0920- Survey (English)

English

Version 6.4

Form Approved

OMB No. 0920-New

Expiration Date: XX/XX/XXXX

Surveillance of HIV-related service barriers among Individuals with Early or Late HIV Diagnoses (SHIELD)

Attachment 6a

Survey (English)

Public reporting burden of this collection of information is estimated to average 50 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

SHIELD Survey

Table of Contents

SHIELD SURVEY (ENGLISH) 3

A. Confirmation of Age, Diagnosis, and Residence 3

B. Demographics 5

Education 5

Ethnicity 6

Race 6

Assigned sex 7

Gender Identity 7

Sexual orientation 8

Gender of partners (YBDX) 8

Nativity 9

Years in US 9

Employment 9

Income 10

C. HIV Testing 11

HIV Testing & Barriers to Testing 11

Testing History – Ever Offer or Test Previously 12

Reasons for not testing for HIV 13

Self-Testing 15

D. HIV Knowledge 17

E. PREP 17

PEP 25

F. Interactions in Healthcare Settings Section 25

Seen HCW 12 months before diagnosis 25

Patient-HCW Communication 27

HCW Discrimination 28

Seeing HCW since diagnosis 29

G. HEALTH SECTION 30

STIs 30

Monkeypox virus 32

H. Hepatitis C 33

I. Mental health 33

J. Stigma & Discrimination 34

K. Perceived Racism Scale 35

L. Homonegativity 36

M. Trans- and non-binary discrimination before diagnosis 37

N. Transnegativity (before diagnosis) 38

O. Stressful Life Events Section 40

Job loss 40

Insurance 40

Housing (YBDX) 41

Police harassment and incarceration. (YBDX) 41

Violence (YBDX) 41

P. Risk Behaviors 42

Q. Non-injection drug use: 43

R. Injection drug use 44

S. Experiences when using drugs 45

Drug use stigma scale 46

PWID Barriers for HIV Prevention 47

T. Behaviors 48

End of Risk Behaviors Section 50

U. Local Questions (up to 5 minutes): 50

FLORIDA LOCAL QUESTIONS 50

HOUSTON LOCAL QUESTIONS 55

LOUSIANA LOCAL QUESTIONS 59

MICHIGAN LOCAL QUESTIONS 60

TOKEN OF APPRECIATION AND REFERRALS 64

RESPONSE CARDS 66

SHIELD - SURVEY

SHIELD SURVEY (ENGLISH)

INTRO.NOTE

Interviewer-Administered (IA) Introduction

Interviewer Note: please READ: “Thank you for your interest in this health survey. Remember that all the information you provide will be kept private and this will not have any personal information linked to it, like your name, where you live, or your birthdate. Some questions I ask might be personal. You might want to participate in a safe and private location where other people cannot overhear our conversation.

 

First, I will ask you a few questions about yourself to confirm that you qualify for this health survey. Once this process is complete and you are confirmed to be eligible, we will move on to the survey.

For this survey, I will need to read all questions as worded so everyone in the study is asked the same questions. There are also several questions in this survey where I’ll ask you to look at response cards that list answer choices.

The person at the health department might have told you where to find the response cards. If not, I can give you the link to access the response cards.

Do you have access to the internet?

[If they say no or they can’t access the response cards, the interviewer will need to read the responses for each question]

After you’ve read the choices on the card, you can tell me your answer or, if you’d prefer, you can tell me the number next to the answer you choose.

At the end of the survey, you will have an opportunity to hear about referrals to programs and services in your area.”

Web-based Survey (WB) Introduction

Thank you for your interest in this health survey. Remember that all the information you provide will be kept private and this will not have any personal information linked to it, for example your name, where you live or birth date. Some questions might be personal. You may want to take the survey in a safe and private location where other people cannot see your screen.

First, there will be a couple of questions about you to confirm that you qualify for the health survey. Once this process is complete and you are confirmed to be eligible, you will move on to the survey. For this survey, the questions and responses will be listed. There is also a sound function [add symbol here] for survey questions in case you would like to have the information read out loud.

If you want to stop and return to the survey at a later time, please remember the following: (To be determined by the Contractor)

1. 

2. 

 At the end of the survey, you will have an opportunity to read about referrals to programs and services in your area 

A. Confirmation of Age, Diagnosis, and Residence

CALC_E_TIME1	Start time of confirmation of eligibility. Automatic hidden variable.
E_TIME1	Confirmation start time
	__ : __

Programming note: For all items in survey where applicable, response option “don’t know” should be available to participants and interviewers for selection, but response option “prefer not to respond” should only be available for selection by interviewers.

A.1.		Age at time of survey
AGE_SRV		How old are you?
		Interviewer Note: Enter age in years, only integers [Range: 16-99]
		____________
		Prefer not to respond	999

Skip pattern

If A.1 < 18 then ineligible. GO TO END.1 Else go to A.5

A.2.	Date of Diagnosis
HIVDX_CR	According to information provided by the health department, you received your first HIV diagnosis in [MONTH/YEAR]. Is this correct?
	No 0 Yes 1
	Programming note: The health department staff will enter the month and year of diagnosis [MONTH/YEAR] into the Contractor’s scheduling portal and it should be automatically populated in this question.

Skip pattern

If A.2 = ‘No’ [0] then GO to A.3 to update the date of diagnosis. Else GO to A.5

A.3 and A.4 (Web) Please enter the month and year when you received your first HIV diagnosis

A.3.	Month (Diagnosis date)
HIVDX_M	Interviewer Note: Enter two digits for the new month of diagnosis.
	MONTH ________________________ (January = 01, February = 02, March = 03, April = 04, May = 05, June = 06, July = 07, August = 08 September = 09, October= 10, November = 11, December = 12)

A.4.	Year (Diagnosis date) Instructions for the INTERVIEWER: Enter four digits for the new year of diagnosis.
	Interviewer Note: Enter four digits for the new year of diagnosis.
HIVDX_Y	YEAR _________________________
	Programming Note: Range = 2000 to current survey year

If A.3 and A.4 is a date more than 18 months prior to the survey date go to A.4b

A.4b	The diagnosis date you entered is more than 18 months ago. Is this correct?
	[Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No, I need to correct it	0
	Yes, it is correct.	1
	Prefer not to respond	99

A.5	State Mostly Reside (YBDX)
STATE_DX	In the 12 months before your diagnosis, which state did you spend the majority of your time in?
	[Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.] Programming note: drop down menu Drop down menu selection: _________________

A.6	County Mostly Reside (YBDX)
CNTY_DX	In the 12 months before your diagnosis, which county did you spend the majority of your time in?
	[Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.] Programming note: drop down menu Drop down menu selection: _________________

A.7	State Currently Reside
STATE_RE	Which state do you currently live in?
	[Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.] Programming note: drop down menu Drop down menu selection: _________________

A.8	County Currently Reside
CNTY_RE	Which county do you currently live in?
	[Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.] Programming note: drop down menu Drop down menu selection: _________________

CALC_E_TIME2	End time of confirmation of eligibility Automatic hidden variable.
E_TIME2	Confirmation end time
	__ : __

B. Demographics

Transition: We are finished confirming your information. You qualify for the health survey. We will now start this survey by asking you a few questions about yourself.

CALC_S_TIME1	Start time of core questionnaire. Automatic hidden variable.
S_TIME1	Respondent start time
	__ : __

B.1		Education
B_EDUC		[WB: What is the highest level of education you have received? Select only one.] [IA: Looking at Response Card A, what is the highest level of education you have received? Please select only one.]
		Interviewer note: Use Response Card A
		Never attended school	1
		Grades 1 through 8	2
		Grades 9 through 12	3
		High school graduate or GED	4
		Some college, but did not complete degree	5
		Technical, Vocational, or Associate’s degree	6
		Bachelor’s degree	7
		Any post-graduate studies	8
		Prefer not to respond	99

B.2	Ethnicity
B_ETHN	Do you identify as Hispanic, Latino/a, or of Spanish origin?
	[Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If B2 = ‘Yes’ [1] then GO to B.3 ELSE GO to B.4

B.3	Hispanic Origin
	How do you describe your Hispanic, Latino/a, or Spanish origin? [WB: Select all that apply] [IA: Answer yes or no for each response]
B_HISP1	Mexican, Mexican American, or Chicano/a	1
B_HISP2	Puerto Rican	2
B_HISP3	Cuban	3
B_HISOT	Another Hispanic, Latino/a, or Spanish origin	96
B_HISDK	Don’t know	98
B_PNRD	Prefer not to respond.	99

Skip Pattern

If B.3=’Another Hispanic, Latino/a, or Spanish origin’ [96] then GO to B.3a ELSE GO to B.4

B.3a	Another Hispanic Origin
B_HISOTb	What is the other Hispanic, Latino/a, or Spanish origin?
	________________________ Interviewer note: Type in a text response

B.4	Race
	How do you describe your race? [WB: Select all that apply] [IA: Answer yes or no for each response]
B_AIAN	American Indian or Alaska Native	1
B_ASIA	Asian	2
B_BLAC	Black or African American	3
B_NHOP	Native Hawaiian or Other Pacific Islander	4
B_WHIT	White	5
B_OTHR	Another race	96
B_PNTR	Prefer not to respond	99

Skip Pattern

If B.4=’Another race’ [96] then GO to B.4a OR If B.4 = ‘Asian’ [2] then GO to B.5 ELSE GO to B.6

B.4a	Another Race
B_OTHRb	What is the other race?
	________________________ Interviewer note: Type in a text response

B.5	Asian Origin – race follow up
	How do you describe your Asian origin? [WB: Select all that apply] [IA: Answer yes or no for each response]
B_ASIAN1	Chinese	1
B_ASIAN2	Filipino	2
B_ASIAN3	Asian Indian	3
B_ASIAN4	Vietnamese	4
B_ASIAN5	Korean	5
B_ASIAN6	Japanese	6
B_AOTHR	Another Asian origin	96
B_ASNR	Prefer not to respond	99

Skip Pattern

If B.5=’Another Asian origin’ [96] then GO to B.5a ELSE GO to B.6

B.5a	Another Asian Origin
B_AOTHRb	What is the other Asian origin? ________________________
	________________________ Interviewer note: Type in a text response

B.6	Assigned sex
B_BRTH	What sex were you assigned at birth? [WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one
	Male	1
	Female	2
	Intersex	3
	Prefer not to respond	99

B.7	Gender Identity
	How do you describe your current gender identity? [WB: Select all that apply] [IA: Answer yes or no for each response]
B_GEN1	Man	1
B_GEN2	Woman	2
B_GEN3	Transgender man	3
B_GEN4	Transgender woman	4
B_GEN5	Non-Binary	5
B_GEN6	Genderqueer	6
B_GENOTR	Another gender identity	96
B_GENNR	Prefer not to respond	99

Skip Pattern

If B.7 = ‘Another gender identity’ [96] then GO to B.7a ELSE GO to B.8

B.7a	Another gender identity
B_GENOTRb	What is the other gender identity?
	________________________ Interviewer note: Type in a text response

B.8	Sexual orientation
	How do you describe your sexual orientation? [WB: Select all that apply] [IA: Answer yes or no for each response]
B_SEX01	Bisexual	1
B_SEX02	Gay or Lesbian	2
B_SEX03	Queer	3
B_SEX04	Same-gender-loving	4
B_SEX05	Straight or heterosexual	5
B_SXOTR	Another sexual orientation	96
B_SEXDK	Don’t know	98
B_SEXNR	Prefer not to respond	99

Skip Pattern

If B.8 = ‘Another sexual orientation’ [96] then GO to B.8a ELSE GO to B.9

B.8a	Another sexual orientation
B_SXOTRb	What is the other sexual orientation?
	________________________ Interviewer note: Type in a text response

B.9	Gender of partners (YBDX)
	In the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2], who did you have sex with? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: If 0 selected, disable other responses Interviewer note: If participant selects 1–95, do not read 0. If participant does not select 1-95, then read 0 and 98.
B_PART01	Men	1
B_PART02	Women	2
B_PART03	Transgender men	3
B_PART04	Transgender women	4
B_PARTOT	People with another gender identity	95
B_PART00	I did not have sex with anyone in the 12 months before my diagnosis	0
B_PARDK	Don’t know	98
B_PARNR	Prefer not to respond	99

B.10	Nativity
B_NATV	Were you born in the United States? [Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If B.10 = ‘No’ [0] then GO to B.11 ELSE GO to B.12

B.11	Years in US
B_YR_US	How many years have you lived in the United States? [WB: Please enter a whole number. If you are between years, please round to the nearest whole number. If less than 1 year, please enter [0]. If you don’t know the exact number please give us your best estimate]
	[Interviewer Note: DO NOT READ: Enter a whole number. If respondent indicates being between years, ask them to round to the nearest whole number. If less than 1 year, please enter [0]. Probe: If you don’t know the exact number please give us your best estimate]
	_________________ Programming note: Valid Range 0—99 ; Logic check – must be less than age of participant.
	Prefer not to respond.	999

B.12	Employment
B_EMPLY	[WB: Which of the options below best describes your current employment status? Select only one.] [IA: Looking at Response Card B, which of the options below best describes your current employment status? Please select only one.]
	Interviewer note: Use Response Card B
	Working full-time, 35 hours or more a week (includes self-employment)	1
	Working part-time, less than 35 hours a week (includes self-employment)	2
	Stay-at-home parent, caregiver, or partner	3
	Full-time student	4
	Unemployed, out of work less than a year	5
	Unemployed, out of work more than a year	6
	Retired	7
	Disabled and not able to work	8
	Not able to work for some other reason	9
	Prefer not to respond	99

Transition: Next, we would like to ask about your combined family income. “Combined family income” means the total amount of money from all family members living in your household.

