MMP Questionnaire 2021 - English

PROGRAMING
QUESTIONNAIRE | Version 21.0

OMB No: 0920-0740 Expiration: xx.xx.xx
Public reporting burden of this collection of information is estimated to average 40 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. An agency may
not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays
a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden to: CDC, Project Clearance Officer,
1600 Clifton Road, MS D–74, Atlanta, GA 30329, ATTN: PRA (0920–0740). Do not send the completed form to
this address.

CS270337B

Table of Contents

.............................................................................................................................................................................1
PRELIMINARY INFORMATION (I)
.............................................................................................................................................................................
Prior to interview (IP)
1
.............................................................................................................................................................................
Introduction (IN)
4
.............................................................................................................................................................................5
ELIGIBILITY CRITERIA (Y)
.............................................................................................................................................................................
MMP participation (YM)
5
.............................................................................................................................................................................
Residence (YS)
6
.............................................................................................................................................................................
Age (YA)
8
.............................................................................................................................................................................
BASIC DEMOGRAPHICS (D)
10
.............................................................................................................................................................................
Education (DE)
10
.............................................................................................................................................................................
Race-ethnicity (DR)
10
.............................................................................................................................................................................
Gender and sexual orientation (DG)
12
.............................................................................................................................................................................
Language ability (DL)
12
.............................................................................................................................................................................
U.S. born (DF)
13
.............................................................................................................................................................................
Incarceration (DJ)
14
.............................................................................................................................................................................
Homeless (DH)
15
.............................................................................................................................................................................
DISABILITY (A)
17
.............................................................................................................................................................................
Disability (AD)
17
.............................................................................................................................................................................
FINANCIAL (F)
19
.............................................................................................................................................................................
Employment (FE)
19
.............................................................................................................................................................................
Income (FI)
19
.............................................................................................................................................................................
Food security (FS)
20
.............................................................................................................................................................................
Healthcare coverage (FH)
20
.............................................................................................................................................................................
GENERAL MEDICAL CARE (J)
24
.............................................................................................................................................................................
Health and well-being (JW)
24
.............................................................................................................................................................................
ER and hospitalizations (JH)
24
.............................................................................................................................................................................
Influenza (JF)
24
.............................................................................................................................................................................
Health literacy (JL)
25
.............................................................................................................................................................................
HIV CARE (K)
26
.............................................................................................................................................................................
Diagnosis date (KD)
26
.............................................................................................................................................................................
Ever care (KE)
27
.............................................................................................................................................................................
Linkage to care (KL)
27
.............................................................................................................................................................................
Care utilization (KU)
29
.............................................................................................................................................................................
Care satisfaction (KS)
30
.............................................................................................................................................................................
Patient-provider relationship (KB)
30
.............................................................................................................................................................................
Barriers and facilitators to care (KP)
33
.............................................................................................................................................................................
HIV TREATMENT AND ADHERENCE (T)
35
.............................................................................................................................................................................
Ever ART (TE)
35
.............................................................................................................................................................................
Current ART (TC)
36
.............................................................................................................................................................................
Adherence (TA)
38
.............................................................................................................................................................................
SEXUAL BEHAVIOR (S)
42
.............................................................................................................................................................................
Total sex partners (ST)
42
.............................................................................................................................................................................
Names of partners (SN)
44

.............................................................................................................................................................................
Partner demographics #1 (SP)
47
.............................................................................................................................................................................
Vaginal sex #1 (SV)
48
.............................................................................................................................................................................
Anal sex #1 (SL)
49
.............................................................................................................................................................................
Transgender and unknown gender sex #1 (SG)
50
.............................................................................................................................................................................
Status #1 (SS)
50
.............................................................................................................................................................................
Pre-exposure prophylaxis #1 (SR)
51
.............................................................................................................................................................................
Partner demographics #2 (SP)
51
.............................................................................................................................................................................
Vaginal sex #2 (SV)
53
.............................................................................................................................................................................
Anal sex #2 (SL)
54
.............................................................................................................................................................................
Transgender and unknown gender sex #2 (SG)
54
.............................................................................................................................................................................
Status #2 (SS)
55
.............................................................................................................................................................................
Pre-exposure prophylaxis #2 (SR)
55
.............................................................................................................................................................................
Partner demographics #3 (SP)
56
.............................................................................................................................................................................
Vaginal sex #3 (SV)
57
.............................................................................................................................................................................
Anal sex #3 (SL)
58
.............................................................................................................................................................................
Transgender and unknown gender sex #3 (SG)
58
.............................................................................................................................................................................
Status #3 (SS)
59
.............................................................................................................................................................................
Pre-exposure prophylaxis #3 (SR)
59
.............................................................................................................................................................................
Partner demographics #4 (SP)
60
.............................................................................................................................................................................
Vaginal sex #4 (SV)
61
.............................................................................................................................................................................
Anal sex #4 (SL)
62
.............................................................................................................................................................................
Transgender and unknown gender sex #4 (SG)
63
.............................................................................................................................................................................
Status #4 (SS)
63
.............................................................................................................................................................................
Pre-exposure prophylaxis #4 (SR)
64
.............................................................................................................................................................................
Partner demographics #5 (SP)
64
.............................................................................................................................................................................
Vaginal sex #5 (SV)
66
.............................................................................................................................................................................
Anal sex #5 (SL)
67
.............................................................................................................................................................................
Transgender and unknown gender sex #5 (SG)
67
.............................................................................................................................................................................
Status #5 (SS)
68
.............................................................................................................................................................................
Pre-exposure prophylaxis #5 (SR)
69
.............................................................................................................................................................................
Aggregate information (SA)
69
.............................................................................................................................................................................
VIOLENCE (B)
71
.............................................................................................................................................................................
Physical violence (BP)
71
.............................................................................................................................................................................
Sexual violence (BS)
71
.............................................................................................................................................................................
DEPRESSION AND ANXIETY (M)
72
.............................................................................................................................................................................
PHQ-4 screening questions (MD)
72
.............................................................................................................................................................................
PHQ-8 depression (MA)
73
.............................................................................................................................................................................
GAD-7 anxiety (MG)
74
.............................................................................................................................................................................
ALCOHOL, SMOKING, AND DRUG USE (U)
76
.............................................................................................................................................................................
Alcohol use (UA)
76
.............................................................................................................................................................................
Cigarette and tobacco use (US)
77
.............................................................................................................................................................................
Non-injection drug use (UN)
79
.............................................................................................................................................................................
Injection drug use (UI)
81

.............................................................................................................................................................................
STIGMA AND DISCRIMINATION (R)
85
.............................................................................................................................................................................
Stigma (RS)
85
.............................................................................................................................................................................
Discrimination (RD)
87
.............................................................................................................................................................................
GYNECOLOGICAL AND REPRODUCTIVE HISTORY (G)
91
.............................................................................................................................................................................
Gynecological care (GH)
91
.............................................................................................................................................................................
Family Planning (GF)
92
.............................................................................................................................................................................
Reproductive history (GR)
94
.............................................................................................................................................................................
MET AND UNMET NEEDS (N)
97
.............................................................................................................................................................................
Services and assistance programs (ND)
97
.............................................................................................................................................................................
Other disability (NS)
109
.............................................................................................................................................................................
PREVENTION ACTIVITIES (P)
111
.............................................................................................................................................................................
Prevention messages (PM)
111
.............................................................................................................................................................................
Risk reduction (PR)
112
.............................................................................................................................................................................
HIV treatment as prevention (PB)
113
.............................................................................................................................................................................
INTERVIEW COMPLETION (E)
114
.............................................................................................................................................................................
End of interview (EE)
114
.............................................................................................................................................................................
Referrals and follow-up (EO)
114
.............................................................................................................................................................................
Data validity (EV)
118
.............................................................................................................................................................................
Local questions (EL)
118
.............................................................................................................................................................................
2020 CALENDAR
A-1
.............................................................................................................................................................................
2021 CALENDAR
B-1
.............................................................................................................................................................................
2022 CALENDAR
C-1
.............................................................................................................................................................................
RESPONSE CARDS
D-1

Page |1

Module: Preliminary information (I)
Topic: Prior to interview (IP)
Calculation_AGEIDATE

I.1.0.

Label_8_Calculation_AGEIDATE
Calculation_IDATE7

I.2.0.

Label_8_Calculation_IDATE7
Calculation_IDATE12

I.3.0.

Label_8_Calculation_IDATE12
Calculation_IDATE24

I.4.0.

Label_8_Calculation_IDATE24
Calculation_LANGUAG

I.5.0.

Calculate the respondent’s age at the time of the interview using DOB_13 (date of birth)
and IDATE (interview date).
Age
Calculate the date 7 days prior to IDATE (interview date). Example, if IDATE is 12/08/2016,
then IDATE7 is 12/01/2016. Coding should take into account leap years.
7 days prior to interview
Calculate the date 12 months prior to IDATE (interview date). Example, if IDATE is
12/02/2016, then IDATE12 is 12/02/2015. Coding should take into account leap years.
12 months prior to interview
Calculate the date 24 months prior to IDATE (interview date). Example, if IDATE is
12/02/2016, then IDATE24 is 12/02/2014. Coding should take into account leap years.
24 months prior to interview

Label_Calculation_LANGUAG

If the English version of the questionnaire is used, then LANGUAG=EN. If the Spanish
version of the questionnaire is used, then LANGUAG=SP.
Language of questionnaire

Calculation_LASTYEAR
I.6.0.
Label_Calculation_LASTYEAR

Calculate last calendar year: LASTYEAR= (Current year) - 1.
Last calendar year

Calculation_VERSION_19 I.7.0.
Label_Calculation_VERSION_19

Automatically enters the QDS version. For the 2019-2020 cycles, the value is 5.0.
QDS software version

Calculation_VERSION

Calculate questionnaire version number using variable name VERSION. This must be
updated every time a change is made in the application.
QDS file version

I.8.0.

Label_Calculation_VERSION
IDATE
Label_IDATE
Soft_edit_IDATE_8

IP.1.0.

Soft_edit2_IDATE_21
QDS_programming_IDATE
IDATECHECK_N21

IP.1.1.

Label_IDATECHECK_N21
QDS_programming_IDATECHECK_
N21
Calculation_CLCSDT_21

Label_CLCSDT_21

IP.1.a.

Interview date
Interview date
Display the following message: “Today's date is [Insert IDATE (Interview date)]. If this is
incorrect, fix the date on your device.” Allow the program to move forward.
Display the following message: "If date on device cannot be fixed, enter today's date in the
next question." Allow the program to move forward.
Automatically calculate IDATE (Interview date) in QDS using the date on the device
If [IDATE] is not correct because the interview device displays the wrong date and cannot
be changed, please enter the correct date now.
Interview date confirmation
If IDATECHECK_N21 (Interview date confirmation) is answered, use IDATECHECK_N21
(Interview date confirmation) as IDATE (Interview date) for all questions. Allow this
question to be skipped if interviewer determines that IDATE (Interview date) is correct.
IDATE CLCSDT_21
June 1, 2021 – May 31, 2022 12/31/2020
June 1, 2022 – May 31, 2023 12/31/2021
June 1, 2023 – May 31, 2024 12/31/2022
June 1, 2024 – May 31, 2025 12/31/2023
June 1, 2025 – May 31, 2026 12/31/2024
Sample draw date based on interview date

Page |2
Intro_N21_MODEADM
MODEADM

IP.2.0.

Label_MODEADM
SITEID
Label_SITEID
Hard_edit_8_SITEID

IP.3.0.

“Interviewer note: Enter the following information prior to interview.”
Was the interview originally administered on paper?
0 No
1 Yes
Interview administered on paper

QDS_programming_SITEID

Site ID of jurisdiction where person was sampled:
Site ID where person sampled
Valid numbers are as follows: 0006, 1600, 0010, 0012, 0013, 3360, 0017, 0018, 4480,
0026, 0028, 0034, 0036, 5600, 0037, 0041, 0042, 6160, 0072, 7360, 0048, 0051, and 0053.
Else read, “Site ID is invalid.” Return to SITEID (Site ID where person sampled).
If SITEID (Site ID where person sampled) is less than 4 digits, then read, "Number must be 4
digits." Return to SITEID (Site ID where person sampled).
4 digits with leading 0s

Calculation_SJURN5_8

Name of sampling jurisdiction based on SITEID (site ID where person sampled).

Hard_edit2_8_SITEID

IP.3.1.a.

Label_Calculation_SJURN5_8
Calculation_CYGSN5_21 IP.3.1.b.

Label_CYGSN5_21

0006 California
1600 Chicago
0010 Delaware
0012 Florida
0013 Georgia
3360 Houston
0017 Illinois
0018 Indiana
4480 Los Angeles County
0026 Michigan
0028 Mississippi
0034 New Jersey
0036 New York
5600 New York City
0037 North Carolina
0041 Oregon
0042 Pennsylvania
6160 Philadelphia
0072 Puerto Rico
7360 San Francisco
0048 Texas
0051 Virginia
0053 Washington
Name of sampling jurisdiction
Calculate cycle year using CYGSN5_21 (cycle year based on interview date)
If IDATE is June 1, 2021 – May 31, 2022, then CYGSN5_21=2021
If IDATE is June 1, 2022 – May 31, 2023, then CYGSN5_21=2022
If IDATE is June 1, 2023 – May 31, 2024, then CYGSN5_21=2023
If IDATE is June 1, 2024 – May 31, 2025, then CYGSN5_21=2024
If IDATE is June 1, 2025 – May 31, 2026, then CYGSN5_21=2025
Cycle year based on date of interview

Page |3
INDID
Label_INDID
Range_INDID
Hard_edit_INDID

IP.3.2.

QDS_programming_INDID
Calculation_21_PARID

IP.3.2.a.

Calculate PARID (participant ID) by combining SITEID (side ID where person sampled) and
09 and last two digits of CYGSN5_21 (cycle year based on date of interview) and INDID
(respondent ID).
Participant ID
0000-0000-0001 to 9999-9999-9999

IP.3.3.

[DON'T READ ALOUD] The Participant ID is [Response to IP.3.0]-[09 and last 2 digits of
CYGSN5_21]-[Response to IP.3.2]. Is that correct?
0 No
1 Yes
Confirmation of PARID
If IDCONFN3 (Confirmation of PARID) is 0 (no), then read, “Interviewer: Please re-enter
participant ID.” Return to SITEID (Site ID where person sampled).
Program should read dashes after every 4th number for legibility (e.g., “The participant ID
is 1111-2222-3333. Is that correct?”)

Label_PARID
Range_PARID
IDCONFN3

Respondent ID:
Respondent ID
0001-9999
If number is less than 4 digits, then read, “Number must be four digits.” Return to INDID
(Respondent ID).
4 digits with leading 0s

Label_IDCONFN3
Hard_edit_IDCONFN3
QDS_programming_IDCONFN3
INTID
Label_INTID
Range_INTID
Hard_edit_INTID

IP.4.0.

Interviewer ID:
Interviewer ID
001–999
If number is less than 3 digits, then read, “Number must be three digits.” Return to INTID
(Interviewer ID).

INTSE_21

IP.5.0.

Interview setting: [SELECT ONLY ONE.]
1 Telephone
2 Prison or jail facility
3 Health facility
4 Health department
5 Private home
6 Public venue (e.g., coffee shop, library)
7 Video conferencing
8 Other
Interview setting 2021 and beyond

IP.6.0.

[DON'T READ ALOUD] What is the site ID of the jurisdiction completing the interview?
Site ID of jurisd. completing interview
0001–9999
Valid numbers are as follows: 0006, 1600, 0010, 0012, 0013, 3360, 0017, 0018, 4480,
0026, 0028, 0034, 0036, 5600, 0037, 0041, 0042, 6160, 0072, 7360, 0048, 0051, and 0053.
Else, read “The site ID of the jurisdiction completing the interview is invalid.” Return to
IJURN5 (Site ID of jurisd. completing interview).
If IJURN5 (Site ID of jurisd. completing interview) is less than 4 digits, then read, "Number
must be 4 digits." Return to IJURN5 (Site ID of jurisd. completing interview).

Label_INTSE_21
IJURN5
Label_IJURN5
Range_IJURN5
Hard_edit_8_IJURN5

Hard_edit2_8_IJURN5

Page |4
INTERPN8

IP.7.0.

[DON'T READ ALOUD] Are you using a language interpreter for this interview?
0 No
1 Yes
Use of interpreter for interview
If INTERPN8 (Use of interpreter for interview) = 0 (no), go to Intro_21_SURVEYIN
(Introduction for MMP survey).
Else, skip to INTLAN8 (Language interview conducted in).

IP.7.1.

[DON'T READ ALOUD] What language is the interpreter using for this interview?
1 Spanish
2 French
3 German
4 Chinese
5 Creole (French or Haitian)
6 American Sign Language (ASL)
7 Arabic
8 Other
Language interview conducted in
If INTLAN8 (Language interview conducted in) is 8 (other), go to ILAN8_OS (Specify other
interpreter language).
Else, skip to Intro_5_SURVEYIN (Introduction for MMP survey).

IP.7.2.

[DON'T READ ALOUD] Please specify what language the interpreter is using for this
interview.
Specify other interpreter language

Label_INTERPN8
Skip_INTERPN8

INTLAN8

Label_INTLAN8
Skip_INTLAN8

ILAN8_OS
Label_ILAN8_OS

Topic: Introduction (IN)
“Thank you for taking part in this interview. Remember, your answers to these questions
are confidential. The answers to some questions may seem obvious, but I need to ask you
all the questions. There is a set of cards that we’ll use during the interview. The cards
include a calendar, pictures, and text to help you answer some of the questions. Please
keep these cards nearby and I will let you know when we need them.”

Intro_21_SURVEYIN

SURVEYIN
Label_SURVEYIN

IN.1.0.
Introduction for MMP survey

Page |5

Module: Eligibility criteria (Y)
Topic: MMP participation (YM)
Calculation_ST_INTN5
YM.0.
Label_Calculation_ST_INTN5

ST_INTN5 = Current time.
Start of Interview

Calculation_STELIGIB
YM.0.a.
Label_Calculation_STELIGIB

Calculate start time of eligibility criteria.
Start time of eligibility criteria

PARTCPT

YM.1.0.

Have you ever participated in the MMP interview?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If questionnaire language is Spanish, then the message in Skip_21_PARTCPT (Ever
participation) should read, "Sólo estoy entrevistando a personas que no han sido
entrevistadas durante este año de recolección de datos. Muchas gracias por su tiempo."
Ever participation
If PARTCPT (Ever participation) = 1 (yes), go to PARTIC (Date participated in MMP). If
PARTCPT (Ever participation) = 0 (no) or 8 (don’t know), then skip to RESCURN8 (Current
residence as of interview date).
If PARTCPT (Ever participation) is 7 (refused to answer), then READ, “I’m only interviewing
people who haven’t already been interviewed during this data collection year. Thank you
very much for your time.” Then, skip to Calculation_EN_INTN5 (End of interview).

YM.1.1.

What month and year did you participate in the MMP interview?
8888 Don't Know
7777 Refused to Answer
If questionnaire is in Spanish, the message in Skip_21_PARTIC (Date participated in MMP)
should read, “Sólo estoy entrevistando a personas que no han sido entrevistadas durante
este año de recolección de datos. Muchas gracias por su tiempo.”
Date participated in MMP
01/2005-current
If CYGSN5_21 (Cycle year based on date of interview) =2021 and PARTIC (Date participated
in MMP) >= June 1, 2021 or if CYGSN5_21 (Cycle year based on date of interview) =2022
and PARTIC (Date participated in MMP) >= June 1, 2022 or if CYGSN5_21 (Cycle year based
on date of interview) =2023 and PARTIC (Date participated in MMP) >= June 1, 2023 or if
CYGSN5_21 (Cycle year based on date of interview) =2024 and PARTIC (Date participated
in MMP) >= June 1, 2024 or if CYGSN5_21 (Cycle year based on date of interview) =2025
and PARTIC (Date participated in MMP) >= June 1, 2025, then read, “I’m only interviewing
people who haven’t already been interviewed during this data collection year. Thank you
very much for your time.” Skip to Calculation_EN_INTN5 (End of interview).
Else, go to RESCURN8 (Current residence as of interview date).
Month is not required. Year is required.

