HIV/AIDS Risk Reduction Interventions for African-American
Heterosexual Men
0920-10CM
Attachment 3i
Data Collection: Baseline/Follow-up Assessment – UNCG
Form Approved
OMB No. 0920-XXXX
Exp. Date XX/XX/20XX
HIV/AIDS Risk Reduction Interventions for African-American
Did you know that you are saving a life today?
Your participation in the Brotherhood Retreat will help researcher develop health programs for African American men.
Brothers Leading Healthy Lives is a sexual health study conducted by the Department of Public Health Education at UNCG with assistance from the Centers for Disease Control and Prevention (CDC). The
So thank you for agreeing to volunteer for the project! Before we start the Retreat, we want to get to know you a little more. Please complete the attached survey to help us get to know about you. Some of the questions are personal, including questions about sexual activity. Your involvement is voluntary and your responses will be kept private. The information you give us will be combined with everybody else’s information so that collectively – not individually – we can describe the group involved in the study. At the end of the Retreat we will give you a $160 gift card.
Section 1: Demographics
Now we have some background questions. These questions let us know something about the people who participate in this study. There is no right or wrong answer to any of these questions. Please try to be as open and honest as you can.
1. How old are you? _____________________
From the following list, which word best describes your present relationship status? ( Read list and allow the respondent to select only one answer)
a. Married
b. Divorced
c. Widowed
d. Separated
e. Single, never been married
f. Long-term relationship with a partner
What is your current classification?
a. freshmen b. sophomore c. junior d. senior
Are you currently employed (part-time or full-time)?
a. yes b. no
Some people have lived in many places as a child, while other people grew up in the same place. Where did you grow up or what place do you consider yourself to be from?
(city/ state/ county)____________________________________________________
Section 2: Male Role Attitude Scale
Instructions: In the space to the left of each sentence below, write the number that most closely represents the degree that you Agree or Disagree with the statement. There is no right or wrong answer to each statement; your own though is what is asked for.
Strongly Agree Strongly Disagree
5 4 3 2 1
_____ It is essential for a guy to get respect from others
_____ A man always deserves the respect of his wife and children
_____ I admire a guy who is completely sure of himself
_____ A guy will lose respect if he talks about his problems
_____ A young man should be physically tough, even if he’s not big
_____ It bothers me when a guy acts like a girl
_____ I don’t think a husband should have to do housework
_____ Men are always ready for sex
Section 3: Sexual Behavior Items
The next set of questions is about your sexual behavior. By sex, we mean vaginal, anal, or oral sex. Please remember that your answers are strictly confidential. Please circle the answer that best answers the question for you.
Have you ever had vaginal, anal, or oral sex?
No
Yes
In the past 3 months, with how many females have you had vaginal, anal, or oral sex?
Enter #______
In the past 3 months, with how many females have had only oral sex?
Enter #______
In the past 3 months, about how many times have you had vaginal or anal sex?
Never
once
2-11 times
12-31 times
32-51 times
52 times or more
In the past 3 months, about how often have you had vaginal or anal sex without using a condom?
Never
Less than half the time
About half of the time
Not always, but more than half of the time
Always
In the past 3 months, has a doctor or health care professional told you that you had any sexually transmitted infection (genital herpes, genital warts, gonorrhea, Chlamydia)?
a. No
b. Yes
Section 4: Attitudes Toward Condoms Scale
Instructions: In the space to the left of each sentence below, write the number that most closely represents the degree that you Agree or Disagree with the statement. There is no right or wrong answer to each statement; your own though is what is asked for.
Strongly Agree Strongly Disagree
5 4 3 2 1
_____ It is a hassle to use condoms.
_____ People can get the same pleasure from "safer" sex as from unprotected sex.
_____ Using condoms interrupts sex play.
_____ The proper use of a condom could enhance sexual pleasure.
_____ Condoms are irritating.
_____ I think "safer" sex would get boring fast.
_____ "Safer" sex reduces the mental pleasure of sex.
_____ The idea of using a condom doesn't appeal to me.
_____ Condoms ruin the natural sex act.
_____ Generally, I am in favor of using condoms.
_____ Condoms interfere with romance.
_____ The sensory aspects (smell, touch, etc.) of condoms make them unpleasant.
_____ With condoms, you can't really "give yourself over" to your partner.
Section 5: HIV Knowledge Scale
Instructions: In the space to the left of each sentence below, write T for statements you believe to be TRUE and F for statements you believe to be FALSE. Write DK if you do not know the answer.