Income

B.13	Preference for answer income question
B_IN_MY	Would you like to answer the following question using monthly income or yearly income?
	Monthly	1
	Yearly	2

Skip Pattern

If B.13 = ‘Monthly’ [1] then GO to B.13a OR If B.13 = ‘Yearly’ [2] then GO to B.13b ELSE GO to B.14

B.13a	Income (monthly)
	Programming note: Populate last year
B_INCOM	[WB: In [INSERT LAST YEAR], what was your combined monthly family income from all sources before taxes? Select only one.] [IA: Looking at Response Card C, in [INSERT LAST YEAR], what was your combined monthly family income from all sources before taxes? Please select only one.]
	Interviewer note: Use Response Card C
	$0 to $1,666 per month	1
	$1,667 to $2,083 per month	2
	$2,084 to $2,499 per month	3
	$2,500 to $3,333 per month	4
	$3,334 to $4,166 per month	5
	$4,167 to $6,249 per month	6
	$6,250 or more per month	7
	Don’t know	98
	Prefer not to respond	99

B.13b	Income (yearly)
	Programming note: Populate year from B13a
B_INCOY	[WB: In [INSERT LAST YEAR], what was your combined yearly family income from all sources before taxes? Select only one.] [IA: Looking at Response Card D, in [INSERT LAST YEAR], what was your combined yearly family income from all sources before taxes? Please select only one.]
	Interviewer note: Use Response Card D
	$0 to $19,999 per year	1
	$20,000 to $24,999 per year	2
	$25,000 to $29,999 per year	3
	$30,000 to $39,999 per year	4
	$40,000 to $49,999 per year	5
	$50,000 to 74,999 per year	6
	$75,000 or more per year	7
	Don’t know	98
	Prefer not to respond	99

B.14	Health insurance
B_INS1	Do you currently have health insurance coverage?
	[Interviewer Note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

End of Demographics Section.

C. HIV Testing

Transition: Now we will be moving on to questions about your HIV testing history.

C.1	Reason for test
	You received an HIV diagnosis in [MONTH/YEAR]. What were the main reasons you got tested for HIV? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Populate diagnosis date. Programming note: Randomize responses 1-11
C_TS01	Felt sick	1
C_TS02	As part of a routine check-up or visit	2
C_TS03	A doctor or healthcare worker recommended getting tested	3
C_TS04	Worried you might have been exposed through sex	4
C_TS05	Worried you might have been exposed through injection drug use	5
C_TS06	Worried you might have been exposed through your job	6
C_TS07	It was required for getting or staying on HIV pre-exposure prophylaxis (PrEP)	7
C_TS08	It was required for health or life insurance coverage	8
C_TS09	A current or former partner had tested positive or might have HIV	9
C_TS10	There was an increase in HIV in your community	10
C_TS11	As part of prenatal care	11
C_TS12	Worried you might have been exposed through sexual assault	12
C_TSOT1	Another reason	96
C_TSNR	Prefer not to respond	99

Skip Pattern

If C.1 = ‘Another reason’ [96] then GO to C.1a ELSE GO to C.2

C.1a	Other reason for initial positive test
C_TSOT2	What was the other reason?
	________________________ Interviewer note: Type in a text response

HIV Testing & Barriers to Testing

C.2	Location of initial positive test
C_LOC01	[WB: Where did you test positive for HIV? Select only one.] [IA: Looking at Response Card E, where did you test positive for HIV? Please select only one.]
	Interviewer note: Use Response Card E. If participant selects 13 (Another place) from Response Card E, interviewer should select 96 (Another place) from the list below. Programming note: Randomize responses 1-12
	Regular doctor’s office	1
	Another type of clinic like a local health department clinic, STD clinic, or family planning clinic	2
	Urgent care or walk-in clinic	3
	Hospital, emergency room, or other inpatient setting	4
	Pharmacy	5
	A community organization	6
	A mobile testing unit like a van or RV	7
	A public gathering like a festival, fair, bar, or night club	8
	Faith-based organization, for example, church or temple	9
	Syringe services program or needle exchange program	10
	Correctional facility (jail or prison)	11
	At home using a self-test or self-collection kit	12
	Another place	96
	Prefer not to respond	99

Skip Pattern

If C.2 = ‘Another location’ [96] then GO to C.2a ELSE GO to C.3

C.2a	Other location of initial positive test
C_LOC02	What is the other place?
	________________________ Interviewer note: Type in a text response

Testing History – Ever Offer or Test Previously

Transition: The next question asks about your experiences with a healthcare worker. A healthcare worker might include a doctor, nurse, nurse practitioner, physician assistant, or pharmacist.

C.3		Provider offer HIV test
C_PROVEVR	Before your diagnosis, did a healthcare worker ever offer or recommend an HIV test to you?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
		No	0
		Yes	1
		Prefer not to respond	99

Transition: For the next three questions, we are asking about HIV tests you might have taken before your diagnosis. Do not include the HIV tests that led to your diagnosis.

C.4	Previous test HIV
C_HIVEVR	Before your diagnosis, did you ever test for HIV?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If C.4 = ‘Yes’ [1] then GO to C.5 If C.4 = ‘No’ [0] then GO to C.7 ELSE GO to D.1

C.5	Frequency of testing
C_TS_FRQ	[WB: Before your diagnosis, approximately how often did you get tested for HIV? Select only one.] [IA: Looking at Response Card F, before your diagnosis, approximately how often did you get tested for HIV? Please select only one.] Interviewer note: Use Response Card F
	Every 3 months or more often	1
	Every 6 months	2
	Yearly	3
	Once every few years	4
	Once in your lifetime	5
	Don’t know	98
	Prefer not to respond	99

C.6	Previous test HIV (YBDX)
C_TSP12	In the 12 months before your diagnosis, from (MONTH/YEAR) to (MONTH/YEAR2), did you test for HIV?
	Programming note: Populate diagnosis dates [Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If C.6= ‘No’ [0] then GO to C.7 If C.6 = ‘Yes’ [1] then GO to C.11 ELSE GO to D.1

Reasons for not testing for HIV

Transition: The next set of questions ask about reasons that may have prevented you from getting tested for HIV.

C.7	Situational Reasons
	Did any of these situations prevent you from getting an HIV test? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1 -15 Interviewer note: If participant selects 1-15, do not read 94. If participant does not select 1-15, read 94.
C_SIT01	Did not know where to go to get tested	1
C_SIT02	Could not afford to get tested	2
C_SIT03	Did not have insurance coverage	3
C_SIT04	Assumed you were already infected with HIV	4
C_SIT05	Did not think you were at risk for HIV	5
C_SIT06	Could not take time off from work	6
C_SIT07	Did not want to test for HIV	7
C_SIT08	HIV testing services were too far away	8
C_SIT09	Could not afford transportation to a testing site	9
C_SIT10	Appointment times were not convenient	10
C_SIT11	Afraid of having blood drawn	11
C_SIT12	Concerned you would test positive for HIV	12
C_SIT13	Concerned you would not be able to afford HIV care	13
C_SIT14	Felt depressed	14
C_SIT15	Had to provide care for another person (children, parent, spouse)	15
C_SIT94	None of these	94
C_SIT99	Prefer not to respond	99

C.8	Relationship reasons
	Did any of these reasons related to your social relationships prevent you from getting an HIV test? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-9 Interviewer note: If participant selects 1-9, do not read 94. If participant does not select 1-9, read 94.
C_REL01	Family or other people you live with might find out you got tested	1
C_REL02	Partner might find out you got tested	2
C_REL03	People might think you were not faithful to your partner	3
C_REL04	People might think you had HIV	4
C_REL05	People might question your sexuality	5
C_REL06	People might think you were sexually active	6
C_REL07	People might think you had too many sexual partners	7
C_REL08	People might think that you were using drugs	8
C_REL09	Did not have anyone to emotionally support you	9
C_REL94	None of these	94
C_REL99	Prefer not to respond	99

C.9	Healthcare reasons
	Did any of these healthcare-related reasons prevent you from getting an HIV test? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-10. Interviewer note: If participant selects 1-10, do not read 94. If participant does not select 1-10, read 94.
C_HEALT01	A healthcare worker did not offer you an HIV test or did not seem knowledgeable about HIV testing	1
C_HEALT02	A healthcare worker said you did not need an HIV test	2
C_HEALT03	Not comfortable asking a healthcare worker for an HIV test	3
C_HEALT04	Had a bad experience with a healthcare worker	4
C_HEALT05	A healthcare worker might share your information with others	5
C_HEALT06	A healthcare worker might discriminate against you because of your gender identity or sexual orientation	6
C_HEALT07	A healthcare worker might discriminate against you because of your race or ethnicity	7
C_HEALT08	A healthcare worker might share your information with immigration enforcement	8
C_HEALT09	A healthcare worker might not understand your language or would not be able to provide an interpreter	9
C_HEALT10	Did not have access to healthcare	10
C_HEALT94	None of these	94
C_HEALT99	Prefer not to respond	99

C.10	Other reasons for not getting tested
C_HEALT96	What other reasons, if any, prevented you from getting an HIV test?
	________________________ Interviewer note: Type in a text response

Self-Testing

Transition: The next set of questions are about HIV self-testing. An HIV self-test is a test that lets you collect your own oral fluid sample by swabbing your mouth, use the testing device yourself, and read your HIV test result within 20 minutes. You can use a self-test to test yourself for HIV at home or another private location.

C.11	Self-testing – ever heard
	Before your diagnosis, had you ever heard of an HIV self-test?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
C_SELFTS	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If C.11 = ‘Yes’ [1] then GO to C.12 Else GO to D.1

C.12	Self-testing – ever use
	Before your diagnosis, did you ever use an HIV self-test?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
C_SELFEVR	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If C.12 = ‘Yes’ [1] then GO to C.13 OR If C.12 = ‘No’ [0] then GO to C.14 ELSE GO to D.1

C.13	Reason for use of self-test
	What were the reasons you used an HIV self-test? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-6
C_SELF01	Did not want to get tested by a doctor or at an HIV testing site	1
C_SELF02	Did not want other people to know you were getting tested.	2
C_SELF03	Wanted to get tested together with someone before you had sex	3
C_SELF04	Wanted to get tested by yourself, before having sex	4
C_SELF05	Wanted to get tested by yourself, after having sex	5
C_SELF06	A sex partner asked you to take an HIV self-test	6
C_SELF96	Another reason	96
C_SELF99	Prefer not to respond	99

Skip Pattern

If C.13 = ‘Another reason’ [96] then GO to C.13a ELSE GO to C.14

C.13a	Other reason for use of self-test
C_SELF96b	What is the other reason?
	________________________ Interviewer note: Type in a text response

C.14	Reason for no use of self-test
	What were the reasons you did not use an HIV self-test? [WB: Select all that apply] [IA: Answer yes or no for each response
	Programming note: Randomize responses 1-7
C_SELNO01	Cost of an HIV self-test was too high	1
C_SELNO02	Afraid of finding out that you have HIV	2
C_SELNO03	Worried about the accuracy of the test	3
C_SELNO04	Worried you would not be able to perform the test correctly or read the result properly	4
C_SELNO05	Did not know where to get an HIV self-test	5
C_SELNO06	Wanted to talk to an expert when you got an HIV test	6
C_SELNO07	Got tested at a different location, such as your doctor’s office	7
C_SELNO96	Another reason	96
C_SELNO99	Prefer not to respond	99

Skip Pattern

If C.14 = ‘Another reason’ [96] then GO to C.14a ELSE GO to D.1

C.14a	Other reason not use self-test
C_SELNO96b	What is the other reason?
	________________________ Interviewer note: Type in a text response

D. HIV Knowledge

Transition: The next question is about HIV transmission.

