=Yes


Question: In the past 12 months, did you have vaginal sex with her without using a condom?


Variable: UVS_F1


Response: UVS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=1


Question: In the past 12 months, did you have anal sex with her?


Variable: AS_F1


Response: AS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=1 and AS_F1=Yes


Question: In the past 12 months, did you have anal sex with her without using a condom?


Variable: UAS_F1


Response: UAS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=1


Question: In the past 12 months, did you give this woman money, drugs, or some other type of payment or trade in exchange for having sex with you?


Variable: EXCH_G_F1


Response: Single exchange give (F sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=1


Question: In the past 12 months, did this woman give you money, drugs, or some other type of payment or trade to have sex with her?


Variable: EXCH_R_F1


Response: Single exchange received (F sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=2 or more


Question: In the past 12 months, with how many of these [fill with # female sex partners] women did you have vaginal sex?


Variable: VS_F


Response: Number of VS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_F=2 or more and VS_F=2 or more


Question: In the past 12 months, with how many of these [fill with # female vaginal sex partners] women did you have vaginal sex without using a condom?


Variable: UVS_F


Response: Number of UVS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_F=2 or more and VS_F=1


Question: In the past 12 months, did you have vaginal sex with her without using a condom?


Variable: UVS_F1A


Response: UVS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=2 or more


Question: In the past 12 months, with how many of these [fill with # female sex partners] women did you have anal sex?


Variable: AS_F


Response: Number of AS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_F=2 or more and AS_F=2 or more


Question: In the past 12 months, with how many of these [fill with # female anal sex partners] women did you have anal sex without using a condom?


Variable: UAS_F


Response: Number of UAS partners - 12 months


Range…0-7000


Note: If Don’t Know or Refuse to Answer, leave it blank.




If SEX12=yes and SEX12_F=2 or more and AS_F=1


Question: In the past 12 months, did you have anal sex with her without using a condom?


Variable: UAS_F1A


Response: UAS partner - 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=2 or more


Question: Of your [fill with # female sex partners] female sex partners in the past 12 months, did you give any of them money, drugs, or some other type of payment or trade in exchange for having sex with you?


Variable: EXCH_G_F


Response: Multiple exchange give (F sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=2 or more


Question: Of your [fill with # female sex partners] female sex partners in the past 12 months, did any of them give you money, drugs, or some other type of payment or trade to have sex with them?


Variable: EXCH_R_F


Response: Multiple exchange received (F sex partner)


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)



If SEX12=yes and SXGENDER=men and GEND=female

Intro: The next questions are about the last time you had either oral, vaginal or anal sex with a man. [variable: intro_female]

If SEX12=yes and SXGENDER=men and GEND=male

Intro: The next questions are about the last time you had either oral or anal sex with a man. [variable: intro_man]


If SEX12=yes and SEX12_M=1 or more


Question: How many days or weeks or months ago was that?


Variable: LSTSXN_M


Response: Last oral/vaginal/anal sex with man


Range…0-365 (if today, enter "0")


Note: If Don’t Know or Refuse to Answer, leave it blank.




[Interviewer: Was this days or weeks or months?]


Variable: LSTSXU_M


Response: Last oral/vaginal/anal sex with man


Days…0


Weeks…1


Months…2




If SEX12=yes and SEX12_M=1 or more


Question: The last time you had sex with this partner, did you know his HIV status?


Variable: LPKNWSTS_M


Response: Knew male partner HIV status at last event


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If LPKNWSTS_M=yes


Question: What was his HIV status? [Do NOT read choices]


Variable: LPHIVSTS_M


Response: Partner HIV status at last event


HIV-negative, that is, he does NOT have HIV…1


HIV-positive, that is, he does have HIV…2


Indeterminate…3


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=1 or more


Question: As far as you know, did he ever inject drugs like heroin, cocaine, or meth?


Variable: LPIDU_M


Response: last male partner ever injected


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_M=1 or more and GEND=female


Question: As far as you know, has he ever had sex with other men?


