Development and Testing of an HIV Prevention Intervention
Targeting Black Bisexually-Active Men
Attachment 3F
CROSS-SITE 3-MONTH FOLLOW-UP ASSESSSMENT and
SITE SPECIFIC QUESTIONS
(Note: Same 3-month follow-up for all sites;
PHMC and Nova Specific Sections Begin with Yellow Highlight.
CSU does not have site specific questions.)
Form Approved
OMB No. 0920-xxxx
Expiration Date:
MULTI-SITE INSTRUMENT
3-MONTH FOLLOW-UP
A. DEMOGRAPHICS
To begin the interview, I’d like to ask you some background questions. This lets us know something about the people who participate in the project. For the following questions, either check the appropriate box or fill in your answer in the spaces provided. Remember, your responses will be kept private.
1. Are you currently employed?
1 = Full time
2 = Part time/ Occasional
3 = Unemployed
4 = Retired
5 = Unable to work (disabled)
2 Are you currently a full time or part time student?
1 = Full time
2 = Part time
3 = Not a student
3. Currently, who do you live with most of the time? (Check ALL that apply)
Alone
Parents
Friends
Other relatives
Partner, lover, or spouse
Your children
Other people not mentioned (please specify):__________________________________________
4. Do you think of yourself as…
1 = Heterosexual or "Straight"
2 = Homosexual or Gay or same gender loving
3 = Bisexual
4 = Unsure/ Questioning
5 = Other ______________________________
6 = None
5. In the past 3 months, have ever spent one night without a regular place to stay? (a shelter, transitional housing facility, or a public or private place like a car or a park)
No Yes
6. Do you consider yourself to be currently homeless?
No Yes
B. HIV AND STD TESTING/HISTORY AND PERCEIVED RISK
Now we would like to ask some questions about your health. There are several diseases or infections that can be transmitted during sex. These are sometimes called venereal diseases or sexually transmitted diseases. We will be using the term sexually transmitted disease or STD to refer to them in the next few questions. Although HIV is a sexually transmitted disease, we will be asking you about it in a different part of this survey.
1. Since you answered the baseline survey (ACASI to insert date) have you been tested for STDs? Do not include an HIV test in this answer.
YES
NO
_777 Don’t know
_888 Prefer not to answer
For which STDs were you tested? (check box)
Gonorrhea
Syphilis
Genital herpes
Chlamydia
Genital Warts (also known as HPV or Human Papilloma Virus)
Hepatitis B virus
Hepatitis C virus
Some other STD, but not HIV (Please enter your answer here_____________)
3. For any checked above -
Were you told by a health care provider that you tested positive for (name STD)? YES
NO
_777 Don’t know
_888 Prefer not to answer
You are now going to be asked some questions about your HIV status and about your experiences taking the HIV test. Please remember that this survey is kept private. It is for HIV-positive men as well as HIV-negative men.
4. Since you answered the baseline survey (ACASI to insert date) have you been tested for HIV? Do not include an HIV test in this answer.
YES
NO (skip to …)
_777 Don’t know
_888 Prefer not to answer (skip to…)
5. Did you receive the test results?
NO
YES
___777 Don’t Know
___888 Prefer not to answer
6. What was the result of your last HIV test? (Choose one)
___1 HIV-Negative (Do not have HIV) (skip next two questions.)
___2 HIV-Positive (Do have HIV) Skip to #6.
___3 I did not get the result of my last test (go to next question)
___4 Inconclusive/Indeterminate (the result was neither positive or negative) (go to next question)
___888 Prefer not to answer
7. Where did you receive the HIV and STD testing?
Open response.
If HIV-positive, skip to next section.
Perceived Risk for HIV
On a scale from 1 to 10, with 1 being (extremely unlikely) and 10 being extremely likely, . . .
8. How likely is it that you are infected with HIV now? _____
___ 88 Prefer not to answer
9. How likely do you think it is that you will become infected with HIV in your lifetime? _____
___ 88 Prefer not to answer
Testing Intentions
10. How often do you plan to get tested in the future?
1. Every 3 months
2. Every 6 months
3. Once a year
4. Once every couple of years
5. I don’t plan to get tested in the future
C. LACK of SUPPORT/ ALIENATION
Please indicate how much you agree or disagree with the following statements.
1. There is no one I can talk to about the important decisions in my life.
1 = Strongly agree
2 = Agree somewhat
3 = Disagree somewhat
4 = Strongly disagree
8 = Prefer not to answer
2. I feel no one respects who I am.
1 = Strongly agree
2 = Agree somewhat
3 = Disagree somewhat
4 = Strongly disagree
8 = Prefer not to answer
3. No one really understands my most private worries and fears.
1 = Strongly agree
2 = Agree somewhat
3 = Disagree somewhat
4 = Strongly disagree
8 = Prefer not to answer
4. There is no one I can depend on to lend me $50 if I needed it for an emergency.
1 = Strongly agree
2 = Agree somewhat
3 = Disagree somewhat
4 = Strongly disagree
8 = Prefer not to answer
5. I often feel isolated and alone.
1 = Strongly agree
2 = Agree somewhat
3 = Disagree somewhat
4 = Strongly disagree
8 = Prefer not to answer
D. DISCLOSURE
The next few questions are about the people in your life who you may have told about your sexual relationships. Please answer the following questions as honestly as you can.
1. Have you told at least one NEW person that you have sex with men since (baseline date)? Please don’t include people who are part of this study.
0 = No (Skip to next section)
1 = Yes
8 = Prefer not to answer (SKIP to next section)
2. Who have you told that you have sex with men? (Check all that apply)
A My mother or the woman who raised me
0 = No
1 = Yes
2 = Do not have that person in my life
8 = Prefer not to answer
B My father or the man who raised me
0 = No
1 = Yes
2 = Do not have that person in my life
8 = Prefer not to answer
C My brother(s) [If have more than one, we would like to know if you have told at least one of your brothers]
0 = No
1 = Yes
2 = Do not have that person in my life
8 = Prefer not to answer
D My sister(s) [[If have more than one, we would like to know if you have told at least one of your sisters]
0 = No
1 = Yes
2 = Do not have that person in my life
8 = Prefer not to answer
E My minister or priest
0 = No
1 = Yes
2 = Do not have that person in my life
8 = Prefer not to answer
F My doctor or medical provider
0 = No
1 = Yes
2 = Do not have that person in my life
8 = Prefer not to answer
For each of the following statements, mark the response that best indicates your experience. Please be as honest as possible in your responses.
1----------2----------3-----------4----------5----------6----------7
Disagree Neither agree Agree
Strongly or disagree Strongly
3. I prefer to keep my sexual relationships rather private.
4. I keep careful control over who knows about my sexual relationships with men.
5. My sexual behavior is nobody's business.
6. If you are not careful about who you let know that you have sex with men, you can get very hurt.
7. I think very carefully before I let someone know that I have sex with other men.
8. My sexual orientation is a very personal and private matter.
E. IDENTITY/COMMUNITY AFFILIATION
The next few questions are about homosexual and bisexual men in the black community. Please indicate how strongly you agree or disagree with the following statements.
Integrated Race & Sexuality Scale (Scale limited to 4 items)
READ: Please indicate how strongly you agree or disagree with the following statements.
Black homosexual and bisexual men contribute to black communities.
1 Strongly Disagree
2 Disagree
3 Mildly Disagree
4 Mildly Agree
5 Agree
6 Strongly Agree
8 Prefer not to answer
Both my race and my sexuality are important to who I am as a man.
1 Strongly Disagree
2 Disagree
3 Mildly Disagree
4 Mildly Agree
5 Agree
6 Strongly Agree
8 Prefer not to answer
Black homosexual and bisexual men can play an important role in Black families.
1 Strongly Disagree
2 Disagree
3 Mildly Disagree
4 Mildly Agree
5 Agree
6 Strongly Agree
8 Prefer not to answer
A Black man who has sex with men can still be a strong man.
1 Strongly Disagree
2 Disagree
3 Mildly Disagree
4 Mildly Agree
5 Agree
6 Strongly Agree
8 Prefer not to answer
G. SEXUAL RISK
1. In general, are you sexually attracted to …
1 Only men
2 Mostly men
3 Both men and women equally
4 Mostly women
5 Only women
6 Other (SPECIFY):
We would like to ask you about your sexual experiences with males, females and transgender persons. By transgender, we mean both male-to-female, that is, those who were born male but now identify as women or as transgender/transsexual and female-to-male that is, those who were born female but now identify as men or as transgender/transsexual. Please answer each of the following questions as accurately as possible. Remember that you may prefer not to answer any question.