D.1	HIV transmission (treatment prevents, PNView)
D_KNOW1	Do you believe the following statement is true, false, or you are not sure? A person with HIV who takes HIV medicine as prescribed and gets and stays virally suppressed or undetectable can stay healthy and will not transmit HIV to their sex partners.
	[DON’T READ RESPONSES. SELECT ONLY ONE.]
	False	0
	True	1
	I am not sure	2

Transition: The next set of questions ask about your experiences in the 12 months before your diagnosis.

D.2–D.5	[WB: Please share how much you agree or disagree with each of the following statements. In the 12 months before your diagnosis, would you say:] [IA: Looking at Response Card G, please tell me how much you agree or disagree with each of the following statements. In the 12 months before your diagnosis, would you say:]
	Interviewer note: Use Response Card G. DON’T READ RESPONSES.
	Strongly disagree	1
	Somewhat disagree	2
	Neutral	3
	Somewhat agree	4
	Strongly agree	5
	Don’t know	98
	Prefer not to respond	99

D.2	D_BURNED	You felt burned out thinking about HIV
D.3	D_TUNED	You often tuned out messages about HIV
D.4	D_ENOUGH	You had heard enough about AIDS, and didn’t want to hear any more about it
D.5	D_AVDTIRED	You thought that people are less careful about avoiding HIV today because they are tired of being safe

End of HIV Section.

E. PREP

Transition: Now we would like to know about your experiences with pre-exposure prophylaxis for HIV, also known as PrEP. PrEP is medicine used to prevent HIV. There are two main types of PrEP available: pills taken by mouth and injections. PrEP can be taken for months or years by a person who is HIV-negative to reduce the risk of getting HIV.

E.1	Ever heard of PrEP
E_HEARD	Before your diagnosis, had you ever heard of PrEP?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If E.1 = ‘No’ [0] then GO to E.22. ELSE GO to E.2

Transition: The next question asks about your experiences with a healthcare worker. A healthcare worker might include a doctor, nurse, nurse practitioner, physician assistant, or pharmacist.

E.2 E_PROVD	Talk with healthcare worker about PrEP Before your diagnosis, did a healthcare worker ever talk to you about taking PrEP?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

E.3	Ever taken PrEP
E_TAKEVR	Before your diagnosis, did you ever take PrEP?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If E.3 = ‘Yes’ [1] then GO to E.4. OR If E.3 = ‘No’ [0] then GO to E.14. ELSE GO to E.22.

E.4	Ever taken PrEP (YBDX)
E_TAKEP12	In the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2] did you take PrEP?
	Programming note: Populate diagnosis date and date from 12 months before [Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If E.3 =’Yes’ [1] and E.4 = ‘Yes’ [1] then GO to E.5. OR If E.3 = “Yes” [1] and E.4 = ‘No’ [0] then GO to E.5. ELSE GO to E.22.

E.5	Location received PrEP medication
	How did you get your PrEP medication? [WB: Select all that apply] [IA: Answer yes or no for each response] Programming note: Randomize responses 1-4
E_GET01	At a pharmacy	1
E_GET02	Given or purchased from a friend or acquaintance	2
E_GET03	Online without a prescription	3
E_GET04	Online with a prescription	4
E_GET96	Another way	96
E_GET99	Prefer not to respond	99

Skip Pattern

If E.5 = ‘Another place’ [96] then GO to E.5a. ELSE GO to E.6.

E.5a	Other location received PrEP medication
E_GET96b	What is the other way?
	________________________ Interviewer note: Type in a text response

Transition: The next two questions ask about PrEP care. PrEP care includes an in-person or virtual clinical visit, an HIV test, and a prescription for PrEP pills or PrEP injections.

E.6	Ever receive PrEP care
E_RECEVR	Before your diagnosis, did you ever receive PrEP care?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If E.6 = ‘Yes’ [1] then GO to E.7. ELSE GO to E.8.

E.7	Location of PrEP care Where did you receive PrEP care? [WB: Select all that apply] [IA: Answer yes or no for each response] Programming note: Randomize responses 1-6 Interviewer note: If participant selects 1-96 do not read 7. If participant does not select 1-96, read 7
E_CARE01	Community health center	1
E_CARE02	Health Department	2
E_CARE03	Private doctor’s office or clinic	3
E_CARE04	Hospital	4
E_CARE05	Pharmacy	5
E_CARE06	On the phone or online with a healthcare worker	6
E_CARE96	Another place	96
E_CARE99	Prefer not to respond	99

Skip Pattern

If E.7 = ‘Another place’ [96] then GO to E.7a. ELSE GO to E.8.

E.7a	Other location PrEP care
E_CARE96b	What is the other place?
	________________________ Interviewer note: Type in a text response

E.8	What kind of PrEP
	You said you took PrEP before your diagnosis. What kind of PrEP did you take? [WB: Select all that apply] [IA: Answer yes or no for each response]
E_ORAL	PrEP pills	1
E_INJECT	Injectable PrEP	2
E_NRSPD	Prefer not to respond	99

Skip Pattern

If E.8 = ‘PrEP pills’ [1] then GO to E.9. ELSE GO to E.10.

E.9	Type of oral PrEP How did you take your PrEP pills? [WB: Select all that apply] [IA: Answer yes or no for each response] Programming note: Randomize responses 1-5
E_ORAL01	Pill taken daily	1
E_ORAL02	Pills taken before and after sex (sometimes called on-demand, 2-1-1, or intermittent PrEP)	2
E_ORAL03	Pill taken before but not after sex	3
E_ORAL04	Pill taken after but not before sex	4
E_ORAL05	Pills taken when you could remember to take them, not on a regular schedule	5
E_ORAL99	Prefer not to respond	99

E.10	Discontinue PrEP altogether
E_STOP	Did you ever stop taking PrEP and not restart it?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If E.10 = ‘Yes’ [1] then GO to E.11. ELSE GO to E.22.

Transition: The next set of questions ask about reasons you stopped taking PrEP.

E.11	Reason stop PrEP (personal) What were the personal reasons you stopped taking PrEP?  [WB: Select all that apply]  [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-11 Interviewer note: If participant selects 1-11, do not read 94. If participant does not select 1-11, read 94
E_PER_01	Concerned about confidentiality and privacy	1
E_PER_02	Experienced side effects	2
E_PER_03	Wanted to use other ways to prevent HIV, such as condoms	3
E_PER_04	Could not remember to take the pill every day	4
E_PER_05	Lost job or income or had a financial hardship	5
E_PER_06	Did not think you needed PrEP anymore because you did not have many sexual partners	6
E_PER_07	Someone told you to stop taking PrEP	7
E_PER_08	Stopped being sexually active	8
E_PER_09	Felt depressed	9
E_PER_10	Felt judged	10
E_PER_11	Afraid your family or friends would find the PrEP and ask questions	11
E_PER_94	None of these	94
E_PER_99	Prefer not to respond	99

E.12	Reason stop PrEP (situation) What situations stopped you from taking PrEP? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-12 Interviewer note: If participant selects 1-12, do not read 94. If participant does not select 1-12, read 94.
E_SIT01	Could not afford PrEP	1
E_SIT02	Had trouble getting a prescription filled	2
E_SIT03	Ran out of a prescription and did not have time to get a refill	3
E_SIT04	A healthcare worker gave you a prescription for only 30 days	4
E_SIT05	Did not know you had to continue to take PrEP daily	5
E_SIT06	A healthcare worker recommended not taking PrEP because of another medical condition	6
E_SIT07	Did not have insurance or insurance stopped covering it	7
E_SIT08	There was a language barrier between you and a healthcare worker	8
E_SIT09	PrEP services were too far away	9
E_SIT10	Could not afford transportation to a clinic	10
E_SIT11	It was hard to keep coming back to the clinic for regular visits or lab tests	11
E_SIT12	Appointment times were not convenient	12
E_SIT94	None of these	94
E_SIT99	Prefer not to respond	99

E.13	Other reason stop take PrEP
E_OTR96	Before your diagnosis, what other reasons, if any, stopped you from taking PrEP?
	________________________ Interviewer note: Type in a text response

Transition: The next set of questions ask about reasons you did not take PrEP.

Skip Pattern

If E.3 = ‘No’ [0] then GO to E.14. OR If E.3 = ‘Yes’ [1] and E.4=’No’ [0] then GO to E.18. ELSE GO to E.22.

E.14	Reason not take PrEP (personal) (BDX)
	Before your diagnosis, did any of these personal reason(s) prevent you from taking PrEP? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-14 Interviewer note: If participant selects 1-14, do not read 94. If participant does not select 1-14, read 94.
E_PERS01	Did not have enough information about PrEP	1
E_PERS02	Concerned about confidentiality and privacy	2
E_PERS03	Concerned about going to the clinic and being exposed to COVID-19	3
E_PERS04	Concerned about side effects	4
E_PERS05	Did not trust that the medication would be safe or effective	5
E_PERS06	Thought PrEP was only for gay men	6
E_PERS07	Did not think you needed PrEP because you did not have many sex partners	7
E_PERS08	It would be too difficult to remember to take a pill everyday	8
E_PERS09	Not sexually active	9
E_PERS10	Wanted to use other ways to prevent HIV, such as condoms	10
E_PERS11	Do not like taking medication	11
E_PERS12	Do not like needles	12
E_PERS13	Not interested in taking PrEP	13
E_PERS14	Had to provide care for another person (children, parent, spouse)	14
E_PERS94	None of these	94
E_PERS99	Prefer not to respond	99

E.15	Reason not take PrEP (relationship) (BDX)
	Before your diagnosis, did any of these reasons related to your social relationships prevent you from taking PrEP? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-9 Interviewer note: If participant selects 1-9, do not read 94. If participant does not select 1-9, read 94.
E_REL01	Family or other people you live with might find out that you were taking PrEP	1
E_REL02	Partner might find out that you were taking PrEP	2
E_REL03	People might think you were not faithful to your partner	3
E_REL04	People might think you have HIV	4
E_REL05	People might question your sexuality	5
E_REL06	People might think you were sexually active	6
E_REL07	People might think you have too many sexual partners	7
E_REL08	People might think you were using drugs	8
E_REL09	People might view you negatively if you started taking PrEP	9
E_REL94	None of these	94
E_REL99	Prefer not to respond	99

E.16	Reason not take PrEP (healthcare) (BDX)
	Before your diagnosis, did any of these healthcare-related reason(s) prevent you from taking PrEP? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-10 Interviewer note: If participant selects 1-10, do not read 94. If participant does not select 1-10, read 94.
E_NTHC01	Worried about a language barrier between you and a healthcare worker	1
E_NTHC02	Worried a healthcare worker might not maintain your privacy	2
E_NTHC03	Did not have insurance or did not think your insurance would cover PrEP	3
E_NTHC04	Not comfortable asking a healthcare worker about PrEP	4
E_NTHC05	Did not know where to get PrEP	5
E_NTHC06	A healthcare worker did not offer you PrEP or did not seem knowledgeable about PrEP	6
E_NTHC07	A healthcare worker said you did not need PrEP	7
E_NTHC08	A healthcare worker recommended not taking PrEP because of another medical condition	8
E_NTHC09	Did not want to get the HIV test needed to start PrEP	9
E_NTHC10	Did not want to keep coming back to the clinic for regular check-ups or lab tests	10
E_NTHC94	None of these	94
E_NTHC99	Prefer not to respond	99

E.17	Other reason not take PrEP (BDX)
E_NTHC96b	Before your diagnosis, what other reasons, if any, prevented you from taking PrEP?
	________________________ Interviewer note: Type in a text response

Skip Pattern

If E.3 = ‘No’ [0] then GO to E.22.