_____ Coughing and sneezing DO NOT spread HIV.
_____ A person can get HIV by sharing a glass of water with someone who has HIV.
_____ Pulling out the penis before a man cums keeps a woman from getting HIV during sex.
_____ A woman can get HIV if she has anal sex with a man.
_____ Showering, or washing one’s genitals/private parts after sex keeps a person from getting HIV.
_____ All pregnant women infected with HIV will have babies born with AIDS.
_____ People who have been infected with HIV quickly show serious signs of being infected.
_____ There is a vaccine that can stop adults from getting HIV.
_____ People are likely to get HIV by deep kissing, putting their tongue in their partner’s mouth, if their partner has HIV.
_____ A woman cannot get HIV if she has sex during her period.
_____ There is a female condom that can help decrease a woman’s chance of getting HIV.
_____ A natural skin condom works better against HIV than does a latex condom.
_____ A person will NOT get HIV if she or he is taking antibiotics.
_____ Having sex with more than one partner can increase a person’s chance of being infected with HIV.
_____ Taking a test for HIV one week after having sex will tell a person if she or he has HIV.
_____ A person can get HIV by sitting in a hot tub or a swimming pool with a person who has HIV.
_____ A person can get HIV from oral sex.
_____ Using Vaseline or baby oil with condoms lowers the chance of getting HIV.
Section 6: HIV Testing & Communication
In the last 3 months before you had sex, did you talk about your HIV status (whether or not you have HIV) with every partner, some of your partners or none of your partners?
every partner
some of my partners
none of my partners
I decline
In the last 3 months before you had sex, did you talk about your partner’s HIV status (whether or not your partner has HIV ) With:
every partner
some of my partners
none of my partners
I decline
Have you been tested for HIV in the past 3 months?
No
Yes
Refused
Don’t know
In the past 3 months, has a healthcare provider told you that you have HIV?
No
Yes
Refused
Don’t know
Section 7: Condom Use Self-Efficacy Scale
Instructions: In the space to the left of each sentence below, write the number that most closely represents the degree that you Agree or Disagree with the statement. There is no right or wrong answer to each statement; your own thought is what is asked for.
Strongly Agree Strongly Disagree
5 4 3 2 1
_____ I feel confident in my ability to put a condom on
_____ 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 I’m accusing them of having an infection
_____ I feel confident in my ability to maintain an erection while using a condom.
_____ I would feel embarrassed to put a condom on.
_____ If I were to suggest using a condom to a partner, I would feel afraid that 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 (e.g. 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 when 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 (e.g. 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 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 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 she would think I thought she 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 that I could use a condom with a partner without "breaking the mood."
_____ I feel confident in my ability to put a condom on 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 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 even in the heat of the moment
Section 8: Health Protective Sex Communication Scale
Instructions: In the space to the left of each sentence below, write the number that most closely represents how often in the past 3 months you have done the behavior
Always Almost Always Sometimes Never Don’t Know Decline to answer
1 2 3 4 5 6
How often in the past 3 months, have you:
_____ Asked a new sex partner how she felt about using condoms before you had intercourse?
_____ Asked a new sex partner about the number of past sex partners she had?
_____ Told a new sex partner about the number of sex partners you had?
_____ Told a new sex partner that you won’t have sex unless a condom is used?
_____ Discussed with a new sex partner the need for both of you to get tested for HIV before having sex?
_____ Talked with a new sex partner about not having sex until you have known each other longer?
_____ Asked a new sex partner if she has ever had some type of STD, like genital herpes, genital warts, syphilis, Chlamydia, or gonorrhea
_____ Asked a new sex partner if she has ever shot drugs like heroin, cocaine, or speed?
_____ Talked about whether you or a new sex partner has ever had homosexual experiences.
_____ Talked with a new sex partner about birth control before having sex for the first time?
Thank you for completing the survey! Please return this form to the Brotherhood Retreat staff.
Section 8: Safer-Sex Attitudes and Intentions
I will make sure a condom is used when I have sex.
I will only have one sexual relationship at a time.
I do not plan on having sex until I am married.
I would only have sex with a person who I have a long term relationship with.
I will not have sex with someone who refuses to use a condom.
If my partner wanted me to have unprotected sex, I would probably "give in". R
If my partner wanted me to participate in "risky" sex and I suggested a lower-risk alternative, we would have the "safer" sex instead.
If my partner wanted me to have unprotected sex and I made some excuse to use a condom, we would still end up having unprotected sex. R
If my partner wanted me to participate in "risky" sex and I said that we needed to be safer, we would still probably end up having "unsafe" sex. R
If a sexual partner didn't want to use condoms, we would have sex without using condoms. R
USE THE FOLLOWING RESPONSE CATEGORIES FOR SCALES ABOVE.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Note: Items followed by an R should be reversed when coding.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | HIV/AIDS Risk Reduction Interventions for Heterosexually Active African-American Men |
| Author | Raekiela Taylor |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |