2024 Programming Questionnaire - English

2024 Programming Questionnaire
| Version 24.0.0

OMB No: 0920-0740

Expiration: XX.XX.XXXX

Public reporting burden of this collection of information is estimated to average 40 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it displays a currently
valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to: CDC, Project Clearance Officer, 1600
Clifton Road, MS D–74, Atlanta, GA 30329, ATTN: PRA (0920–0740). Do not send the completed form to this
address.

CS328379-A

Table of Contents

.............................................................................................................................................................................1
RECRUITMENT (Z)
.............................................................................................................................................................................
Preparation (ZP)
1
.............................................................................................................................................................................
Confidential space (ZS)
2
.............................................................................................................................................................................
Confirmation (ZC)
3
.............................................................................................................................................................................
Age (ZA)
3
.............................................................................................................................................................................
Residence at Sampling Date (ZR)
4
.............................................................................................................................................................................
Current residence (ZE)
6
.............................................................................................................................................................................
Diagnosis (ZD)
7
.............................................................................................................................................................................
Willingness (ZW)
8
.............................................................................................................................................................................
CONSENT (O)
10
.............................................................................................................................................................................
Consent (OC)
10
.............................................................................................................................................................................
PRELIMINARY INFORMATION (I)
13
.............................................................................................................................................................................
Prior to interview (IP)
13
.............................................................................................................................................................................
Introduction (IN)
16
.............................................................................................................................................................................
ELIGIBILITY CRITERIA (Y)
17
.............................................................................................................................................................................
MMP participation (YM)
17
.............................................................................................................................................................................
Residence (YS)
19
.............................................................................................................................................................................
Age (YA)
23
.............................................................................................................................................................................
BASIC DEMOGRAPHICS (D)
24
.............................................................................................................................................................................
Education (DE)
24
.............................................................................................................................................................................
Race-ethnicity (DR)
24
.............................................................................................................................................................................
Gender and sexual orientation (DG)
26
.............................................................................................................................................................................
Language ability (DL)
27
.............................................................................................................................................................................
U.S. born (DF)
28
.............................................................................................................................................................................
Incarceration (DJ)
28
.............................................................................................................................................................................
Homeless (DH)
29
.............................................................................................................................................................................
DISABILITY (A)
31
.............................................................................................................................................................................
Disability (AD)
31
.............................................................................................................................................................................
FINANCIAL (F)
33
.............................................................................................................................................................................
Employment (FE)
33
.............................................................................................................................................................................
Income (FI)
33
.............................................................................................................................................................................
Food security (FS)
34
.............................................................................................................................................................................
Healthcare coverage (FH)
34
.............................................................................................................................................................................
GENERAL MEDICAL CARE (J)
37
.............................................................................................................................................................................
Health and well-being (JW)
37
.............................................................................................................................................................................
ER and hospitalizations (JH)
37
.............................................................................................................................................................................
Influenza (JF)
37
.............................................................................................................................................................................
Health literacy (JL)
38
.............................................................................................................................................................................
HIV CARE (K)
39
.............................................................................................................................................................................
Diagnosis date (KD)
39
.............................................................................................................................................................................
Ever care (KE)
40

.............................................................................................................................................................................
Linkage to care (KL)
40
.............................................................................................................................................................................
Care utilization (KU)
42
.............................................................................................................................................................................
Patient-provider relationship (KB)
43
.............................................................................................................................................................................
Barriers and facilitators to care (KP)
43
.............................................................................................................................................................................
HIV TREATMENT AND ADHERENCE (T)
45
.............................................................................................................................................................................
Ever ART (TE)
45
.............................................................................................................................................................................
Current ART (TC)
47
.............................................................................................................................................................................
Adherence (TA)
48
.............................................................................................................................................................................
SEXUAL BEHAVIOR (S)
54
.............................................................................................................................................................................
Total sex partners (ST)
54
.............................................................................................................................................................................
Names of partners (SN)
56
.............................................................................................................................................................................
Partner demographics #1 (SP)
59
.............................................................................................................................................................................
Vaginal sex #1 (SV)
60
.............................................................................................................................................................................
Anal sex #1 (SL)
61
.............................................................................................................................................................................
Transgender and unknown gender sex #1 (SG)
62
.............................................................................................................................................................................
Status #1 (SS)
62
.............................................................................................................................................................................
Pre-exposure prophylaxis #1 (SR)
63
.............................................................................................................................................................................
Partner demographics #2 (SP)
63
.............................................................................................................................................................................
Vaginal sex #2 (SV)
65
.............................................................................................................................................................................
Anal sex #2 (SL)
66
.............................................................................................................................................................................
Transgender and unknown gender sex #2 (SG)
67
.............................................................................................................................................................................
Status #2 (SS)
67
.............................................................................................................................................................................
Pre-exposure prophylaxis #2 (SR)
68
.............................................................................................................................................................................
Partner demographics #3 (SP)
68
.............................................................................................................................................................................
Vaginal sex #3 (SV)
70
.............................................................................................................................................................................
Anal sex #3 (SL)
71
.............................................................................................................................................................................
Transgender and unknown gender sex #3 (SG)
72
.............................................................................................................................................................................
Status #3 (SS)
72
.............................................................................................................................................................................
Pre-exposure prophylaxis #3 (SR)
73
.............................................................................................................................................................................
Partner demographics #4 (SP)
73
.............................................................................................................................................................................
Vaginal sex #4 (SV)
75
.............................................................................................................................................................................
Anal sex #4 (SL)
76
.............................................................................................................................................................................
Transgender and unknown gender sex #4 (SG)
77
.............................................................................................................................................................................
Status #4 (SS)
77
.............................................................................................................................................................................
Pre-exposure prophylaxis #4 (SR)
78
.............................................................................................................................................................................
Partner demographics #5 (SP)
78
.............................................................................................................................................................................
Vaginal sex #5 (SV)
80
.............................................................................................................................................................................
Anal sex #5 (SL)
81
.............................................................................................................................................................................
Transgender and unknown gender sex #5 (SG)
82
.............................................................................................................................................................................
Status #5 (SS)
82
.............................................................................................................................................................................
Pre-exposure prophylaxis #5 (SR)
83
.............................................................................................................................................................................
Aggregate information (SA)
83

.............................................................................................................................................................................
VIOLENCE (B)
86
.............................................................................................................................................................................
Physical violence (BP)
86
.............................................................................................................................................................................
Forced Sex (BS)
86
.............................................................................................................................................................................
DEPRESSION AND ANXIETY (M)
87
.............................................................................................................................................................................
PHQ-4 screening questions (MD)
87
.............................................................................................................................................................................
PHQ-8 depression (MA)
88
.............................................................................................................................................................................
GAD-7 anxiety (MG)
89
.............................................................................................................................................................................
EMOTIONAL SOCIAL SUPPORT (V)
91
.............................................................................................................................................................................
Emotional social support (VS)
91
.............................................................................................................................................................................
ALCOHOL, SMOKING, AND DRUG USE (U)
92
.............................................................................................................................................................................
Alcohol use (UA)
92
.............................................................................................................................................................................
Smoking and vaping (US)
93
.............................................................................................................................................................................
Non-injection drug use (UN)
95
.............................................................................................................................................................................
Injection drug use (UI)
97
.............................................................................................................................................................................
STIGMA AND DISCRIMINATION (R)
101
.............................................................................................................................................................................
Stigma (RS)
101
.............................................................................................................................................................................
Discrimination (RD)
103
.............................................................................................................................................................................
GYNECOLOGICAL AND REPRODUCTIVE HISTORY (G)
105
.............................................................................................................................................................................
Gynecological care (GH)
105
.............................................................................................................................................................................
Family planning (GF)
106
.............................................................................................................................................................................
Reproductive history (GR)
108
.............................................................................................................................................................................
MET AND UNMET NEEDS (N)
112
.............................................................................................................................................................................
Services and assistance programs (ND)
112
.............................................................................................................................................................................
Other disability (NS)
122
.............................................................................................................................................................................
PREVENTION ACTIVITIES (P)
123
.............................................................................................................................................................................
Prevention messages (PM)
123
.............................................................................................................................................................................
Risk reduction (PR)
123
.............................................................................................................................................................................
HIV treatment as prevention (PB)
124
.............................................................................................................................................................................
INTERVIEW COMPLETION (E)
125
.............................................................................................................................................................................
End of interview (EE)
125
.............................................................................................................................................................................
Referrals and follow-up (EO)
125
.............................................................................................................................................................................
Data validity (EV)
129
.............................................................................................................................................................................
Local questions (EL)
129
.............................................................................................................................................................................
2023 CALENDAR
A-1
.............................................................................................................................................................................
2024 CALENDAR
B-1
.............................................................................................................................................................................
2025 CALENDAR
C-1
.............................................................................................................................................................................
RESPONSE CARDS
D-1

Page | 1

Module: Recruitment (Z)
Topic: Preparation (ZP)
R_INTIDN22
ZP.1.0.
Label_R_INTIDN22
RANGE_R_INTIDN22
HARD_EDIT_R_INTIDN22

Please enter your Data Collector ID.
Recruitment Data Collector ID
001-999
Please enter a number from 001 to 999

R_INTRON22

Interviewer Note: The following prompts are provided as guidance for staff making initial
contact with a sampled person over the phone. Follow the prompts according to MMP and
local project area guidelines.

ZP.2.0.

Information Needed Before the Call
To confirm a sampled person’s identity over the phone, you should obtain their
information before calling the sampled person. When you contact the sampled person,
you will ask them to provide matching information. Use two or more methods to confirm
their identity.
Examples include:
• Full first, middle, and last name (including suffix, if available)
• Date of birth (month, day, and year)
• Medical facility used
• Phone number
• Current or past address
• Social Security Number

LABEL_R_INTRON22

In addition, you should check whether the sampled person is aware of their HIV status by
looking into eHARS or other supplementary sources of information. For example, a single
report in eHARS with no subsequent visits to an HIV provider and no additional CD4 or viral
load tests may indicate that the person may not be aware of their status.
1 Continue
Recruitment Introduction

Page | 2
R_CONFSPN22

ZP.3.0.

Interviewer Note: The following prompts are provided as guidance for staff making initial
contact with a sampled person over the phone. Follow the prompts according to MMP and
local project area guidelines.
Recruiter: Hi, may I speak to [Insert first name of person]?
If the person is not available and someone else answers:
Recruiter: My name is [Insert your name]. [Insert sampled person’s first name] was chosen
to take part in a health survey. Please have them call me back at [Insert phone number].
Select ‘End Recruitment’
If you reach their voicemail:
Recruiter: Hi, I’m trying to reach [Insert sampled person’s first name]. This is [Insert your
name] from the [HEALTH_DEPT]. You are one of only [SAMPLE_SIZE] people chosen to
take part in our confidential health survey. If you decide to take part, you’ll get [Insert amount
and type of token of appreciation]. Please give me a call at [Insert your phone number].
Thank you.
Select ‘End Recruitment’
If the person is available:
Recruiter: My name is [Insert your name]. I’m calling from the [HEALTH_DEPT] to let you
know that you were selected to take part in our health survey. If you take part, you’ll get
[Insert amount and type of token of appreciation].

1 Continue
2 End Recruitment
Recruitment Initial Contact Prompts

LABEL_R_CONFSPN22

Topic: Confidential space (ZS)
R_CONFSP2N22

ZS.1.0.

Recruiter: Since only people chosen for this survey can take part, I do need to ask you a
few questions to make sure that I am talking to the correct person. To keep your
information private, you need to be in a space where no one can hear your answers. Are
you in a private space?
> If YES, select “Next”
> If NO, ask…
Recruiter: Can you get to a private space? I can give you a moment.

Label_R_CONFSP2N22

> If YES, select “Next”
> If NO, select “End Recruitment” and schedule a call back for a different time
1 Continue
2 End Recruitment
Respondent in private space

Page | 3

Topic: Confirmation (ZC)
INTRO_R_IDENT1N22

R_IDENT1N22

ZC.1.0.

LABEL_R_IDENT1N22
Skip_R_IDENT1N22
R_IDENT2N22

Interviewer Note: The following prompts are provided as guidance for staff making initial
contact with a sampled person over the phone. Follow the prompts according to MMP and
local project area guidelines. Select any of the questions below to validate the
respondent’s identity. • What is your full name (including middle name and/or suffix)? •
What is your date of birth? • I see you were born in [Insert month]. Can you tell me the
year? • Do you have a regular place or person that you go to for medical care? If yes,
what is the name of that place or person (Interviewer Note: only for persons whose care is
confirmed by facility)? • In my records, I have another phone number for [Insert sampled
person’s first and last name] that begins with (XXX) XXX. Can you tell me the last four digits
of that phone number? • In my records, I have an old address for [Insert sampled
person’s first and last name] with the street number 1437. Can you tell me what street
goes with that number? • I have the first 3 digits of your Social Security # as [Insert first
three digits], can you tell me the last 4 digits? • Would you please show me an ID card or
a driver’s license so that I can make sure I am speaking with the right person (Interviewer
Note: only for in person or video recruitment)?
Respondent identity confirmed?
1 Confirmed
2 Not Confirmed
Identity confirmation
If ZC.1.0.=2 (Not confirmed) → ZC.2.0.; Else → ZA.1.0.

ZC.2.0.

Unfortunately, we cannot move forward because I was not able to confirm your identity.
This does not mean that you can no longer take part in this survey, but we would need
some answers for the questions we just talked about so that you can take part. If you are
interested in taking part at a later date, you can reach me at [Insert health department
contact information].
1 End Recruitment
End recruitment_identity not confirmed

ZA.1.0.

Thank you for confirming your identity. Next, I’ll ask you a few questions to see if you are
eligible for the survey. How old were you on [RECRUIT_CALCULATION_CLCSDT_21]?
Recruitment age
0-150
Please enter a number from 0 to 150
If ZA.1.0.=0-17 → ZA.2.0.; Else → ZR.1.0.

ZA.2.0.

Thank you for this information. Based on your age, we cannot move forward with the
survey, but thank you for your time.
1 End Recruitment
End Recruitment_Age

LABEL_R_IDENT2N22

Topic: Age (ZA)
R_AGE1N22
LABEL_R_AGE1N22
RANGE_R_AGE1N22
Hard_edit_R_AGE1N22
SKIP_R_AGE1N22
R_AGE2N22

LABEL_R_AGE2N22

Page | 4

Topic: Residence at Sampling Date (ZR)
R_RES1N22

ZR.1.0.

What state or territory did you live in on [RECRUIT_CALCULATION_CLCSDT_21]?
1 Alabama (AL)
2 Alaska (AK)
3 Arizona (AZ)
4 Arkansas (AR)
5 California (CA)
6 Colorado (CO)
7 Connecticut (CT)
8 Delaware (DE)
9 District of Columbia (DC)
10 Florida (FL)
11 Georgia (GA)
12 Hawaii (HI)
13 Idaho (ID)
14 Illinois (IL)
15 Indiana (IN)
16 Iowa (IA)
17 Kansas (KS)
18 Kentucky (KY)
19 Louisiana (LA)
20 Maine (ME)
21 Maryland (MD)
22 Massachusetts (MA)
23 Michigan (MI)
24 Minnesota (MN)
25 Mississippi (MS)
26 Missouri (MO)
27 Montana (MT)
28 Nebraska (NE)
29 Nevada (NV)
30 New Hampshire (NH)
31 New Jersey (NJ)
32 New Mexico (NM)
33 New York (NY)
34 North Carolina (NC)
35 North Dakota (ND)
36 Ohio (OH)
37 Oklahoma (OK)
38 Oregon (OR)
39 Pennsylvania (PA)
40 Puerto Rico (PR)
41 Rhode Island (RI)
42 South Carolina (SC)
43 South Dakota (SD)
44 Tennessee (TN)
45 Texas (TX)
46 Utah (UT)
47 Vermont (VT)
48 Virginia (VA)
49 Washington (WA)
50 West Virginia (WV)

Page | 5

51 Wisconsin (WI)
52 Wyoming (WY)
53 Not living in the United States/Puerto Rico (ZZ)
88 Don't know
77 Refused to answer
Recruitment_Residence at Sampling Date
IF ZR.1.0. = AL, AK, AZ, AR, CO, CT, DC, HI, ID, IA, KS, KY, LA, ME, MD, MA, MN, MO, MT, NE,
NV, NH, NM, ND, OH, OK, RI, SC, SD, TN, UT, VT, WV, WI, WY, Not living in US/PR, 88 (Don't
know) or 77 (Refused to answer) → ZR.2.0; Else → ZE.1.0.

LABEL_R_RES1N22
SKIP_R_RES1N22

R_RES2N22

LABEL_R_RES2N22

ZR.2.0.

Thank you for this information. Based on where you live, we cannot move forward with
the survey, but thank you for your time.
1 End Recruitment
End recruitment_residence

Page | 6

Topic: Current residence (ZE)
R_RES3N22

ZE.1.0.

What state or territory do you currently live in?
1 Alabama (AL)
2 Alaska (AK)
3 Arizona (AZ)
4 Arkansas (AR)
5 California (CA)
6 Colorado (CO)
7 Connecticut (CT)
8 Delaware (DE)
9 District of Columbia (DC)
10 Florida (FL)
11 Georgia (GA)
12 Hawaii (HI)
13 Idaho (ID)
14 Illinois (IL)
15 Indiana (IN)
16 Iowa (IA)
17 Kansas (KS)
18 Kentucky (KY)
19 Louisiana (LA)
20 Maine (ME)
21 Maryland (MD)
22 Massachusetts (MA)
23 Michigan (MI)
24 Minnesota (MN)
25 Mississippi (MS)
26 Missouri (MO)
27 Montana (MT)
28 Nebraska (NE)
29 Nevada (NV)
30 New Hampshire (NH)
31 New Jersey (NJ)
32 New Mexico (NM)
33 New York (NY)
34 North Carolina (NC)
35 North Dakota (ND)
36 Ohio (OH)
37 Oklahoma (OK)
38 Oregon (OR)
39 Pennsylvania (PA)
40 Puerto Rico (PR)
41 Rhode Island (RI)
42 South Carolina (SC)
43 South Dakota (SD)
44 Tennessee (TN)
45 Texas (TX)
46 Utah (UT)
47 Vermont (VT)
48 Virginia (VA)
49 Washington (WA)
50 West Virginia (WV)

Page | 7

51 Wisconsin (WI)
52 Wyoming (WY)
53 Not living in the United States/Puerto Rico (ZZ)
88 Don't know
77 Refused to answer
Recruitment_Current Residence
IF ZE.1.0. = HI, ID, KS, KY, MO, MN, NE,SD, 88 (Don't know) or 77 (Refused to answer) →
ZE.2.0; Else → ZD.1.0.

LABEL_R_RES3N22
SKIP_R_RES3N22
R_RES4N22

ZE.2.0.

Thank you for this information. Based on where you live, we cannot move forward with
the survey, but thank you for your time.
1 End Recruitment
End recruitment_Current Residence

ZD.1.0.

Thank you for confirming that information. The reason you were selected for this project is
because you were diagnosed with a health condition that is reported to the state health
department.

LABEL_R_RES4N22

Topic: Diagnosis (ZD)
R_DIAG1N22

Can you tell me the health condition or conditions you have been diagnosed with?
Interviewer Note: Do not capture response to this question. Select "Next".
1 Continue
Recruitment_diagnosis selected

LABEL_R_DIAG1N22
R_DIAG2N22

ZD.2.0.

Interviewer Note: Did the respondent mention being diagnosed with HIV?
0 No
1 Yes
Recruitment_Mention HIV
IF ZD.2.0. = 0 (No) → ZD.3.0; Else → ZD.9.0.

ZD.3.0.

Would it be alright if I listed some health conditions that are reported to the health
department? You can tell me whether you have been diagnosed with any of these
conditions.
0 No
1 Yes
Recruitment_Health conditions
IF ZD.3.0. = 1 (Yes) → ZD.4.0; Else → ZD.8.0.

ZD.4.0.

Interviewer Note: Read each of the questions and allow the respondent to answer. Only
capture their response to the question regarding a diagnosis of HIV.

LABEL_R_DIAG2N22
SKIP_R_DIAG2N22
R_DIAG3N22

LABEL_R_DIAG3N22
SKIP_R_DIAG3N22
R_DIAG4N22

Have you been diagnosed with meningitis?
1 Continue
Recruitment_Meningitis diagnosis

LABEL_R_DIAG4N22
R_DIAG5N22
LABEL_R_DIAG5N22

ZD.5.0.

Have you been diagnosed with tuberculosis?
1 Continue
Recruitment_Tuberculosis diagnosis

Page | 8
R_DIAG6N22

ZD.6.0.

Have you been diagnosed with HIV?
0 No
1 Yes
88 Don't know
77 Refused to answer
Recruitment_HIV diagnosis
IF ZD.6.0. = 1 (Yes) → ZD.7.0; Else → ZD.8.0.

ZD.7.0.

Have you been diagnosed with measles?
1 Continue
Recruitment_Measles Diagnosis
IF ZD.7.0. = 1 (Continue) → ZD.9.0.

ZD.8.0.

Unfortunately, based on your answers, we cannot move forward with the survey. Thank
you for your time. I hope you have a great day.

LABEL_R_DIAG6N22
SKIP_R_DIAG6N22
R_DIAG7N22
LABEL_R_DIAG7N22
SKIP_R_DIAG7N22
R_DIAG8N22

Interviewer Note: Provide local referrals to sampled person as needed.
1 End Recruitment
End Recruitment_Diagnosis

LABEL_R_DIAG8N22
R_DIAG9N22

ZD.9.0.

Were you first diagnosed with HIV on or before
[RECRUIT_CALCULATION_CLCSDT_21]?
0 No
1 Yes
88 Don't Know
77 Refused to answer
Recruitment_Diagnosis Date
IF ZD.9.0. = 0 (No), 88 (Don't Know), or 77 (Refused to answer) → ZD.10.0.; Else → ZW.1.0.

ZD.10.0.

Thank you for this information. Based on your date of diagnosis, we cannot move forward
with the survey, but thank you for your time.
1 End Recruitment
End recruitment_Diagnosis Date

LABEL_R_DIAG9N22
SKIP_R_DIAG9N22
R_DIAG10N22

LABEL_R_DIAG10N22

Topic: Willingness (ZW)
R_INTERST1N22

LABEL_R_INTERST1N22
SKIP_R_INTERST1N22

ZW.1.0.

Thank you for allowing me to check that you are the right person. As a reminder, this
survey is confidential and will cover some sensitive health information. To keep your
information private, please stay in a location where no one can overhear.
The health survey is called the Medical Monitoring Project or MMP. I will ask you
questions about your health and medical care. Your answers to these questions will be
kept private. The [HEALTH_DEPT] plans to speak with about [SAMPLE_SIZE] people with
HIV to better understand their experiences with medical care in [SITEID] and how we can
improve programs and services. For example, [Interviewer Note: add example of how data
from MMP have been applied]. For taking part, you will receive [$ Interviewer Note: Insert
project area token amount here]. Does this sound like something you would be interested
in doing?
0 No
1 Yes
Recruitment_Interest
IF ZW.1.0. = 0 (No) → ZW.2.0.; Else → ZW.3.0.

Page | 9
R_INTERST2N22

ZW.2.0.

Interviewer Note: Address concerns using refusal aversion techniques. If they still refuse,
thank the person for their time and end recruitment. Enter the reason(s) why the
participant refused to participate.
1 End Recruitment
End Recruitment_Not Interested

R_INTERST2N22
R_WILL1N22

ZW.3.0.

Great! The survey will take about 60 minutes. Do you have time to complete the survey
now over the phone?
0 No
1 Yes
Recruitment_Willing
IF ZW.3.0. = 0 (No) → ZW.4.0.; Else → ZW.5.0.

ZW.4.0.

Interviewer Note: Offer a telephone interview first and ask them for a mailing or email
address to send response cards. Only schedule a video or in person interview if the
participant refuses a telephone interview.

LABEL_R_WILL1N22
SKIP_R_WILL1N22
R_WILL2N22

May I ask why you are not interested? Knowing why will help us improve the survey in the
future.

Recruiter: Ok, let’s find a day and time that works for you.
Interviewer Note: Schedule the interview or schedule a time to call them back.
Closing statement for interviews scheduled:
Interviewer Note: Ask the respondent if they will have internet access at the time of the
scheduled interview. If they won’t have internet access or are unsure, offer to mail them
the response cards prior to the interview.
Recruiter: I look forward to speaking with you on [Day of week, Month, Day] at [Time].
Interviewer Note:
For scheduled telephone interviews say: “I will give you a phone call at that time.”
For scheduled video interviews say: “I will send you a link for the video interview after we
hang up.”
Recruiter: Thank you so much for your willingness to take part. I hope you have a good rest
of your day.
1 End Recruitment
Recruitment_Schedule Interview

LABEL_R_WILL2N22
R_WILL3N22

LABEL_R_WILL3N22

ZW.5.0.

Now I have a little more information to share with you about the survey and then we can
begin.
Please give me a moment to enter some information before we get started.
1 Continue
Recruitment_Information to share

Page | 10

Module: Consent (O)
Topic: Consent (OC)
C_CONSNT1N22

OC.1.0.

Interviewer Note: Provide a hard copy of the consent form to the participant. Read the
following exactly as written to obtain informed consent.
We chose you for this project because you have HIV. Taking part in this project is up to
you. You can choose to participate or not to participate. You don’t have to be in the
project if you don’t want to be. If you decide to take part, you may leave the project at any
time. There are no penalties or loss of benefits if you choose not to take part or to leave
the project early.
[Interviewer Note: If participant is currently incarcerated, add: Taking part in this project
will not affect your parole.]
Your health department and the Centers for Disease Control and Prevention (CDC) are
doing this project to learn more about people living with HIV, including the services they
use and need. This information will help improve programs that keep people healthy and
get them the help they need.
If you choose to be in this project, we will ask you questions and look at your medical
records.
Answering the questions will take about 45 minutes. You don’t have to answer any
question you don’t want to answer. The questions ask about your:
• medical past
• use of medical and social services
• sex practices
• use of drugs and alcohol
• reproductive history
• ability to work and take care of yourself
If we need more information, a staff member may contact you later.

LABEL_C_CONSNT1N22

We send the answers to CDC, but we don’t send them your name. Instead, we will assign a
code number to your answers. We don’t send CDC any information that identifies you. We
don’t send CDC any information that could trace back to you. Your answers are
confidential. All project materials are kept in a locked cabinet or secure computer.
1 Continue
Consent_Project Information

Page | 11
C_CONSNT2N22

OC.2.0.

We will also look at your medical record to collect information about your HIV. This
includes medicines you are taking, clinic visits, and lab test results. Again, we don’t send
CDC any information that can identify you or that could trace back to you. A code number
will link information from your medical records to your answers.
Supervisors will observe a small number of interviews and medical record reviews to give
feedback to MMP staff on their work.
We protect your privacy. All information you give us will be private and confidential. Your
records will be confidential as much as the law allows. We will group your answers with
answers from other people who take part in this project so that no one will know your
answers. We will send CDC information from this project, but we will not send any
information that could identify you. Federal law protects the confidentiality of information
kept at CDC.
You will receive [$ Interviewer Note: Insert project area token amount here] as a token of
appreciation for taking part in the project if you answer the questions and let us review
your medical records. If you later choose to leave the project, you may keep the money.
• There is no cost to you other than your time and effort for being in this project.
• If you like, we can give you information about how to avoid giving HIV to someone else.
• If you like, we can give you information about where to get medical and social services.
• There are no direct benefits from being in this project. However, the information you
give us can help us improve services available to other people living with HIV.
• Some of the questions may make you feel uncomfortable or may be too personal.
Remember: You don’t have to answer any questions you don’t wish to answer.
1 Continue
Consent_Privacy

LABEL_C_CONSNT2N22
C_CONSNT3N22

OC.3.0.

If you have questions about this project or your token of appreciation, please ask me or
call the principal investigator [Interviewer Note: Insert principal investigator] at
[Interviewer Note: Insert phone number].
• If you have questions about your rights and how the project works across the country,
please contact:
• Interviewer Note: If applicable: The institutional review board (IRB) at [Interviewer Note:
insert state/local health department] at [Interviewer Note: insert phone number].
• Interviewer Note: If applicable: [Interviewer Note: insert local IRB contact] at
[Interviewer Note: insert phone number].
• CDC at 1-404-639-6475. Please leave a brief message letting us know how to contact
you. Say that you are calling in reference to the Medical Monitoring Project. Someone will
return your call as soon as possible.
1 Continue
Consent_Token of Appreciation

OC.4.0.

Interviewer Note: The sample questions below may be used to confirm competency.
• What questions do you have for me?
• I want to make sure we have some understanding about this project. Can you tell me
what this project is about in your own words?
• What do you expect to gain?
• What should you do if you agree to participate, but later change your mind?
• What should you do if you have any questions or concerns about participating?
1 Continue
Consent_Competency Questions

LABEL_C_CONSNT3N22
C_CONSNT4N22

LABEL_C_CONSNT4N22

Page | 12
C_CONSNT5N22

OC.5.0.

Do you agree to participate in this project?
Interviewer Note: Did the participant consent?
By clicking “Consented”, you are confirming that the respondent gave you verbal informed
consent to participate in MMP in compliance with all federal, state, and local
requirements.
1 Consented
2 Did not consent
Consent_Participant Consent
IF OC.5.0. = 2 (Did not consent) →OC.6.0.; Else → OC.7.0.