Alt_text_21_PARTCPT

Label_PARTCPT
Skip_21_PARTCPT

PARTIC

Alt_text_21_PARTIC

Label_PARTIC
Range_n6_PARTIC
Skip_21_PARTIC

QDS_programming_PARTIC

Page |6

Topic: Residence (YS)
RESCURN8

YS.1.0.

What state or territory do you currently live in?
Interviewer instructions [DON’T READ]: Enter the two-character state abbreviation. For
reference, the abbreviations are: Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR),
California (CA), Colorado (CO), Connecticut (CT), Delaware (DE), District of Columbia (DC),
Florida (FL), Georgia (GA), Hawaii (HI), Idaho (ID), Illinois (IL), Indiana (IN), Iowa (IA), Kansas
(KS), Kentucky (KY), Louisiana (LA), Maine (ME), Maryland (MD), Massachusetts (MA),
Michigan (MI), Minnesota (MN), Mississippi (MS), Missouri (MO), Montana (MT), Nebraska
(NE), Nevada (NV), New Hampshire (NH), New Jersey (NJ), New Mexico (NM), New York
(NY), North Carolina (NC), North Dakota (ND), Ohio (OH), Oklahoma (OK), Oregon (OR),
Pennsylvania (PA), Puerto Rico (PR), Rhode Island (RI), South Carolina (SC), South Dakota
(SD), Tennessee (TN), Texas (TX), Utah (UT), Vermont (VT), Virginia (VA), Washington (WA),
West Virginia (WV), Wisconsin (WI), Wyoming (WY), Not living in the United States/Puerto
Rico (ZZ).
__ __
8 Don't Know
7 Refused to Answer
Current residence as of interview date
If RESCURN8 (Current residence as of interview date) is not one of these values: AL, AK, AZ,
AR, CA, CO, CT, DE, DC, FL, GA, HI,ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO,
MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA,
WA, WV, WI, WY, or ZZ, then read, “Incorrect abbreviation. Consult list of state or territory
abbreviations.” Return to RESCURN8 (Current residence as of interview date).
If RESCURN8 (Current residence as of interview date) is CA, IL, NY, PA, or TX, go to
MMPCTYN5 (MMP current city of residence).
Else, skip to RESAMPN8 (Residence on sampling date).

Label_RESCURN8
Hard_edit_RESCURN8

Skip_RESCURN8

MMPCTYN5

Label_MMPCTYN5
Hard_edit_8_MMPCTYN5

YS.1.1.

What city do you currently live in? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Chicago
2 Houston
3 Los Angeles County
4 New York City
5 Philadelphia
6 San Francisco
7 Other U.S. city
88 Don't Know
77 Refused to Answer
MMP current city of residence
Only valid combinations for MMPCTYN5 (MMP current city of residence) and RESCURN8
(Current residence as of interview date) are: RESCURN8 (Current residence as of
interview date) and MMPCTYN5 (MMP current city of residence) 1 California and 3 Los
Angeles County 1 California and 6 San Francisco 1 California and 7 Other U.S. City 1
California and 77 Refused 1 California and 88 Don’t Know 5 Illinois and 1 Chicago 5 Illinois
and 7 Other U.S. City 5 Illinois and 77 Refused 5 Illinois and 88 Don’t Know 12 New York
and 4 New York City 12 New York and 7 Other U.S. City 12 New York and 77 Refused 12
New York and 88 Don’t Know 15 Pennsylvania and 5 Philadelphia 15 Pennsylvania and 7
Other U.S. City 15 Pennsylvania and 77 Refused 15 Pennsylvania and 88 Don’t Know 18
Texas and 2 Houston 18 Texas and 7 Other U.S. City 18 Texas and 77 Refused 18 Texas and
88 Don’t Know Else, read, “That city does not match with the state you selected. Please
tell me the city again.” Return to MMPCTYN5 (MMP current city of residence).

Page |7
RESAMPN8

YS.2.0.

What state or territory did you live in on [Calculation_CLCSDT_21]?
Interviewer instructions [DON’T READ]: Enter the two-character state abbreviation. For
reference, the abbreviations are: Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR),
California (CA), Colorado (CO), Connecticut (CT), Delaware (DE), District of Columbia (DC),
Florida (FL), Georgia (GA), Hawaii (HI), Idaho (ID), Illinois (IL), Indiana (IN), Iowa (IA), Kansas
(KS), Kentucky (KY), Louisiana (LA), Maine (ME), Maryland (MD), Massachusetts (MA),
Michigan (MI), Minnesota (MN), Mississippi (MS), Missouri (MO), Montana (MT), Nebraska
(NE), Nevada (NV), New Hampshire (NH), New Jersey (NJ), New Mexico (NM), New York
(NY), North Carolina (NC), North Dakota (ND), Ohio (OH), Oklahoma (OK), Oregon (OR),
Pennsylvania (PA), Puerto Rico (PR), Rhode Island (RI), South Carolina (SC), South Dakota
(SD), Tennessee (TN), Texas (TX), Utah (UT), Vermont (VT), Virginia (VA), Washington (WA),
West Virginia (WV), Wisconsin (WI), Wyoming (WY), Not living in the United States/Puerto
Rico (ZZ).

Alt_text_21_RESAMPN8

Label_RESAMPN8
Hard_edit_RESAMPN8

Skip_21_RESAMPN8

__ __
8 Don't know
7 Refused to answer
If questionnaire is in Spanish, then Skip_21_RESAMPN8 (Residence on sampling date)
should read, "Solo estoy entrevistando a personas que vivían en ciertos estados en [Inserte
Calculation_CLCSDT_21 (Sample draw date based on interview date)]. Muchas gracias por
su tiempo."
Residence on sampling date
If RESAMPN8 (Residence on sampling date) is not one of these values: AL, AK, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, HI,ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE,
NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV,
WI, WY, or ZZ, then read, “Incorrect abbreviation. Consult list of state or territory
abbreviations.” Return to RESAMPN8 (Residence on sampling date).
If RESAMPN8 (Residence on sampling date) is CA, IL, NY, PA, or TX, go to SAMPCTN5 (MMP
city of residence at sampling).
Else, if RESAMPN8 (Residence on sampling date) is DE, FL, GA, IN, MI, MS, NJ, NC, OR, PR,
VA, or WA, then skip to DOB_13 (Date of birth).
Else, read, "I am only interviewing people who lived in certain states on [Insert
Calculation_CLCSDT_21 (Sample draw date based on interview date)]. Thank you very
much for your time." Then, skip to Calculation_EN_INTN5 (End of interview).

Page |8
SAMPCTN5

YS.2.1.

What city did you live in at that time? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Chicago
2 Houston
3 Los Angeles County
4 New York City
5 Philadelphia
6 San Francisco
7 Other U.S. city
88 Don't Know
77 Refused to Answer
MMP city of residence at sampling
If the values of RESAMPN8 (Residence on sampling date)and SAMPCTN5 (MMP city of
residence at sampling) result in any of these combinations: RESAMPN8 (Residence on
sampling date) and SAMPCTN5 (MMP city of residence at sampling) 1 California and 3 Los
Angeles County 1 California and 6 San Francisco 1 California and 7 Other U.S. City 1
California and 77 Refused 1 California and 88 Don’t Know 5 Illinois and 1 Chicago 5 Illinois
and 7 Other U.S. City 5 Illinois and 77 Refused 5 Illinois and 88 Don’t Know 12 New York
and 4 New York City 12 New York and 7 Other U.S. City 12 New York and 77 Refused 12
New York and 88 Don’t Know 15 Pennsylvania and 5 Philadelphia 15 Pennsylvania and 7
Other U.S. City 15 Pennsylvania and 77 Refused 15 Pennsylvania and 88 Don’t Know 18
Texas and 2 Houston 18 Texas and 7 Other U.S. City 18 Texas and 77 Refused 18 Texas and
88 Don’t Know, Then combination is valid. Else read, "That city does not match with the
state you selected. Please tell me the city again." Return to SAMPCTN5 (MMP city of
residence at sampling).

YA.1.0.

Please tell me the month and year of your date of birth.
8888 Don't Know
7777 Refused to Answer
Date of birth
01/1900–current
DOB_13 (Date of birth) requires a response for both the month and year. Partial date is not
accepted.

Label_SAMPCTN5
Hard_edit_8_SAMPCTN5

Topic: Age (YA)
DOB_13

Label_DOB_13
Range_N6_DOB_13
QDS_programming_DOB_13
Calculation_21_AGESMP YA.1.0a
N8
Label_AGESMPN8
Skip_21_AGESMPN8

QDS_programming_21_AGESMPN
8

Calculate the difference in years between Calculation_CLCSDT_21 and DOB_13, accounting
for leap years. Since we do not gather day information for DOB_13, a day will need to be
imputed: the last day of their birth month.
Age at sampling date
If Calculation_21_AGESMPN8 is < 18 years, then READ, “I am only interviewing people who
were age 18 years or older on [INSERT Calculation_CLCSDT_21 (Sample draw date based
on interview date)]. Thank you very much for your time.” Then skip to
Calculation_EN_INTN5 (End of interview).
If DOB_13 (Date of birth) is 7 (refused to answer) or 8 (don’t know), or if Calculation_21
_AGESMPN8 is equal to 18 years, go to AGEVER_8 (Age verification).
Else, skip to Calculation_EN_ELGN5 (End of eligibility section).
If questionnaire language is Spanish, the message in Skip_21_AGESMPN8 should read,
“Solo estoy entrevistando a personas de 18 años o más en [Insert Calculation_CLCSDT_21
(Sample draw date based on interview date)]. Muchas gracias por su tiempo”.

Page |9
AGEVER_8

YA.1.1.

Alt_text_21_AGEVER_8

Label_AGEVER_8
Skip_21_AGEVER_8

Were you at least 18 years old on [Calculation_CLCSDT_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If questionnaire language is Spanish, the message in Skip_21_AGEVER_8 (Age verification)
should read, “Solo estoy entrevistando a personas de 18 años o más en [Insert
Calculation_CLCSDT_21 (Sample draw date based on interview date)]. Muchas gracias por
su tiempo”.
Age verification
If AGEVER_8 (Age verification) is 0 (no), 7 (refused to answer), or 8 (don’t know), then
read, “I am only interviewing people who were 18 years or older on [Calculation_CLCSDT_
21 (Sample draw date based on interview date)]. Thank you very much for your time.”
Then skip to Calculation_EN_INTN5 (End of interview).
Else, go to Calculation_EN_ELGN5 (End of eligibility section).

Calculation_EN_ELGN5 Y.0.1.
Label_Calculation_EN_ELGN5

EN_ELGN5= Current time.
End of eligibility section

Calculation_TL_ELGN5 Y.0.b
Label_Calculation_TL_ELGN5

Calculate elapsed time between ST_INTN5 and EN_ELGN5 = TL_ELGN5
Total time for eligibility section

Page |10

Module: Basic demographics (D)
Topic: Education (DE)
Calculation_STBSDMN5 D.0.
Label_Calculation_STBSDMN5

STBSDMN5 = Current time
Start of basic demographics

EDUC

What is the highest level of education you completed? [READ RESPONSES. SELECT ONLY
ONE.]
1 Never attended school
2 Grades 1 through 8
3 Grades 9 through 11
4 Grade 12 or GED
5 Some college, associate's degree, or technical degree
6 Bachelor's degree
7 Any post-graduate studies
88 Don't Know
77 Refused to Answer
Education

DE.1.0.

Label_EDUC

Topic: Race-ethnicity (DR)
HISPA_13

DR.1.0.

Label_HISPA_13
Skip_HISPA_13

Intro_HISN3A
HISN3A

DR.1.1.

Label_HISN3A
HISN3B

Label_HISN3C

"Which of the following describes your Hispanic, Latino/a, or Spanish origin? You can
choose more than one." [READ RESPONSES.]
Mexican, Mexican American, or Chicano/a
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Mexican, Mexican American, or Chicano/a

DR.1.2.

Puerto Rican
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Puerto Rican origin

DR.1.3.

Cuban
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Cuban origin

Label_HISN3B
HISN3C

Do you consider yourself to be of Hispanic, Latino/a, or Spanish origin?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Hispanic-Latino origin
If HISPA_13 (Hispanic-Latino origin) is 1 (yes), go to Intro_HISN3A (Mexican, Mexican
American, or Chicano/a).
Else, skip to Intro_RACE_9A (American Indian or Alaska Native race).

Page |11
HISN3D

DR.1.4.

Label_HISN3D
Hard_edit_N8_HISN3D

Intro_RACE_9A
RACE_9A

DR.2.1.

Label_RACE_9A
RACE_9B

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Asian race

DR.2.3.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Black or African American race

DR.2.4.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Native Hawaiian/Other Pacific Islander

DR.2.5.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
White race
If RACE_9A (American Indian or Alaska Native race) = 0 (No), RACE_9B (Asian race) = 0
(No), RACE_9C (Black or African American race) = 0 (No), RACE_9D (Native Hawaiian/Other
Pacific Islander) = 0 (No), and RACE_9E (White race) = 0 (No), then read, “The respondent
did not select any racial group. Please confirm responses.” Allow the program to move
forward.

Label_RACE_9C
RACE_9D

Label_RACE_9D
RACE_9E

Label_RACE_9E
Soft_edit_N8_RACE_9E

"Which racial group or groups do you consider yourself to be in? You may choose more
than one option." [READ RESPONSES.]
American Indian or Alaska Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
American Indian or Alaska Native race

DR.2.2.

Label_RACE_9B
RACE_9C

Another Hispanic, Latino/a, or Spanish origin
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Another Hispanic, Latino/a, or Spanish
If HISPA_13 (Hispanic-Latino origin) = 1 (Yes) and HISN3A (Mexican, Mexican American, or
Chicano/a) = 0 (No) and HISN3B (Puerto Rican origin) = 0 (No) and HISN3C (Cuban origin) =
0 (No) and HISN3D (Another Hispanic, Latino/a, or Spanish) = 0 (No), then read, “Earlier
you said that you considered yourself to be of Hispanic, Latino/a, or Spanish origin. I'll go
back and read the choices again." Return to HISPA_13 (Hispanic-Latino origin).

Page |12

Topic: Gender and sexual orientation (DG)
BIRTGEN

DG.1.0.

What was your sex at birth? [READ RESPONSES EXCEPT “Intersex/ambiguous.” SELECT
ONLY ONE.]
1 Male
2 Female
3 Intersex/ambiguous
8 Don't Know
7 Refused to Answer
Sex at birth

DG.2.0.

Do you consider yourself to be male, female, or transgender? [DON’T READ RESPONSES.
SELECT ONLY ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Gender

DG.3.0.

Do you think of yourself as [READ RESPONSES. SELECT ONLY ONE.]:
1 Lesbian or gay
2 Straight, that is, not gay
3 Bisexual
4 Something else
8 Don't Know
7 Refused to Answer
Sexual orientation

Label_BIRTGEN
GENDER

Label_GENDER
SEXOR_N5

Label_SEXOR_N5

Topic: Language ability (DL)
LANWL1N3

DL.1.0.

How well do you speak English? [READ RESPONSES. SELECT ONLY ONE.]
1 Very well
2 Well
3 Not well
4 Not at all
8 Don't Know
7 Refused to Answer
How well do you speak English?

DL.2.0.

Do you speak a language other than English at home?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Speak a language other than English
If LANWL2N3 (Speak a language other than English) is 0 (no), 7 (refused to answer), or 8
(don’t know), then skip to COBORN_8 (Country or territory of birth).
Else, go to LANWL3N8 (Name of language spoken).

Label_LANWL1N3
LANWL2N3

Label_LANWL2N3
Skip_8_LANWL2N3

Page |13
LANWL3N8

DL.2.1.

What is this language? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 Spanish
2 French
3 German
4 Haitian Creole
5 Amharic
6 Tagalog
7 Arabic
8 American Sign Language
9 Chinese
10 Italian
11 Other
88 Don't know
77 Refused to answer
Name of language spoken
If LANWL3N8 (Name of language spoken) is 11 (other), go to LANN3_OS (Specify other
language).
Else skip to COBORN_8 (Country or territory of birth).

DL.2.2.

Specify language:
Specify other language

DF.1.0.

In what country or territory were you born? [DON'T READ RESPONSES. SELECT ONLY ONE.]
1 United States
2 Puerto Rico
3 Mexico
4 Haiti
5 Dominican Republic
6 Cuba
7 Other
88 Don't Know
77 Refused to Answer
Country or territory of birth

Label_LANWL3N8
Skip_LANWL3N8

LANN3_OS
Label_LANN3_OS

Topic: U.S. born (DF)
COBORN_8

Label_COBORN_8
Skip_21_OTCTRY

OTCTRY
Label_OTCTRY

DF.1.1.

If COBORN_8 (Country or territory of birth) is 7 (other), go to OTCTRY (Other specifycountry/territory of birth).
Else, skip to Intro1_8_HOMEL_9A (Lived on the street).
Specify other country:
Other specify-country/territory of birth

Page |14

Topic: Incarceration (DJ)
JAIL_N5

DJ.1.0.

During the past 12 months, how many different times were you in jail, detention, or prison
for longer than 24 hours?
888 Don't Know
777 Refused to Answer
Number of times incarcerated
0-180
If INTSE_21 (Interview setting 2021 and beyond) = 02 and JAIL_N5 (Number of times
incarcerated) = 0, then read, "Interviewer: the interview setting is a prison or jail facility,
but the respondent said s/he has not been incarcerated during the past 12 months. Please
clarify." Return to JAIL_N5 (Number of times incarcerated).
If JAIL_N5 (Number of times incarcerated) is 0, 777 (refused to answer), or 888 (don’t
know), then skip to Calculation_ENBSDMN5 (End of basic demographics).
Else go to DYINCN5 (Number of days when last incarcerated).

DJ.1.1.

The last time you were in jail, detention, or prison for longer than 24 hours, how many
days did you spend in jail, detention, or prison?
8888 Don't Know
7777 Refused to Answer
If INTSE_21 (Interview setting 2021 and beyond) = 1, 3, 4, 5, 6, 7, 8 and JAIL_N5 (Number
of times incarcerated) = 1, read the question as follows: "How many days did you spend in
jail, detention, or prison?" If the questionnaire is in Spanish, this should read, "¿Cuántos
días estuvo detenido, encarcelado o en prisión?"
If INTSE_21 (Interview setting 2021 and beyond) = 02 (prison or jail facility), read the
question as follows: "How many days have you currently spent in jail, detention, or
prison?"
Number of days when last incarcerated
1–7776
If INTSE_21 (Interview setting 2021 and beyond) = 2, then skip to Calculation_ENBSDMN5
(End of basic demographics).
Else go to DTINCN5 (Date of last release).

DJ.1.2.

The last time you were in jail, detention, or prison for longer than 24 hours, what month
and year were you released?
8888 Don't Know
7777 Refused to Answer
If JAIL_N5 (Number of times incarcerated) = 1, read the question as follows: "What month
and year were you released?"
Date of last release
01/1900–current
DTINCN5 (Date of last release) cannot be earlier than IDATE (Interview date) – 12 months.
If DTINCN5 (Date of last release) is earlier than IDATE (Interview date) – 12 months, then
read, “The release date has to be within the past 12 months. Please re-enter date.” Do not
allow the program to advance. If date is exactly 12 months prior to IDATE (Interview date),
then message should not pop up. Allow program to advance.

Label_JAIL_N5
Range_6_JAIL_N5
Hard_edit_21_JAIL_N5

Skip_JAIL_N5

DYINCN5

Alt_text2_21_DYINCN5

Alt_text1_21_DYINCN5

Label_DYINCN5
Range_DYINCN5
Skip_21_DYINCN5

DTINCN5

Alt_text_N8_DTINCN5
Label_DTINCN5
Range_N6_DTINCN5
Hard_edit1_DTINCN5

Page |15

Topic: Homeless (DH)
Intro1_8_HOMEL_9A
Intro2_6_HOMEL_9A
HOMEL_9A

DH.1.1.

Label_HOMEL_9A
QDS_programming_8_HOMEL_9A
HOMEL_9B

DH.1.2.