Now, we would like to ask you about the people you have recently had sex with. For the following questions, we will ask you about oral, vaginal and anal sex. Oral sex refers to mouth on penis, vagina, or anus. Vaginal sex refers to penis in vagina. Anal sex refers to penis in butt or anus.
How many women have you had sex with in the past 3 months? By sex we mean fingering, hand jobs, oral sex, vaginal sex, or anal sex?
How many men have you had sex with in the past 3 months? By sex we mean jacking off, oral sex, or anal sex?
How many male-to-female transgender women have you had sex with in the past 3 months? By sex we mean jacking off, oral sex, vaginal sex, anal sex?
For the following questions, we will ask you about your experiences with main partners. We define main partner as someone with whom you have a relationship in which there is both emotional and sexual involvement (e.g., boyfriend / girlfriend, husband / wife, partner, lover).
How many main partners have you had since the age of 18? __
How many of these main partners have been women?
2 How many of these main partners have been men?
3 How many of these main partners have been male-to-female transgender?
In the future, do you see yourself being with main partners who are (mark all that apply).
Women
Men
Male-to-female transgender
Female-to-male transgender
I do not see myself having main partners in the future
A. MAIN Male Partners
Please answer the following questions thinking about a ‘main’ male sex partner that you have had in the past 3 months. By a main partner, we mean someone you are in or have been in a relationship with like (sites provide examples).
1. During the past 3 months, how many main male partners have you had ?________
(IF JUST ONE MAIN MALE PARTNER)
1a. Please type the initials or nickname of your main male partner.
________ (MAIN MALE PARTNER 1 INITIALS)
(IF MORE THAN ONE MAIN PARTNER, READ)
1b. Please type the initials or nickname of your most recent main male partner.
________ (MAIN MALE PARTNER 1 INITIALS)
2. How long have you been sexually involved with MAIN MALE PARTNER 1?
(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)
Years_____
Months____
Weeks_____
3. During the time you were sexually involved with MAIN MALE PARTNER 1, did you have sex with anyone else?
1= Yes
2= No
8= Prefer not to answer
4. During the time you were sexually involved with MAIN MALE PARTNER 1, did he have sex with anyone else?
1= Yes
2= No
3= I do not know
8= Prefer not to answer
5. What is MAIN MALE PARTNER 1’s current HIV status?
1 = HIV-positive (He has HIV) (Skip to 5)
2 = HIV-negative (He does not have HIV) (Skip to 5)
3 = I do not know or not sure of his status
4 = Prefer not to answer
6. Could you tell me what you think his HIV status is? (Skip to 6)
1 = He has HIV
2 = He does not have HIV
7. How did you learn about his HIV status?
1 He told me directly
2 I guessed based on other things he has talked about
3 I guessed based on things I had seen in his home
4 Someone else told me
5 His physical appearance
6 We got tested together
7 I saw his test results
8 I went with him to get his test results
9 Other
8. Does he know your HIV status?
1. Yes
2. No
3. I don’t know
9. In the past 3 months, what types of sex did you engage in with (MAIN PARTNER 1)? Mark all that apply.
Anal sex (topping or bottoming) (if NOT checked SKIP to non-main male partner section)
Oral sex (sucking or getting sucked)
Jacking off (SKIP to next section)
We did not have sex
10. How many times in the past 3 months did you top (MAIN MALE PARTNER 1) (put your penis in his butt) WITHOUT a condom?_______
11. How many times in the past 3 months did you top (MAIN MALE PARTNER 1) WITH a condom?_______
12. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 1) (he put his penis in your butt) WITHOUT a condom?_______
13. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 1) WITH a condom?_______
(IF JUST ONE MAIN MALE PARTNER) Skip to next section.
(IF MORE THAN ONE MAIN PARTNER, READ) Please answer the following questions about your second to last main male partner.
Please type the initials or nickname of the other main male partner you have had in the past 3 months.
________ (MAIN MALE PARTNER 2 INITIALS)
14. How long have you been sexually involved with MAIN MALE PARTNER 2?
(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)
Years_____
Months____
Weeks_____
15. During the time you were sexually involved with MAIN MALE PARTNER 2, did you have sex with anyone else?
1= Yes
2= No
8= Prefer not to answer
16. During the time you were sexually involved with MAIN MALE PARTNER 2, did he have sex with anyone else?
1= Yes
2= No
3= I do not know
8= Prefer not to answer
17. What is MAIN MALE PARTNER 2’s current HIV status?
1 = HIV-positive (He has HIV) (Skip to 15)
2 = HIV-negative (He does not have HIV) (Skip to 15)
3 = I do not know or not sure of his status
4 = Prefer not to answer
18. Could you tell me what you think his HIV status is? (Skip to 16)
1 = He has HIV
2 = He does not have HIV
19. How did you learn about his HIV status?
1 He told me directly
2 I guessed based on other things he has talked about
3 I guessed based on things I had seen in his home
4 Someone else told me
5 His physical appearance
6 We got tested together
7 I saw his test results
8 I went with him to get his test results
9 Other
20. Does he know your HIV status?
1 Yes
2 No
3 I don’t know
21. In the past 3 months, what types of sex did you engage in with (MAIN MALE PARTNER 2)? Mark all that apply.
Anal sex (topping or bottoming) (if NOT checked SKIP to next section)
Oral sex (sucking or getting sucked)
Jacking off
We did not have sex
22. How many times in the past 3 months did you top (MAIN MALE PARTNER 2) WITHOUT a condom?_______
23. How many times in the past 3 months did you top (MAIN MALE PARTNER 2) WITH a condom?_______
24. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 2) WITHOUT a condom?_______
25. How many times in the past 3 months did you bottom for (MAIN MALE PARTNER 2) WITH a condom?_______
B. Non-Main Male Partners (not including main sex partners above)
[INTRO FOR MEN WITH BOTH MAIN AND NON-MAIN MALE PARTNERS] Now I am going to ask about sexual activities with men other than a main partner in the past 3 months. We will call these men non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.
1. How many non-main male sex partners did you have in the past 3 months?
________ (If ZERO SKIP to next applicable section)
[INTRO FOR MEN WITH NO MAIN PARTNERS] Now I am going to ask you about sexual activities with men other than main partners in the past 3 months. We will call them non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.
1a. How many male sex partners did you have in the past 3 months?
________ (If ZERO SKIP to female partner section)
2. How often were you high on drugs or alcohol when you had sex with these XX men in the past 3 months?
Always
Most of the time
Half of the time
A few times
Never
Number of Non-Main Male Partners by HIV Status
You said that you had sex with XX non-main male sex partners in the past 3 months,
3. How many of these XX men were you unsure or did not know their HIV status?_______ (If ‘0’,SKIP questions about unknown status partners)
4. How many of these XX men did you believe were HIV-positive (had the virus that causes AIDS)? _______ (If ‘0’, SKIP questions about HIV positive partners)
5. How many of these XX men did you believe were HIV-negative (did NOT have the virus that causes AIDS)?_____ (If ‘0’, SKIP questions about HIV negative non-main partners)
Anal Sex with Unknown Status non-main male partners
6. How many of your (##) male non-main partners whose HIV status you did not know did you have anal sex with (topping or bottoming) in the past 3 months? ________ PARTNERS
7. How many times in the past 3 months did you top (put your penis in their butt) these (Q17##) partners without a condom? _______ TIMES
8. How many times in the past 3 months did you top these (##) partners with a condom? _______TIMES
9. How many times in the past 3 months did you bottom (they put their penis in your butt) these (Q17##) partners without a condom? _______ TIMES
10. How many times in the past 3 months did you bottom these (Q17##) partners with a condom? _______ TIMES
Anal Sex with HIV-positive non-main male partners
11. How many of your ## HIV-positive male non-main partner(s) did you have anal sex with (topping or bottoming) in the past 3 months?________ PARTNERS
12. How many times in the past 3 months did you top (put your penis in their butt) these ## partners without a condom? _______ TIMES
13. How many times in the past 3 months did you top these ## partners with a condom? _______ TIMES
14. How many times in the past 3 months did you bottom (they put their penis in your butt) these ## partners without a condom? _______TIMES
15. How many times in the past 3 months did you bottom these ## partners with a condom?
_______ TIMES
Anal Sex with HIV-negative non-main male partners
16. How many of your (##) HIV-negative male non-main partner(s) did you have anal sex with (topping or bottoming) in the past 3 months?________
17. How many times in the past 3 months did you top (put your penis in their butt) these (Q7##) partners without a condom? _______
18. How many times in the past 3 months did you top these ## partners with a condom?
19. How many times in the past 3 months did you bottom (they put their penis in your butt) these ## partners without a condom? _______
20. How many times in the past 3 months did you bottom (they put their penis in your butt) these ## partners with a condom? _______
21. With how many of these XX (total non-main anal sex partners) men did you talk about your HIV status before having sex? _____
Exchange Sex with Male Partners
22. In the past 3 months have you given or received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex with a man?
1) Yes – PROCEED WITH EXCHANGE SEX QUESTIONS
2) No – SKIP TO FEMALE PARTER QUESTIONS
IF YES TO EXCHANGE SEX WITH MALES
22a. In the past 3 months, how many men have you given any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex?
