ACASI Survey interview

APPENDIX NUMBER 7: ACASI Survey

(administered via computer)

Form Approved

OMB NO. ________

Exp. Date ________

Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXX)

Read: Thank you for taking part in this study about women, their health and their lives. Please listen to each question and all the responses before you choose a response. Some questions may ask you about things that people consider very personal. We would like you to know that anything you tell us in this interview will be kept private at all times. You do not have to answer any question that you do not want to answer.

There are some questions where we ask that you to tell us the number of times a certain thing happened. If you are not sure of the exact number, please give us your best guess.

DEMOGRAPHIC SECTION

RACE, NATIONALITY, and AGE

Read: We would like to begin by asking some questions about your background. When we ask about ethnicity, we mean the culture and ancestry that you share with other people.  Women, whose origins are Cuban, Mexican, Puerto Rican, South American, Central American or some other Spanish-speaking group, are referred to as Hispanics or Latinas.

1. DEM1 How old are you?

age (years) [18-99]

Validation: if age is less than age18 years, skip back to DEM1 and Read: Please enter your age again.

Validation: if age re-entered is less than age 18 years, Read: You must be at least 18 years old to be in this study. Please call the study assistant to help you.

If age is ≥ (greater than or equal to) to age 18, go to DEM2.

2. DEM2 What is your ethnicity? Choose one.

Hispanic or Latina

Not Hispanic or Latina

3. DEM3 What race do you consider yourself to be? Choose all groups that describe your race.

White

Black or African-American

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

If Q2 DEM2 = “not Hispanic or Latina” skip to Q8 DEM8

4. DEM4 What country were you born in?

United States

Mexico

Puerto Rico

Cuba

Another country (name of country __________________)

If Q4 DEM4= United States skip to Q8

5. DEM5 About how old were you when you first moved to the US?

age (years)

A baby (less that 1 year old)

6. DEM6 In what country was your mother born?

United States

Mexico

Puerto Rico

Cuba

Some other country

7. DEM7 In what country was your father born?

United States

Mexico

Puerto Rico

Cuba

Some other country

EDUCATION

8. DEM8 What is the highest grade or year of school you completed?

Never went to school

Dropped out of high school

High school graduate or GED

Technical or Trade school or some college

College graduate

MARITAL STATUS

9. DEM9 What is your current marital status?

Single, never married

Married

Living as married (common law marriage)

Married but separated from husband

Divorced

Widowed

INCOME AND EMPLOYMENT

10. DEM10 During the past 12 months, or since (insert 12 month calculated date), where have you gotten money from? Choose all that apply.

Steady employment with earned pay, either full or part time

Temporary employment (work every now and then or do seasonal work)

Self employed

Unemployment compensation

Odd jobs (babysitting, hair braiding, selling flowers, food or crafts, panhandling, etc.)

Federal or State assistance, welfare, public assistance, disability, etc.

Anything such as sex for money, selling drugs, boosting/shoplifting, selling food stamps, etc.

From your husband

From a sexual partner (but not someone who gives money only for sex)

Other family members or friends

11. DEM11 What is the total monthly income of your household before taxes? By household, we mean the place where you stay most of the time. Before you answer, think of all the ways in which members of your household get money to live on such as jobs, Social Security, help from relatives, and so on.

$ 0 - $250 per month

$ 251 - $500 per month

$501 - 1,000 per month

$1,001 - $2,000 per month

$2,001 - $3,000 per month

Over $3,000 per month

12. DEM12 How many people usually depend on this money, including you?

Number of people

13. DEM13 In the past 30 days, have you been concerned about having enough food for you or your family?

No

Yes

RESIDENCE

14. DEM14 Where are you currently staying or living?

In your own house or apartment

In someone else's house or apartment (family or friend’s home)

In a rooming house, boarding house, or hotel

In a group home with support staff

In a shelter

On the street/homeless/in your car

In residential drug or alcohol treatment facility

If Q14 DEM14= “house or apartment” or “someone else’s house” ask Q15 DEM15 else skip to Q17 DEM17

15. DEM15 How many people currently live with you most of the time? Do not count yourself.

Number of people (range 0-99)

Don’t want to answer

If Q15 DEM15 = “0” skip to Q17 DEM17

16. DEM16 With whom do you currently live? Choose all that apply.

Mother

Father

Siblings

Grandparents

Other relatives

Husband or sexual partner

Your child or children

Roommate(s) or friend(s)

Someone else’s child or children

17. DEM17 What is the zip code where you currently live?

5-digit zip code

DISCRIMINATION

Read: Sometimes people are treated unfairly because of their race or ethnicity. We are going to ask you a few questions about your experiences with this.

DISCR1 In the past 12 months, have you experienced discrimination, been hassled or made to feel inferior because of your race or ethnicity when you were at school?	No Yes
DISCR2 In the past 12 months, have you experienced discrimination, been hassled or made to feel inferior because of your race or ethnicity when you getting a job?	No Yes
DISCR3 In the past 12 months, have you experienced discrimination, been hassled or made to feel inferior because of your race or ethnicity when you were getting housing?	No Yes
DISCR4 In the past 12 months, have you experienced discrimination, been hassled or made to feel inferior because of your race or ethnicity when you were at work?	No Yes
DISCR5 In the past 12 months, have you experienced discrimination, been hassled or made to feel inferior because of your race or ethnicity when you were at home?	No Yes
DISCR6 In the past 12 months, have you experienced discrimination, been hassled or made to feel inferior because of your race or ethnicity when you were getting medical care?	No Yes
DISCR7 In the past 12 months, have you experienced discrimination, been hassled or made to feel inferior because of your race or ethnicity when you were on the street or in a public place.	No Yes

If site= Miami go to instructions before Q25 BICULT1 else skip to Q50 REL1

BICULTURAL INVOLVEMENT SECTION (MIAMI SITE ONLY)

Read: The next questions ask you how you feel and what you enjoy about some parts of your culture. Please choose the response that best describes how you feel.

25. BICULT1 In what language do you speak most of the time? Choose one.

English

Spanish

English and Spanish equally

Other: ____________________ (specify)

A. How comfortable do you feel speaking SPANISH…? (insert stem for each question)

	Not at all				Very Much
BICULT2 At home	1	2	3	4	5
BICULT3 In school	1	2	3	4	5
BICULT4 At work	1	2	3	4	5
BICULT5 With friends	1	2	3	4	5
BICULT6 In general	1	2	3	4	5

B. How comfortable do you feel speaking ENGLISH…? (insert stem for each question)

	Not at all				Very Much
BICULT7 At home	1	2	3	4	5
BICULT8 In school	1	2	3	4	5
BICULT9 At work	1	2	3	4	5
BICULT10 With friends	1	2	3	4	5
BICULT11 In general	1	2	3	4	5

C. How much do you enjoy…? (insert stem for each question)

	Not at all				Very much
BICULT12 Hispanic music	1	2	3	4	5
BICULT13 Hispanic dances	1	2	3	4	5
BICULT14 Hispanic-oriented places	1	2	3	4	5
BICULT15 Hispanic-type recreation	1	2	3	4	5
BICULT16 Hispanic TV programs	1	2	3	4	5
BICULT17 Hispanic radio stations	1	2	3	4	5
BICULT18 Hispanic books and magazines	1	2	3	4	5
BICULT19 American music	1	2	3	4	5
BICULT20 American dances	1	2	3	4	5
BICULT21 American-oriented places	1	2	3	4	5
BICULT22 American-type recreation	1	2	3	4	5
BICULT23 American TV programs	1	2	3	4	5
BICULT24 American radio stations	1	2	3	4	5
BICULT25 American books and magazines	1	2	3	4	5

RELIGION

Read: Now we are going to ask you to tell us about the role religion or spirituality has in your life. Choose the responses that best describe how you feel.

50. REL1 What is your religion at this time?

Baptist

African Methodist Episcopal

Methodist

Pentecostal

Episcopalian

Lutheran

Presbyterian

Catholic

Muslim

Born again Christian

Non-denominational Christian

Jewish

Seventh Day Adventist

Jehovah Witness

Unitarian Universalist

None

Other

RELIGIOSITY

51. REL2 Since (insert 12 month calculated date), how often did you attend religious services (go to church, temple, the mosque, etc.)?

Never

About once or twice per year

About once a month

About every week

Please tell us how these statements describe yourself and your feelings about religion and spirituality. Choose the response that best describes how you feel.

	Strongly Agree	Agree	Disagree	Strongly Disagree
REL3 You often read religious books, magazines, or pamphlets.	1	2	3	4
REL4 You often watch or listen to religious programs on television.	1	2	3	4
REL5 Your spiritual beliefs are the source of your whole approach to life.	1	2	3	4
REL6 You have a personal relationship with God.	1	2	3	4
REL7 You pray or meditate often.	1	2	3	4
REL8 You rely on God to keep you in good health.	1	2	3	4

HEALTH SECTION

GENERAL HEALTH

Read: Now, we are going to ask you some questions about your health.

58. HEALTH1 In general, would you say your health is…

Excellent

Very good

Good

Fair

Poor

PREGNANCY

59. GYN1 Have you ever been pregnant?

No

Yes

If Q 59 GYN1 = no, skip to Q65 GYN7, else ask Q60 GYN2

60. GYN2 About how old were you when you became pregnant the first time?

age (years) [range: ≥ (greater than or equal to) age 7 years]

Validation: if number is less than age 7, Read: “That number is too small. Please try again.” Allow participant to correct answer.

61. GYN3 Are you currently pregnant?

No

Yes

62. GYN4 How many living children who are 18 years old or younger do you have?

(Range: 0-99)

If Q62 GYN4= “0” skip to Q64 GYN6 else ask Q63 GYN5

63. GYN5 How many of these (ACASI inserts # of children from Q62 GYN4) children, 18 years of age or younger, live with you most of the time?

Validation: GYN5 cannot be greater than GYN4

If GYN5 is greater than GYN4, Read: The number of children 18 years or younger who are living with you is more than the number of children 18 years old or younger you said that you have. Please try again. You can change the number of children for either answer.

Re-ask:GYN4 and GYN5 again…validate numbers (GYN5 cannot be greater than GYN4). If numbers are valid, skip to GYN6.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

64. GYN6 How many different men fathered your children? Please think of all your children, not just those 18 years old or younger.

(Range: 0-99)

65. GYN7 What birth control methods have you used in the past 12 months, or since (computer inserts 12 month date calculation)? Choose all that apply. SHOW PICTURES

The Pill (Birth control pills)

The Shot (Depo-Provera)

Nor-Plant

The Patch

The Ring (hormone ring used inside the vagina)

Condoms

Diaphragm, the Sponge or a cervical cap

IUD

Morning After Pill (Plan B)

Spermicides (foam, gel, cream, suppositories)

Your tubes are tied (tubal ligation)

Rhythm method or natural family planning

Your partner had a vasectomy

No birth control

66. GYN8 In the past 12 months or since (computer inserts 12 month date calculation), did you have vaginal (or regular) sex where the man pulls out before he ejaculates or cums?