…lived in a shelter?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived in a shelter

DH.1.3.

…lived in a Single Room Occupancy (SRO) hotel?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived in a SRO hotel

DH.1.4.

…lived in a car?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived in a car

DH.2.0.

During the past 12 months, did you ever move in with other people even for a little while
because of financial problems?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Doubled up in past 12 months

DH.3.0.

How many times have you moved during the past 12 months?
888 Don't Know
777 Refused to Answer
Frequency of moves during past 12 months
0-365

DH.4.0.

Have you been evicted at any time during the past 12 months?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Eviction during the past 12 months

Label_HOMEL_9B
HOMEL_9C

Label_HOMEL_9C
HOMEL_9D

Label_HOMEL_9D
DOUBLEN8

Label_DOUBLEN8
MOVESN8

Label_MOVESN8
Range_MOVESN8
EVICTN8

Label_EVICTN8

“Next I’ll ask about the past 12 months. That is from last year [INSERT IDATE (Interview
date)-12 MONTHS] to today.”
"During the past 12 months, have you done any of the following:"
…lived on the street?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Lived on the street
The QDS program should enter the appropriate dates. Example: If IDATE (Interview date) is
11/11/2018, then the program should read, “That is from last year, 11/11/2017 to today.”

Page |16
Calculation_ENBSDMN5 D.0.a.
Label_Calculation_ENBSDMN5

ENBSDMN5 = Current time
End of basic demographics

Calculation_TLBSDMN5 D.0.b.
Label_Calculation_TLBSDMN5

Calculate elapsed time between STBSDMN5 and ENBSDMN5 = TLBSDMN5
Total time for basic demographics

Page |17

Module: Disability (A)
Topic: Disability (AD)
Calculation_STDSABN5 A.0.
Label_Calculation_STDSABN5

STDSABN5 = Current time
Start time of disability

Intro_21_DISDEFN3
DISDEFN3

“Now, I’m going to ask about conditions you may or may not have.”
Are you deaf or do you have serious difficulty hearing?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Deaf or serious difficulty hearing

AD.1.0.

Label_DISDEFN3
DISBLNN3

AD.2.0.

Are you blind or do you have serious difficulty seeing, even when wearing glasses?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Blind or serious difficulty seeing

AD.3.0.

Because of a physical, mental, or emotional condition, do you have serious difficulty
concentrating, remembering, or making decisions?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Difficulty concentrating, remembering…

AD.4.0.

Do you have serious difficulty walking or climbing stairs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Difficulty walking or climbing stairs

AD.5.0.

Do you have difficulty dressing or bathing?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Difficulty dressing or bathing

AD.6.0.

Label_DISERRN3

Because of a physical, mental, or emotional condition, do you have difficulty doing errands
alone such as visiting a doctor's office or shopping?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Difficulty doing errands alone

Calculation_ENDSABN5 A.0.a.
Label_Calculation_ENDSABN5

ENDSABN5 = Current time
End of disability section

Label_DISBLNN3
DISCONN3

Label_DISCONN3
DISWLKN3

Label_DISWLKN3
DISDRSN3

Label_DISDRSN3
DISERRN3

Page |18
Calculation_TLDSABN5

A.0.b.

Label_Calculation_TLDSABN5

Calculate elapsed time between STDSABN5 (start time of disability) and ENDSABN5 (end of
disability section) = TLDSABN5
Total time for disability section

Page |19

Module: Financial (F)
Topic: Employment (FE)
Calculation_STFINAN5
F.0.
Label_Calculation_STFINAN5

STFINAN5 = Current time
Start time of financial section

Intro_5_WORK_N3

“For the next question, please choose the answer that best describes your current
employment status. Tell me after I’ve read all the choices.”
Are you currently…? [READ RESPONSES. SELECT ONLY ONE.]
1 Employed for wages
2 Self-employed
3 Out of work for more than 1 year
4 Out of work for less than 1 year
5 A homemaker
6 A student
7 Retired
8 Or unable to work
88 Don't Know
77 Refused to Answer
Current employment status

WORK_N3

FE.1.0.

Label_WORK_N3

Topic: Income (FI)
Intro_INCOME_8_21

INCOME_8_21

Label_INCOME_8_21
Skip_INCOME_8_21

FI.1.0.

“Now I’d like to ask you some questions about [INSERT LASTYEAR (Last calendar year) (Last
calendar year)]. That is from January 1st, [INSERT LASTYEAR (Last calendar year) (Last
calendar year)] to December 31st, [INSERT LASTYEAR (Last calendar year) (Last calendar
year)]. For this next question, we will use Response Card A as well as the calendar.”
In [INSERT LASTYEAR], what was your combined monthly or yearly family income from all
sources before taxes When I say “combined family income,” I mean the total amount of
money from all family members living in your household. Please tell me the letter that
matches your income. [USE RESPONSE CARD.]
1 a. $0 to $916 per month or $0 to $10,999 per year
2 b. $917 to $1,083 per month or $11,000 to $12,999 per year
3 c. $1,084 to $1,249 per month or $13,000 to $14,999 per year
4 d. $1,250 to $1,416 per month or $15,000 to $16,999 per year
5 e. $1,417 to $1,666 per month or $17,000 to $19,999 per year
6 f. $1,667 to $2,083 per month or $20,000 to $24,999 per year
7 g. $2,084 to $2,499 per month or $25,000 to $29,999 per year
8 h. $2,500 to $3,333 per month or $30,000 to $39,999 per year
9 i. $3,334 to $4,166 per month or $40,000 to $49,999 per year
10 j. $4,167 to $6,249 per month or $50,000 to $74,999 per year
11 k. $6,250 or more per month or $75,000 or more per year
88 Don't Know
77 Refused to Answer
Income - monthly and yearly
If INCOME_8_21 (Income - monthly and yearly) (Income-monthly and yearly) is 77 (refused
to answer) or 88 (don’t know), skip to FOOD3_N5 (Food security-hungry) (Food securityhungry).
Else, go to DEPND_IN (Number of dependents) (Number of dependents).

Page |20
DEPND_IN

FI.2.0.

Including you, how many people depended on this income in [INSERT LAST YEAR]?
88 Don't Know
77 Refused to Answer
Number of dependents
1–49
If DEPND_IN (Number of dependents) is greater than 1, go to DEPND_N3 (Number of
dependents < 18 years old). Else, skip to FOOD3_N5 (Food security-hungry).

FI.2.1.

Of the people who depended on this income in [INSERT LAST YEAR], how many were less
than 18 years old?
88 Don't Know
77 Refused to Answer
Number of dependents < 18 years old
0-48
If DEPND_N3 (Number of dependents < 18 years old) is greater than or equal to DEPND_IN
(Number of dependents), read, "The number of people under 18 who depended on your
income in [INSERT LAST YEAR] must be less than the total number of people who
depended on your income in [INSERT LAST YEAR]." Do not advance program.

Label_DEPND_IN
Range_DEPND_IN
Skip_DEPND_IN
DEPND_N3

Label_DEPND_N3
Range_DEPND_N3
Hard_edit_DEPND_N3

Topic: Food security (FS)
FOOD3_N5

FS.1.0.

Label_FOOD3_N5

During the past 12 months, were you ever hungry but didn't eat because there wasn't
enough money for food?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Food security-hungry

Topic: Healthcare coverage (FH)
Intro_INSEMPN5_21
INSEMPN5_21

FH.1.1.

Label_INSEMPN5_21
INSMKTN5_21

FH.1.2.

Did you purchase health insurance through Healthcare.gov or the Health Insurance
Marketplace?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-marketplace

FH.1.3.

Did you purchase a health insurance plan directly from a health insurance company?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-insurance company

Label_INSMKTN5_21
INSCOMPN21

Label_INSCOMPN21

“I’d like to ask you about health insurance and healthcare coverage you had during the
past 12 months. This is from [IDATE (Interview date)-12 months] to today.”
Did you have health insurance through your employer or a family member's employer?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-employer

Page |21
KINDB_5

FH.1.4.

Did you have Medicaid?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-Medicaid

FH.1.5.

Did you have Medicare?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-Medicare

FH.1.6.

Did you have coverage through Ryan White HIV/AIDS Program or AIDS Drug Assistance
Program, also called ADAP?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-Ryan White or ADAP

Label_KINDB_5
KINDC_5

Label_KINDC_5
KINDD_5

Label_KINDD_5
Skip_KINDEN21

KINDEN21

FH.1.7.

LABEL_KINDEN21
KINDG_5

FH.1.8.

Did you have city, county, state or other publicly funded insurance, not including
Medicaid?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-city/county/st/other public

FH.1.9.

Did you have any other insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-other insurance
If KINDJ_5 (Insurance-other insurance) is 1 (yes), go to KINDOSN5 (Insurance-other
specify).
Else, skip to Skip_21_KINDOSN5 (Insurance-other specify).

Label_KINDG_5
KINDJ_5

Label_KINDJ_5
Skip_21_KINDJ_5

If INTSE_21 (Interview setting 2021 and beyond) = 2 (prison or jail facility) and DYINCN5
(Number of days when last incarcerated) >= 365, skip to KINDG_5 (Insurancecity/county/st/other public).
Else go to KINDEN21 (Insurance-military).
Did you have military-based healthcare coverage, such as TRICARE, CHAMPUS, CHAMPVA,
or healthcare coverage through the Veterans Administration?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-military

Page |22
KINDOSN5

FH.1.10.

Please tell me the other type of insurance that you had.
888 Don't Know
777 Refused to Answer
Insurance-other specify
If INSEMPN5_21 (Insurance-employer) through KINDJ_5 (Insurance-other insurance) = 0
(no), go to KINDZN5_21 (Insurance-no coverage confirmation).
Else, skip to INS12_9_21 (Gap in insurance or coverage).

FH.1.11.

So, during the past 12 months, you had no health insurance and no other coverage for any
type of healthcare including help with payment for your medications. Is that correct?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Insurance-no coverage confirmation
If KINDZN5_21 (Insurance-no coverage confirmation) = 0 (no), then return to INSEMPN5_
21 (Insurance-employer). Ask this section again.
If KINDZN5_21 (Insurance-no coverage confirmation) = 1 (yes), 7 (refused to answer), or 8
(don't know), go to PAY_N5 (ACA – problems paying).

FH.2.0.

During the past 12 months, was there a time that you didn’t have any health insurance or
healthcare coverage?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Gap in insurance or coverage
If INS12_9_21 (Gap in insurance or coverage) is 1 (yes), go to INSMTHN5_21 (Insurancemonths without coverage) .
Else, skip to PAY_N5 (ACA – problems paying).

FH.2.1.

During the past 12 months, about how many months were you without health insurance
or other healthcare coverage? If it is less than one month, round up to "1 month."
88 Don't Know
77 Refused to Answer
Insurance-months without coverage
1-12

FH.3.0.

During the past 12 months, did you have problems paying or were you unable to pay any
medical bills for your own care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
ACA – problems paying

Label_KINDOSN5
Skip_21_KINDOSN5

KINDZN5_21

Label_KINDZN5_21
Skip_KINDZN5_21

INS12_9_21

Label_INS12_9_21
Skip_INS12_9_21

INSMTHN5_21

Label_INSMTHN5_21
Range_INSMTHN5_21
PAY_N5

Label_PAY_N5

Page |23
BILLS_N5

FH.4.0.

Label_BILLS_N5

Do you currently have any medical bills for your own care that are being paid off over
time? This could include medical bills being paid off with a credit card, through personal
loans, or bill paying arrangements with hospitals or other providers. The bills can be from
earlier years as well as this year.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
ACA – paying off medical bills over time

Calculation_ENFINAN5 F.0.a.
Label_Calculation_ENFINAN5

ENFINAN5= Current time
End of financial section

Calculation_TLFINAN5
F.0.b.
Label_Calculation_TLFINAN5

Calculate elapsed time between STFINAN5 and ENFINAN5 = TLFINAN5
Total time for financial section

Page |24

Module: General medical care (J)
Topic: Health and well-being (JW)
Calculation_STGNMDN5 J.0.
Label_Calculation_STGNMDN5

STGNMDN5 = Current time.
Start time of General Medical Care

INTRO_21_GENHLTHN8
GENHLTN8
JW.1.0.

"Now I'm going to ask about your health."
In general, is your health [READ RESPONSES. SELECT ONLY ONE.]:
1 Poor
2 Fair
3 Good
4 Very good
5 Excellent
8 Don't know
7 Refused to answer
Perception of general health

Label_GENHLTN8

Topic: ER and hospitalizations (JH)
HOSPERN5

JH.1.0.

During the past 12 months, how many times have you gone to a hospital emergency room
about your own health? This includes emergency room visits that resulted in a hospital
admission.
888 Don't Know
777 Refused to Answer
Number of times gone to hospital ER
0–776

JH.2.0.

During the past 12 months, were you a patient in a hospital overnight? Don’t include an
overnight stay in the emergency room.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever in a hospital overnight
If HOSPONN5 (Ever in a hospital overnight) = 0 (no), 7 (refused to answer), or 8 (don’t
know), then skip to VACFL_8 (Influenza vaccination past 12 months).
Else, go to NUMONN5 (Num times stayed in hospital overnight).

JH.2.1.

During the past 12 months, how many different times did you stay in any hospital
overnight or longer?
888 Don't Know
777 Refused to Answer
Num times stayed in hospital overnight
1-365

JF.1.0

During the past 12 months, did you get a flu shot?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Influenza vaccination past 12 months

Label_HOSPERN5
Range_HOSPERN5
HOSPONN5

Label_HOSPONN5
Skip_HOSPONN5_8

NUMONN5

Label_NUMONN5
Range_NUMONN5

Topic: Influenza (JF)
VACFL_8

Label_VACFL_8

Page |25

Topic: Health literacy (JL)

Label_HLMF_12
Skip_8_HLMF_12

"For the next question, we'll use Response Card B."
How confident are you filling out medical forms by yourself? [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Extremely
2 Quite a bit
3 Somewhat
4 A little bit
5 Not at all
8 Don't Know
7 Refused to Answer
Health lit: filling out medical forms
Skip to Calculation_ENGNMDN5 (End of General medical care).

Calculation_ENGNMDN5 J.0.a.
Label_Calculation_ENGNMDN5

ENGNMDN5 = Current time
End of General medical care

Calculation_TLGNMDN5 J.0.b.
Label_Calculation_TLGNMDN5

Calculate elapsed time between STGNMDN5 and ENGNMDN5 = TLGNMDN5
Total time for General medical care

Intro_8_HLMF_12
HLMF_12

JL.1.0.

Page |26

Module: HIV care (K)
Topic: Diagnosis date (KD)
Calculation_STHVCAN5 K.0.
Label_Calculation_STHVCAN5

STHVCAN5 = Current time
Start time of HIV care

Intro_N21_IPERINN3
IPERINN3

"Next, I'm going to ask some questions about HIV."
Were you born with HIV?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Were you born with HIV?
If IPERINN3 (Were you born with HIV?) is 1 (yes) and DOB_13 (Date of birth) is earlier than
January 1977, read, “The date of birth provided is earlier than 1977, the date of the first
persons born with HIV were documented. Confirm date of birth.” Allow program to move
forward.
If IPERINN3 (Were you born with HIV?) = 1, then skip to Intro_21_EVERCR_8 (Ever rcvd.
HIV care).
Else, go to POS1S_9 (Date first tested positive for HIV).

KD.1.0.

Label_IPERINN3
Soft_edit_8_IPERINN3

Skip_21_IPERINN3

POS1S_9

KD.2.0.

Label_POS1S_9
Soft_edit_POS1S_9

Hard_edit_POS1S_9

QDS_programming_POS1S_9

What month and year did you first test positive for HIV? Tell me when you got your result,
not when you got your test.
8888 Don't Know
7777 Refused to Answer
Date first tested positive for HIV
If POS1S_9 (Date first tested positive for HIV) is earlier than March 1985, confirm response.
If POS1S_9 (Date first tested positive for HIV) is earlier than 03/1985, read, “The date
entered is earlier than 03/1985, the date of the first FDA-approved HIV test. Confirm date
of HIV test.” Program should move forward regardless of date.
POS1S_9 (Date first tested positive for HIV) cannot be earlier than DOB_13 (Date of birth).
If POS1S_9 (Date first tested positive for HIV) is earlier than DOB_13 (Date of birth), then
read, “Date first tested positive cannot be earlier than date of birth.”
Allow a blank response for month.

Page |27

Topic: Ever care (KE)
Intro_21_EVERCR_8

EVERCR_8

KE.1.0.

Alt_text_EVERCR_8

Label_EVERCR_8
soft_edit_EVERCR_8
Skip_EVERCR_8

“Next, I’ll ask about HIV care. By that, I mean routine care from a doctor, nurse, or other
healthcare worker to treat HIV—not emergency care when you go to an urgent care
center, emergency room, or stay in a hospital overnight”
Since testing positive for HIV in _ _ /_ _ _ _ [INSERT POS1S_9 (date first tested positive for
HIV)], have you ever seen a doctor, nurse, or other healthcare worker for HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) has an unknown month value but a known
year value, then read: “Since testing positive for HIV in [Insert year from POS1S_9 (Date
first tested positive for HIV)], have you ever seen a doctor, nurse, or other healthcare
worker for HIV care?” If POS1S_9 (Date first tested positive for HIV) is 77/7777 (refused to
answer) or 88/8888 (don’t know), then EVERCR_8 (Ever rcvd. HIV care) should read as
follows: “Since testing positive for HIV, have you ever seen a doctor, nurse, or other
healthcare worker for HIV care?”
Ever rcvd. HIV care
If EVERCR_8 (Ever rcvd. HIV care) = 0, then read "Are you sure that you have never
received HIV care?" Allow the program to move forward.
If IPERINN3 (Were you born with HIV?) = 1, then skip to Skip_MSAPPT_8 (Missed
appointments).
Else, go to Skip_CARE1_8 (1st HIV care visit).

Topic: Linkage to care (KL)
Skip_CARE1_8

Skip2_CARE1_8
CARE1_8

KL.1.0.

Label_CARE1_8
Intro_PREF1_8

PREF1_8

Label_PREF1_8

KL.2.0.

If POS1S_9 (Date first tested positive for HIV) < 5 years from IDATE (Interview date), go to
Skip2_CARE1_8 (1st HIV care visit).
If POS1S_9 (Date first tested positive for HIV) >= 5 years from IDATE (Interview date) or if
POS1S_9 (Date first tested positive for HIV) is 88/8888 (don't know), 77/7777 (refused to
answer), or skipped, skip to Skip_MSAPPT_8 (Missed appointments).
If EVERCR_8 (Ever rcvd. HIV care) is 0, 7, or 8, skip to Intro_PREF1_8 (Offered help finding
medical care).
Within 30 days after testing positive, did you see a doctor, nurse, or other healthcare
worker for HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
1st HIV care visit
“Next I’ll ask whether you got help getting connected to HIV care from a professional. A
professional could be someone like a doctor, nurse, social worker, patient navigator, or
receptionist. If you don’t remember, it’s okay to answer ‘don’t know’.”
Within 30 days after testing positive, did a professional ask if you needed help finding a
place to go for HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Offered help finding medical care

Page |28
PREF2N8

KL.3.0.

Within 30 days after testing positive, did a professional tell you where you could go for HIV
care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Told of HIV care

KL.4.0.

Within 30 days after testing positive, did a professional help you figure out if you qualified
for free or low-cost HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage free or low cost HIV care

KL.5.0.

Within 30 days after testing positive, did a professional make an appointment for you to
receive HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage making appointment

KL.6.0.

Within 30 days after testing positive, did a professional arrange transportation for you to
an HIV care appointment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage help arranging transport

KL.7.0.

Within 30 days after testing positive, did anyone contact you to remind you of your first
HIV care appointment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage appointment reminder

Label_PREF2N8
AREF4_8

Label_AREF4_8
AREF1_8

Label_AREF1_8
AREF2_8

Label_AREF2_8
AREF5N8

Label_AREF5N8
Skip_AREF3_8

AREF3_8

Label_AREF3_8

KL.8.0.