Transition: The next set of questions ask about reasons you did not take PrEP in the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2].

E.18	Reason not take PrEP (personal) (YBDX)
	In the 12 months before your diagnosis, did any of these personal reason(s) prevent you from taking PrEP? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-14 Interviewer note: If participant selects 1-14, do not read 94. If participant does not select 1-14, read 94.
E_INFOP12	Did not have enough information about PrEP	1
E_CONFP12	Concerned about confidentiality and privacy	2
E_CLINICP12	Concerned about going to the clinic and being exposed to COVID-19	3
E_EFFECTP12	Concerned about side effects	4
E_SAFEP12	Did not trust that the medication would be safe or effective	5
E_MENP12	Thought PrEP was only for gay men	6
E_NUMP12	Did not think you needed PrEP because you did not have many sex partners	7
E_PILLP12	It would be too difficult to remember to take a pill everyday	8
E_ACTIVEP12	Not sexually active	9
E_CONDP12	Wanted to use other ways to prevent HIV, such as condoms	10
E_MEDP12	Do not like taking medication	11
E_NEEDP12	Do not like needles	12
E_NOINTP12	Not interested in taking PrEP	13
E_PROVIDP12	Had to provide care for another person (children, parent, spouse)	14
E_NONEP12a	None of these	94
E_PNTRP12a	Prefer not to respond	99

E.19	Reason not take PrEP (relationship) (YBDX)
	In the 12 months before your diagnosis, did any of these reasons related to your social relationships prevent you from taking PrEP? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-9 Interviewer note: If participant selects 1-9, do not read 94. If participant does not select 1-9, read 94.
E_FINDP12	Family or other people you live with might find out that you were taking PrEP	1
E_PARNTP12	Partner might find out that you were taking PrEP	2
E_FAITHP12	People might think you were not faithful to your partner	3
E_THINKP12	People might think you have HIV	4
E_SEXUALP12	People might question your sexuality	5
E_SACTIVP12	People might think you were sexually active	6
E_NUMBP12	People might think you have too many sexual partners	7
E_NPDRUP12	People might think you were using drugs	8
E_NEGATP12	People might view you negatively if you started taking PrEP	9
E_NONEP12b	None of these	94
E_PNTRP12b	Prefer not to respond	99

E.20	Reason not take PrEP (healthcare) (YBDX)
	In the 12 months before your diagnosis, did any of these healthcare-related reason(s) prevent you from taking PrEP? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-10 Interviewer note: If participant selects 1-10, do not read 94. If participant does not select 1-10, read 94.
E_LANGP12	Worried about a language barrier between you and a healthcare worker	1
E_PRIVP12	Worried a healthcare worker might not maintain your privacy	2
E_NOINSP12	Did not have insurance or did not think your insurance would cover PrEP	3
E_COMFP12	Not comfortable asking a healthcare worker about PrEP	4
E_WHERP12	Did not know where to get PrEP	5
E_OFFERP12	A healthcare worker did not offer you PrEP or did not seem knowledgeable about PrEP	6
E_NONDP12	A healthcare worker said you did not need PrEP	7
E_CONDP12	A healthcare worker recommended not taking PrEP because of another medical condition	8
E_HIVTSTP12	Did not want to get the HIV test needed to start PrEP	9
E_CHKUPP12	Did not want to keep coming back to the clinic for regular check-ups or lab tests	10
E_NONEP12c	None of these	94
E_PNTRP12c	Prefer not to respond	99

E.21	Other reason not take PrEP (YBDX)
	In the 12 months before your diagnosis, what other reasons, if any, prevented you from taking PrEP?
E_NOOTRP12	________________________ Interviewer note: Type in a text response

PEP

Transition: Now we would like to know about your experiences with PEP or post-exposure prophylaxis. 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.

E.22	Before your diagnosis, had you ever heard of PEP?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
E_EVRPEP	No	0
	Yes	1
	Prefer not to respond	99

End of PrEP Section

F. Interactions in Healthcare Settings Section

Transition: Now we would like to ask about your interactions with healthcare workers. Healthcare workers might include a doctor, nurse, nurse practitioner, physician assistant, or pharmacist. In the next question, we are asking about healthcare visits that were not related to HIV. Please consider any office, urgent care, or emergency room visits that happened in person, by phone, or online.

Seen HCW 12 months before diagnosis

F.1	Seen DNW for health (YBDX)
	In the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2] had you seen a healthcare worker for medical services?
	Programming note: Populate diagnosis dates
F_SEENP12	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If F.1 = ‘Yes’ [1] then GO to F.2 If F.1 =’No’ [0] then GO to F.3 ELSE GO to F.12

F.2	Reason for visit - Seen DNW other than HIV (YBDX)
	What were the reason(s) for your visit? [WB: Select all that apply] [IA: Answer yes or no for each response]
F_REASON01	A general physical exam	1
F_REASON02	A physical exam for sports, school, or work	2
F_REASON03	A healthcare visit when you were sick or hurt	3
F_REASON95	Another reason	95
F_REASON99	Prefer not to respond	99

Skip Pattern

If F.2 in (1, 2, 3, 95, 98, or 99) GO to F.6 **ALL PARTICPANTS REGARDLESS OF HOW THEY ANSWERED F.1 WILL ANSWER F.6-F.11.

Transition for F3: The following questions ask about reasons you had not seen a healthcare worker.

F.3	Reason no visit (YBDX) personal
	Did any of these personal reasons prevent you from seeing a healthcare worker? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-7 Interviewer note: If participant selects 1-7, do not read 94. If participant does not select 1-7, read 94.
F_NOPERS01	Did not want to hear bad news	1
F_NOPERS02	Concerned about confidentiality and privacy	2
F_NOPERS03	Concerned about going to the clinic and being exposed to COVID-19	3
F_NOPERS04	Concerned a healthcare worker would not understand your language or would not be able to provide an interpreter	4
F_NOPERS05	Did not trust the healthcare system	5
F_NOPERS06	Concerned that a healthcare worker would judge you because of you drug use behaviors	6
F_NOPERS07	Had a bad experience with a healthcare worker	7
F_NOPERS94	None of these	94
F_NOPERS99	Prefer not to respond	99

F.4	Reason no visit (YBDX) situational
	Did any of these situations prevent you from seeing a healthcare worker? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1- 10 Interviewer note: If participant selects 1-10, do not read 94. If participant does not select 1-10, read 94.
F_NOSIT01	Did not need to because you were not sick	1
F_NOSIT02	Had an illness or a disability that made it too difficult to get care	2
F_NOSIT03	Did not know where to go for care	3
F_NOSIT04	Could not afford to pay for a visit	4
F_NOSIT05	Did not have insurance coverage	5
F_NOSIT06	Could not take time off from work	6
F_NOSIT07	Healthcare worker’s office or clinic was too far away	7
F_NOSIT08	Could not afford transportation to a clinic	8
F_NOSIT09	Appointment times were not convenient	9
F_NOSIT10	Had to provide care for another person (children, parent, spouse)	10
F_NOSIT94	None of these	94
F_NOSIT99	Prefer not to respond	99

F.5	Other reasons not see DNW (YBDX)
F_NOOTR	What other reasons, if any, prevented you from seeing a healthcare worker?
	________________________ Interviewer note: Type in a text response

Patient-HCW Communication

Transition: The next few questions are about conversations or interactions you might have had with a healthcare worker.

Skip Pattern

If F.2 in (1, 2, 3, 95, 98, or 99) GO to F.6 If F.4 in (1-99) then GO to F.6 **ALL PARTICPANTS REGARDLESS OF HOW THEY ANSWERED F.1 WILL ANSWER F.6-F.11.

F.6	Topics for HCW to discuss (sexual health)
	Before your diagnosis, which of the following topics did you and a healthcare worker talk about: [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-11 Interviewer note: If participant selects 1-11, do not read 94. If participant does not select 1-11, read 94.
F_DISCU01	Sexual history	1
F_DISCU02	How to prevent HIV or sexually transmitted diseases (STDs)	2
F_DISCU03	Sexual health for gay, bisexual, or other men who have sex with men	3
F_DISCU04	Sexual health for transgender or non-binary people	4
F_DISCU05	Counseling about safer sex practices or reducing number of sex partners	5
F_DISCU06	Getting tested and knowing your HIV status	6
F_DISCU07	PrEP or pre-exposure prophylaxis	7
F_DISCU08	PEP or post-exposure prophylaxis	8
F_DISCU09	Using alcohol or drugs before or during sex	9
F_DISCU10	Treatment for drug or alcohol use	10
F_DISCU11	Safer injection practices	11
F_DISCU94	None of these	94
F_DISCU99	Prefer not to respond	99

Skip Pattern

If (B.7=’Man’ [1] OR B.7=’Transgender man’ [3] OR B.7=’Non-Binary’ [5] OR B.7=’Genderqueer’ [6]) & (B.8=’Bisexual’ [1] OR B.8=’Gay or Lesbian’ [2] OR B.8 =’Queer’ [3] OR B.8=’Same-gender loving’ [4]) OR If (B.7=’Man’ [1] OR B.7=’Transgender man’ [3] OR B.7=’Non-Binary’ [5] OR B.7=’Genderqueer’ [6]) & (B.9=’Men’ [1] OR B.9=’Transgender men’ [3]) OR If B.6=’Male’ [1] & (B.9=’Men’ [1] OR B.9=’Transgender Men’ [3]) Then GO TO F.7 Else GO to F.9

F.7	Patient out to provider – MSM (BDX)
F_MSMHC	Before your diagnosis, did you share with a healthcare worker that you were attracted to or had sex with men?
	[DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If B.7=’Transgender man’ [3] or B.7=’Transgender woman’ [4] or B.7=’Non-Binary’ [5] or B.7 = ‘Genderqueer’ [6] or B.7=’Another gender identity, please specify’ [96] THEN GO to F.8 ELSE GO TO F.9

F.8	Patient out to provider – Trans/nonbinary (BDX)
F_TRNBHC	Before your diagnosis, did you share your gender identity with a healthcare worker?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

HCW Discrimination

Transition: Now we would like to know about conversations or interactions you might have had with healthcare workers or healthcare staff. Healthcare workers might include a doctor, nurse practitioner, physician assistant, or pharmacist. Healthcare staff might include a receptionist, patient advocate, or interpreter.

F.9	DNW condescending
F_HCRUDE	Before your diagnosis, did healthcare workers or staff in a healthcare setting use a disrespectful or rude tone with you?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

F.10	DNW not listening
F_HCLISTEN	Before your diagnosis, did healthcare workers or staff in a healthcare setting not listen to what you were saying?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If F.9 = ’Yes’ [1] or 1.F.10 = ’Yes’ [1] then GO to F.11 ELSE GO to F.12

F.11	Why discrimination (BDX)
	Based on your responses to the last two questions you may have experienced discrimination when getting care. Which of the following do you believe are reasons you may have experienced discrimination? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1-10 Interviewer note: If participant selects 1-10, do not read 94. If participant does not select 1-8, read 94.
F_DISCRIM01	Gender	1
F_DISCRIM02	Sexual orientation	2
F_DISCRIM03	Race or ethnicity	3
F_DISCRIM04	Income or social class	4
F_DISCRIM05	Use of drugs	5
F_DISCRIM06	Use of alcohol	6
F_DISCRIM07	Weight	7
F_DISCRIM08	Type of health insurance or because you did not have health insurance	8
F_DISCRIM09	Immigration status	9
F_DISCRIM10	Disability status	10
F_DISCRIM94	None of these	94
F_DISCRIM99	Prefer not to respond	99

Seeing HCW since diagnosis

Transition: The next set of questions are about HIV care since your diagnosis.

F.12	Currently seeing DNW for health (SDX)
F_SEENHC	Since your diagnosis, have you seen a healthcare worker for your HIV care?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to answer	99

Skip Pattern

If F.12 = ‘No’ [0] then GO to G.1 If F.12 = ‘Yes’ [1] the GO to F.13 ELSE GO to G.1

F.13	Seen doctor for HIV infection within 30 days of diagnosis
F_SEEN30D	Were you seen by a healthcare worker about your HIV infection within 30 days of your diagnosis, from [MONTHYEAR] to [MONTHYEAR2]?
	Programming note: Populate diagnosis and post diagnosis dates [Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

F.14	Treat HIV within 7 days after first visit
F_7DAYS	Did you start taking medication to treat your HIV infection within 7 days of your first visit with a healthcare worker for treatment of HIV?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

End of Provider Interactions Section

G. HEALTH SECTION

Transition: The next set of questions ask about sexually transmitted diseases, also called STDs. Examples of STDs include gonorrhea, chlamydia, syphilis, genital herpes, HPV, (also called human papillomavirus), or trichomoniasis or trich. Feel free to skip any questions that you are not comfortable answering.

STIs

G.1	Ever test STI
	Before your HIV diagnosis, had you ever been tested for an STD other than HIV?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
G_EVRSTI	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If G.1 = ‘Yes’ [1] then GO to G.2 ELSE GO to G.7

Transition: Now we would like to know about your experiences with STD testing in the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2].

Programming note: Populate diagnosis dates

G.2	Test STI past 12 months
	In the 12 months before your HIV diagnosis, were you tested for an STD other than HIV?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
G_P12STI	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If G.2 = ‘Yes’ [1] then GO to G.3 ELSE GO to G.4

G.3	Location of STD test
	In the 12 months before your HIV diagnosis, where did you test for STDs? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1 - 12
G_LOCSTI01	Regular doctor’s office	1
G_LOCSTI02	Another type of clinic like a local health department clinic, STD clinic, or family planning clinic	2
G_LOCSTI03	Hospital, emergency room, or other inpatient clinic	3
G_LOCSTI04	Pharmacy	4
G_LOCSTI05	A community organization	5
G_LOCSTI06	A mobile testing unit like a van or RV	6
G_LOCSTI07	A public gathering like a festival, fair, bar, or night club	7
G_LOCSTI08	Faith-based organization, for example, church or temple	8
G_LOCSTI09	Syringe services program or needle exchange program	9
G_LOCSTI10	Correctional facility (jail or prison)	10
G_LOCSTI11	At home or other location using an STD self-collection kit	11
G_LOCSTI12	Urgent care or walk-in clinic	12
G_LOCSTI96	Another place	96
G_LOCSTI99	Prefer not to respond	99

Skip Pattern

If G.3 = ‘Another place’ [96] then GO to G.3a ELSE GO to G.4

G.3a	Other location of STD test
G_OTRSTI	What is the other place?
	________________________ Interviewer note: Type in a text response

G.4	Test for HIV at same time STD
G_HIVSTD	In the 12 months before your diagnosis, when you tested for an STD, did a healthcare worker offer you an HIV test, even if it was only one time?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

G.5	Diagnosed STD
G_OTRHIV	In the 12 months before your HIV diagnosis, did a healthcare worker tell you that you had an STD other than HIV?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If G.5 = ‘Yes’ [1] then GO to G.6 ELSE GO to G.7.

G.6	HIV test after diagnosed STD
G_OFFERHIV	When a healthcare worker told you that you had an STD, were you offered an HIV test?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Monkeypox virus

G.7	Test for MPX virus
G_MPXEVR	Before your HIV diagnosis, had you ever been tested for Monkeypox virus?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If G.7 = ‘Yes’ [1] then GO to G.8 ELSE GO to H.1

G.8	Offer HIV test at same time MPX test
G_MPXHIV	Before your HIV diagnosis, when you tested for Monkeypox virus, did a healthcare worker ever offer you an HIV test?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

G.9	Diagnosed MPX
G_MPXDX	Before your HIV diagnosis, did a healthcare worker ever tell you that you had Monkeypox?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

H. Hepatitis C

Transition: The following questions ask about your experiences testing for Hepatitis C.

H.1	Test for HCV
H_TSTHCV	Before your HIV diagnosis, had you ever been tested for Hepatitis C?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If H.1 = ‘Yes’ [1] then GO to H.2 ELSE GO to I.1

H.2	Offer HIV test at same time HCV test
H_TSTHIV	Before your HIV diagnosis, when you tested for Hepatitis C, did a healthcare worker ever offer you an HIV test?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

H.3	Diagnosed HCV
H_HAVEHCV	Before your HIV diagnosis, did a healthcare worker ever tell you that you had Hepatitis C?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

I. Mental health (seen professional before diagnosis)

Transition: The next two questions are about mental health. We would like to know about your experiences with mental health professionals in the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2].

(Programming note: Populate diagnosis dates)

Mental health professionals might include a psychologist, psychiatrist, psychiatric nurse, or therapist. Feel free to skip any questions that you are not comfortable answering.

I.1	Seen mental health professional (MHP)
I_SEENMH	In the 12 months before your HIV diagnosis, did you seek assistance or treatment about your mental health, even if it was only one time?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

I.2	Ever told mental health problem
I_DEPRESS	In the 12 months before your HIV diagnosis, did a healthcare worker or mental health professional tell you that you had depression, anxiety, or another mental health condition?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

End of Health Section

J. Stigma & Discrimination

Transition: Now we would like to ask how you currently feel about attitudes in the community where you mostly lived 12 months before your diagnosis, from [MONTH/YEAR] to MONTH/YEAR2].

(Programming note: Populate diagnosis dates)

J.1 – J.5	Community Attitudes
	[WB: Please share how much you agree or disagree with each of the following statements.] [IA: Looking at Response Card G, please tell me how much you agree or disagree with each of the following statements.
	Interviewer note: Use Response Card G. DON’T READ RESPONSES.
	Strongly disagree	1
	Somewhat disagree	2
	Neutral	3
	Somewhat agree	4
	Strongly agree	5
	Don’t know	98
	Prefer not to respond	99

J.1	J_ATT_RE	Most people in [County/State] are accepting of people who are different races or ethnicities.
J.2	J_ATT_SEX	Most people in [County/State] are accepting of people who are gay or bisexual or same-gender-loving.
J.3	J_ATT_TRNB	Most people in [County/State] are accepting of people who are transgender or non-binary.
J.4	J_ATT_HIV	Most people in [County/State] are accepting of people living with HIV.
J.5	J_ATT_SSP	Most people in [County/State] believe that people who use drugs should have access to community programs that safely distribute and dispose of needles.

Programming note: Populate [County/State] from A.5 (state) or A.6 (county). Randomize J.1 – J.5

K. Perceived Racism Scale (adapted)

Transition: The next set of questions ask how you felt about experiences you may have had related to your race or ethnicity. Feel free to skip any questions that you are not comfortable answering.

K.1	Treated differently
K_DIFFERNT	Before your diagnosis, were you treated with disrespect or ignored in public settings because of your race or ethnicity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

K.2	Low quality medical treatment
K_DIAGNOSIS	Before your diagnosis, were you given low quality medical treatment in healthcare settings because of your race or ethnicity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

K.3	Refused treatment
K_REFUSED	Before your diagnosis, were you refused treatment in healthcare settings because of your race or ethnicity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

K.4	Refused housing
K_HOUSE	Before your diagnosis, were you refused housing because of your race or ethnicity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

K.5	Harassed by police
K_POLICE	Before your diagnosis, were you stopped, ignored, or harassed by police because of your race or ethnicity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

K.6	Physical violence due to race
K_VIOLENCE	Before your diagnosis, were you slapped, punched, shoved, kicked, shaken, or physically hurt in another way because of your race or ethnicity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	1
	Yes	2
	Don’t know	98
	Prefer not to respond	99

K.7	Language/accent
K_ACCENT	Before your diagnosis, were you disrespected or ignored because English is not your preferred language?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Not applicable, English is my preferred language	2
	Don’t know	98
	Prefer not to respond	99

L. Homonegativity

Skip Pattern

If B.8=’Bisexual’ [1] or B.8=’Gay or Lesbian’ [2] or B.8=’Queer’[3] or B.8=’Same-gender-loving' [4] or B.8=’Another sexual orientation” [96] Then Go to L.1 Else Go to O.1

Transition: The following questions ask how you felt about your sexual orientation when interacting with other people. Feel free to skip any questions that you are not comfortable answering.

L.1	Comfortable with disclosure
L_DISCLOSE	Before your diagnosis, were you comfortable with people knowing about your sexuality?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

L.2	Comfortable with discussing sexuality
L_SEXUALITY	Before your diagnosis, were you comfortable discussing your sexuality in public situations?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

M. Trans- and non-binary discrimination before diagnosis

Skip Pattern

If B.7=’Transgender man’ [3] OR B.7=’Transgender woman’ [4] OR B.7=’Non-binary [5] OR B.7=’Genderqueer’ [6] OR B.7 = ‘Another gender identity’ [96] then go to M.1 Else go to O.1

@@ SHIFT

Transition: The next set of questions ask how you felt about your experiences as a non-cisgender person (such as someone who identifies as transgender, non-binary, or genderqueer). Feel free to skip any questions that you are not comfortable answering.

M.1	Difficult to find work
M_WORK	Before your diagnosis, did you have trouble getting a job or keeping a job because of your gender identity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

M.2	Denied access to bathrooms
M_BATHRM	Before your diagnosis, were you denied access to bathrooms that matched your gender identity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

M.3	Denied housing
M_HOUSING	Before your diagnosis, were you denied housing or evicted because of your gender identity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

M.4	Denied quality healthcare
M_DHEALTH	Before your diagnosis, were you denied or given lower quality healthcare because of your gender identity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

N. Transnegativity (before diagnosis)

Skip Pattern

If B.7=’Transgender man’ [3] or B.7=’Transgender woman’ [4] or B.7=’Non-binary’ [5] or B.7=’Genderqueer’ [6] or B.7=’Another gender identity’ [96] then go to N.1 Else go to O.1

Transition: The following questions ask how you felt about your gender identity. Feel free to skip any questions that you are not comfortable answering.

N.1	Feel proud of gender identity
N_PROUD	Before your diagnosis, did you feel proud of your gender identity?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

s

N.2	Comfortable with identity disclosure
N_IDENTITY	Before your diagnosis, were you comfortable sharing your gender identity with others?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

End of Stigma & Discrimination Section

O. Stressful Life Events Section

Transition: The next set of questions are about difficult life experiences that some people may have had. We are asking about the 12 months before your HIV diagnosis, from [MONTH/YEAR to MONTH/YEAR2]. Feel free to skip any questions that you are not comfortable answering.

(Programming note: Populate diagnosis dates)

The first question asks about job loss. Job loss could include being laid off, leaving due to medical reasons, being moved from full-time to part-time, or having your hours cut.

Job loss

O.1	Job loss (YBDX)
O_JOBLOSS	In the 12 months before your diagnosis, did you experience job loss?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Insurance

O.2	Health insurance (YBDX)
O_INSUR	In the 12 months before your diagnosis, did you have health insurance coverage?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If O.2 = ‘Yes’ [1] then GO to O.3 ELSE GO to O.4

O.3	Type of health insurance (YBDX)
O_TYPEINS	[WB: What kind of health insurance coverage did you have? Select only one.] [IA: Looking at Response Card H, what kind of health insurance coverage did you have? Please select only one.] Interviewer note: Use Response Card H. If participant selects 8 (Some other health insurance) from Response Card H, interviewer should select 95 (Some other health insurance) from list below.
	A private health plan – through an employer or purchased directly	1
	Medicaid – for people with low incomes	2
	Medicare – for the elderly and people with disabilities	3
	Indian Health Service	4
	Health insurance through healthcare.gov or Obamacare	5
	City, county, state, or other publicly funded insurance, not including Medicaid	6
	TRICARE, CHAMPUS, CHAMPVA, or Veterans Administration	7
	Some other health insurance	95
	Don’t know	98
	Prefer not to respond	99

Housing (YBDX)

O.4	Housing (YBDX)
	In the 12 months before your diagnosis, where were you living? [WB: Select all that apply] [IA: Answer yes or no for each response]
O_SHARE	Housing you shared with others, such as a family member or partner, without paying rent	1
O_RENT	Housing you rented (such as an apartment)	2
O_OWN	Housing you owned	3
O_SHELT	A shelter, safe haven, or transitional housing	4
O_JAIL	Institutional housing (including hospital, jail, prison, juvenile detention, long-term care facility, nursing home, or drug treatment facility)	5
O_COUCH	Other peoples’ homes for a short period of time (also called couch surfing)	6
O_CAR	A place other than a home (including a car, on the street, or under a bridge)	7
O_PNTR	Prefer not to respond	99

Transition: The next question asks about being harassed by police or law enforcement. Being harassed could include physical aggression, threats, intimidation, or name calling.