No

Yes

67. GYN9 Have you ever used a female condom? (Show picture)

No

Yes

If Q67 GYN9 = “no” skip to statement before Q69 STD1, else ask Q68 GYN10

68. GYN10 In the past 12 months or since (computer inserts 12 month date calculation), how often did you use a female condom when you had sex?

Less than half of the time

Half of the time

Most of the time

All of the time

Never in the past 12 months.

WOMEN’S HEALTH

Read: Now, we are going to ask you a few questions about some infections that women can get from having sex. These infections are called STDs.

69. STD1 Have you ever had any of these STDs in your lifetime? Choose all that apply.

The Clap, also called gonorrhea or GC

Chlamydia

Syphilis

Trich or trichomonas

Genital herpes

Genital warts or HPV

BV, also called bacterial vaginosis or gardnerella

PID or pelvic inflammatory disease

Hepatitis B or C

Chancroid

You have never had any of these infections

Yes, but you don’t remember which one(s).

If Q69 STD1 = “you have never had any of these infections” or Q69 STD1= “yes, but you don’t know which one” skip to statement before Q86 TEST1

IF Q69 STD1 = or “don’t want to answer” skip to Q69a STD1a

69a. STD1a Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

If Q69a STD1a = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q69. STD1

If Q69a STD1a = “no” or “don’t want to answer” skip to statement before Q86 TEST1

If Q69 STD1= Gonorrhea ask Q70 STD2 else skip to instructions before Q72 STD4

70. STD2 Have you had the Clap or Gonorrhea in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q70 STD2 = “no” skip to instructions before Q72 STD4

71. STD3 About how many times have you had the Clap or Gonorrhea since (insert 12 month calculated date)?

Once

2 to 3 times

4 or more times

If Q69 STD1 = Chlamydia ask Q72 STD4 else skip to instructions before Q74 STD6

72. STD4 Have you had Chlamydia in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q72 STD4= “no” skip to instructions before Q74 STD6

73. STD5 About how many times have you had Chlamydia since (insert 12 month calculated date)?

Once

2 to 3 times

4 or more times

If Q69 STD1= Syphilis ask Q74 STD6 else skip to instructions before Q76 STD8

74. STD6 Have you had Syphilis in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q74 STD6 = “no” skip to instructions before Q76 STD8

75. STD7 About how many times have you had Syphilis since (insert 12 month calculated date)?

Once

2 to 3 times

4 or more times

If Q69 STD1= Trich ask Q76 STD8 else skip to instructions before Q78 STD10

76. STD8 Have you had Trich or Trichomonas in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q76 STD8 = “no” skip to instructions before Q78 STD10

77. STD9 About how many times have you had Trich or Trichomonas since (insert 12 month calculated date)?

Once

2 to 3 times

4 or more times

If Q69 STD1= Genital Herpes ask Q78 STD10 else skip to instructions before Q79 STD11

78. STD10 Have you had any outbreaks of genital herpes in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q69 STD1 = HPV ask Q79 STD11 else skip to instructions before Q80 STD12

79. STD11 Were you diagnosed with genital warts or HPV in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q69 STD1 = Bacterial Vaginosis ask Q80 STD12 else skip to instructions before Q82 STD14

80. STD12 Have you had BV or bacterial vaginosis in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q80 STD12= “no” skip to instructions before Q82 STD14

81. STD13 About how many times have you had BV or bacterial vaginosis since (insert 12 month calculated date)?

Once

2 to 3 times

4 or more times

If Q69 STD1= Pelvic Inflammatory Disease ask Q82 STD14 else skip to instructions before Q84 STD16

82. STD14 Have you had PID or pelvic inflammatory disease in the past 12 months or since (insert 12 month calculated date)?

No

Yes

If Q82 STD14 = “no” skip to instructions before Q84 STD16

83. STD15 About how many times have you had PID or pelvic inflammatory disease since (insert 12 month calculated date)?

Once

2 to 3 times

4 or more times

If Q69 STD1= Hepatitis B or C ask Q84 STD16 else skip to Q85 STD17

84. STD16 Were you diagnosed with Hepatitis B or C in the past 12 months or since (insert 12 month calculated date)?

No

Yes

Don’t want to answer

If Q69 STD1 = Chancroid ask Q85 STD17 else skip to statement before Q86 TEST1

85. STD17 Have you had a Chancroid infection in the past 12 months or since (insert 12 month calculated date)?

No

Yes

Don’t want to answer

HIV TESTING QUESTIONS

Read: The next questions are about getting tested for HIV. HIV is the virus that causes AIDS.

86. TEST1 Have you ever been tested for HIV before today?

No

Yes

If Q86 TEST1 = no skip to Q89 TEST4

If Q86 TEST1= don’t want to answer…ask Q86a TEST1a

If Q86 TEST1 = yes skip to Q87 TEST2

86a. TEST1a Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

If Q86a TEST1a = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q86. TEST1

If Q86a TEST1a= “no” or “don’t want to answer” skip to Q89 TEST4

87. TEST2 How many times had you been tested for HIV before today?

One time

2-3 times

More than 3 times

88. TEST3 When was the last time you got tested for HIV?

Month

Year (range: 1982 –today’s date)

89. TEST4 What is your current HIV status?

You have HIV, also called being “Positive”

You don’t have HIV, also called being “Negative”

You don’t know, you never got tested for HIV

You don’t know, you got tested for HIV but you never got your test results

If Q89 TEST4= HIV positive skip to statement before Q92 MH1

If Q89 TEST4 = HIV negative skip to Q90 TEST5

If Q89 TEST4 = you never got tested skip to Q91 TEST6

If Q89 TEST4= “don’t want to answer skip to Q89a TEST4a

89a. TEST4a Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

If Q89a TEST4a= Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q89. TEST4

If Q89a TEST4a = “no” or “don’t want to answer” skip to statement before Q92 MH1

90. TEST5 How did you find out you do not have HIV or are “Negative”?

You got tested and they told you that you did not have HIV

You got tested and they did not call you back so you don’t have HIV

You got tested but did not go back for your results because you know that you do not have HIV

You never got tested but you know you do not have HIV

If Q90 TEST5 = tested and told did not have HIV skip to statement before Q92 MH1

If Q90 TEST5 = got tested but didn’t get called back OR didn’t get results skip to statement before Q92 MH1

If Q90 TEST5= never got tested ask Q91 TEST6

91. TEST6 Why haven’t you gotten tested for HIV before today? Choose all that apply.

You didn’t think you were at risk for HIV infection

You didn’t know where to go to be tested

You didn’t have money to pay for the HIV test

You were afraid to get tested for HIV

You were afraid someone you knew might find out you were getting tested

You didn’t think you needed to get tested because you know you don’t have HIV

MENTAL HEALTH SECTION

Read: We have asked you to tell us about your physical health. Now we will ask a few questions about your mental or emotional health. Please choose the answer that best describes how you felt in the past week.

92. MH1 During the past week, you were bothered by things that usually don’t bother you.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

93. MH2 During the past week, you had trouble keeping your mind on what you were doing.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

94. MH3 During the past week, you felt depressed.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

95. MH4 During the past week, you felt that everything you did was an effort.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

96. MH5 During the past week, you felt hopeful about the future.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

97. MH6 During the past week, you felt fearful.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

98. MH7 During the past week, your sleep was restless.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

99. MH8 During the past week, you were happy.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

100. MH9 During the past week, you felt lonely.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

101. MH10 During the past week, you could not get going.

Rarely or none of the time (less than 1 day)

Some or a little of the time (1-2 days)

Occasionally or a moderate amount of time (3-4 days)

All of the time (5-7 days)

102. MH11 Thinking back over the past 12 months, did you get professional help for a mental health or emotional problem? Do not include help from a friend or family member.

No

Yes

After Q102 MH11 read: Thank you for answering these questions about how you feel. At the end of this survey, the study assistant who has been working with you will help you contact someone you can talk to if you would like help with emotional or mental health problems.

ALCOHOL USE

Read: We are going to ask you to tell us about your drinking habits. By “a drink” we mean drinks with alcohol in them like, a can of beer, a glass of wine, a mixed drink or a shot of liquor.

103. ETOH1 In the past 30 days, how many days did you drink any alcohol?

Every day

At least 3 days each week

1 or 2 days each week

Once a week

Once in the past 30 days

I didn’t drink any alcohol at all

If Q103 ETOH1 = “I didn’t drink any alcohol at all” skip to Q105 ETOH3

104. ETOH2 In the past 30 days, how many days did you drink five or more alcoholic drinks in a single day?

None

Only 1 day

2 to 3 days

4 to 6 days

7 to 10 days

More than 10 days

105. ETOH3 In the past 12 months or since (insert calculated date), which of these treatments for alcohol use, if any, have you received? Choose all that apply.

Support group like AA (Alcoholics Anonymous)

Inpatient alcohol or drug use treatment including detox

Living in a halfway house

Outpatient treatment

No treatment for alcohol use

ILLICIT DRUG USE

Read: Now we are going to ask you some questions about recreational or street drugs that you may have used. We mean drugs that were not prescribed for you. Please don’t tell us about drugs you may have injected or shot up in this set of questions. We will ask you about injected drugs later.

106. DRUG1 Which of these drugs, if any, have you sniffed, swallowed or smoked at any time in your life? Choose all that apply.

Marijuana (pot, weed)

Crack or rock cocaine (rock)

Powder cocaine (blow or nose candy)

Heroin (smack or junk)

Methamphetamine or speed (Cristy, Crank, Tina, crystal meth or ice)

Club drugs (Ecstasy, XTC, GHB, Roofies, Special K, etc.)

Narcotics (Oxycontin, Vicodin, Dilaudid)

Downers (Ativan, Valium, Xanax)

You never sniffed, swallowed or smoked any of these drugs

If Q106 DRUG1 = “you never used any drugs like these” skip to Marker A

If Q106 DRUG1= “don’t want to answer ask Q106a. DRUG1a

If Q106 DRUG1= Marijuana ask Q107 DRUG2 else skip to instructions before Q109 DRUG4

106a. DRUG1a Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q106a DRUG1a = “Yes” read “Thank you for agreeing to reconsider answering that question” and skip back to Q106. DRUG1

If Q106a DRUG1a = “no” or “don’t want to answer” skip to Marker A

107. DRUG2 Have you smoked marijuana in the past 12 months or since (insert calculated date)?

No

Yes

If Q107 DRUG2= no skip to instructions before Q109 DRUG4

108. DRUG3 How often in the past 30 days did you smoke marijuana?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q106 DRUG1 = Crack ask Q109 DRUG4 else skip to instructions before Q111 DRUG6

109. DRUG4 Have you smoked crack in the past 12 months or since (insert calculated date)?

No

Yes

If Q109 DRUG4= no skip to instructions before Q111 DRUG6

110. DRUG5 How often in the past 30 days did you smoke crack?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q106 DRUG1= Cocaine ask Q111 DRUG6 else skip to instructions before Q113 DRUG8

111. DRUG6 Have you sniffed or snorted cocaine in the past 12 months or since (insert calculated date)?

No

Yes

If Q111 DRUG6= no skip to instructions before Q113 DRUG8

112. DRUG7 How often in the past 30 days did you sniff or snort cocaine?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q106 DRUG1= Heroin ask Q113 DRUG8 else skip to instructions before Q115 DRUG10

113. DRUG8 Have you sniffed or snorted heroin in the past 12 months or since (insert calculated date)?

No

Yes

If Q113 DRUG8 = no skip to instructions before Q115 DRUG10

114. DRUG9 How often in the past 30 days did you sniff or snort heroin?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q106 DRUG1 = Meth or speed ask Q115 DRUG10 else skip to instructions before Q117 DRUG12

115. DRUG10 Have you snorted or swallowed meth or speed in the past 12 months or since (insert calculated date)?

No

Yes

If Q115 DRUG10= no skip to instructions before Q117 DRUG12

116. DRUG11 How often in the past 30 days did you snort or swallow meth or speed?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q106 DRUG1 = Club drug ask Q117 DRUG12 else skip to instructions before Q119 DRUG14

117. DRUG12 Have you used or been given a club drug in the past 12 months or since (insert calculated date)? Again, club drugs include Ecstasy, XTC, GHB, Roofies, Special K, etc.

No

Yes

Don’t know

If Q117 DRUG12= “no” or “don’t know” no skip to instructions before Q119 DRUG14

118. DRUG13 How often in the past 30 days did you use or someone give you a club drug?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q106 DRUG1 = Narcotics ask Q119 DRUG14 else skip to Q121 DRUG16

119. DRUG14 Have you used narcotics (like Oxycontin, Vicodin, Dilaudid) in the past 12 months or since (insert calculated date)?

No

Yes

If Q119 DRUG14= “no” skip to Q121 DRUG16

120. DRUG15 How often in the past 30 days did you use narcotics (like Oxycontin, Vicodin, Dilaudid)?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q106 DRUG1 = downers ask Q121 DRUG16 else skip to Marker A

121. DRUG16 Have you used downers (like Ativan, Valium, Xanax) in the past 12 months or since (insert calculated date)?

No

Yes

If Q121 DRUG16= “no” skip to Marker A

122. DRUG17 How often in the past 30 days did you use downers (like Ativan, Valium, Xanax)?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

*****************************Marker A***********************************

INJECTION DRUG USE

Read: The next questions ask you about recreational or street drugs that you may have injected or shot up that were not prescribed for you by a doctor.

123. IDU1 Which of these drugs, if any, have you injected or shot up at any time in your life? Choose all that apply.

Cocaine by itself

Heroin by itself

Heroin and cocaine together (Speedballl)

Methamphetamine by itself (Crystal Meth or Speed)

Heroin and amphetamines together (Goofball)

Street methadone

You never used any of these drugs

If Q123 IDU1 =”never used any of these drugs” skip to Marker B

If Q123 IDU1 = “don’t want to answer” ask Q123a IDU1a

If Q123 IDU1 = Cocaine by itself ask Q124 IDU2 else skip to instructions before Q126 IDU4

123a. IDU1a Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q123a IDU1a = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q123. IDU1

If Q123a IDU1a = “no” or “don’t want to answer” skip to Marker B

124. IDU2 Have you shot up cocaine by itself in the past 12 months or since (insert calculated date)?

No

Yes

If Q124 IDU2= no skip to instructions before Q126 IDU4

125. IDU3 How often in the past 30 days did you shoot up cocaine by itself?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q123 IDU1 = Heroin by itself ask Q126 IDU4 else skip to instructions before Q128 IDU6

126. IDU4 Have you shot up heroin by itself in the past 12 months or since (insert calculated date)?

No

Yes

If Q126 IDU4= no skip to instructions before Q128 IDU6

127. IDU5 How often in the past 30 days did you shoot up heroin by itself?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q123 IDU1 = Heroin and cocaine together ask Q128 IDU6 else skip to instructions before Q130 IDU8

128. IDU6 Have you shot up heroin and cocaine (Speedball) together in the past 12 months or since (insert calculated date)?

No

Yes

If Q128 IDU6 = no skip to instructions before Q130 IDU8

129. IDU7 How often in the past 30 days did you shoot up heroin and cocaine (Speedball) together?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q123 IDU1 = methamphetamine by itself ask Q130 IDU8 else skip to instructions before Q132 IDU10

130. IDU8 Have you shot up methamphetamine (Crystal Meth or Speed) by itself in the past 12 months or since (insert calculated date)?

No

Yes

If Q130 IDU8 = no skip to instructions before Q132 IDU10

131. IDU9 How often in the past 30 days did you shoot up methamphetamine (Crystal Meth or Speed) by itself?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q123 IDU1 = heroin and amphetamines together ask Q132 IDU10 else skip to instructions before Q134 IDU12

132. IDU10 Have you shot up heroin and amphetamines (Goofball) together in the past 12 months or since (insert calculated date)?

No

Yes

If Q132 IDU10= no skip to instructions before Q134 IDU12

133. IDU11 How often in the past 30 days did you shoot up heroin and amphetamines (Goofball) together?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q123 IDU1 = street methadone ask Q134 IDU12 else skip to instructions before Q136 IDU14

134. IDU12 Have you shot up street methadone in the past 12 months or since (insert calculated date)?

No

Yes

If Q134 IDU12= no skip to instructions before Q136 IDU14

135. IDU13 How often in the past 30 days did you shoot up street methadone?

Not at all

Only 1 day

2 to 3 days

4 to 10 days

More than 10 days

If Q124 IDU2 or Q126 IDU4 or Q128 IDU6 or Q130 IDU8 or Q132 IDU10 or Q134 IDU12 = “yes” ask Q136 IDU14 and Q137 IDU15 else skip to Marker B

136. IDU14 In the past 12 months, or since (insert 12 month calculated date), did you use anyone else’s needle or works to shoot up after they had used them? Check all the things you used after someone else had used them.

Needle

Syringe

Cooker

Cotton

Rinse water

You didn’t use a needle, syringe or works after someone else used it in the past 12 months

137. IDU15 In the past 12 months, or since (insert 12 month calculated date), which of these things, if any, did someone else use to shoot up after you had already used it? Choose all that apply.

Needle

Syringe

Cooker

Cotton

Rinse water

You never shared a needle, syringe or works after you used it in the past 12 months

*********************************************Marker B*****************************************

INCARCERATION

Read: Sometimes people have legal trouble and have to spend some time in jail or prison. The next two questions ask about this.

138. INCAR1 What is the single longest amount of time, if any, that you were locked up in jail? Do not include time you were in prison.

Never

Days (range: 1-31 days)

Months (range: 1-99 months)

Years (range: 1-99 years)

Validation: If number of days entered is greater than 31, READ: “The number of days you entered is too big. Please use the month or year response choices to answer this question if you were in jail longer than 31 days.” (permit entries for all fields).

Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

139. INCAR2 What is the single longest amount of time, if any, that you were locked up in prison?

Never

Days (range: 1-31 days)

Months (range: 1-99 months)

Years (range: 1-99 years)

Validation: If number of days entered is greater than 31, READ: “The number of days you entered is too big. Please use the month or year response choices to answer this question if you were in jail longer than 31 days.” (permit entries for all fields)

Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

SEXUAL RISK SECTION

Read: Now we are going to ask you some questions about your past sexual experiences. When we ask you about sex, we mean either vaginal sex, where a man puts his penis in a woman’s vagina, or anal sex, where a man puts his penis in a woman’s anus or butt.

SEXUAL HISTORY

140. SEXHIS1 About how old were you the very first time you had sex?

age (years) (range: 1-99)

141. SEXHIS2 About how old was the first boy or man that you had sex with?

age (years) (range: 1-99)

Don’t know

142. SEXHIS3 Starting with the first boy or man, about how many different men have you had sex with in your lifetime, even if it was just one time? If you can’t remember, enter your best guess.

(range 1-9999)

If Q142 SEXHIS3 = “don’t want to answer” ask Q142a SEXHIS3a else skip to Q143 SEXHIS4

142a. SEXHIS3a Your answer to this question will help you answer a question later and is very important to our study. Would you reconsider answering that question?

No

Yes

If Q142a SEXHIS3a = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q142. SEXHIS3

If Q142a SEXHIS3a = “no” or “don’t want to answer” skip to Q143 SEXHIS4

143. SEXHIS4 Has anyone ever pressured you or tricked you into having sex with them?

No

Yes

If Q143 SEXHIS4 =” no” or “don’t want to answer” skip to Q145. SEXHIS6

144. SEXHIS5 About how old were you when this first happened?

age (years) (range: 1-99)

145. SEXHIS6 Has anyone physically stronger than you ever forced you to have sexual contact with them when you didn’t want it? You can define sexual contact in any way you want.

No

Yes

If Q145 SEXHIS6 = “no” or “don’t want to answer” skip to Q147. SEXHIS8

146. SEXHIS7 About how old were you when this first happened?

age (years) (range: 1-99)

147. SEXHIS8 Has a man you were having sex with ever slapped, kicked, bit or hit you with a fist or another object, beaten you up, threatened you with a knife or a gun, stabbed or shot you? We don’t mean just during sex but at any time at all.

No

Yes

If Q147 SEXHIS8 = no skip to statement before Q149 SEXHIS10

148. SEXHIS9 Have any of these things happened to you since (insert 12 month date calculation)?

No

Yes

We appreciate your responses to these sensitive questions. At the end of this survey, the study assistant who has been working with you will give you information and help you contact someone you can talk to if you want to. Next, we will ask you some more questions about having sex.

149. SEXHIS10 Have you ever had to have sex in exchange for things that you needed? If so, check those things from the list below.

Drugs or alcohol

A place to stay

Food

Gifts (clothing, jewelry, beauty supplies, etc.)

Money for you

Money for someone else (like a pimp)

You’ve never had sex to get any of these things

For the next few questions, we want you to think about the last 12 months only.