___________ NUMBER OF PARTNERS HE PAID FOR SEX
22b. In the past 3 months, from how many men have you received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex?
___________ NUMBER OF PARTNERS WHO PAID HIM FOR SEX
22c. How many times in the past 3 months did a male partner pay you and you had anal sex WITHOUT a condom?______ TIMES HE WAS PAID FOR ANAL SEX WITHOUT CONDOM
22d. How many times in the past 3 months did a male partner pay you and you had anal sex WITH a condom?______ TIMES HE WAS PAID FOR ANAL SEX WITH CONDOM
22e. How many times in the past 3 months did you pay a male partner you had anal sex WITHOUT a condom?______ TIMES HE PAID FOR ANAL SEX WITHOUT CONDOM
22f. How many times in the past 3 months did you pay a male partner you had anal sex WITH a condom?______ TIMES HE PAID FOR ANAL SEX WITH CONDOM
C. MAIN Female Partners
Please answer the following questions thinking about a ‘main’ female sex partner that you have had in the past 3 months. By a main partner, we mean someone you are or have been in a relationship with like ‘your woman‘, girlfriend, or wife (sites provide examples).
During the past 3 months, how many main female partners have you had?
________MAIN FEMALE PARTNERS
IF MORE THAN ONE MAIN FEMALE PARTNER, READ) Please answer the following questions about your most recent main female partner.
1a. Please type the initials or nickname of your most recent main female partner.
________ MAIN FEMALE PARTNER 1 INITIALS
2. How long have you been sexually involved with MAIN FEMALE PARTNER 1?
(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)
Years_____
Months____
Weeks_____
3. During the time you were sexually involved with MAIN FEMALE PARTNER 1, did you have sex with anyone else?
1= Yes
2= No
8= Prefer not to answer
4. During the time you were sexually involved with MAIN FEMALE PARTNER 1, did she have sex with anyone else?
1= Yes
2= No
3= I do not know
8= Prefer not to answer
5. What is MAIN FEMALE PARTNER 1’s current HIV status?
1 = HIV-positive (She has HIV) (Skip to 5)
2 = HIV-negative (She does not have HIV) (Skip to 5)
3 = I do not know or not sure of her status
4 = Prefer not to answer
6. Could you tell me what you think her HIV status is? (Skip to 6)
1 = She has HIV
2 = She does not have HIV
7. How did you learn about her HIV status?
1 She told me directly
2 I guessed based on other things she has talked about
3 I guessed based on things I had seen in her home
4 Someone else told me
5 Her physical appearance
6 We got tested together
7 I saw her test results
8 I went with her to get his test results
9 Other
8. Does she know your HIV status?
1 Yes
2 No
3 I don’t know
9. In the past 3 months, what types of sex did you engage in with MAIN FEMALE PARTNER 1? Mark all that apply.
Vaginal or anal sex (if not marked, SKIP to non-main female partners’ section)
Oral sex or going down/ getting sucked
Fingering her/getting a hand job / masturbating
We did not have sex
Vaginal Sex and Condom Use with Main Female Partner 1
10. How many times in the past 3 months did you have vaginal sex (penis in vagina) with MAIN FEMALE PARTNER 1 WITHOUT a condom?_______
11. How many times in the past 3 months did you have vaginal sex with MAIN FEMALE PARTNER 1 WITH a condom?_______
Anal Sex and Condom Use with Main Female Partner 1
12. How many times in the past 3 months did you have anal sex (penis in the butt) with MAIN FEMALE PARTNER 1 WITHOUT a condom?_______
13. How many times in the past 3 months did you have anal sex with MAIN FEMALE PARTNER 1 WITH a condom?_______
14. Does MAIN FEMALE PARTNER 1 know that you have ever had sex with men?
1=Yes
2=No
15. Does MAIN FEMALE PARTNER know that you had sex with a man in the past year?
1=Yes
2=No
(IF JUST ONE MAIN FEMALE PARTNER) Skip to non-main female partner section.
(IF MORE THAN ONE MAIN FEMALE PARTNER, READ) Please answer the following questions about your second-to-last main female partner.
Please type the initials or nickname of another main female partner you have had in the past 3 months.
________ (MAIN FEMALE PARTNER 2 INITIALS)
16. How long have you been sexually involved with MAIN FEMALE PARTNER 1?
(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)
Years_____
Months____
Weeks_____
17. During the time you were sexually involved with MAIN FEMALE PARTNER 2, did you have sex with anyone else?
1= Yes
2= No
8= Prefer not to answer
18. During the time you were sexually involved with MAIN FEMALE PARTNER 2, did she have sex with anyone else?
1= Yes
2= No
3= I do not know
8= Prefer not to answer
19. What is MAIN FEMALE PARTNER 2’s current HIV status?
1 = HIV-positive (She has HIV) (Skip to 17)
2 = HIV-negative (She does not have HIV) (Skip to 17)
3 = I do not know or not sure of her status
4 = Prefer not to answer
20. Could you tell me what you think her HIV status is? (Skip to 18)
1 = She has HIV
2 = She does not have HIV
21. How did you learn about her HIV status?
1 She told me directly
2 I guessed based on other things she has talked about
3 I guessed based on things I had seen in her home
4 Someone else told me
5 Her physical appearance
6 We got tested together
7 I saw her test results
8 I went with her to get his test results
9 Other
22. Does she know your HIV status?
1 Yes
2 No
3 I don’t know
23. In the past 3 months, what types of sex did you engage in with FEMALE MAIN PARTNER 2?
Mark all that apply.
Vaginal or anal sex (fucking) (if not marked, SKIP to non-main female partners’ section)
Oral sex or going down/ getting sucked
Fingering her/ getting a hand job / masturbating
We did not have sex
Vaginal Sex and Condom Use with Female Main Partner 2
24. How many times in the past 3 months did you have vaginal sex (penis in vagina) with FEMALE MAIN PARTNER 2 WITHOUT a condom?_______ TIMES
25. How many times in the past 3 months did you have vaginal sex with FEMALE MAIN PARTNER 2 WITH a condom?_______ TIMES
Anal Sex and Condom Use with Female Main Partner 2
26. How many times in the past 3 months did you have anal sex (penis in the butt) with FEMALE MAIN PARTNER 2 WITHOUT a condom?_______ TIMES
27. How many times in the past 3 months did you have anal sex with FEMALE MAIN PARTNER 2 WITH a condom?_______ TIMES
28. Does FEMALE MAIN PARTNER 2 know that you have ever had sex with men?
1=Yes
2=No
29. Does FEMALE MAIN PARTNER 2 know that you had sex with a man in the past year?
1=Yes
2=No
D. Non-Main Female Partners
[INTRO FOR MEN WITH BOTH MAIN AND NON-MAIN FEMALE PARTNERS] Now I am going to ask about sexual activities with women other than your main partner in the past 3 months. We will call these non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.
1. How many non-main female sex partners did you have in the past 3 months?
______ NUMBER OF NON-MAIN FEMALE PARTNERS
(If ZERO SKIP to TRANSGENDER section)
[INTRO FOR MEN WITH NON-MAIN FEMALE PARTNERS ONLY] Now I am going to ask about sexual activities with women other than main partners in the past three months. We will call them non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.