Variable: LPMSM_M


Response: last male partner ever MSM


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)



If SEX12=yes and SXGENDER=women and GEND=male


Intro: The next questions are about the last time you had oral, vaginal, or anal sex with a woman. (ASK ONLY MALE RESPONDENTS) [variable: intro_mnf]


If SEX12=yes and SEX12_F=1 or more


Question: How many days or weeks or months ago was that?


Variable: LSTSXN_F


Response: Last oral, vaginal, anal sex with woman


Range…0-365 (if today, enter "0")


Note: If Don’t Know or Refuse to Answer, leave it blank.




[Interviewer: Was this days or weeks or months?]


Variable: LSTSXU_F


Response: Last oral/vaginal/anal sex with man


Days…0


Weeks…1


Months…2




If SEX12=yes and SEX12_F=1 or more


Question: The last time you had sex with this partner, did you know her HIV status?


Variable: LPKNWSTS_F


Response: Knew female partner HIV status at last event


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If LPKNWSTS_F=yes


Question: What was her HIV status? [Do NOT read choices]


Variable: LPHIVSTS_F


Response: Partner HIV status at last event


HIV-negative, that is, she does NOT have HIV…1


HIV-positive, that is, she does have HIV…2


Indeterminate…3


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12=yes and SEX12_F=1 or more


Question: As far as you know, did she ever inject drugs like heroin, cocaine, or meth?


Variable: LPIDU_F


Response: last female partner ever injected


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




DRUG USE


Intro: Now I am going to ask you about experiences you may have had with drugs that you did NOT inject. This includes times that you may have smoked, snorted, inhaled, or ingested drugs such as marijuana, methamphetamine, or cocaine. This also includes drugs such as Oxycontin or benzodiazepines that were not prescribed to you or that you may have used in a way other than instructed by your healthcare provider.” [Variable: intro_nidu]


Question: Have you ever in your life used any drugs that you did not inject?


Variable: EVRNIDU


Response: Ever used non-injection drugs


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If EVRNIDU=yes


Question: When was the last time you used any drug that you did not inject? That is, how many days or months or years ago did you last use drugs?


Variable: NIDUN


Response: When last used non-injection drugs, number


___


Range: 0-365 (if today, enter "0")


Note: If Don’t Know or Refuse to Answer, leave it blank.




If EVRNIDU=yes and NIDUN=0-365


Question: Was this in days or months or years?


Variable: NIDUU


Response: When last used non-injection drugs, unit


Days…0


Months…1


Years…2


Don’t Know…(.D)


Refuse to Answer…(.R)




If EVRNIDU=yes and NIDUN+NIDUU = last 12 months


Question: In the past 12 months, which drugs did you use that you did NOT inject? Please say “yes” or “no” to each drug I mention.


Variable: NIDUDRG


Response: Non-injection drugs used


NIDUDRGA: Marijuana


NIDUDRGB: Methamphetamine


NIDUDRGC: Crack cocaine


NIDUDRGD: Powder cocaine


NIDUDRGE: Downers, such as Benzodiazepines, Valium, Xanax, or Klonopin


NIDUDRGF: Painkillers, such as Oxycontin, Dilaudid, or Percocet


NIDUDRGG: X, ecstasy, or MDMA


NIDUDRGH: Heroin


NIDUDRGI: Fentanyl


NIDUDRGJ: Stimulants, such as Adderall or Ritalin


NIDUDRGK: Something else


Don’t Know…(.D)


Refuse to Answer…(.R)



Intro: Next I'm going to ask you about your injecting behaviors in the past 12 months, that is, since [fill with interview month] of last year. When I ask you about "needles," I'm talking about needles and syringes. (ASK ONLY IF IDU IN PAST 12 MONTHS) [intro_indr]


If LINJN+LINJU= in last 12 months


Question: In the past 12 months, did you use needles that someone else had already injected with?


Variable: SHARNDLE


Response: Used needle after, Y/N


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




HIV TESTING


Intro: Now I'm going to ask you a few questions about getting tested for HIV. Remember, an HIV test checks whether someone has HIV infection. [variable: intro_hiv]


Question: Have you ever had an HIV test?


Variable: EVERTEST


Response: Ever tested for HIV


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If EVERTEST=yes


Question: Have you ever tested positive for HIV, that is, do you have HIV?