LABEL_C_CONSNT5N22
SKIP_C_CONSNT5N22
C_NOCONSNTN22

OC.6.0.

Interviewer Note: Thank the participant for their time and follow procedures to close out
interview.
1 End interview
End Consent

OC.7.0.

Do you have internet access?

LABEL_C_NOCONSNTN22
C_INTERNTN22

LABEL_INTERNTN22

Interviewer Note: If they have internet access, help them locate the online response cards
at 4MMP.cdc.gov. If they do not have access to the internet and you believe you may lose
the interview if you schedule it later, continue with the interview and be prepared to read
aloud the response card options to the participant.
1 Continue
Consent_Internet Access

Page | 13

Module: Preliminary information (I)
Topic: Prior to interview (IP)
Calculation_IDATEAVN21 IP.1.0.
Label_Calculation_IDATEAVN21

Automatically calculate interview date based on device date
Automatic calculation for interview date

Intro_IDATEVERN21_24
IDATEVERN21_24
IP.1.1.

Enter the following information prior to the interview.

1 Interview date is correct
2 Interview date is incorrect
Verification for interview date

Label_IDATEVERN21_24
ASKIF_IDATECHECKN21

Ask if IDATEVERN21_24=2

IDATECHECKN21
IP.1.2.
Label_IDATECHECKN21
Range_IDATECHECKN21
Soft_edit_24_IDATECHECKN21
Voxco_note1N22_IDATECHECKN2
1
Voxco_note2N22_IDATECHECKN2
1
Voxco_note3N24_IDATECHECKN2
1
Calculation_IDATE

IP.1.3.

Label_calculation_IDATE
Voxco_note1N22_calculation_IDA
TE
Voxco_note2N22_calculation_IDA
TE

Calculation_IDATE7

IP.1.4.

Label_8_Calculation_IDATE7
Calculation_IDATE12

Today's date is [Insert Calculation_IDATEAVN21]. If this is correct, select “Interview date is
correct.” If this is incorrect, exit Voxco and change the date on your device. If the date cannot
be fixed on your device, select “Interview date is incorrect.” I

IP.1.5.

If you cannot change the date on your device, please enter the correct date.
Interview date correction
06/01/2021 - 05/31/2024
Read "Interview date has been updated to [Insert IDATECHECKN21 (Interview date
correction)]. If this is not correct, use "Previous Question" button to go back and correct."
Requires response for month, day, and year. Partial dates not accepted.
Provide the following instructions to click on "set" in Voxco: "Select the correct date on
the calendar, and then click "SET."
If IDATEVERN21_24 is 1, DK, or REF, then skip to Calculation_
If the device date is correct, use IDATEAVN21 for interview date. Otherwise, use the
manually entered date [IDATECHECKN21].
Interview Date calculated or corrected
If (IDATEVERN21_22 (Verification for interview date) = 1, IDATEAVN21 (Automatic
calculation for interview date), IDATECHECKN21 (Interview date correction)).
Calculation_IDATE (Interview Date calculated or corrected) will display as IDATE (Interview
Date calculated or corrected) in the data. Reference to IDATE (Interview Date calculated or
corrected) in the questionnaire refers to Calculation_IDATE (Interview Date calculated or
corrected).
Calculate the date 7 days prior to IDATE (interview date). Example, if IDATE is 12/08/2016,
then IDATE7 is 12/01/2016. Coding should take into account leap years.
7 days prior to interview

Label_8_Calculation_IDATE12

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

Calculation_LASTYEAR
IP.1.6.
Label_Calculation_LASTYEAR

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

Calculation _SHIDATE21 IP.1.7.
Label_Calculation_SHIDATE21

String version of the interview date. SHORTDATE(IDATE)
Short date for current date

Page | 14
Calculation_CLCSDT_21

IP.2.0.

Label_CLCSDT_21
Calculation_CYGSN5_21 IP.2.1.

Label_CYGSN5_21
SURVEYMODEN24

IP.3.0.

Label_ SURVEYMODEN24
Voxco__ SURVEYMODEN24
MODEADM

Label_INTLAN8
Skip_INTLAN8

1 Telephone interview
2 In-person interview
telephone or in-person interview
Select only one response

IP.5.0.

Is the respondent currently in prison or jail? [SELECT ONLY ONE.]

0 No
1 Yes
interviewed in prison or jail
Select only one response
IP.6.0.

[DON'T READ ALOUD] Are you using a language interpreter for this interview?
0 No
1 Yes
Use of interpreter for interview
If INTERPN8 (Use of interpreter for interview) = 0 (no), skip to Intro_21_SURVEYIN
(Introduction for MMP survey). Else, go to INTLAN8 (Language interview conducted in).

P.6.1.

[DON'T READ ALOUD] What language is the interpreter using for this interview?
1 Spanish
2 French
3 German
4 Chinese
5 Creole (French or Haitian)
6 American Sign Language (ASL)
7 Arabic
8 Other
Language interview conducted in
If INTLAN8 (Language interview conducted in) is 8 (other), go to ILAN8_OS (Specify other
interpreter language). Else, skip to Intro_21_SURVEYIN (Introduction for MMP survey).

Label_INTERPN8
Skip_INTERPN8
INTLAN8

Is this a telephone or in-person interview? [SELECT ONLY ONE.]

Was the interview originally administered on paper?
0 No
1 Yes
Interview administered on paper

Label_ PRISONSETN24
Voxco_PRISONSETN24
INTERPN8

Calculate cycle year using CYGSN5_21 (cycle year based on interview date)
If IDATE is June 1, 2021 – May 31, 2022, then CYGSN5_21=2021
If IDATE is June 1, 2022 – May 31, 2023, then CYGSN5_21=2022
If IDATE is June 1, 2023 – May 31, 2024, then CYGSN5_21=2023
If IDATE is June 1, 2024 – May 31, 2025, then CYGSN5_21=2024
If IDATE is June 1, 2025 – May 31, 2026, then CYGSN5_21=2025
Cycle year based on date of interview

IP.4.0.

Label_MODEADM
PRISONSETN24

IDATE CLCSDT_21
June 1, 2021 – May 31, 2022 12/31/2020
June 1, 2022 – May 31, 2023 12/31/2021
June 1, 2023 – May 31, 2024 12/31/2022
June 1, 2024 – May 31, 2025 12/31/2023
June 1, 2025 – May 31, 2026 12/31/2024
Sample draw date based on interview date

Page | 15
SITEID
Label_SITEID
Hard_edit_8_SITEID

IP.7.0.

Site ID of jurisdiction where person was sampled:
Site ID where person sampled
Valid numbers are as follows: 0006, 1600, 0010, 0012, 0013, 3360, 0017, 0018, 4480,
0026, 0028, 0034, 0036, 5600, 0037, 0041, 0042, 6160, 0072, 7360, 0048, 0051, and 0053.
Else read, “Site ID is invalid.” Return to SITEID (Site ID where person sampled).
If SITEID (Site ID where person sampled) is less than 4 digits, then read, "Number must be
4 digits." Return to SITEID (Site ID where person sampled).
4 digits with leading 0s

IP.7.1.

Name of sampling jurisdiction based on SITEID (site ID where person sampled).

Hard_edit2_8_SITEID
Voxco_noteN22_SITEID
Calculation_SJURN5_8

Label_Calculation_SJURN5_8
IJURN5
Label_IJURN5
Range_IJURN5
Hard_edit_8_IJURN5

IP.7.2.

[DON'T READ ALOUD] What is the site ID of the jurisdiction completing the interview?
Site ID of jurisd. completing interview
0001–9999
Valid numbers are as follows: 0006, 1600, 0010, 0012, 0013, 3360, 0017, 0018, 4480,
0026, 0028, 0034, 0036, 5600, 0037, 0041, 0042, 6160, 0072, 7360, 0048, 0051, and 0053.
Else, read “The site ID of the jurisdiction completing the interview is invalid.” Return to
IJURN5 (Site ID of jurisd. completing interview).
If IJURN5 (Site ID of jurisd. completing interview) is less than 4 digits, then read, "Number
must be 4 digits." Return to IJURN5 (Site ID of jurisd. completing interview).

IP.7.3

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

Hard_edit2_8_IJURN5
INDID
Label_INDID
Range_INDID
Hard_edit_INDID
Voxco_noteN22_INDID

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

Page | 16
Calculation_21_PARID

IP.7.4.

Calculate PARID (participant ID) by combining SITEID (side ID where person sampled) and
09 and last two digits of CYGSN5_21 (cycle year based on date of interview) and INDID
(respondent ID).
Participant ID
0000-0000-0001 to 9999-9999-9999

IP.7.5.

[DON'T READ ALOUD] The Participant ID is [Response to IP.3.0]-[09 and last 2 digits of
CYGSN5_21]-[Response to IP.3.3]. Is that correct?
0 No
1 Yes
Confirmation of PARID
If IDCONFN3 (Confirmation of PARID) is 0 (no), then read, Interviewer: Please re-enter
participant ID. Return to SITEID (Site ID where person sampled).
Program should read dashes after every 4th number for legibility (e.g., “The participant ID
is 1111-2222-3333. Is that correct?”)

Label_PARID
Range_PARID
IDCONFN3

Label_IDCONFN3
Hard_edit_IDCONFN3
Voxco_noteN22_IDCONFN3
INTID
Label_INTID
Range_INTID
Hard_edit_INTID

IP.3.0.

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

Topic: Introduction (IN)
Intro_21_SURVEYIN

SURVEYIN
IN.1.0.
Label_SURVEYIN
Voxco_note2N22_SURVEYIN
Voxco_note1N22_SURVEYIN

“Thank you for taking part in this interview. Remember, your answers to these questions
are confidential. The answers to some questions may seem obvious, but I need to ask you
all the questions. There is a set of cards that we’ll use during the interview. The cards
include a calendar, pitcures, and text to help you answer some of the questions. Please
keep these cards nearby and I will let you know when we need them.”
Introduction for MMP survey
No question number is needed for this variable.
Include the associated cycle year image to indicate that this is the start of a cycle year. For
example, use the van image for the 2022 cycle.

Page | 17

Module: Eligibility criteria (Y)
Topic: MMP participation (YM)
Calculation_ST_INTN5
YM.0.
Label_Calculation_ST_INTN5

ST_INTN5 = Current time
Start of Interview

Calculation_STELIGIB
YM.1.
Label_Calculation_STELIGIB

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

PARTCPT

Have you ever participated in the MMP interview?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever participation
If PARTCPT (Ever participation) is 7 (refused to answer) then READ, “I’m only interviewing
people who haven’t already been interviewed during this data collection year. Thank you
very much for your time.” Allow program to move forward.
If PARTCPT (Ever participation) = 1 (yes), go to PARTIC (Date participated in MMP). If
PARTCPT (Ever participation) = 0 (no) or 8 (don’t know), then skip to RESCURN8_21
(Current residence as of IDATE_21).
If PARTCPT (Ever participation) is 7 (refused to answer), skip to Calculation_EN_INTN5 (End
of interview).

Label_PARTCPT
Soft_edit_N21_PARTCPT

Skip_21_PARTCPT

YM.1.0.

Page | 18
PARTIC

Label_PARTIC
Range_21_PARTIC
Soft_edit_N21_PARTIC

Hard_edit_N21_PARTIC

Skip_21_PARTIC

Voxco_noteN22_PARTIC

YM.1.1.

What month and year did you participate in the MMP interview?
8888 Don't Know
7777 Refused to Answer
Date participated in MMP
06/2005-01/2050
If CYGSN5_21 (Cycle year based on date of interview) =2021 and PARTIC (Date participated
in MMP) >= June 1, 2021 or if CYGSN5_21 (Cycle year based on date of interview) =2022
and PARTIC (Date participated in MMP) >= June 1, 2022 or if CYGSN5_21 (Cycle year based
on date of interview) =2023 and PARTIC (Date participated in MMP) >= June 1, 2023 or if
CYGSN5_21 (Cycle year based on date of interview) =2024 and PARTIC (Date participated
in MMP) >= June 1, 2024 or if CYGSN5_21 (Cycle year based on date of interview) =2025
and PARTIC (Date participated in MMP) >= June 1, 2025, then read, “I’m only interviewing
people who haven’t already been interviewed during this data collection year. Thank you
very much for your time.” Allow program to move forward.
PARTIC (Date participated in MMP) cannot be later than IDATE (Interview Date calculated
or corrected). If PARTIC (Date participated in MMP) > IDATE (Interview Date calculated or
corrected), then read, "Date cannot be later than interview date." Do not allow program to
advance.
If CYGSN5_21 (Cycle year based on date of interview) =2021 and PARTIC (Date participated
in MMP) >= June 1, 2021 or if CYGSN5_21 (Cycle year based on date of interview) =2022
and PARTIC (Date participated in MMP) >= June 1, 2022 or if CYGSN5_21 (Cycle year based
on date of interview) =2023 and PARTIC (Date participated in MMP) >= June 1, 2023 or if
CYGSN5_21 (Cycle year based on date of interview) =2024 and PARTIC (Date participated
in MMP) >= June 1, 2024 or if CYGSN5_21 (Cycle year based on date of interview) =2025
and PARTIC (Date participated in MMP) >= June 1, 2025, then skip to
Calculation_EN_INTN5 (End of interview). If PARTIC (Date participated in MMP) is 7777
(refused to answer), skip to Calculation_EN_INTN5 (End of interview). If PARTIC (Date
participated in MMP) is 888 (don't know), then go to RESCURN8_21 (Current residence as
of IDATE_21). Else, go to RESCURN8_21 (Current residence as of IDATE_21).
Month is not required. Year is required.

Page | 19

Topic: Residence (YS)
RESCURN8_21

YS.1.0.

What state or territory do you currently live in? [DON’T READ RESPONSES. SELECT ONLY
ONE.]
1 Alabama (AL)
2 Alaska (AK)
3 Arizona (AZ)
4 Arkansas (AR)
5 California (CA)
6 Colorado (CO)
7 Connecticut (CT)
8 Delaware (DE)
9 District of Columbia (DC)
10 Florida (FL)
11 Georgia (GA)
12 Hawaii (HI)
13 Idaho (ID)
14 Illinois (IL)
15 Indiana (IN)
16 Iowa (IA)
17 Kansas (KS)
18 Kentucky (KY)
19 Louisiana (LA)
20 Maine (ME)
21 Maryland (MD)
22 Massachusetts (MA)
23 Michigan (MI)
24 Minnesota (MN)
25 Mississippi (MS)
26 Missouri (MO)
27 Montana (MT)
28 Nebraska (NE)
29 Nevada (NV)
30 New Hampshire (NH)
31 New Jersey (NJ)
32 New Mexico (NM)
33 New York (NY)
34 North Carolina (NC)
35 North Dakota (ND)
36 Ohio (OH)
37 Oklahoma (OK)
38 Oregon (OR)
39 Pennsylvania (PA)
40 Puerto Rico (PR)
41 Rhode Island (RI)
42 South Carolina (SC)
43 South Dakota (SD)
44 Tennessee (TN)
45 Texas (TX)
46 Utah (UT)
47 Vermont (VT)
48 Virginia (VA)
49 Washington (WA)

Page | 20

Label_RESCURN8_21
Soft_edit_N21_RESCURN8_21
Skip_RESCURN8_21

MMPCTYN5

YS.1.1.

Label_MMPCTYN5
Hard_edit_21_MMPCTYN5

Voxco_noteN22_MMPCTYN5

50 West Virginia (WV)
51 Wisconsin (WI)
52 Wyoming (WY)
53 Not living in the United States/Puerto Rico (ZZ)
88 Don't know
77 Refused to answer
Current residence as of IDATE_21
If Current Residence= HI, ID, KS, KY, MO, MN, NE, or SD then read, “I am only interviewing
people who currently live in certain states. Thank you very much for your time.”
If RESCURN8_21 (Current residence as of IDATE_21) is CA, IL, NY, PA, or TX, go to
MMPCTYN5 (MMP current city of residence). If RESCURN8_21 (Current residence as of
IDATE_21)(Current Residence) is HI, ID, KS, KY, MO, MN, NE, or SD, skip to
Calculation_EN_INTN5 (End of interview) (End of interview). If RESCURN8_21 (Current
residence as of IDATE_21) is 88 (don't know) or 77 (refused to answer) skip to RESAMPN8_
21 (Residence on sampling date). Else, skip to RESAMPN8_21 (Residence on sampling
date).
What city do you currently live in? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Chicago
2 Houston
3 Los Angeles County
4 New York City
5 Philadelphia
6 San Francisco
7 Other U.S. city
88 Don't Know
77 Refused to Answer
MMP current city of residence
Only valid combinations for MMPCTYN5 (MMP current city of residence) and RESCURN8_
21 (Current residence as of IDATE_21) are: RESCURN8_21 (Current residence as of
IDATE_21) and MMPCTYN5 (MMP current city of residence) 5 California and 3 Los
Angeles County 5 California and 6 San Francisco 5 California and 7 Other U.S. City 5
California and 77 Refused 5 California and 88 Don’t Know 14 Illinois and 1 Chicago 14
Illinois and 7 Other U.S. City 14 Illinois and 77 Refused 14 Illinois and 88 Don’t Know 33
New York and 4 New York City 33 New York and 7 Other U.S. City 33 New York and 77
Refused 33 New York and 88 Don’t Know 39 Pennsylvania and 5 Philadelphia 39
Pennsylvania and 7 Other U.S. City 39 Pennsylvania and 77 Refused 39 Pennsylvania and
88 Don’t Know 45 Texas and 2 Houston 45 Texas and 7 Other U.S. City 45 Texas and 77
Refused 45 Texas and 88 Don’t Know Else, read, “That city does not match with the state
you selected. Please tell me the city again.” Return to MMPCTYN5 (MMP current city of
residence).
Program responses as a drop-down menu.

Page | 21
RESAMPN8_21

YS.2.0

What state or territory did you live in on [Calculation_CLCSDT_21]? [DON’T READ
RESPONSES. SELECT ONLY ONE.]
1 Alabama (AL)
2 Alaska (AK)
3 Arizona (AZ)
4 Arkansas (AR)
5 California (CA)
6 Colorado (CO)
7 Connecticut (CT)
8 Delaware (DE)
9 District of Columbia (DC)
10 Florida (FL)
11 Georgia (GA)
12 Hawaii (HI)
13 Idaho (ID)
14 Illinois (IL)
15 Indiana (IN)
16 Iowa (IA)
17 Kansas (KS)
18 Kentucky (KY)
19 Louisiana (LA)
20 Maine (ME)
21 Maryland (MD)
22 Massachusetts (MA)
23 Michigan (MI)
24 Minnesota (MN)
25 Mississippi (MS)
26 Missouri (MO)
27 Montana (MT)
28 Nebraska (NE)
29 Nevada (NV)
30 New Hampshire (NH)
31 New Jersey (NJ)
32 New Mexico (NM)
33 New York (NY)
34 North Carolina (NC)
35 North Dakota (ND)
36 Ohio (OH)
37 Oklahoma (OK)
38 Oregon (OR)
39 Pennsylvania (PA)
40 Puerto Rico (PR)
41 Rhode Island (RI)
42 South Carolina (SC)
43 South Dakota (SD)
44 Tennessee (TN)
45 Texas (TX)
46 Utah (UT)
47 Vermont (VT)
48 Virginia (VA)
49 Washington (WA)
50 West Virginia (WV)

Page | 22

51
52
53
88
77

Label_RESAMPN8_21
Soft_edit_N21_RESAMPN8_21

Skip_21_RESAMPN8_21

Voxco_noteN22_RESAMPN8_21
SAMPCTN5

YS.2.1.

Label_SAMPCTN5
Hard_edit_21_SAMPCTN5

Wisconsin (WI)
Wyoming (WY)
Not living in the United States/Puerto Rico (ZZ)
Don't know
Refused to answer

Residence on sampling date
If RESAMPN8_21 (Residence on sampling date) is not CA, IL, NY, PA, TX, DE, FL, GA, IN, MI,
MS, NJ, NC, OR, PR, VA, or WA, then read, “I am only interviewing people who lived in
certain states on [INSERT Calculation_CLCSDT_21 (Sample draw date based on interview
date)].Thank you very much for your time.” Allow program to move forward.
If RESAMPN8_21 (Residence on sampling date) is CA, IL, NY, PA, or TX, go to SAMPCTN5
(MMP city of residence at sampling). If RESAMPN8_21 (Residence on sampling date) is DE,
FL, GA, IN, MI, MS, NJ, NC, OR, PR, VA, or WA, then skip to DOB_13 (Date of birth). If
RESAMPN8_21 (Residence on sampling date) is 88 (don't know) or 77 (refused to answer),
skip to Calculation_EN_INTN5 (End of interview). Else skip to Calculation_EN_INTN5 (End
of interview).
Program responses as a drop-down menu.

What city did you live in at that time? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Chicago
2 Houston
3 Los Angeles County
4 New York City
5 Philadelphia
6 San Francisco
7 Other U.S. city
88 Don't Know
77 Refused to Answer
MMP city of residence at sampling
If the values of RESAMPN8_21 (Residence on sampling date) and SAMPCTN5 (MMP city of
residence at sampling) result in any of these combinations: RESAMPN8_21 (Residence on
sampling date) and SAMPCTN5 (MMP city of residence at sampling) 5 California and 3 Los
Angeles County 5 California and 6 San Francisco 5 California and 7 Other U.S. City 5
California and 77 Refused 5 California and 88 Don’t Know 14 Illinois and 1 Chicago 14
Illinois and 7 Other U.S. City 14 Illinois and 77 Refused 14 Illinois and 88 Don’t Know 33
New York and 4 New York City 33 New York and 7 Other U.S. City 33 New York and 77
Refused 33 New York and 88 Don’t Know 39 Pennsylvania and 5 Philadelphia 39
Pennsylvania and 7 Other U.S. City 39 Pennsylvania and 77 Refused 39 Pennsylvania and
88 Don’t Know 45 Texas and 2 Houston 45 Texas and 7 Other U.S. City 45 Texas and 77
Refused 45 Texas and 88 Don’t Know, Then combination is valid. Else read, "That city
does not match with the state you selected. Please tell me the city again." Return to
SAMPCTN5 (MMP city of residence at sampling).

Page | 23

Topic: Age (YA)
DOB_13

YA.1.0.

Label_DOB_13
Range_21_DOB_13
Hard_edit_N21_DOB_13

Voxco_note_DOB_13
Calculation_AGESMPN8_ YA.1.1.
21
Label_AGESMPN8_21
Soft_edit_N21_AGESMPN8_21

Skip_AGESMPN8_21

Calculation_AGEIDATE

YA.1.3.

Label_8_Calculation_AGEIDATE
AGEVER_8

YA.1.2.

Label_AGEVER_8
Soft_edit_N21_AGEVER_8

Skip_21_AGEVER_8

Please tell me the month and year of your date of birth.
8888 Don't Know
7777 Refused to Answer
Date of birth
01/1900-01/2050
DOB_13 (Date of birth) cannot be later than IDATE (Interview Date calculated or
corrected). If DOB_13 (Date of birth) > IDATE (Interview Date calculated or corrected),
then read, "Date cannot be later than interview date." Do not allow program to advance.
DOB_13 (Date of birth) requires a response for both the month and year. Partial date is
not accepted.
Calculate the difference in years between Calculation_CLCSDT_21 and DOB_13, accounting
for leap years. Since we do not gather day information for DOB_13, a day will need to be
imputed: the last day of their birth month.
Age at sampling date
If Calculation_AGESMPN8_21 (Age at sampling date) is < 18 years, then READ, “I am only
interviewing people who were age 18 years or older on [INSERT Calculation_CLCSDT_21
(Sample draw date based on interview date)]. Thank you very much for your time.” Allow
program to move forward.
If Calculation_AGESMPN8_21 (Age at sampling date) is < 18 years, then skip to
Calculation_EN_INTN5 (End of interview). If DOB_13 (Date of birth) is 7 (refused to
answer) or 8 (don’t know), or if Calculation_AGESMPN8_21 (Age at sampling date) is equal
to 18 years, go to AGEVER_8 (Age verification). Else, skip to Calculation_EN_ELGN5 (End of
eligibility section).
Calculate the respondent’s age at the time of the interview using DOB_13 (date of birth)
and IDATE (interview date).
Age
Were you at least 18 years old on [Calculation_CLCSDT_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Age verification
If AGEVER_8 (Age verification) is 0 (no), 7 (refused to answer), or 8 (don’t know), then
read, “I am only interviewing people who were 18 years or older on [Calculation_CLCSDT_
21 (Sample draw date based on interview date)]. Thank you very much for your time.”
Allow program to move forward.
If AGEVER_8 (Age verification) is 0 (no), 7 (refused to answer), or 8 (don’t know), then
skip to Calculation_EN_INTN5 (End of interview). Else, go to Calculation_EN_ELGN5 (End
of eligibility section).

Calculation_EN_ELGN5 Y.0.1.
Label_Calculation_EN_ELGN5

EN_ELGN5= Current time
End of eligibility section

Calculation_TL_ELGN5 Y.0.b
Label_Calculation_TL_ELGN5

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

Page | 24

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

STBSDMN5 = Current time
Start of basic demographics

EDUC

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

DE.1.0.

Label_EDUC

Topic: Race-ethnicity (DR)
HISPA_13

DR.1.0.

Label_HISPA_13
Skip_HISPA_13

Intro_HISN3A
HISN3A

DR.1.1.

Label_HISN3A
HISN3B

Label_HISN3C

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

DR.1.2.

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

DR.1.3.

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

Label_HISN3B
HISN3C

Do you consider yourself to be of Hispanic, Latino/a, or Spanish origin?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Hispanic-Latino origin
If HISPA_13 (Hispanic-Latino origin) is 1 (yes), go to Intro_HISN3A (Mexican, Mexican
American, or Chicano/a). Else, skip to Intro_RACE_9A (American Indian or Alaska Native
race).

Page | 25
HISN3D

DR.1.4.

Label_HISN3D
Hard_edit_N8_HISN3D

Intro_RACE_9A
RACE_9A

DR.2.1.

Label_RACE_9A
RACE_9B

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

DR.2.3.

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

DR.2.4.

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

DR.2.5.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
White race
If RACE_9A (American Indian or Alaska Native race) = 0 (No), RACE_9B (Asian race) = 0
(No), RACE_9C (Black or African American race) = 0 (No), RACE_9D (Native
Hawaiian/Other Pacific Islander) = 0 (No), and RACE_9E (White race) = 0 (No), then display,
The respondent did not select any racial group. Please confirm responses. Allow the
program to move forward.

Label_RACE_9C
RACE_9D

Label_RACE_9D
RACE_9E

Label_RACE_9E
Soft_edit_N8_RACE_9E

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

DR.2.2.

Label_RACE_9B
RACE_9C

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

Page | 26

Topic: Gender and sexual orientation (DG)
BIRTGEN

DG.1.0.

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

DG.2.0.

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

DG.2.1.

Label_GENDEREXPN24
SKIP_GENDEREXPN24

Do you use a term other than [GENDER] to describe yourself? [DON’T READ RESPONSES.
SELECT ONLY ONE.]
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Gender exploratory question
If GENDEREXPN24=1 (Yes), go to GENDEXPN24OS; Else skip to

GENDEXPN24OS
DG.2.2.
Label_ GENDEXPOSN24
Voxco_ GENDEXPOSN24

What term do you use to describe yourself?
Gender exploratory specify
Limit 500 characters

SEXOR_N5

DG.3.0.

Do you think of yourself as [READ RESPONSES. SELECT ONLY ONE.]:
1 Lesbian or gay
2 Straight, that is, not gay
3 Bisexual
4 Something else
8 Don't Know
7 Refused to Answer
Sexual orientation
If SEXOR_N5 (Sexual orientation) =4 (something else), go to SEXOREXPN24. Else skip to
LANWL2N3 (Speak a language other than English).

DG.3.1.

What term do you use to describe yourself?
Sexual orientation exploratory specify
Limit 500 characters

Label_BIRTGEN
GENDER

Label_GENDER
GENDEREXPN24

Label_SEXOR_N5
SKIP_24_SEXOR_N5
SEXOREXPN24
Label_ SEXOREXPN24
Voxco_ SEXOREXPN24

Page | 27

Topic: Language ability (DL)
LANWL2N3

DL.1.0.

Do you speak a language other than English at home?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Speak a language other than English
If LANWL2N3 (Speak a language other than English) is 1 (yes), go to LANWL3N8_24. Else
skip to COBORN_8 (Country or territory of birth).

DL.1.1.

What is this language? [DON’T READ RESPONSES. SELECT ALL THAT APPLY.]
1 American Sign Language
2 Armharic
3 Arabic
4 Chinese
5 French
6 German
7 Haitian Creole
8 Italian
9 Portuguese
10 Spanish
11 Swahili
12 Tagalog
13 Other
88 Don't know
77 Refused to answer
Name of language spoken 24
If LANWL3N8_25 = 13 (Other), go to LANN3_OS_24. Else, skip to
If LANWL2N3 (Speak a language other than English) (Speak a language other than English)
is 0 (no), 7 (refused to answer), or 8 (don’t know), then skip to COBORN_8 (Country or
territory of birth) (Country or territory of birth).

Label_LANWL2N3
Skip_24_LANWL2N3
LANWL3N8_24

Label_LANWL3N8_24
Skip_LANWL3N8_24
Voxco_ LANWL3N8_24

If LANWL3N8_24 (Name of language spoken 24) is 13 (other), ask LANN3_OS_24 (Specify
other language 2024).