2. How many non-main female sex partners did you have in the past 3 months?
______ NUMBER OF NON-MAIN FEMALE PARTNERS
(If ZERO SKIP to TRANSGENDER section)
3. How often were you high on drugs or alcohol when you had sex with these XX female partner(s) in the past 3 months?
Always
Most of the time
Half of the time
A few times
Never
4. Did any of these XX female partners know that you have ever had sex with men?
1=Yes
2=No
5. Did any of these XX female partners know that you had sex with a man in the past year?
1=Yes
2=No
Number of Non-Main Female Partners and HIV Status
6. How many of your XX non-main female sex partners in the past 3 months were you unsure/ did not know their HIV status?_______ (If ‘0’, SKIP questions 23-29) NOTE: We will call these unknown status partners.
7. How many of your XX non-main female sex partners in the past 3 months did you believe were HIV-positive (had the virus that causes AIDS)? _______ (If ‘0’, SKIP questions 16-22)
8. How many of your XX non-main female sex partners in the past 3 months did you believe were HIV-negative (did NOT have the virus that causes AIDS)?_____ (If ‘0’, SKIP questions 9-15)
Vaginal and Anal Sex with Unknown Status non-main male partners
9. How many of your (##) female non-main partner(s) whose status you did not know did you have vaginal or anal sex with in the past 3 months? ________ PARTNERS
10. How many times in the past 3 months did you have vaginal sex with these (##) partners without a condom? _______TIMES
11. How many times in the past 3 months did you have vaginal sex with these ## partners with a condom? ______TIMES
12. How many times in the past 3 months did you have anal sex with these ## partners without a condom? _______TIMES
13. How many times in the past 3 months did you have anal sex with these ## partners with a condom? _______TIMES
Vaginal and anal Sex with HIV-positive non-main female partners
14. How many of your (##) HIV-positive female non-main partner(s) did you have vaginal or anal sex with in the past 3 months? ________ PARTNERS
15. How many times in the past 3 months did you have vaginal sex with these (Q7##) partners without a condom? _______TIMES
16. How many times in the past 3 months did you have vaginal sex with these ## partners with a condom? ______TIMES
17. How many times in the past 3 months did you have anal sex with these ## partners without a condom? _______TIMES
18. How many times in the past 3 months did you have anal sex with these ## partners with a condom? _______TIMES
Vaginal and Anal Sex with HIV-negative non-main female partners
19. How many of your (##) HIV-negative female non-main partner(s) did you have vaginal or anal sex with in the past 3 months?________ PARTNERS
20. How many times in the past 3 months did you have vaginal sex with these (Q7##) partners without a condom? _______TIMES
21. How many times in the past 3 months did you have vaginal sex with these ## partners with a condom? ______TIMES
22. How many times in the past 3 months did you have anal sex with these ## partners without a condom? _______TIMES
23. How many times in the past 3 months did you have anal sex with these ## partners with a condom? _______TIMES
24. With how many of these XX (total non-main vaginal and anal female sex partners) women did you talk about your HIV status before having sex? _____
EXCHANGE SEX
25. In the past 3 months, have you given or received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex with woman?
1) Yes
2) No (skip to next applicable section)
25a. In the past 3 months, how many women have you given any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex? ___________
25b. In the past 3 months, from how many women have you received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex? ___________
25c. How many times in the past 3 months did a woman pay you and you had vaginal sex WITHOUT a condom?______
25d. How many times in the past 3 months did a woman pay you and you had vaginal sex WITH a condom?______
25e. How many times in the past 3 months did you pay a woman you had anal sex WITHOUT a condom?______
25f. How many times in the past 3 months did you pay a woman you had anal sex WITH a condom?
______
E. Main Transgender Partners
Please answer the following questions thinking about a ‘main’ transgender sex partner that you have had in the past 3 months. By a main partner, we mean someone you are or have been in a relationship with like (sites provide examples).
1. During the past 3 months, how many main transgender women partners have you had? ________
(IF MORE THAN ONE MAIN TRANSGENDER PARTNER, READ) Please answer the following questions about your most recent main transgender partner.
Please type the initials or nickname of your most recent main transgender partner
__________ (MAIN TRANSGENDER PARTNER 1 INITIALS)
2. How long have you been sexually involved with MAIN TRANSGENDER PARTNER 1?
(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)
Years_____
Months____
Weeks_____
3. During the time you were sexually involved with MAIN TRANSGENDER PARTNER 1, did you have sex with anyone else?
1= Yes
2= No
8= Prefer not to answer
4. During the time you were sexually involved with MAIN TRANSGENDER PARTNER 1, did she have sex with anyone else?
1= Yes
2= No
3= I do not know
8= Prefer not to answer
5. What is MAIN TRANSGENDER PARTNER 1’s current HIV status?
1 = HIV-positive (She has HIV) (Skip to 5)
2 = HIV-negative (She does not have HIV) (Skip to 5)
3 = I do not know or not sure of her status
4 = Prefer not to answer
6. Could you tell me what you think her HIV status is? (Skip to 6)
1 = She has HIV
2 = She does not have HIV
7. How did you learn about her HIV status?
1 She told me directly
2 I guessed based on other things she has talked about
3 I guessed based on things I had seen in her home
4 Someone else told me
5 Her physical appearance
6 We got tested together
7 I saw her test results
8 I went with her to get his test results
9 Other
8. Does she know your HIV status?
1 Yes
2 No
3 I don’t know
9. In the past 3 months, what types of sex did you engage in with MAIN TRANSGENDER PARTNER 1? Mark all that apply.
Vaginal or anal sex (fucking) (if NOT checked SKIP to next section)
Oral sex or sucking or getting sucked
Jacking off/ fingering/getting a hand job
We did not have sex.
10. How many times in the past 3 months did you put your penis in the vagina or butt of MAIN TRANSGENDER PARTNER 1WITHOUT a condom?_______
11. How many times in the past 3 months did you put your penis in the vagina or butt of MAIN TRANSGENDER PARTNER 1WITH a condom?_______
(IF JUST ONE MAIN PARTNER) Skip to next section.
(IF MORE THAN ONE MAIN TRANSGENDER PARTNER)
Please type the initials or nickname of another main transgender partner you have had in the past 3 months.
(MAIN TRANSGENDER PARTNER 2 INITIALS)
12. How long have you been sexually involved with MAIN TRANSGENDER PARTNER 2?
(Only provide answer for the longest period of time. If you were involved with someone for 2 years, 3 months, 1 week, just answer 2 years)
Years_____
Months____
Weeks_____
13. During the time you were sexually involved with MAIN MALE PARTNER 2, did you have sex with anyone else?
1= Yes
2= No
8= Prefer not to answer
14. During the time you were sexually involved with MAIN MALE PARTNER 2, did he have sex with anyone else?
1= Yes
2= No
3= I do not know
8= Prefer not to answer
15. What is MAIN TRANSGENDER PARTNER 2’s current HIV status?
1 = HIV-positive (She has HIV) (Skip to 13)
2 = HIV-negative (She does not have HIV) (Skip to 13)
3 = I do not know or not sure of her status
4 = Prefer not to answer
16. Could you tell me what you think her HIV status is? (Skip to 14)
1 = She has HIV
2 = She does not have HIV
17. How did you learn about her HIV status?
1 She told me directly
2 I guessed based on other things she has talked about
3 I guessed based on things I had seen in her home
4 Someone else told me
5 Her physical appearance
6 We got tested together
7 I saw her test results
8 I went with her to get his test results
9 Other
18. Does she know your HIV status?
1 Yes
2 No
3 I don’t know
19. In the past 3 months, what types of sex did you engage in with TRANSGENDER PARTNER 2? Mark all that apply.
Vaginal or anal sex (fucking) (if NOT checked SKIP to next section)
Oral sex or sucking or getting sucked
Jacking off/ fingering/getting a hand job
We did not have sex.
20. How many times in the past 3 months did you put your penis in the vagina or butt of TRANSGENDER PARTNER 2WITHOUT a condom?_______
21. How many times in the past 3 months did you put your penis in the vagina or butt of TRANSGENDER PARTNER 2 WITH a condom?_______
F. Other Transgender Partners (not including main sex partners above)
[INTRO FOR MEN WITH MAIN AND NON-MAIN TRANSGENDER PARTNERS] Now I am going to ask about sexual activities with transgender partners other than your main partner in the past 3 months. We will call these non-main partners. We realize that some of the questions are very personal. The answers that you give will be kept private.