Police harassment and incarceration. (YBDX)

O.5	Police harassment (YBDX)
O_HARASS	In the 12 months before your diagnosis, were you ever harassed by police or law enforcement?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

O.6	Incarceration (YBDX)
O_JAIL	In the 12 months before your diagnosis, were you held in a detention center, jail, or prison for more than 24 hours?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Violence (YBDX)

O.7	Physical violence (YBDX)
O_PHYSICAL	In the 12 months before your diagnosis, did anyone slap, punch, shove, kick, shake, or otherwise physically hurt you?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

O.8	Sexual violence (YBDX)
O_SEXUALV	In the 12 months before your diagnosis, did anyone pressure you to have sex when you did not want to?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

O.9	Psychological/emotional violence (YBDX)
O_EMOTION	In the 12 months before your diagnosis, did anyone swear at you, insult you, or put you down?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If O.7 = ‘Yes’ [1] OR O.8 = ‘Yes’ [1] OR O.9=’Yes’ [1] then GO to O.10 (and referral to domestic violence services) ELSE GO to P.1

Transition: The next question asks about domestic violence services. For example, information or other related services received in person, by phone, or online.

O.10	Receive domestic violence services
O_DOMESTIC	In the 12 months before your diagnosis, did you receive domestic violence services?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

P. Risk Behaviors

Transition: The next question asks about treatment for alcohol use. By treatment, we mean you participated in a program or took medicine to treat your alcohol use before your diagnosis. This includes outpatient, inpatient, residential, detox, or a 12-step program. This does not include treatment for drug use.

P.1	Seek alcohol services
P_TREAT	Before your diagnosis, did you ever get treatment for alcohol use? [DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Q. Non-injection drug use:

Transition: Now we would like to ask about experiences you may have had with drugs that you did NOT inject. This includes times that you have smoked, snorted, inhaled, or ingested drugs, such as methamphetamine or cocaine. This also includes prescription drugs like benzodiazepines or painkillers, such as Oxycontin, that were NOT prescribed to you or that you used in a way other than instructed by your healthcare provider. Feel free to skip any questions that you are not comfortable answering.

Q.1	Ever use non-injection drugs
Q_NONINJ	Before your diagnosis, had you ever used any drugs that you did NOT inject?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If Q.1 = ‘Yes’ [1] then GO to Q.2 ELSE GO to R.1

Q.2	Ever use non-injection drugs (YBDX)
Q_NIJP12	In the 12 months before your diagnosis, from [MONTH/YEAR to MONTH/YEAR2], did you use any drugs that you did NOT inject?
	Programming note: Populate diagnosis dates [Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If Q.2 = ‘Yes’ [1] then GO to Q.3 ELSE GO to R.1

Q.3	Type of non-injection drug use
	In the 12 months before your diagnosis, which drugs did you use that you did NOT inject? [WB: Select all that apply] [IA: Answer yes or no for each response] Programming note: Randomize responses 1-11
Q_MARIJ	Marijuana	1
Q_METH	Methamphetamine, also known as meth or speed	2
Q_CRACK	Crack cocaine	3
Q_COCO	Powder cocaine	4
Q_BENZO	Benzodiazepines or other downers such a Valium, Xanax, or Klonopin	5
Q_OXY	Painkillers, such as Oxycontin, Dilaudid, or Percocet	6
Q_MDMA	Molly or ecstasy (MDMA)	7
Q_ACID	Acid, LSD, or other hallucinogens	8
Q_HEROIN	Heroin	9
Q_FENTAN	Fentanyl, by itself or in combination with other drugs	10
Q_ADDERAL	Adderall, Ritalin, or other commonly prescribed stimulants	11
Q_OTR96	Another type of drug	96
Q_PNTR	Prefer not to respond	99

Skip Pattern

If Q.3 = ‘Another type of drug’ [96] then GO to Q.3a ELSE GO to R.1

Q.3a	Other non-injection drug use (YBDX)
Q_OTR96B	What is the other type of drug?
	________________________ Interviewer note: Type in a text response

R. Injection drug use

Transition: Now we would like to ask about experiences you may have had with injecting drugs. This means injecting drugs yourself or having someone who is not a healthcare provider inject you with a needle, either in your vein, under the skin, or in the muscle. This includes prescription drugs that were NOT prescribed to you or that you used in a way other than instructed by your healthcare provider.

Feel free to skip any questions that you are not comfortable answering.

R.1	Ever inject drugs
R_INJECT	Before your diagnosis, had you ever shot up or injected any drugs other than those prescribed for you?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If R.1 = ‘Yes’ [1] then GO to R.2 ELSE GO to S.1

R.2	Ever use injection drugs
R_INJP12	In the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2], had you shot up or injected any drugs other than those prescribed for you?
	Programming note: Populate diagnosis dates [Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If R.2 = ‘Yes’ [1] then GO to R.3 ELSE GO to S.1

R.3	Type of injection drug use In the 12 months before your diagnosis, which drugs did you inject? [WB: Select all that apply] [IA: Answer yes and no for each response] Programming note: Randomize responses 1-11
R_SPEEDBALL	Speedball, which is heroin and cocaine together	1
R_GOOFBALL	Heroin and methamphetamine together, such as goofball	2
R_FENTANYL	Fentanyl, by itself or in combination with other drugs	3
R_HEROIN	Heroin, by itself	4
R_METH	Methamphetamine, by itself, also known as meth or speed	5
R_COCO	Powder cocaine, by itself	6
R_CRACK	Crack cocaine, by itself	7
R_OXY	Painkillers, such as Oxycontin, Dilaudid, or Percocet	8
R_BENZO	Benzodiazepines or other downers such a Valium, Xanax, or Klonopin	9
R_METHAD	Methadone	10
R_BUPREN	Buprenorphine, also known as Suboxone or Subutex	11
R_OTR96	Another type of drug	96
R_PNTR	Prefer not to respond	99

Skip Pattern

If R.3 = ‘Another type of drug’ [96] then GO to R.3a ELSE GO to S.1

R.3a	Other injection drug use
R_OTR96B	What is the other type of drug?
	________________________ Interviewer note: Type in a text response

S. Experiences when using drugs

Skip Pattern

If Q.1 = ‘Yes’ [1] OR R.1 = ‘Yes’ [1] then GO to S.1 ELSE GO to T.1

Transition: The next few questions ask about your experiences when using drugs.

S.1	In the 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2], did you receive supplies or services from any of the following places or people: [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Populate diagnosis dates and randomize responses 1-6
S_SSP	Syringe services program or needle exchange program	1
S_PHARM	Pharmacy or drug store	2
S_DOC	Doctor’s office, clinic, or hospital	3
S_FRIEND	Friend, relative, or sex partner	4
S_DEALER	Needle dealer, drug dealer, shooting gallery, or off the street	5
S_ONLINE	Online or through the mail	6
S_OTHER95	Some other place or person	95
S_PNTR	Prefer not to respond	99

S.2	Patient out to provider – PWID (BDX)
S_HCUSED	Before your diagnosis, did you share with a healthcare worker that you used non-injection or injection drugs not prescribed by a doctor, such as methamphetamines, cocaine, or heroin?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Transition: The next question asks about treatment for drug use. By treatment, we mean you participated in a program or took medicine to treat your drug use before your diagnosis. This includes outpatient, inpatient, residential, detox, or a 12-step program. This does not include treatment for alcohol use.

S.3	Seek drug use services
S_TREAT	Before your diagnosis, did you ever get treatment for drug use?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Drug use stigma scale

Skip Pattern

If Q.2 = ‘Yes’ [1] OR R.2 = ‘Yes’ [1] then GO to S.4 ELSE GO to T.1

Transition: The following questions ask how you felt about your drug use. Feel free to skip any questions that you are not comfortable answering.

S.4	Doubt character or judge
S_JUDGE	Before your diagnosis, did you think people would doubt your character or judge you because you used drugs?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

S.6	Ashamed
S_ASHAM	Before your diagnosis, did you ever feel shame about using drugs?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

PWID Barriers for HIV Prevention

Skip Pattern

If R.1 = ‘Yes’ [1] then GO to S.7 ELSE GO to T.1

Transition: The next two questions are about your experiences with law enforcement or police.

S.7	Police confiscate needles (inject equipment)
S_CONFISC	Before your diagnosis, did law enforcement or police ever take or destroy your needles or other injection equipment?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

S.8	Police prevent access to SSPs
S_ACCESS	Before your diagnosis, did law enforcement or police ever keep you from getting syringes or other injection equipment from a syringe service program or needle exchange program?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

T. Behaviors

Transition: The next set of questions ask about your behaviors 12 months before your diagnosis, from [MONTH/YEAR] to [MONTH/YEAR2]. Feel free to skip any questions that you are not comfortable answering.

Programming note: Populate diagnosis date

Skip Pattern

If B.9 = “Men” [1] or B.9= “Women” [2] or B.9= “Transgender men” [3] or B.9=”Transgender women” [4] or B.9=“People with some other gender identity” [95] then GO to T.1 If B.9 = ”I did not have sex with anyone in the 12 months before my diagnosis” then GO to T.4 ELSE GO to T.4

T.1	Number of partners vaginal and anal sex (YBDX)
T_PARTNER	In the 12 months before your diagnosis, approximately how many different partners do you remember having vaginal or anal sex with? Only include people 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. [WB: Please enter a whole number. If less than 1 partner, please enter [0]. If you don’t know the exact number, please give us your best estimate] [Interviewer Note: DO NOT READ: Enter a whole number. If respondent indicates less than 1 partner, please enter [0]. Probe: If you don’t know the exact number please give us your best estimate]
	Programming note: Valid range: 1-9,999 ; Integers only; do not allow text
	Number of partners __________________
	Prefer not to respond	99999

T.2	Condomless sex (YBDX)
T_CONDLESS	In the 12 months before your diagnosis, how often did you or your partner(s) use a condom when you had vaginal or anal sex? [WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one
	Never	1
	Sometimes	2
	Mostly	3
	Always	4
	Don’t know	98
	Prefer not to respond	99

T.3	Transactional sex YBDX
T_MONEY	In the 12 months before your diagnosis, did you receive money, drugs, or some other type of payment or trade for sex? What we mean by sex, is oral, anal, or vaginal sex.
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

T.4	Free condoms
T_FREECOND	In the 12 months before your diagnosis, did you get any free condoms?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If T.4 = ‘Yes’ [1] then GO to T.5 ELSE GO to END OF SURVEY

T.5	Location of free condoms
	In the 12 months before your diagnosis, did you get free condoms from any of these places or people? [WB: Select all that apply] [IA: Answer yes or no for each response]
	Programming note: Randomize responses 1 -14
T_DOCTOR	Regular doctor’s office	1
T_CLINIC	Another type of clinic like a local health department clinic, STD clinic, or family planning clinic	2
T_ER	Hospital, emergency room, or other inpatient clinic	3
T_PHARM	Pharmacy	4
T_COMMUN	A community organization	5
T_VAN	A mobile testing unit like a van or RV	6
T_FESTIVAL	A public gathering like a festival, fair, bar, or night club	7
T_FAITH	Faith-based organization, for example, church or temple	8
T_SSP	Syringe services program or needle exchange program	9
T_JAIL	Correctional facility (jail or prison)	10
T_FRIEND	A friend or family member	11
T_SEXPART	A person you had or have sex with	12
T_ONLINE	Online	13
T_URGENT	Urgent care or walk-in clinic	14
T_OTR96	Another place or person	96
T_PNTR	Prefer not to respond	99

Skip Pattern

If T.5 = ‘Another place’ [96] then GO to T.5a ELSE GO to END OF SURVEY

T.5a	Other location of condoms
T_OTR96B	What is the other place or person?
	________________________ Interviewer note: Type in a text response

End of Risk Behaviors Section

CALC_S_TIME2	End time of core survey. Automatic hidden variable.
S_TIME2	Respondent end time
	__ : __

U. Local Questions (up to 5 minutes):

Local_Time_Start	Start time of local questions. Automatic hidden variable.
	Respondent Start time
LOCAL_START	__ : __

Skip Pattern

If INTRO.7= ‘1’ [Florida] then GO to LQ_FL.1 (transition statement starting section) ELSE if INTRO.7 = ‘2’ [Louisiana] then GO to LQ_LA.1 (transition statement starting section) ELSE if INTRO.7 = ‘3’ [Michigan] then GO to MI_INTRO1 (transition statement starting section) ELSE if INTRO.7 = ‘4’ [Houston, TX] then GO to LQ_TX.1 (transition statement starting section)

FLORIDA LOCAL QUESTIONS

Transition: We have reached the last part of the survey. The final set of questions can help improve HIV services in Florida. This should take no more than 5 minutes.