ASKIF_ LANN3_OS_24
LANN3_OS_24
Label_LANN3_OS_24

DL.1.2.

ASKIF_ LANWL1N3_24
LANWL1N3_24

Label_LANWL1N3_24
Voxco_LANWL1N3_24

Specify language:
Specify other language 2024
Ask if LANWL2N3 (Speak a language other than English) is 1 (yes).

DL.2.0.

How well do you speak English? [READ RESPONSES. SELECT ONLY ONE.]
1 Very well
2 Well
3 Not well
4 Not at all
8 Don't Know
7 Refused to Answer
How well do you speak English revised 24
Go to next topic.

Page | 28

Topic: U.S. born (DF)
COBORN_8

DF.1.0.

Label_COBORN_8
Skip_21_OTCTRY

OTCTRY
Label_OTCTRY

In what country or territory were you born? [DON'T READ RESPONSES. SELECT ONLY ONE.]
1 United States
2 Puerto Rico
3 Mexico
4 Haiti
5 Dominican Republic
6 Cuba
7 Other
88 Don't Know
77 Refused to Answer
Country or territory of birth
If COBORN_8 (Country or territory of birth) is 7 (other), go to OTCTRY (Other specifycountry/territory of birth). If COBORN_8 (Country or territory of birth) is 88 (don't know) or
77 (refused to answer), skip to JAIL_N5 (Number of times incarcerated). Else, skip to
JAIL_N5 (Number of times incarcerated).

DF.1.1.

Specify other country:
Other specify-country/territory of birth

Topic: Incarceration (DJ)
JAIL_N5

DJ.1.0.

During the past 12 months, how many different times were you in jail, detention, or prison
for longer than 24 hours?
888 Don't Know
777 Refused to Answer
Number of times incarcerated
0-180
If PRISONSETN24 = 01 and JAIL_N5 (Number of times incarcerated) = 0, then read,
Interviewer: the interview setting is a prison or jail facility, but the respondent said they
have not been incarcerated during the past 12 months. Please clarify. Return to JAIL_N5
(Number of times incarcerated).
If JAIL_N5 (Number of times incarcerated) is 0, 777 (refused to answer), or 888 (don’t
know), then skip to Intro1_8_HOMEL_9A (Lived on the street).
Else go to DYINCN5 (Number of days when last incarcerated).

DJ.1.1.

The last time you were in jail, detention, or prison for longer than 24 hours, how many
days did you spend in jail, detention, or prison?
8888 Don't Know
7777 Refused to Answer
If PRISON-SET-N24 (interviewed in prison or jail) = 0 and JAIL_N5 (Number of times
incarcerated) (Number of times incarcerated) = 1, read the question as follows: How many
days did you spend in jail, detention, or prison?
If PRISON-SET-N24 (interviewed in prison or jail) = 1 (yes), read the question as follows:
How many days have you currently spent in jail, detention, or prison?
Number of days when last incarcerated
1–7776
If PRISON-SET-N24 (interviewed in prison or jail) = 1, then skip to Intro1_8_HOMEL_9A
(Lived on the street) (Lived on the street). If DYINCN5 (Number of days when last
incarcerated) (Number of days when last incarcerated) is 8888 (don't know) or 7777
(refused to answer), go to DTINCN5 (Date of last release) (Date of last release). Else go to
DTINCN5 (Date of last release) (Date of last release).

Label_JAIL_N5
Range_6_JAIL_N5
Hard_edit_24_JAIL_N5

Skip21_JAIL_N5

DYINCN5

Alt_text2_24_DYINCN5

Alt_text1_24_DYINCN5
Label_DYINCN5
Range_DYINCN5
Skip_24_DYINCN5

Page | 29
DTINCN5

DJ.1.2.

Alt_text_N8_DTINCN5
Label_DTINCN5
Range_21_DTINCN5
Hard_edit1_DTINCN5

Hard_edit2_N21_DTINCN5

The last time you were in jail, detention, or prison for longer than 24 hours, what month
and year were you released?
8888 Don't Know
7777 Refused to Answer
If JAIL_N5 (Number of times incarcerated) = 1, read the question as follows: "What month
and year were you released?"
Date of last release
01/1900-01/2050
DTINCN5 (Date of last release) cannot be earlier than IDATE (Interview Date calculated or
corrected) – 12 months. If DTINCN5 (Date of last release) is earlier than IDATE (Interview
Date calculated or corrected) – 12 months, then read, “The release date has to be within
the past 12 months. Please re-enter date.” Do not allow the program to advance. If date is
exactly 12 months prior to IDATE (Interview Date calculated or corrected), then message
should not pop up. Allow program to advance.
DTINCN5 (Date of last release) cannot be later than IDATE (Interview Date calculated or
corrected). If DTINCN5 (Date of last release) > IDATE (Interview Date calculated or
corrected), then read, “Date cannot be later than interview date." Do not allow program
to advance.

Topic: Homeless (DH)
Intro1_8_HOMEL_9A
Intro2_6_HOMEL_9A
HOMEL_9A

DH.1.1.

Label_HOMEL_9A
Voxco_noteN22_HOMEL_9A

HOMEL_9B

DH.1.2.

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

DH.1.3.

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

Label_HOMEL_9B
HOMEL_9C

Label_HOMEL_9C

Next I’ll ask about the past 12 months. That is from last year [INSERT IDATE (Interview
Date calculated or corrected)-12 MONTHS] to today.
During the past 12 months,have you done any of the following:
…lived on the street?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived on the street
Voxco should insert the appropriate dates. Example: If IDATE (Interview Date calculated or
corrected) is 11/11/2022, then the program should read, “That is from last year,
11/11/2021 to today.”

Page | 30
HOMEL_9D

DH.1.4.

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

DH.2.0.

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

DH.3.0.

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

DH.4.0.

Label_EVICTN8

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

Calculation_ENBSDMN5 D.0.a.
Label_Calculation_ENBSDMN5

ENBSDMN5 = Current time
End of basic demographics

Calculation_TLBSDMN5 D.0.b.
Label_Calculation_TLBSDMN5

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

Label_HOMEL_9D
DOUBLEN8

Label_DOUBLEN8
MOVESN8

Label_MOVESN8
Range_MOVESN8
EVICTN8

Page | 31

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

STDSABN5 = Current time
Start time of disability

Intro_21_DISDEFN3
DISDEFN3

“Now, I’m going to ask about conditions you may or may not have.”
Are you deaf or do you have serious difficulty hearing?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Deaf or serious difficulty hearing

AD.1.0.

Label_DISDEFN3
DISBLNN3

AD.2.0.

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

AD.3.0.

Because of a physical, mental, or emotional condition, do you have serious difficulty
concentrating, remembering, or making decisions?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Difficulty concentrating, remembering…

AD.4.0.

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

AD.5.0.

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

AD.6.0.

Label_DISERRN3

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

Calculation_ENDSABN5 A.0.a.
Label_Calculation_ENDSABN5

ENDSABN5 = Current time
End of disability section

Label_DISBLNN3
DISCONN3

Label_DISCONN3
DISWLKN3

Label_DISWLKN3
DISDRSN3

Label_DISDRSN3
DISERRN3

Page | 32
Calculation_TLDSABN5

A.0.b.

Label_Calculation_TLDSABN5

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

Page | 33

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

STFINAN5 = Current time
Start time of financial section

Intro_5_WORK_N3

“For the next question, please choose the answer that best describes your current
employment status. Tell me after I’ve read all the choices.”
Are you currently…? [READ RESPONSES. SELECT ONLY ONE.]
1 Employed for wages
2 Self-employed
3 Out of work for more than 1 year
4 Out of work for less than 1 year
5 A homemaker
6 A student
7 Retired
8 Or unable to work
88 Don't Know
77 Refused to Answer
Current employment status

WORK_N3

FE.1.0.

Label_WORK_N3

Topic: Income (FI)
Intro_INCOME_8_21

INCOME_8_21

FI.1.0.

Label_INCOME_8_21
Skip_INCOME_8_21

Voxco_noteN22_INCOME_8_21

“Now I’d like to ask you some questions about [INSERT LASTYEAR (Last calendar year)].
That is from January 1st, [INSERT LASTYEAR (Last calendar year)] to December 31st,
[INSERT LASTYEAR (Last calendar year)]. For this next question, we will use Response Card
A as well as the calendar.”
In [INSERT LASTYEAR], what was your combined monthly or yearly family income from all
sources before taxes? When I say “combined family income,” I mean the total amount of
money from all family members living in your household. Please tell me the letter that
matches your income. [USE RESPONSE CARD.]
1 a. $0 to $916 per month or $0 to $10,999 per year
2 b. $917 to $1,083 per month or $11,000 to $12,999 per year
3 c. $1,084 to $1,249 per month or $13,000 to $14,999 per year
4 d. $1,250 to $1,416 per month or $15,000 to $16,999 per year
5 e. $1,417 to $1,666 per month or $17,000 to $19,999 per year
6 f. $1,667 to $2,083 per month or $20,000 to $24,999 per year
7 g. $2,084 to $2,499 per month or $25,000 to $29,999 per year
8 h. $2,500 to $3,333 per month or $30,000 to $39,999 per year
9 i. $3,334 to $4,166 per month or $40,000 to $49,999 per year
10 j. $4,167 to $6,249 per month or $50,000 to $74,999 per year
11 k. $6,250 or more per month or $75,000 or more per year
88 Don't Know
77 Refused to Answer
Income - monthly and yearly
If INCOME_8_21 (Income - monthly and yearly) is 77 (refused to answer) or 88 (don’t
know), skip to FOOD3_N5 (Food security-hungry). Else, go to DEPND_IN (Number of
dependents).
Use spacing in Voxco for the response options to aid with readability.

Page | 34
DEPND_IN

FI.2.0.

Including you, how many people depended on this income in [INSERT LASTYEAR]?
88 Don't Know
77 Refused to Answer
Number of dependents
1–49
If DEPND_IN (Number of dependents) is greater than 1, go to DEPND_N3 (Number of
dependents < 18 years old). Else, skip to FOOD3_N5 (Food security-hungry).

FI.2.1.

Of the people who depended on this income in [INSERT LASTYEAR], how many were less
than 18 years old?
88 Don't Know
77 Refused to Answer
Number of dependents < 18 years old
0-48
If DEPND_N3 (Number of dependents < 18 years old) is greater than or equal to DEPND_IN
(Number of dependents), read, "The number of people under 18 who depended on your
income in [INSERT LASTYEAR (Last calendar year)] must be less than the total number of
people who depended on your income in [INSERT LAST YEAR]." Do not advance program.

Label_DEPND_IN
Range_DEPND_IN
Skip_DEPND_IN
DEPND_N3

Label_DEPND_N3
Range_DEPND_N3
Hard_edit_DEPND_N3

Topic: Food security (FS)
FOOD3_N5

FS.1.0.

Label_FOOD3_N5

During the past 12 months, were you ever hungry but didn't eat because there wasn't
enough money for food?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Food security-hungry

Topic: Healthcare coverage (FH)
Intro_INSEMPN5_21

INSEMPN5_21

FH.1.1.

Label_INSEMPN5_21
INSMKTN5_21

FH.1.2.

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

FH.1.3.

Did you purchase a health insurance plan directly from a health insurance company?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-insurance company

Label_INSMKTN5_21
INSCOMPN21

Label_INSCOMPN21

I’d like to ask you about health insurance and healthcare coverage you had during the past
12 months. This is from [IDATE (Interview Date calculated or corrected)-12 months] to
today.
Did you have health insurance through your employer or a family member's employer?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-employer

Page | 35
KINDB_5

FH.1.4.

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

FH.1.5.

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

FH.1.6.

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

Label_KINDB_5
KINDC_5

Label_KINDC_5
KINDD_5

Label_KINDD_5

If PRISON-SET-N24 (interviewed in prison or jail) = 1, and DYINCN5 (Number of days when
last incarcerated) (Number of days when last incarcerated) >= 365, skip to KINDG_5
(Insurance-city/county/st/other public) (Insurance city/ county/st/other public). Else go to
KINDEN21 (Insurance-military) (Insurance-military).

Skip_24_KINDEN21

KINDEN21

FH.1.7.

Did you have military-based healthcare coverage, such as TRICARE, CHAMPUS, CHAMPVA,
or healthcare coverage through the Veterans Administration?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-military

FH.1.8.

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

FH.1.9.

Did you have any other insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-other insurance
If KINDJ_5 (Insurance-other insurance) is 1 (yes), go to KINDOSN5 (Insurance-other
specify). If KINDJ_5 (Insurance-other insurance) is 0 (no), 7 (refused to answer) or 8 (don’t
know), skip to Skip_21_KINDOSN5 (Insurance-other specify).

LABEL_KINDEN21
KINDG_5

Label_KINDG_5
KINDJ_5

Label_KINDJ_5
Skip_21_KINDJ_5

Page | 36
KINDOSN5

FH.1.10.

Please tell me the other type of insurance that you had.
888 Don't Know
777 Refused to Answer
Insurance-other specify
If KINDEN21 (Insurance-military) is Skipped, treat as 0 (no). If INSEMPN5_21 (Insuranceemployer) through KINDJ_5 (Insurance-other insurance) = 0 (no), go to KINDZN5_21
(Insurance-no coverage confirmation). Else, skip to INS12_9_21 (Gap in insurance or
coverage).

FH.1.11.

So, during the past 12 months, you had no health insurance and no other coverage for any
type of healthcare including help with payment for your medications. Is that correct?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-no coverage confirmation
If KINDZN5_21 (Insurance-no coverage confirmation) = 0 (no), then return to INSEMPN5_
21 (Insurance-employer). Ask this section again. If KINDZN5_21 (Insurance-no coverage
confirmation) = 1 (yes), 7 (refused to answer), or 8 (don't know), go to PAY_N5 (ACA –
problems paying).

FH.2.0.

During the past 12 months, was there a time that you didn’t have any health insurance or
healthcare coverage?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Gap in insurance or coverage
If INS12_9_21 (Gap in insurance or coverage) is 1 (yes), go to INSMTHN5_21 (Insurancemonths without coverage) .
If INS12_9_21 (Gap in insurance or coverage) is 0 (no), 7 (refused to answer) or 8 (don't
know), skip to PAY_N5 (ACA – problems paying).

FH.2.1.

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

FH.3.0.

Label_PAY_N5

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

Calculation_ENFINAN5 F.0.a.
Label_Calculation_ENFINAN5

ENFINAN5= Current time
End of financial section

Calculation_TLFINAN5
F.0.b.
Label_Calculation_TLFINAN5

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

Label_KINDOSN5
Skip_21_KINDOSN5

KINDZN5_21

Label_KINDZN5_21
Skip_KINDZN5_21

INS12_9_21

Label_INS12_9_21
Skip_INS12_9_21

INSMTHN5_21

Label_INSMTHN5_21
Range_INSMTHN5_21
PAY_N5

Page | 37

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

STGNMDN5 = Current time
Start time of General Medical Care

INTRO_21_GENHLTHN8
GENHLTN8
JW.1.0.

"Now I'm going to ask about your health."
In general, is your health [READ RESPONSES. SELECT ONLY ONE.]:
1 Poor
2 Fair
3 Good
4 Very good
5 Excellent
8 Don't know
7 Refused to answer
Perception of general health

Label_GENHLTN8

Topic: ER and hospitalizations (JH)
HOSPERN5

JH.1.0.

During the past 12 months, how many times have you gone to a hospital emergency room
about your own health? This includes emergency room visits that resulted in a hospital
admission.
888 Don't Know
777 Refused to Answer
Number of times gone to hospital ER
0–776

JH.2.0.

During the past 12 months, were you a patient in a hospital overnight? Don’t include an
overnight stay in the emergency room.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever in a hospital overnight
If HOSPONN5 (Ever in a hospital overnight) = 0 (no), 7 (refused to answer), or 8 (don’t
know), then skip to VACFL_8 (Influenza vaccination past 12 months). Else, go to
NUMONN5 (Num times stayed in hospital overnight).

JH.2.1.

During the past 12 months, how many different times did you stay in any hospital
overnight or longer?
888 Don't Know
777 Refused to Answer
Num times stayed in hospital overnight
1-365

JF.1.0.

During the past 12 months, did you get a flu shot?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Influenza vaccination past 12 months

Label_HOSPERN5
Range_HOSPERN5
HOSPONN5

Label_HOSPONN5
Skip_HOSPONN5_8

NUMONN5

Label_NUMONN5
Range_NUMONN5

Topic: Influenza (JF)
VACFL_8

Label_VACFL_8

Page | 38

Topic: Health literacy (JL)

Label_HLMF_12
Skip_8_HLMF_12

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

Calculation_ENGNMDN5 J.0.a.
Label_Calculation_ENGNMDN5

ENGNMDN5 = Current time
End of General medical care

Calculation_TLGNMDN5 J.0.b.
Label_Calculation_TLGNMDN5

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

Intro_8_HLMF_12
HLMF_12

JL.1.0.

Page | 39

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

STHVCAN5 = Current time
Start time of HIV care

Intro_N21_IPERINN3
IPERINN3

Next, I'm going to ask some questions about HIV.
Were you born with HIV?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Were you born with HIV?
If IPERINN3 (Were you born with HIV?) is 1 (yes) and DOB_13 (Date of birth) is earlier than
January 1977, read, “The date of birth provided is earlier than 1977, the date of the first
persons born with HIV were documented. Confirm date of birth.” Allow program to move
forward.
If IPERINN3 (Were you born with HIV?) = 1, then skip to Intro_21_EVERCR_8 (Ever rcvd.
HIV care). IPERINN3 (Were you born with HIV?) = 0 (no), 8 (don't know) or 7 (refused to
answer), go to POS1S_9 (Date first tested positive for HIV).

KD.1.0.

Label_IPERINN3
Soft_edit_8_IPERINN3

Skip_21_IPERINN3

POS1S_9

KD.2.0.

Label_POS1S_9
Range_POS1S_9
Soft_edit_POS1S_9

Hard_edit_POS1S_9

Hard_edit2_N21_POS1S_9

Voxco_noteN22_POS1S_9

What month and year did you first test positive for HIV? Tell me when you got your result,
not when you got your test.
8888 Don't Know
7777 Refused to Answer
Date first tested positive for HIV
01/1900-01/2050
If POS1S_9 (Date first tested positive for HIV) is earlier than March 1985, confirm
response. If POS1S_9 (Date first tested positive for HIV) is earlier than 03/1985, read, “The
date entered is earlier than 03/1985, the date of the first FDA-approved HIV test. Confirm
date of HIV test.” Program should move forward regardless of date.
POS1S_9 (Date first tested positive for HIV) cannot be earlier than DOB_13 (Date of birth).
If POS1S_9 (Date first tested positive for HIV) is earlier than DOB_13 (Date of birth), then
read, “Date first tested positive cannot be earlier than date of birth.”
POS1S_9 (Date first tested positive for HIV) cannot be later than IDATE (Interview Date
calculated or corrected). If POS1S_9 (Date first tested positive for HIV) > IDATE (Interview
Date calculated or corrected), then read, “Date cannot be later than interview date." Do
not allow program to advance.
Allow a blank response for month.

Page | 40

Topic: Ever care (KE)
Intro_21_EVERCR_8

EVERCR_8

KE.1.0.

alt_text_21_evercr_8_24

Label_EVERCR_8
Soft_edit_EVERCR_8
Skip_EVERCR_8

Next, I’ll ask about HIV care. By that, I mean routine care from a doctor, nurse, or other
healthcare worker to treat HIV—not emergency care when you go to an urgent care
center, emergency room, or stay in a hospital overnight.
Since testing positive for HIV in _ _ /_ _ _ _ [INSERT POS1S_9 (date first tested positive for
HIV)], have you ever seen a doctor, nurse, or other healthcare worker for HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) has an unknown month value but a known
year value, then read: Since testing positive for HIV in [Insert year from POS1S_9 (Date first
tested positive for HIV)], have you ever seen a doctor, nurse, or other healthcare worker
for HIV care? If POS1S_9 (Date first tested positive for HIV) is 77/7777 (refused to answer),
88/8888 (don’t know) or Skipped, then EVERCR_8 (Ever rcvd. HIV care) should read as
follows: Since testing positive for HIV, have you ever seen a doctor, nurse, or other
healthcare worker for HIV care? If IPERINN3 (Were you born with HIV?) = 1 (yes), then
read: Have you ever seen a doctor, nurse, or other healthcare worker for HIV care?
Ever rcvd. HIV care
If EVERCR_8 (Ever rcvd. HIV care) = 0, then read "Are you sure that you have never
received HIV care?" Allow the program to move forward.
If IPERINN3 (Were you born with HIV?) = 1, then skip to Skip_MSAPPT_8 (Missed
appointments). Else, go to Skip_CARE1_8 (1st HIV care visit).

Topic: Linkage to care (KL)
Skip_CARE1_8

If POS1S_9 (Date first tested positive for HIV) < 5 years from IDATE (Interview Date
calculated or corrected), go to Skip2_CARE1_8 (1st HIV care visit).
If POS1S_9 (Date first tested positive for HIV)>= 5 years from IDATE (Interview Date
calculated or corrected) or if POS1S_9 (Date first tested positive for HIV) is 88/8888 (don't
know), 77/7777 (refused to answer), or skipped, skip to Skip_MSAPPT_8 (Missed
appointments).

Skip2_CARE1_8

If EVERCR_8 (Ever rcvd. HIV care) is 0 (no), 7 (refused to answer), or 8 (don't know), skip to
Intro_PREF1_8 (Offered help finding medical care).

CARE1_8

KL.1.0.

Label_CARE1_8
Intro_PREF1_8

PREF1_8

Label_PREF1_8

KL.2.0.

Within 30 days after testing positive, did you see a doctor, nurse, or other healthcare
worker for HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
1st HIV care visit
Next I’ll ask whether you got help getting connected to HIV care from a professional. A
professional could be someone like a doctor, nurse, social worker, patient navigator, or
receptionist. If you don’t remember, it’s okay to answer "don’t know."
Within 30 days after testing positive, did a professional ask if you needed help finding a
place to go for HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Offered help finding medical care

Page | 41
PREF2N8

KL.3.0.

Within 30 days after testing positive, did a professional tell you where you could go for
HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Told of HIV care

KL.4.0.

Within 30 days after testing positive, did a professional help you figure out if you qualified
for free or low-cost HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage free or low cost HIV care

KL.5.0.

Within 30 days after testing positive, did a professional make an appointment for you to
receive HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage making appointment

KL.6.0.

Within 30 days after testing positive, did a professional arrange transportation for you to
an HIV care appointment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage help arranging transport

KL.7.0.

Within 30 days after testing positive, did anyone contact you to remind you of your first
HIV care appointment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage appointment reminder

Label_PREF2N8
AREF4_8

Label_AREF4_8
AREF1_8

Label_AREF1_8
AREF2_8

Label_AREF2_8
AREF5N8

Label_AREF5N8

If CARE1_8 (1st HIV care visit) = 0 (no), 7 (refused), or 8 (don't know), then skip to
Skip_MSAPPT_8 (Missed appointments). If EVERCR_8 (Ever rcvd. HIV care) = 0 (no), 7
(refused), or 8 (don't know), then skip to Skip_MSAPPT_8 (Missed appointments). Else, go
to AREF3_8 (Linkage accompany 1st appt).

Skip_AREF3_8

AREF3_8

Label_AREF3_8

KL.8.0.

Within 30 days after testing positive, did a professional go with you to your first HIV care
appointment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage accompany 1st appt

Page | 42

Topic: Care utilization (KU)
If EVERCR_8 (Ever rcvd. HIV care) = 1 (yes), go to MSAPPT_8 (Missed appointments).
If EVERCR_8 (Ever rcvd. HIV care) = 0 (no), 7 (refused to answer), or 8 (don't know), skip to
Intro_21_BARRI1N8 (Barriers to care: financial).

Skip_ MSAPPT_8

MSAPPT_8

KU.1.0.

During the past 12 months, have you missed any scheduled appointments for HIV care
that you didn’t cancel? Don't include appointments that were cancelled by the clinic.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed appointments

KU.2.0.

What month and year was your most recent visit to a doctor, nurse, or other healthcare
worker for HIV care?
8888 Don't Know
7777 Refused to Answer
Date most recent outpt. HIV care visit
01/1900-01/2050
LASCA_8 (Date most recent outpt. HIV care visit) cannot be earlier than DOB_13 (Date of
birth). If LASCA_8 (Date most recent outpt. HIV care visit) < DOB_13 (Date of birth), then
read, "Date cannot be earlier than date of birth." Do not allow program to advance.
LASCA_8 (Date most recent outpt. HIV care visit) cannot be earlier than POS1S_9 (Date
first tested positive for HIV). If LASCA_8 (Date most recent outpt. HIV care visit) < POS1S_
9 (Date first tested positive for HIV), then read, "Your most recent care visit cannot be
earlier than your diagnosis date." Do not allow program to advance.
LASCA_8 (Date most recent outpt. HIV care visit) cannot be later than IDATE (Interview
Date calculated or corrected). If LASCA_8 (Date most recent outpt. HIV care visit) > IDATE
(Interview Date calculated or corrected), then read, "Date cannot be later than interview
date." Do not allow program to advance.
If LASCA_8 (Date most recent outpt. HIV care visit) is 2 years or more before IDATE
(Interview Date calculated or corrected), then skip to HCPROVN8_24. Else, go to USOCN5_
8 (HIV care facility name).
Allow a blank response for month.

Label_MSAPPT_8
LASCA_8

Label_LASCA_8
Range_21_LASCA_8
Hard_edit_LASCA_8

Hard_edit2_LASCA_8

Hard_edit3_N21_LASCA_8

Skip_24_LASCA_8

Voxco_noteN22_LASCA_8
USOCN5_8

KU.3.0.

Label_USOCN5_8
Voxco_noteN22_USOCN5_8

NYMLTF_21

Label_NYMLTF_21
Skip_24_NYMLTF_21

KU.4.0.

During the past 2 years, what is the name of the place you went for most of your HIV
care?
HIV care facility name
Interviewer instructions: The name of the usual place of outpatient care is not recorded in
Voxco, but will be used in later questions. This is the name of the location where the
medical record abstraction should be performed.
During the past 2 years, have you seen a doctor, nurse, or other healthcare worker for HIV
care at any facility besides [INSERT NAME OF PLACE YOU WENT FOR MOST OF YOUR
CARE]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Other facilities used for HIV care
If NYMLTF_21 (Other facilities used for HIV care) = 0 (no), 7 (refused to answer), or 8 (don't
know), then skip to HCPROVN8_24. Else, go to MLTFA2_8 (Total facilities attended for HIV
care).

Page | 43
MLTFA2_8

KU.4.1.

Label_MLTFA2_8
Range_MLTFA2_8

During the past 2 years, at how many total facilities have you received HIV care? Please
include [INSERT NAME OF PLACE YOU WENT FOR MOST OF YOUR CARE] in the total.
888 Don't Know
777 Refused to Answer
Total facilities attended for HIV care
2-99

Topic: Patient-provider relationship (KB)
HCPROVN8_24

KB.1.0.

0 No
1 Yes
8 Don't Know
7 Refused to Answer
Health care provider identified
If HCPROVN8_24 = 0 (no), 7 (refused to answer), or 8 (don’t know), skip to Intro_21
_BARRI1N8 (Barriers to care: financial). Else, go to Intro_commu1n24.

Label_HCPROVN8_24
Skip_HCPROVN8_24
Intro_COMMU1N24
COMMU1N24

KB.2.0.

Label_COMMU1N24
COMMU2N24

Do you have a doctor, nurse, or other health care worker whom you see for most of your HIV
care?

KB.3.0.

Label_COMMU2N24

The next two questions are about the doctor, nurse, or other health care worker you see
for most of your HIV care.
How often do they take the time to listen to you?
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Always
8 Don't Know
7 Refused to Answer
takes the time to listen
How often do they involve you in decisions about your health?
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Always
8 Don't Know
7 Refused to Answer
Shared decision making

Topic: Barriers and facilitators to care (KP)
Intro_21_BARRI1N8
BARRI1N8

Label_BARRI1N8

KP.1.0.

"I want to ask you about things that either get in the way or help people get HIV care."
During the past 12 months, have problems with money or health insurance made it
difficult for you to get HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: financial

Page | 44
BARRI2N8

KP.2.0.

During the past 12 months, has depression or mental health problems made it difficult for
you to get HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: mental health

KP.3.0.

During the past 12 months, have you delayed getting HIV care because you felt well?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: felt well

KP.4.0.

During the past 12 months, have you had trouble getting HIV care because a doctor's
office or HIV clinic was hard to get to?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: lack access

KP.5.0.

During the past 12 months, have you delayed getting HIV care because you were too busy
with other personal things, such as family or work?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: personal things

KP.6.0.

During the past 12 months, have you delayed getting HIV care for some other reason?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: other
If BARRI6N21 (Barriers to care: other) = 1 (yes), then go to BARRI6N21OS (Barrier- other
specify).
If BARRI6N21 (Barriers to care: other) = 0 (no), 7 (refused to answer) or 8 (don't know),
skip to FACCI1N8 (Facilitators to care: easy access) .

KP.6.1.

Label_BARRI6N21OS
Voxco_noteN22_BARRI6N21OS

What is this reason?
888 Don't know
777 Refused to Answer
Barrier- other specify
Character limit is 250 words.