Variable: EVERPOS


Response: Ever test positive for HIV


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If EVERPOS=yes


Question: When did you FIRST test positive? Please tell me the month and year.


[INTERVIEWER: FIRST ENTER MONTH OF HIV TEST]


Variable: POS1ST_mm


January…1


February…2


March…3


April…4


May…5


June…6


July…7


August…8


September…9


October…10


November…11


December…12


Don’t Know…(0)


Refuse to Answer…(-1)




[INTERVIEWER: ENTER YEAR OF MOST RECENT HIV TEST]


Variable: POS1ST_yy


Response: Date of first positive test


Response: __ __ __ __ (YYYY)


Range (year)…1900-2100


Note: If Don’t Know or Refuse to Answer, enter 1900.




If EVERTEST=yes and EVERPOS=no/DK/Refused


Question: Were you tested for HIV in the past 12 months, that is, since [fill with interview month] of last year?


Variable: RCNTST12


Response: HIV test in the past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




SEXUALLY TRANSMITTED DISEASES


Intro: Now, I'm going to ask you some questions about sexually transmitted diseases, or STDs, other than HIV and hepatitis. [variable: intro_std]


Question: In the past 12 months, that is, since [fill with interview month] of last year, were you tested by a doctor or other health care provider for a sexually transmitted disease like gonorrhea, chlamydia, or syphilis? Do NOT include tests for HIV or hepatitis.


Variable: STDTEST


Response: Tested for STD past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If SEX12_M=yes, and GEND=male and STDTEST=yes


Question: In the past 12 months, did you have an anal or rectal STD test?


Variable: RSTDTEST


Response: Rectal STD test past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)



Intro: In the past 12 months, has a doctor or other health care provider told you that you had… [variable: std_group]


Question: Gonorrhea?


Variable: GONORR


Response: Gonorrhea past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




Question: Chlamydia?


Variable: CHLAMYD


Response: Chlamydia past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




Question: Syphilis?


Variable: SYPHILIS


Response: Syphilis past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




HIV PREVENTION


Intro: Next I'd like to ask you about HIV prevention activities that happen around here. [variable: intro_hivpre]


Question: In the past 12 months, that is, since [fill with interview month] of last year, have you gotten any free condoms, not counting those given to you by a friend, relative or sex partner?


Variable: COND12


Response: Received free condoms past 12m


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If LINJU= in last 12 months


Question: In the past 12 months, have you used services at a syringe exchange program?


Variable: SSPU


Response: SSP use, 12m


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If EVERPOS NE yes and (no previous HIV-positive test result)


Intro: The next questions are about the use of anti-HIV medicines, also called antiretrovirals. There are two ways that people who are HIV-negative can take anti-HIV medicines to reduce their risk of becoming infected. [variable: intro_pepre]


Question: PRE-exposure prophylaxis, or PrEP, is an antiretroviral medicine, such as Truvada (or Descovy), taken for months or years by a person who is HIV-negative to reduce the risk of getting HIV. Before today, have you ever heard of PrEP?


Variable: PRPAWR


Response: PrEP, awareness


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If PRPAWR=Yes


Question: In the past 12 months, have you had a discussion with a health care provider about taking PrEP?


Variable: PRPDSC


Response: PrEP, discussed with HCP, 12m


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If PRPAWR=Yes


Question: In the past 12 months, have you taken PrEP to reduce the risk of getting HIV?


Variable: PRPUS12M


Response: PrEP use, 12m


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)


If EVERPOS NE yes and (no previous HIV-positive test result)


Question: When a person who is HIV-negative takes pills for 28 days after a single high-risk exposure to reduce their chances of getting HIV, this is called POST-exposure prophylaxis, or PEP. In the past 12 months, have you taken PEP?


Variable: PEPUSE


Response: PEP, use, 12m


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




SELF-REPORTED POSITIVE (SRP) HIV CARE


If EVERPOS = yes



Intro: Next I'd like to ask you a few questions about care you may have received for your HIV infection. [Variable: intro_SRP]


Question: Have you ever been seen by a doctor, nurse, or other health care provider for a medical evaluation or care related to your HIV infection?