1. How many non-main transgender sex partners did you have in the past 3 months?
__________ (IF ZERO SKIP to next applicable section)
[INTRO FOR MEN WITH NON-MAIN TRANSGENDERPARTNERS ONLY] Now I am going to ask you about sexual activities with non-main transgender partners in the past 3 months. We realize that some of the questions are very personal. The answers that you give will be kept private.
1a. How many non-main transgender sex partners did you have in the past 3 months?
__________ (IF ZERO SKIP to next applicable section)
2. How often were you high on drugs or alcohol when you had sex with these XX non-main transgender partner(s) in the past 3 months?
Always
Most of the time
Half of the time
A few times
Never
3. How many of these ## non-main transgender sex partners in the past 3 months did you believe were HIV-negative (did NOT have the virus that causes AIDS)?_____ (If ‘0’, SKIP questions 9-14)
4. How many of your non-main transgender sex partners in the past 3 months did you believe were HIV-positive (had the virus that causes AIDS)? _______ (If ‘0’, SKIP questions 15-20)
5. How many of your non-main transgender sex partners in the past 3 months were you unsure about/ did not know their HIV status?_______ (If ‘0’, SKIP questions 21-26) NOTE: We will call these unknown status partners.
HIV-negative transgender partners
6. Thinking about your NN HIV-negative non-main transgender partner(s), how many in the past 3 months did you have vaginal sex (penis in vagina) or anal sex (penis in butt) with?________
7. Thinking about your NX HIV-negative non-main transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITHOUT a condom?_______
8. Thinking about your NX HIV-negative non-main transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITH a condom?_______
HIV-positive transgender partners
9. Thinking about your PP HIV-negative transgender partner(s), how many in the past 3 months did you have vaginal sex (penis in vagina) or anal sex (penis in butt) with?________
10. Thinking about your PX HIV-positive transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITHOUT a condom?_______
11. Thinking about your PX HIV-positive transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITH a condom?_______
HIV-unknown transgender partners
12. Thinking about your UU unknown status transgender partner(s), how many in the past 3 months did you have vaginal sex (penis in vagina) or anal sex (penis in butt) with?________
13. Thinking about your UU HIV-unknown transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITHOUT a condom?_______
14. Thinking about your UU HIV-unknown transgender partner(s), how many times in the past 3 months did you put your penis in their vagina or butt WITH a condom?_______
15. With how many of these XX (total non-main vaginal and anal sex partners) transgender partners did you talk about your HIV status before having sex? _____
EXCHANGE SEX
16. In the past 3 months, have you given or received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex with a transgender woman?
1) Yes
2) No (skip to next applicable section)
16a. In the past 3 months, how many transgender partners have you given any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex? ___________
16b. In the past 3 months, from how many transgender partners have you received any type of payment (for example, money, drugs, a place to stay) in exchange for any type of sex?___________
16c. How many times in the past 3 months did a transgender partner pay you and you had vaginal sex WITHOUT a condom?______
16d. How many times in the past 3 months did a transgender partner pay you and you had vaginal sex WITH a condom?______
16e. How many times in the past 3 months did you pay a transgender partner and you had anal sex WITHOUT a condom?______
16f. How many times in the past 3 months did you pay a transgender partner and you had anal sex WITH a condom? ______
G. MENTAL HEALTH
READ: I am going to show you a list of problems and complaints that people sometimes have. For each one, tell me how much that problem has bothered or distressed you during the past week, including today. Please tell me whether each problem has bothered you not at all, a little bit, moderately, quite a bit, or extremely.
HOW OFTEN DO YOU EXPERIENCE . . .
1. Faintness or dizziness? (Choose one)
1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
2. Feeling no interest in things? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
3. Nervousness or shakiness inside? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
4. Pains in heart or chest? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
5. Feeling lonely? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
6. Feeling tense or keyed up? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
7. Nausea or upset stomach? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
8. Feeling blue or sad? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
9 Not Applicable
9. Being suddenly scared for no reason? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
10. Trouble getting your breath? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
11. In the past week, how much have you been bothered by...having urges to beat, injure, or harm someone? (Choose one)
1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
8 Prefer not to answer
12. In the past week, how much have you been bothered by...having urges to break or smash things? (Choose one) 1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
8 Prefer not to answer
13. Feelings of worthlessness? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
14. Episodes of terror or panic? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
15. Numbness or tingling in parts of your body? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
16. Feeling hopeless about the future? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
17. Feeling so restless that you could not sit still? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
18. Feeling weak in parts of your body? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
19. Thoughts of ending your life? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
20. Feeling fearful? (Choose one) 1 Not At All
2 A Little Bit
3 Moderately
4 Quite A Bit
5 Extremely
8 Refuse to Answer
Hostility Items
21. Feeling easily annoyed or irritated (Choose one)
1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
8 Prefer not to answer
22. ..temper outbursts that you could not control? (Choose one)
1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
8 Prefer not to answer
5 Extremely
8 Prefer not to answer
23. ....having urges to beat, injure, or harm someone? (Choose one)
1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
8 Prefer not to answer
24. ...having urges to break or smash things? (Choose one)
1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
8 Prefer not to answer
25 ...getting into frequent arguments? (Choose one)1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely
8 Prefer not to answer
H. SUBSTANCE USE
The next section asks about your experience of using alcohol and other substances. These include substances that can be smoked, swallowed, snorted, inhaled, injected or taken in the form of pills. Remember that all of your answers will be kept private, and that you can skip any question you do not want to answer.
1. Have you ever been in an alcohol recovery program or drug treatment program?
0=No
1=Yes
8=Prefer not to answer
2. In the past 90 days, how often did you drink any kind of beverage that contained alcohol?
1=Three or more times a day
2=Two times a day
3=Once a day
4=Nearly every day
5=Three or four times a week
6=Once or twice a week
7=Two or three times a month
8=About once a month
9=Less than once a month
0 = no alcohol use in the last 90 days (SKIP TO #4 BELOW)
3. In the last 90 days, on a typical day when you drank alcohol, how many drinks did you have?
By a drink I mean a can or bottle of beer, wine cooler, glass of wine, mixed drink, or a shot of hard liquor.
_______ # of drinks
4. During the last 3 months have you had a feeling of guilt or remorse after drinking?
0=No
1=Yes
8=Prefer not to answer
9=Don’t Know
5. During the last 3 months has a friend or a family member ever told you about things you said or did while you were drinking that you could not remember?
0=No
1=Yes
8=Prefer not to answer
9=Don’t Know
6. During the last 3 months have you failed to do what was normally expected from you because of drinking?
0=No
1=Yes
8=Prefer not to answer
9=Don’t Know
7. Do you sometimes take a drink when you first get up in the morning?
0=No
1=Yes
8=Prefer not to answer
9=Don’t Know
|
Never |
Once or Twice |
Monthly |
Weekly |
Daily or Almost Daily |
8. Used marijuana (weed, pot, etc.)?
|
0 |
1 |
2 |
3 |
4 |
9. Used powdered cocaine?
|
0 |
1 |
2 |
3 |
4 |
10. Used crack or rock cocaine?
|
0 |
1 |
2 |
3 |
4 |
11. Used methamphetamine (crystal meth, tina, crank, etc)?
|
0 |
1 |
2 |
3 |
4 |
12. Used poppers or inhaled nitrites?
|
0 |
1 |
2 |
3 |
4 |
13. Used Club Drugs (Ecstacy, GHB, Special K, etc.) ?
|
0 |
1 |
2 |
3 |
4 |
14. Used heroin ?
|
0 |
1 |
2 |
3 |
4 |
15. Used other opioids that were not prescribed to you like OxyContin, Codeine, Methadone, Vicodin, or Demerol
|
0 |
1 |
2 |
3 |
4 |
16. Used depressants that were not prescribed to you like Valium, Xanax, Halcion, Rohypnol, Mebaral, Klonopin |
0 |
1 |
2 |
3 |
4 |
17. Used other stimulants that were not prescribed to you like Ritalin and Dexedrine |
0 |
1 |
2 |
3 |
4 |
18. In the past three months, how often have you used Viagra, Cialis or Levitra without a prescription?
|
0 |
1 |
2 |
3 |
4 |
I. INCARCERATION
For the following questions, please focus on the last three months. We ask about having been in jail, prison or a detention facility in order to better understand how to serve people with this experience. We do not ask about why you may have gone to prison or jail
1. In the last three months, have you spent more than one day in a jail, prison or detention facility? 1 Yes
2 No (Skip to question #5)
8 Prefer not to answer
2. In the last three months, how much time have you spent in jail, prison, or a detention facility altogether?
Less than 1 week
b. 7-30 days
c. 1-3 months
3. When were you last incarcerated? Enter the year and month that that you were last released from a jail, prison, or detention facility.