Calculation_ENHVCAN5 K.0.a.
Label_Calculation_ENHVCAN5

ENHVCAN5 = Current time
End of HIV in care section

Calculation_TLHVCAN5 K.0.b.
Label_Calculation_TLHVCAN5

Calculate elapsed time between STHVCAN5 and ENHVCAN5 = TLHVCAN5
Total time for HIV Care

Label_BARRI2N8
BARRI3N8

Label_BARRI3N8
BARRI4N8

Label_BARRI4N8
BARRI5N8

Label_BARRI5N8
BARRI6N21

Label_BARRI6N21
Skip_BARRI6N21

BARRI6N21OS

Page | 45

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

STADHRN5 = Current time
Start HIV treatment and adherence

Skip_21_EART_N5

If EVERCR_8 (Ever rcvd. HIV care) is 1 (yes), go to Intro_21_EART_N5 (Ever taken ART).
Else if EVERCR_8 (Ever rcvd. HIV care) is 0 (No) or 8 (Don't Know) or 7 (Refused to Answer),
skip to Calculation_ENADHRN5 (End of HIV treatment and adherence).
“Now I’m going to ask about medicines that you may be taking for HIV. These HIV
medicines are also known as antiretroviral medicines or ART. The questions are about HIV
medicines taken after you tested positive for HIV.”
Have you ever taken any HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever taken ART
If EART_N5 (Ever taken ART) is 1 (yes), skip to Skip_N21_FART_N5. If EART_N5 (Ever taken
ART) is 7 (refused to answer) or 8 (don’t know), skip to Calculation_ENADHRN5 (End of HIV
treatment and adherence). Else if EART_N5 (Ever taken ART) is 0 (No) go Intro_8_NART1
_N5 (Never ART: No one talked about it).

Intro_21_EART_N5

EART_N5

TE.1.0.

Label_EART_N5
Skip2_21_EART_N5

Intro_8_NART1_N5

NART1_N5

TE.1.1.

Label_NART1_N5
Skip_8_NART1_N5

NART2_N5

TE.1.2.

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

TE.1.3.

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

Label_NART2_N5
NART3_N5

Label_NART3_N5

“I’m going to read you a list of reasons why some people have not taken HIV medicines
after testing positive for HIV. For each reason, please tell me 'yes' or 'no' if it applies to
your situation.”
No healthcare provider has ever talked to you about taking HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: No one talked about it
If NART1_N5 (Never ART: No one talked about it) = 1 (yes) then skip to NART3_N5 (Never
ART: Prob. with money/insurance). Else, go to NART2_N5 (Never ART: Dr said not to
start).

Page | 46
NART4_N5

TE.1.4.

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

TE.1.5.

You decided not to take HIV medicines because you think they would make you feel sick or
harm you.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: Think would feel sick or harm
Skip to Calculation_ENADHRN5 (End of HIV treatment and adherence).

Label_NART4_N5
NART5_N5

Label_NART5_N5
Skip_N21_NART5_N5
Skip_N21_FART_N5

FART_N5

If POS1S_9 (Date first tested positive for HIV) is greater than 5 years from IDATE (Interview
Date calculated or corrected), skip to CART_N5 (Currently taking ART). If POS1S_9 (Date first
tested positive for HIV) is 7777 (refused to answer) Or 8888 (don't know) or missing, then
skip to CART_N5 (Currently taking ART). If IPERINN3 (Were you born with HIV?) = 1, then
skip to CART_N5 (Currently taking ART). If POS1S-9 is REF, DK, or missing, then skip o
CART_N5 (Currently taking ART). Else If POS1S_9M is missing and (POS1S_9Y = 5 years from
IDATE (Interview Date calculated or corrected) or POS1S_9Y is less than 5 years from IDATE
(Interview Date calculated or corrected)) go to FART_N5 (Date first took ART). If POS1S_9
(Date first tested positive for HIV) = 5 years from IDATE (Interview Date calculated or
corrected) or POS1S_9 (Date first tested positive for HIV) is less than 5 years from IDATE
(Interview Date calculated or corrected) go to FART_N5 (Date first took ART).
TE.2.0.

Label_FART_N5
Range_21_FART_N5
Hard_edit1_FART_N5

Hard_edit2_FART_N5

Hard_edit3_N21_FART_N5

Voxco_noteN22_FART_N5

When was the first time you ever took any HIV medicines? Please tell me the month and
year.
8888 Don't Know
7777 Refused to Answer
Date first took ART
01/1900-01/2050
FART_N5 (Date first took ART) cannot be earlier than POS1S_9 (Date first tested positive
for HIV). If FART_N5 (Date first took ART) was before POS1S_9 (Date first tested positive
for HIV), then read, “The date first took HIV medications cannot be earlier than the HIV
diagnosis date. Please re-enter date." Do not allow the program to advance.
FART_N5 (Date first took ART) cannot be earlier than DOB_13 (Date of birth). If FART_N5
(Date first took ART) was before DOB_13 (Date of birth), then read, “The date first took
HIV medications cannot be earlier than the date of birth. Please re-enter date." Do not
allow the program to advance.
FART_N5 (Date first took ART) cannot be later than IDATE (Interview Date calculated or
corrected). If FART_N5 (Date first took ART) > IDATE (Interview Date calculated or
corrected), then read, "Date cannot be later than interview date." Do not allow program to
advance.
Allow a blank response for month. If month is blank for FART_N5 (Date first took ART), use
the year values for the validation.

Page | 47

Topic: Current ART (TC)
CART_N5

TC.1.0.

Are you currently taking any HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Currently taking ART
If CART_N5 (Currently taking ART) is 1 (yes), skip to Intro_8_ADH1_N5 (Days missed taking
ART). If CART_N5 (Currently taking ART) is 0 (no), 7 (refused to answer) or 8 (don’t know),
go to ATMD12_9 (Took ART in past 12 months).

TC.2.0.

During the past 12 months, have you taken HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Took ART in past 12 months
If CART_N5 (Currently taking ART) is 1 (yes), 7 (refused to answer) or 8 (don't know), then
skip to Skip_21_DASK_N5 (Dr asked if missed ART doses).
If CART_N5 (Currently taking ART) is 0 (no), go to Intro_8_CART1_N5 (Stopped ART: No
one talked about it).

Label_CART_N5
Skip_8_CART_N5

ATMD12_9

Label_ATMD12_9
Skip_21_ATMD12_9

Intro_8_CART1_N5
CART1_N5

TC.2.1.

Label_CART1_N5
Skip_8_CART1_N5

CART2_N5

TC.2.2.

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

TC.2.3.

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

Label_CART2_N5
CART3_N5

Label_CART3_N5

“I’m going to read you a list of reasons why some people are not currently taking HIV
medicines. For each reason, please tell me 'yes' or 'no' if it applies to your situation.”
No healthcare provider has talked to you about restarting HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped ART: No one talked about it
If CART1_N5 (Stopped ART: No one talked about it) = 1 (yes) then skip to CART3_N5 (Stop
ART: Prob. with money or insurance). Else, go to CART2_N5 (Stopped ART: Dr said not to
start).

Page | 48
CART4_N5

TC.2.4.

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

TC.2.5.

You decided not to take HIV medicines because you think they would make you feel sick or
harm you.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stop ART: Think would feel sick or harm
Skip to Skip_21_DASK_N5 (Dr asked if missed ART doses).

Label_CART4_N5
CART5_N5

Label_CART5_N5
Skip_N21_CART5_N5

Topic: Adherence (TA)
Intro_ARTTYP1N24
ARTTYP1N24

TA.1.0.

Label_ARTTYP1N24
ARTTYP2N24

TA.1.1.

IV infusions?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Current ART type - IV infusions

TA.1.2.

Shots?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Current ART type - Shots

TA.1.3.

Implants?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Current ART Type - Implants
If ARTTYP1N24 (Pills) =0 (no) and ARTTYP2N24 (IV infusions)=0 (no) and ARTTYP3N24
(shots)=0 (no) and ARTTYP4N24 (implants)=0 (no), then read" Earlier you told me that you
are currently taking HIV medication. Is this correct?" Interview instructions: Return to
previous questions to correct error.

Label_ARTTYP2N24
ARTTYP3N24

Label_ARTTYP3N24
ARTTYP4N24

Label_ARTTYP4N24
Hard_Edit_ARTTYPN24

People can take HIV medicines in different forms. Are any of your current HIV medicines…
Pills?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Current ART type - Pills

Page | 49
Intro1_24_ADH1N5_24

We realize it can be hard for people to take all their medications exactly as they are
supposed to.
Now I am going to ask you about your HIV medicines that are pills. I’m going to ask you
about the past 30 days. That is from [INSERT IDATE (Interview Date calculated or
corrected) - 30 DAYS] to today. [SHOW RESPONDENT CALENDAR]
IF ARTTYP1N24 = 1 (yes), then go to Intro2_8_ADH1_24. Else skip to Skip_

Intro2_24_ADH1N5_24

Skip_N24_ADH1_24
ADH1N5_24

TA.1.4.

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

TA.1.5

In the past 30 days, how good a job did you do at taking your HIV pills in the way you were
supposed to? [READ RESPONSES. SELECT ONLY ONE].
1 Very poor
2 Poor
3 Fair
4 Good
5 Very good
6 Excellent
8 Don't Know
7 Refused to Answer
How good a job taking ART pills

TA.1.6

During the past 30 days, how often did you take your HIV pills in the way you were
supposed to? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Almost always
6 Always
8 Don't Know
7 Refused to Answer
How often took ART pills

Label_ADH1_24
ADH2N5_24

Label_ADH2_24
ADH3N5_24

Label_ADH3_24
Skip_IVADH1N24
Intro_IVADH1N24
IVADH1N24

Label_IVADH1N24

TA.1.7.

If ARTTYP3N24 (IV infusions)=1 (yes) go to Intro_IVADH1N24. Else go to Skip_INJADH1N24.
Now I am going to ask you about your HIV medicines that are IV infusions.
In the past 12 months, did you miss an IV infusion?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART infusion

Page | 50
IVADH2N24

TA.1.8.

In the past 12 months, how good a job did you do at getting your IV infusions in the way
you were supposed to? [READ RESPONSES. SELECT ONLY ONE].
1 Very poor
2 Poor
3 Fair
4 Good
5 Very good
6 Excellent
8 Don't Know
7 Refused to Answer
How good a job getting ART infusions

TA.1.9.

During the past 12 months, how often did you get your infusions in the way you were
supposed to? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Almost always
6 Always
8 Don't Know
7 Refused to Answer
How often got ART infusions

Label_IVADH2N24
IVADH3N24

Label_IVADH3N24
Skip_INJADH1N24
Intro_INJADH1N24
INJADH1N24

TA.1.10.

Label_INJADH1N24
INJADH2N24

Label_INJADH2N24

TA.1.11.

If ARTTYP3N24 (shots) = 1 (yes), go to Intro_INJADH1N24. Else go to Skip_IMPADH1N24.
Now I am going to ask you about your HIV medicines that are shots.
In the past 12 months, did you miss a shot?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART injection
In the past 12 months, how good a job did you do at getting your shots in the way you
were supposed to?
1 Very poor
2 Poor
3 Fair
4 Good
5 Very good
6 Excellent
8 Don't Know
7 Refused to Answer
How good a job getting ART injections

Page | 51
INJADH3N24

TA.1.12.

Label_INJADH3N24
Skip_IMPADH1N24
Intro_IMPADH1N24
IMPADH1N24

TA.1.13.

Label_IMPADH1N24
IMPADH2N24

Label_IMPADH3N24

If ARTTYP4N24 (implant) = yes, go to Intro_IMPADH1N24. Else go to
Now I am going to ask you about your HIV medicines that are implants.
In the past 12 months, did you miss an implant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART implant

TA.1.14.

In the past 12 months, how good a job did you do at getting your implants in the way you
were supposed to?
1 Very poor
2 Poor
3 Fair
4 Good
5 Very good
6 Excellent
8 Don't Know
7 Refused to Answer
How good a job at getting ART implant

TA.1.15.

During the past 12 months, how often did you get your implants when you were supposed
to?
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Almost always
6 Always
8 Don't Know
7 Refused to Answer
How often got ART implants

Label_IMPADH2N24
IMPADH3N24

During the past 12 months, how often did you get your shots when you were supposed
to?
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Almost always
6 Always
8 Don't Know
7 Refused to Answer
How often got ART injections

Page | 52
TRBL_EFT

TA.2.0.

Label_TRBL_EFT
Skip_TRBL_EFT
Intro_MIS1N5_8
MIS1N5_8

TA.3.0.

Label_MIS1N5_8
MIS2_N5

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

TA.3.2.

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

TA.3.3.

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

TA.3.4.

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

Label_MIS3_N5
MIS4_N5

Label_MIS4_N5
MIS5_N5

Label_MIS5_N5

“The last time you missed taking your HIV medicines, which of the following were reasons
you missed? Please answer 'yes' or 'no' to each reason.”
You had a problem paying for your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Problem paying

TA.3.1.

Label_MIS2_N5
MIS3_N5

For the next question we will use Response Card D. During the past 30 days, how often
were you troubled by side effects from any of your HIV medicines? [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Never
2 Rarely
3 About half of the time
4 Most of the time
5 Always
8 Don't Know
7 Refused to Answer
How often side effects
IF ARTTYP1N24=1 (Pills) go to INTRO_MIS1N5_8; else skip to Calculation_ENADHRN5 (End
of HIV treatment and adherence)

Page | 53
MIS6_N5

TA.3.5.

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

TA.3.6.

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

TA.3.8.

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

TA.3.9.

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

Label_MIS6_N5
MIS7_N5

Label_MIS7_N5
MIS9_N5

Label_MIS9_N5
MIS10_N8

Label_MIS10_N8

If CART_N5 (Currently taking ART) is 1 (yes) or if ATMD12_9 (Took ART in past 12 months) is
1 (yes), go to DASK_N5 (Dr asked if missed ART doses). Else if CART_N5 (Currently taking
ART) is 0 (No) or 8 (Don't Know) or 7 (Refused to Answer) or if ATMD12_9 (Took ART in past
12 months) is 0 (No) or 8 (Don’t Know) or 7 (Refused to Answer), skip to
Calculation_ENADHRN5 (End of HIV treatment and adherence).

Skip_21_DASK_N5

DASK_N5

TA.4.0.

During the past 12 months, did your doctor or other clinic staff ask you whether you
missed taking any doses of your HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Dr asked if missed ART doses

TA.5.0.

Label_PROB_N5

During the past 12 months, did your doctor or other clinic staff ask you whether you had
problems taking your HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Dr asked if problems taking ART doses

Calculation_ENADHRN5 T.0.a.
Label_Calculation_ENADHRN5

ENADHRN5 = Current time
End of HIV treatment and adherence

Calculation_TLADHRN5 T.0.b.
Label_Calculation_TLADHRN5

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

Label_DASK_N5
PROB_N5

Page | 54

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

ST_SEXN5 = Current time
Start time of sexual behavior

Calculation_SX_GEN

If GENDER=Male and BIRTGEN=Male, then SX_GEN=1 (Male).
If GENDER=Female and BIRTGEN=Female, then SX_GEN=2 (Female).
If (GENDER=Male and BIRTGEN=Female) or (GENDER=Female and BIRTGEN=Male) or
(GENDER=Transgender and [BIRTGEN=1 (Male), 2 (Female), 7 (refused to answer), or 8
(don’t know)]), then SX_GEN=3 (Transgender).
If BIRTGEN=intersex, then SX_GEN=4 (Indeterminate).
If ([GENDER=7 (refused to answer) or 8 (don’t know)] and [BIRTGEN = 1 (Male), 2 (Female),
7 (refused to answer), or 8 (don’t know)], then SX_GEN=4 (Indeterminate).
If BIRTGEN=7 (refused to answer) or 8 (don’t know), and GENDER is 1 (male), 2 (female), 7
(refused to answer), or 8 (don’t know), then SX_GEN=4 (Indeterminate).
1 Male
2 Female
3 Transgender
4 Indeterminate
Sex gender
If SX_GEN (Sex gender) = 3, skip to Intro2_N21_SX_TFPN4. Else, go to Intro1_N21
_SX_TFPN4.

ST.1.0.

Label_Calculation_SX_GEN
Skip_N21_SX_GEN
Intro1_N21_SX_TFPN4

"Next I'm going to ask you about sex. When I say sex, I mean vaginal or anal sex. Vaginal
sex means penis in the vagina and anal sex means penis in the anus. When answering,
don't include people you only had oral sex with. The number of people could range
anywhere from 0 to over a hundred. Remember that your answers will be private."
All responses go to Skip2_SX_TFPN4 (Number of female partners).
"Next I'm going to ask you about sex. When I say sex, I mean vaginal or anal sex. Vaginal
sex means penis in the vagina, neovagina, or front hole. Anal sex means penis in the anus,
butt, or back hole. When answering, don't include people you only had oral sex with. The
number of people could range anywhere from 0 to over a hundred. Remember that your
answers will be private."
If SX_GEN (Sex gender)=2 (Female), skip to SX_TMPN4 (Number of male partners). Else, go
to SX_TFPN4 (Number of female partners).

Skip1_SX_TFPN4
Intro2_N21_SX_TFPN4

Skip2_SX_TFPN4
SX_TFPN4

ST.2.0.

During the past 12 months, how many females have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of female partners
0-999

ST.3.0.

During the past 12 months, how many males have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of male partners
0-999

ST.4.0.

During the past 12 months, how many transgender persons have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of transgender partners
0-999

Label_SX_TFPN4
Range_SX_TFPN4
SX_TMPN4

Label_SX_TMPN4
Range_SX_TMPN4
SX_TTPN4

Label_SX_TTPN4
Range_SX_TTPN4

Page | 55
Calculation_SX_TOTN4

ST.5.0.

Label_Calculation_SX_TOTN4
Calculation_SXFMONN4 ST.6.0.

Label_Calculation_SXFMONN4
Calculation_SXMLONN4 ST.7.0.

Label_Calculation_SXMLONN4
Calculation_SXTGONN4

ST.8.0.

Label_Calculation_SXTGONN4
SXTOVRN4

Alt_text_N21_SXTOVRN4
Label_SXTOVRN4
Hard_edit_21_SXTOVRN4

Skip1_21_SXTOVRN4
Skip2_N21_SXTOVRN4

ST.9.0.

Create a calculated variable where the sum of SX_TFPN4 + SX_TMPN4 + SX_TTPN4 =
SX_TOTN4 (total number of sex partners).
If the response to SX_TFPN4 (number of female partners), SX_TMPN4 (number of male
partners), and SX_TTPN4 (number of transgender partners) is 7 (refused to answer) or 8
(don’t know), then calculate the response as “0.” EXAMPLE: if SX_TFPN4 = 8 (don’t know)
AND SX_TMPN4 = 8 (don’t know), AND SX_TTPN4 = 7 (refused to answer), THEN
SX_TOTN4 = 0.
If any of the values are Skipped (.S), then do not include the value in the calculation.
EXAMPLE: if SX_TFPN4 = 2 AND SX_TMPN4 = 8 (don’t know), AND SX_TTPN4 = Skipped,
then SX_TOTN4 (total number of sex partners) = 2.
Total number of vaginal and anal sex partners
Female only partners: create a calculated variable SXFMONN4 (female only partners) if
SX_TMPN4 (number of male partners) = 0, 8 (don’t know), or 7 (refused to answer) AND
SX_TTPN4 (number of transgender partners) = 0, 8 (don’t know), or 7 (refused to answer)
AND SX_TFPN4 (number of female partners) >= 1, then SXFMONN4 (female only partners)
= 1; else SXFMONN4 = 0.
Female only partners
Male only partners: create a calculated variable SXMLONN4 (male only partners) if
SX_TFPN4 (number of female partners) = 0, 8 (don’t know), or 7 (refused to answer) or .S
(skipped) AND SX_TTPN4 (number of transgender partners) = 0, 8 (don’t know), or 7
(refused to answer) AND SX_TMPN4 (number of male partners) >= 1, then SXMLONN4
(male only partners) = 1; else SXMLONN4 = 0.
Male only partners
Transgender only partners: create a calculated variable SXTGONN4 (transgender only
partners) if SX_TFPN4 (number of female partners) = 0, 8 (don’t know), or 7 (refused to
answer) AND SX_TMPN4 (number of male partners) = 0, 8 (don’t know), or 7 (refused to
answer) AND SX_TTPN4 (number of transgender partners) >= 1, then SXTGONN4
(transgender only partners) = 1; else SXTGONN4 = 0.
Transgender only partners
So, the total number of people you had vaginal or anal sex with during the past 12 months
was [INSERT SX_TOTN4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1, then display the text as
follows: "So, you only had vaginal or anal sex with one person during the past 12 months?
Verification of total sex partners
If SXTOVRN4 (Verification of total sex partners) = 0 (no) or 8 (don't know), then read “Let
me go back and reread the questions.” Return to Skip2_SX_TFPN4 (Number of female
partners).
If SXTOVRN4 (Verification of total sex partners) = 7 (refused to answer), skip to
Calculation_EN_SEXN5 (End of sexual behavior).
No vaginal or anal sex partners: If SX_TFPN4 (Number of female partners), SX_TMPN4
(Number of male partners), and SX_TTPN4 (Number of transgender partners) are all some
combination of 0, 7 (refused to answer), or 8 (don't know), then skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, go to Skip1_21_SX_NM1N4_21
(Name of partner 1).

Page | 56

Topic: Names of partners (SN)
Skip1_21_SX_NM1N4_21

Intro1_21_SX_NM1N4_21

Skip2_5_SX_NM1N4_21
Intro2_21_SX_NM1N4_21

Skip3_5_SX_NM1N4_21
Intro3_21_SX_NM1N4_21

Skip4_5_SX_NM1N4_21
SX_NM1N4_21

SN.1.0.

Alt_text_SX_NM1N4_21
Label_SX_NM1N4_21
Range_SX_NM1N4_21
Soft_edit_21_SX_NM1N4_21

Skip5_21_SX_NM1N4_21

Voxco_note1N22_SX_NM1N4_21
Voxco_note2N22_SX_NM1N4_21

If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1, go to Intro1_21
_SX_NM1N4_21 (Name of partner 1). If SX_TOTN4 (Total number of vaginal and anal sex
partners) = 2-5, skip to Intro2_21_SXNM1N4_21.
If SX_TOTN4 (Total number of vaginal and anal sex partners)> 5, skip to Intro3_21
_SX_NM1N4_21 (Name of partner 1).
"The next questions are about the person you had sex with during the past 12 months. I'll
need a way to refer to this person. You may refer to them in any way you want—initials,
nickname, or where you met. However, please don't provide a last name or any other
identifying information."
Skip to SX_NM1N4_21 (Name of partner 1).
“The next questions are about the [Calculation_SX_TOTN4 (Total number of vaginal and
anal sex partners): if 2, 3, 4, or 5] people you had sex with during the past 12 months.
Please answer to the best of your knowledge, but it’s okay to tell me you don’t know. I’ll
need a way to refer to each person. You may refer to them in any way you want—initials,
nickname, or where you met. However, please don’t provide a last name or any other
identifying information.”
Skip to SX_NM1N4_21 (Name of partner 1).
“The next questions are about the 5 people you recently had sex with during the past 12
months. Please answer to the best of your knowledge, but it’s okay to tell me you don’t
know. I’ll need a way to refer to each person. You may refer to them in any way you
want—initials, nickname, or where you met. However, please don’t provide a last name or
any other identifying information.”
Skip to SX_NM1N4_21 (Name of partner 1).
What should we call the last person you had sex with during the past 12 months?
77 Refused to Answer
If SX_TOTN4 (Total number of vaginal and anal sex partners) is 1, then display the text as
follows: What should we call the person you had sex with during the past 12 months?
Name of partner 1
Character limit = 50
If SX_NM1N4_21 (Name of partner 1) is 7 (refused to answer), then read the message,
Interviewer: remind the respondent that they can provide initials, nicknames, or another
name to identify the partner. Allow program to move forward.
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1 and SX_NM1N4_21
(Name of partner 1) is 7 (refused to answer), skip to Calculation_EN_SEXN5 (End of sexual
behavior). If SX_TOTN4 (Total number of vaginal and anal sex partners) is > 1, go to
SX_NM2N4_21 (Name of partner 2).
If SX_TOTN4 (Total number of vaginal and anal sex partners) is 1, skip to Intro_N21
_SXPGN1N4.
Use open-ended response. Do not allow an 8 (don't know) response option.
Character limit = 50

Page | 57
SX_NM2N4_21

SN.1.1.

Label_SX_NM2N4_21
Range_SX_NM2N4_21
Soft_edit_21_SX_NM2N4_21

Hard_edit_SX_NM2N4_21

Skip_21_SX_NM2N4_21

Voxco_noteN22_SX_NM2N4_21
SX_NM3N4_21

SN.1.2.

Label_ SX_NM3N4_21
Range_SX_NM3N4_21
Soft_edit_21_SX_NM3N4_21

Hard_edit_SX_NM3N4_21

Skip_SX_NM3N4_21

Voxco_noteN22_SX_NM3N4_21

What should we call the 2nd person you had sex with during the past 12 months?
77 Refused to Answer
Name of partner 2
Character limit = 50
If SX_NM2N4_21 (Name of partner 2) is 7 (refused to answer), read, Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner. Allow program to move forward.
If SX_NM1N4_21 (Name of partner 1) and SX_NM2N4_21 (Name of partner 2) are
identical, then read, “You gave me the same name for another partner. Can you please
give me another name?” The program should return to SX_NM2N4_21 (Name of partner
2).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 2 and SX_NM1N4_21
(Name of partner 1) and SX_NM2N4_21 (Name of partner 2) are 7 (refused to answer),
skip to Calculation_EN_SEXN5 (End of sexual behavior).
If SX_TOTN4 (Total number of vaginal and anal sex partners) >2, go to SX_NM3N4_21
(Name of partner 3).Else, skip to Skip1_21_SXPGN1N4 (Partner gender-partner 1).
Use open-ended response. Do not allow an 8 (don’t know) response option.
What should we call the 3rd person you had sex with during the past 12 months?
77 Refused to Answer
Name of partner 3
Character limit = 50
If SX_NM3N4_21 (Name of partner 3) is 7 (refused to answer), read, Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner. Allow program to move forward.
If either SX_NM1N4_21 (Name of partner 1), SX_NM2N4_21 (Name of partner 2), or
SX_NM3N4_21 (Name of partner 3) are identical, then read, “You gave me the same name
for another partner. Can you please give me another name?” The program should return
to SX_NM3N4_21 (Name of partner 3).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 3 and SX_NM1N4_21
(Name of partner 1), SX_NM2N4_21 (Name of partner 2) and SX_NM3N4_21 (Name of
partner 3) are 7 (refused to answer), skip to Calculation_EN_SEXN5 (End of sexual
behavior).
If SX_TOTN4 (Total number of vaginal and anal sex partners) > 3, go to SX_NM4N4_21
Use open-ended responses. Do not allow an 8 (don’t know) response option.

Page | 58
SX_NM4N4_21

SN.1.3.

Label_SX_NM4N4_21
Range_SX_NM4N4_21
Soft_edit_21_SX_NM4N4_21

Hard_edit_SX_NM4N4_21

Skip_SX_NM4N4_21

Voxco_noteN22_SX_NM4N4_21
SX_NM5N4_21

SN.1.4.

Label_SX_NM5N4_21
Range_SX_NM5N4_21
Soft_edit_21_SX_NM5N4_21

Hard_edit_SX_NM5N4_21

Skip_SX_NM5N4_21

Voxco_noteN22_SX_NM5N4_21

What should we call the 4th person you had sex with during the past 12 months?
77 Refused to Answer
Name of partner 4
Character limit = 50
If SX_NM4N4_21 (Name of partner 4) is 7 (refused to answer), read, Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner. Allow program to move forward.
If either SX_NM1N4_21 (Name of partner 1), SX_NM2N4_21 (Name of partner 2),
SX_NM3N4_21 (Name of partner 3), or SX_NM4N4_21 (Name of partner 4) are identical,
then read, “You gave me the same name for another partner. Can you please give me
another name?” The program should return to SX_NM4N4_21 (Name of partner 4).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 4 and SX_NM1N4_21
(Name of partner 1), SX_NM2N4_21 (Name of partner 2), SX_NM3N4_21 (Name of
partner 3) and SX_NM4N4_21 (Name of partner 4) are 7 (refused to answer), skip to
Calculation_EN_SEXN5 (End of sexual behavior).
If SX_TOTN4 (Total number of vaginal and anal sex partners) > 4, go to SX_NM5N4_21
(Name of partner 5). Else, skip to Skip1_21_SXPGN1N4 (Partner gender-partner 1).
Use open-ended responses. Do not allow an 8 (don’t know) response option.
What should we call the 5th person you had sex with in the past 12 months?
77 Refused to Answer
Name of partner 5
Character limit = 50
If SX_NM5N4_21 (Name of partner 5) is 7 (refused to answer), read, Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner. Allow program to move forward.
If either SX_NM1N4_21 (Name of partner 1), SX_NM2N4_21 (Name of partner 2),
SX_NM3N4_21 (Name of partner 3), SX_NM4N4_21 (Name of partner 4) or SX_NM5N4_21
(Name of partner 5) are identical, then read, “You gave me the same name for another
partner. Can you please give me another name?” The program should return to
SX_NM5N4_21 (Name of partner 5).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 5 and SX_NM1N4_21
(Name of partner 1), SX_NM2N4_21 (Name of partner 2), SX_NM3N4_21 (Name of
partner 3), SX_NM4N4_21 (Name of partner 4), SX_NM5N4_21 (Name of partner 5) are all
7 (refused to answer), skip to Calculation_EN_SEXN5 (End of sexual behavior).
If SX_TOTN4 (Total number of vaginal and anal sex partners)> 5 and SX_NM1N4_21 (Name
of partner 1), SX_NM2N4_21 (Name of partner 2), SX_NM3N4_21 (Name of partner 3),
SX_NM4N4_21 (Name of partner 4), and SX_NM5N4_21 (Name of partner 5) are all 7
(refused to answer), then skip to Skip_21_SXAGC1N4 (Aggregate condom use-6 partners).
Else, go to Skip1_21_SXPGN1N4 (Partner gender-partner 1).
Use open-ended responses. Do not allow an 8 (don’t know) response option.

