NonSubstantive Change Request Justification

Non-substantive Change Request

OMB Control Number 0920-1402; Expiration Date 05/31/2027

Surveillance of HIV-Related Service Barriers Among Individuals with Early or Late HIV

Diagnoses (SHIELD)

Date Submitted: 03/12/2025

Summary of request: CDC/NCHHSTP is requesting a change request to revise questions to align with EO 14168 Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.

Description of Changes Requested: This request updates sex questions used in Surveillance of HIV-Related Service Barriers Among Individuals with Early or Late HIV Diagnoses (SHIELD) to be in accordance with EO 14168. Please check the boxes below if your request includes:

☒Revision of an existing question(s)

☒Deletion of an existing question(s)

The requested changes are listed in Table A below and red-lined in Attachment 6A (English survey instrument) and Attachment 6B (Spanish survey instrument).

Description of Changes to Burden (if applicable):

There is no change in Burden Hours associated with the modifications made to comply with EO 14168. Most of the deleted questions are only asked of participants who self-identified as transgender, estimated to be <10% of all respondents. Question revisions are minor and not expected to change burden.

Table A: Description of Changes
Type of Change	Question/Item	Requested Change
Question Revision	What sex were you assigned at birth? 1 Male 2 Female 3 Intersex 99 Prefer not to respond [HIDE IF MODE=WB]	What is your sex, male or female? 1 Male 2 Female 99 Prefer not to respond [HIDE IF MODE=WB]
Question Deletion	How do you describe your current gender identity? 1 Man 2 Woman 3 Transgender man 4 Transgender woman 5 Non-Binary 6 Genderqueer 96 Another gender identity 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]	N/A
Question Deletion	What is the other gender identity?	N/A
Question Revision	How do you describe your sexual orientation? 1 Bisexual 2 Gay or Lesbian 3 Queer 4 Same-gender-loving 5 Straight or heterosexual 96 Another sexual orientation 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]	How do you describe your sexual orientation? 1 Bisexual 2 Gay or Lesbian 3 Straight or heterosexual 96 Another sexual orientation 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]
Question Revision	In the 12 months before your diagnosis, from [HIVDX_M] [HIVDX_Y_M1Y] to [HIVDX_M] [HIVDX_Y], who did you have sex with? 1 Men 2 Women 3 Transgender men 4 Transgender women 95 People with another gender identity 0 I did not have sex with anyone in the 12 months before my diagnosis [EXCLUSIVE] 98 Don’t know [EXCLUSIVE] 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]	In the 12 months before your diagnosis, from [HIVDX_M] [HIVDX_Y_M1Y] to [HIVDX_M] [HIVDX_Y], who did you have sex with? 1 Men 2 Women 0 I did not have sex with anyone in the 12 months before my diagnosis [EXCLUSIVE] 98 Don’t know [EXCLUSIVE] 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]
Question Revision	Did any of these healthcare-related reasons prevent you from getting an HIV test? 1 A healthcare worker did not offer you an HIV test or did not seem knowledgeable about HIV testing 2 A healthcare worker said you did not need an HIV test 3 Not comfortable asking a healthcare worker for an HIV test 4 Had a bad experience with a healthcare worker 5 A healthcare worker might share your information with others 6 A healthcare worker might discriminate against you because of your gender identity or sexual orientation 7 A healthcare worker might discriminate against you because of your race or ethnicity 8 A healthcare worker might share your information with immigration enforcement 9 A healthcare worker might not understand your language or would not be able to provide an interpreter 10 Did not have access to healthcare 94 None of these [EXCLUSIVE] 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]	Did any of these healthcare-related reasons prevent you from getting an HIV test? 1 A healthcare worker did not offer you an HIV test or did not seem knowledgeable about HIV testing 2 A healthcare worker said you did not need an HIV test 3 Not comfortable asking a healthcare worker for an HIV test 4 Had a bad experience with a healthcare worker 5 A healthcare worker might share your information with others 6 A healthcare worker might discriminate against you because of your sex or sexual orientation 7 A healthcare worker might discriminate against you because of your race or ethnicity 8 A healthcare worker might share your information with immigration enforcement 9 A healthcare worker might not understand your language or would not be able to provide an interpreter 10 Did not have access to healthcare 94 None of these [EXCLUSIVE] 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]