LQ_FL.1	Condom prevent STI
FL_PREVENT	Are you aware that using condoms can help prevent you from getting a sexually transmitted infection?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

LQ_FL.2	Resistance to medications
FL_RESIST	Are you aware that getting a sexually transmitted infection can result in a rise in your HIV viral load that could cause you to develop resistance to your HIV medications?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

LQ_FL.3	Hepatitis A vaccine
FL_HEPA	Have you been vaccinated for hepatitis A?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_FL.4	Hepatitis B
FL_HEPB1	Do you have chronic active hepatitis B?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If LQ_FL.4 = ‘Yes’ [1] then GO to LQ_FL.4a ELSE GO to LQ_FL.5

LQ_FL.4a	Hepatitis B vaccine
FL_HEPB2	Have you been vaccinated for hepatitis B?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_FL.5	Hepatitis C
FL_HEPC	Do you have chronic active hepatitis C?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	No	0
	Yes	1
	Not currently, was treated	2
	Don’t know	98
	Prefer not to respond	99

LQ_FL.6	Current marijuana
FL_MARIJUANA	Do you currently use marijuana?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If LQ_FL.6 = ‘Yes’ [1] then GO to LQ_FL.6a ELSE GO to LQ_FL.7

LQ_FL.6a	How use marijuana
FL_HOWUSE	Do you currently use marijuana recreationally or with a medical prescription?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	Recreationally	1
	With a medical prescription	2
	Prefer not to respond	99

LQ_FL.6b	Why use marijuana
	What are the primary reasons you use marijuana?
	[WB: Select all that apply] [IA: Answer yes or no for each response]
FL_MJRELAX	To relax or reduce stress	1
FL_MJAPP	To increase appetite	2
FL_MJSLEEP	To induce sleep	3
FL_MJRELIEVE	To relieve pain	4
FL_MJHIGH	To get high	5
FL_OTRMJ	Another reason	96
	Prefer not to respond	99

Skip Pattern

If LQ_FL.6b = ‘Another reason’ [96] then GO to LQ_FL.6c ELSE GO to LQ_FL.7

LQ_FL.6c	Another reason_Why use marijuana
FL_OTR96A	What is the other reason?
	________________________ Interviewer note: Type in a text response

LQ_FL.7	Prescribed medical marijuana
FL_PRESCRIBE	Have you been prescribed medical marijuana, but could not fill the prescription?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If LQ_FL.7 = ‘Yes’ [1] then GO to LQ_FL.7a ELSE GO to LQ_FL.8

LQ_FL.7a	Why not prescription
	Why were you not able to fill the prescription?
	[WB: Select all that apply] [IA: Answer yes or no for each response]
FL_NOTCOV	Insurance did not cover the prescription	1
FL_NOMONEY	Did not have the money to pay for the prescription	2
FL_NOGO	Did not have transportation to go fill the prescription	3
FL_NOWHERE	Did not know where to fill the prescription	4
FL_NOBELIEF	It was against your beliefs	5
	Another reason	96
	Prefer not to respond	99

Skip Pattern

If LQ_FL.7a = ‘Another reason’ [96] then GO to LQ_FL.7b ELSE GO to LQ_FL.8

LQ_FL.7b	Another reason_Why not prescription
FL_OTR96B	What is the other reason?
	________________________ Interviewer note: Type in a text response

LQ_FL.8	Cell phone
FL_PHONE	Do you currently own and use a cell phone?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If LQ_FL.8 = ‘Yes’ [1] then GO to LQ_FL.9 ELSE GO to LQ_FL.10

LQ_FL.9	Data plan
FL_DATA	Do you have a data plan on your phone?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If LQ_FL.9 = ‘Yes’ [1] then GO to LQ_FL.9a ELSE GO to LQ_FL.10

LQ_FL.9a	Type of data plan
FL_PLANTYPE	What type of data plan do you have?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	Limited data	1
	Unlimited data	2
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If LQ_FL.9 = ‘Yes’ [1] then GO to LQ_FL.9b ELSE GO to LQ_FL.10

Transition: Telehealth is a service allowing patients to have face-to-face visits with their healthcare teams over a confidential private internet connection. Please answer yes or no for each of the following questions.

LQ_FL.9b	Telehealth use
FL_TELEHEALTH1	Would you use telehealth to visit with a healthcare practitioner?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

LQ_FL.9c	Telehealth use
FL_TELEHEALTH2	Would you use telehealth to visit with a case manager?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

LQ_FL.9d	Telehealth use
FL_TELEHEALTH3	Would you use telehealth to visit with an ADAP service provider?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

LQ_FL.10	Genotype test
FL_GENOTYPE	Have you ever received a genotype test, also known as a resistance test, to determine if you have any resistance to your HIV medications?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

LQ_FL.11	Molecular HIV surveillance
FL_MHS	Have you ever heard of the public health activity referred to as Molecular HIV Surveillance, or MHS?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

LQ_FL.12	Ending the HIV Epidemic
FL_EHE	Have you engaged or been involved in any community discussions around ending the HIV epidemic in Florida?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

HOUSTON LOCAL QUESTIONS

Transition: The following questions ask how you feel about your quality of life, health, and other areas of your life. Feel free to skip any questions that you are not comfortable answering.

LQ_HTX.1 HTX_GHLTH	[WB: In general, how would you rate your health?] [IA: Looking at Response Card I, in general, how would you rate your health?] Interviewer note: Use Response Card I. DON’T READ RESPONSES. Select only one.
	Poor	1
	Fair	2
	Good	3
	Very good	4
	Excellent	5
	Prefer not to respond	99

LQ_HTX.2
HTX_PHLTH	Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
	Programming note: Valid range: 1-30 ; Integers only; do not allow text
	Number of days _ _
	None	94
	Prefer not to respond	99

LQ_HTX.3
HTX_MHLTH	Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
	Programming note: Valid range: 1-30 ; Integers only; do not allow text
	Number of days _ _
	None	94
	Prefer not to respond	99

LQ_HTX.4
HTX_PMHLTH	During the past 30 days, for how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?
	Programming note: Valid range: 1-30 ; Integers only; do not allow text
	Number of days _ _
	None	94
	Prefer not to respond	99

Transition: Now we would like to ask a few questions about the social and emotional supports that you received from your family, relatives, or friends.

LQ_HTX.5
HTX_EMSUPORT	Can you count on anyone to provide you with emotional support such as talking over problems or helping you make a difficult decision?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	No	0
	Yes	1
	Do not need emotional support right now	2
	Prefer not to respond	99

Skip Pattern

If LQ_HTX.5 = ‘Yes’ [1] then GO to LQ_HTX.6 ELSE GO to LQ_HTX.7

LQ_HTX.6
HTX_HELPSUPP
	[WB: In the last 12 months, who has been the most helpful in providing you with emotional support? Select only one.] [IA: Looking at Response Card J, please tell me, in the last 12 months, who has been the most helpful in providing you with emotional support?] Interviewer note: Use Response Card J. DON’T READ RESPONSES. Select only one.
	Spouse	1
	Child	2
	Sibling	3
	Parent	4
	Other relatives	5
	Neighbors	6
	Co-workers	7
	Church members	8
	Professionals	9
	Friends	10
	No one	11
	Other	95
	Don’t know	98
	Prefer not to respond	99

LQ_HTX.7
HTX_EMSUPUSE	In the last 12 months, could you have used more emotional support than you received?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	No	0
	Yes	1
	Did not need emotional support in the last 12 months	2
	Don’t know	98
	Prefer not to respond	99

Skip Pattern

If LQ_HTX.7 = ‘Yes’ [1] then GO to LQ_HTX.8 ELSE GO to LQ_HTX.9

LQ_HTX.8
HTX_MORESUPP	How much more emotional support would you have liked to receive?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	A little	1
	Some	2
	A lot	3
	Don’t know	98
	Prefer not to respond	99

LQ_HTX.9
HTX_SCOWSICK	Is there someone you could count on to help you if you were sick, for example, to take you to the doctor or help you with daily chores?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	No	0
	Yes	1
	Yes, but you would not accept help	2
	Prefer not to respond	99

LQ_HTX.10
HTX_SEHFINAN	If you need some extra help financially, could you count on anyone to help you, for example, by paying bills, housing costs, medical expenses, or providing you with food or clothes?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	No	0
	Yes	1
	Yes, but you would not accept help	2
	Prefer not to respond	99

Transition: The following few questions are concerned with your personal beliefs and how they affect your quality of life. These questions refer to religion, spirituality, and any other beliefs you now hold. These questions refer to the last two weeks.

LQ_HTX.11
HTX_PBELIEFS	Do your personal beliefs give meaning to your life?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	Not at all	1
	A little	2
	A lot	3
	Prefer not to respond	99

LQ_HTX.12
HTX_PBSTRENG	To what extent do your personal beliefs give you the strength to face difficulties?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	Not at all	1
	A little	2
	A lot	3
	Prefer not to respond	99

LQ_HTX.13
HTX_BOTHERED	How much are you bothered by people blaming you for your HIV status?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	Not at all	1
	A little	2
	A lot	3
	Prefer not to respond	99

LQ_HTX.14
HTX_EXTGUILTY	To what extent do you feel guilty when you need the help and care of others?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	Not at all	1
	A little	2
	A lot	3
	Prefer not to respond	99

LQ_HTX.15
HTX_FATEDEST	To what extent are you bothered by any feelings that you are suffering from fate or destiny?
	[WB: Select only one] [IA: I will read all responses and you will select one] Interviewer note: Read all response options first, then allow participant to select one.
	Not at all	1
	A little	2
	A lot	3
	Prefer not to respond	99

LOUSIANA LOCAL QUESTIONS

Transition: The next few questions ask about how you deal with hardship.

LQ_LA.1 – LQ_LA.2	[WB: Please share how much you agree or disagree with the following statements.] [IA: Looking at Response Card K, please tell me how much you agree or disagree with the following statements.]
	Interviewer note: Use Response Card K. DON’T READ RESPONSES. Select only one.
	Not true at all	1
	Rarely true	2
	Sometimes true	3
	Often true	4
	True nearly all of the time	5
	Don’t know	98
	Prefer not to respond	99

LQ_LA.1	LA_BOUNCE	I tend to bounce back after illness, injury, or other hardships.
LQ_LA.2	LA_ADAPT	I am able to adapt when changes occur.

Transition: The next few questions ask about how you have been feeling in the past 30 days.