__ __ / __ __ __ __ mm / yyyy
4. Are you currently on parole or probation?
1 Yes
2 No
8 Prefer not to answer
READ: Remember, none of the information you report will be shared with your parole or probation officer.
The next questions are about any time that you spent incarcerated during your entire lifetime. The questions ask specifically about sex with other men or with transgender female partners. Unless otherwise specified, sex refers vaginal, anal, or oral sex or mutual masturbation.
5. Did you ever have sex with a man or a transgender female while you were in prison or jail?
1 = Yes
2 = No (skip to 2)
8 = Prefer not to answer
6a. Not including any childhood sexual contact, did your first sexual experience with a man or transgender female occur while you were in jail or prison?
1 = Yes
2 = No
8 = Prefer not to answer
6. At any point in your lifetime, when you were in prison or jail, did you participate in any of the following with a man or a transgender female?
a. Mutual masturbation?
1 = Yes
2 = No
8 = Prefer not to answer
b. Oral sex?
1 = Yes
2 = No
8 = Prefer not to answer
c. Anal sex?
1 = Yes
2 = No
8 = Prefer not to answer
7. During the last three months, were you coerced or forced to engage in sexual activity with someone while you were in prison or jail?
1 = Yes
2 = No
8 = Prefer not to answer
J. HIV STIGMA
The next set of questions asks about some of your feelings and opinions about HIV/AIDS. Please indicate how much you agree or disagree with the following statements:
1. People who have HIV or AIDS should be isolated from the rest of society.
1. Strongly Disagree
2. Disagree
3. Agree
4. Strongly Agree
8. Prefer not to answer
2. People who have HIV or AIDS should only date other HIV positive people.
1. Strongly Disagree
2. Disagree
3. Agree
4. Strongly Agree
8. Prefer not to answer
3. People who have HIV or AIDS are not sexually desirable.
1. Strongly Disagree
2. Disagree
3. Agree
4. Strongly Agree
8. Prefer not to answer
4. People who have HIV or AIDS are more sexually promiscuous than most people.
1. Strongly Disagree
2. Disagree
3. Agree
4. Strongly Agree
8. Prefer not to answer
5. The promiscuity of people who are gay is the reason why HIV/AIDS exists.
5. The promiscuity of people who are gay is the reason why HIV/AIDS exists.
1. Strongly Disagree
2. Disagree
3. Agree
4. Strongly Agree
8. Prefer not to answer
6. AIDS is a punishment from God.
1. Strongly Disagree
2. Disagree
3. Agree
4. Strongly Agree
8. Prefer not to answer
K. TREATMENT OPTIMISM
The following section refers to combination treatments, “Drug Cocktails” or HAART for HIV/AIDS. Please indicate how much you agree with each statement.
____________
Strongly Somewhat Somewhat Strongly
Disagree Disagree Agree Agree
______
1. HIV positive persons who take HIV
medications are less likely to infect
their sex partners during unsafe sex. 1 2 3 4
2. New AIDS treatments make it
easier to relax about unsafe sex. 1 2 3 4
3. Men like me are less worried
about HIV because of new treatments. 1 2 3 4
4. My friends practice more unsafe
sex because of new HIV treatments. 1 2 3 4
5. It is safe to have anal sex without a condom
with an HIV positive man who has an
undetectable viral load. 1 2 3 4
Self efficacy for disclosure of HIV status
The
following section asks questions about disclosing your HIV status to
sexual partners who are HIV-negative or who don’t know their
own HIV status. Remember, all of your answers are private.
7. I can disclose my HIV status before having sex, even to a really hot new sex partner.
1 =
Absolutely sure I cannot
2 = Somewhat sure I cannot
3 =
Unsure if I can or cannot
4 = Somewhat sure I can
5 =
Absolutely sure I can
8. I can disclose my HIV status before having sex, even to a really hot new sex partner who I think might be HIV negative.
1 =
Absolutely sure I cannot
2 = Somewhat sure I cannot
3 =
Unsure if I can or cannot
4 = Somewhat sure I can
5 =
Absolutely sure I can
9. I can disclose my HIV status before having sex even if my partner did not know I was HIV positive the first time we had sex.
1 =
Absolutely sure I cannot
2 = Somewhat sure I cannot
3 =
Unsure if I can or cannot
4 = Somewhat sure I can
5 =
Absolutely sure I can
10. I can disclose my HIV status before having sex even if I was worried that my partner wouldn't have sex with me if they knew.
1 =
Absolutely sure I cannot
2 = Somewhat sure I cannot
3 =
Unsure if I can or cannot
4 = Somewhat sure I can
5 =
Absolutely sure I can
11. I can disclose my HIV status before having sex even to a sex partner who hasn't told me their HIV status.
1 =
Absolutely sure I cannot
2 = Somewhat sure I cannot
3 =
Unsure if I can or cannot
4 = Somewhat sure I can
5 =
Absolutely sure I can
3F.1 PHMC:
Site-Specific 3 Month Follow-Up Questions
ACASI Section
M. SELF-ESTEEM (18-items Beck Self-Esteem Self Scale)
Below is a list of adjectives that some people use to describe themselves. Please read each pair
of adjectives and place an ‘X’ at the point along the line which best describes you right now.
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Unsuccessful |
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2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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Very Much |
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Slightly |
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Very Much |
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Unattractive |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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Very Much |
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Slightly |
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Very Much |
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Unpopular |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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Very Much |
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Slightly |
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Very Much |
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Dependent |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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Very Much |
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Slightly |
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Very Much |
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Dishonest |
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Undesirable |
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Weak |
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Very Much |
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Very Much |
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Dumb |
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Powerless |
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Unlovable |
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Unpleasant |
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Inefficient |
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8 |
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10 |
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Slightly |
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Irresponsible |
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1 |
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8 |
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Slightly |
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Very Much |
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Selfish |
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1 |
2 |
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5 |
6 |
7 |
8 |
9 |
10 |
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Very Much |
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Slightly |
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Very Much |
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Worthless |
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1 |
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10 |
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Boring |
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1 |
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8 |
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10 |
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Very Much |
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Slightly |
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Very Much |
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Ignorant |
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1 |
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Slightly |
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Very Much |
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Bad |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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Very Much |
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Slightly |
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Very Much |
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Interviewer Section
For
the remainder of the interview, I will ask you some questions and I
will enter your answers into the computer. Please remember all of
your answers are private. If you have a question about anything in
this section of the survey, please stop me before we go on. You
don't have to answer any of the questions if you don't want to. If
anything we talk about today makes you uncomfortable and you would
like to talk to a doctor or a counselor, I can give you some referral
information after the interview.
Do you have any questions for me before we start?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
2. On a scale from 1 to 10, with 1 being not at all stressful and 10 being very stressful, how
stressful would you rate this event/problem?
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Not at all Stressful |
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Coping Scale (28-item Brief COPE measure: Carver, C. S. (1997). Reliability for the 14 scales ranges from .54 to .90.)
The following statements are some ways people have reacted or dealt with stressful situations in their lives. Thinking about the situation you just described to me, and how you reacted to it, please tell me how much you did each of the following. Your answer choices are: I didn't do this at all, I did this a little bit, I did this a medium amount, or I did this a lot. Please remember there are no right or wrong answers.