If CARE1_8 (1st HIV care visit) = 0 (no), 7 (refused), or 8 (don't know), then skip to
Skip_MSAPPT_8 (Missed appointments).
If EVERCR_8 (Ever rcvd. HIV care) = 0 (no), 7 (refused), or 8 (don't know), then skip to
Skip_MSAPPT_8 (Missed appointments).
Else, go to AREF3_8 (Linkage accompany 1st appt).
Within 30 days after testing positive, did a professional go with you to your first HIV care
appointment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Linkage accompany 1st appt

Page |29

Topic: Care utilization (KU)
Skip_ MSAPPT_8

MSAPPT_8

KU.1.0.

Label_MSAPPT_8
LASCA_8

KU.2.0.

Label_LASCA_8
Range_6_LASCA_8
Hard_edit_LASCA_8

Hard_edit2_LASCA_8

Skip_LASCA_8

QDS_programming_LASCA_8
USOCN5_8

KU.3.0.

Label_USOCN5_8
QDS_programming_USOCN5_8

NYMLTF_21

Label_NYMLTF_21
Skip_NYMLTF_21

KU.4.0.

If EVERCR_8 (Ever rcvd. HIV care) = 1, go to MSAPPT_8 (Missed appointments).
If EVERCR_8 (Ever rcvd. HIV care) = 0, 7, or 8, go to Intro_21_BARRI1N8 (Barriers to care:
financial).
During the past 12 months, have you missed any scheduled appointments for HIV care
that you didn’t cancel? Don't include appointments that were cancelled by the clinic.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed appointments
What month and year was your most recent visit to a doctor, nurse, or other healthcare
worker for HIV care?
8888 Don't Know
7777 Refused to Answer
Date most recent outpt. HIV care visit
01/1900–current
LASCA_8 (Date most recent outpt. HIV care visit) cannot be earlier than DOB_13 (Date of
birth). If LASCA_8 (Date most recent outpt. HIV care visit) < DOB_13 (Date of birth), then
read, "Date cannot be earlier than date of birth." Do not allow program to advance.
LASCA_8 (Date most recent outpt. HIV care visit) cannot be earlier than POS1S_9 (Date
first tested positive for HIV). If LASCA_8 (Date most recent outpt. HIV care visit) < POS1S_9
(Date first tested positive for HIV), then read, "Your most recent care visit cannot be earlier
than your diagnosis date." Do not allow program to advance.
If LASCA_8 (Date most recent outpt. HIV care visit) is 2 years or more before IDATE
(Interview date), then skip to HCPROVN8 (Healthcare provider identified).
Else, go to USOCN5_8 (HIV care facility name).
Allow a blank response for month.
During the past 2 years, what is the name of the place you went for most of your HIV
care?
HIV care facility name
Interviewer instructions: The name of the usual place of outpatient care is not recorded in
QDS, but will be used in later questions. This is the name of the location where the medical
record abstraction should be performed.
During the past 2 years, have you seen a doctor, nurse, or other healthcare worker for HIV
care at any facility besides [INSERT NAME OF PLACE YOU WENT FOR MOST OF YOUR
CARE]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Other facilities used for HIV care
If NYMLTF_21 (Other facilities used for HIV care) = 0, 7, or 8, then skip to Skip_GESAT_8
(Care satisfaction). Else, go to MLTFA2_8 (Total facilities attended for HIV care).

Page |30
MLTFA2_8

KU.4.1.

Label_MLTFA2_8
Range_MLTFA2_8

During the past 2 years, at how many total facilities have you received HIV care? Please
include [INSERT NAME OF PLACE YOU WENT FOR MOST OF YOUR CARE] in the total.
888 Don't Know
777 Refused to Answer
Total facilities attended for HIV care
2-99

Topic: Care satisfaction (KS)
SKIP_GESAT_8

GESAT_8

KS.1.0.

Label_GESAT_8

If LASCA_8 (Date most recent outpt. HIV care visit) is > 12 months prior to the IDATE
(Interview date), then skip to HCPROVN8 (Healthcare provider identified).
Else, go to GESAT_8 (Care satisfaction).
In general, how satisfied are you with the HIV care you received in the past 12 months?
[READ RESPONSES. SELECT ONLY ONE.]
1 Very satisfied
2 Somewhat satisfied
3 Somewhat dissatisfied
4 Very dissatisfied
8 Don't Know
7 Refused to Answer
Care satisfaction

Topic: Patient-provider relationship (KB)
HCPROVN8

KB.1.0.

Label_HCPROVN8
Skip_HCPROVN8

Intro_TRUS1N8
TRUS1N8

Label_TRUS1N8

KB.2.0.

Do you have a healthcare provider such as a doctor or nurse whom you see for most of
your HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Healthcare provider identified
If HCPROVN8 (Healthcare provider identified) = 0 (no), 7 (refused to answer), or 8 (don't
know), go to Intro_21_BARRI1N8 (Barriers to care: financial).
Else, skip to Intro_TRUS1N8 (HCR trust scale: options).
"I’m going to read you a few statements to better understand how you feel about that
healthcare provider. We'll use Response Card C."
How often does your healthcare provider discuss options and choices with you before
healthcare decisions are made? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: options

Page |31
TRUS2N8

KB.3.0.

My healthcare provider is committed to providing the best care possible. [USE RESPONSE
CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: best care

KB.4.0.

My healthcare provider is sincerely interested in me as a person. [USE RESPONSE CARD.
SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: interest

KB.5.0.

My healthcare provider is an excellent listener. [USE RESPONSE CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: excellent listener

KB.6.0.

My healthcare provider accepts me for who I am. [USE RESPONSE CARD. SELECT ONLY
ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: acceptance

KB.7.0.

My healthcare provider tells me the complete truth about my health-related problems.
[USE RESPONSE CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: truthful

Label_TRUS2N8
TRUS3N8

Label_TRUS3N8
TRUS4N8

Label_TRUS4N8
TRUS5N8

Label_TRUS5N8
TRUS6N8

Label_TRUS6N8

Page |32
TRUS7N8

KB.8.0.

My healthcare provider treats me as an individual. [USE RESPONSE CARD. SELECT ONLY
ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: individual

KB.9.0.

My healthcare provider makes me feel that I am worthy of his/her time and effort. [USE
RESPONSE CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: worthy

KB.10.0.

My healthcare provider takes the time to listen to me during each appointment. [USE
RESPONSE CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: listens to me

KB.11.0.

I feel comfortable talking to my healthcare provider about my personal issues. [USE
RESPONSE CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: personal issues

KB.12.0.

I feel better after seeing my healthcare provider. [USE RESPONSE CARD. SELECT ONLY
ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: feel better

Label_TRUS7N8
TRUS8N8

Label_TRUS8N8
TRUS9N8

Label_TRUS9N8
TRUS10N8

Label_TRUS10N8
TRUS11N8

Label_TRUS11N8

Page |33
TRUS12N8

KB.13.0.

How often do you think about changing to a new healthcare provider? [USE RESPONSE
CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: changing HCP

KB.14.0.

How often does your healthcare provider consider your need for privacy? [USE RESPONSE
CARD. SELECT ONLY ONE.]
0 None of the time
1 A little of the time
2 About half of the time
3 Most of the time
4 All of the time
8 Don't Know
7 Refused to Answer
HCR trust scale: privacy

Label_TRUS12N8
TRUS13N8

Label_TRUS13N8

Topic: Barriers and facilitators to care (KP)
Intro_21_BARRI1N8
BARRI1N8

KP.1.0.

Label_BARRI1N8
BARRI2N8

KP.2.0.

During the past 12 months, has depression or mental health problems made it difficult for
you to get HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: mental health

KP.3.0.

During the past 12 months, have you delayed getting HIV care because you felt well?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: felt well

KP.4.0.

During the past 12 months, have you had trouble getting HIV care because a doctor's
office or HIV clinic was hard to get to?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: lack access

Label_BARRI2N8
BARRI3N8

Label_BARRI3N8
BARRI4N8

Label_BARRI4N8

"I want to ask you about things that either get in the way or help people get HIV care."
During the past 12 months, have problems with money or health insurance made it
difficult for you to get HIV care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: financial

Page |34
BARRI5N8

KP.5.0.

During the past 12 months, have you delayed getting HIV care because you were too busy
with other personal things, such as family or work?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: personal things

KP.6.0.

During the past 12 months, have you delayed getting HIV care for some other reason?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barriers to care: other
If BARRI6N21 (Barriers to care: other) = 1 (yes), then go to BARRI6N21OS (Barrier- other
specify). Else, skip to FACCI1N8 (Facilitators to care: easy access) .

Label_BARRI5N8
BARRI6N21

Label_BARRI6N21
Skip_BARRI6N21
BARRI6N21OS

KP.6.1.

FACCI1N8

KP.7.0.

What is this reason?
888 Don't know
777 Refused to Answer
Label_BARRI6N21OS
Barrier- other specify
QDS_programming_BARRI6N21OS Character limit is 250 words.

Label_FACCI1N8

During the past 12 months, was there a doctor's office or HIV clinic that was easy for you
to get to?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Facilitators to care: easy access

Calculation_ENHVCAN5 K.0.a.
Label_Calculation_ENHVCAN5

ENHVCAN5 = Current time
End of HIV in care section

Calculation_TLHVCAN5 K.0.b.
Label_Calculation_TLHVCAN5

Calculate elapsed time between STHVCAN5 and ENHVCAN5 = TLHVCAN5
Total time for HIV Care

Page |35

Module: HIV treatment and adherence (T)
Topic: Ever ART (TE)
Calculation_STADHRN5 T.0.
Label_Calculation_STADHRN5

STADHRN5 = Current time.
Start HIV treatment and adherence

Skip_21_EART_N5

If EVERCR_8 (Ever rcvd. HIV care) is 1 (yes), go to Intro_21_EART_N5 (Ever taken ART).
Else, skip to Calculation_ENADHRN5 (End of HIV treatment and adherence).
“Now I’m going to ask about medicines that you may be taking for HIV. These HIV
medicines are also known as antiretroviral medicines or ART. The questions are about HIV
medicines taken after you tested positive for HIV.”
Have you ever taken any HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever taken ART
If EART_N5 (Ever taken ART) is 1 (yes), skip to Skip_N21_FART_N5. If EART_N5 (Ever taken
ART) is 7 (refused to answer) or 8 (don’t know), skip to Calculation_ENADHRN5 (End of HIV
treatment and adherence). Else go Intro_8_NART1_N5 (Never ART: No one talked about
it).

Intro_21_EART_N5

EART_N5

TE.1.0.

Label_EART_N5
Skip2_21_EART_N5

Intro_8_NART1_N5

NART1_N5

TE.1.1.

Label_NART1_N5
Skip_8_NART1_N5

NART2_N5

TE.1.2.

Your doctor said you should not start taking HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: Dr said not to start

TE.1.3.

You have problems paying for or getting insurance or coverage for HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: Prob. with money/insurance

Label_NART2_N5
NART3_N5

Label_NART3_N5

“I’m going to read you a list of reasons why some people have not taken HIV medicines
after testing positive for HIV. For each reason, please tell me 'yes' or 'no' if it applies to
your situation.”
No healthcare provider has ever talked to you about taking HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: No one talked about it
If NART1_N5 (Never ART: No one talked about it) = 1 (yes) then skip to NART3_N5 (Never
ART: Prob. with money/insurance).
Else, go to NART2_N5 (Never ART: Dr said not to start).

Page |36
NART4_N5

TE.1.4.

You decided not to take HIV medicines because you don’t think you need them.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: Don’t think you need them

TE.1.5.

You decided not to take HIV medicines because you think they would make you feel sick or
harm you.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Never ART: Think would feel sick or harm
Skip to Calculation_ENADHRN5 (End of HIV treatment and adherence).

Label_NART4_N5
NART5_N5

Label_NART5_N5
Skip_N21_NART5_N5
Skip_N21_FART_N5
FART_N5

TE.2.0.

Label_FART_N5
Range_N6_FART_N5
QDS_programming_FART_N5

If POS1S_9 (Date first tested positive for HIV) is greater than 5 years from IDATE (Interview
date), skip to CART_N5 (Currently taking ART). Else go to FART_N5 (Date first took ART).
When was the first time you ever took any HIV medicines? Please tell me the month and
year.
8888 Don't Know
7777 Refused to Answer
Date first took ART
01/1900–current
Allow a blank response for month. If month is blank for FART_N5 (Date first took ART), use
the year values for the validation.

Topic: Current ART (TC)
CART_N5

TC.1.0.

Are you currently taking any HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Currently taking ART
If CART_N5 (Currently taking ART) is 1 (yes), skip to Intro_8_ADH1_N5 (Days missed taking
ART).
If CART_N5 (Currently taking ART) is 0 (no), 7 (refused to answer) or 8 (don’t know), skip
to ATMD12_9 (Took ART in past 12 months).

TC.2.0.

During the past 12 months, have you taken HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Took ART in past 12 months
If CART_N5 (Currently taking ART) is 1 (yes), 7 (refused to answer) or 8 (don't know), then
skip to Skip_21_DASK_N5 (Dr asked if missed ART doses).
If CART_N5 (Currently taking ART) is 0 (no), go to Intro_8_CART1_N5 (Stopped ART: No one
talked about it).

Label_CART_N5
Skip_8_CART_N5

ATMD12_9

Label_ATMD12_9
Skip_21_ATMD12_9

Page |37
Intro_8_CART1_N5
CART1_N5

TC.2.1.

Label_CART1_N5
Skip_8_CART1_N5

CART2_N5

TC.2.2.

Your doctor said you should not take HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped ART: Dr said not to start

TC.2.3.

You have problems paying for or getting insurance or coverage for HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stop ART: Prob. with money or insurance

TC.2.4.

You decided not to take HIV medicines because you don’t think you need them.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped ART: Don’t think you need them

TC.2.5.

You decided not to take HIV medicines because you think they would make you feel sick or
harm you.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stop ART: Think would feel sick or harm
If CART1_N5 (Stopped ART: No one talked about it) through CART5_N5 (Stop ART: Think
would feel sick or harm) are all “no,” then READ: “The respondent said earlier that he or
she is not currently taking HIV medicines. Please confirm that the respondent has no
reason for not taking any HIV medicines.” Allow the program to advance.
Skip to Skip_8_DASK_N5 (Dr asked if missed ART doses).

Label_CART2_N5
CART3_N5

Label_CART3_N5
CART4_N5

Label_CART4_N5
CART5_N5

Label_CART5_N5
Soft_edit_CART5_N5

Skip_21_CART6_N5

“I’m going to read you a list of reasons why some people are not currently taking HIV
medicines. For each reason, please tell me 'yes' or 'no' if it applies to your situation.”
No healthcare provider has talked to you about restarting HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped ART: No one talked about it
If CART1_N5 (Stopped ART: No one talked about it) = 1 (yes) then skip to CART3_N5 (Stop
ART: Prob. with money or insurance).
Else, go to CART2_N5 (Stopped ART: Dr said not to start).

Page |38

Topic: Adherence (TA)
Intro_8_ADH1_N5

ADH1_N5

TA.1.0.

Label_ADH1_N5
Range_ADH1_N5
ADH2_N5

TA.1.1.

In the past 30 days, how good a job did you do at taking your HIV medicines in the way you
were supposed to? [READ RESPONSES. SELECT ONLY ONE.]
1 Very poor
2 Poor
3 Fair
4 Good
5 Very good
6 Excellent
8 Don't Know
7 Refused to Answer
How good a job taking ART

TA.1.2.

During the past 30 days, how often did you take your HIV medicines in the way you were
supposed to? [READ RESPONSES. SELECT ONLY ONE.]
1 Never
2 Rarely
3 Sometimes
4 Usually
5 Almost always
6 Always
8 Don't Know
7 Refused to Answer
How often took ART

TA.2.0.

For the next question we will use Response Card D. During the past 30 days, how often
were you troubled by side effects from any of your HIV medicines? [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Never
2 Rarely
3 About half of the time
4 Most of the time
5 Always
8 Don't Know
7 Refused to Answer
How often side effects

Label_ADH2_N5
ADH3_N5

Label_ADH3_N5
TRBL_EFT

Label_TRBL_EFT

“Now I am going to ask you about the HIV medicines you are currently taking. We realize it
can be hard for people to take all their medications exactly as they are supposed to. I’m
going to ask you about the past 30 days. That is from [INSERT IDATE (Interview date)
(interview date) - 30 DAYS] to today. If you have been taking HIV medicines for less than 30
days, please think about the time since you started taking them.” [SHOW RESPONDENT
CALENDAR]
In the past 30 days, on how many days did you miss at least one dose of any of your HIV
medicines?
88 Don't Know
77 Refused to Answer
Days missed taking ART
0–30

Page |39
OFT_N5

TA.3.0.

Label_OFT_N5
Skip_N21_OFT_N5
Intro_MIS1N5_8
MIS1N5_8

TA.4.0.

Label_MIS1N5_8
MIS2_N5

You were in the hospital or too sick to take your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Hospitalized or sick

TA.4.2.

You fell asleep early or overslept.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Asleep or overslept

TA.4.3.

You had a change in your daily routine or were out of town.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Miss ART: Change routine or out of town

TA.4.4.

You had side effects from your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Side effects

Label_MIS3_N5
MIS4_N5

Label_MIS4_N5
MIS5_N5

Label_MIS5_N5

“The last time you missed taking your HIV medicines, which of the following were reasons
you missed? Please answer 'yes' or 'no' to each reason.”
You had a problem paying for your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Miss ART: Problem paying

TA.4.1.

Label_MIS2_N5
MIS3_N5

How often are you supposed to take your HIV medicines? If you take more than one pill at
the same time, count this as one time. [READ RESPONSES. SELECT ONLY ONE.]
1 Three times or more a day
2 Twice a day
3 Once a day
4 Less often than once a day-for example, every other day or weekly
8 Don't Know
7 Refused to Answer
How often take ART
If ADH1_N5 (Days missed taking ART) >=1 go to Intro_MIS1N5_8 (Miss ART: Problem
paying).Else skip to Skip_21_DASK_N5 (Dr asked if missed ART doses).

Page |40
MIS6_N5

TA.4.5.

You felt depressed or overwhelmed.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Depressed or overwhelmed

TA.4.6.

You were drinking or using drugs.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Drinking or using drugs

TA.4.7.

You forgot to take your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Forgot

TA.4.8.

You did not feel like taking your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Didn’t feel like taking

TA.4.9.

You had a problem getting a prescription or a refill for your HIV medicines.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Missed ART: Problem prescription/refill

Label_MIS6_N5
MIS7_N5

Label_MIS7_N5
MIS8_N5

Label_MIS8_N5
MIS9_N5

Label_MIS9_N5
MIS10_N8

Label_MIS10_N8
Skip_21_DASK_N5

DASK_N5

TA.5.0.

Label_DASK_N5
PROB_N5

Label_PROB_N5

TA.6.0.

If CART_N5 (Currently taking ART) is 1 (yes) or if ATMD12_9 (Took ART in past 12 months)
is 1 (yes), go to DASK_N5 (Dr asked if missed ART doses).
Else, skip to Calculation_ENADHRN5 (End of HIV treatment and adherence).
During the past 12 months, did your doctor or other clinic staff ask you whether you
missed taking any doses of your HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Dr asked if missed ART doses
During the past 12 months, did your doctor or other clinic staff ask you whether you had
problems taking your HIV medicines?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Dr asked if problems taking ART doses

Page |41
Calculation_ENADHRN5 T.0.a.
Label_Calculation_ENADHRN5

ENADHRN5 = Current time
End of HIV treatment and adherence

Calculation_TLADHRN5 T.0.b.
Label_Calculation_TLADHRN5

Calculate elapsed time between STADHRN5 and ENADHRN5 = TLADHRN5
Total time for HIV tx and adherence

Page |42

Module: Sexual behavior (S)
Topic: Total sex partners (ST)
Calculation_ST_SEXN5
S.0.
Label_Calculation_ST_SEXN5

ST_SEXN5 = Current time
Start time of sexual behavior

Calculation_SX_GEN

ST.1.0.a. If GENDER=Male and BIRTGEN=Male, then SX_GEN=1 (Male).
If GENDER=Female and BIRTGEN=Female, then SX_GEN=2 (Female).
If (GENDER=Male and BIRTGEN=Female) or (GENDER=Female and BIRTGEN=Male) or
(GENDER=Transgender and [BIRTGEN=1 (Male), 2 (Female), 7 (refused to answer), or 8
(don’t know)]), then SX_GEN=3 (Transgender).
If BIRTGEN=intersex, then SX_GEN=4 (Indeterminate).
If ([GENDER=7 (refused to answer) or 8 (don’t know)] and [BIRTGEN = 1 (Male), 2 (Female),
7 (refused to answer), or 8 (don’t know)], then SX_GEN=4 (Indeterminate).
If BIRTGEN=7 (refused to answer) or 8 (don’t know), and GENDER is 1 (male), 2 (female), 7
(refused to answer), or 8 (don’t know), then SX_GEN=4 (Indeterminate).
1 Male
2 Female
3 Transgender
4 Indeterminate
8 Don't Know
7 Refused to Answer
Label_Calculation_SX_GEN
Sex gender
Skip_N21_SX_GEN
If SX_GEN (Sex gender) = 3, skip to Intro2_N21_SX_TFPN4. Else, go to Intro1_N21
_SX_TFPN4.
Intro1_N21_SX_TFPN4

Intro2_N21_SX_TFPN4

Skip_SX_TFPN4
SX_TFPN4

ST.1.0.