Page | 59

Topic: Partner demographics #1 (SP)
If SX_NM1N4_21 (Name of partner 1) = 7 (refused to answer), skip to Skip_21_PREP1N4_
21 (PrEP-partner 1).
Else, go to Intro_N21_SXPGN1N4 (partner gender- partner 1).
"Now I'm going to ask you about [INSERT SX_NM1N4_21 (Name of partner 1)]."
Skip partner gender questions if the respondent had sex with only one gender:
If SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, skip to SXPEN1N4 (Partner ethnicity-partner 1). Else,
go to SXPGN1N4 (Partner gender-partner 1).

Skip1_21_SXPGN1N4

Intro_N21_SXPGN1N4
Skip2_21_SXPGN1N4

SXPGN1N4

SP.1.0.

Is [INSERT SX_NM1N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Partner gender-partner 1
If SX_GEN (Sex gender) = 2 (female) and SXPGN1N4 (Partner gender-partner 1) = female
(2), read, “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." Interviewer instructions: Return to previous question if necessary. Allow survey to
move forward.

SP.2.0.

Is [INSERT SX_NM1N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 1

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM1N4_21]?
Select all that apply. If you’re not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY.]
Race-partner 1

SP.3.0.

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

SP.3.0.

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

Label_SXPGN1N4
Soft_edit_21_SXPGN1N4

SXPEN1N4

Label_SXPEN1N4
SXPR1N4

Label_SXPR1N4
SXPR1N4A

Label_SXPR1N4A
SXPR1N4B

Label_SXPR1N4B

Page | 60
SXPR1N4C

SP.3.0.

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

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 1: Native Hawaiian or Other Pacific Islander

SP.3.0.

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

Label_SXPR1N4C
SXPR1N4D

Label_SXPR1N4D
SXPR1N4E

Label_SXPR1N4E

Topic: Vaginal sex #1 (SV)
Skip_21_SX_VS1N4

SX_VS1N4

Label_SX_VS1N4
Skip2_21_SX_VS1N4

Transgender/unknown gender respondent:
If SX_GEN (Sex gender) = 3 (transgender) or 4 (indeterminate), then skip to SX_TG1N4
(Transgender-partner 1).
Transgender/unknown gender partner:
If SXTGONN4 (Transgender only partners) = 1 or SXPGN1N4 (Partner gender-partner 1) = 3
(transgender), 7 (refused to answer), or 8 (don’t know), then skip to SX_TG1N4
(Transgender-partner 1).
Male-male partners:
If SX_GEN (Sex gender) = 1 (male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex
gender) = 1 (male) and SXPGN1N4 (Partner gender-partner 1) = 1 (male), then skip to
SXANL1N4 (Anal sex-partner 1).
Female-female partners:
If SX_GEN (Sex gender) = 2 (female) and SXPGN1N4 (Partner gender-partner 1) = 2 (female),
skip to Skip_21_PREP1N4_21 (PrEP-partner 1).
Else, go to SX_VS1N4 (Vaginal sex-partner 1).
SV.1.0.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM1N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 1
If SX_VS1N4 (Vaginal sex-partner 1) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL1N4 (Anal sex-partner 1).
Else if SX_VS1N4 (Vaginal sex-partner 1) = 1 (yes), go to Intro_21_SXVC1BN4_21 (Condom
vaginal-partner 1).

Page | 61
Intro_21_SXVC1BN4_21
SXVC1BN4_21

SV.1.1.

Label_SXVC1BN4_21

“The next question is about condom use. Please include when a condom was used the
entire time, not only part of the time during sex.”
During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM1N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 1

Topic: Anal sex #1 (SL)
SXANL1N4

SL.1.0.

Label_SXANL1N4
Soft_edit1_21_SXANL1N4

Soft_edit2_21_SXANL1N4

Soft_edit3_21_SXANL1N4

Skip_21_SXANL1N4

Intro_21_SXAC1BN4_21
SXAC1BN4_21

Label_SXAC1BN4_21
Skip_21_SXAC1BN4_21

SL.1.1.

During the past 12 months, did you have anal sex with [INSERT SX_NM1N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 1
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN1N4 (Partner genderpartner 1) = 1 (male) or SXMLONN4 (Male only partners) =1 and SXANL1N4 (Anal sexpartner 1) = 0 (no), then read “Earlier you told me that you had anal sex with [INSERT
SX_NM1N4_21 (Name of partner 1)]. Is this correct?” Interviewer instructions: Return to
previous questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among males with female partners: If SX_GEN (Sex gender)
= 1 (male) and SXPGN1N4 (Partner gender-partner 1) = 2 (female) or SXFMONN4 (Female
only partners) = 1 and SX_VS1N4 (Vaginal sex-partner 1) = 0 (no) and SXANL1N4 (Anal sexpartner 1) = 0 (no), then read “Earlier you told me that you had vaginal or anal sex with
[INSERT SX_NM1N4_21 (Name of partner 1)]. Is this correct?” Interviewer instructions:
Return to previous questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among females with male partners: If SX_GEN (Sex gender)
= 2 (female) and SXPGN1N4 (Partner gender-partner 1) = 1 (male) or SXMLONN4 (Male
only partners) =1 and SX_VS1N4 (Vaginal sex-partner 1) = 0 (no) and SXANL1N4 (Anal sexpartner 1) = 0 (no), then read “Earlier you told me that you had vaginal or anal sex with
[INSERT SX_NM1N4_21 (Name of partner 1)]. Is this correct?” Interviewer instructions:
Return to previous questions to correct error. Allow program to move forward.
If SXANL1N4 (Anal sex-partner 1) = 1 (yes), go to Intro_21_SXAC1BN4_21 (Condom analpartner 1).
If SXANL1N4 (Anal sex-partner 1) = 0 (no), 7 (refused) or 8 (don’t know), skip to STPRT1N4
(Partner status-partner 1).
"The next question is about condom use. Please include when a condom was used the
entire time, not only part of the time."
During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM1N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 1
For all responses, skip to STPRT1N4 (Partner status-partner 1).

Page | 62

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

SG.1.0.

Label_SX_TG1N4
Soft_edit_SX_TG1N4

Skip_21_SX_TG1N4

Intro_21_TGC1BN4_21
TGC1BN4_21

SG.1.1.

Label_ TGC1BN4_21

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM1N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 1
If SX_TG1N4 (Transgender-partner 1) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM1N4_21 (Name of partner 1)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG1N4 (Transgender-partner 1) = 1 (yes), go to Intro_21_TGC1BN4_21 (Condom
transgender-partner 1).
If SX_TG1N4 (Transgender-partner 1) = 0 (no), 7 (refused) or 8 (don’t know), skip to
STPRT1N4 (Partner status-partner 1).
"The next question is about condom use. Please include times when a condom was used
the entire time, not only part of the time during sex.”
During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM1N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't know
7 Refused to Answer
Condom transgender-partner 1

Topic: Status #1 (SS)
STPRT1N4

Label_STPRT1N4
Skip_21_STPRT1N4

SS.1.0.

Do you know [INSERT SX_NM1N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 1
If STPRT1N4 (Partner status-partner 1) = 1 (yes), go to PRTST1N4 (Partner status first sexpartner 1). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 1 and
STPRT1N4 (Partner status-partner 1) = 0 (no), 7 (refused) or 8 (don’t know), skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) >1 and STPRT1N4 (Partner status-partner 1) = 0 (no), 7
(refused) or 8 (don’t know), skip to Skip1_21_SXPGN2N4 (Partner gender-partner 2).

Page | 63
PRTST1N4

SS.1.1.

Label_PRTST1N4
Skip_21_PRTST1N4

During the past 12 months, what was [INSERT SX_NM1N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 1
If PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV Negative), go to Intro_PREP1N4_
21 (PrEP-partner 1). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 1
and PRTST1N4 (Partner status first sex-partner 1) = 1 (HIV Positive), 7 (refused) or 8 (don’t
know) , skip to Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total
number of vaginal and anal sex partners) >1 and PRTST1N4 (Partner status first sex-partner
1) = 1 (HIV positive), 7 (refused) or 8 (don’t know), skip to Skip1_21_SXPGN2N4 (Partner
gender-partner 2).

Topic: Pre-exposure prophylaxis #1 (SR)
Intro_PREP1N4_21
PREP1N4_21

SR.1.0.

Label_ PREP1N4_21
Skip_21_PREP1N4_21

"Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP."
Was [INSERT SX_NM1N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 1
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >=2, go to Skip1_21_SXPGN2N4 (Partner gender-partner 2).

Topic: Partner demographics #2 (SP)
Skip1_21_SXPGN2N4

If SX_NM2N4_21 (Name of partner 2) = 7 (Refused to answer), skip to Skip2_21_PREP2N4_
21 (PrEP-partner 2).
Else, go to Intro_N21_SXPGN2N4 (partner gender-partner 2).
“Now I’m going to ask you about [INSERT SX_NM2N4_21 (Name of partner 2)].”
Skip partner gender questions if the respondent had sex with only one gender:
If SXTGONN4 (Transgender only partners) = 1 or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN2N4 (Partner ethnicity-partner 2).
Else, go to SXPGN2N4 (Partner gender-partner 2).

Intro_N21_SXPGN2N4
Skip2_21_SXPGN2N4

SXPGN2N4

Label_SXPGN2N4
Soft_edit_21_SXPGN2N4

SP.1.0.

Is [INSERT SX_NM2N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Partner gender-partner 2
If SEX_GEN = 2 (female) and SXPGN2N4 (Partner gender-partner 2) = female (2), read,
“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”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward.

Page | 64
SXPEN2N4

SP.2.0.

Is [INSERT SX_NM2N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 2

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM2N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY.]
Race-partner 2

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: American Indian Alaska Native

SP.3.0.

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

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: Native Hawaiian or Other Pacific Islander

SP.3.0.

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

Label_SXPEN2N4
SXPR2N4

Label_SXPR2N4
SXPR2N4A

Label_SXPR2N4A
SXPR2N4B

Label_SXPR2N4B
SXPR2N4C

Label_SXPR2N4C
SXPR2N4D

Label_SXPR2N4D
SXPR2N4E

Label_SXPR2N4E

Page | 65

Topic: Vaginal sex #2 (SV)
Transgender/unknown gender respondent:
If SX_GEN (Sex gender) =3 (transgender) or 4 (indeterminate), then skip to SX_TG2N4
(Transgender-partner 2).
Transgender/unknown gender partner:
If SXTGONN4 (Transgender only partners) = 1 or SXPGN2N4 (Partner gender-partner 2) = 3
(transgender), 7 (refused to answer), or 8 (don’t know), then skip to SX_TG2N4
(Transgender-partner 2).
Male-male partners:
If SX_GEN (Sex gender) = 1 (male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex
gender) = 1 (male) and SXPGN2N4 (Partner gender-partner 2) = 1 (male), then skip to
SXANL2N4 (Anal sex-partner 2).
Female-female partners:
If SX_GEN (Sex gender) = 2 (female) and SXPGN2N4 (Partner gender-partner 2) = 2 (female),
skip to Skip2_21_PREP2N4_21 (PrEP-partner 2). Else go to SX_VS2N4 (Vaginal sex-partner
2).

Skip_21_SX_VS2N4

SX_VS2N4

SV.1.0.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM2N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 2
If SX_VS2N4 (Vaginal sex-partner 2) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL2N4 (Anal sex-partner 2). Else, go to SXVC2BN4_21 (Condom vaginal-partner 2).

SV.1.1.

During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM2N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 2

Label_SX_VS2N4
Skip2_21_SX_VS2N4
SXVC2BN4_21

Label_SXVC2BN4_21

Page | 66

Topic: Anal sex #2 (SL)
SXANL2N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM2N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 2
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN2N4 (Partner genderpartner 2) = 1 or SXMLONN4 (Male only partners) = 1 and SXANL2N4 (Anal sex-partner 2) =
0 (no), then read “Earlier you told me that you had anal sex with [INSERT SX_NM2N4_21
(Name of partner 2)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among males with female partners: If SX_GEN (Sex
gender) = 1 (male) and SXPGN2N4 (Partner gender-partner 2) = 2 (female) or SXFMONN4
(Female only partners) = 1 and SX_VS2N4 (Vaginal sex-partner 2) = 0 (no) and SXANL2N4
(Anal sex-partner 2) = 0 (no), then read “Earlier you told me that you had vaginal or anal
sex with [INSERT SX_NM2N4_21 (Name of partner 2)]. Is this correct?” Interviewer
instructions: Return to previous questions to correct error. Allow program to move
forward.
No vaginal or anal sex reported among females with male partners: If SX_GEN (Sex
gender) = 2 (female) and SXPGN2N4 (Partner gender-partner 2) = 1 (male) or SXMLONN4
(Male only partners) =1 and SX_VS2N4 (Vaginal sex-partner 2) = 0 (no) and SXANL2N4
(Anal sex-partner 2) = 0 (no), then read “Earlier you told me that you had vaginal or anal
sex with [INSERT SX_NM2N4_21 (Name of partner 2)]. Is this correct?” Interviewer
instructions: Return to previous questions to correct error. Allow program to move
forward.
If SXANL2N4 (Anal sex-partner 2) = 1 (yes), go to SXAC2BN4_21 (Condom anal-partner 2). If
SXANL2N4 (Anal sex-partner 2) = 0 (no), 7 (refused) or 8 (don’t know), skip to STPRT2N4
(Partner status-partner 2).

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM2N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 2
For all responses, skip to STPRT2N4 (Partner status-partner 2).

Label_SXANL2N4
Soft_edit1_21_SXANL2N4

Soft_edit2_21_SXANL2N4

Soft_edit3_21_SXANL2N4

Skip_21_SXANL2N4

SXAC2BN4_21

Label_ SXAC2BN4_21
Skip_21_SXAC2BN4_21

Page | 67

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

SG.1.0.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM2N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 2
If SX_TG2N4 (Transgender-partner 2) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM2N4_21 (Name of partner 2)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG2N4 (Transgender-partner 2) = 1 (yes), go to TGC2BN4_21 (Condom transgenderpartner 2). If SX_TG2N4 (Transgender-partner 2) = 0 (no), 7 (refused), or 8 (don’t know),
skip to STPRT2N4 (Partner status-partner 2).

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM2N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 2

SS.1.0.

Do you know [INSERT SX_NM2N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 2
If STPRT2N4 (Partner status-partner 2) = 1 (yes), go to PRTST2N4 (Partner status first sexpartner 2). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 2 and
STPRT2N4 (Partner status-partner 2) = 0 (no), 7 (refused) or 8 (don’t know), skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) > 2 and STPRT2N4 (Partner status-partner 2) = 0 (no), 7
(refused) or 8 (don’t know), skip to Skip1_21_SXPGN3N4 (Partner gender-partner 3).

SS.1.1.

During the past 12 months, what was [INSERT SX_NM2N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 2
If PRTST2N4 (Partner status first sex-partner 2) = 2 (HIV Negative), go to Skip1_21
_PREP2N4_21 (PrEP-partner 2). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 2 and PRTST2N4 (Partner status first sex-partner 2) = 1 (HIV positive), 7
(refused) or 8 (don’t know), skip to Calculation_EN_SEXN5 (End of sexual behavior). If
SX_TOTN4 (Total number of vaginal and anal sex partners) >2 and PRTST2N4 (Partner
status first sex-partner 2) = 1 (HIV positive), 7 (refused) or 8 (don’t know), skip to Skip1_21
_SXPGN3N4 (Partner gender-partner 3).

Label_SX_TG2N4
Soft_Edit_SX_TG2N4

Skip_21_SX_TG2N4

TGC2BN4_21

Label_ TGC2BN4_21

Topic: Status #2 (SS)
STPRT2N4

Label_STPRT2N4
Skip_21_STPRT2N4

PRTST2N4

Label_PRTST2N4
Skip_21_PRTST2N4

Page | 68

Topic: Pre-exposure prophylaxis #2 (SR)
Skip1_21_PREP2N4_21

Intro_PREP2N4_21
PREP2N4_21

SR.1.0.

Label_ PREP2N4_21
Skip2_21_PREP2N4_21

If PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV negative), skip to PREP2N4_21
(PrEP-partner 2). If PRTST1N4 (Partner status first sex-partner 1) = 1 (HIV Positive), 7
(refused) or 8 (don't know), go to Intro_PREP2N4_21 (PrEP-partner 2).
"Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP."
Was [INSERT SX_NM2N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 2
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 2, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >2, go to Skip1_21_SXPGN3N4 (Partner gender-partner 3).

Topic: Partner demographics #3 (SP)
Skip1_21_SXPGN3N4

If SX_NM3N4_21 (Name of partner 3) = 7 (refused to answer), skip to Skip2_21_PREP3N4_
21 (PrEP-partner 3). Else, go to Intro_N21_SXPGN3N4 (partner gender-partner 3).
“Now I’m going to ask you about [INSERT SX_NM3N4_21 (Name of partner 3)].”
Skip partner gender questions if the respondent had sex with only one gender:
If SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN3N4 (Partner ethnicity-partner 3).
Else, go to SXPGN3N4 (Partner gender-partner 3).

Intro_N21_SXPGN3N4
Skip2_21_SXPGN3N4

SXPGN3N4

SP.1.0.

Is [INSERT SX_NM3N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Partner gender-partner 3
If SEX_GEN = 2 (female) and SXPGN3N4 (Partner gender-partner 3) = female (2), read,
“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”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward.

SP.2.0.

Is [INSERT SX_NM3N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 3

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM3N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY.]
Race-partner 3

Label_SXPGN3N4
Soft_edit_21_SXPGN3N4

SXPEN3N4

Label_SXPEN3N4
SXPR3N4

Label_SXPR3N4

Page | 69
SXPR3N4A

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: American Indian or Alaska Native

SP.3.0.

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

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: Native Hawaiian or Other Pacific Islander

SP.3.0.

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

Label_SXPR3N4A
SXPR3N4B

Label_SXPR3N4B
SXPR3N4C

Label_SXPR3N4C
SXPR3N4D

Label_SXPR3N4D
SXPR3N4E

Label_SXPR3N4E

Page | 70

Topic: Vaginal sex #3 (SV)
Transgender/unknown gender respondent:
If SX_GEN (Sex gender) = 3 (transgender) or 4 (indeterminate), then skip to SX_TG3N4
(Transgender-partner 3).
Transgender/unknown gender partner:
If SXTGONN4 (Transgender only partners) = 1 or SXPGN3N4 (Partner gender-partner 3) = 3
(transgender), 7 (refused to answer), or 8 (don’t know), then skip to SX_TG3N4
(Transgender-partner 3).
Male-male partners:
If SX_GEN (Sex gender) = 1 (male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex
gender) = 1 (male) and SXPGN3N4 (Partner gender-partner 3) = 1 (male), then skip to
SXANL3N4 (Anal sex-partner 3).
Female-female partners:
If SX_GEN (Sex gender) = 2 (female) and SXPGN3N4 (Partner gender-partner 3) = 2 (female),
skip to Skip2_21_PREP3N4_21 (PrEP-partner 3).
Elsego to SX_VS3N4 (Vaginal sex-partner 3).

Skip_21_SX_VS3N4

SX_VS3N4

SV.1.0.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM3N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 3
If SX_VS3N4 (Vaginal sex-partner 3) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL3N4 (Anal sex-partner 3).
Else if SX_VS3N4 (Vaginal sex-partner 3)= 1 (yes), go to SXVC3BN4_21 (Condom vaginalpartner 3).

SV.1.1.

During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM3N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 3

Label_SX_VS3N4
Skip2_21_SX_VS3N4

SXVC3BN4_21

Label_SXVC3BN4_21

Page | 71

Topic: Anal sex #3 (SL)
SXANL3N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM3N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 3
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN3N4 (Partner genderpartner 3) = 1 (male) or SXMLONN4 (Male only partners) =1 (yes) and SXANL3N4 (Anal sexpartner 3) = 0 (no), then read “Earlier you told me that you had anal sex with [INSERT
SX_NM3N4_21 (Name of partner 3)]. Is this correct?” Interviewer instructions: Return to
previous questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among males with female partners: If SX_GEN (Sex gender)
= 1 (male) and SXPGN3N4 (Partner gender-partner 3) = 2 (female) or SXFMONN4 (Female
only partners) = 1 and SX_VS3N4 (Vaginal sex-partner 3) = 0 (no) and SXANL3N4 (Anal sexpartner 3) = 0 (no), then read “Earlier you told me that you had vaginal or anal sex with
[INSERT SX_NM3N4_21 (Name of partner 3)]. Is this correct?” Interviewer instructions:
Return to previous questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among females with male partners: If SX_GEN (Sex
gender) = 2 (female) and SXPGN3N4 (Partner gender-partner 3) = 1 (male) or SXMLONN4
(Male only partners) =1 and SX_VS3N4 (Vaginal sex-partner 3) = 0 (no) and SXANL3N4
(Anal sex-partner 3) = 0 (no), then read “Earlier you told me that you had vaginal or anal
sex with [INSERT SX_NM3N4_21 (Name of partner 3)]. Is this correct?” Interviewer
instructions: Return to previous questions to correct error. Allow program to move
forward.
If SXANL3N4 (Anal sex-partner 3) = 1 (yes), go to SXAC3BN4_21 (Condom anal-partner 3). If
SXANL3N4 (Anal sex-partner 3) = 0 (no), 7 (refused) or 8 (don’t know), skip to STPRT3N4
(Partner status-partner 3).

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM3N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 3
For all responses, skip to STPRT3N4 (Partner status-partner 3).

Label_SXANL3N4
Soft_edit1_21_SXANL3N4

Soft_edit2_21_SXANL3N4

Soft_edit3_21_SXANL3N4

Skip_21_SXANL3N4

SXAC3BN4_21

Label_SXAC3BN4_21
Skip_21_SXAC3BN4_21

Page | 72

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

SG.1.0.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM3N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 3
If SX_TG3N4 (Transgender-partner 3) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM3N4_21 (Name of partner 3)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG3N4 (Transgender-partner 3) = 1 (yes), go to TGC3BN4_21 (Condom transgenderpartner 3). If SX_TG3N4 (Transgender-partner 3) = 0 (no), 7 (refused) or 8 (don’t know),
skip to STPRT3N4 (Partner status-partner 3).

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM3N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 3

SS.1.0.

Do you know [INSERT SX_NM3N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 3
If STPRT3N4 (Partner status-partner 3) = 1 (yes), go to PRTST3N4 (Partner status first sexpartner 3). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 3 and
STPRT3N4 (Partner status-partner 3) = 0 (no), 7 (refused) or 8 (don’t know), skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) >3 and STPRT3N4 (Partner status-partner 3) = 0 (no), 7
(refused) or 8 (don’t know), skip to Skip1_21_SXPGN4N4 (Partner gender-partner 4).

SS.1.1.

During the past 12 months, what was [INSERT SX_NM3N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 3
If PRTST3N4 (Partner status first sex-partner 3) = 2 (HIV Negative), go to Skip1_21
_PREP3N4_21 (PrEP-partner 3). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 3 and PRTST3N4 (Partner status first sex-partner 3)=1 (HIV Positive), 7
(refused) or 8 (don’t know), skip to Calculation_EN_SEXN5 (End of sexual behavior). If
SX_TOTN4 (Total number of vaginal and anal sex partners) >3 and PRTST3N4 (Partner
status first sex-partner 3)=1 (HIV Positive), 7 (refused) or 8 (don’t know), skip to Skip1_21
_SXPGN4N4 (Partner gender-partner 4).

Label_SX_TG3N4
Soft_edit_SX_TG3N4

Skip_21_SX_TG3N4

TGC3BN4_21

Label_TGC3BN4_21

Topic: Status #3 (SS)
STPRT3N4

Label_STPRT3N4
Skip_21_STPRT3N4

PRTST3N4

Label_PRTST3N4
Skip_21_PRTST3N4

Page | 73

Topic: Pre-exposure prophylaxis #3 (SR)
Skip1_21_PREP3N4_21

Intro_PREP3N4_21
PREP3N4_21

SR.1.0.

Label_PREP3N4_21
Skip2_21_PREP3N4_21

If PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV negative) or PRTST2N4 (Partner
status first sex-partner 2) = 2 (HIV negative), skip to PREP3N4_21 (PrEP-partner 3). Else, go
to Intro_PREP3N4_21 (PrEP-partner 3).
"Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP."
Was [INSERT SX_NM3N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 3
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 3, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >3, go to Skip1_21_SXPGN4N4 (Partner gender-partner 4).

Topic: Partner demographics #4 (SP)
Skip1_21_SXPGN4N4

If SX_NM4N4_21 (Name of partner 4) = 7 (refused to answer), skip to Skip2_21_PREP4N4_
21 (PrEP-Partner 4).
Else, go to Intro_N21_SXPGN4N4 (partner gender-partner 4).
“Now I’m going to ask you about [INSERT SX_NM4N4_21 (Name of partner 4)].”
Skip partner gender questions if the respondent had sex with only one gender: If
SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN4N4 (Partner ethnicity-partner 4).
Else, go to SXPGN4N4 (Partner gender-partner 4).

Intro_N21_SXPGN4N4
Skip2_21_SXPGN4N4

SXPGN4N4

SP.1.0.

Is [INSERT SX_NM4N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Partner gender-partner 4
If SEX_GEN = 2 (female) and SXPGN4N4 (Partner gender-partner 4) = 2 (female), read,
“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”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward.

SP.2.0.

Is [INSERT SX_NM4N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 4

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM4N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY.]
Race-partner 4

Label_SXPGN4N4
Soft_edit_21_SXPGN4N4

SXPEN4N4

Label_SXPEN4N4
SXPR4N4

Label_SXPR4N4

Page | 74
SXPR4N4A

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: American Indian or Alaska Native

SP.3.0.

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

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: Native Hawaiian or Other Pacific Islander

SP.3.0.

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

Label_SXPR4N4A
SXPR4N4B

Label_SXPR4N4B
SXPR4N4C

Label_SXPR4N4C
SXPR4N4D

Label_SXPR4N4D
SXPR4N4E

Label_SXPR4N4E

Page | 75

Topic: Vaginal sex #4 (SV)
Transgender/unknown gender respondent:
If SX_GEN (Sex gender) = 3 (transgender) or 4 (indeterminate), then skip to SX_TG4N4
(Transgender-partner 4).
Transgender/unknown gender partner:
If SXTGONN4 (Transgender only partners) = 1 or SXPGN4N4 (Partner gender-partner 4) = 3
(transgender), 7 (refused to answer), or 8 (don’t know), then skip to SX_TG4N4
(Transgender-partner 4).
Male-male partners:
If SX_GEN (Sex gender) = 1 (male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex
gender) = 1 (male) and SXPGN4N4 (Partner gender-partner 4) = 1 (male), then skip to
SXANL4N4 (Anal sex-partner 4).
Female-female partners:
If SX_GEN (Sex gender) = 2 (female) and SXPGN4N4 (Partner gender-partner 4) = 2 (female),
skip to Skip2_21_PREP4N4_21 (PrEP-Partner 4). Else go to SX_VS4N4 (Vaginal sex-partner
4).

Skip_21_SX_VS4N4

SX_VS4N4

SV.1.0.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM4N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 4
If SX_VS4N4 (Vaginal sex-partner 4) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL4N4 (Anal sex-partner 4). Else if SX_VS4N4 (Vaginal sex-partner 4)= 1 (yes), go to
SXVC4BN4_21 (Condom vaginal-partner 4).

SV.1.1.

During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM4N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 4

Label_SX_VS4N4
Skip2_21_SX_VS4N4

SXVC4BN4_21

Label_SXVC4BN4_21

Page | 76

Topic: Anal sex #4 (SL)
SXANL4N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM4N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 4
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN4N4 (Partner genderpartner 4) = 1 or SXMLONN4 (Male only partners) =1 and SXANL4N4 (Anal sex-partner 4) is
0 (no), then read “Earlier you told me that you had anal sex with [INSERT SX_NM4N4_21
(Name of partner 4)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among males with female partners: If SX_GEN (Sex gender)
= 1 (male) and SXPGN4N4 (Partner gender-partner 4) = 2 (female) or SXFMONN4 (Female
only partners) = 1 and SX_VS4N4 (Vaginal sex-partner 4) = 0 (no) and SXANL4N4 (Anal sexpartner 4) = 0 (no), then read “Earlier you told me that you had vaginal or anal sex with
[INSERT SX_NM4N4_21 (Name of partner 4)]. Is this correct?” Interviewer instructions:
Return to previous questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among females with male partners: If SX_GEN (Sex gender)
= 2 (female) and SXPGN4N4 (Partner gender-partner 4) = 1 (male) or SXMLONN4 (Male
only partners) =1 and SX_VS4N4 (Vaginal sex-partner 4) = 0 (no) and SXANL4N4 (Anal sexpartner 4) = 0 (no), then read “Earlier you told me that you had vaginal or anal sex with
[INSERT SX_NM4N4_21 (Name of partner 4)]. Is this correct?” Interviewer instructions:
Return to previous questions to correct error. Allow program to move forward.
If SXANL4N4 (Anal sex-partner 4) = 1 (yes), go to SXAC4BN4_21 (Condom anal-partner 4).
If SXANL4N4 (Anal sex-partner 4) = 0 (no), 7 (refused) or 8 (don’t know), skip to STPRT4N4
(Partner status-partner 4).

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM4N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 4
For all responses, skip to STPRT4N4 (Partner status-partner 4).

Label_SXANL4N4
Soft_edit1_21_SXANL4N4

Soft_edit2_21_SXANL4N4

Soft_edit3_21_SXANL4N4

Skip_21_SXANL4N4

SXAC4BN4_21

Label_SXAC4BN4_21
Skip_21_SXAC4BN4_21

Page | 77

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

SG.1.0.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM4N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 4
If SX_TG4N4 (Transgender-partner 4) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM4N4_21 (Name of partner 4)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG4N4 (Transgender-partner 4) = 1 (yes), go to TGC4BN4_21 (Condom transgenderpartner 4). If SX_TG4N4 (Transgender-partner 4) = 0 (no), 7 (refused) or 8 (don’t know),
skip to STPRT4N4 (Partner status-partner 4).

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM4N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 4

SS.1.0.

Do you know [INSERT SX_NM4N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 4
If STPRT4N4 (Partner status-partner 4) = 1 (yes), go to PRTST4N4 (Partner status first sexpartner 4). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 4 and
STPRT4N4 (Partner status-partner 4)= 0 (no), 7 (refused) or 8 (don’t know), skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) > 4 and STPRT4N4 (Partner status-partner 4)= 0 (no), 7
(refused) or 8 (don’t know), skip to Skip1_21_SXPGN5N4 (Partner gender-partner 5).

SS.1.1.

During the past 12 months, what was [INSERT SX_NM4N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 4
If PRTST4N4 (Partner status first sex-partner 4) = 2 (HIV Negative), go to Skip1_21
_PREP4N4_21 (PrEP-Partner 4). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 4 and PRTST4N4 (Partner status first sex-partner 4)= 1 (HIV positive), 7
(refused) or 8 (don’t know), skip to Calculation_EN_SEXN5 (End of sexual behavior). If
SX_TOTN4 (Total number of vaginal and anal sex partners) > 4 and PRTST4N4 (Partner
status first sex-partner 4)= 1 (HIV positive), 7 (refused) or 8 (don’t know), skip to Skip1_21
_SXPGN5N4 (Partner gender-partner 5).

Label_SX_TG4N4
Soft_edit_SX_TG4N4

Skip_21_SX_TG4N4

TGC4BN4_21

Label_TGC4BN4_21

Topic: Status #4 (SS)
STPRT4N4

Label_STPRT4N4
Skip_21_STPRT4N4

PRTST4N4

Label_PRTST4N4
Skip_21_PRTST4N4

Page | 78

Topic: Pre-exposure prophylaxis #4 (SR)
Skip1_21_PREP4N4_21

Intro_PREP4N4_21
PREP4N4_21

SR.1.0.

Label_PREP4N4_21
Skip2_21_PREP4N4_21

If PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV negative) or PRTST2N4 (Partner
status first sex-partner 2) = 2 (HIV negative), or PRTST3N4 (Partner status first sex-partner
3) = 2 (HIV negative), skip to PREP4N4_21 (PrEP-Partner 4).
Else, go to Intro_PREP4N4_21 (PrEP-Partner 4).
"Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP."
Was [INSERT SX_NM4N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-Partner 4
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 4, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal
and anal sex partners) >4, go to Skip1_21_SXPGN5N4 (Partner gender-partner 5).

Topic: Partner demographics #5 (SP)
If SX_NM5N4_21 (Name of partner 5) = 7 (refused to answer), skip to Skip2_21_PREP5N4_
21 (PrEP-partner 5).
Else, go to Intro_N21_SXPGN5N4 (partner gender-partner 5).
“Now I’m going to ask you about [INSERT SX_NM5N4_21 (Name of partner 5)].”
Skip partner gender questions if the respondent had sex with only one gender:
If SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN5N4 (Partner ethnicity-partner
5).Else, go to SXPGN5N4 (Partner gender-partner 5).

Skip1_21_SXPGN5N4

Intro_N21_SXPGN5N4
Skip2_21_SXPGN5N4

SXPGN5N4

SP.1.0.

Is [INSERT SX_NM5N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Partner gender-partner 5
If SEX_GEN = 2 (female) and SXPGN5N4 (Partner gender-partner 5) = 2 (female), read,
“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”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward.

SP.2.0.

Is [INSERT SX_NM5N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 5
For all responses go to SXPR5N4 (Race-partner 5).

Label_SXPGN5N4
Soft_edit_21_SXPGN5N4

SXPEN5N4

Label_SXPEN5N4
Skip_SXPEN5N4

Page | 79
SXPR5N4

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM5N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY.]
Race-partner 5

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: American Indian or Alaska Native

SP.3.0.

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

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: Native Hawaiian or Other Pacific Islander

SP.3.0.

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

Label_SXPR5N4
SXPR5N4A

Label_SXPR5N4A
SXPR5N4B

Label_SXPR5N4B
SXPR5N4C

Label_SXPR5N4C
SXPR5N4D

Label_SXPR5N4D
SXPR5N4E

Label_SXPR5N4E

Page | 80

Topic: Vaginal sex #5 (SV)
Transgender/unknown gender respondent:
If SEX_GEN= 3 (transgender) or 4 (indeterminate), then skip to SX_TG5N4 (Transgenderpartner 5).
Transgender/unknown gender partner:
If SXTGONN4 (Transgender only partners) = 1 or SXPGN5N4 (Partner gender-partner 5) = 3
(transgender), 7 (refused to answer), or 8 (don’t know), then skip to SX_TG5N4
(Transgender-partner 5).
Male-male partners:
If SX_GEN (Sex gender) = 1 (male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex
gender) = 1 (male) and SXPGN5N4 (Partner gender-partner 5) = 1 (male), then skip to
SXANL5N4 (Anal sex-partner 5).
Female-female partners:
If SX_GEN (Sex gender) = 2 (female) and SXPGN5N4 (Partner gender-partner 5) = 2 (female),
skip to Skip2_21_PREP5N4_21 (PrEP-partner 5). Else go to SX_VS5N4 (Vaginal sex-partner
5).

Skip_21_SX_VS5N4

SX_VS5N4

SV.1.0.

During the past 12 months, did you have vaginal sex with [INSERT SX_NM5N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 5
If SX_VS5N4 (Vaginal sex-partner 5) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL5N4 (Anal sex-partner 5). Else if SX_VS5N4 (Vaginal sex-partner 5)= 1 (yes), go to
SXVC5BN4_21 (Condom vaginal-partner 5).

SV.1.1.

During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM5N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 5

Label_SX_VS5N4
Skip2_21_SX_VS5N4

SXVC5BN4_21

Label_SXVC5BN4_21

Page | 81

Topic: Anal sex #5 (SL)
SXANL5N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM5N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 5
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN5N4 (Partner genderpartner 5) = 1 (male) or SXMLONN4 (Male only partners) =1 and SXANL5N4 (Anal sexpartner 5) = 0 (no), then read “Earlier you told me that you had anal sex with [INSERT
SX_NM5N4_21 (Name of partner 5)]. Is this correct?” Interviewer instructions: Return to
previous questions to correct error. Allow program to move forward.
No vaginal or anal sex reported among males with female partners: If SX_GEN (Sex
gender) = 1 (male) and SXPGN5N4 (Partner gender-partner 5) = 2 (female) or SXFMONN4
(Female only partners) = 1 and SX_VS5N4 (Vaginal sex-partner 5) = 0 (no) and SXANL5N4
(Anal sex-partner 5) = 0 (no), then read “Earlier you told me that you had vaginal or anal
sex with [INSERT SX_NM5N4_21 (Name of partner 5)]. Is this correct?” Interviewer
instructions: Return to previous questions to correct error. Allow program to move
forward.
No vaginal or anal sex reported among females with male partners: If SX_GEN (Sex
gender) = 2 (female) and SXPGN5N4 (Partner gender-partner 5) = 1 (male) or SXMLONN4
(Male only partners) =1 and SX_VS5N4 (Vaginal sex-partner 5) = 0 (no) and SXANL5N4
(Anal sex-partner 5) = 0 (no), then read “Earlier you told me that you had vaginal or anal
sex with [INSERT SX_NM5N4_21 (Name of partner 5)]. Is this correct?” Interviewer
instructions: Return to previous questions to correct error. Allow program to move
forward.
If SXANL5N4 (Anal sex-partner 5) = 1 (yes), go to SXAC5BN4_21 (Condom anal-partner 5). If
SXANL5N4 (Anal sex-partner 5) = 0 (no), 7 (refused) or 8 (don’t know), skip to STPRT5N4
(Partner status-partner 5).

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM5N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 5
For all responses, skip to STPRT5N4 (Partner status-partner 5).

Label_SXANL5N4
Soft_edit1_21_SXANL5N4

Soft_edit2_21_SXANL5N4

Soft_edit3_21_SXANL5N4

Skip_21_SXANL5N4

SXAC5BN4_21

Label_SXAC5BN4_21
Skip_21_SXAC5BN4_21

Page | 82

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

SG.1.0.

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM5N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 5
If SX_TG5N4 (Transgender-partner 5) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM5N4_21 (Name of partner 5)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG5N4 (Transgender-partner 5) = 1 (yes), go to TGC5BN4_21 (Condom transgenderpartner 5). If SX_TG5N4 (Transgender-partner 5) = 0 (no), 7 (refused) or 8 (don’t know),
skip to STPRT5N4 (Partner status-partner 5).

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM5N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 5

SS.1.0.

Do you know [INSERT SX_NM5N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 5
If STPRT5N4 (Partner status-partner 5) = 1 (yes), go to PRTST5N4 (Partner status first sexpartner 5). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 5 and
STPRT5N4 (Partner status-partner 5) = 0 (no), 7 (refused) or 8 (don’t know), skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) >5 and STPRT5N4 (Partner status-partner 5) = 0 (no), 7
(refused) or 8 (don’t know), skip to Skip_21_SXAGC1N4 (Aggregate condom use-6
partners).

Label_SX_TG5N4
Soft_edit_SX_TG5N4

Skip_21_SX_TG5N4

TGC5BN4_21

Label_TGC5BN4_21

Topic: Status #5 (SS)
STPRT5N4

Label_STPRT5N4
Skip_21_STPRT5N4

Page | 83
PRTST5N4

SS.1.1.

Label_PRTST5N4
Skip_21_PRTST5N4

During the past 12 months, what was [INSERT SX_NM5N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 5
If PRTST5N4 (Partner status first sex-partner 5) = 2 (HIV Negative), go to Skip1_21
_PREP5N4_21 (PrEP-partner 5). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 5 and PRTST5N4 (Partner status first sex-partner 5) = 1 (HIV Positive), 7
(refused) or 8 (don’t know), skip to Calculation_EN_SEXN5 (End of sexual behavior). If
SX_TOTN4 (Total number of vaginal and anal sex partners) >5 and PRTST5N4 (Partner
status first sex-partner 5) = 1 (HIV Positive), 7 (refused) or 8 (don’t know), skip to Skip_21
_SXAGC1N4 (Aggregate condom use-6 partners).

Topic: Pre-exposure prophylaxis #5 (SR)
Skip1_21_PREP5N4_21

Intro_PREP5N4_21
PREP5N4_21

SR.1.0.

Label_PREP5N4_21
Skip2_21_PREP5N4_21

If PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV negative) or PRTST2N4 (Partner
status first sex-partner 2) = 2 (HIV negative), or PRTST3N4 (Partner status first sex-partner
3) = 2 (HIV negative), or PRTST4N4 (Partner status first sex-partner 4) = 2 (HIV negative),
skip to PREP5N4_21 (PrEP-partner 5). Else, go to Intro_PREP5N4_21 (PrEP-partner 5).
"Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP."
Was [INSERT SX_NM5N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 5
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 5, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >5, go to Skip_21_SXAGC1N4 (Aggregate condom use-6 partners).

Topic: Aggregate information (SA)
Skip_21_SXAGC1N4

Intro_21_SXAGC1N4
SXAGC1N4

Label_SXAGC1N4

SA.1.0.

If SX_TOTN4 (Total number of vaginal and anal sex partners) = 6, go to Intro_21
_SXAGC1N4 (Aggregate condom use-6 partners). If SX_TOTN4 (Total number of vaginal
and anal sex partners) > 6, skip to Intro_N21_SXAGC2N4.
“We just talked about the five people you recently had sex with. Now I’d like to ask you
about the other person you had sex with during the past 12 months.”
During the past 12 months, was a condom always used when you had vaginal or anal sex
with your other partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aggregate condom use-6 partners

Page | 84
SXAGP1N4

SA.1.1.

Label_SXAGP1N4
Skip_21_SXAGP1N4_21
Intro_N21_SXAGC2N4
SXAGC2N4

SA.1.2.

Label_SXAGC2N4
Range_SXAGC2N4
Hard_edit_SXAGC2N4

Skip_N21_SXAGC2N4

Calculation_SXAGUPN4

SA.1.2a.

Label_Calculation_SXAGUPN4
SXAGC3N4_21

SA.1.3.

Label_SXAGC3N4_21
Hard_edit_21_SXAGC3N4_21

Skip_N21_SXAGC3N4_21
SXAGP2N4

Label_SXAGP2N4
Range_SXAGP2N4
Hard_edit_SXAGP2N4

SA.1.4.

Was your other partner HIV positive?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aggregate partner status-6 partners
All responses skip to Calculation_EN_SEXN5 (End of sexual behavior).
“We just talked about the five people you most recently had sex with. Now I’d like to ask
you about the other people you had sex with during the past 12 months.”
During the past 12 months, with how many of these [INSERT [SX_TOTN4] - 5] other
partners was a condom always used when you had vaginal or anal sex?
8888 Don't Know
7777 Refused to Answer
Aggregate: # partners condom always used
0-2997
If SXAGC2N4 (Aggregate: # partners condom always used) is > [SX_TOTN4 (Total number of
vaginal and anal sex partners) - 5], then read the following: “The number of additional
partners with whom you used a condom cannot be greater than [insert value from
(SX_TOTN4 (Total number of vaginal and anal sex partners)) - 5]." Confirm Answer. Go
back to SXAGC2N4 (Aggregate: # partners condom always used).
If SXAGC2N4 (Aggregate: # partners condom always used) = [SX_TOTN4 (Total number of
vaginal and anal sex partners)-5], 7 (refused to answer) or 8 (don’t know), then skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, go to Calculation_SXAGUPN4
(Aggregate # condomless sex partners).
Create a calculated variable to indicate the aggregate number of partners with whom the
respondent had sex without a condom. If SX_TOTN4 is > 5, then create SXAGUPN4 where
([SX_TOTN4 (total number of vaginal and anal sex partners)] - (minus) 5] - SXAGC2N4).
Aggregate # condomless sex partners
So, you had sex without a condom with [INSERT SXAGUPN4] of these other partners?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aggregate: confirm # condomless partners
If SXAGC3N4_21 (Aggregate: confirm # condomless partners) is 0 (no), then read, “The
number of partners with whom you had sex without a condom does not add up.” Return
to SXAGC2N4 (Aggregate: # partners condom always used).
If SXAGC3N4_21 (Aggregate: confirm # condomless partners) is 7777 (refused to answer)
or 8888 (don’t know), skip to Calculation_EN_SEXN5 (End of sexual behavior).
How many of those [INSERT SXAGUPN4] other partners were HIV positive?
8888 Don't Know
7777 Refused to Answer
Aggregate: # of concordant partners
0-2997
SXAGP2N4 (Aggregate: # of concordant partners) cannot be greater than SXAGUPN4
(Aggregate # condomless sex partners). If SXAGP2N4 (Aggregate: # of concordant
partners) > SXAGUPN4 (Aggregate # condomless sex partners), then read, “The response is
out of range” and return to SXAGP2N4 (Aggregate: # of concordant partners).

Page | 85
Calculation_EN_SEXN5 S.0.a.
Label_Calculation_EN_SEXN5

EN_SEXN5 = Current time
End of sexual behavior

Calculation_TL_SEXN5
S.0.b.
Label_Calculation_TL_SEXN5

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

Page | 86

Module: Violence (B)
Topic: Physical violence (BP)
Calculation_STIPVN5
B.0.
Label_Calculation_STIPVN5

STIPVN5 = Current time
Start time intimate partner violence

Intro_21_IPVPH1N5

"Next, I’ll ask about experiences with romantic or sexual partners who may have physically
hurt you. This may include spouses, boyfriends, girlfriends, people you’ve dated, or people
you hooked up with. Remember, your answers are private, and you do not have to answer
any questions you do not want to."
How many of your romantic or sexual partners have ever slapped, punched, shoved,
kicked, choked or otherwise physically hurt you?
8888 Don't Know
7777 Refused to Answer
Ever IPV physical violence
0-999
If IPVPH1N5 (Ever IPV physical violence) = 1-999, go to IPVPH2N5 (Last year IPV physical
violence). Else, skip to Intro_IPVSX1N5_21 (Ever IPV Sexual violence).

IPVPH1N5

BP.1.0.

Label_IPVPH1N5
Range_IPVPH1N5
Skip_21_IPVPH1N5
IPVPH2N5

BP.1.1.

Label_IPVPH2N5

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

Topic: Forced Sex (BS)
Intro_IPVSX1N5_21
IPVSX1N5_21

BS.1.0

Label_IPVSX1N5_21
Range_IPVSX1N5_21
Skip_IPVSX1N5_21

IPVSX2N5

BS.1.1.

“Some people experience unwanted sexual situations by strangers or people they know,
such as a partner, friend, teacher, coworker, supervisor, or family member.”
How many people have ever threatened or forced you to have vaginal, anal, or oral sex
when you did not want to?
8888 Don't Know
7777 Refused to Answer
Ever IPV Sexual violence
0-999
If IPVSX1N5_21 (Ever IPV Sexual violence) = 1-999, go to IPVSX2N5 (Last year IPV sexual
violence). If IPVSX1N5_21 (Ever IPV Sexual violence) = 0 (no), 7777 (refused to answer), or
8888 (don't know), skip to Calculation_ENIPVN5 (End of intimate partner violence).

Label_IPVSX2N5

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

Calculation_ENIPVN5
B.0.a.
Label_Calculation_ENIPVN5

ENIPVN5 = Current time
End of intimate partner violence

Calculation_TLIPVN5
B.0.b.
Label_Calculation_TLIPVN5

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

Page | 87

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

STMNHLN5 = Current time
Start time mental health

Intro_21_ANXDEPA8

“Now I’m going to ask you some questions about your mood. When answering, please
think about how often the following has occurred during the past 2 weeks. We’ll use
Response Card E for these questions. We’ll also use the calendar to refer to the past 2
weeks.”
“Over the past 2 weeks, how often have you been bothered by any of the following
problems?”
Little interest or pleasure in doing things? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ little interest

Intro_ANXDEPA8
ANXDEPA8

MD.1.0

Label_ANXDEPA8
ANXDEPB8

MD.2.0

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

MD.3.0

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

MD.4.0

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

Label_ANXDEPB
ANXNR_8

Label_ANXNR_8
ANXSW_8

Label_ANXSW_8
Calculation_PHQ2N8

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

Page | 88
Calculation_GAD2N8

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

Topic: PHQ-8 depression (MA)
ANXDEPC8

MA.1.0

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

MA.2.0

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

MA.3.0

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

MA.4.0

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

Label_ANXDEPC8
ANXDEPD8

Label_ANXDEPD8
ANXDEPE8

Label_ANXDEPE8
ANXDEPF8

Label_ANXDEPF8

Page | 89
ANXDEPG8

MA.5.0

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

MA.6.0

Moving or speaking so slowly that other people could have noticed, or the opposite—
being so fidgety or restless that you have been moving around a lot more than usual? [USE
RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ moving slowly or being fidgety

Label_ANXDEPG8
ANXDEPH8

Label_ANXDEPH8

Topic: GAD-7 anxiety (MG)
Skip_ANXWR_8
ANXWR_8

If GAD2N8 (GAD2 score) >=3, go to ANXWR_8 (GAD worrying too much). Else, skip to
Calculation_ENMNHLN5 (End of mental health).
MG.1.0

Worrying too much about different things? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD worrying too much

MG.2.0

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

MG.3.0

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

Label_ANXWR_8
ANXRX_8

Label_ANXRX_8
ANXRS_8

Label_ANXRS_8

Page | 90
ANXIR_8

MG.4.0

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

MG.5.0

Label_ANXAF_8

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

Calculation_ENMNHLN5 M.0.a.
Label_Calculation_ENMNHLN5

ENMNHLN5 = Current time
End of mental health

Calculation_TLMNHLN5 M.0.b.
Label_Calculation_TLMNHLN5

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

Label_ANXIR_8
ANXAF_8

Page | 91

Module: Emotional social support (V)
Topic: Emotional social support (VS)
Intro_SUPPORT1N24
SUPPORT1N24

VS.1.0.

Label_Support1N24
SUPPORT2N24

VS.2.0.

I have someone to confide in or talk to about myself or my problems.
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Always
8 Don't Know
7 Refused to answer
Confide in about problems

VS.3.0.

I have someone who makes me feel appreciated.
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Always
8 Don't Know
7 Refused to answer
Feel appreciated

VS.4.0.

I have someone to talk with when I have a bad day.
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Always
8 Don't Know
7 Refused to answer
Talk with during bad day

Label_SUPPORT2N24
SUPPORT3N24

Label_SUPPORT3N24
SUPPORT4N24

Label_SUPPORT4N24

Next, I will ask you four questions about social support.
I have someone who will listen to me when I need to talk.
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Always
8 Don't Know
7 Refused to answer
Listen to me

Page | 92

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

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

Intro_8_ALCOHO_9

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

ALCOHO_9

UA.1.0.

Label_ALCOHO_9
Skip_ALCOHO_9
Intro_8_DRINK_9

DRINK_9

UA.2.0.

Label_DRINK_9
Range_DRINK_9
Skip_DRINK_9
NDRINK_9

Label_NDRINK_9
Range_21_NDRINK_9

UA.3.0.

“We’ll use the Alcohol Response Card for the next questions. For these questions a drink of
alcohol is a 12 oz. beer, a 5 oz. glass of wine, or a 1.5 oz. shot of liquor. We'll use the
calendar to refer to the past 30 days.”
During the past 30 days, on how many days did you have an alcoholic drink?
88 Don't Know
77 Refused to Answer
Number of days drank past 30 days
0–30
If DRINK_9 (Number of days drank past 30 days) is 0, 77 (refused to answer), or 88 (don’t
know), then skip to Intro_CIGEVRN5 (Ever smoked cigarettes).
During the past 30 days, how many alcoholic drinks did you have on a typical day when
you were drinking?
88 Don't Know
77 Refused to Answer
# drinks/day typical day past 30 days
1-100

Page | 93
BINGE_8

UA.4.0.

Alt_text_BINGE_8

Label_BINGE_8
Range_BINGE_8
Hard_edit_BINGE_8

During the past 30 days, on how many days did you have [5 or 4] or more alcoholic drinks
in one sitting?
88 Don't Know
77 Refused to Answer
If BIRTGEN (Sex at birth) = 2 (female), 3 (intersex/ambiguous), then read, “During the past
30 days, on how many days did you have 4 or more alcoholic drinks in one sitting?” If
BIRTGEN (Sex at birth) = 1 (male), 7 (refused), or 8 (don’t know), then read, “During the
past 30 days, on how many days did you have 5 or more alcoholic drinks in one sitting?”
The same tokens apply to Hard_edit_BINGE_8 (# binge drink days past 30 days).
# binge drink days past 30 days
0-30
If BINGE_8 (# binge drink days past 30 days) > DRINK_9 (Number of days drank past 30
days), then read, “The number of days that you had any drink should be equal to or larger
than the number of days you had [5 or 4] or more drinks.” Return to DRINK_9 (Number of
days drank past 30 days).

Topic: Smoking and vaping (US)
Intro_24_CIGEVRN5
CIGEVRN5

US.1.0.

Label_CIGEVRN5
Skip_CIGEVRN5

Intro_CIG_OFT
CIG_OFT

US.1.1.

Label_CIG_OFT
CIGARN5

Label_CIGARN5
Skip_CIGARN5

US.2.0.

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

Page | 94
CIGARFN5

US.2.1.

Label_CIGARFN5
Skip_CIG_QTN5

Intro_CIG_QTN5
CIG_QTN5

US.3.0.

Label_CIG_QTN5
CIG_DQ_8

US.4.0.

Label_CIG_DQ_8
Intro_CIGELCN5_21
CIGELCN5_21

US.5.0.

Label_CIGELCN5_21
Skip_CIGELCN5_21

Intro_VAPE_TOBACCON21
VAPE_TOBACCON21
US.5.1.

Label_VAPE_TOBACCON21

Do you now smoke cigars, cigarillos, or little filtered cigars every day, some days, rarely, or
not at all? [SELECT ONE RESPONSE.]
1 Every day
2 Some days
3 Rarely
4 Not at all
8 Don't Know
7 Refused to Answer
Current use cigars, etc.
If CIG_OFT (Current use cigarettes) = 1 (Daily), 2 (Weekly), 3 (Monthly), or 4 (Less than
monthly) or if CIGARFN5 (Current use cigars, etc.) = 1 (every day), 2 (some days), or 3
(rarely), go to Intro_CIG_QTN5 (Stopped smoking one day or longer). Else, skip to
Intro_CIGELCN5_21 (Ever vaped with any device).
“The next questions ask about quitting smoking. By smoking, I mean smoking cigarettes,
cigars, cigarillos, or little filtered cigars.”
During the past 12 months, have you stopped smoking for one day or longer because you
were trying to quit?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped smoking one day or longer
During the past 12 months, has a doctor, nurse, or other healthcare worker advised you to
quit smoking?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Doctor advised to quit smoking
"The next questions are about vaping e-cigarettes or other vaping devices. People can
vape nicotine, tobacco, marijuana, flavoring or other substances."
Have you ever, even once, vaped anything with an e-cigarette or other vaping device?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever vaped with any device
If CIGELCN5_21 (Ever vaped with any device) is 1 (yes), go to Intro_VAPE_TOBACCON21
(Vaped tobacco or nicotine past 30 days). Else if CIGELCN5_21 (Ever vaped with any
device) is 0 (No) or 8 (Don't know) or 7 (Refused to Answer), skip to INTRO_21_MARIJU_9.
"During the past 30 days, have you vaped any of the following:"
Tobacco or nicotine?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaped tobacco or nicotine past 30 days

Page | 95
VAPE_MARIJN21

US.5.2.

Marijuana, including marijuana concentrates, marijuana waxes, THC or hash oils?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vape marijuana past 30 days

US.5.3.

Any other substances?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vape other substances

Label_VAPE_MARIJN21
VAPE_OTHERN21

Label_VAPE_OTHERN21

Topic: Non-injection drug use (UN)
“I’m going to read you a list of drugs. For each drug I mention, please tell me how often
you used it during the past 12 months. Don’t include drugs you injected or drugs that were
used for medical purposes. We’ll use Response Card F for these questions.”
If VAPE_MARIJN21 (Vape marijuana past 30 days) = 1 (yes), skip to CRACK1_9 (Used crack).
Else if MARIJN21 is 0 (No) or 8 (Don't Know) or 7 (Refused to Answer), go to MARIJU_9
(Used marijuana).

Intro_21_MARIJU_9

Skip_21_MARIJU_9

MARIJU_9

UN.1.0.

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

UN.2.0.

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

UN.3.0.

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

Label_MARIJU_9
CRACK1_9

Label_CRACK1_9
COCSMO_9

Label_COCSMO_9

Page | 96
METHN5

UN.4.0.

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

UN.5.0.

During the past 12 months, how often did you use club drugs such as Ecstasy (also called
X), ketamine (also called Special K), or GHB (also called Liquid Ecstasy)? [USE RESPONSE
CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used club drugs

UN.6.0.

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

UN.7.0.

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

Label_METHN5
CLUBN5

Label_CLUBN5
POPPER_9

Label_POPPER_9
HEROIN_9

Label_HEROIN_9

Page | 97
PAINKN5_21

UN.8.0.

Next, I’ll ask about prescription pain relievers such as oxycodone, hydrocodone, Percocet,
or Vicodin. During the past 12 months, how often did you take a prescription pain reliever
that was not prescribed to you or was prescribed to you, but you took more than
directed? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used painkillers

UN.9.0.