Variable: POSMD


Response: Seen health care provider for HIV infection


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If POSMD=Yes


Question: When did you first go to your health care provider after learning you had HIV? Please tell me the month and year.


[INTERVIEWER: FIRST ENTER MONTH]


Variable: FRSMD_mm


January…1


February…2


March…3


April…4


May…5


June…6


July…7


August…8


September…9


October…10


November…11


December…12


Don’t Know…(13)


Refuse to Answer…(14)




[INTERVIEWER: ENTER YEAR]


Variable: FRSMD_yy


Response: First saw health care provider after learning HIV+


Response: __ __ __ __ (YYYY)


Range (year)…1900-2100


Note: If Don’t Know or Refuse to Answer, enter 2100.




Question: Are you currently taking antiretroviral medicines to treat your HIV infection?


Variable: CURRAMED


Response: Currently taking antiretrovirals


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)



Intro: An HIV viral load test measures the amount of HIV in your blood. [Variable: intro_vl]


Question: In the past 12 months, that is, since [fill with interview month] of last year, have you had an HIV viral load test?


Variable: VLTST12


Response: viral load test in past 12 months


No…0


Yes…1


Don’t Know…(.D)


Refuse to Answer…(.R)




If VLTST12=Yes


Question: A person with HIV whose amount of virus in their body is very low may be told by a health care provider that their HIV viral load is undetectable. Thinking of your most recent viral load test, was the result undetectable, detectable, or you don’t know?


Variable: VLTSTRSLT


Response: result of most recent viral load test


Undetectable…1


Detectable…2


Don’t Know…(.D)


Refuse to Answer…(.R)






END OF SURVEY



If CONSENTB = no


Question: My records reflect that you did not agree to HIV testing when asked earlier during the interview. Before I close out the survey, I’d like to ask you again about whether or not you would like an HIV test. Did you want the HIV test that is part of today’s survey? [Do NOT read choices]


Variable: C_T_CNST


Response: Confirmation of HIV testing consent


No, respondent does NOT want an HIV test…0


Yes, respondent DOES want an HIV test…1




If C_T_CNST = Yes


Question: Do you agree to HIV counseling and testing?


Variable: HIVCNSTB


Response: Revised consent to HIV testing


No…0


Yes…1




If HIVCNSTB = Yes


Question: Do you agree to let us store some of your test sample(s) for future testing?


Variable: CNSTSTOREB


Response: Revised consent to specimen storage


No…0


Yes…1




[INTERVIEWER: Enter the end time]


Variable: ENDTIME



FLASHCARD A


MONTHLY Income

OR

YEARLY Income

A.

$0 to $416

or

A.

$0 to $4,999

B.

$417 to $833

or

B.

$5,000 to $9,999

C.

$834 to $1,041

or

C.

$10,000 to $12,499

D.

$1,042 to $1,249

or

D.

$12,500 to $14,999

E.

$1,250 to $1,666

or

E.

$15,000 to $19,999

F.

$1,667 to $2,083

or

F.

$20,000 to $24,999

G.

$2,084 to $2,499

or

G.

$25,000 to $29,999

H.

$2,500 to $2,916

or

H.

$30,000 to $34,999

I.

$2,917 to $3,333

or

I.

$35,000 to $39,999

J.

$3,334 to $4,166

or

J.

$40,000 to $49,999

K.

$4,167 to $4,999

or

K.

$50,000 to $59,999

L.

$5,000 to $6,249

or

L.

$60,000 to $74,999

M.

$6,250 to $8332

or

M.

$75,000 to $99,999

N.

$8333 or more

or

N.

$100,000 or more






FLASHCARD B


  • A private health plan- purchased through an employer or purchased directly


  • Medicaid- for people with low incomes


  • Medicare- for the elderly and people with disabilities


  • Indian Health Service



  • TRICARE/CHAMPUS



  • Veterans Administration coverage



  • Some other government plan



  • Some other health insurance






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AuthorCha, Susan (CDC/DDID/NCHHSTP/DHPSE)
File Modified0000-00-00
File Created2023-08-26

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