Label_SX_TFPN4
Range_SX_TFPN4
SX_TMPN4

ST.2.0.

During the past 12 months, how many males have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of male partners
0-999

ST.3.0.

During the past 12 months, how many transgender persons have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of transgender partners
0-999

Label_SX_TMPN4
Range_SX_TMPN4
SX_TTPN4

Label_SX_TTPN4
Range_SX_TTPN4

"Next I'm going to ask you about sex. When I say sex, I mean vaginal or anal sex. Vaginal
sex means penis in the vagina and anal sex means penis in the anus. When answering,
don't include people you only had oral sex with. The number of people could range
anywhere from 0 to over a hundred. Remember that your answers will be private."
"Next I'm going to ask you about sex. When I say sex, I mean vaginal or anal sex. Vaginal
sex means penis in the vagina, neovagina, or front hole. Anal sex means penis in the anus,
butt, or back hole. When answering, don't include people you only had oral sex with. The
number of people could range anywhere from 0 to over a hundred. Remember that your
answers will be private."
If SX_GEN (Sex gender)=2 (Female), skip to SX_TMPN4 (Number of male partners).
Else, go to SX_TFPN4 (Number of female partners).
During the past 12 months, how many females have you had sex with?
8888 Don't Know
7777 Refused to Answer
Number of female partners
0-999

Page |43
Calculation_SX_TOTN4

ST.3.0.a. Create a calculated variable where the sum of SX_TFPN4 + SX_TMPN4 + SX_TTPN4 =
SX_TOTN4 (total number of sex partners).
If the response to SX_TFPN4 (number of female partners), SX_TMPN4 (number of male
partners), and SX_TTPN4 (number of transgender partners) is 7 (refused to answer) or 8
(don’t know), then calculate the response as “0.” EXAMPLE: if SX_TFPN4 = 8 (don’t know)
AND SX_TMPN4 = 8 (don’t know), AND SX_TTPN4 = 7 (refused to answer), THEN SX_TOTN4
= 0.
If any of the values are Skipped (.S), then do not include the value in the calculation.
EXAMPLE: if SX_TFPN4 = 2 AND SX_TMPN4 = 8 (don’t know), AND SX_TTPN4 = Skipped,
then SX_TOTN4 (total number of sex partners) = 2.
Label_Calculation_SX_TOTN4
Total number of vaginal and anal sex partners
Calculation_SXFMONN4 ST.3.0.b. Female only partners: create a calculated variable SXFMONN4 (female only partners) if
SX_TMPN4 (number of male partners) = 0, 8 (don’t know), or 7 (refused to answer) AND
SX_TTPN4 (number of transgender partners) = 0, 8 (don’t know), or 7 (refused to answer)
AND SX_TFPN4 (number of female partners) >= 1, then SXFMONN4 (female only partners)
= 1; else SXFMONN4 = 0.
Label_Calculation_SXFMONN4
Female only partners
Calculation_SXMLONN4 ST.3.0.c.

Label_Calculation_SXMLONN4

Male only partners: create a calculated variable SXMLONN4 (male only partners) if
SX_TFPN4 (number of female partners) = 0, 8 (don’t know), or 7 (refused to answer) or .S
(skipped) AND SX_TTPN4 (number of transgender partners) = 0, 8 (don’t know), or 7
(refused to answer) AND SX_TMPN4 (number of male partners) >= 1, then SXMLONN4
(male only partners) = 1; else SXMLONN4 = 0.
Male only partners

Calculation_SXTGONN4

ST.3.0.d. Transgender only partners: create a calculated variable SXTGONN4 (transgender only
partners) if SX_TFPN4 (number of female partners) = 0, 8 (don’t know), or 7 (refused to
answer) AND SX_TMPN4 (number of male partners) = 0, 8 (don’t know), or 7 (refused to
answer) AND SX_TTPN4 (number of transgender partners) >= 1, then SXTGONN4
(transgender only partners) = 1; else SXTGONN4 = 0.
Label_Calculation_SXTGONN4
Transgender only partners
SXTOVRN4

Alt_text_N21_SXTOVRN4
Label_SXTOVRN4
Skip1_21_SXTOVRN4

Skip2_N21_SXTOVRN4

ST.4.0.

So, the total number of people you had vaginal or anal sex with during the past 12 months
was [INSERT SX_TOTN4]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1, then display the text as
follows: "So, you only had vaginal or anal sex with one person during the past 12 months?"
Verification of total sex partners
If SXTOVRN4 (Verification of total sex partners) = 0 (no) or 8 (don't know), return to
Skip_SX_TFPN4 (Number of female partners). If SXTOVRN4 (Verification of total sex
partners) = 1 (yes), go to Skip1_21_SX_NM1N4_21 (Name of partner 1). If SXTOVRN4
(Verification of total sex partners) = 7 (refused to asnwer), skip to Calculation_EN_SEXN5
(End of sexual behavior).
No vaginal or anal sex partners: If SX_TFPN4 (Number of female partners), SX_TMPN4
(Number of male partners), and SX_TTPN4 (Number of transgender partners) are all some
combination of 0, 7 (refused to answer), or 8 (don't know), then skip to
Calculation_EN_SEXN5 (End of sexual behavior).

Page |44

Topic: Names of partners (SN)
Skip1_21_SX_NM1N4_21

Intro1_21_SX_NM1N4_21

Skip2_5_SX_NM1N4_21
Intro2_21_SX_NM1N4_21

Skip3_5_SX_NM1N4_21
Intro3_21_SX_NM1N4_21

Skip4_5_SX_NM1N4_21
SX_NM1N4_21
SN.1.0.
Alt_text_SX_NM1N4_21
Label_SX_NM1N4_21
Range_SX_NM1N4_21
Soft_edit_21_SX_NM1N4_21

Skip5_21_SX_NM1N4_21

QDS_programming_SX_NM1N4_2
1

If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1, go to Intro1_21
_SX_NM1N4_21 (Name of partner 1). If SX_TOTN4 (Total number of vaginal and anal sex
partners) = 2-5, skip to Intro2_21_SX_NM1N4_21 (Name of partner 1). If SX_TOTN4 (Total
number of vaginal and anal sex partners) > 5, skip to Intro3_21_SX_NM1N4_21 (Name of
partner 1).
"The next questions are about the person you had sex with during the past 12 months. I'll
need a way to refer to this person. You may refer to them in any way you want—initials,
nickname, or where you met. However, please don't provide a last name or any other
identifying information."
Skip to SX_NM1N4_21 (Name of partner 1).
“The next questions are about the [Calculation_SX_TOTN4 (Total number of vaginal and
anal sex partners): if 2, 3, 4, or 5] people you had sex with during the past 12 months.
Please answer to the best of your knowledge, but it’s okay to tell me you don’t know. I’ll
need a way to refer to each person. You may refer to them in any way you want—initials,
nickname, or where you met. However, please don’t provide a last name or any other
identifying information.”
Skip to SX_NM1N4_21 (Name of partner 1).
“The next questions are about the 5 people you recently had sex with during the past 12
months. Please answer to the best of your knowledge, but it’s okay to tell me you don’t
know. I’ll need a way to refer to each person. You may refer to them in any way you
want—initials, nickname, or where you met. However, please don’t provide a last name or
any other identifying information.”
Skip to SX_NM1N4_21 (Name of partner 1).
What should we call the last person you had sex with during the past 12 months?
77 Refused to Answer
If SX_TOTN4 (Total number of vaginal and anal sex partners) is 1, then display the text as
follows: What should we call the person you had sex with during the past 12 months?
Name of partner 1
Character limit = 50
If SX_NM1N4_21 (Name of partner 1) is 7 (refused to answer), then read the message
“Interviewer: remind the respondent that they can provide initials, nicknames, or another
name to identify the partner.” Allow program to move forward.
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1 and SX_NM1N4_21 (Name
of partner 1) is 7 (refused to answer), skip to Calculation_EN_SEXN5 (End of sexual
behavior). If SX_TOTN4 (Total number of vaginal and anal sex partners) is > 1, go to
SX_NM2N4_21 (Name of partner 2). If SX_TOTN4 (Total number of vaginal and anal sex
partners) is 1, skip to Intro_N21_SXPGN1N4.
Use open-ended response. Do not allow an 8 (don't know) response option.

Page |45
SX_NM2N4_21

SN.1.1.

Label_SX_NM2N4_21
Range_SX_NM2N4_21
Soft_edit_21_SX_NM2N4_21

Hard_edit_SX_NM2N4_21

Skip_21_SX_NM2N4_21

QDS_programming_SX_NM2N4_2
1
SX_NM3N4_21

SN.1.2.

Label_ SX_NM3N4_21
Range_SX_NM3N4_21
Soft_edit_21_SX_NM3N4_21

Hard_edit_SX_NM3N4_21

Skip_SX_NM3N4_21

QDS_programming_SX_NM3N4_2
1

What should we call the 2nd person you had sex with during the past 12 months?
77 Refused to Answer
Name of partner 2
Character limit = 50
If SX_NM2N4_21 (Name of partner 2) is 7 (refused to answer), read, “Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner.” Allow program to move forward.
If SX_NM1N4_21 (Name of partner 1) and SX_NM2N4_21 (Name of partner 2) are
identical, then read, “You gave me the same name for another partner. Can you please
give me another name?” The program should return to SX_NM2N4_21 (Name of partner
2).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 2 and SX_NM1N4_21 (Name
of partner 1) and SX_NM2N4_21 (Name of partner 2) are 7 (refused to answer), skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >2, go to SX_NM3N4_21 (Name of partner 3). Else, skip to Intro_N21
_SXPGN1N4.
Use open-ended response. Do not allow an 8 (don’t know) response option.
What should we call the 3rd person you had sex with during the past 12 months?
77 Refused to Answer
Name of partner 3
Character limit = 50
If SX_NM3N4_21 (Name of partner 3) is 7 (refused to answer), read, “Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner.” Allow program to move forward.
If either SX_NM1N4_21 (Name of partner 1), SX_NM2N4_21 (Name of partner 2), or
SX_NM3N4_21 (Name of partner 3) are identical, then read, “You gave me the same name
for another partner. Can you please give me another name?” The program should return
to SX_NM3N4_21 (Name of partner 3).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 3 and SX_NM1N4_21 (Name
of partner 1), SX_NM2N4_21 (Name of partner 2) and SX_NM3N4_21 (Name of partner 3)
are 7 (refused to answer), skip to Calculation_EN_SEXN5 (End of sexual behavior). If
SX_TOTN4 (Total number of vaginal and anal sex partners) > 3, go to SX_NM4N4_21 (Name
of partner 4). Else Skip to Intro_N21_SXPGN1N4.
Use open-ended responses. Do not allow an 8 (don’t know) response option.

Page |46
SX_NM4N4_21

SN.1.3.

Label_SX_NM4N4_21
Range_SX_NM4N4_21
Soft_edit_21_SX_NM4N4_21

Hard_edit_SX_NM4N4_21

Skip_SX_NM4N4_21

QDS_programming_SX_NM4N4_2
1
SX_NM5N4_21

SN.1.4.

Label_SX_NM5N4_21
Range_SX_NM5N4_21
Soft_edit_21_SX_NM5N4_21

Hard_edit_SX_NM5N4_21

Skip_SX_NM5N4_21

QDS_programming_SX_NM5N4_2
1

What should we call the 4th person you had sex with during the past 12 months?
77 Refused to Answer
Name of partner 4
Character limit = 50
If SX_NM4N4_21 (Name of partner 4) is 7 (refused to answer), read, “Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner.” Allow program to move forward.
If either SX_NM1N4_21 (Name of partner 1), SX_NM2N4_21 (Name of partner 2),
SX_NM3N4_21 (Name of partner 3), or SX_NM4N4_21 (Name of partner 4) are identical,
then read, “You gave me the same name for another partner. Can you please give me
another name?” The program should return to SX_NM4N4_21 (Name of partner 4).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 4 and SX_NM1N4_21 (Name
of partner 1), SX_NM2N4_21 (Name of partner 2), SX_NM3N4_21 (Name of partner 3) and
SX_NM4N4_21 (Name of partner 4) are 7 (refused to answer), skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) > 4, go to SX_NM5N4_21 (Name of partner 5). Else, skip to Intro_N21
_SXPGN1N4.
Use open-ended responses. Do not allow an 8 (don’t know) response option.
What should we call the 5th person you had sex with in the past 12 months?
77 Refused to Answer
Name of partner 5
Character limit = 50
If SX_NM5N4_21 (Name of partner 5) is 7 (refused to answer), read, “Interviewer: remind
the respondent that they can provide initials, nicknames, or another name to identify the
partner.” Allow program to move forward.
If either SX_NM1N4_21 (Name of partner 1), SX_NM2N4_21 (Name of partner 2),
SX_NM3N4_21 (Name of partner 3), SX_NM4N4_21 (Name of partner 4) or SX_NM5N4_21
(Name of partner 5) are identical, then read, “You gave me the same name for another
partner. Can you please give me another name?” The program should return to
SX_NM5N4_21 (Name of partner 5).
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 5 and SX_NM1N4_21 (Name
of partner 1), SX_NM2N4_21 (Name of partner 2), SX_NM3N4_21 (Name of partner 3),
SX_NM4N4_21 (Name of partner 4), SX_NM5N4_21 (Name of partner 5) are all 7 (refused
to answer), skip to Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total
number of vaginal and anal sex partners) > 5 and SX_NM1N4_21 (Name of partner 1),
SX_NM2N4_21 (Name of partner 2), SX_NM3N4_21 (Name of partner 3), SX_NM4N4_21
(Name of partner 4), and SX_NM5N4_21 (Name of partner 5) are all 7 (refused to answer),
then skip to Skip_21_SXAGC1N4 (Aggregate condom use-6 partners). Else, go to Intro_N21
_SXPGN1N4.
Use open-ended responses. Do not allow an 8 (don’t know) response option.

Page |47

Topic: Partner demographics #1 (SP)
"Now I'm going to ask you about [INSERT SX_NM1N4_21 (Name of partner 1)]."
Skip partner gender questions if the respondent had sex with only one gender: If
SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, skip to SXPEN1N4 (Partner ethnicity-partner 1). Else,
go to SXPGN1N4 (Partner gender-partner 1).
SXPGN1N4
SP.1.0.
Is [INSERT SX_NM1N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Label_SXPGN1N4
Partner gender-partner 1
Soft_edit_21_SXPGN1N4
If SX_GEN (Sex gender) = 2 (female) and SXPGN1N4 (Partner gender-partner 1) = female
(2), read, “Only include people with whom you had vaginal or anal sex. Remember, for
these questions, vaginal sex means penis in the vagina and anal sex means penis in the
anus." Interviewer instructions: Return to previous question if necessary. Allow survey to
move forward. Else, go to SXPEN1N4 (Partner ethnicity-partner 1).
QDS_programming_21_SXPGN1N4 When question instructions say “insert partner name,” then insert response from
SX_NM1N4_21 (Name of partner 1).

Intro_N21_SXPGN1N4
Skip_21_SXPGN1N4

SXPEN1N4

SP.2.0.

Is [INSERT SX_NM1N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 1

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM1N4_21]?
Select all that apply. If you’re not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY.]
Race-partner 1

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 1: American Indian or Alaska Native

SP.3.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 1: Asian

Label_SXPEN1N4
SXPR1N4

Label_SXPR1N4
SXPR1N4A

Label_SXPR1N4A
SXPR1N4B

Label_SXPR1N4B

Page |48
SXPR1N4C

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 1: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 1: Native Hawaiian or Other Pacific Islander

SP.3.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 1: White

Label_SXPR1N4C
SXPR1N4D

Label_SXPR1N4D
SXPR1N4E

Label_SXPR1N4E

Topic: Vaginal sex #1 (SV)
Skip_21_SX_VS1N4

SX_VS1N4

SV.1.0.

Label_SX_VS1N4
Skip2_21_SX_VS1N4

QDS_programming_21_partnerde
mo1

Transgender/unknown gender respondent: If SX_GEN (Sex gender) = 3 (transgender) or 4
(indeterminate), then skip to SX_TG1N4 (Transgender-partner 1). Transgender/unknown
gender partner: If SXTGONN4 (Transgender only partners) = 1 or SXPGN1N4 (Partner
gender-partner 1) = 3 (transgender), 7 (refused to answer), or 8 (don’t know), then skip to
SX_TG1N4 (Transgender-partner 1). Male-male partners: If SX_GEN (Sex gender) = 1
(male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex gender) = 1 (male) and
SXPGN1N4 (Partner gender-partner 1) = 1 (male), then skip to SXANL1N4 (Anal sex-partner
1). Female-female partners: If SX_GEN (Sex gender) = 2 (female) and SXPGN1N4 (Partner
gender-partner 1) = 2 (female), skip to Skip_21_PREP1N4_21 (PrEP-partner 1). Else, go to
SX_VS1N4 (Vaginal sex-partner 1).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM1N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 1
If SX_VS1N4 (Vaginal sex-partner 1) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL1N4 (Anal sex-partner 1). Else if SX_VS1N4 (Vaginal sex-partner 1) = 1 (yes), go to
Intro_21_SXVC1BN4_21 (Condom vaginal-partner 1).
When question instructions say “insert partner name," then insert response from
SX_NM1N4_21 (Name of partner 1).

Page |49
Intro_21_SXVC1BN4_21
SXVC1BN4_21

SV.1.1.

Label_SXVC1BN4_21

“The next question is about condom use. Please include when a condom was used the
entire time, not only part of the time during sex.”
During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM1N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 1

Topic: Anal sex #1 (SL)
SXANL1N4

SL.1.0.

Label_SXANL1N4
Soft_edit_21_SXANL1N4

Skip_21_SXANL1N4
Intro_21_SXAC1BN4_21
SXAC1BN4_21

Label_SXAC1BN4_21
Skip_21_SXAC1BN4_21

SL.1.1.

During the past 12 months, did you have anal sex with [INSERT SX_NM1N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 1
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN1N4 (Partner gender-partner
1) = 1 (male) or SXMLONN4 (Male only partners) =1 and SXANL1N4 (Anal sex-partner 1) = 0
(no), then read “Earlier you told me that you had anal sex with [INSERT SX_NM1N4_21
(Name of partner 1)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward. No vaginal or anal sex
reported among males with female partners: If SX_GEN (Sex gender) = 1 (male) and
SXPGN1N4 (Partner gender-partner 1) = 2 (female) and SX_VS1N4 (Vaginal sex-partner 1) =
0 (no) and SXANL1N4 (Anal sex-partner 1) = 0 (no), then read “Earlier you told me that you
had vaginal or anal sex with [INSERT SX_NM1N4_21 (Name of partner 1)]. Is this correct?”
Interviewer instructions: Return to previous questions to correct error. Allow program to
move forward. No vaginal or anal sex reported among females with male partners: If
SX_GEN (Sex gender) = 2 (female) and SXPGN1N4 (Partner gender-partner 1) = 1 (male)
and SX_VS1N4 (Vaginal sex-partner 1) = 0 (no) and SXANL1N4 (Anal sex-partner 1) = 0 (no),
then read “Earlier you told me that you had vaginal or anal sex with [INSERT SX_NM1N4_
21 (Name of partner 1)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward.
If SXANL1N4 (Anal sex-partner 1) = 1 (yes), go to Intro_21_SXAC1BN4_21 (Condom analpartner 1). Else, skip to STPRT1N4 (Partner status-partner 1).
"The next question is about condom use. Please include when a condom was used the
entire time, not only part of the time."
During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM1N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 1
For all responses, skip to STPRT1N4 (Partner status-partner 1).