I am going to ask you about prescription tranquilizers such as Valium, Ativan, Xanax, or
downers. During the past 12 months, how often did you take a prescription tranquilizer
that was not prescribed to you, or was prescribed to you but you took more than
directed? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used tranquilizers

Label_PAINKN5_21
TRANQN5_21

Label_TRANQN5_21
OTHERDRUGN21

OTHERDRUGN21

UN.10.0. During the past 12 months, did you use any other drug? Remember, don’t include drugs
you injected or drugs that were used for medical purposes.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Used other drug

Topic: Injection drug use (UI)
Intro_EVRINJN5
EVRINJN5

Label_EVRINJN5
Skip_EVRINJN5

UI.1.0.

“The next questions are about injection drug use. This means injecting drugs yourself or
having someone else inject you.”
Have you ever shot up or injected any drugs that weren’t used for medical purposes? By
shooting up, I mean anytime a needle was used to inject drugs in your veins, under the
skin, or in the muscle.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever used injection drugs
If EVRINJN5 (Ever used injection drugs) is 1 (yes), go to INJECTN5 (Used injection drugs past
12 months). Else, skip to Calculation_ENDRUGN5 (End of alcohol, smoking, and drug use).

Page | 98
INJECTN5

UI.1.1.

Label_INJECTN5
Skip_INJECTN5

Intro_COCINJN5

COCINJN5

UI.2.0.

Label_COCINJN5
HERINJN5

Label_SPDBALN5

“Now I'm going to read you a list of drugs. For each drug I mention, please tell me how
often you injected it during the past 12 months. We’ll use Response Card F for these
questions.”
During the past 12 months, how often did you inject powder cocaine? [USE RESPONSE
CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected powder cocaine

UI.3.0.

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

UI.4.0.

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

Label_HERINJN5
SPDBALN5

During the past 12 months, have you shot up or injected any drugs that weren’t used for
medical purposes?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Used injection drugs past 12 months
If INJECTN5 (Used injection drugs past 12 months) is 1 (yes) then go to Intro_COCINJN5
(Injected powder cocaine). Else, skip to next topic Calculation_ENDRUGN5 (End of alcohol,
smoking, and drug use).

Page | 99
METINJN5

UI.5.0.

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

UI.6.0.

During the past 12 months, how often did you inject painkillers, such as oxycodone,
hydrocodone, Percocet, or Vicodin? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected painkillers
If INJECTN5 (Used injection drugs past 12 months) is 1 (yes) and [COCINJN5 (Injected
powder cocaine), HERINJN5 (Injected heroin), SPDBALN5 (Injected speedball), METINJN5
(Injected methamphetamines), or PKINJN5_21 (Injected painkillers)] are all 5 (Never), then
display: The respondent said that they didn’t inject any of the specific drugs that you asked
about. Verify that the respondent injected drugs during the past 12 months. Allow the
program to move forward.

Label_METINJN5
PKINJN5_21

Label_PKINJN5_21
Soft_edit_PKINJN5_21

Intro_SHRNDLN5
SHRNDLN5

UI.7.0.

Label_SHRNDLN5
SHR_WRKS

Label_SHR_WRKS

UI.8.0.

“Now I am going to ask you some questions about sharing needles and other injection
equipment. When I ask you about needles, I’m talking about needles and syringes.”
When you injected during the past 12 months, did someone use the same needle after
you used it to either inject drugs or divide drugs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Shared needles
When you injected during the past 12 months, did someone use the same cookers, cotton,
or rinse water after you used it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Shared injection works

Page | 100
Intro_GETNDAN5
GETNDAN5

UI.9.0.

Label_GETNDAN5
GETNDBN5

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

UI.9.1.

A pharmacy or drug store?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needles at pharmacy

UI.9.2.

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

UI.9.3.

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

UI.9.4.

Label_GETNDEN5

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

Calculation_ENDRUGN5 U.0.a.
Label_Calculation_ENDRUGN5

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

Calculation_TLDRUGN5 U.0.b.
Label_8_Calculation_TLDRUGN5

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

Label_GETNDBN5
GETNDCN5

Label_GETNDCN5
GETNDDN5

Label_GETNDDN5
GETNDEN5

Page | 101

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

STSTIGN5 = Current time
Start time stigma and discrimination

Intro_21_STGA12N8

"Next, I'll read statements that some people with HIV feel. We want to know if you
experience these feelings. These statements are not things that I or anyone in this project
thinks. Remember that you don't have to answer any question you don't want to. For each
statement that I read, tell me how strongly you disagree or agree. We'll use Response Card
G."
During the past 12 months, I have been hurt by how people reacted to learning I have HIV.
[USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Stigma – hurt by people p12m

STGA12N8

RS.1.0

Label_STGA12N8
STGB12N8

RS.2.0

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

RS.3.0

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

RS.4.0.

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

Label_STGB12N8
STGC12N8

Label_STGC12N8
STIGMDN5

Label_STIGMDN5

Page | 102
STIGMEN5

RS.5.0.

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

RS.6.0.

I feel that I am not as good a person as others because I have HIV. [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Not as good a person as others

RS.7.0.

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

RS.8.0.

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

RS.9.0.

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

Label_STIGMEN5
STIGMFN5

Label_STIGMFN5
STIGMGN5

Label_STIGMGN5
STIGMHN5

Label_STIGMHN5
STIGMIN5

Label_STIGMIN5

Page | 103
STIGMJN5

RS.10.0.

Label_STIGMJN5

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

Topic: Discrimination (RD)
INTRO_DISC1N24
DISC1N24

RD.1.1.

Label_DISC1N24
DISC2N24

RD.1.2.

You were rejected by a potential sexual or romantic partner
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - rejected by partner

RD.1.3.

You were denied a job, or you lost a job
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - denied or lost job

RD.1.4

You were treated with hostility or coldness by strangers
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - treated with hostility

RD.1.5.

Someone acted as if you could not be trusted
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - not trusted

Label_DISC2N24
DISC3N24

Label_DISC3N24
DISC4N24

Label_DISC4N24
DISC5N24

Label_DISC5N24

During the past 12 months, did any of the following things happen to you because
someone knew or suspected that you have HIV?  
You were ignored, excluded, or avoided by people close to you
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - ignored or excluded

Page | 104
DISC6N24

RD.1.6.

Someone insulted or made fun of you
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - insulted or made fun

RD.1.7.

You were denied a place to live or lost a place to live
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - denied or lost housing

RD.1.8.

Your personal property was damaged or stolen
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - property damaged

RD.1.9.

You were physically assaulted or beaten up
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - physically assaulted

Label_DISC6N24
DISC7N24

Label_DISC7N24
DISC8N24

Label_DISC8N24
DISC9N24

Label_DISC9N24
DISC10N24

Label_DISC10N24

RD.1.10. You were treated poorly or made to feel inferior when receiving health care
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Discrimination - treated poorly

Calculation_ENSTIGN5 R.0.a.
Label_Calculation_ENSTIGN5

ENSTIGN5 = Current time
End of stigma and discrimination

Calculation_TLSTIGN5
R.0.b.
Label_Calculation_TLSTIGN5

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

Page | 105

Module: Gynecological and reproductive history (G)
Topic: Gynecological care (GH)
Calculation_STOBGYN5 G.0.
Label_Calculation_STOBGYN5

STOBGYN5 = current time
Start time gyn and reproductive history

Skip_21_PLV_EX_9

If SX_GEN (Sex gender) = 2 (female), then go to Intro_PLV_EX_9 (Pelvic exam). If SX_GEN
(Sex gender) = 1 (male) or 3 (transgender) or 4 (indeterminate), skip to
Skip_INTENTDADN21 (Try biological father).
“I’m now going to ask some questions about pelvic exams and Pap smears. A pelvic exam
is a vaginal examination. A Pap smear, also called a cervical cancer test or Pap test, is a test
used to check for cancer of the cervix. Often a pelvic exam and Pap smear are performed
at the same time.”
During the past 12 months, have you had a pelvic examination?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Pelvic exam

Intro_PLV_EX_9

PLV_EX_9

GH.1.0.

Label_PLV_EX_9
PAP_EX_8

GH.2.0.

[During the past 3 years or Since testing positive for HIV], have you had a Pap smear?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV)<3 years prior to interview date, 8888 (don't
know), or 7777 (refused to answer), then question should read, "Since testing positive for
HIV, have you had a Pap smear?" If POS1S_9 (Date first tested positive for HIV) >=3 years
ago or POS1S_9 (Date first tested positive for HIV) = Skipped, then question should read as
"During the past 3 years, have you had a Pap smear?"
Pap smear

GH.3.0.

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

GH.4.0.

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

Alt_text_21_PAP_EX_8

Label_PAP_EX_8
POSTMEN8

Label_POSTMEN8
TUBLIGN8

Label_TUBLIGN8

Page | 106
HYSTERN8

GH.5.0

Label_HYSTERN8
Skip_21_HYSTERN8

Have you had a hysterectomy? A hysterectomy is when all or some of your uterus is
removed.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Hysterectomy
If POSTMEN8 (Post menopausal) is 1 (yes) or TUBLIGN8 (Tubal ligation) is 1 (yes) or
HYSTERN8 (Hysterectomy) is 1 (yes), then skip to Intro_N21_PREG_21 (Number of times
pregnant). If POSTMEN8 (Post menopausal) is 0 (no), 7 (refused to answer) or 8 (don’t
know) and TUBLIGN8 (Tubal ligation) is 0 (no), 7 (refused to answer) or 8 (don’t know) and
HYSTERN8 (Hysterectomy) is 0 (no), 7 (refused to answer) or 8 (don’t know), skip to
Skip_INTENTDADN21 (Try biological father).

Topic: Family planning (GF)
Skip_INTENTDADN21

Intro_INTENTDADN21
INTENTDADN21

GF.1.0.

Label_INTENTDADN21
Skip2_INTENTDADN21

PREGNOWN21

Label_PREGNOWN21

GF.2.0.

If SX_GEN (Sex gender) = 2 (female) and SX_TMPN4 (Number of male partners) = 0, 777
(refused to answer) or 888 (don’t know), skip to Intro_N21_PREG_21. If SX_GEN (Sex
gender) = 2 (female) and SX_TMPN4 (Number of male partners) >=1, skip to
PREGNOWN21 (Currently pregnant). If SX_GEN (Sex gender) = 1 (male), skip to
Intro_INTENTDADN21 (Try biological father). IF SX_GEN (Sex gender) = 3 (transgender) or 4
(indeterminate), skip to Calculation_ENOBGYN5 (End of gynecological and reproductive
hi).
"Now I’m going to ask you about becoming a biological father."
At any time during the past 12 months, have you tried to become a biological father?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Try biological father
If INTENTDADN21 (Try biological father) = 0 (no) skip to skip_PREGTALKN21 (Dr talk
prevent pregnancy). If INTENTDADN21 (Try biological father) = 1 (yes), skip to KIDTALKN21
(Dr talked about children). If INTENTDADN21 (Try biological father) is 7 (refused to answer)
or 8 (don’t know), skip to Calcualtion_ENOBGYN5 (End of gynecological and reproductive
hi).
Are you currently pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Currently pregnant

Page | 107
INTENTN8_21

GF.3.0.

At any time during the past 12 months, have you tried to get pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If PREGNOWN21 (Currently pregnant) = 1 (yes), then display question as, “Were you trying
to get pregnant?”
Pregnancy intent
If INTENTN8_21 (Pregnancy intent) = 1 (yes), skip to KIDTALKN21 (Dr talked about
children). If INTENTN8_21 (Pregnancy intent) = 0 (no), 7 (refused to answer), or 8 (don’t
know), skip to NOPREGN21 (Prevent pregnancy).

GF.4.0.

During the past 12 months, has a doctor, nurse, or other healthcare worker talked with
you about your desire to have children?
0 No
1 Yes
8 Don’t Know
7 Refused to Answer
Dr talked about children
If SX_GEN (Sex gender) = 1 (male), skip to Calculation_ENOBGYN5 (End of gynecological
and reproductive hi). If SX_GEN (Sex gender) = 2 (female), go to NOPREGN21 (Prevent
pregnancy).

GF.5.0.

Some things women do to prevent pregnancy include using birth control pills or condoms.
At any time during the past 12 months, have you tried to prevent getting pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prevent pregnancy
If NOPREGN21 (Prevent pregnancy) = 1 (yes) go to PREGTALKN21 (Dr talk prevent
pregnancy). If NOPREGN21 (Prevent pregnancy) = 0 (no), 7 (refused to answer) or 8 (don’t
know), skip to Skip_VERTRANN21 (Prevent vertical trans).

Alt_text_INTENTN8_21
Label_INTENTN8_21
Skip_INTENTN8_21

KIDTALKN21

Label_KIDTALKN21
Skip_KIDTALKN21

NOPREGN21

Label_NOPREGN21
Skip_NOPREGN21

Skip_PREGTALKN21

PREGTALKN21

Alt_Text_PREGTALKN21

Label_PREGTALKN21

If SX_GEN (Sex gender) = 1 (male) AND SX_TFPN4 (Number of female partners) ≥ 1, go to
PREGTALKN21 (Dr talk prevent pregnancy). If SX_GEN (Sex gender) = 1 (male) and
SX_TFPN4 (Number of female partners) = 0, 7777 (refused to answer) or 8888 (don’t know),
skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
GF.6.0.

During the past 12 months, has a doctor, nurse, or other healthcare worker talked with
you about how to prevent pregnancy?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
INTENTDADN21 (Try biological father) = 0 (no), then question should read, “Some things
men do to prevent getting someone pregnant include using condoms or getting a
vasectomy. During the past 12 months, has a doctor, nurse, or other healthcare worker
talked with you about doing anything to prevent getting someone pregnant?”
Dr talk prevent pregnancy

Page | 108
Skip_VERTRANN21

VERTRANN21

If PREGNOWN21 (Currently pregnant) = 1 (yes) or INTENTN8_21 (Pregnancy intent) = 1
(yes), go to VERTRANN21 (Prevent vertical trans). If INTENTN8_21 (Pregnancy intent) = 0
(no) or 7 (refused) or 8 (don’t know), skip to Intro_N21_PREG_21 (Number of times
pregnant). If PREGNOWN21 (Currently pregnant) = 0 (no) or 7 (refused) or 8 (don’t know),
skip to Intro_N21_PREG_21 (Number of times pregnant). If SX_GEN (Sex gender) = 1 (male)
skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
GF.7.0.

Label_VERTRANN21

During the past 12 months, has a doctor, nurse, or other healthcare worker talked with
you about how to prevent passing HIV on to your baby?
0 No
1 Yes
8 Don’t Know
7 Refused to Answer
Prevent vertical trans

Topic: Reproductive history (GR)
Intro_N21_PREG_21

PREG_21

Alt_text_PREG_21

Label_PREG_21
Range_PREG_21
Skip_PREG_21

GR.1.0.

"Now I’m going to ask about pregnancies you may have had since testing positive for HIV.
These pregnancies could have resulted in a live birth, miscarriage, abortion, stillbirth, or
ectopic pregnancy."
Since testing positive for HIV in [INSERT POS1S_9 (date of first positive test)], how many
times have you been pregnant?
888 Don't Know
777 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) is 77/7777 (refused to answer), 88/8888
(don’t know) or Skipped and PREGNOWN21 (Currently pregnant) = 1 (yes), then PREG_21
(Number of times pregnant) should read as follows: "Since testing positive for HIV, how
many times have you been pregnant? Don’t count your current pregnancy.” If
PREGNOWN21 (Currently pregnant) = 1 (yes) then PREG_21 (Number of times pregnant)
should read as follows: “Since testing positive for HIV in [INSERT POS1S_9 (Date first tested
positive for HIV)], how many times have you been pregnant? Don’t count your current
pregnancy.” If POS1S_9 (Date first tested positive for HIV) is 77/7777 (refused to answer),
88/8888 (don’t know) or Skipped, then PREG_21 (Number of times pregnant) should read
as follows: "Since testing positive for HIV, how many times have you been pregnant?"
Number of times pregnant
0-100
If PREGNOWN21 (Currently pregnant) = 1 (yes) AND PREG_21 (Number of times pregnant)
= 0, then skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi). If
PREG_21 (Number of times pregnant) = 0, 777 (refused to answer) or 888 (don’t know),
skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi). If PREG_21
(Number of times pregnant) >= 1, go to Skip_OUTCM1N3_21 (Single pregnancy outcome).

Page | 109
Skip_OUTCM1N3_21

OUTCM1N3_21

If PREG_21 (Number of times pregnant) = 1, go to OUTCM1N3_21 (Single pregnancy
outcome). If PREG_21 (Number of times pregnant) > 1, go to OUTCM1N21 (Outcome-live
birth).
GR.2.0.

What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY ONE.]
1 Live birth
2 Miscarriage
3 Abortion
4 Stillbirth
5 Ectopic pregnancy
8 Don’t know
7 Refused to answer
Single pregnancy outcome
If OUTCM1N3_21 (Single pregnancy outcome) = 1 (Live birth), then skip to KID1HVN3_21
(Single pregnancy vertical transmission). If OUTCM1N3_21 (Single pregnancy outcome) is
8 (don’t know) or 7 (refused to answer), skip to Calculation_ENOBGYN5 (End of
gynecological and reproductive hi). Else, skip to Calculation_ENOBGYN5 (End of
gynecological and reproductive hi).

GR.3.0.

How many of these pregnancies resulted in a live birth?
888 Don’t know
777 Refused to Answer
Outcome-live birth
0-100
If OUTCM1N21 (Outcome-live birth) > PREG_21 (Number of times pregnant), display the
following message: "This does not add up with the number you gave me earlier." Do not
allow the program to advance.
If PREG_21 (Number of times pregnant) = OUTCM1N21 (Outcome-live birth), skip to
KIDHIVN21 (Children born HIV+). If OUTCM1N21 (Outcome-live birth) is 888 (don’t know)
or 777 (Refused to answer), go to OUTCM2N21 (Outcome-miscarriage). Else, go to
OUTCM2N21 (Outcome-miscarriage).

GR.4.0.

How many of these pregnancies resulted in a miscarriage?
888 Don’t know
777 Refused to Answer
Outcome-miscarriage
0-100
If OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage) > PREG_21
(Number of times pregnant), display the following message: “This does not add up with
the number you gave me earlier”. Do not allow the program to advance.
If PREG_21 (Number of times pregnant) = OUTCM2N21 (Outcome-miscarriage) and
OUTCM1N21 (Outcome-live birth) = 0, skip to Calculation_ENOBGYN5 (End of
gynecological and reproductive hi). If PREG_21 (Number of times pregnant) =
OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage), then skip to
Skip_KID1HVN3_21 (Single pregnancy vertical transmission). If OUTCM2N21 (Outcomemiscarriage) is 888 (don’t know) or 777 (refused to answer), go to OUTCM3N21 (Outcomeabortion). Else, go to OUTCM3N21 (Outcome-abortion).

Label_OUTCM1N3_21
Skip2_OUTCM1N3_21

OUTCM1N21

Label_OUTCM1N21
Range_OUTCM1N21
Hard_edit_OUTCM1N21

Skip_OUTCM1N21

OUTCM2N21

Label_OUTCM2N21
Range_OUTCM2N21
Hard_edit_OUTCM2N21

Skip_OUTCM2N21

Page | 110
OUTCM3N21

GR.5.0.

How many of these pregnancies resulted in an abortion?
888 Don’t know
777 Refused to Answer
Outcome-abortion
0-100
If OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21
(Outcome-abortion) > PREG_21 (Number of times pregnant), display the following
message: “This does not add up with the number you gave me earlier”. Do not allow the
program to advance.
If PREG_21 (Number of times pregnant) = OUTCM3N21 (Outcome-abortion) and
OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage) = 0, skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive hi). If PREG_21 (Number of
times pregnant) = OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcomemiscarriage) + OUTCM3N21 (Outcome-abortion), then skip to Skip_KID1HVN3_21 (Single
pregnancy vertical transmission). If OUTCM3N21 (Outcome-abortion) = 888 (don’t know)
or 777 (refused to answer), go to OUTCM4N21 (Outcome-stillbirth). Else, go to
OUTCM4N21 (Outcome-stillbirth).

GR.6.0.

How many of these pregnancies resulted in a stillbirth?
888 Don’t know
777 Refused to Answer
Outcome-stillbirth
0-100
If OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21
(Outcome-abortion) + OUTCM4N21 (Outcome-stillbirth) > PREG_21 (Number of times
pregnant), display the following message: “This does not add up with the number you gave
me earlier”. Do not allow the program to advance.
If PREG_21 (Number of times pregnant) = OUTCM4N21 (Outcome-stillbirth) and
OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21
(Outcome-abortion) = 0, skip to Calculation_ENOBGYN5 (End of gynecological and
reproductive hi). If PREG_21 (Number of times pregnant) = OUTCM1N21 (Outcome-live
birth) + OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21 (Outcome-abortion) +
OUTCM4N21 (Outcome-stillbirth), then skip to Skip_KID1HVN3_21 (Single pregnancy
vertical transmission). If OUTCM4N21 (Outcome-stillbirth) is 777 (refused to answer) or
888 (don’t know), go to OUTCM5N21 (Outcome-ectopic pregnancy). Else, go to
OUTCM5N21 (Outcome-ectopic pregnancy).

Label_OUTCM3N21
Range_OUTCM3N21
Hard_edit_OUTCM3N21

Skip_OUTCM3N21

OUTCM4N21

Label_OUTCM4N21
Range_OUTCM4N21
Hard_edit_OUTCM4N21

Skip_OUTCM4N21

Page | 111
OUTCM5N21

GR.7.0.

Label_OUTCM5N21
Range_OUTCM5N21
Soft_edit_OUTCM5N21

Hard_edit_OUTCM5N21

Skip_OUTCM5N21

Skip_KID1HVN3_21

KID1HVN3_21

How many of these pregnancies resulted in an ectopic pregnancy?
888 Don’t know
777 Refused to Answer
Outcome-ectopic pregnancy
0-100
If PREG_21 (Number of times pregnant) does not equal OUTCM1N21 (Outcome-live birth)
+ OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21 (Outcome-abortion) + OUTCM4N21
(Outcome-stillbirth) + OUTCM5N21 (Outcome-ectopic pregnancy), then display “The
number of pregnancy outcomes does not add up to the number of pregnancies.” Allow the
program to move forward.
If OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21
(Outcome-abortion) + OUTCM4N21 (Outcome-stillbirth) + OUTCM5N21 (Outcome-ectopic
pregnancy) > PREG_21 (Number of times pregnant), display the following message: “This
does not add up with the number you gave me earlier”. Do not allow the program to
advance.
If PREG_21 (Number of times pregnant) = OUTCM5N21 (Outcome-ectopic pregnancy) and
OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21
(Outcome-abortion) + OUTCM4N21 (Outcome-stillbirth) = 0, skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive hi). If OUTCM5N21
(Outcome-ectopic pregnancy) is 777 (refused to answer) or 888 (don’t know), go to
Skip_KID1HVN3_21 (Single pregnancy vertical transmission). Else, go to Skip_KID1HVN3_
21 (Single pregnancy vertical transmission).
If OUTCM1N21 (Outcome-live birth) = 1, then go to KID1HVN3_21 (Single pregnancy vertical
transmission). If OUTCM1N21 (Outcome-live birth) > 1, then go to KIDHIVN21 (Children born
HIV+).
Else, go to
Calculation_ENOBGYN5 (End of gynecological and reproductive hi).

GR.8.0.

Was the child diagnosed with HIV?
0 No
1 Yes
2 Indeterminate
8 Don’t know
7 Refused to answer
Single pregnancy vertical transmission
All responses skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).

GR.9.0.

Label_KIDHIVN21
Range_KIDHIVN21
Hard_edit_KIDHIVN21

How many of your biological children were born with HIV?
888 Don’t know
777 Refused to Answer
Children born HIV+
0-100
KIDHIVN21 (Children born HIV+) must be ≤ OUTCM1N21 (Outcome-live birth). If
KIDHIVN21 (Children born HIV+) > OUTCM1N21 (Outcome-live birth) then read, “Earlier
you said that you had [OUTCM1N21 (Outcome-live birth)] live births, but the number you
just gave me is greater than that.” Do not allow the program to advance.

Calculation_ENOBGYN5 G.0.a.
Label_Calculation_ENOBGYN5

ENOBGYN5 = Current time
End of gynecological and reproductive hi

Calculation_TLOBGYN5 G.0.b.
Label_Calculation_TLOBGYN5

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

Label_KID1HVN3_21
Skip2_KID1HVN3_21
KIDHIVN21

Page | 112

Module: Met and unmet needs (N)
Topic: Services and assistance programs (ND)
Intro_8_CSMNA_5

CSMNA_5

ND.1.0.

Label_CSMNA_5
Skip_6_CSMNA_5

CSMNB_5

ND.1.1.

During the past 12 months, have you needed HIV case management services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed HIV case management services
If CSMNB_5 (Needed HIV case management services) is 1 (yes), go to CSMNCN24. Else,
skip to Skip1_6_TKMDA_5 (Get help taking meds on time/correctly).

ND.1.2.

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - HIV case mgmt
If CSMNCN24 is 1 (yes), go to CSMNDN24. Else, skip to Skip1_6_TKMDA_5 (Get help taking
meds on time/correctly).

ND.1.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - HIV case mgmt

Label_CSMNB_5
Skip_24_CSMNB_5
CSMNCN24

Label_CSMNCN24
Skip_CSMNCN24
CSMNDN24

Label_CSMNDN24

“For these next questions, I’m going to ask about services you used or needed during the
past 12 months.First, I'll ask whether you got the service, and if you didn’t, I'll ask whether
you needed it. These questions might sound similar, but I need to ask you all of them.”
The first question is about HIV case management services. A case manager is a
professional who helps you to get care and other services that you or your family may
need. During the past 12 months, did you get HIV case management services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get HIV case management services
If CSMNA_5 (Get HIV case management services) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to CSMNB_5 (Needed HIV case management services). Else, skip to Skip1
_6_TKMDA_5 (Get help taking meds on time/correctly).

Page | 113
Skip1_6_TKMDA_5

TKMDA_5

If CART_N5 (Currently taking ART) = 1 (yes) or ATMD12_9 (Took ART in past 12 months) = 1
(yes), then go to TKMDA_5 (Get help taking meds on time/correctly). Else, skip to
Skip_NEDADA_5 (Needed ADAP).
ND.2.0.

During the past 12 months, did you get professional help on how to take your HIV
medicines on time or correctly?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get help taking meds on time/correctly
If TKMDA_5 (Get help taking meds on time/correctly) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to TKMDB_5 (Need help taking meds on time/correctly). Else, skip to
Skip_NEDADA_5 (Needed ADAP).

ND.2.1.

During the past 12 months, have you needed professional help on how to take your HIV
medicines on time or correctly?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need help taking meds on time/correctly
If TKMDB_5 (Need help taking meds on time/correctly) is 1 (yes), go to TKMDCN24. Else,
skip to Skip_NEDADA_5 (Needed ADAP).

ND.2.2

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Help taking meds
If TKMDCN24 is 1 (yes), go to TKMDDN24. Else, skip to Skip_NEDADA_5 (Needed ADAP).

ND.2.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Help taking meds

Label_TKMDA_5
Skip2_6_TKMDA_5

TKMDB_5

Label_TKMDB_5
Skip_24_TKMDB_5
TKMDCN24

Label_TKMDCN24
SKIP_TKMDCN24
TKMDDN24

Label_TKMDDN24

If KINDD_5 (Insurance-Ryan White or ADAP) is 0 (no), go to NEDADA_5 (Needed ADAP).
Else, skip to Intro_PATNAVN5 (Get patient navigation services).

Skip_NEDADA_5
NEDADA_5

Label_NEDADA_5
Skip2_24_NEDADA_5

ND.3.1.

Earlier you told me that during the past 12 months you did not have Ryan White or ADAP
coverage. During the past 12 months, have you needed to get medicine through ADAP?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed ADAP
If NEDADA_5 (Needed ADAP) is 1 (yes), go to ADAPCN24. Else, skip to Intro_PATNAVN5
(Get patient navigation services).

Page | 114
ADAPCN24

ND.3.2.

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - ADAP
If ADAPCN24 is 1 (yes), go to ADAPDN24. Else, skip to Intro_PATNAVN5 (Get patient
navigation services).

ND.3.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - ADAP

Label_ADAPCN24
SKIP_ADAPCN24
ADAPDN24

Label_ADAPDN24
Intro_PATNAVN5

PATNAVN5

ND.4.0.

Label_PATNAVN5
Skip_PATNAVN5

PATNABN5

ND.4.1.

During the past 12 months, have you needed patient navigation services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed patient navigation services
If PATNABN5 (Needed patient navigation services) is 1 (yes), go to PATNACN24. Else, skip
to GET_GRP (Get HIV peer group support).

ND.4.2

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Patient navigation
If PATNACN24 is 1 (yes), go to PATNADN24. Else, skip to GET_GRP (Get HIV peer group
support).

ND.4.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Patient navigation

Label_PATNABN5
Skip_24_PATNABN5
PATNACN24

Label_PATNACN24
SKIP_PATNACN24
PATNADN24

Label_PATNADN24

“The next question is about patient navigation services. This is someone whose job it is to
help you get the best medical care for you. For example, a patient navigator might help
you talk to your doctor about your care or go with you to your medical appointments.”
During the past 12 months, did you get patient navigation services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get patient navigation services
If PATNAVN5 (Get patient navigation services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to PATNABN5 (Needed patient navigation services). Else, skip to GET_GRP (Get
HIV peer group support).

Page | 115
GET_GRP

ND.5.0.

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

ND.5.1.

