Consent for MSM Audiences

Consent form

Act Against AIDS – MSM Audiences

Reading level 7.6 (assessed by Flesch-Kincaid)

Introduction and Purpose:

You have been asked to take part in a focus group as part of a research study. The purpose of the interview is to hear your opinions about personal HIV risk and prevention. RTI International, a non-profit company in North Carolina is conducting the interview. The interview is sponsored by the Centers for Disease Control and Prevention (CDC).

Procedures:

During the focus group, we will ask you to talk a little bit about yourself and what you think and feel about prevention messages and concepts. You may also be asked to review some draft materials and tell us your thoughts. The focus group will take about an hour.

We will be doing focus groups with people in cities where there is a high prevalence of HIV. About 300 people will take part in a 60 minute focus group and pencil and paper interview.

The person doing the focus group will take notes. CDC staff working on this project may observe the interview through a one-way mirror.

We anticipate consenting to this study will take approximately 5 minutes.

Risk/Discomforts:

You might feel embarrassed or upset by the things that are talked about during the focus group. 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 stop being in the focus group at any time.

During the focus group, you may be asked to fill out a paper and pencil survey. Your name will not go on this survey. It is your right to refuse to answer any questions or stop taking the survey at any time.

Benefits:

There is no direct benefit to you for being in this focus group. However, you may learn more about your own risk behaviors and ways to prevent HIV. What we learn from the focus group will help us to develop materials about personal awareness of HIV risk and prevention.

Privacy:

We may audio-tape the focus group. Tapes will be kept in a locked cabinet. They will be destroyed at the end of the project. Notes will be made of the tapes. 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 at the end of the project. However, there is still a small risk that your privacy could be broken.

Also, any information that this local facility already has about you -- because you have been in other projects -- will still be kept there. You may be contacted by them to be in other projects in the future. If you have not been contacted by this facility before this project, they will not keep any of your contact information.

Payment:

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

Right to Refuse or Withdraw:

It is your choice to participate in the focus group. You can choose not to talk about any topic. You can stop being in the focus group at any time.

Persons to Contact:

If you have questions about the interview or the amount of time to consent and complete 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 Wendy Visscher of 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. I agree to be in the focus group interview.

Print – First Name/Pseudonym Only

Date

Facilitator Signature