Page |50

Topic: Transgender and unknown gender sex #1 (SG)
SX_TG1N4

SG.1.0.

Label_SX_TG1N4
Soft_edit_SX_TG1N4

Skip_21_SX_TG1N4
QDS_programming_21_transgen1
Intro_21_TGC1BN4_21
TGC1BN4_21

SG.1.1.

Label_ TGC1BN4_21

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM1N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 1
If SX_TG1N4 (Transgender-partner 1) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM1N4_21 (Name of partner 1)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG1N4 (Transgender-partner 1) = 1 (yes), go to Intro_21_TGC1BN4_21 (Condom
transgender-partner 1). Else skip to STPRT1N4 (Partner status-partner 1).
When question instructions say “insert partner name,” then insert response from
SX_NM1N4_21 (Name of partner 1).
"The next question is about condom use. Please include times when a condom was used
the entire time, not only part of the time during sex.”
During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM1N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't know
7 Refused to Answer
Condom transgender-partner 1

Topic: Status #1 (SS)
STPRT1N4

SS.1.0.

Do you know [INSERT SX_NM1N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 1
If STPRT1N4 (Partner status-partner 1) = 1 (yes), go to PRTST1N4 (Partner status first sexpartner 1). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 1, skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) >1, skip to Intro_N21_SXPGN2N4.

SS.1.1.

During the past 12 months, what was [INSERT SX_NM1N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 1
If PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV Negative), go to Intro_21
_PREP1N4_21 (PrEP-partner 1). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 1, skip to Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total
number of vaginal and anal sex partners) >1, skip to Intro_N21_SXPGN2N4.

Label_STPRT1N4
Skip_21_STPRT1N4

PRTST1N4

Label_PRTST1N4
Skip_21_PRTST1N4

Page |51

Topic: Pre-exposure prophylaxis #1 (SR)
Intro_21_ PREP1N4_21
PREP1N4_21

SR.1.0.

Label_ PREP1N4_21
Skip_21_PREP1N4_21

QDS_programming_21_PREP1N4

Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP.
Was [INSERT SX_NM1N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 1
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 1, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >=2, go to Intro_N21_SXPGN2N4.
When question instructions say “insert partner name, then insert response from
SX_NM1N4_21 (Name of partner 1) (Name of partner 1).

Topic: Partner demographics #2 (SP)
Intro_N21_SXPGN2N4
Skip_21_SXPGN2N4

“Now I’m going to ask you about [INSERT SX_NM2N4_21 (Name of partner 2)].”
Skip partner gender questions if the respondent had sex with only one gender: If
SXTGONN4 (Transgender only partners) = 1 or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN2N4 (Partner ethnicity-partner 2).
Else, go to SXPGN2N4 (Partner gender-partner 2).
SXPGN2N4
SP.1.0.
Is [INSERT SX_NM2N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Label_SXPGN2N4
Partner gender-partner 2
Soft_edit_21_SXPGN2N4
If SEX_GEN = 2 (female) and SXPGN2N4 (Partner gender-partner 2) = female (2), read,
“Only include people with whom you had vaginal or anal sex. Remember, for these
questions, vaginal sex means penis in the vagina and anal sex means penis in the anus”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward. Else, go to Soft_edit2_21_SXPGN2N4 (Partner gender-partner 2).
Soft_edit2_21_SXPGN2N4
If SXPGN2N4 (Partner gender-partner 2) (partner gender- partner 2) and SXPGN1N4
(Partner gender-partner 1) (partner gender- partner 1) does not match what they report in
SX_TFPN4 (Number of female partners) (females had sex with), SX_TMPN4 (Number of
male partners) (males had sex with) and SX_TTPN4 (Number of transgender partners)
(transgender had sex with) then display a message letting them know.
QDS_programming_21_SXPGN2N4 When question instructions say “insert partner name,” insert response to SX_NM2N4_21
(Name of partner 2).
SXPEN2N4

Label_SXPEN2N4
Skip_SXPEN2N4

SP.2.0.

Is [INSERT SX_NM2N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 2
For all responses go to SXPR2N4 (Race-partner 2).

Page |52
SXPR2N4

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM2N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY]
Race-partner 2

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: American Indian Alaska Native

SP.3.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: Asian

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: Native Hawaiian or Other Pacific Islander

SP.3.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 2: White

Label_SXPR2N4
SXPR2N4A

Label_SXPR2N4A
SXPR2N4B

Label_SXPR2N4B
SXPR2N4C

Label_SXPR2N4C
SXPR2N4D

Label_SXPR2N4D
SXPR2N4E

Label_SXPR2N4E

Page |53

Topic: Vaginal sex #2 (SV)
Skip_21_SX_VS2N4

SX_VS2N4

SV.1.0.

Label_SX_VS2N4
Skip2_21_SX_VS2N4
QDS_programming_21_partnerde
mo2
SXVC2BN4_21

Label_SXVC2BN4_21

SV.1.1.

Transgender/unknown gender respondent: If SX_GEN (Sex gender) =3 (transgender) or 4
(indeterminate), then skip to SX_TG2N4 (Transgender-partner 2). Transgender/unknown
gender partner: If SXTGONN4 (Transgender only partners) = 1 or SXPGN2N4 (Partner
gender-partner 2) = 3 (transgender), 7 (refused to answer), or 8 (don’t know), then skip to
SX_TG2N4 (Transgender-partner 2). Male-male partners: If SX_GEN (Sex gender) = 1
(male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex gender) = 1 (male) and
SXPGN2N4 (Partner gender-partner 2) = 1 (male), then skip to SXANL2N4 (Anal sex-partner
2). Female-female partners: If SX_GEN (Sex gender) = 2 (female) and SXPGN2N4 (Partner
gender-partner 2) = 2 (female), skip to Skip2_21_PREP2N4_21 (PrEP-partner 2). Else go
to SX_VS2N4 (Vaginal sex-partner 2).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM2N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 2
If SX_VS2N4 (Vaginal sex-partner 2) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL2N4 (Anal sex-partner 2). Else, go to SXVC2BN4_21 (Condom vaginal-partner 2).
When question instructions say “insert partner name,” insert response to SX_NM2N4_21
(Name of partner 2).
During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM2N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 2

Page |54

Topic: Anal sex #2 (SL)
SXANL2N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM2N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 2
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN2N4 (Partner gender-partner
2) = 1 or SXMLONN4 (Male only partners) = 1 and SXANL2N4 (Anal sex-partner 2) =0 (no),
then read “Earlier you told me that you had anal sex with [INSERT SX_NM2N4_21 (Name of
partner 2)]. Is this correct?” Interviewer instructions: Return to previous questions to
correct error. Allow program to move forward. No vaginal or anal sex reported among
males with female partners: If SX_GEN (Sex gender) = 1 (male) and SXPGN2N4 (Partner
gender-partner 2) = 2 (female) and SX_VS2N4 (Vaginal sex-partner 2) = 0 (no) and
SXANL2N4 (Anal sex-partner 2) = 0 (no), then read “Earlier you told me that you had
vaginal or anal sex with [INSERT SX_NM2N4_21 (Name of partner 2)]. Is this correct?”
Interviewer instructions: Return to previous questions to correct error. Allow program to
move forward. No vaginal or anal sex reported among females with male partners: If
SX_GEN (Sex gender) = 2 (female) and SXPGN2N4 (Partner gender-partner 2) = 1 (male)
and SX_VS2N4 (Vaginal sex-partner 2) = 0 (no) and SXANL2N4 (Anal sex-partner 2) = 0 (no),
then read “Earlier you told me that you had vaginal or anal sex with [INSERT SX_NM2N4_
21 (Name of partner 2)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward.
If SXANL2N4 (Anal sex-partner 2) = 1 (yes), go to SXAC2BN4_21 (Condom anal-partner 2).
Else, skip to STPRT2N4 (Partner status-partner 2).

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM2N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 2
For all responses, skip to STPRT2N4 (Partner status-partner 2).

Label_SXANL2N4
Soft_edit_21_SXANL2N4

Skip_21_SXANL2N4
SXAC2BN4_21

Label_ SXAC2BN4_21
Skip_21_SXAC2BN4_21

Topic: Transgender and unknown gender sex #2 (SG)
SX_TG2N4

SG.1.0.

Label_SX_TG2N4
Soft_Edit_21_SX_TG2N4

Skip_21_SX_TG2N4
QDS_programming_21_transgen2

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM2N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 2
If SX_TG2N4 (Transgender-partner 2) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM2N4_21 (Name of partner 2)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG2N4 (Transgender-partner 2) = 1 (yes), go to TGC2BN4_21 (Condom transgenderpartner 2). Else skip to STPRT2N4 (Partner status-partner 2).
When question instructions say “insert partner name," insert response to SX_NM2N4_21
(Name of partner 2).

Page |55
TGC2BN4_21

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM2N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 2

SS.1.0.

Do you know [INSERT SX_NM2N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 2
If STPRT2N4 (Partner status-partner 2) = 1 (yes), go to PRTST2N4 (Partner status first sexpartner 2). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 2, skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of vaginal
and anal sex partners) > 2, skip to Intro_N21_SXPGN3N4.

SS.1.1.

During the past 12 months, what was [INSERT SX_NM2N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 2
If PRTST2N4 (Partner status first sex-partner 2) = 2 (HIV Negative), go to Skip1_21
_PREP2N4_21 (PrEP-partner 2). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 2, skip to Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total
number of vaginal and anal sex partners) >2, skip to Intro_N21_SXPGN3N4.

Label_ TGC2BN4_21

Topic: Status #2 (SS)
STPRT2N4

Label_STPRT2N4
Skip_21_STPRT2N4

PRTST2N4

Label_PRTST2N4
Skip_21_PRTST2N4

Topic: Pre-exposure prophylaxis #2 (SR)
Skip1_21_PREP2N4_21

Intro_ PREP2N4_21
PREP2N4_21

SR.1.0.

Label_ PREP2N4_21
Skip2_21_PREP2N4_21

QDS_programming_PREP2N4

If PRTST1N4 (Partner status first sex-partner 1) = 1 (HIV positive), 8 (Don’t know) or 7
(refused to answer), skip to Intro_PREP2N4_21 (PrEP-partner 2). If PRTST1N4 (Partner
status first sex-partner 1) = 2 (HIV negative), skip to PREP2N4_21 (PrEP-partner 2).
Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP.
Was [INSERT SX_NM2N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 2
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 2, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >2, skip to Intro_N21_SXPGN3N4.
When question instructions say “insert partner name,” then insert response from
SX_NM2N4_21 (Name of partner 2).

Page |56

Topic: Partner demographics #3 (SP)
“Now I’m going to ask you about [INSERT SX_NM3N4_21 (Name of partner 3)].”
Skip partner gender questions if the respondent had sex with only one gender: If
SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN3N4 (Partner ethnicity-partner 3).
Else, go to SXPGN3N4 (Partner gender-partner 3).
SXPGN3N4
SP.1.0.
Is [INSERT SX_NM3N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Label_SXPGN3N4
Partner gender-partner 3
Soft_edit_21_SXPGN3N4
If SEX_GEN = 2 (female) and SXPGN3N4 (Partner gender-partner 3) = female (2), read,
“Only include people with whom you had vaginal or anal sex. Remember, for these
questions, vaginal sex means penis in the vagina and anal sex means penis in the anus”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward. Else, go to Soft_edit2_21_SXPGN3N4 (Partner gender-partner 3).
Soft_edit2_21_SXPGN3N4
If SXPGN2N4 (Partner gender-partner 2) and SXPGN1N4 (Partner gender-partner 1) does
not match what they report in SX_TFPN4 (Number of female partners) , SX_TMPN4
(Number of male partners) and SX_TTPN4 (Number of transgender partners) then display
a message letting them know.
QDS_programming_21_SXPGN5N4 When question instructions say “insert partner name,” insert response to SX_NM3N4_21
(Name of partner 3).

Intro_N21_SXPGN3N4
Skip_21_SXPGN3N4

SXPEN3N4

SP.2.0.

Is [INSERT SX_NM3N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 3
For all responses go to SXPR3N4 (Race-partner 3).

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM3N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY]
Race-partner 3

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: American Indian or Alaska Native

SP.3.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: Asian

Label_SXPEN3N4
Skip_SXPEN3N4
SXPR3N4

Label_SXPR3N4
SXPR3N4A

Label_SXPR3N4A
SXPR3N4B

Label_SXPR3N4B

Page |57
SXPR3N4C

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: Native Hawaiian or Other Pacific Islander

SP.3.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 3: White

Label_SXPR3N4C
SXPR3N4D

Label_SXPR3N4D
SXPR3N4E

Label_SXPR3N4E

Topic: Vaginal sex #3 (SV)
Skip_21_SX_VS3N4

SX_VS3N4

SV.1.0.

Label_SX_VS3N4
Skip2_21_SX_VS3N4

QDS_programming_21_partnerde
mo3
SXVC3BN4_21

Label_SXVC3BN4_21

SV.1.1.

Transgender/unknown gender respondent: If SX_GEN (Sex gender) = 3 (transgender) or 4
(indeterminate), then skip to SX_TG3N4 (Transgender-partner 3). Transgender/unknown
gender partner: If SXTGONN4 (Transgender only partners) = 1 or SXPGN3N4 (Partner
gender-partner 3) = 3 (transgender), 7 (refused to answer), or 8 (don’t know), then skip to
SX_TG3N4 (Transgender-partner 3). Male-male partners: If SX_GEN (Sex gender) = 1
(male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex gender) = 1 (male) and
SXPGN3N4 (Partner gender-partner 3) = 1 (male), then skip to SXANL3N4 (Anal sex-partner
3). Female-female partners: If SX_GEN (Sex gender) = 2 (female) and SXPGN3N4 (Partner
gender-partner 3) = 2 (female), skip to Skip2_21_PREP3N4_21 (PrEP-partner 3). Else go
to SX_VS3N4 (Vaginal sex-partner 3).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM3N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 3
If SX_VS3N4 (Vaginal sex-partner 3) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL3N4 (Anal sex-partner 3). Else if SX_VS3N4 (Vaginal sex-partner 3)= 1 (yes), go to
SXVC3BN4_21 (Condom vaginal-partner 1).
When question instructions say “insert partner name,” insert response to SX_NM3N4_21
(Name of partner 3).
During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM3N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 1

Page |58

Topic: Anal sex #3 (SL)
SXANL3N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM3N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 3
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN3N4 (Partner gender-partner
3) = 1 (male) or SXMLONN4 (Male only partners) =1 (yes) and SXANL3N4 (Anal sex-partner
3) = 0 (no), then read “Earlier you told me that you had anal sex with [INSERT SX_NM3N4_
21 (Name of partner 3)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward. No vaginal or anal sex
reported among males with female partners: If SX_GEN (Sex gender) = 1 (male) and
SXPGN3N4 (Partner gender-partner 3) = 2 (female) and SX_VS3N4 (Vaginal sex-partner 3) =
0 (no) and SXANL3N4 (Anal sex-partner 3) = 0 (no), then read “Earlier you told me that you
had vaginal or anal sex with [INSERT SX_NM3N4_21 (Name of partner 3)]. Is this correct?”
Interviewer instructions: Return to previous questions to correct error. Allow program to
move forward. No vaginal or anal sex reported among females with male partners: If
SX_GEN (Sex gender) = 2 (female) and SXPGN3N4 (Partner gender-partner 3) = 1 (male)
and SX_VS3N4 (Vaginal sex-partner 3) = 0 (no) and SXANL3N4 (Anal sex-partner 3) = 0 (no),
then read “Earlier you told me that you had vaginal or anal sex with [INSERT SX_NM3N4_
21 (Name of partner 3)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward.
If SXANL3N4 (Anal sex-partner 3) = 1 (yes), go to SXAC3BN4_21 (Condom anal-partner 3).
Else, skip to STPRT3N4 (Partner status-partner 3)

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM3N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 3
For all responses, skip to STPRT3N4 (Partner status-partner 3).

Label_SXANL3N4
Soft_edit_21_SXANL3N4

Skip_21_SXANL3N4
SXAC3BN4_21

Label_SXAC3BN4_21
Skip_21_SXAC3BN4_21

Topic: Transgender and unknown gender sex #3 (SG)
SX_TG3N4

SG.1.0.

Label_SX_TG3N4
Soft_edit_SX_TG3N4

Skip_21_SX_TG3N4
QDS_programming_21_transgen3

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM3N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 3
If SX_TG3N4 (Transgender-partner 3) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM3N4_21 (Name of partner 3)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG3N4 (Transgender-partner 3) = 1 (yes), go to TGC3BN4_21 (Condom transgenderpartner 3). Else skip to STPRT3N4 (Partner status-partner 3).
When question instructions say “insert partner name,” insert response to SX_NM3N4_21
(Name of partner 3).

Page |59
TGC3BN4_21

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM3N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 3

SS.1.0.

Do you know [INSERT SX_NM3N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 3
If STPRT3N4 (Partner status-partner 3) = 1 (yes), go to PRTST3N4 (Partner status first sexpartner 3). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 3, skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) >3, skip to Intro_N21_SXPGN4N4.

SS.1.1.

During the past 12 months, what was [INSERT SX_NM3N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 3
If PRTST3N4 (Partner status first sex-partner 3) = 2 (HIV Negative), go to Skip1_21
_PREP3N4_21 (PrEP-partner 3). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 3, skip to Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total
number of vaginal and anal sex partners) >3, skip to Intro_N21_SXPGN4N4.

Label_TGC3BN4_21

Topic: Status #3 (SS)
STPRT3N4

Label_STPRT3N4
Skip_21_STPRT3N4

PRTST3N4

Label_PRTST3N4
Skip_21_PRTST3N4

Topic: Pre-exposure prophylaxis #3 (SR)
Skip1_21_PREP3N4_21

Intro_PREP3N4_21
PREP3N4_21

Label_PREP3N4_21
Skip2_21_PREP3N4_21

SR.1.0.

If PRTST1N4 (Partner status first sex-partner 1) = 1 (HIV positive), 8 (Don’t know) or 7
(refused to answer) and PRTST2N4 (Partner status first sex-partner 2) = 1 (HIV positive), 8
(Don’t know) or 7 (refused to answer), skip to Intro_PREP3N4_21 (PrEP-partner 3). If
PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV negative) or PRTST2N4 (Partner
status first sex-partner 2) = 2 (HIV negative), skip to PREP3N4_21 (PrEP-partner 3). Else,
skip to Skip2_21_PREP3N4_21 (PrEP-partner 3).
Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP.
Was [INSERT SX_NM3N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-partner 3
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 3, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >3, skip to Intro_N21_SXPGN4N4.

Page |60

Topic: Partner demographics #4 (SP)
“Now I’m going to ask you about [INSERT SX_NM4N4_21 (Name of partner 4)].”
Skip partner gender questions if the respondent had sex with only one gender: If
SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN4N4 (Partner ethnicity-partner 4).
Else, go to SXPGN4N4 (Partner gender-partner 4).
SXPGN4N4
SP.1.0.
Is [INSERT SX_NM4N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Label_SXPGN4N4
Partner gender-partner 4
Soft_edit_21_SXPGN4N4
If SEX_GEN = 2 (female) and SXPGN4N4 (Partner gender-partner 4) = 2 (female), read,
“Only include people with whom you had vaginal or anal sex. Remember, for these
questions, vaginal sex means penis in the vagina and anal sex means penis in the anus”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward. Else go to Soft_edit2_21_SXPGN4N4 (Partner gender-partner 4).
Soft_edit2_21_SXPGN4N4
If SXPGN2N4 (Partner gender-partner 2) (partner gender- partner 2) and SXPGN1N4
(Partner gender-partner 1) (partner gender- partner 1) does not match what they report in
SX_TFPN4 (Number of female partners) (females had sex with), SX_TMPN4 (Number of
male partners) (males had sex with) and SX_TTPN4 (Number of transgender partners)
(transgender had sex with) then display a message letting them know.
QDS_programming_21_SXPGN4N4 When question instructions say “insert partner name,” insert response to SX_NM4N4_21
(Name of partner 4).
Intro_N21_ SXPGN4N4
Skip_21_SXPGN4N4

SXPEN4N4

SP.2.0.