LQ_LA.3 – LQ_LA.8	[WB: About how often during the past 30 days did you feel each of the following:] [IA: Looking at Response Card L. please tell me about how often during the past 30 days you felt each of the following:]
	Interviewer note: Use Response Card L. DON’T READ RESPONSES. Select only one.
	All of the time	1
	Most of the time	2
	Some of the time	3
	A little of the time	4
	None of the time	5
	Don’t know	98
	Prefer not to respond	99

LQ_LA.3	LA_NERVOUS	Nervous
LQ_LA.4	LA_HOPELESS	Hopeless
LQ_LA.5	LA_RESTLESS	Restless or fidgety
LQ_LA.6	LA_DEPRESS	So depressed that nothing could cheer you up
LQ_LA.7	LA_EFFORT	That everything was an effort
LQ_LA.8	LA_WORTH	Worthless

MICHIGAN LOCAL QUESTIONS

Transition (MI_INTRO1): We would like to ask some questions about your interactions with health department staff at the time you received your HIV test results.

LQ_MI.1	Notify partners
MI_NOTIFY	The last time you received a positive HIV or STI result, did you talk to someone from the health department, a physician, or facility staff about the ways to notify your sex partners?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If LQ_MI.1 = ‘Yes’ [1] then GO to LQ_MI.2 ELSE GO to LQ_MI.3

LQ_MI.2	Notify explain
MI_EXPLAIN	Were the ways to notify your sex partners clearly explained to you?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Transition (MI_INTRO2): Next, we will ask some questions about your access to HIV care and the type of facility where you may be receiving treatment for HIV.

LQ_MI.3	Referred HIV care facility
MI_REFFAC
	[WB: What type of facility were you referred to for HIV care after you received your HIV test results? Select only one.] [IA: We will use Response Card M for this next question. What type of facility were you referred to for HIV care after you received your HIV test results?] Interviewer note: Use Response Card M. DON’T READ RESPONSES. Select only one.
	Primary care clinic	1
	Clinic specializing in HIV treatment	2
	Public health department clinic or STI clinic	3
	Urgent care or walk-in clinic	4
	Hospital or emergency room	5
	Community organization	6
	Veterans Health Administration facility	7
	Correctional facility (jail or prison)	8
	Was not referred anywhere for HIV care	9
	Another place	96
	Prefer not to respond	99

Skip Pattern

If LQ_MI.3 = ‘Another place’ [96] then GO to LQ_MI.3a ELSE GO to LQ_MI.4

LQ_MI.3a	Another place_HIV care facility
MI_OTRFAC96A	What is the other place?
	________________________ Interviewer note: Type in a text response

Transition (MI_INTRO3): Now we will ask about whether you got help getting connected to HIV care from healthcare workers or healthcare staff. Healthcare workers might include a doctor, nurse practitioner, physician assistant, or pharmacist. Healthcare staff might include a receptionist, patient advocate, or interpreter.

LQ_MI.4	Ask need help
MI_NEEDHELP	Within 30 days of testing positive, did healthcare workers or staff ask if you needed help finding a place to go for HIV care?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_MI.5	Qualify help
MI_QUALIFY	Within 30 days of testing positive, did healthcare workers or staff help you figure out if you qualified for free or low-cost HIV care?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_MI.6	Make appointment
MI_MAKEAPPT	Within 30 days of testing positive, did healthcare workers or staff make an appointment for you to receive HIV care?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_MI.7	Arrange transportation
MI_TRANSPORT	Within 30 days of testing positive, did healthcare workers or staff arrange transportation for you to an HIV care appointment?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_MI.8	Reminder contact
MI_REMIND	Within 30 days of testing positive, did healthcare workers or staff contact you to remind you of your first HIV care appointment?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_MI.9	Go with you
MI_GOWITH	Within 30 days of testing positive, did healthcare workers or staff go with you to your first HIV care appointment?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Don’t know	98
	Prefer not to respond	99

LQ_MI.10	Currently see for HIV care
MI_CURRSEE	Are you currently seeing a doctor, nurse, or other healthcare worker for HIV care?
	[Interviewer note: DON’T READ RESPONSES. SELECT ONLY ONE.]
	No	0
	Yes	1
	Prefer not to respond	99

Skip Pattern

If LQ_MI.10 = ‘Yes’ [1] then GO to LQ_MI.11 ELSE GO to LQ_MI.13

LQ_MI.11	Current HIV care facility
MI_CURRFAC
	[WB: At what type of facility are you receiving care for HIV? Select only one.] [IA: Looking at Response Card N, please tell me at what type of facility are you receiving care for HIV?] Interviewer note: Use Response Card N. DON’T READ RESPONSES. Select only one.
	Primary care clinic	1
	Clinic specializing in HIV treatment	2
	Public health department clinic or STI clinic	3
	Urgent care or walk-in clinic	4
	Hospital or emergency room	5
	Community organization	6
	Veterans Health Administration facility	7
	Correctional facility (jail or prison)	8
	Another place	96
	Prefer not to respond	99

Skip Pattern

If LQ_MI.11 = ‘Another place’ [96] then GO to LQ_MI.11a ELSE GO to LQ_MI.13

LQ_MI.11a	Another place_HIV care facility
MI_OTRFAC96B	What is the other place?
	________________________ Interviewer note: Type in a text response

Skip Pattern

If LQ_MI.10 = ‘Yes’ [1] then GO to LQ_MI.12 ELSE GO to LQ_MI.13

LQ_MI.12	Mode of transportation
MI_MODE	[WB: In the last 12 months, what type of transportation did you use most often for HIV care? Select only one] [IA: Looking at Response Card O, please tell me, in the last 12 months, what type of transportation did you use most often for HIV care?]
	Interviewer note: Use Response Card O. DON’T READ RESPONSES. Select only one.
	Drove myself	1
	Friend or family member drove me	2
	Uber, Lyft, taxi, or hired driver	3
	Agency or insurance provided transportation	4
	Bus or other public transportation	5
	Walk or bike	6
	Don’t know	98
	Prefer not to respond	99

Transition (MI_INTRO4): Now we will ask you some questions about access to HIV-related services in your area.

LQ_MI.13	Access resources
	Which of the following services in your area are you able to get to if you needed help?
	[WB: Select all that apply] [IA: Answer yes or no for each response]
MI_RESHIV	HIV-related medical care	1
MI_RESINSR	Health insurance or co-pay assistance	2
MI_RESMEDS	Help with starting HIV medications	3
MI_RESPAY	Help with paying for HIV medications	4
MI_RESDNTL	A dental provider	5
MI_RESASSIST	Shelter or housing assistance	6
MI_RESDRUG	Drug or alcohol counseling or treatment	7
MI_RESDVS	Domestic violence services	8
MI_RESFOOD	Food assistance or SNAP	9
MI_RESMEAL	Meal or food services	10
MI_RESPEER	Peer or group support	11
MI_RESHLTH	Mental health support or counseling	12
MI_RESPREG	Support during or after pregnancy	13
MI_RESTRNP	Transportation assistance	14
	Prefer not to respond	99

Local_Time_End	End time of local questions. Automatic hidden variable.
	Respondent End time
LOCAL_STOP	__ : __

END.1 “Thank you again for taking part in this interview. Please remember that all the information you have given me will be kept confidential”.

TOKEN OF APPRECIATION AND REFERRALS

Now we can discuss how to give you your token of appreciation for participating in the health survey, as well as talk to you about medical or support services you might need.

Interviewer instructions: provide the referrals if participant meets specified criteria:

If F.12 = ‘No’ [0] then offer referral to HIV care

If G.1 = ‘No’ [0] then offer referral to STD testing

If G.2 = ‘No’ [0] then offer referral to STD testing

If O.1 = ‘Yes’ [1] then offer referral to suicide hotline and local employment resources

If O.2 = ‘No’ [0] then offer referral to local health insurance resources or healthcare.gov

If O.4 in (4, 5, 6, or 7) then offer referral to suicide hotline and local housing resources

If O.5 = ‘Yes’ [1] then offer referral to suicide hotline and local or national general counseling for mental health

If O.6 = ‘Yes’ [1] then offer referral to suicide hotline and local resources for transitioning out from jail/prison

If O.7 = ‘Yes’ [1] OR O.8 = ‘Yes’ [1] OR O.9=’Yes’ [1] then offer referral to domestic violence services and suicide hotline and sexual abuse services and general counseling for mental health

********************************Call ends here ***********************************************

ICF, could the interviewer circle back with the project area staff and let them know what referrals have been provided to each participant?

RESPONSE CARDS

Response Card A

1. Never attended school

2. Grades 1 through 8

3. Grades 9 through 12

4. High school graduate or GED

5. Some college, but did not complete degree

6. Technical, Vocational, or Associate’s degree

7. Bachelor’s degree

8. Any post-graduate studies

Response Card B

1) Working full-time, 35 hours or more a week (includes self-employment)

2) Working part-time, less than 35 hours a week (includes self-employment)

3) Stay-at-home parent, caregiver, or partner

4) Full-time student

5) Unemployed, out of work less than a year

6) Unemployed, out of work more than a year

7) Retired

8) Disabled and not able to work

9) Not able to work for some other reason

Response Card C

Monthly Income

1. $0 to $1,666 per month

2. $1,667 to $2,083 per month

3. $2,084 to $2,499 per month

4. $2,500 to $3,333 per month

5. $3,334 to $4,166 per month

6. $4,167 to $6,249 per month

7. $6,250 or more per month

8. Don’t know

Response Card D

Yearly Income

1. $0 to $19,999 per year

2. $20,000 to $24,999 per year

3. $25,000 to $29,999 per year

4. $30,000 to $39,999 per year

5. $40,000 to $49,999 per year

6. $50,000 to 74,999 per year

7. $75,000 or more per year

8. Don’t know

Response Card E

1. Regular doctor’s office

2. Another type of clinic like a local health department clinic, STD clinic, or family planning clinic

3. Urgent care or walk-in clinic

4. Hospital, emergency room, or other inpatient setting

5. Pharmacy

6. A community organization

7. A mobile testing unit like a van or RV

8. A public gathering like a festival, fair, bar, or night club

9. Faith-based organization, for example, church or temple

10. Syringe services program or needle exchange program

11. Correctional facility (jail or prison)

12. At home using a self-test or self-collection kit

13) Another place

Response Card F

1. Every 3 months or more often

2. Every 6 months

3. Yearly

4. Once every few years

5. Once in your lifetime

6. Don’t know

Response Card G

1. Strongly disagree

2. Somewhat disagree

3. Neutral

4. Somewhat agree

5. Strongly agree

6. Don’t know

Response Card H

1. A private health plan – through an employer or purchased directly

2. Medicaid – for people with low incomes

3. Medicare – for the elderly and people with disabilities

4. Indian Health Service

5. Health insurance through healthcare.gov or Obamacare

6. City, county, state, or other publicly funded insurance, not including Medicaid

7. TRICARE, CHAMPUS, CHAMPVA, or Veterans Administration

8. Some other health insurance

9. Don’t know

Response Card I

1. Poor

2. Fair

3. Good

4. Very good

5. Excellent

Response Card J

1. Spouse

2. Child

3. Sibling

4. Parent

5. Other relatives

6. Neighbors

7. Co-workers

8. Church members

9. Professionals

10. Friends

11. No one

12. Other

13. Don’t know

Response Card K

1. Not true at all

2. Rarely true

3. Sometimes true

4. Often true

5. True nearly all of the time

6. Don’t know

Response Card L

1. All of the time

2. Most of the time

3. Some of the time

4. A little of the time

5. None of the time

6. Don’t know

Response Card M

1. Primary care clinic

2. Clinic specializing in HIV treatment

3. Public health clinic or STI clinic

4. Urgent care or walk-in clinic

5. Hospital or emergency room

6. Community organization

7. Veterans Health Administration facility

8. Correctional facility (jail or prison)

9. Was not referred anywhere for HIV care

10. Another place

Response Card N

1. Primary care clinic

2. Clinic specializing in HIV treatment

3. Public health clinic or STI clinic

4. Urgent care or walk-in clinic

5. Hospital or emergency room

6. Community organization

7. Veterans Health Administration facility

8. Correctional facility (jail or prison)

9. Another place

Response Card O

1. Drove myself

2. Friend or family member drove me

3. Uber, Lyft, taxi, or hired driver

4. Agency or insurance provided transportation

5. Bus or other public transportation

6. Walk or bike

7. Don’t know