I didn’t do this at all(1) |
I did this a little bit(2) |
I did this a medium amount(3) |
I did this a lot(4) |
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O. CONDOM SELF-EFFICACY: MALE PARTNERS (Items from DiIorio et al. (1997)
I would like to get your opinion on some statements about using condoms with your male partners. For each statement that I read, please tell me from 1 to 5, with 1 being not at all sure you can do it to and with 5 being completely sure you can do it when you are having sex with your male partners?
|
(1) Not at all sure I can do |
(2) Somewhat unsure |
(3) Undecided |
(4) Somewhat Sure |
(5) Completely sure I can do |
(8) Refuse to Answer |
(9) Not Applicable |
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P. CONDOM SELF-EFFICACY: FEMALE PARTNERS (Items from DiIorio et al. (1997))
I would like to get your opinion on some statements about using condoms with your female partners. Please do not include male-to-female transgender partners. Male-to-female transgender partners are those who were born male but now identify as women or as transgender/transsexual. For each statement that I read, please tell me from 1 to 5, with 1 being not at all sure you can do it to and with 5 being completely sure you can do it when you are having sex with your female partners?
|
(1) Not at all sure I can do |
(2) Somewhat unsure |
(3) Undecided |
(4) Somewhat Sure |
(5) Completely sure I can do |
(8) Refuse to Answer |
(9) Not Applicable |
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Q. CONDOM SELF-EFFICACY: TRANSGENDER PARTNERS (DiIorio et al. (1997))
(Asked only of men who report a recent transgender partner)
I would like to get your opinion on some statements about using condoms with your male-to-female transgender partners. Male-to-female transgender partners are those who were born male but now identify as women or as transgender/transsexual. For each statement that I read, please tell me from 1 to 5, with 1 being not at all sure you can do it to and with 5 being completely sure you can do it when you are having sex with your male-to-female transgender partners?
|
(1) Not at all sure I can do |
(2) Somewhat unsure |
(3) Undecided |
(4) Somewhat Sure |
(5) Completely sure I can do |
(8) Refuse to Answer |
(9) Not Applicable |
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R. ATTITUDES ABOUT HEALTH AND AIDS (6-item Locus of Control from FACT Survey).
I would like to get your opinion on some statements about your health and HIV. For each statement that I read, please tell me if you strongly agree, agree, disagree or strongly disagree?
|
Strongly Agree |
Agree |
Disagree |
Strongly Disagree |
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S. INTERNALIZED HOMONEGATIVITY (items from Nungesser Homosexual attitudes Inventory and HIV Center for Clinical & Behavioral Studies at the New York State Psychiatric Institute =.92)
The following are some statements that people can make about being gay or bisexual.
For each statement, please indicate if you Strongly Agree, Agree, Disagree or Strongly
Disagree. If you feel that a statement does not apply to you, please select the "Not
Applicable" button on the right side of the screen.
|
(1) Strongly Agree |
(2) Agree |
(3) Disagree |
(4) Strongly Disagree |
(8) Refuse to Answer |
(9) Not Applicable |
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T. EXPOSURE TO HIV MESSAGES AND INTERVENTIONS (CARDS survey)
I am now going to ask you a few questions about HIV prevention activities in the since your first interview on _(INSERT DATE OF BASELINE INTERVIEW)
11. Since (INT_DATE), have you participated in any sessions sponsored by a community-based organization or other places involving a small group of people talking about HIV/AIDS or other sexually transmitted infections, or sexual behavior?
____ 1 Yes
____ 0 No
____ 7 Don't Know
____ 8 Refuse to Answer
11a. IF YES: What community organization was this? Any other organization?
Ask the following for each organization they mention:
|
Organization |
What was the name of the program or intervention? |
How many times did you meet in the past 12 months? |
What was the main topic of the discussion? |
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12. Since (INT_DATE), aside from the Connections Project, have you talked with someone, such as a case manager or counselor at a community-based organization or other places in an individual or one-on-one session about HIV/AIDS or other sexually transmitted infections, or sexual behavior? Please do not include times when it was only an HIV test.
____ 1 Yes
____ 0 No
____ 7 Don't Know
____ 8 Refuse to Answer
12a. IF YES: What community organization was this? Any other organization?
Ask the following for each organization they mention:
|
Organization |
What was the name of the program or intervention? |
How many times did you meet in the past 12 months? |
What was the goal or purpose for the meeting? |
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13. Since (INT_DATE), aside from the Connections project, have you participated in any surveys or research about HIV/AIDS or other sexually transmitted infections, sexual risk or sexual behavior? (Probe: Have you answered any questions like this either on a computer, on a paper questionnaire, or with an interviewer?)
____ 1 Yes
____ 0 No
____ 7 Don't Know
____ 8 Refuse to Answer
13a. IF YES: What community organization was this? Any other organization?
Ask the following for each organization they mention:
|
Organization |
What was the name of the project or program? |
Where did you do the survey?? |
What was the main topic of the survey? |
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U. MASCULINITY IDEOLOGY (12-items adapted from Multicultural Masculinity Ideology
Scale: Doss & Hopkins (1998) CARDS reliability for these items: = .87)
Next are some statements about the expectations people may have about men. For each of the following statements, please tell me if you Strongly Agree, Agree, Disagree or Strongly Disagree.
|
(1) Strongly Agree |
(2) Agree |
(3) Disagree |
(4) Strongly Disagree |
(8) Refuse to Answer |
(9) Not Applicable |
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(1) Strongly Agree |
(2) Agree |
(3) Disagree |
(4) Strongly Disagree |
(8) Refuse to Answer |
(9) Not Applicable |
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You have finished the interview. Thank you for your participation.
3F.2 NOVA:
Site-Specific 3 Month Follow-Up Questions
HIV/STD KNOWLEDGE QUESTIONNAIRE
The following statements are about STDs (Sexually Transmitted Diseases) and HIV. Please indicate whether you think the statement is “true” or “false”. If you aren’t sure, choose “don’t know”.
Douching after sex helps protect you from STDs.
You can’t get the AIDS virus through a cut in your skin.
You can’t always tell if your partner has as STD.
Pre-ejaculatory fluids (pre-cum) carry HIV.
People who have HIV generally feel sick right away.
You can’t get HIV by sharing knives and forks or a bathroom with a person who has HIV.
An untreated STD can possibly result in being unable to have children.
Condoms with spermicide will protect you from most STDs.
Women can spread STDs to men when they don’t use condoms.
If a woman uses birth control pills, it lowers her risk for getting HIV.
Having an STD puts you at greater risk for getting HIV.
If a person has HIV, it is still safe to kiss them on the lips, as you would kiss a friend or relative.
The most effective way to prevent the spread of HIV is abstinence from sex.
Sheep skin condoms are better than latex condoms for preventing HIV.
Using oil based lubricants such as Vaseline or Crisco with condoms will reduce the risk of getting HIV.
All STDs, except for HIV, can be cured with antibiotics.
Condom Use Self-Efficacy Scale (CUSES)
The following questions ask about your feelings about using condoms, using the following scale:
1=Strongly Agree
2=Agree
3=Undecided
4=Disagree
5=Strongly Disagree
I feel confident in my ability to put a condom on myself or my partner.
I feel confident I could purchase condoms without feeling embarrassed.
I feel confident I could remember to carry a condom with me should I need one.
I feel confident in my ability to discuss condom usage with any partner I might have.
I feel confident in my ability to suggest using condoms with a new partner.
I feel confident I could suggest using a condom without my partner feeling "diseased".
I feel confident in my own or my partner's ability to maintain an erection while using a condom.
I would feel embarrassed to put a condom on myself or my partner.
If I were to suggest using a condom to a partner, I would feel afraid that he or she would reject me.
If I were unsure of my partner's feelings about using condoms, I would not suggest using one.
I feel confident in my ability to use a condom correctly.
I would feel comfortable discussing condom use with a potential sexual partner before we ever had any sexual contact (such as hugging, kissing, caressing, etc.)
I feel confident in my ability to persuade a partner to accept using a condom when we have intercourse.
I feel confident I could gracefully remove and dispose of a condom after we have intercourse.
If my partner and I were to try to use a condom and did not succeed, I would feel embarrassed to try to use one again (such as not being able to unroll condom, putting it on backwards, or awkwardness).
I would not feel confident suggesting using condoms with a new partner because I would be afraid he or she would think I've had a homosexual experience.
I would not feel confident suggesting using condoms with a new partner because I would be afraid he or she would think I have a sexually transmitted disease.
I would not feel confident suggesting using condoms with a new partner because I would be afraid he or she would think I thought they had a sexually transmitted disease.
I would feel comfortable discussing condom use with a potential partner before we ever engaged in intercourse.
I feel confident in my ability to incorporate putting a condom on myself or my partner into foreplay.
I feel confident that I could use a condom with a partner without "breaking the mood."
I feel confident in my ability to put a condom on myself or my partner quickly.