150. SEXHIS11 Is there a man that you have not had sex with in the past 12 months because he is in jail or prison, but you plan to be with him when he returns? 

No

Yes

151. SEXHIS12 Earlier, you said you had vaginal or anal sex with (ACASI inserts # from Q142SEXHIS3) men in your lifetime. About how many different men have you had sex with since (insert 12 month calculated date) even if it was only once? If you can’t remember, just enter your best guess.

(range: 0- 9999, using validation below)

If Q151 SEXHIS12 = “don’t want to answer” ask Q151a SEXHIS12a

Validation: Q151 SEXHIS12 cannot be greater than Q142 SEXHIS3 and cannot = 0

If Q151 SEXHIS12 is greater than Q142 SEXHIS3 , Read: The number of men you said you had sex with in the past 12 months is more than the number of your lifetime sex partners. Please try again. You can change the number of partners for either answer.

Re-ask: Q142 SEXHIS3 then skip to Q151 SEXHIS12 again…revalidate numbers (Q151 SEXHIS12 cannot be greater than Q142 SEXHIS3). If numbers are valid, skip to Q152 SEXHIS13.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

IF SEXHIS12 =0, skip to SEXHIS12b

Note: Validation is not possible if Q142 SEXHIS3= “don’t want to answer”.

151a. SEXHIS12a Your answer to this question will help you answer the next few questions and is very important to our study. Would you reconsider answering that question?

No

Yes

If Q151a SEXHIS12a = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q 151. SEXHIS12

If Q151a SEXHIS12a = “no” or “don’t want to answer” skip to 152 SEXHIS13

151b. SEXHIS12b Your said that you have not had vaginal or anal sex with a man in the past 12 months. Is this correct?

No

Yes

SEXHIS12b = Yes, Read “You seem to be having trouble with this question. Please call the study assistant working with you for help.” 

If Q151b SEXHIS12b = “no” re-ask SEXHIS12. IF on re-ask, answer is "zero" READ: “You seem to be having trouble with this question. Please call the study assistant working with you for help.” 

152. SEXHIS13 Do you know or suspect that any of the men you had sex with (insert 12 month calculated date) had done any of these things during this time period? Choose all that apply.

Shot up drugs

Smoked crack

Snorted cocaine or heroin

Used Crystal Meth or speed

Had sex with other men

Paid for or traded sex for drugs, money or a place to stay

Had sex with other women during the time period you were having a sexual relationship with him

Had an STD like Syphilis, Gonorrhea, genital warts or Herpes

Spent more than 24 hours in jail or prison

None of your sex partners did any of these things in the past 12 months

If Q152 SEXHIS13= “don’t want to answer” ask Q152a SEXHIS13a else skip to Q153 SEXHIS14

152a. SEXHIS13a Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

If Q152a SEXHIS13a = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q152. SEXHIS13

If Q152a SEXHIS13a = “no” or “don’t want to answer” skip to153 SEXHIS14

153. SEXHIS14 Do you know or suspect that any of the men you have had sex with since (insert 12 month calculated date) were HIV positive?

No

Yes

If Q153 SEXHIS14 = “don’t want to answer” ask Q153a SEXHIS14a else skip to statement before Q154 SEXREC1

153a. SEXHIS14a Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

If Q153a SEXHIS14a= Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q153. SEXHIS14

If Q153a SEXHIS14a= “no” or “don’t want to answer” skip to statement before Q154 SEXREC1

RECENT SEXUAL RISK ACTIVITY

Read: The next questions ask about men you have had sex with in the past 3 months or since (insert 3 month calculated date). Please include men that you might have had sex with only once.

154. SEXREC1 In the past 3 months, how many different men
     have you had vaginal or anal sex with?

(range: 0- 9999, using validation below)

Validation: SEXREC1 cannot be greater than SEXHIS12

If SEXREC1 is greater than SEXHIS12 , Read: The number of men you said you had sex with in the past 3 months is more than the number of your sex partners in the past year. Please try again. You can change the number of partners for either answer.

Re-ask: SEXHIS12 then skip to SEXREC1 again…revalidate numbers (SEXREC1 cannot be greater than SEXHIS12). If numbers are valid, skip to SEXREC2.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

Note: Validation is not possible if SEXHIS12= “don’t want to answer”.

If Q154 SEXREC1= “1” skip to Q158 SEXREC5

If Q154 SEXREC1= “0” skip to statement before Q175 SEXCON1

If Q154 SEXREC1= “don’t want to answer” ask Q154a SEXREC1a

Else ask Q155 SEXREC2, Q156 SEXREC3, Q157 SEXREC4 and then skip to instructions before Q163 SEXREC10 (do not ask Q158-Q162 SEXREC5- SEXREC9)

154a. SEXREC1a Your answer to this question will help you answer the next few questions and is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q154a SEXREC1a = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q154. SEXREC1

If Q154a SEXREC1a= “no” or “don’t want to answer” skip to Q155 SEXREC2

155. SEXREC2 How many of the [ACASI INSERTS NUMBER FROM Q154 SEXREC1] men you had sex with in the past 3 months did you know were HIV-positive?

(range: 0- 9999, using validation following SEXREC4)

156. SEXREC3 How many of the [ACASI INSERTS NUMBER FROM Q154] SEXREC1 men you had sex in the past 3 months did you know were HIV-negative?

(range: 0- 9999, using validation following SEXREC4)

157. SEXREC4 How many of the [ACASI INSERTS NUMBER FROM Q154 SEXREC1] men you had sex with in the past 3 months were you not sure about of their HIV status?

(range: 0- 9999, using validation following SEXREC4)

Validate: Q155 SEXREC2 +Q156 SEXREC3 +Q157 SEXREC4 = Q154 SEXREC1. If totals are valid skip to instructions before Q163 SEXREC10

If : Q155 SEXREC2 +Q156 SEXREC3 +Q157 SEXREC4 do not = Q154 SEXREC1, Read: The number of men you had sex with in the past 3 months who were HIV-positive, HIV-negative or men you weren’t sure about doesn’t match the total number of sex partners you had in the past 3 months. Please try again. You can change the number of partners for any of your answers.

Re-ask: Q154 SEXREC1 through Q157 SEXREC4 again according to skip logic for Q154 SEXREC1…revalidate numbers: (Q155 SEXREC2 +Q156 SEXREC3 +Q157 SEXREC4 = Q154 SEXREC1). If numbers are valid, skip to statement before Q163. SEXREC10

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

Note: Validation is not possible if Q154 SEXREC1= “don’t want to answer”.

SEXUAL RISK ACTIVITY: ONLY ONE MALE SEX PARTNER

158. SEXREC5 What is his HIV status?

He is HIV-positive

He is HIV-negative

You don’t know his HIV status for sure

159. SEXREC6 Did you have vaginal sex with him in the past 3 months or since (ACASI inserts 3 month date calculation)?

No

Yes

If Q159 SEXREC6= “no” or don’t want to answer” skip to Q161 SEXREC8

160. SEXREC7 Did you have vaginal sex with him since (ACASI inserts 3 month date calculation) and not use condoms?

No

Yes

161. SEXREC8 Did you have anal sex with him since (ACASI inserts 3 month date calculation)?

No

Yes

If Q161 SEXREC8 = “no” or “Don’t want to answer” skip to statement before Q175 SEXCON1

162. SEXREC9 Did you have anal sex with him since (ACASI inserts 3 month date calculation) and not use condoms?

No

Yes

Skip to statement before Q175 SEXCON1

SEXUAL RISK ACTIVITY: MULTIPLE MALE SEX PARTNERS

SEXUAL RISK ACTIVITY: HIV POSITIVE MALE SEX PARTNERS

If Q155 =0 SEXREC2 skip to instructions before Q167 SEXREC14 (HIV Negative Male Sex Partners).

Read: The next questions are about the HIV positive men you had sex with in the past 3 months. You said you had sex with [ACASI INSERTS NUMBER FROM Q155 SEXREC2] HIV positive men since (ACASI inserts 3 month calculated date).

163. SEXREC10 How many of these [ACASI INSERTS NUMBER FROM Q155 SEXREC2] HIV-positive men did you have vaginal sex with?

(range: 0- 9999, using validation below)

Q163 SEXREC10 cannot be greater than Q155 SEXREC2

If Q163 SEXREC10 is greater than Q155 SEXREC2, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

164. SEXREC11 With how many of these [ACASI INSERTS NUMBER FROM Q163 SEXREC10] HIV-positive men did you have vaginal sex without using a condom?

(range: 0- 9999, using validation below)

Q164 SEXREC11 cannot be greater than Q163 SEXREC10

If Q164 SEXREC11 is greater than Q163 SEXREC10, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

165. SEXREC12 How many of these [ACASI INSERTS NUMBER FROM Q155 SEXREC2] HIV-positive men did you have anal sex with?

(range: 0- 9999, using validation below)

Q165 SEXREC12 cannot be greater than Q155 SEXREC2

If Q165 SEXREC12 is greater than Q155 SEXREC2, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

166. SEXREC13 With how many of these [ACASI INSERTS NUMBER FROM Q165 SEXREC12] HIV-positive men did you have anal sex without using a condom?

(range: 0- 9999, using validation below)

Q166 SEXREC13 cannot be greater than Q165 SEXREC12

If Q166 SEXREC13 is greater than Q165 SEXREC12, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

SEXUAL RISK ACTIVITY: HIV NEGATIVE MALE SEX PARTNERS

If Q156 =0 SEXREC3 skip to instructions before Q171 SEXREC18 (HIV Status Unknown Male Sex Partners).

Read: The next questions are about the HIV negative men you had sex with in the past 3 months. You said you had sex with [ACASI INSERTS NUMBER FROM Q156 SEXREC3] HIV negative men since (ACASI inserts 3 month calculated date).

167. SEXREC14 How many of these [ACASI INSERTS NUMBER FROM Q156 SEXREC3] HIV-negative men did you have vaginal sex with?

(range: 0- 9999, using validation below)

Q167 SEXREC14 cannot be greater than Q156 SEXREC3

If Q167 SEXREC14 is greater than Q156 SEXREC3, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

168. SEXREC15 With how many of these [ACASI INSERTS NUMBER FROM Q167 SEXREC14] HIV-negative men did you have vaginal sex without using a condom?

(range: 0- 9999, using validation below)

Q168 SEXREC15 cannot be greater than Q167 SEXREC14

If Q168 SEXREC15 is greater than Q167 SEXREC14, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

169. SEXREC16 How many of these [ACASI INSERTS NUMBER FROM Q156 SEXREC3] HIV-negative men did you have anal sex with?

(range: 0- 9999, using validation below)

Q169 SEXREC16 cannot be greater than Q156 SEXREC3

If Q169 SEXREC16 is greater than Q156 SEXREC3, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

170. SEXREC17 With how many of these [ACASI INSERTS NUMBER FROM Q169 SEXREC16] HIV-negative men, did you have anal sex without using a condom?