During the past 12 months, have you needed HIV peer group support?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed HIV peer group support
If NED_GRP (Needed HIV peer group support) is 1 (yes), go to GRPSCN24. Else, skip to
DENS12_9 (Get dental care).

ND.5.2.

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - HIV peer group support
If GRPSCN24 is 1 (yes), go to GRPSDN24. Else, skip to DENS12_9 (Get dental care).

ND.5.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - HIV peer group support

ND.6.0.

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

ND.6.1.

During the past 12 months, have you needed dental care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed dental care
If DENSER_9 (Needed dental care) is 1 (yes), go to DENSCN24.
GET_SUBU (Get drug/alcohol counseling or treatment).

Label_GET_GRP
Skip_GET_GRP

NED_GRP

Label_NED_GRP
Skip_24_NED_GRP
GRPSCN24

Label_GRPSCN24
Skip_GRPSCN24
GRPSDN24

Label_GRPSDN24
DENS12_9

Label_DENS12_9
Skip_DENS12_9

DENSER_9

Label_DENSER_9
Skip_DENSER_9

Else, skip to

Page | 116
DENSCN24

ND.6.2.

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Dental care
If DENSCN24 is 1 (yes), go to DENSDN24. Else, skip to GET_SUBU (Get drug/alcohol
counseling or treatment).

ND.6.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Dental care

ND.7.0.

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

ND.7.1.

During the past 12 months, have you needed drug or alcohol counseling or treatment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need drug/alcohol counsel or treatment
If NED_SUBU (Need drug/alcohol counsel or treatment) is 1 (yes), go to SUBUCN24. Else,
skip to MENTA_5 (Get mental health counsel or treatment).

ND.7.2.

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Drug/alcohol counseling
If SUBUCN24 is 1 (yes), go to SUBUDN24. Else, skip to MENTA_5 (Get mental health
counsel or treatment).

ND.7.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Drug/alcohol counseling

Label_DENSCN24
Skip_ DENSCN24
DENSDN24

Label_DENSDN24
GET_SUBU

Label_GET_SUBU
Skip_GET_SUBU

NED_SUBU

Label_NED_SUBU
Skip_24_NED_SUBU
SUBUCN24

Label_SUBUCN24
Skip_SUBUCN24
SUBUDN24

Label_SUBUDN24

Page | 117
MENTA_5

ND.8.0.

During the past 12 months, have you seen or talked to a mental health professional such
as a psychologist, psychiatrist, psychiatric nurse, or clinical social worker about your
health?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get mental health counsel or treatment
If MENTA_5 (Get mental health counsel or treatment) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to MENTB_5 (Need mental health counsel or treatment). Else, skip to
TRAS12_9 (Get transportation assistance).

ND.8.1.

During the past 12 months, have you needed to see or talk to a mental health professional
about your health?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need mental health counsel or treatment
If MENTB_5 (Need mental health counsel or treatment) is 1 (yes), go to MENTCN24. Else,
skip to TRAS12_9 (Get transportation assistance).

ND.8.2.

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Mental health counseling
If MENTCN24 is 1 (yes), go to MENTDN24. Else, skip to

ND.8.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Mental health counseling

ND.9.0.

During the past 12 months, did you get transportation assistance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get transportation assistance
If TRAS12_9 (Get transportation assistance) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to TRASAS_9 (Needed transportation assistance). Else, skip to SHLTA_5 (Get
shelter or housing services).

Label_MENTA_5
Skip_MENTA_5

MENTB_5

Label_MENTB_5
Skip_24_MENTB_5
MENTCN24

Label_MENTCN24
Skip_MENTCN24
MENTDN24

Label_MENTDN24
TRAS12_9

Label_TRAS12_9
Skip_TRAS12_9

Page | 118
TRASAS_9

ND.9.1.

During the past 12 months, have you needed transportation assistance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed transportation assistance
If TRASAS_9 (Needed transportation assistance) is 1 (yes), go to TRANCN24. Else, skip to
SHLTA_5 (Get shelter or housing services).

ND.9.2.

Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Transportation assistance
If TRANCN24 is 1 (yes), go to TRANDN24. Else, skip to SHLTA_5 (Get shelter or housing
services).

ND.9.3.

Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Transportation assistance

Label_TRASAS_9
Skip_24_TRASAS_9
TRANCN24

Label_TRANCN24
Skip_TRANCN24
TRANDN24

Label_TRANDN24
SHLTA_5

Label_SHLTA_5
Skip_24_SHLTA_5
SHLTB_5

Label_SHLTB_5
Skip_24_ SHLTB_5
SHLTCN24

Label_SHLTCN24
Skip_SHLTCN24

ND.10.0. During the past 12 months, did you get shelter or housing services where you got help
with temporary or long-term housing including section 8 vouchers?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get shelter or housing services
If SHLTA_5 (Get shelter or housing services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to SHLTB_5 (Needed shelter or housing services). Else, skip to FOODAN5_24.
ND.10.1. During the past 12 months, have you needed shelter or housing services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed shelter or housing services
If SHLTB_5 (Needed shelter or housing services) is 1 (yes), go to SHLTCN24. Else, skip to
FOODAN5_24.
ND.10.2. Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Shelter/housing services
If SHLTCN24 is 1 (yes), go to SHLTDN24. Else, skip to FOODAN5_24.

Page | 119
SHLTDN24

Label_SHLTDN24
FOODAN5_24

Label_FOODA_24
Skip_FOODAN5_24
FOODBN5_24

Label_FOODB_24
Skip_FOODBN5_24
FOODCN24

Label_FOODCN24
Skip_FOODCN24
FOODDN24

Label_FOODDN24
Intro_24_MLSF12_24

MLSF12_24

Label_MLSF12_24
Skip_MLSF12_24

ND.10.3. Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Shelter/housing services
ND.11.0. During the past 12 months, did you get food benefits from SNAP-Supplemental Nutrition
Assistance Program or WIC-The Special Supplemental Nutrition Program for Women,
Infants, and Children?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get SNAP/WIC
If FOODAN5_24 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to FOODBN5_24.
Else, skip to INTRO_MLSF12_24.
ND.11.1. During the past 12 months, have you needed food benefits from SNAP or WIC?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need SNAP/WIC
If FOODBN5_24 =1 (yes), go to FOODCN24. Else skip to MLSF12_24.
ND.11.2. Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - SNAP/WIC
If FOODCN24 =1 (yes), go to FOODDN24. Else skip to INTRO_MLSF12_24.
ND.11.3. Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - SNAP/WIC

Next, I’m going to ask about getting free or low-cost food. People may receive free or lowcost food through food vouchers or gift cards, food pantries, food banks, soup kitchens, or
free home delivered meals.
ND.12.0. During the past 12 months, did you get free or low-cost food?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get free or low-cost food
If MLSF12_24 is 0 (no), 7 (refused to answer) or 8 (don’t know), go to MLSFOD_24. Else,
skip to FATYPAN24.

Page | 120
MLSFOD_24

Label_MLSFOD_24
Skip_MLSFOD_24
MEALCN24

Label_MEALCN24
Skip_MEALCN24
MEALDN24

Label_MEALDN24
FATYPAN24

ND.12.1. During the past 12 months, have you needed free or low-cost food?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need free or low-cost food
If MLSFOD_24=1 (yes), go to MEALCN24. Else, skip to FATYPAN24.
ND.12.2. Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Free or low-cost food
If MEALCN24=1 (yes), go to MEALDN24. Else, skip to FATYPAN24.
ND.12.3. Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Free or low-cost food

Label_FATYPAN24
Skip_FATYPAN24

ND.12.4. During the past 12 months, did you get any other type of food assistance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Receive other food assistance
If FATYPAN24 is 1 (Yes) go to FATYPAN24OS; Else, skip to

FATYPAN24OS
Label_FATYPBN24

ND.12.5. What type of food assistance did you get?
Type of other food assistance

GET_DOMS

ND.13.0. During the past 12 months, did you get domestic violence services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get domestic violence services
If GET_DOMS (Get domestic violence services) is 0 (no), 7 (refused to answer) or 8 (don’t
know), go to NED_DOMS (Needed domestic violence services). Else, skip to EMPLAN24.

Label_GET_DOMS
Skip_24_ GET_DOMS
NED_DOMS

Label_NED_DOMS
Skip_24_NED_DOMS

ND.13.1. During the past 12 months, have you needed domestic violence services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed domestic violence services
If NED_DOMS (Needed domestic violence services) is 1 (yes), go to DOMSCN24. Else, skip
to EMPLAN24.

Page | 121
DOMSCN24

Label_DOMSCN24
Skip_DOMSCN24
DOMSDN24

Label_DOMSDN24
Intro_EMPLAN24
EMPLAN24

Label_EMPLAN24
Skip_EMPLAN24
EMPLBN24

Label_EMPLBN24
Skip_EMPLBN24
EMPLCN24

Label_EMPLCN24
Skip_EMPLCN24
EMPLDN24

Label_EMPLDN24

ND.13.2. Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Domestic violence services
If DOMSCN24 is 1 (yes), go to DOMSDN24. Else, skip to EMPLAN24.
ND.13.3. Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Domestic violence services

Job assistance programs prepare you to get a job or help you consider other job
opportunities.
ND.14.0. During the past 12 months, did you get help from a job assistance program?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Got job assistance
If EMPLAN24 is 0 (no), 7 (refused to answer), or 8 (don’t know), go to EMPLBN24. Else, skip
to COND12_9 (Gotten any free condoms).
ND.14.1. During the past 12 months, have you needed help from a job assistance program?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed job assistance
If EMPLBN24 is 1 (yes)go to EMPLCN24. Else, skip to COND12_9 (Gotten any free
condoms).
ND.14.2. Did you know this service existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 1 - Job assistance
If EMPLCN24 is 1 (yes)go to EMPLDN24. Else, skip to COND12_9 (Gotten any free
condoms).
ND.14.3. Did you know how to get this service?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier 2 - Job assistance

Page | 122
COND12_9

Label_COND12_9
Skip_21_COND12_9
NEDCONDN21

Label_NEDCONDN21

ND.15.0. During the past 12 months, have you gotten any free condoms, not counting those given
to you by a friend, relative, or sex partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Gotten any free condoms
If COND12_9 (Gotten any free condoms) is 0 (no), 7 (refused to answer), or 8 (don't know),
go to NEDCONDN21 (Need free condoms). Else, skip to INTRO_SSIA_N8.
ND.15.1. During the past 12 months, have you needed free condoms?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need free condoms

Topic: Other disability (NS)
Intro_SSIA_N8

SSIA_N8

NS.1.0.

Label_SSIA_N8
Intro_SSDIA_N8

"The next question is about Supplemental Security Income or SSI. SSI is a federal program
that provides money for food, clothing, and shelter for older persons or persons with
disabilities."
During the past 12 months, did you get SSI?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get SSI

Label_SSDIA_N8

"Now I’m going to ask about Social Security Disability Insurance or SSDI. SSDI is a federal
insurance program that provides income to people unable to work because of a disability."
During the past 12 months, did you get SSDI?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get SSDI

Calculation_ENNEEDN5 N.0.a.
Label_Calculation_ENNEEDN5

ENNEEDN5 = Current time
End of met and unmet needs

Calculation_TLNEEDN5 N.0.b.
Label_Calculation_TLNEEDN5

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

SSDIA_N8

NS.2.0.

Page | 123

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

STPREVN5 = Current time
Start prevention activities

Topic: Risk reduction (PR)
Calculation_STPREVN5 P.0.
Label_Calculation_STPREVN5

STPREVN5 = Current time
Start prevention activities

Intro_TALK_A_21
TALK_A_21

Now I'll ask you about preventing HIV and STDs
During the past 12 months, have you talked to a doctor, nurse, or other healthcare worker
about how to prevent HIV or other STDs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) is Skipped, 8888 (don’t know), or 7777
(refused to answer), then display the text as follows, “During the past 12 months, have you
talked to a doctor, nurse, or other healthcare worker about how to prevent HIV or other
STDs?”
If POS1S_9 (Date first tested positive for HIV) is less than 12 months from IDATE (Interview
Date calculated or corrected) or POS1S_9M is missing and POS1S_9Y = 1 year from IDATE
(Interview Date calculated or corrected) then display the text as follows, "During the past
12 months, not including when you may have been tested for HIV, have you talked to a
doctor, nurse or other healthcare worker about how to prevent HIV or other STDs?”
Conversation with a doctor, nurse…

PR.1.0

Alt_text2_TALK_A_21

Alt_Text_TALK_A_21

Label_TALK_A_21
TALK_B_21

Alt_text2_TALK_B_21

Alt_Text_TALK_B_21

Label_TALK_B_21

PR.2.0

During the past 12 months, have you talked to an outreach worker, counselor, or
prevention program worker about how to prevent HIV or other STDs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) is Skipped, 8888 (don’t know), or 7777
(refused to answer), then display the text as follows, “During the past 12 months, have you
talked to an outreach worker, counselor, or prevention program worker about how to
prevent HIV or other STDs?"
If POS1S_9 (Date first tested positive for HIV) is less than 12 months from IDATE (Interview
Date calculated or corrected) or POS1S_9M is missing and POS1S_9Y = 1 year from IDATE
(Interview Date calculated or corrected) then display the text as follows, "During the past
12 months, not including when you may have been tested for HIV, have you talked to an
outreach worker, counselor, or prevention program worker about how to prevent HIV or
other STDs?"
Conversation with an outreach worker…

Page | 124

Topic: HIV treatment as prevention (PB)
TASP1N8

PB.1.0.

Label_TASP1N8

Have you heard that if you have an undetectable viral load, you will not pass on HIV to
sexual partners?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware of treatment as prevention

Calculation_ENPREVN5 P.0.a.
Label_Calculation_ENPREVN5

ENPREVN5 = Current time
End of prevention activities

Calculation_TLPREVN5 P.0.b.
Label_Calculation_TLPREVN5

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

Page | 125

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

EN_INTN5 = Current time
End of interview

Calculation_TL_TIMN5 E.0.a.
Label_Calculation_TL_TIMN5

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

Intro_RECCOMP_8

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

RECCOMP
EE.1.0.
Label_RECCOMP
Voxco_noteN22_RECCOMP
Calculation_LANGUAG

EE.2.0.

Label_Calculation_LANGUAG
Calculation_VERSION

EE.3.0.

Label_Calculation_VERSION
Calculation_VERSION

EE.3.0.

Label_Calculation_VERSION

If the English version of the questionnaire is used, then LANGUAG=EN. If the Spanish
version of the questionnaire is used, then LANGUAG=SP.
Language of questionnaire
Calculate questionnaire version number using variable name VERSION. This must be
updated every time a change is made in the application.
Voxco file version
Calculate questionnaire version number using variable name VERSION. This must be
updated every time a change is made in the application.
Voxco file version

Topic: Referrals and follow-up (EO)
If EVERCR_8 (Ever rcvd. HIV care) is 0 (no), go to RFLKPN8 (Passive referral: LTC or reengagement). If LASCA_8 (Date most recent outpt. HIV care visit) is > 12 months prior to
IDATE (Interview Date calculated or corrected), go to RFLKPN8 (Passive referral: LTC or reengagement). Else, skip to PREV_N8 (Offered prevention materials).

Skip_RFLKPN8

RFLKPN8

EO.1.0

[DON'T READ ALOUD] Did you offer the respondent information about a provider or HIV
agency they can go to for HIV medical services or treatment? This includes offering them
written or verbal information such as a contact name, location, phone number, or hours of
operation of a provider or agency.
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Passive referral: LTC or re-engagement

EO.1.1

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

EO.1.2

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

Label_RFLKPN8
RFLKA1N8

Label_RFLKA1N8
RFLKA2N8

Label_RFLKA2N8

Page | 126
PREV_N8

EO.2.0

Label_PREV_N8
Skip_SMOKCEN8

SMOKCEN8

Alt_text_SMOKCESN8

Label_SMOKCEN8

[DON'T READ ALOUD] Did you offer the respondent HIV prevention materials such as palm
cards, pamphlets, or videos?
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Offered prevention materials
If CIG_OFT (Current use cigarettes) is 1 (daily), 2 (weekly), 3 (monthly) or 4 (less than
monthly), go to SMOKCEN8 (Need smoking cessation). If CIGARFN5 (Current use cigars, etc.)
is 1 (every day), 2 (some days) or 3 (rarely), go to SMOKCEN8 (Need smoking cessation).
Else, skip to RFANS_8 (Refs ancillary services).

EO.3.0

Earlier, you said that a healthcare professional has not advised you to quit smoking in the
past 12 months. Would you like any assistance, information, or additional advice to help
you quit smoking?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Tokens are used to alter how this question appears based on the respondent’s answer to
CIG_DQ_8 (Doctor advised to quit smoking). If CIG_DQ_8 (Doctor advised to quit smoking)
is 0 (no), then question should read, “Earlier, you said that a healthcare professional has
not advised you to quit smoking in the past 12 months. Would you like any assistance,
information, or advice to help you quit smoking?” If CIG_DQ_8 (Doctor advised to quit
smoking) is 1 (yes), then question should read, “Earlier, you said that a healthcare
professional advised you to quit smoking in the past 12 months. Would you like any
assistance, information, or additional advice to help you quit smoking?” If CIG_DQ_8
(Doctor advised to quit smoking) is 7 (don’t know) or 8 (Refused), the question should read
“Earlier, we asked you if a healthcare professional has advised you to quit smoking in the
past 12 months. Would you like any assistance, information, or additional advice to help
you quit smoking?”
Need smoking cessation

Page | 127
RFANS_8

EO.4.0

Label_RFANS_8
Voxco_noteN22_RFANSN8

RFANS_8A

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

EO.4.0.

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

EO.4.0.

ADAP
0 No
1 Yes
Refs ancillary services: ADAP

EO.4.0.

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

EO.4.0.

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

Label_RFANS_8B
RFANS_8C

Label_RFANS_8C
RFANS_8D

Label_RFANS_8D
RFANS_8E

Label_RFANS_8E

[Resources previously indicated as needed by the respondent are flagged with an asterisk
(*)]
Refs ancillary services
If CSMNB_5 (Needed HIV case management services) =1 then show asterisk next to
RFANS_8A (Refs ancillary services: HIV case mgmt). If TKMDB_5 (Need help taking meds
on time/correctly) =1 then show asterisk next to RFANS_8B (Refs ancillary services: Adhere
counsel). If NEDADA_5 (Needed ADAP) =1 then show asterisk next to RFANS_8C (Refs
ancillary services: ADAP). If PATNABN5 (Needed patient navigation services) =1 then show
asterisk next to RFANS_8D (Refs ancillary services: Pt navigation). If NED_GRP (Needed
HIV peer group support) =1 then show asterisk next to RFANS_8E (Refs ancillary services:
HIV grp support). If DENSER_9 (Needed dental care) =1 then show asterisk next to RFANS_
8F (Refs ancillary services: Dental). If NED_SUBU (Need drug/alcohol counsel or
treatment) =1 then show asterisk next to RFANS_8G (Refs ancillary services: Drug alcohol
tx). If MENTB_5 (Need mental health counsel or treatment) =1 then show asterisk next to
RFANS_8H (Refs ancillary services: Mental hlth tx). If TRASAS_9 (Needed transportation
assistance)=1 then show asterisk next to RFANS_8I (Refs ancillary services:
Transportation). If SHLTB_5 (Needed shelter or housing services) =1 then show asterisk
next to RFANS_8J (Refs ancillary services: Shltr or house). If FOODB_N5 (Needed food
assistance)=1 then show asterisk next to RFANS_8K (Refs ancillary services: Food assist). If
MLSFOD_9 (Needed meal or food services)=1 then show asterisk next to RFANS_8L (Refs
ancillary services: Meal services). If NED_DOMS (Needed domestic violence services)=1
then show asterisk next to RFANS_8M (Refs ancillary services: Dom violence). If
SMOKCEN8 (Need smoking cessation)=1 then show asterisk next to RFANS_8N (Refs
ancillary services: Smoke cessation). If NEDCONDN21 (Need free condoms)=1 then show
asterisk next to RFANS_N21.

EO.4.0.

Label_RFANS_8A
RFANS_8B

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

Page | 128
RFANS_8F

EO.4.0.

Dental care
0 No
1 Yes
Refs ancillary services: Dental

EO.4.0.

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

EO.4.0.

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

EO.4.0.

Transportation
0 No
1 Yes
Refs ancillary services: Transportation

EO.4.0.

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

EO.4.0.

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

EO.4.0.

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

EO.4.0.

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

EO.4.0.

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

EO.4.0.

Condoms
0 No
1 Yes
Refs ancillary services: Condoms

EO.4.0.

No ancillary resources offered
0 No
1 Yes
Refs ancillary services: none offered

Label_RFANS_8F
RFANS_8G

Label_RFANS_8G
RFANS_8H

Label_RFANS_8H
RFANS_8I

Label_RFANS_8I
RFANS_8J

Label_RFANS_8J
RFANS_8K

Label_RFANS_8K
RFANS_8L

Label_RFANS_8L
RFANS_8M

Label_RFANS_8M
RFANS_8N

Label_RFANS_8N
RFANS_8P

Label_RFANS_8P
RFANS_8Q

Label_RFANS_8Q
Hard_edit_21_RFANS_8Q

Page | 129

Topic: Data validity (EV)
Intro_N8_CONF

CONF

EV.1.0.

Label_CONF
ADDCOM1

EV.2.0.

Label_ADDCOM1
Voxco_note1N22_ADDCOM1
Voxco_note2N22_ADDCOM1

Interviewer instructions [DON'T READ ALOUD]: Don’t pay the respondent if the respondent
already participated in an MMP interview during the [INSERT CYCLE YEAR] data collection
cycle OR the respondent is < 18 years old. Pay the respondent if the interview was partially
or fully completed.
[DON'T READ ALOUD] How confident are you of the validity of the respondent’s answers?
1 Confident
2 Some doubts
3 Not confident at all
Validity confidence
[DON'T READ ALOUD] Record any additional comments, including disruptions that might
have taken place during the interview, reason the interview might have been stopped, or
why the respondent’s answers may not have been reliable.
666 Not Applicable
Additional comments
Include a 6 (not applicable) response option.
Character limit is 250 words.

Topic: Local questions (EL)
LOCSURN6

Label_LOCSURN6

EL.1.0.

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

AI1

2023
Su
1
8
15
22
29

Mo
2
9
16
23
30

January 23
Tu We Th
3 4 5
10 11 12
17 18 19
24 25 26
31

Fr
6
13
20
27

Sa
7
14
21
28

April 23
Su Mo Tu We Th Fr Sa
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30

July 23
Su Mo Tu We Th Fr Sa
1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31

Su
1
8
15
22
29

Mo
2
9
16
23
30

October 23
Tu We Th
3 4 5
10 11 12
17 18 19
24 25 26
31

Fr
6
13
20
27

Sa
7
14
21
28

February 23
Su Mo Tu We Th
1 2
5 6 7 8 9
12 13 14 15 16
19 20 21 22 23
26 27 28

Fr
3
10
17
24

Sa
4
11
18
25

March 23
Su Mo Tu We Th
1 2
5 6 7 8 9
12 13 14 15 16
19 20 21 22 23
26 27 28 29 30

Fr
3
10
17
24
31

Sa
4
11
18
25

June 23
Tu We Th
1
6 7 8
13 14 15
20 21 22
27 28 29

Fr
2
9
16
23
30

Sa
3
10
17
24

May 23
Tu We Th
2 3 4
9 10 11
16 17 18
23 24 25
30 31

Fr
5
12
19
26

Sa
6
13
20
27

August 23
Su Mo Tu We Th
1 2 3
6 7 8 9 10
13 14 15 16 17
20 21 22 23 24
27 28 29 30 31

Fr
4
11
18
25

Sa
5
12
19
26

September 23
Su Mo Tu We Th Fr
1
3 4 5 6 7 8
10 11 12 13 14 15
17 18 19 20 21 22
24 25 26 27 28 29

Sa
2
9
16
23
30

Sa
4
11
18
25

December 23
Mo Tu We Th Fr
1
4 5 6 7 8
11 12 13 14 15
18 19 20 21 22
25 26 27 28 29

Sa
2
9
16
23
30

Su Mo
1
7 8
14 15
21 22
28 29

Su
5
12
19
26

November 23
Mo Tu We Th
1 2
6 7 8 9
13 14 15 16
20 21 22 23
27 28 29 30

Fr
3
10
17
24

Su Mo

4 5
11 12
18 19
25 26

Su
3
10
17
24
31

BI1

2024
January 24
Su Mo Tu We Th
7

4

Fr

Sa

February 24
Su Mo Tu We Th

Fr

Sa

5

6

1

2

3

8

9

10

1

2

3

8

9

10 11 12 13

4

5

6

7

March 24
Su Mo Tu We Th
3

4

5

6

7

Fr

Sa

1

2

8

9

14 15 16 17 18 19 20

11 12 13 14 15 16 17

10 11 12 13 14 15 16

21 22 23 24 25 26 27

18 19 20 21 22 23 24

17 18 19 20 21 22 23

28 29 30 31

25 26 27 28 29

24 25 26 27 28 29 30

31

April 24
Su Mo Tu We Th

Sa

5

6

1

2

3

8

9

10 11 12 13

Fr

Sa
4

June 24
Su Mo Tu We Th

Fr

Sa

1

2

3

8

9

10 11

2

3

14 15 16 17 18 19 20

12 13 14 15 16 17 18

9

10 11 12 13 14 15

21 22 23 24 25 26 27

19 20 21 22 23 24 25

16 17 18 19 20 21 22

28 29 30

26 27 28 29 30 31

23 24 25 26 27 28 29

7

4

Fr

May 24
Su Mo Tu We Th
5

6

7

1
4

5

6

7

8

30

July 24
Su Mo Tu We Th
7

4

Fr

Sa

August 24
Su Mo Tu We Th

5

6

1

2

3

1

2

3

8

9

10

8

9

10 11 12 13 14

1

2

3

8

9

10 11 12 13

4

5

6

7

Fr

Sa

September 24
Su Mo Tu We Th Fr

Sa
7

4

5

6

14 15 16 17 18 19 20

11 12 13 14 15 16 17

15 16 17 18 19 20 21

21 22 23 24 25 26 27

18 19 20 21 22 23 24

22 23 24 25 26 27 28

28 29 30 31

25 26 27 28 29 30 31

29 30

October 24
Su Mo Tu We Th

Fr

Sa

November 24
Su Mo Tu We Th Fr

Sa

December 24
Su Mo Tu We Th Fr

Sa

1

2

3

4

5

1

2

1

2

3

7

8

9

10 11 12

8

9

8

9

10 11 12 13 14

6

7

3

4

5

6

7

4

5

6

13 14 15 16 17 18 19

10 11 12 13 14 15 16

15 16 17 18 19 20 21

20 21 22 23 24 25 26

17 18 19 20 21 22 23

22 23 24 25 26 27 28

27 28 29 30 31

24 25 26 27 28 29 30

29 30 31

CI1

2025
January 25
Su Mo Tu We Th

Fr

Sa
4

February 25
Su Mo Tu We Th

Fr

Sa

March 25
Su Mo Tu We Th

Fr

1

2

3

8

9

10 11

2

3

8

2

3

12 13 14 15 16 17 18

9

10 11 12 13 14 15

9

10 11 12 13 14 15

19 20 21 22 23 24 25

16 17 18 19 20 21 22

16 17 18 19 20 21 22

26 27 28 29 30 31

23 24 25 26 27 28

23 24 25 26 27 28 29

5

6

7

1

Sa

4

5

6

7

1
4

5

6

7

8

30 31

April 25
Su Mo Tu We Th

Fr

1

2

3

4

8

9

10 11 12

6

7

Sa

May 25
Su Mo Tu We Th

Fr

5

1
8

4

5

6

7

Sa

June 25
Su Mo Tu We Th

Fr

Sa

2

3

1

2

3

6

7

9

10

8

9

10 11 12 13 14

4

5

13 14 15 16 17 18 19

11 12 13 14 15 16 17

15 16 17 18 19 20 21

20 21 22 23 24 25 26

18 19 20 21 22 23 24

22 23 24 25 26 27 28

27 28 29 30

25 26 27 28 29 30 31

29 30

July 25
Su Mo Tu We Th

Fr

Sa

August 25
Su Mo Tu We Th

September 25
Su Mo Tu We Th Fr

1

2

3

4

5

8

9

10 11 12

6

7

3

4

5

6

7

Fr

Sa

1

2

8

9

7

4

5

Sa

1

2

3

6

8

9

10 11 12 13

13 14 15 16 17 18 19

10 11 12 13 14 15 16

14 15 16 17 18 19 20

20 21 22 23 24 25 26

17 18 19 20 21 22 23

21 22 23 24 25 26 27

27 28 29 30 31

24 25 26 27 28 29 30

28 29 30

31

October 25
Su Mo Tu We Th

Fr

Sa
4

November 25
Su Mo Tu We Th Fr

Sa

December 25
Su Mo Tu We Th Fr

1

2

3

8

9

10 11

2

3

12 13 14 15 16 17 18

9

10 11 12 13 14 15

14 15 16 17 18 19 20

19 20 21 22 23 24 25

16 17 18 19 20 21 22

21 22 23 24 25 26 27

26 27 28 29 30 31

23 24 25 26 27 28 29

28 29 30 31

5

6

7

1

30

4

5

6

7

8

7

4

5

Sa

1

2

3

6

8

9

10 11 12 13