I
feel confident I could use a condom during intercourse without
reducing any sexual sensations.
I feel confident that I would remember to use a condom even after I have been drinking.
I feel confident that I would remember to use a condom even if I were high.
If my partner didn't want to use a condom during intercourse, I could easily convince him or her that it was necessary to do so.
I feel confident that I could use a condom successfully.
I feel confident I could stop to put a condom on myself or my partner even in the heat of passion.
Rosenberg Self-Esteem Scale
The following statements deal with your general feelings about yourself. Choose the answer that best describes your feelings.
Strongly Agree
Agree
Disagree
Strongly Disagree
I feel that I am a person of worth, at least on an equal basis with others.
I feel that I have a number of good qualities.
All
in all, I am inclined to feel that I am a failure.
I am able to do things as well as most other people.
I
feel I do not have much to be proud of.
I
take a positive attitude toward myself.
On the whole, I am satisfied with myself.
I wish I could have more respect for myself.
I certainly feel useless at times.
At times I think I am no good at all.
The Multi-Group Ethnic Identity Measure (MEIM) (Phinney, 1992)
In this country, people come from many different countries and cultures, and there are many different words to describe the different backgrounds or ethnic groups that people come from. Some examples of the names of ethnic groups are Hispanic or Latino, Black or African American, Asian American, Chinese, Filipino, American Indian, Mexican American, Caucasian or White, Italian American, and many others. These questions are about your ethnicity or your ethnic group and how you feel about it or react to it.
Please fill in: In terms of ethnic group, I consider myself to be ____________________
Use the numbers below to indicate how much you agree or disagree with each statement.
(4) Strongly agree (3) Agree (2) Disagree (1) Strongly disagree
1. I have spent time trying to find out more about my ethnic group, such as its history, traditions, and customs.
2. I am active in organizations or social groups that include mostly members of my own ethnic group.
3. I have a clear sense of my ethnic background and what it means for me.
4. I think a lot about how my life will be affected by my ethnic group membership.
5. I am happy that I am a member of the group I belong to.
6. I have a strong sense of belonging to my own ethnic group.
7. I understand pretty well what my ethnic group membership means to me.
8. In order to learn more about my ethnic background, I have often talked to other people about my ethnic group.
9. I have a lot of pride in my ethnic group.
10. I participate in cultural practices of my own group, such as special food, music, or customs.
11. I feel a strong attachment towards my own ethnic group.
12. I feel good about my cultural or ethnic background.
13. My race/ethnicity is:
(1) Asian
(2) Black or African American
(3) White
(4) American Indian/ Alaska Native
(5) Native Hawaiian/Pacific Islander
14. I am Latino/Hispanic. Yes/No
15. My father's race/ethnicity is: (use numbers above).
16. My father is Latino/Hispanic. Yes/No
17. My mother's ethnicity is: (use numbers above)
18. My mother is Latina/Hispanic. Yes/No
Klein Sexual Orientation Grid
Using the following scale, choose the answer that corresponds to your feelings, actions, and thoughts.
For Categories A through E:
0 – Exclusively the other sex
1 – Mostly the other sex, infrequently the same sex
2 – Often the other sex, sometimes the same sex
3 – Equally the other sex and the same sex
4 – Often the same sex, sometimes the other sex
5 – Mostly the same sex, infrequently the other sex
6 – Exclusively the same sex
For Categories F and G:
0 – Exclusively heterosexual
1 – Mostly heterosexual, infrequently homosexual
2 – Often heterosexual, sometimes homosexual
3 – Equally heterosexual and homosexual
4 – Often homosexual, sometimes heterosexual
5 – Mostly homosexual, infrequently heterosexual
6 – Exclusively homosexual
A1. In the past, who were you sexually attracted to (males, females, both)?
A2. In the present, who are you sexually attracted to (males, females, both)?
A3. Ideally, who would you be sexually attracted to (males, females, both)?
B1. In the past, with whom did you have sex (males, females, both)?
B2. In the present, with whom do you have sex (males, females, both)?
B3. Ideally, whom would you have sex with (males, females, both)?
C1. In the past, who did you have sexual fantasies about, whether they occurred during masturbation, daydreaming, or as part of your daily life?
C2. In the present, who do you have sexual fantasies about, whether they occur during masturbation, daydreaming, or as part of your daily life?
C3. Ideally, who would you have sexual fantasies about, whether they occur during masturbation, daydreaming, or as part of your daily life?
D1. In the past, who did you feel emotionally close to (males, females, both)?
D2. In the present, who do you feel emotionally close to (males, females, both)?
D3. Ideally, who would you feel emotionally close to (males, females, both)?
E1. In the past, who did you like to hang out with and spend time socially (males, females, both)?
E2. In the present, who do you like to hang out with and spend time socially (males, females, both)?
E3. Ideally, who would you like to hang out with and spend time socially (males, females, both)?
F1. In the past, how did you identify or think about yourself sexually?
F2. In the present, how do you identify or think about yourself sexually?
F3. Ideally, how would you identify or think about yourself sexually?
G1. In the past, where did you tend to spend time and with whom (in the gay and lesbian world, the heterosexual world, both)?
G2. In the present, where do you tend to spend time and with whom (in the gay and lesbian world, the heterosexual world, both)?
G3. Ideally, where would you tend to spend time and with whom (in the gay and lesbian world, the heterosexual world, both)?
Masculine Gender Role Stress Scale
Please rate the following items according to how stressful the situation would be for you…
0 = Not stressful
1
3
4
5
6
7 = Extremely stressful
Feeling that you are not in good physical condition
Not being able to find a sexual partner
Having your lover say that she/he is not satisfied
Being perceived by someone as “gay”
Losing in a sports competition
Being perceived as having feminine traits
Appearing less athletic than a friend
Being compared unfavorably to men
Knowing you cannot hold your liquor as well as others
Telling your spouse that you love her/him
Telling someone that you feel hurt by what he/she said
Admitting that you are afraid of something
Having your children see you cry
Talking with a woman who is crying
Comforting a male friend who is upset
Having a man put his arm around your shoulder
Being outperformed at work by a woman
Having a female boss
Letting a woman take control of the situation
Being married to someone who makes more money that you
Being with a woman who is more successful than you
Being outperformed in a game by a woman
Needing your spouse to work to help support the family
Admitting to your friends that you do housework
Being with a woman who is much taller than you
Having to ask for directions when you are lost
Working with people who seem more ambitious than you
Talking with a “feminist”
Having people say that you are indecisive
Having others say that you are too emotional
Working with people who are brighter than yourself
Staying home during the day with a sick child
Being unemployed
Not making enough money
Finding you lack the occupational skills to succeed
Being unable to perform sexually
Being too tired for sex when your lover initiates it
Being unable to become sexually aroused when you want
Getting passed over for a promotion
Getting fired from your job
Internalized Homophobia Scale
Please choose the number that best describes your response to each item:
1 = strongly agree
2 = moderately agree
3 = slightly agree
4 = neither agree or disagree
5 = slightly disagree
6 = moderately disagree
7 = strongly disagree
Obviously effeminate homosexual men make me feel uncomfortable
I prefer to have anonymous sexual partners
It would not be easier in life to be heterosexual
Most of my friends are homosexual
I do not feel confident about making an advance to another man
I feel comfortable in gay bars
Social situations with gay men make me feel uncomfortable
I don’t like thinking about my homosexuality
When I think about other homosexual men, I think of negative situations
I feel comfortable about being seen in public with an obviously gay person
I feel comfortable discussing homosexuality in a public setting
It is important to me to control who knows about my homosexuality
Most people have negative reactions to homosexuality
Homosexuality is not against the will of God
Society still punishes people for being gay
I object if an anti-gay joke is told in my presence
I worry about becoming old and gay
I worry about becoming unattractive
I would prefer to be more heterosexual
Most people don’t discriminate against homosexuals
I feel comfortable about being homosexual
Homosexuality is morally acceptable
I am not worried about anyone finding out that I am gay
Discrimination against gay people is still common
Even if I could change my sexual orientation, I wouldn’t
Homosexuality is as natural as heterosexuality
File Type | application/msword |
File Title | 3F: 3-MONTH FOLLOW-UP BY SITE |
Author | iqe6 |
Last Modified By | Thelma Elaine Sims |
File Modified | 2010-05-10 |
File Created | 2010-05-10 |