Question Revision	Before your diagnosis, which of the following topics did you and a healthcare worker talk about: 1 Sexual history 2 How to prevent HIV or sexually transmitted diseases (STDs) 3 Sexual health for gay, bisexual, or other men who have sex with men 4 Sexual health for transgender or non-binary people 5 Counseling about safer sex practices or reducing number of sex partners 6 Getting tested and knowing your HIV status 7 PrEP or pre-exposure prophylaxis 8 PEP or post-exposure prophylaxis 9 Using alcohol or drugs before or during sex 10 Treatment for drug or alcohol use 11 Safer injection practices 94 None of these [EXCLUSIVE]	Before your diagnosis, which of the following topics did you and a healthcare worker talk about: 1 Sexual history 2 How to prevent HIV or sexually transmitted diseases (STDs) 3 Sexual health for gay, bisexual, or other men who have sex with men 4 Counseling about safer sex practices or reducing number of sex partners 5 Getting tested and knowing your HIV status 6 PrEP or pre-exposure prophylaxis 7 PEP or post-exposure prophylaxis 8 Using alcohol or drugs before or during sex 9 Treatment for drug or alcohol use 10 Safer injection practices 94 None of these [EXCLUSIVE]
Question Deletion	Before your diagnosis, did you share your gender identity with a healthcare worker?  0 No 1 Yes 99 Prefer not to respond [HIDE IF MODE=WB]	N/A
Question Revision	Based on your responses to the last two questions you may have experienced discrimination when getting care. Which of the following do you believe are reasons you may have experienced discrimination? 1 Gender 2 Sexual orientation 3 Race or ethnicity 4 Income or social class 5 Use of drugs 6 Use of alcohol 7 Weight 8 Type of health insurance or because you did not have health insurance 9 Immigration status 10 Disability status 94 None of these [EXCLUSIVE] 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]	Based on your responses to the last two questions you may have experienced discrimination when getting care. Which of the following do you believe are reasons you may have experienced discrimination? 1 Sex 2 Sexual orientation 3 Race or ethnicity 4 Income or social class 5 Use of drugs 6 Use of alcohol 7 Weight 8 Type of health insurance or because you did not have health insurance 9 Immigration status 10 Disability status 94 None of these [EXCLUSIVE] 99 Prefer not to respond [EXCLUSIVE] [HIDE IF MODE=WB]
Question Revision	Most people in [J_INSERT] are accepting of people who are gay or bisexual or same-gender-loving. 1 Strongly disagree 2 Somewhat disagree 3 Neutral 4 Somewhat agree 5 Strongly agree 98 Don’t know 99 Prefer not to respond [HIDE IF MODE=WB]	Most people in [J_INSERT] are accepting of people who are gay or bisexual. 1 Strongly disagree 2 Somewhat disagree 3 Neutral 4 Somewhat agree 5 Strongly agree 98 Don’t know 99 Prefer not to respond [HIDE IF MODE=WB]
Question Deletion	Most people in [J_INSERT] are accepting of people who are transgender or non-binary. 1 Strongly disagree 2 Somewhat disagree 3 Neutral 4 Somewhat agree 5 Strongly agree 98 Don’t know 99 Prefer not to respond [HIDE IF MODE=WB]	N/A
Question Deletion	Before your diagnosis, did you have trouble getting a job or keeping a job because of your gender identity? 0 No 1 Yes 98 Don’t know 99 Prefer not to respond [HIDE IF MODE=WB]	N/A
Question Deletion	Before your diagnosis, were you denied access to bathrooms that matched your gender identity? 0 No 1 Yes 98 Don’t know 99 Prefer not to respond [HIDE IF MODE=WB]	N/A
Question Deletion	Before your diagnosis, were you denied housing or evicted because of your gender identity? 0 No 1 Yes 98 Don’t know 99 Prefer not to respond [HIDE IF MODE=WB]	N/A
Question Deletion	Before your diagnosis, were you denied or given lower quality healthcare because of your gender identity? 0 No 1 Yes 98 Don’t know 99 Prefer not to respond [HIDE IF MODE=WB]	N/A
Question Deletion	Before your diagnosis, did you feel proud of your gender identity? 0 No 1 Yes 99 Prefer not to respond [HIDE IF MODE=WB]	N/A
Question Deletion	Before your diagnosis, were you comfortable sharing your gender identity with others? 0 No 1 Yes 99 Prefer not to respond [HIDE IF MODE=WB]	N/A