Form No number No number No name

Attachment 3: Transgender HIV Study

Introduction to cognitive interview

OMB #0920-0222; Expiration Date: 02/28/10

Public reporting burden for this collection of information is estimated to average 60 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, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0222).

Introduction

Thank you for agreeing to participate in this interview today. You have read the Informed Consent form and you agree to take part in this research study. Is that correct? [Interviewer waits for verbal acknowledgment]. You have given your permission for me to tape record your interview today and, if needed, to play it to other people working on this study. Is that correct? [Interviewer waits for verbal acknowledgment].

I have in front of me questions from a larger survey about gender and behaviors that can put people at risk for contracting HIV, the virus that causes AIDS. Some of the questions are very personal—for example, some questions are about sexual activities, number of sexual partners, and the use of silicone and hormones. There are also some questions on networking – strategies for finding eligible participants. The final survey, including some of the questions I would like to ask you, will be used with people who were born male but identify, live, act, or consider themselves to be a woman. Before interviewers begin to use the survey with more people, we need to test the questions. This interview with you will help us find out if the questions are difficult to answer and whether or not they make sense to people.

First, I want to read the questions to you and have you answer them. It is important that I ask all of these questions, but you don’t have to answer specific questions that you do not want to answer. I want to remind you that this interview is strictly confidential. Confidential means that your name will never be linked to the answers you give. When we write a report, we will not put your name in it.

After we finish with the questions in the survey, I will ask you some follow-up questions about how you decided your answers and how you interpreted certain words. I will also ask you if there were any questions that were not easy to understand and how you think we could change the questions so more people will understand them.

Do you have any questions you want to ask me before we begin?

Transgender HIV Behavioral Survey

Items from the Eligibility Screener

1. During 2008, did you already complete at least part of the health survey that

[Insert Project Name] is conducting? It could have been here or at another location.

No………………….……………….……………….  0

Yes….……………………………….……..............  1

Refused to answer………………………..………  R

Don't know.……………..………………...............  D

2. What was your physical sex assigned at birth? [Check only one]

If the person reports being born female or intersex/ambigous, then end survey.

Male…...…………………………………………….  1

Female…....…....…………………………………….  2

Intersex/ambiguous………....……………………….  3

Refused to answer………....…………………………  R

Don't know……………..……………………............  D

3. Do you consider yourself to be male, female, or transgender? [Check only one]

Male………………………………………………… 1

If female or transgender then skip to Q5

Female ……………………………………………..  2

Transgender ………………………………………..  3

Other (Specify__________________)……………..  4

Refused to answer…………………………………  R

Don't know……………..……………………..........  D

4. In the past 12 months, have you ever lived as a woman? By living as a woman,

I mean dressing and presenting yourself as a woman.

No ………….……………………………………….  0

Yes ………………………………………………….  1

Refused to answer…………………………………  R

Don’t know………………………………………….  D

5. About how many people do you know personally who were born male but identify, live, act, or consider themselves to be a woman and who are at least 15 years of age, live in [San Francisco, r Chicago, or Washington DC], and who you’ve seen in the past 30 days?.

INTERVIEWER: USE FLASHCARD A

____ _____ ____ ____ (R=Refused; D=Don’t know)

Items from Core Questionnaire

6. Do you currently have health insurance coverage? This includes Medicaid or Medicare.

If no, refused or don’t know then skip to Q7

No………………….……………………………….  0

Yes…………………………………………….........  1

Refused to answer…………………………………  R

Don't know……………..……………………..........  D

6a. Does the insurance cover transgender-related medical care, such as hormone therapy or sexual reassignment surgeries (SRS)?

No………………….………………………………..  0

Yes…………………………………………….........  1

Refused to answer…………………………………  R

Don't know……………..……………………..........  D

SAY: Some people are very open about their transgender identity. Others prefer to tell only a few people. For the next question, you will see a list of groups you may have told about your transgender identity. For each one, check “YES” if you have told some people in the group or check “NO” if you have not.

7. Which of the following groups have you told about your transgender identity?

No Yes Refused Don’t Not

to answer Know Applicable

a. Have you told friends who are transgender………………..  0  1  R  D  N

b. Have you told gay, lesbian, or bisexual friends…………….  0  1  R  D  N

c. Have you told friends who are not gay, lesbian, or bisexual.  0  1  R  D  N

d. Have you told your family members………………………..  0  1  R  D  N

e. Have you told your medical providers………………………  0  1  R  D .N

f. Have you told your mental health providers………………..  0  1  R  D  N

SEXUAL BEHAVIOR

SAY: The next questions are about sexual behavior. Some of the questions are for people who have a penis and some are for people who have a vagina. To ask you the proper questions, we would first like to ask about your physical anatomy.

8. Do you have a surgically constructed vagina?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  R

Don’t Know……………..……………………...  D

Male Sex Partners

If Q8 is no, refused, or don’t know SAY:

Now we would like to ask you some questions about having sex with men. Some of the questions may not apply to you. Please remember your answers will be kept private.

For these questions, "having sex" means oral or anal sex. Oral sex means your partner put his mouth on your penis or you put your mouth on his penis. Anal sex means you put your penis in his anus (butt) or he put his penis in your anus (butt).

If Q8 is yes, SAY:

Now we would like to ask you some questions about having sex with men. Some of the questions may not apply to you. Please remember your answers will be kept private.

For these questions, "having sex" means oral, vaginal, or anal sex. Oral sex means your partner put his mouth on your vagina or you put your mouth on his penis. Vaginal sex means your partner put his penis in your vagina. Anal sex means you put your penis in his anus (butt) or he put his penis in your anus (butt).

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If no, refused or don’t know skip to the female sex partner section

. Have you ever had [insert “oral or anal” if Q8 in (no, refused, or don’t know; insert “oral, vaginal, or anal” if Q8 = yes] sex with a man?

No………………….………….………………..  0 Yes………………………………..………….....  1

Refused to answer…………………………..…..  R

Don't know……………..………….………........  D

10. In the past 12 months, has anyone ever forced you to have sex with them?

No……………………..………………...............  0

Yes………………………..………….…………  1

Refused to answer…………………..…………..  R

Don’t Know…………….……………..................  D

11. Think about the last time you had sex with a male partner. At that time was this

partner aware you were transgender or gender variant?

No………………….…………………..……….  0

Yes………………………………………..……..  1

Refused to answer………………………………  R

Don't know……………..……………………..  D

11a. Did you tell him that you were transgender or gender variant?

No………………….…………………..……….  0

Yes………………………………………..……..  1

Refused to answer………………………………  R

Don't know……………..……………………..  D

Female Sex Partners

Note: if Q8 is no, refused, or don’t know, then skip toQ13 Transgender Sex Partner Section

if Q8 is yes, then continue with this section

SAY: Now we would like to ask you some questions about having sex with women. Some of the questions may not apply to you. Please remember your answers will be kept private.

For these questions, "having sex" means oral, vaginal, or anal sex. Oral sex means your partner put her mouth on your vagina or you put your mouth on her vagina.

12. Have you ever had sex with a woman?

No………………….……………………………  0

Yes……………………………………………...  1

Refused to answer………………………………  R

Don't know……………..…………………….....  D

Transgender Sex Partners

SAY: The next questions are about transgender persons with whom you have had sex. By “transgender” we mean persons who were born either male or female but who identify or live as the opposite gender.

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If no transgender sex partners, or refused/don’t know then skip to the Drug Use History Section

3. In the past 12 months, with how many different transgender persons have you had vaginal or anal sex?

___ ___ ____ ____

[Refused = R, Don't know = D]

Last transgender sex partner

13a. Was the last transgender person you had sex with assigned a male or female sex at birth?

Male …………….……………………………  1

Female………………………………………...  2

Refused to answer………………………………  R

Don't know……………..…………………….....  D

DRUG USE HISTORY

Hormone Section

SAY: The next questions are about hormone use. This means hormones that you have used to change your body to make it more feminine in appearance.

14. Have you ever used hormones to change your body? This would include hormones

that are applied topically, taken orally, or injected.

If no, refused or don’t know then skip to the Silicone Section survey

No………………….……………………………  0

Yes………………………………………………  1

Refused to answer…..…………………………..  R

Don’t know………..……………………………  D

15. Have you ever injected or been injected with hormones?

If no, refused or don’t know then skip to the Silicone Section

No………….…………………………………..  0

Yes……………………………………………..  1

Refused to answer…………………………..….  R

Don’t Know……………..……………………...  D

16. How often did you get hormone injections in the past 12 months?

[Check only one.]

Never….…….…………………..…………………  0

If never, refused or don’t know then skip to the Silicone Section

More than once a day…………….……..…………  1

Once a day………………………………………….  2

More than once a week..……………………..........  3

Once a week………………………………………  4

More than once a month.………………………….  5

Once a month…………………………………….  6

Less than once a month..…………………….......  7

Refused to answer…..…………………………….  R

Don’t know………..………………………………  D

17. How are you getting hormones for your injections? [Check all that apply.]

Through a prescription from a doctor ………………  1

From someone on the street ……………………….  2

From a friend ……………………………....……..  3

Other ………………………………………………  4

(Specify___________________________________)

Refused to answer…………………………………  R

Don’t know………..………………………………  D

18. In the past 12 months, with how many people did you use a needle after someone

else had injected hormones with it?

[Refused = R, Don't know = D] __ __ __

Silicone Section

19. Have you ever injected, or been injected with, a substance like silicone to change the shape of your body?

No………………….……………………………….  0 Yes………………………………………………….  1

Refused to answer…………………………..………  R

Don’t Know……………..…………………….........  D

FLASHCARD A (Use with question 5)

Who you know personally that

• were born male but identify, live, act, or consider themselves to be a woman,

• are at least 15 years of age,

• live in [project area], and

• you’ve seen in the past 30 days.

Ending the interview

In looking at my watch, we are pretty much out of time. Do you have any last thoughts or questions? [If not, proceed]. [Continue recording] I want to thank you for coming today and sharing your thoughts, experiences, and opinions. The information you have provided will be very useful in helping to improve the questionnaire. [Hand the respondent the packet containing the thank-you letter, copy of consent form, and the $50]. In this packet you’ll see we have provided you with a copy of the consent form you read prior to the start of our interview. This is for your records [point to consent form]. We have also included a thank-you letter signed by the Director of the National Center for Health Statistics along with the $50 cash incentive we promised [point to thank you letter and envelope containing $50]. Can you please say that you have received everything for the tape recorder? [Wait for acknowledgement]. Again, thank you for all of your assistance today. [Turn off audio tape recorder at this time]. [Escort respondent out of the RTI interviewing room].

INTERVIEWER NOTE: Once the interview has concluded and the respondent has left the interviewing room, the audiotape, consent form and the modified participant data collection sheet will be turned over to an NCHS staff person.

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