(range: 0- 9999, using validation below)

Q170 SEXREC17 cannot be greater than Q169 SEXREC16
If Q170 SEXREC17 is greater than Q169 SEXREC16, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

SEXUAL RISK ACTIVITY: HIV STATUS UNKNOWN MALE SEX

If Q157 SEXREC4= 0 skip to statement before Q175 SEXCON1 (Sexual Mixing and Concurrency)

Read: These questions are about the men you had sex with in the past 3 months whose HIV status you are not sure about. We will call them HIV unknown men to make it easier to ask you questions about these men. You said you had sex with [ACASI INSERTS NUMBER FROM Q157 SEXREC4] HIV unknown men since (ACASI inserts 3 month calculated date).

171. SEXREC18 How many of these [ACASI INSERTS NUMBER FROM Q157 SEXREC4] HIV unknown men did you have vaginal sex with?

(range: 0- 9999, using validation below)

Q171 SEXREC18 cannot be greater than Q157 SEXREC4

If Q171 SEXREC18 is greater than Q157 SEXREC4, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

172. SEXREC19 With how many of these [ACASI INSERTS NUMBER FROM Q171 SEXREC18] HIV unknown men did you have vaginal sex without using a condom?

(range: 0- 9999, using validation below)

Q172 SEXREC19 cannot be greater than Q171 SEXREC18

If Q172 SEXREC19 is greater than Q171 SEXREC18, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

173. SEXREC20 How many of these [ACASI INSERTS NUMBER FROM Q157 SEXREC4] HIV unknown men did you have anal sex with?

(range: 0- 9999, using validation below)

Q173 SEXREC20 cannot be greater than Q157 SEXREC4

If Q173 SEXREC20 is greater than Q157 SEXREC4, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

174. SEXREC21 With how many of these [ACASI INSERTS NUMBER FROM Q173 SEXREC20] HIV unknown men did you have anal sex without using a condom?

(range: 0- 9999, using validation below)

Q174 SEXREC21 cannot be greater than Q173 SEXREC20

If Q174 SEXREC21is greater than Q173 SEXREC20, Read: That number is too big, Please try again. Allow participant to correct answer.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

SEXUAL MIXING AND CONCURRENCY

Read: In this section, we want you to think about the 3 most recent men you had vaginal or anal sex with since (ACASI inserts 12 month date calculation), even if it was only once. To help us talk about each man, we’ll use their initials. Let’s start with the last man you had sex with.

175. SEXCON1 What are his initials? _____

176. SEXCON2 What are the initials of the man you had sex with before [ACASI INSERTS PARTNER #1 SEXCON1INITIALS] since (ACASI inserts 12 month date calculation)?

______

No other partner

If Q176 SEXCON2 = no other partner skip to Marker C else ask Q177 SEXCON3

177. SEXCON3 What are the initials of the man you had sex with before [ACASI INSERTS PARTNERS #1 SEXCON1 and #2 SEXCON2 INITIALS] since (ACASI inserts 12 month date calculation)?

______

No other partner

178. SEXCON4 When you were having a sexual relationship with [ACASI INSERTS PARTNER #1 SEXCON1 INITIALS], did you also have sex one or more times with [ACASI INSERTS PARTNER #2 SEXCON2 INITIALS]?

Yes

No

If Q177 SEXCON3 = no other partner skip to Marker C else ask Q179 SEXCON5

179. SEXCON5 When you were having a sexual relationship with [ACASI INSERTS PARTNER #1 SEXCON1 INITIALS], did you also have sex one or more times with [ACASI INSERTS PARTNER #3 SEXCON3 INITIALS]?

Yes

No

180. SEXCON6 When you were having a sexual relationship with [ACASI INSERTS PARTNER #1 SEXCON1 INITIALS], did you also have sex one or more times with anyone else besides [ACASI INSERTS CONCURRENT PARTNERS 2 SEXCON2 and/or PARTNER # 3 SEXCON3 INITIALS]?

Yes

No

*****************************Marker C*******************************************

MOST RECENT PARTNER: PARTNER #1

Read: Okay, the next questions are about only [ACASI INSERTS PARTNER #1 INITIALS].

181. SEX1PART1 How long have you known [ACASI INSERTS PARTNER #1 INITIALS]?

Less than 1 month

Months [range 1-99 but cannot be greater than DEM1 (participant’s age)]

Years [range 1-99 but cannot be greater than DEM1 (participant’s age)]

Validation: sum of months and years cannot be greater than DEM1. If number is too big, read: “The length of time you said you have known [ACASI INSERTS PARTNER #1 INITIALS is more than your age. Please try again.” Loop back to SEX1PART1 and repeat validation.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

182. SEX2PART1 What is [ACASI INSERTS PARTNER #1 INITIALS]’s ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Don’t know

183. SEX3PART1 What is [ACASI INSERTS PARTNER #1 INITIALS]’s race? Choose all groups that describe his race.

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

Don’t know

If Site= Miami ask Q184, SEX4PART1 else skip to Q185 SEX5PART1

184. SEX4PART1 Was [ACASI INSERTS PARTNER #1 INITIALS] born in:

The United States

Another county (name of country:____________________)

Don’t know

Miami site only

185. SEX5PART1 For this question, we would like you to pick one answer that best fits how you think of [ACASI INSERTS PARTNER #1 INITIALS]. When you last had sex with him, was he… (choose one)

A friend

Someone you just met and hooked up with one time

Someone you have sex with off and on

The person you go out and party with

Your boyfriend, fiancé

Your husband/common-law husband

Your ex-husband or ex-boyfriend

186. SEX6PART1 What is the highest level of education that [ACASI INSERTS PARTNER #1 INITIALS] completed? Would you say:

He never went to school

Dropped out of high school

Graduated high school or got GED

Technical or Trade school or some college

College graduate

Don’t know

187. SEX7PART1 During the past 12 months, how did [ACASI INSERTS PARTNER #1 INITIALS] get money? Choose all that apply.

Steady employment with regular pay, either full or part time

Temporary employment (works every now and then or does seasonal work)

Self employed

Unemployment compensation

Federal or state assistance (welfare, public assistance, disability, etc.).

Street income (selling cans, returning bottles, windshield washing, panhandling, etc.).

Anything else such as boosting, shoplifting, selling food stamps, selling drugs, sex for money, etc.

From family or friends

Don’t know

188. SEX8PART1 Since (insert 12 month date calculation), has [ACASI INSERTS PARTNER #1 INITIALS] given you or your family…Choose all that apply?

Money

A place to live

Food

Clothing

Gifts (clothing, jewelry, beauty supplies, etc.)

Things for your house

Paid my bills

Don’t know

189. SEX9PART1 Since (ACASI inserts 12 month date calculation), when was the last time you had sex with [ACASI INSERTS PARTNER #1 INITIALS]? If you are not sure of the month, please give us your best guess.

Program 12 buttons with month and year (e.g. June 2006) as per ACASI 12 month date calculation based on today’s date.

190. SEX10PART1 What day in (ACASI inserts month and year from Q189 SEX9PART1) was the last time you had have sex with [ACASI INSERTS PARTNER #1 INITIALS]? If you are not sure of the day, please give us your best guess.

Program: show accurate calendar for the month and year indicated by Q189 SEX9PART1. Respondent must be able to select the date from this calendar.

191. SEX11PART1 When was the first time you had sex with [ACASI INSERTS PARTNER #1 INITIALS]? If you are not sure, please give us your best guess.

Month (range 1-99 but cannot be greater than sum of SEX1PART1)

Year (range 1-99 but cannot be greater than sum of SEX1PART1)

Don’t know

Validation: sum of months and years cannot be greater than sum of SEX1PART1. If number is too big, read: “The date you first had sex with [ACASI INSERTS PARTNER #1 INITIALS] is before you said you knew [ACASI INSERTS PARTNER #1 INITIALS]. Please try again.” You can change either the date for how long you’ve known [ACASI INSERTS PARTNER #1 INITIALS] or the date you first had sex with him. Loop back to SEX1PART1, then skip to SEX11PART1 and repeat validation.

If Q191 SEX11PART1 = “don’t know” ask Q192 SEX12PART1 else skip to Q193 SEX12PART1 if response is validated

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

192. SEX12PART1 About how old were you when you first had sex with [ACASI INSERTS PARTNER #1 INITIALS]?

age (years) (range:1-99 SEX12PART1 cannot be greater than SEXHIS1)

Validation: the age response cannot be less than the age from SEXHIS1. If number is too small, Read: “Earlier, you said you were XX years old [ACASI INSERTS AGE FROM SEXHIS1] the very first time you had sex with anyone. You just said you had sex with [ACASI INSERTS PARTNER #1 INITIALS] before you were XX years old [ACASI INSERTS AGE FROM SEXHIS1]. Please try again. You can change either your age for the very first time you had sex or your age when you first had sex with [ACASI INSERTS PARTNER #1 INITIALS]. Loop back to SEXHIST1, then skip to SEX12PART1 and repeat validation.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

193. SEX13PART1 About how old was [ACASI INSERTS PARTNER #1 INITIALS] when you first had sex with him?

age (years) (range 7-99)

Don’t know

194. SEX14PART1 Since (insert 12 month date calculation), about how often have you had sex with [ACASI INSERTS PARTNER #1 INITIALS]?

Only one time

Less than once a month

Once a month

Once a week

Several times each week

195. SEX15PART1 When you’ve had sex with [ACASI INSERTS PARTNER #1 INITIALS] since (insert 12 month date calculation), how often did you two use condoms? Show pictures

Not at all

Less than half of the time

Half of the time

More than half of the time

Every time

If Q195 SEX15PART1= “every time” skip to Q197 SEX17PART1

196. SEX16PART1 What are the reasons you didn’t use condoms? (Choose all that apply).

Didn’t have any

Too expensive

You trust him not to give you an STD

He doesn’t like to use condoms

He would think you were having sex with someone else

You don’t like to use condoms

You use another method of birth control

Condoms decrease sexual pleasure

Religious reasons

Got carried away by the moment

Wanted to have a child

197. SEX17PART1 Since (insert 12 month date calculation), have you used alcohol or drugs within 3 hours of having sex with [ACASI INSERTS PARTNER #1 INITIALS]?

No

Yes

198. SEX18PART1 Since (insert 12 month date calculation), has [ACASI INSERTS PARTNER #1 INITIALS] used alcohol or drugs within 3 hours of having sex with you?

No

Yes

Don’t know

199. SEX19PART1 To the best of you knowledge, has [ACASI INSERTS PARTNER #1 INITIALS] ever smoked crack, used cocaine, used heroin or shot up any drugs not prescribed for him?

No

Yes

Don’t know

200. SEX20PART1 As far as you know, has [ACASI INSERTS PARTNER #1 INITIALS] ever been locked up one or more nights in jail or prison?

No

Yes

Don’t know

If Q200 SEX20PART1 = “no” or “don’t know” skip to Q203 SEX23PART1

201. SEX21PART1 What is your best guess of the total amount of time [ACASI INSERTS PARTNER #1 INITIALS] has been in jail or prison?

Less than 1 week

Less than 6 months

Less than 2 years

More than 2 years

Don’t know

202. SEX22PART1 When was [ACASI INSERTS PARTNER #1 INITIALS] most recently released from jail or prison?

He’s still locked up

In the past 12 months

In the past 5 years

More than 5 years ago

Don’t know

203. SEX23PART1 Do you know [ACASI INSERTS PARTNER #1 INITIALS]’s HIV status?

You don’t know if he has HIV

He has HIV, also called being “Positive”

He does not have HIV, also called being “Negative”

If Q203 SEX23PART1 = “you don’t know if he has HIV” skip to Q206 SEX26PART1

If Q203 SEX23PART1 = “He has HIV…Positive” ask Q204 SEX24PART1 then skip to Q206 SEX26PART1

If Q203 SEX23PART1 = “He does not have HIV…Negative” skip to Q205 SEX25PART1

If Q203 SEX23PART1 = “don’t want to answer” skip to Q203a SEX23aPART1

203a. SEX23aPART1 Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q203a SEX23aPART1 = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q203. SEX23PART1

If Q203a SEX23aPART1 = “no” or “don’t want to answer” skip to Q206 SEX26PART1

204. SEX24PART1 How did you find out [ACASI INSERTS PARTNER #1 INITIALS] is HIV positive? (Choose all that apply).

He told you

You asked him

You guessed

Someone else told you

He looked sick

We got tested together

You saw his test results

Someone from the Health Department asked you where to find him

205. SEX25PART1 How did you find out [ACASI INSERTS PARTNER #1 INITIALS is HIV negative? (Choose all that apply).

He told you

You asked him

You guessed

Someone else told you

He didn’t look like he had HIV

We got tested together

You saw his test results

206. SEX26PART1 Does [ACASI INSERTS PARTNER #1 INITIALS] know your HIV status?

No

Yes

Don’t know

If Q206 SEX26PART1= “no” or “don’t know skip to statement before Q208 SEX28PART1

If Q206 SEX26PART1 = “don’t want to answer” skip to Q206a SEX26aPART1

Else ask Q207 SEX27PART1

206a. SEX26aPART1Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q206a SEX26aPART1 = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q206. SEX26PART1

If Q206a SEX26aPART1 = “no” or “don’t want to answer” skip to statement before Q208 SEX28PART1

207. SEX27PART1 How did [ACASI INSERTS PARTNER #1 INITIALS] find out your HIV status? (Choose all that apply).

You told him

He asked you

He guessed

Someone else told him

We got tested together

He saw my test results

Someone from the Health Department came looking for you

Read: Sometimes two people only have sex with each other. In other situations,

one or both partners have sex with other people. Now we want to ask you

some questions about [ACASI INSERTS PARTNER #1 INITIALS] and what you know about his sexual relationships with people other than yourself.

208. SEX28PART1 As far as you know, during the time you were having a sexual relationship with [ACASI INSERTS PARTNER #1 INITIALS], did he have sex with other men or women?

Definitely did not

Probably did not

Probably did

Definitely had sex with other people

If Q208 SEX28PART1= “definitely not” skip to Marker D

209. SEX29PART1 Did [ACASI INSERTS PARTNER #1 INITIALS] have sex with:

Only men

Only women

Both men and women

Don’t know

**********************************Marker D***********************************

If Q176 SEXCON2 = no other partner skip to statement before Q271 SSUP1 else continue

MOST RECENT PARTNER: PARTNER #2

Read: Now we’re going to talk about ACASI INSERTS PARTNER #2 INITIALS]. Remember, when we ask about sex, we mean any sex where a man puts his penis in a woman’s vagina or butt.

210. SEXCON7 When you were having a sexual relationship with [ACASI INSERTS PARTNER #2 INITIALS], did you also have sex one or more times with [ACASI INSERTS PARTNER #3 INITIALS]?

211. SEXCON8 When you were having a sexual relationship with [ACASI INSERTS PARTNER #2 INITIALS], did you also have sex one or more times with anyone else besides [ACASI INSERTS CONCURRENT PARTNERS #1 and #3 INITIALS]? By sexual relationship we mean sexual activity.

No

Yes

212. SEX1PART2 How long have you known [ACASI INSERTS PARTNER #2 INITIALS]?

Less than 1 month

Months [range 1-99 but cannot be greater than DEM1 (participant’s age)]

Years [range 1-99 but cannot be greater than DEM1 (participant’s age)]

Validation: sum of months and years cannot be greater than DEM1. If number is too big, read: “The length of time you said you have known [ACASI INSERTS PARTNER #2 INITIALS] is more than your age. Please try again.” Loop back to SEX1PART2 and repeat validation.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

213. SEX2PART2 What is [ACASI INSERTS PARTNER #2 INITIALS]’s ethnicity?

Hispanic or Latino

Not Hispanic or Latino

Don’t know

214. SEX3PART2 What is [ACASI INSERTS PARTNER #2 INITIALS]’s race? Choose all groups that describe his race.

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

Don’t know

If Site= Miami ask Q215 SEX4PART2, else skip to Q216 SEX5PART2

215. SEX4PART2 Was [ACASI INSERTS PARTNER #2 INITIALS] born in:

The United States

Another country (name of country:____________________)

Don’t know

Miami site only

216. SEX5PART2 For this question, we would like you to pick one answer that best fits how you think of [ACASI INSERTS PARTNER #2 INITIALS]. When you last had sex with him, was he… (choose one)

A friend

Someone you just met and hooked up with one time

Someone you have sex with off and on

The person you go out and party with

Your boyfriend, fiancé

Your husband/common-law husband

Ex-husband or ex- boyfriend

217. SEX6PART2 What is the highest level of education that [ACASI INSERTS PARTNER #2 INITIALS] completed? Would you say:

He never went to school

Dropped out of high school

Graduated high school or got GED

Technical or Trade school or some college

College graduate

Don’t know

218. SEX7PART2 During the past 12 months, how did [ACASI INSERTS PARTNER #2 INITIALS] get money? Choose all that apply.

Steady employment with regular pay, either full or part time

Temporary employment (works every now and then or does seasonal work)

Self employed

Unemployment compensation

Federal or state assistance (welfare, public assistance, disability, etc.).

Street income (selling cans, returning bottles, windshield washing, panhandling, etc.).

Anything else such as boosting, shoplifting, selling food stamps, selling drugs, sex for money, etc.

From family or friends

Don’t know

219. SEX8PART2 Since (insert 12 month date calculation), has [ACASI INSERTS PARTNER #2 INITIALS] given you or your family… (choose all that apply)?

Money

A place to live

Food

Clothing

Gifts (clothing, jewelry, beauty supplies, etc)

Things for your house

Paid your bills

Don’t know

220. SEX9PART2 Since (ACASI inserts 12 month date calculation), when was the last time you had sex with [ACASI INSERTS PARTNER #2 INITIALS]? If you are not sure of the month, please give us your best guess.

Program 12 buttons with month and year (e.g. June 2006) as per ACASI 12 month date calculation based on today’s date.

221. SEX10PART2 What day in (ACASI inserts month and year from Q220 SEX9PART2) was the last time you had have sex with [ACASI INSERTS PARTNER #2 INITIALS]? If you are not sure of the day, please give us your best guess.

Program: show accurate calendar for the month and year indicated by Q220 SEX9PART2. Respondent must be able to select the date from this calendar.

222. SEX11PART2 When was the first time you had sex with [ACASI INSERTS PARTNER #2 INITIALS]? If you are not sure, please give us your best guess.

Month

Year

Don’t know

Validation: sum of months and years cannot be greater than sum of SEX1PART2. If number is too big, read: “The date you first had sex with [ACASI INSERTS PARTNER #2 INITIALS] is before you said you knew [ACASI INSERTS PARTNER #2 INITIALS]. Please try again.” You can change either the date for how long you’ve known [ACASI INSERTS PARTNER #2 INITIALS] or the date for the first time you had sex with him. Loop back to SEX1PART2, then skip to SEX11PART2 and repeat validation.

If Q222 SEX11PART2 = “don’t know” ask Q223 SEX12PART2 else skip to Q224 SEX13PART2

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

223. SEX12PART2 About how old were you when you first had sex with [ACASI INSERTS PARTNER #2 INITIALS] ?

age (years) (range:1-99 SEX12PART2 cannot be greater than SEXHIS1)

Validation: the age response cannot be less than the age from SEXHIS1. If number is too small, Read: “Earlier, you said you were XX years old [ACASI INSERTS AGE FROM SEXHIS1} the very first time you had sex with anyone. You just said you had sex with [ACASI INSERTS PARTNER #2 INITIALS} before you were XX years old [ACASI INSERTS AGE FROM SEXHIS1}. Please try again. You can change either your age for the very first time you had sex or your age when you first had sex with [ACASI INSERTS PARTNER #2 INITIALS}. Loop back to SEXHIST1, then skip to SEX12PART2 and repeat validation.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

224. SEX13PART2 About how old was [ACASI INSERTS PARTNER #2 INITIALS] when you first had sex with him?

age (years) (range 7-99)

Don’t know

225. SEX14PART2 Since (insert 12 month date calculation), about how often have you had sex with [ACASI INSERTS PARTNER #2 INITIALS]?

Only one time

Less than once a month

Once a month

Once a week

Several times each week

226. SEX15PART2 When you’ve had sex with [ACASI INSERTS PARTNER #2 INITIALS] since (insert 12 month calculated date), how often did you two use condoms? SHOW PICTURES

Not at all

Less than half of the time

Half of the time

More than half of the time

Every time

If Q 226 SEX15PART2 = “every time” skip to Q228 SEX17PART2

227. SEX16PART2 What are the reasons you didn’t use condoms? (Choose all that apply).

Didn’t have any

Too expensive

You trust him not to give you an STD

He doesn’t like to use condoms

He would suspect you were having sex with someone else

You don’t like to use condoms

You use another method of birth control

Condoms decrease sexual pleasure

Religious reasons

Got carried away

Wanted to have a child

228. SEX17PART2 Since (insert 12 month date calculation), have you used alcohol or drugs within 3 hours of having sex with [ACASI INSERTS PARTNER #2 INITIALS]?

No

Yes

229. SEX18PART2 Since (insert 12 month date calculation), has [ACASI INSERTS PARTNER #2 INITIALS] used alcohol or drugs within 3 hours of having sex with you?

No

Yes

Don’t know

230. SEX19PART2 To the best of your knowledge, has [ACASI INSERTS PARTNER #2 INITIALS] smoked crack, used cocaine, used heroin or shot up any drugs not prescribed for him?

No

Yes

Don’t know

231. SEX20PART2 As far as you know, has [ACASI INSERTS PARTNER #2 INITIALS] ever been locked up one or more nights in jail or prison?

No

Yes

Don’t know

If Q231 SEX20PART2 = “no” or “don’t know” skip to Q234 SEX23PART2

232. SEX21PART2 What is your best guess of the total amount of time [ACASI INSERTS PARTNER #2 INITIALS] has been in jail or prison?

Less than 1 week

Less than 6 months

Less than 2 years

More than 2 years

Don’t know

233. SEX22PART2 When was [ACASI INSERTS PARTNER #2 INITIALS] most recently released from jail or prison?

He’s still locked up

In the past 12 months

In the past 5 years

More than 5 years ago

Don’t know

234. SEX23PART2 Do you know [ACASI INSERTS PARTNER #2 INITIALS]’s HIV status?

You don’t know if he has HIV

He has HIV, also called being “Positive”

He doesn’t have HIV, also called being “Negative”

If Q234 SEX23PART2= “You don’t know” skip to Q237 SEX26PART2

If Q234 SEX23PART2= “He has HIV….Positive” ask Q235 SEX24PART2 then skip to Q237 SEX26PART2

If Q234 SEX23PART2= “He does not have HIV...Negative” skip to Q236 SEX25PART2

If Q234 SEX23PART2= “don’t want to answer” skip to Q234a SEX23aPART2

234a. SEX23aPART2 Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q234a SEX23aPART2 = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q234. SEX23PART2

If Q234a SEX23aPART2 = “no” or “don’t want to answer” skip to Q237 SEX26PART2

235. SEX24PART2 How did you find out [ACASI INSERTS PARTNER #2 INITIALS] is HIV positive? (Choose all that apply).

He told you

You asked him

You guessed

Someone else told you

He looked sick

We got tested together

You saw his test results

Someone from the health department asked you where to find him

236. SEX25PART2 How did you find out [ACASI INSERTS PARTNER #2 INITIALS] is HIV negative? (Choose all that apply).

He told you

You asked him

You guessed

Someone else told you

He didn’t look like he had HIV

We got tested together

You saw his test results

237. SEX26PART2 Does [ACASI INSERTS PARTNER #2 INITIALS] know your HIV status?

No

Yes

Don’t know

If Q237 SEX26PART2 = “no” or “don’t know” skip to statement before Q239 SEX28PART2

If Q237 SEX26PART2 = “don’t want to answer” skip to Q237a SEX26aPART2

Else ask Q238 SEX27PART2

237a. SEX26aPART2 Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q237a SEX26aPART2 = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q237. SEX26PART2

If Q237a SEX26aPART2 = “no” or “don’t want to answer” skip to statement before Q239 SEX28PART2

238. SEX27PART2 How did [ACASI INSERTS PARTNER #2 INITIALS] find out your HIV status? Choose all that apply.

You told him

He asked you

He guessed

Someone else told him

We got tested together

He saw my test results

Someone from the Health Department asked him where to find you

Read: Sometimes two people only have sex with each other. In other situations,

one or both partners have sex with other people Now we want to ask you

some questions about [ACASI INSERTS PARTNER #2 INITIALS] and what you know about his sexual relationships with people other than yourself.

239. SEX28PART2 As far as you know, during the time you were having a sex with [ACASI INSERTS PARTNER #2 INITIALS], did he have sex with other men or women?

Definitely did not

Probably did not

Probably did

Definitely had sex with other people

If Q239 SEX28PART2 = “definitely not” skip to Marker E

240. SEX29PART2 Did [ACASI INSERTS PARTNER #2 INITIALS] have sex with:

Only men

Only women

Both men and women

Don’t know

***********************************Marker E**********************************

If Q177 SEXCON3 = no other partner skip to statement before Q271 SSUP1else continue

MOST RECENT PARTNER: PARTNER #3

Read: Okay, this is the last set of questions about your three most recent sex partners. This time, we want to ask about [ACASI INSERTS PARTNER #3 INITIALS].

241. SEXCON9 When you were having a sexual relationship with [ACASI INSERTS PARTNER #3 INITIALS], did you also have sex one or more times with any other man or men besides [ACASI INSERTS CONCURENT PARTNERS 1 and PARTNER 2 INITIALS ? By sexual relationship we mean sexual activity.

Yes

No

242. SEX1PART3 How long have you known [ACASI INSERTS PARTNER #3 INITIALS]?

Less than 1 month

Months [range 1-99 but cannot be greater than DEM1 (participant’s age)]

Years [range 1-99 but cannot be greater than DEM1 (participant’s age)]

Validation: sum of months and years cannot be greater than DEM1. If number is too big, read: “The length of time you said you have known [ACASI INSERTS PARTNER #3 INITIALS] is more than your age. Please try again.” Loop back to SEX1PART3 and repeat validation.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

243. SEX2PART3 What is [ACASI INSERTS PARTNER #3 INITIALS]’s ethnicity? (Choose all that apply)

Hispanic or Latino

Not Hispanic or Latino

Don’t know

244. SEX3PART3 What is [ACASI INSERTS PARTNER #3 INITIALS]’s race? Choose all groups that describe his race.

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

Don’t know

If Site= Miami ask Q245, SEX4PART3 else skip to Q246 SEX5PART3

245. SEX4PART3 Was [ACASI INSERTS PARTNER #3 INITIALS] born in:

The United States

Another country (name of country:____________________)

Don’t know

Miami site only

246. SEX5PART3 For this question, we would like you to pick one answer that best fits how you think of [ACASI INSERTS PARTNER #3 INITIALS]. When you last had sex with him, was he… (choose one)

A friend

Someone you just met and hooked up with one time

Someone you have sex with off and on

The person you go out and party with

Your boyfriend, fiancé

Your husband/common-law husband

Ex-husband or ex-boyfriend

247. SEX6PART3 What is the highest level of education that [ACASI INSERTS PARTNER #3 INITIALS] completed? Would you say:

He never went to school

Dropped out of high school

Graduated high school or got GED

Technical or Trade school or some college

College graduate

Don’t know

248. SEX7PART3 During the past 12 months, how did [ACASI INSERTS PARTNER #3 INITIALS] get money? Choose all that apply.

Steady employment (steady job with regular pay, either full or part time

Temporary employment (works every now and then or does seasonal work)

Self employed

Unemployment compensation

Federal or state assistance (welfare, public assistance, disability, etc.).

Street income (selling cans, returning bottles, windshield washing, panhandling, etc.).

Anything else such as boosting, shoplifting, selling food stamps, selling drugs, sex for money, etc.

From family or friends

Don’t know

249. SEX8PART3 Since (insert 12 month date calculation), has [ACASI INSERTS PARTNER #3 INITIALS] given you or your family…(choose all that apply)?

Money

A place to live

Gifts (clothing, jewelry, beauty supplies, etc).

Food

Clothing

Things for your house

Paid your bills

Don’t know

250. SEX9PART3 Since (ACASI inserts 12 month date calculation), when was the last time you had sex with [ACASI INSERTS PARTNER #3 INITIALS]? If you are not sure of the month, please give us your best guess.

Program 12 buttons with month and year (e.g. June 2006) as per ACASI 12 month date calculation based on today’s date.

251. SEX10PART3 What day in (ACASI inserts month and year from Q250 ) SEX9PART3 was the last time you had have sex with [ACASI INSERTS PARTNER #3 INITIALS]? If you are not sure of the day, please give us your best guess.

Program: show accurate calendar for the month and year indicated by Q250. SEX9PART3 Respondent must be able to select the date from this calendar.

252. SEX11PART3 When was the first time you had sex with [ACASI INSERTS PARTNER #3 INITIALS]? If you are not sure, please give us your best guess.

Month

Year

Don’t know

Validation: sum of months and years cannot be greater than sum of SEX1PART3. If number is too big, read: “The date you first had sex with [ACASI INSERTS PARTNER #3 INITIALS] is before you said you knew [ACASI INSERTS PARTNER #3 INITIALS]. Please try again.” You can change either the date for how long you’ve known [ACASI INSERTS PARTNER #3 INITIALS] or the date for the first time you had sex with him. Loop back to SEX1PART3, then skip to SEX11PART3 and repeat validation.

If Q252 SEX11PART3 = “don’t know” ask Q253 SEX12PART3 else skip to Q254

SEX13PART3 if response is valid.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

253. SEX12PART3 About how old were you when you first had sex with [ACASI INSERTS PARTNER #3 INITIALS]?

age (years) (range:1-99 SEX12PART3 cannot be greater than SEXHIS1)

Validation: the age response cannot be less than the age from SEXHIS1. If number is too small, Read: “Earlier, you said you were XX years old [ACASI INSERTS AGE FROM SEXHIS1] the very first time you had sex with anyone. You just said you had sex with [ACASI INSERTS PARTNER #3 INITIALS] before you were XX years old [ACASI INSERTS AGE FROM SEXHIS1]. Please try again. You can change either your age for the very first time you had sex or your age when you first had sex with [ACASI INSERTS PARTNER #3 INITIALS].. Loop back to SEXHIS1, then skip to SEX12PART3 and repeat validation.

If numbers are not valid, Read. “You seem to be having trouble with this question. Please call the study assistant working with you for help.”

254. SEX13PART3 About how old was [ACASI INSERTS PARTNER #3 INITIALS] when you first had sex with him)?

age (years) (range:7-99)

Don’t know

255. SEX14PART3 Since (insert 12 month date calculation), how often have you had sex with [ACASI INSERTS PARTNER #3 INITIALS]?

Only one time

Less than once a month

Once a month

Once a week

Several times each week

256. SEX15PART3 When you’ve had sex with [ACASI INSERTS PARTNER #3 INITIALS] since (insert 12 month date calculation), how often did you two use condoms? SHOW PICTURES

Not at all

Less than half of the time

Half of the time

More than half of the time

Every time

If Q256 SEX15PART3 = “every time” skip to Q258 SEX17PART3

257. SEX16PART3 What are the reasons you didn’t use condoms? (Choose all that apply).

Didn’t have any

Too expensive

You trust him not to give you an STD

He doesn’t like to use condoms

He would suspect you were having sex with someone else

You don’t like to use condoms

You use another method of birth control

Condoms decrease sexual pleasure

Religious reasons

Got carried away by the moment

Wanted to have a child

258. SEX17PART3 Since (insert 12 month date calculation), have you used alcohol or drugs within 3 hours of having sex with [ACASI INSERTS PARTNER #3 INITIALS]?

No

Yes

259. SEX18PART3 Since (insert 12 month date calculation), has [ACASI INSERTS PARTNER #3 INITIALS], used alcohol or drugs within 3 hours of having sex with you?

No

Yes

Don’t know

260. SEX19PART3 To the best of your knowledge, has [ACASI INSERTS PARTNER #3 INITIALS], ever smoked crack, used cocaine, used heroin or shot up drugs not prescribed for him?

No

Yes

Don’t know

261. SEX20PART3 As far as you know, has [ACASI INSERTS PARTNER #3 INITIALS] ever been locked up one or more nights in jail or prison?

No

Yes

Don’t know

If Q261 SEX20PART3 = “no” or “don’t know” skip to Q264 SEX23PART3

262. SEX21PART3 What is your best guess of the total amount of time [ACASI INSERTS PARTNER #3 INITIALS] has been in jail or prison?

Less than 1 week

Less than 6 months

Less than 2 years

More than 2 years

Don’t know

263. SEX22PART3 When was [ACASI INSERTS PARTNER #3 INITIALS] most recently released from jail or prison?

He’s still locked up

In the past 12 months

In the past 5 years

More than 5 years ago

Don’t know

264. SEX23PART3 Do you know [ACASI INSERTS PARTNER #3 INITIALS]’s HIV status?

You don’t know if he has HIV

He has HIV, also called being “Positive”

He does not have HIV, also called being “Negative”

If Q264 SEX23PART3 = “You don’t know” skip to Q267 SEX26PART3

If Q264 SEX23PART3= “He has HIV….Positive” ask Q265 SEX24PART3 then skip to Q267 SEX26PART3

If Q264 SEX23PART3= “He does not have HIV….Negative” skip to Q266 SEX25PART3

If Q264 SEX23PART3= “don’t want to answer” skip to Q264a SEX23aPART3

264a. SEX23aPART3Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q264a SEX23aPART3= Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q264. SEX23PART3

If Q264a SEX23aPART3 = “no” or “don’t want to answer” skip to 267 SEX26PART3

265. SEX24PART3 How did you find out [ACASI INSERTS PARTNER #3 INITIALS] is HIV positive? (Choose all that apply).

He told you

You asked him

You guessed

Someone else told you

He looked sick

We got tested together

You saw his test results

Someone from the Health Department asked you where to find him

266. SEX25PART3 How did you find out [ACASI INSERTS PARTNER #3 INITIALS] is HIV negative? (Choose all that apply).

He told you

You asked him

You guessed

Someone else told you

He didn’t look like he had HIV

We got tested together

You saw his test results

267. SEX26PART3 Does [ACASI INSERTS PARTNER #3 INITIALS] know your HIV status?

No

Yes

Don’t know

If Q267 SEX26PART3=”no” or “don’t know” skip to statement before Q269 SEX28PART3

If Q267 SEX26PART3= “don’t want to answer” skip to Q267a SEX26aPART3

Else ask Q268 SEX27PART3

267a. SEX26aPART3 Your answer to this question is very important to our study. Would you reconsider answering that question?

No

Yes

Don’t want to answer

If Q267a SEX26aPART3 = Yes read “Thank you for agreeing to reconsider answering that question” and skip back to Q267 SEX26PART3

If Q267a SEX26aPART3 = “no” or “don’t want to answer” skip to statement before Q269 SEX28PART3

268. SEX27PART3 How did [ACASI INSERTS PARTNER #3 INITIALS] find out your HIV status? Choose all that apply.

You told him

He asked you

He guessed

Someone else told him

We got tested together

He saw your test results

Someone from the Health Department asked him where to find you

Read: Sometimes two people only have sex with each other. In other situations,

one or both partners have sex with other people. Now we want to ask you

some questions about [ACASI INSERTS PARTNER #3 INITIALS] and what you know about his sexual relationships with people other than yourself.

269. SEX28PART3 As far as you know, during the time you were having a sexual relationship with [ACASI INSERTS PARTNER #3 INITIALS], did he have sex with other men or women?

Definitely did not

Probably did not

Probably did

Definitely had sex with other people

If Q269 SEX28PART3 = “definitely not” skip to statement before Q271 SSUP1

270. SEX29PART3 Did [ACASI INSERTS PARTNER #3 INITIALS] have sex with:

Only men

Only women

Both men and women

Don’t know

SOCIAL SUPPORT

Read: Now we are going to switch to something different with questions about social support you may get from friends, family, people you work with or others in your life.

271. SSUP1 Are there people in your life who would help take care of you if you were sick in bed?

No

Yes

272. SSUP2 Are there people who would be able to run errands for you or watch your children if you needed help?

No

Yes

273. SSUP3 Are there people you could turn to if you needed to borrow some money?

No

Yes

274. SSUP4 Are there people who you could confide in if you needed to talk to someone?

No

Yes

275. SSUP5 Are there people who accept you totally including your worst and your best points?

No

Yes

SELF-ESTEEM

Read: The questions in the next section ask how you feel about yourself most of the time.

276. ESTM1 You feel that you are a person of worth, at least on an equal basis with others.

Strongly Agree

Agree

Disagree

Strongly Disagree

277. ESTM2 You feel that you have a number of good qualities.

Strongly Agree

Agree

Disagree

Strongly Disagree

278. ESTM3 All in all, you are inclined to feel that you are a failure.

Strongly Agree

Agree

Disagree

Strongly Disagree

279. ESTM4 You are able to do things as well as most other people.

Strongly Agree

Agree

Disagree

Strongly Disagree

280. ESTM5 You feel you do not have much to be proud of.

Strongly Agree

Agree

Disagree

Strongly Disagree

281. ESTM6 You take a positive attitude toward yourself.

Strongly Agree

Agree

Disagree

Strongly Disagree

282. ESTM7 On the whole, you are satisfied with yourself.

Strongly Agree

Agree

Disagree

Strongly Disagree

283. ESTM8 You wish you could have more respect for yourself.

Strongly Agree

Agree

Disagree

Strongly Disagree

284. ESTM9 You certainly feel useless at times.

Strongly Agree

Agree

Disagree

Strongly Disagree

285. ESTM10 At times you think you are no good at all.

Strongly Agree

Agree

Disagree

Strongly Disagree

286. ESTM11 You feel you are not worth anything without a man in your life.

Strongly Agree

Agree

Disagree

Strongly Disagree

SEXUAL SELF-EFFICACY

Read: Now we are going to ask you how sure you are that you can do the following things when you are in a sexual relationship with a man. For each question, please select the response that best describes how sure you are that you can do these things well.

	Not At All Sure	Somewhat Sure	Very Sure
SSE1 How sure are you that you could buy condoms in a store?	1	2	3
SSE2 How sure are you that you could talk with him about safer sex?	1	2	3
SSE3 How sure are you that you could refuse to have sex with someone you didn't know very well? (like an acquaintance or someone you just met)?	1	2	3
SSE4 How sure are you that you could say no to sex without a condom?	1	2	3
SSE5 How sure are you that you could convince him that he should use a condom?	1	2	3
SSE6 How sure are you that you could help him correctly put on a male condom if he wanted to use one?	1	2	3
SSE7 How sure are you that you could use a female condom correctly if you wanted to use one?	1	2	3
SSE8 How sure are you that you could ask him about the other women or men he was also having sex with?	1	2	3
SSE9 How sure are you that you could refuse to have sex with him because you weren’t in the mood?	1	2	3
SSE10 How sure are you that you could refuse to engage in sexual practices that you didn’t like or didn’t want to do?	1	2	3
SSE11 How sure are you that you could ask him to wait while you got a condom?	1	2	3

PARTNER DEPENDENCY / POWER INEQUITY / DOMESTIC VIOLENCE

Read: Now think about the sexual relationships you have had with men since (insert 12 month date calculation). We would like you to tell us overall, how much you agree or disagree with the following statements about these relationships. When choosing a response, please think about your sexual relationships in general.

	Strongly Agree	Agree	Disagree	Strongly Disagree
PWR1 When you ask a man to use a condom, he would get angry.	1	2	3	4
PWR2 Most of the time, you do what a man wants to do.	1	2	3	4
PWR3 A man has more say than you do about important decisions that affect both of you.	1	2	3	4
PWR4 If you ask a man to use a condom, he would think you are having sex with other people.	1	2	3	4
PWR5 A man does what he wants, even if you do not want him to.	1	2	3	4
PWR6 You are more committed to the relationship than a man is.	1	2	3	4
PWR7 A man might be having sex with other people.	1	2	3	4
PWR8 A man has more to say about whether or not you have sex.	1	2	3	4
PWR9 A man has more to say about what type of sex you have.	1	2	3	4

HIV KNOWLEDGE

Read: You are almost finished with the survey. In these last few questions, we are going to ask your opinions about HIV, the virus that causes AIDS.

307. HIVKNOW1 Do you think that a person who got HIV from shooting up drugs can give the virus to someone else by having sex with them?

No

Yes

308. HIVKNOW2 Do you think that a pregnant woman can give HIV to her unborn baby?

No

Yes

309. HIVKNOW3 Do you think that only people who look sick can give HIV to someone else?

No

Yes

310. HIVKNOW4 Do you think that only people who have sex with gay (homosexual) people can get HIV?

No

Yes

311. HIVKNOW5 Do you think that birth control pills prevent a woman from getting HIV?

No, they do not prevent HIV infection

Yes, they do prevent HIV infection

312. HIVKNOW6 Do you think that having an STD, like Gonorrhea, Chlamydia, or Syphilis, increases a woman’s risk of getting infected with HIV?

No

Yes

Read: This is the end of the survey. Thank you for your time. Please tell the study assistant that helped you begin this survey that you are done.

Prior to ending saving and ending interview, ACASI will ask the study assistant the following question.

313. RDS Has this participant indicated an interest in becoming an RDS recruiter?

No

Yes

If RDS= no, end interview

If RDS =yes, ACASI will generate 3 Respondent Driven Sampling (RDS) coupon numbers according to prescribed algorithm. An expiration date of 30 days will be assigned to the RDS coupons based on the date the ACASI interview is ended. If the expiration date falls on a Saturday or Sunday, shift expiration date to the first Monday following the initially calculated expiration date.

Read: Study assistant, please write the RDS coupon numbers and expiration date exactly as assigned here on 3 blank coupons and give the numbered and dated coupons to this participant per the manual of study procedures.

Then end interview.

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