Consent for HIV+ Audiences

Consent

Act Against AIDS— HIV Positive Audiences

Introduction and Purpose:

You have been asked to take part in a one-on-one interview as part of this project. The purpose of the interview is to hear your thoughts about HIV materials under development, such as a public service announcement, billboard or other type of advertisement. RTI International, a non-profit company in North Carolina is doing the interview. The interview is sponsored by the Centers for Disease Control and Prevention (CDC).

Procedures:

During the interview, we will ask you to review some draft materials and tell us your thoughts. The interview will take about 60 minutes.

We will be doing interviews with a total of [ ] people in the [insert city] area.

Risk/Discomforts:

You might feel embarrassed or upset by the things that are talked about during the interview. If that happens, we will refer you to someone who can talk with you about your concerns. You can decline to talk about any topic for any reason. You can also stop being in the interview at any time.

Benefits:

There is no direct benefit to you for being in this interview. What we learn from the interview will help CDC to develop materials about HIV that are sensitive to the perceptions of and stigma faced by other HIV-positive individuals.

Privacy:

We may audio-record the interview. The recorder will be kept in a locked cabinet. The audio files will be destroyed at the end of the project. Notes will be made of the recordings. We will only refer to first names in the notes. Your comments will be kept private to the extent allowable by law. The notes will be kept on a password-protected computer. Only authorized project staff will be able to see them. Any forms related to the project that have your name or information that could identify you will be kept in a locked file cabinet. These forms will be destroyed once the project ends. However, there is still a small risk that your privacy could be broken.

Payment:

We will give you $40 as a token of appreciation.

Right to Refuse or Withdraw:

It is your choice to do this interview. You can choose not to talk about any topic. You can stop being in the interview at any time.

Persons to Contact:

If you have questions about the interview, you can call Jennifer Uhrig at 1-800-334-8571 extension 3311. She can be reached between 9 AM and 5 PM Eastern Standard Time Monday - Friday. If you have questions about your rights as a participant, you can call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

Your Consent:

I have read this consent form. I had a chance to ask questions and my questions were answered. I was given a copy of this consent form.

Do you consent to participate in the interview now?

__Yes

__No

Interviewer Signature Date