Is [INSERT SX_NM4N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 4
For all responses go to SXPR4N4 (Race-partner 4).

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM4N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY]
Race-partner 4

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: American Indian or Alaska Native

Label_SXPEN4N4
Skip_SXPEN4N4
SXPR4N4

Label_SXPR4N4
SXPR4N4A

Label_SXPR4N4A

Page |61
SXPR4N4B

SP.3.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: Asian

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: Native Hawaiian or Other Pacific Islander

SP.3.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 4: White

Label_SXPR4N4B
SXPR4N4C

Label_SXPR4N4C
SXPR4N4D

Label_SXPR4N4D
SXPR4N4E

Label_SXPR4N4E

Topic: Vaginal sex #4 (SV)
Skip_21_SX_VS4N4

Transgender/unknown gender respondent: If SX_GEN (Sex gender) = 3 (transgender) or 4
(indeterminate), then skip to SX_TG4N4 (Transgender-partner 4). Transgender/unknown
gender partner: If SXTGONN4 (Transgender only partners) = 1 or SXPGN4N4 (Partner
gender-partner 4) = 3 (transgender), 7 (refused to answer), or 8 (don’t know), then skip to
SX_TG4N4 (Transgender-partner 4). Male-male partners: If SX_GEN (Sex gender) = 1
(male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex gender) = 1 (male) and
SXPGN4N4 (Partner gender-partner 4) = 1 (male), then skip to SXANL4N4 (Anal sex-partner
4). Female-female partners: If SX_GEN (Sex gender) = 2 (female) and SXPGN4N4 (Partner
gender-partner 4) = 2 (female), skip to Skip2_21_PREP4N4_21 (PrEP-Partner 4). Else go
to SX_VS4N4 (Vaginal sex-partner 4).
SX_VS4N4
SV.1.0.
During the past 12 months, did you have vaginal sex with [INSERT SX_NM4N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Label_SX_VS4N4
Vaginal sex-partner 4
Skip2_21_SX_VS4N4
If SX_VS4N4 (Vaginal sex-partner 4) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL4N4 (Anal sex-partner 4). Else if SX_VS4N4 (Vaginal sex-partner 4)= 1 (yes), go to
SXVC4BN4_21 (Condom vaginal-partner 4).
QDS_programming_partnerdemo4 When question instructions say “insert partner name,” insert response to SX_NM4N4.

Page |62
SXVC4BN4_21

SV.1.1.

During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM4N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM4N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 4
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN4N4 (Partner gender-partner
4) = 1 or SXMLONN4 (Male only partners) =1 and SXANL4N4 (Anal sex-partner 4) is 0 (no),
then read “Earlier you told me that you had anal sex with [INSERT SX_NM4N4_21 (Name of
partner 4)]. Is this correct?” Interviewer instructions: Return to previous questions to
correct error. Allow program to move forward. No vaginal or anal sex reported among
males with female partners: If SX_GEN (Sex gender) = 1 (male) and SXPGN4N4 (Partner
gender-partner 4) = 2 (female) and SX_VS4N4 (Vaginal sex-partner 4) = 0 (no) and
SXANL4N4 (Anal sex-partner 4) = 0 (no), then read “Earlier you told me that you had
vaginal or anal sex with [INSERT SX_NM4N4_21 (Name of partner 4)]. Is this correct?”
Interviewer instructions: Return to previous questions to correct error. Allow program to
move forward. No vaginal or anal sex reported among females with male partners: If
SX_GEN (Sex gender) = 2 (female) and SXPGN4N4 (Partner gender-partner 4) = 1 (male)
and SX_VS4N4 (Vaginal sex-partner 4) = 0 (no) and SXANL4N4 (Anal sex-partner 4) = 0 (no),
then read “Earlier you told me that you had vaginal or anal sex with [INSERT SX_NM4N4_
21 (Name of partner 4)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward.
If SXANL4N4 (Anal sex-partner 4) = 1 (yes), go to SXAC4BN4_21 (Condom anal-partner 4).
Else, skip to STPRT4N4 (Partner status-partner 4).

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM4N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 4
For all responses, skip to STPRT4N4 (Partner status-partner 4).

Label_SXVC4BN4_21

Topic: Anal sex #4 (SL)
SXANL4N4

Label_SXANL4N4
Soft_edit_21_SXANL4N4

Skip_21_SXANL4N4
SXAC4BN4_21

Label_SXAC4BN4_21
Skip_21_SXAC4BN4_21

Page |63

Topic: Transgender and unknown gender sex #4 (SG)
SX_TG4N4

SG.1.0.

Label_SX_TG4N4
Soft_edit_SX_TG4N4

Skip_21_SX_TG4N4
QDS_programming_21_transgen4
TGC4BN4_21

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM4N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 4
If SX_TG4N4 (Transgender-partner 4) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM4N4_21 (Name of partner 4)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG4N4 (Transgender-partner 4) = 1 (yes), go to TGC4BN4_21 (Condom transgenderpartner 4). Else skip to STPRT4N4 (Partner status-partner 4).
When question instructions say “insert partner name,” insert response to SX_NM4N4_21
(Name of partner 4).

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM4N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 4

SS.1.0.

Do you know [INSERT SX_NM4N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 4
If STPRT4N4 (Partner status-partner 4) = 1 (yes), go to PRTST4N4 (Partner status first sexpartner 4). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 4, skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of vaginal
and anal sex partners) >4, skip to Intro_N21_SXPGN5N4.

SS.1.1.

During the past 12 months, what was [INSERT SX_NM4N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 4
If PRTST4N4 (Partner status first sex-partner 4) = 2 (HIV Negative), go to Skip1_21
_PREP4N4_21 (PrEP-Partner 4). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 4, skip to Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total
number of vaginal and anal sex partners) >4, skip to Intro_N21_SXPGN5N4.

Label_TGC4BN4_21

Topic: Status #4 (SS)
STPRT4N4

Label_STPRT4N4
Skip_21_STPRT4N4

PRTST4N4

Label_PRTST4N4
Skip_21_PRTST4N4

Page |64

Topic: Pre-exposure prophylaxis #4 (SR)
Skip1_21_PREP4N4_21

Intro_PREP4N4_21
PREP4N4_21

SR.1.0.

Label_PREP4N4_21
Skip2_21_PREP4N4_21

QDS_programming_21_PREP4N4

If PRTST1N4 (Partner status first sex-partner 1) = 1 (HIV positive), 8 (Don’t know) or 7
(refused to answer) and PRTST2N4 (Partner status first sex-partner 2) = 1 (HIV positive), 8
(Don’t know) or 7 (refused to answer), and PRTST3N4 (Partner status first sex-partner 3) =
1 (HIV positive), 8 (Don’t know) or 7 (refused to answer), skip to Intro_PREP4N4_21 (PrEPPartner 4). If PRTST1N4 (Partner status first sex-partner 1) = 2 (HIV negative) or PRTST2N4
(Partner status first sex-partner 2) = 2 (HIV negative), or PRTST3N4 (Partner status first sexpartner 3) = 2 (HIV negative), skip to PREP4N4_21 (PrEP-Partner 4). Else, skip to Skip2_21
_PREP4N4_21 (PrEP-Partner 4).
Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP.
Was [INSERT SX_NM4N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
PrEP-Partner 4
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 4, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal
and anal sex partners) >4, skip to Intro_N21_SXPGN5N4.
When question instructions say “insert partner name,” then insert response from
SX_NM4N4_21 (Name of partner 4).

Topic: Partner demographics #5 (SP)
“Now I’m going to ask you about [INSERT SX_NM5N4_21 (Name of partner 5)].”
Skip partner gender questions if the respondent had sex with only one gender: If
SXTGONN4 (Transgender only partners) = 1, or SXFMONN4 (Female only partners) = 1 or
SXMLONN4 (Male only partners) = 1, then skip to SXPEN5N4 (Partner ethnicity-partner 5).
Else, go to SXPGN5N4 (Partner gender-partner 5).
SXPGN5N4
SP.1.0.
Is [INSERT SX_NM5N4_21] male, female, or transgender? [READ RESPONSES. SELECT ONLY
ONE.]
1 Male
2 Female
3 Transgender
8 Don't Know
7 Refused to Answer
Label_SXPGN5N4
Partner gender-partner 5
Soft_edit_21_SXPGN5N4
If SEX_GEN = 2 (female) and SXPGN5N4 (Partner gender-partner 5) = 2 (female), read,
“Only include people with whom you had vaginal or anal sex. Remember, for these
questions, vaginal sex means penis in the vagina and anal sex means penis in the anus”.
Interviewer instructions: Return to previous question if necessary. Allow survey to move
forward. Else go to Soft_edit2_21_SXPGN5N4 (Partner gender-partner 5).
Soft_edit2_21_SXPGN5N4
If SXPGN2N4 (Partner gender-partner 2) (partner gender- partner 2) and SXPGN1N4
(Partner gender-partner 1) (partner gender- partner 1) does not match what they report in
SX_TFPN4 (Number of female partners) (females had sex with), SX_TMPN4 (Number of
male partners) (males had sex with) and SX_TTPN4 (Number of transgender partners)
(transgender had sex with) then display a message letting them know.
QDS_programming_21_SXPGN5N4 When question instructions say “insert partner name,” insert response to SX_NM5N4_21
(Name of partner 5).
Intro_N21_SXPGN5N4
Skip_21_SXPGN5N4

Page |65
SXPEN5N4

SP.2.0.

Is [INSERT SX_NM5N4_21] Hispanic, Latino/a, or of Spanish origin? If you’re not sure, give
me your best guess.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner ethnicity-partner 5
For all responses go to SXPR5N4 (Race-partner 5).

SP.3.0.

Which of the following racial group or groups best describes [INSERT SX_NM5N4_21]?
Select all that apply. If you're not sure, give me your best guess. [READ RESPONSES. SELECT
ALL THAT APPLY]
Race-partner 5

SP.3.0.

American Indian or Alaskan Native
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: American Indian or Alaska Native

SP.3.0.

Asian
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: Asian

SP.3.0.

Black or African American
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: Black or African American

SP.3.0.

Native Hawaiian or Other Pacific Islander
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: Native Hawaiian or Other Pacific Islander

SP.3.0.

White
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Race-partner 5: White

Label_SXPEN5N4
Skip_SXPEN5N4
SXPR5N4

Label_SXPR5N4
SXPR5N4A

Label_SXPR5N4A
SXPR5N4B

Label_SXPR5N4B
SXPR5N4C

Label_SXPR5N4C
SXPR5N4D

Label_SXPR5N4D
SXPR5N4E

Label_SXPR5N4E

Page |66

Topic: Vaginal sex #5 (SV)
Skip_21_SX_VS5N4

SX_VS5N4

SV.1.0.

Label_SX_VS5N4
Skip2_21_SX_VS5N4

QDS_programming_21_partnerde
mo5
SXVC5BN4_21

Label_SXVC5BN4_21

SV.1.1.

Transgender/unknown gender respondent: If SEX_GEN= 3 (transgender) or 4
(indeterminate), then skip to SX_TG5N4 (Transgender-partner 5). Transgender/unknown
gender partner: If SXTGONN4 (Transgender only partners) = 1 or SXPGN5N4 (Partner
gender-partner 5) = 3 (transgender), 7 (refused to answer), or 8 (don’t know), then skip to
SX_TG5N4 (Transgender-partner 5). Male-male partners: If SX_GEN (Sex gender) = 1
(male) and SXMLONN4 (Male only partners) = 1 or if SX_GEN (Sex gender) = 1 (male) and
SXPGN5N4 (Partner gender-partner 5) = 1 (male), then skip to SXANL5N4 (Anal sex-partner
5). Female-female partners: If SX_GEN (Sex gender) = 2 (female) and SXPGN5N4 (Partner
gender-partner 5) = 2 (female), skip to Skip2_21_PREP5N4_21 (PrEP-partner 5). Else go
to SX_VS5N4 (Vaginal sex-partner 5).
During the past 12 months, did you have vaginal sex with [INSERT SX_NM5N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaginal sex-partner 5
If SX_VS5N4 (Vaginal sex-partner 5) = 0 (no), 7 (refused), or 8 (don't know), skip to
SXANL5N4 (Anal sex-partner 5). Else if SX_VS5N4 (Vaginal sex-partner 5)= 1 (yes), go to
SXVC5BN4_21 (Condom vaginal-partner 5).
When question instructions say “insert partner name,” insert response to SX_NM5N4_21
(Name of partner 5).
During the past 12 months when you had vaginal sex, how often did you or [INSERT
SX_NM5N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom vaginal-partner 5

Page |67

Topic: Anal sex #5 (SL)
SXANL5N4

SL.1.0.

During the past 12 months, did you have anal sex with [INSERT SX_NM5N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Anal sex-partner 5
No anal sex partners reported among male respondents who previously said they had only
male partners: If SX_GEN (Sex gender) = 1 (male) and if SXPGN5N4 (Partner gender-partner
5) = 1 (male) or SXMLONN4 (Male only partners) =1 and SXANL5N4 (Anal sex-partner 5) = 0
(no), then read “Earlier you told me that you had anal sex with [INSERT SX_NM5N4_21
(Name of partner 5)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward. No vaginal or anal sex
reported among males with female partners: If SX_GEN (Sex gender) = 1 (male) and
SXPGN5N4 (Partner gender-partner 5) = 2 (female) and SX_VS5N4 (Vaginal sex-partner 5) =
0 (no) and SXANL5N4 (Anal sex-partner 5) = 0 (no), then read “Earlier you told me that you
had vaginal or anal sex with [INSERT SX_NM5N4_21 (Name of partner 5)]. Is this correct?”
Interviewer instructions: Return to previous questions to correct error. Allow program to
move forward. No vaginal or anal sex reported among females with male partners: If
SX_GEN (Sex gender) = 2 (female) and SXPGN5N4 (Partner gender-partner 5) = 1 (male)
and SX_VS5N4 (Vaginal sex-partner 5) = 0 (no) and SXANL5N4 (Anal sex-partner 5) = 0 (no),
then read “Earlier you told me that you had vaginal or anal sex with [INSERT SX_NM5N4_
21 (Name of partner 5)]. Is this correct?” Interviewer instructions: Return to previous
questions to correct error. Allow program to move forward.
If SXANL5N4 (Anal sex-partner 5) = 1 (yes), go to SXAC5BN4_21 (Condom anal-partner 5).
Else, skip to STPRT5N4 (Partner status-partner 5).

SL.1.1.

During the past 12 months when you had anal sex, how often did you or [INSERT
SX_NM5N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom anal-partner 5
For all responses, skip to STPRT5N4 (Partner status-partner 5).

Label_SXANL5N4
Soft_edit_21_SXANL5N4

Skip_21_SXANL5N4
SXAC5BN4_21

Label_SXAC5BN4_21
Skip_21_SXAC5BN4_21

Topic: Transgender and unknown gender sex #5 (SG)
SX_TG5N4

SG.1.0.

Label_SX_TG5N4
Soft_edit_SX_TG5N4

Skip_21_SX_TG5N4
QDS_programming_21_transgen5

During the past 12 months, did you have vaginal or anal sex with [INSERT SX_NM5N4_21]?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Transgender-partner 5
If SX_TG5N4 (Transgender-partner 5) is 0 (no), then read, "Earlier you told me that you had
vaginal or anal sex with [Insert SX_NM5N4_21 (Name of partner 5)]. Is this correct?"
Interviewer instructions: return to previous questions to correct error. Allow program to
move forward.
If SX_TG5N4 (Transgender-partner 5) = 1 (yes), go to TGC5BN4_21 (Condom transgenderpartner 5). Else skip to STPRT5N4 (Partner status-partner 5).
When question instructions say “insert partner name,” insert response to SX_NM5N4_21
(Name of partner 5).

Page |68
TGC5BN4_21

SG.1.1.

During the past 12 months when you had vaginal or anal sex, how often did you or [INSERT
SX_NM5N4_21] use a condom? [READ RESPONSES. SELECT ONLY ONE.]
1 Never - not even once
2 Sometimes
3 Absolutely every time
8 Don't Know
7 Refused to Answer
Condom transgender-partner 5

SS.1.0.

Do you know [INSERT SX_NM5N4_21]’s HIV status?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Partner status-partner 5
If STPRT5N4 (Partner status-partner 5) = 1 (yes), go to PRTST5N4 (Partner status first sexpartner 5). Else, if SX_TOTN4 (Total number of vaginal and anal sex partners) = 5, skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, if SX_TOTN4 (Total number of
vaginal and anal sex partners) >5, skip to Skip_21_SXAGC1N4 (Aggregate condom use-6
partners).

SS.1.1.

During the past 12 months, what was [INSERT SX_NM5N4_21]’s HIV status the first time
that you had sex? [DON’T READ RESPONSES. SELECT ONLY ONE.]
1 HIV Positive
2 HIV Negative
8 Don't Know
7 Refused to Answer
Partner status first sex-partner 5
If PRTST5N4 (Partner status first sex-partner 5) = 2 (HIV Negative), go to Skip1_21
_PREP5N4_21 (PrEP-partner 5). Else, if SX_TOTN4 (Total number of vaginal and anal sex
partners) = 5, skip to Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total
number of vaginal and anal sex partners) >5, skip to Skip_21_SXAGC1N4 (Aggregate
condom use-6 partners).

Label_TGC5BN4_21

Topic: Status #5 (SS)
STPRT5N4

Label_STPRT5N4
Skip_21_STPRT5N4

PRTST5N4

Label_PRTST5N4
Skip_21_PRTST5N4

Page |69

Topic: Pre-exposure prophylaxis #5 (SR)
If PRTST1N4 (Partner status first sex-partner 1) = 1 (HIV positive), 8 (Don’t know) or 7
(refused to answer) and PRTST2N4 (Partner status first sex-partner 2) = 1 (HIV positive), 8
(Don’t know) or 7 (refused to answer), and PRTST3N4 (Partner status first sex-partner 3) =
1 (HIV positive), 8 (Don’t know) or 7 (refused to answer), and PRTST4N4 (Partner status
first sex-partner 4) = 1 (HIV positive), 8 (Don’t know) or 7 (refused to answer), skip to
Intro_PREP5N4_21 (PrEP-partner 5). If PRTST1N4 (Partner status first sex-partner 1) = 2
(HIV negative) or PRTST2N4 (Partner status first sex-partner 2) = 2 (HIV negative), or
PRTST3N4 (Partner status first sex-partner 3) = 2 (HIV negative), or PRTST4N4 (Partner
status first sex-partner 4) = 2 (HIV negative), skip to PREP5N4_21 (PrEP-partner 5). Else,
skip to Skip2_21_PREP5N4_21 (PrEP-partner 5).
Intro_PREP5N4_21
Sometimes people who are HIV negative take antiretroviral medicine to prevent them
from getting HIV. This is called PrEP.
PREP5N4_21
SR.1.0.
Was [INSERT SX_NM5N4_21] taking PrEP when you last had sex? If you aren’t sure, that’s
okay.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Label_PREP5N4_21
PrEP-partner 5
Skip2_21_PREP5N4_21
If SX_TOTN4 (Total number of vaginal and anal sex partners) = 5, skip to
Calculation_EN_SEXN5 (End of sexual behavior). If SX_TOTN4 (Total number of vaginal and
anal sex partners) >5, go to Skip_21_SXAGC1N4 (Aggregate condom use-6 partners).
QDS_programming_21_PREP5N4_ When question instructions say “insert partner name,” then insert response from
21
SX_NM5N4_21 (Name of partner 5).
Skip1_21_PREP5N4_21

Topic: Aggregate information (SA)
Skip_21_SXAGC1N4

Intro_21_SXAGC1N4
SXAGC1N4

SA.1.0.

Label_SXAGC1N4
SXAGP1N4

Label_SXAGP1N4
Skip_21_SXAGP1N4_21

SA.1.1.

If SX_TOTN4 (Total number of vaginal and anal sex partners) = 6, go to Intro_21
_SXAGC1N4 (Aggregate condom use-6 partners). If SX_TOTN4 (Total number of vaginal
and anal sex partners) > 6, skip to Intro_N21_SXAGC2N4.
“We just talked about the five people you recently had sex with. Now I’d like to ask you
about the other person you had sex with during the past 12 months.”
During the past 12 months, was a condom always used when you had vaginal or anal sex
with your other partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aggregate condom use-6 partners
Was your other partner HIV positive?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aggregate partner status-6 partners
All responses skip to Calculation_EN_SEXN5 (End of sexual behavior).

Page |70
Intro_N21_SXAGC2N4
SXAGC2N4

SA.1.2.

Label_SXAGC2N4
Range_SXAGC2N4
Hard_edit_SXAGC2N4

Skip_N21_SXAGC2N4

Calculation_SXAGUPN4

SA.1.2a.

Label_Calculation_SXAGUPN4
SXAGC3N4_21

SA.1.3.

Label_SXAGC3N4_21
Hard_edit_21_SXAGC3N4_21

SXAGP2N4

SA.1.4.

Label_SXAGP2N4
Range_SXAGP2N4
Hard_edit_SXAGP2N4

“We just talked about the five people you most recently had sex with. Now I’d like to ask
you about the other people you had sex with during the past 12 months.”
During the past 12 months, with how many of these [INSERT [SX_TOTN4] - 5] other
partners was a condom always used when you had vaginal or anal sex?
8888 Don't Know
7777 Refused to Answer
Aggregate: # partners condom always used
0-2997
If SXAGC2N4 (Aggregate: # partners condom always used) is > [SX_TOTN4 (Total number of
vaginal and anal sex partners) - 5], then read the following: “The number of additional
partners with whom you used a condom cannot be greater than [insert value from
(SX_TOTN4 (Total number of vaginal and anal sex partners)) - 5]." Confirm Answer. Go
back to SXAGC2N4 (Aggregate: # partners condom always used).
If SXAGC2N4 (Aggregate: # partners condom always used) = [SX_TOTN4 (Total number of
vaginal and anal sex partners)-5], 7 (refused to answer) or 8 (don’t know), then skip to
Calculation_EN_SEXN5 (End of sexual behavior). Else, go to Calculation_SXAGUPN4
(Aggregate # condomless sex partners).
Create a calculated variable to indicate the aggregate number of partners with whom the
respondent had sex without a condom. If SX_TOTN4 is > 5, then create SXAGUPN4 where
([SX_TOTN4 (total number of vaginal and anal sex partners)] - (minus) 5] - SXAGC2N4). (If
SXAGC2N4 is don’t know or refuse, assign it a 7777 if refused or 8888 if don’t know.)
Aggregate # condomless sex partners
So, you had sex without a condom with [INSERT SXAGUPN4] of these other partners?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aggregate: confirm # condomless partners
If SXAGC3N4_21 (Aggregate: confirm # condomless partners) is 0 (no), 7 (refused to
answer) or 8 (don’t know), then read, “The number of partners with whom you had sex
without a condom does not add up.” Return to SXAGC2N4 (Aggregate: # partners condom
always used).
How many of those [INSERT RESPONSE FROM SXAGUPN4] other partners were HIV
positive?
8888 Don't Know
7777 Refused to Answer
Aggregate: # of concordant partners
0-2997
SXAGP2N4 (Aggregate: # of concordant partners) cannot be greater than SXAGUPN4
(Aggregate # condomless sex partners). If SXAGP2N4 (Aggregate: # of concordant
partners) > SXAGUPN4 (Aggregate # condomless sex partners), then read, “The response is
out of range” and return to SXAGP2N4 (Aggregate: # of concordant partners).

Calculation_EN_SEXN5 S.0.a.
Label_Calculation_EN_SEXN5

EN_SEXN5 = Current time
End of sexual behavior

Calculation_TL_SEXN5
S.0.b.
Label_Calculation_TL_SEXN5

Calculate elapsed time between ST_SEXN5 and EN_SEXN5 = TL_SEXN5
Total time for sexual behavior

Page |71

Module: Violence (B)
Topic: Physical violence (BP)
Calculation_STIPVN5
B.0.
Label_Calculation_STIPVN5

STIPVN5 = Current time
Start time intimate partner violence

Intro_21_IPVPH1N5

"Next, I’ll ask about experiences with romantic or sexual partners who may have physically
hurt you. This may include spouses, boyfriends, girlfriends, people you’ve dated, or people
you hooked up with. Remember, your answers are private, and you do not have to answer
any questions you do not want to."
How many of your romantic or sexual partners have ever slapped, punched, shoved,
kicked, choked or otherwise physically hurt you?
8888 Don't Know
7777 Refused to Answer
Ever IPV physical violence
0-999
If IPVPH1N5 (Ever IPV physical violence) = 1-999, go to IPVPH2N5 (Last year IPV physical
violence).
Else, skip to Intro_IPVSX1N5.

IPVPH1N5

BP.1.0.

Label_IPVPH1N5
Range_IPVPH1N5
Skip_IPVPH1N5

IPVPH2N5

BP.1.1.

Label_IPVPH2N5

During the past 12 months, has a partner slapped, punched, shoved, kicked, choked, or
otherwise physically hurt you?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Last year IPV physical violence

Topic: Sexual violence (BS)
Intro_IPVSX1N5_21
IPVSX1N5_21

BS.1.0

Label_IPVSX1N5_21
Range_IPVSX1N5_21
Skip_IPVSX1N5_21

IPVSX2N5

BS.1.1.

“Some people experience unwanted sexual situations by strangers or people they know,
such as a partner, friend, teacher, coworker, supervisor, or family member.”
How many people have ever threatened or forced you to have vaginal, anal, or oral sex
when you did not want to?
8888 Don't Know
7777 Refused to Answer
Ever IPV Sexual violence
0-999
If IPVSX1N5_21 (Ever IPV Sexual violence) = 1-999, go to IPVSX2N5 (Last year IPV sexual
violence).
Else, skip to Calculation_ENIPVN5 (End of intimate partner violence).

Label_IPVSX2N5

During the past 12 months, have you been threatened or forced to have vaginal, anal, or
oral sex when you did not want to?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Last year IPV sexual violence

Calculation_ENIPVN5
B.0.a.
Label_Calculation_ENIPVN5

ENIPVN5 = Current time
End of intimate partner violence

Calculation_TLIPVN5
B.0.b.
Label_Calculation_TLIPVN5

Calculate elapsed time between STIPVN5 and ENIPVN5 = TLIPVN5
Total time for intimate partner violence

Page |72

Module: Depression and anxiety (M)
Topic: PHQ-4 screening questions (MD)
Calculation_STMNHLN5 M.0.
Label_Calculation_STMNHLN5

STMNHLN5 = Current time
Start time mental health

Intro_21_ANXDEPA8

“Now I’m going to ask you some questions about your mood. When answering, please
think about how often the following has occurred during the past 2 weeks. We’ll use
Response Card E for these questions. We’ll also use the calendar to refer to the past 2
weeks.”
“Over the past 2 weeks, how often have you been bothered by any of the following
problems?”
Little interest or pleasure in doing things? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ little interest

Intro_ANXDEPA8
ANXDEPA8

MD.1.0

Label_ANXDEPA8
ANXDEPB8

MD.2.0

Feeling down, depressed, or hopeless? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ feeling down

MD.3.0

Feeling nervous, anxious or on edge? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD anxious

MD.4.0

Not being able to stop or control worrying? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD not stop worrying

Label_ANXDEPB
ANXNR_8

Label_ANXNR_8
ANXSW_8

Label_ANXSW_8
Calculation_PHQ2N8

MD.4.0a Create a calculated where the sum of ANXDEPA8 + ANXDEPB8=PHQ2N8. If the response to
ANXDEPA8 or ANXDEPB8= 7 (refused to answer) or 8 (don’t know), then calculate the
response as 0.
Label_Calculation_PHQ2N8
PHQ2 score

Page |73
Calculation_GAD2N8

MD.4.0b Create a calculated variable where the sum of ANXNR_8 + ANXSW_8= GAD2N8. If the
response to ANXNR_8 or ANXSW_8= 7 (refused to answer) or 8 (don’t know), then
calculate the response as 0.
Label_Calculation_GAD2N8
GAD2 score
Skip_Calculation_GAD2N8
If PHQ2N8 (PHQ2 score) =>3, go to ANXDEPC8 (PHQ sleep trouble).
Else, skip to Skip_ANXWR_8 (GAD worrying too much).

Topic: PHQ-8 depression (MA)
ANXDEPC8

MA.1.0

Trouble falling or staying asleep, or sleeping too much? [USE RESPONSE CARD. SELECT
ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ sleep trouble

MA.2.0

Feeling tired or having little energy? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ feeling tired

MA.3.0

Poor appetite or overeating? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ poor appetite

MA.4.0

Feeling bad about yourself—or that you are a failure or have let yourself or your family
down? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ feeling bad about self

Label_ANXDEPC8
ANXDEPD8

Label_ANXDEPD8
ANXDEPE8

Label_ANXDEPE8
ANXDEPF8

Label_ANXDEPF8

Page |74
ANXDEPG8

MA.5.0

Trouble concentrating on things, such as reading the newspaper or watching television?
[USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ trouble concentrating

MA.6.0

Moving or speaking so slowly that other people could have noticed, or the opposite—
being so fidgety or restless that you have been moving around a lot more than usual? [USE
RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
PHQ moving slowly or being fidgety

Label_ANXDEPG8
ANXDEPH8

Label_ANXDEPH8

Topic: GAD-7 anxiety (MG)
Skip_ANXWR_8
ANXWR_8

MG.1.0

Label_ANXWR_8
ANXRX_8

MG.2.0

Trouble relaxing? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD trouble relaxing

MG.3.0

Being so restless that it’s hard to sit still? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD restless

Label_ANXRX_8
ANXRS_8

Label_ANXRS_8

If GAD2N8 (GAD2 score) >=3, go to ANXWR_8 (GAD worrying too much).
Else, skip to Calculation_ENMNHLN5 (End of mental health).
Worrying too much about different things? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD worrying too much

Page |75
ANXIR_8

MG.4.0

Becoming easily annoyed or irritable? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD irritable

MG.5.0

Label_ANXAF_8

Feeling afraid as if something awful might happen? [USE RESPONSE CARD. SELECT ONLY
ONE.]
0 Not at all
1 Several days
2 More than half the days
3 Nearly every day
8 Don't Know
7 Refused to Answer
GAD feeling afraid

Calculation_ENMNHLN5 M.0.a.
Label_Calculation_ENMNHLN5

ENMNHLN5 = Current time
End of mental health

Calculation_TLMNHLN5 M.0.b.
Label_Calculation_TLMNHLN5

Calculate elapsed time between STMNHLN5 and ENMNHLN5 = TLMNHLN5
Total time for mental health

Label_ANXIR_8
ANXAF_8

Page |76

Module: Alcohol, smoking, and drug use (U)
Topic: Alcohol use (UA)
Calculation_STDRUGN5 U.0.
Label_Calculation_STDRUGN5

STDRUGN5 = Current time
Start time of alcohol, smoking, drug use

Intro_8_ALCOHO_9

“These next questions are about drinking alcohol. Included are beer, wine, wine coolers,
and liquor, such as whiskey or gin, and any other type of alcohol. We will use Response
Card H.”
During the past 12 months, how often did you drink alcohol? [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
How often drank alcohol in past 12 mos
If ALCOHO_9 (How often drank alcohol in past 12 mos) is 5 (never), 7 (refused to answer),
8 (don’t know), then skip to Intro_CIGEVRN5 (Ever smoked cigarettes).

ALCOHO_9

UA.1.0.

Label_ALCOHO_9
Skip_ALCOHO_9
Intro_8_DRINK_9

DRINK_9

UA.2.0.

Label_DRINK_9
Range_DRINK_9
Skip_DRINK_9
NDRINK_9

Label_NDRINK_9
Range_8_NDRINK_9

UA.3.0.

“We’ll use the Alcohol Response Card for the next questions. For these questions a drink of
alcohol is a 12 oz. beer, a 5 oz. glass of wine, or a 1.5 oz. shot of liquor. We'll use the
calendar to refer to the past 30 days.”
During the past 30 days, on how many days did you have an alcoholic drink?
88 Don't Know
77 Refused to Answer
Number of days drank past 30 days
0–30
If DRINK_9 (Number of days drank past 30 days) is 0, 77 (refused to answer), or 88 (don’t
know), then skip to Intro_CIGEVRN5 (Ever smoked cigarettes).
During the past 30 days, how many alcoholic drinks did you have on a typical day when
you were drinking?
88 Don't Know
77 Refused to Answer
# drinks/day typical day past 30 days
1-30

Page |77
BINGE_8

UA.4.0.

Alt_text_BINGE_8

Label_BINGE_8
Range_BINGE_8
Hard_edit_BINGE_8

During the past 30 days, on how many days did you have [5 or 4] or more alcoholic drinks
in one sitting?
88 Don't Know
77 Refused to Answer
If BIRTGEN (Sex at birth) = 2 (female), 3 (intersex/ambiguous), then read, “During the past
30 days, on how many days did you have 4 or more alcoholic drinks in one sitting?” If
BIRTGEN (Sex at birth) = 1 (male), 7 (refused), or 8 (don’t know), then read, “During the
past 30 days, on how many days did you have 5 or more alcoholic drinks in one sitting?”
The same tokens apply to Hard_edit_BINGE_8 (# binge drink days past 30 days).
# binge drink days past 30 days
0-30
If BINGE_8 (# binge drink days past 30 days) > DRINK_9 (Number of days drank past 30
days), then read, “The number of days that you had any drink should be equal to or larger
than the number of days you had [5 or 4] or more drinks.” Return to DRINK_9 (Number of
days drank past 30 days).

Topic: Cigarette and tobacco use (US)
Intro_CIGEVRN5
CIGEVRN5

US.1.0.

Label_CIGEVRN5
Skip_CIGEVRN5

Intro_CIG_OFT
CIG_OFT

US.1.1.

Label_CIG_OFT
CIGARN5

Label_CIGARN5
Skip_CIGARN5

US.2.0.

“The next questions are about smoking cigarettes.”
Have you smoked at least 100 cigarettes, equal to 5 packs of cigarettes, in your entire life?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever smoked cigarettes
If CIGEVRN5 (Ever smoked cigarettes) is 0 (no), 7 (refused to answer), or 8 (don’t know),
then skip to CIGARN5 (Ever smoked cigars, etc.).
Else, go to Intro_CIG_OFT (Current use cigarettes).
“Now we will use Response Card F.”
How often do you smoke cigarettes now? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Current use cigarettes
Have you smoked cigars, cigarillos, or little filtered cigars at least 50 times in your entire
life?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever smoked cigars, etc.
If CIGARN5 (Ever smoked cigars, etc.) is 0 (no), 7 (refused to answer), or 8 (don’t know),
then skip to Skip_CIG_QTN5 (Stopped smoking one day or longer).
Else, go to CIGARFN5 (Current use cigars, etc.).

Page |78
CIGARFN5

US.2.1.

Label_CIGARFN5
Skip_CIG_QTN5

Intro_CIG_QTN5
CIG_QTN5

US.3.0.

Label_CIG_QTN5
CIG_DQ_8

US.4.0.

Label_CIG_DQ_8
Intro_CIGELCN5_21
CIGELCN5_21

US.5.0.

Label_CIGELCN5_21
Skip_CIGELN5_21
Intro_vape_tobaccoN21
Vape_TobaccoN21
US.5.1.

Label_Vape_TobaccoN21

Do you now smoke cigars, cigarillos, or little filtered cigars every day, some days, rarely, or
not at all? [SELECT ONE RESPONSE.]
1 Every day
2 Some days
3 Rarely
4 Not at all
8 Don't Know
7 Refused to Answer
Current use cigars, etc.
If CIG_OFT (Current use cigarettes) = 1 (Daily), 2 (Weekly), 3 (Monthly), or 4 (Less than
monthly) or if CIGARFN5 (Current use cigars, etc.) = 1 (every day), 2 (some days), or 3
(rarely), go to Intro_CIG_QTN5 (Stopped smoking one day or longer).
Else, skip to Intro_CIGELCN5.
“The next questions ask about quitting smoking. By smoking, I mean smoking cigarettes,
cigars, cigarillos, or little filtered cigars.”
During the past 12 months, have you stopped smoking for one day or longer because you
were trying to quit?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Stopped smoking one day or longer
During the past 12 months, has a doctor, nurse, or other healthcare worker advised you to
quit smoking?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Doctor advised to quit smoking
The next questions are about vaping e-cigarettes or other vaping devices. People can vape
nicotine or tobacco, marijuana, flavoring or other substances.
Have you ever, even once, vaped anything with an e-cigarette or other vaping device?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever vaped with any device
If CIGELCN5_21 (Ever vaped with any device) is 1 (yes), go to Intro_VAPE_TOBACCON21
(Vaped tobacco or nicotine past 30 days). Else, skip to INTRO_21_MARIJU_9.
During the past 30 days, have you vaped any of the following:
Tobacco or nicotine
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vaped tobacco or nicotine past 30 days

Page |79
Vape_MarijN21

US.5.2.

Marijuana, including marijuana concentrates, marijuana waxes, THC or hash oils
0 No
1 Yes
8 Don't Know
7 Refused to Answer
vape marijuana past 30 days

US.5.3.

Any other substances?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Vape other substances

Label_VAPE_marijn21
Vape_otherN21

Label_vapeotherN21

Topic: Non-injection drug use (UN)
Intro_21_MARIJU_9

Skip_21_MARIJU_9
MARIJU_9

UN.1.0.

Label_MARIJU_9
CRACK1_9

UN.2.0.

During the past 12 months, how often did you use crack? [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used crack

UN.3.0.

During the past 12 months, how often did you use cocaine that is smoked or snorted? [USE
RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used cocaine

Label_CRACK1_9
COCSMO_9

Label_COCSMO_9

“I’m going to read you a list of drugs. For each drug I mention, please tell me how often
you used it during the past 12 months. Don’t include drugs you injected or drugs that were
used for medical purposes. We’ll use Response Card F for these questions.”
If VAPE_MARIJN21 (vape marijuana past 30 days) = 1 (yes), skip to CRACK1_9 (Used crack).
Else, go to MARIJU_9 (Used marijuana).
During the past 12 months, how often did you use marijuana? [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used marijuana

Page |80
METHN5

UN.4.0.

During the past 12 months, how often did you use any methamphetamines, such as crystal
meth, tina, crank, or ice? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used methamphetamines

UN.5.0.

During the past 12 months, how often did you use club drugs such as Ecstasy (also called
X), ketamine (also called Special K), or GHB (also called Liquid Ecstasy)? [USE RESPONSE
CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used club drugs

UN.6.0.

During the past 12 months, how often did you use poppers, also called amyl nitrite? [USE
RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used poppers

UN.7.0.

During the past 12 months, how often did you use heroin or opium that is smoked or
snorted? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used non-injected heroin

Label_METHN5
CLUBN5

Label_CLUBN5
POPPER_9

Label_POPPER_9
HEROIN_9

Label_HEROIN_9

Page |81
PAINKN5_21

UN.8.0.

Next, I’ll ask about prescription pain relievers such as oxycodone, hydrocodone, Percocet,
or Vicodin. During the past 12 months, how often did you take a prescription pain reliver
that was not prescribed to you or was prescribed to you, but you took more than directed?
[USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used painkillers

UN.9.0.

I am going to ask you about prescription tranquilizers such as Valium, Ativan, Xanax, or
downers. During the past 12 months, how often did you take a prescription tranquilizer
that was not prescribed to you, or was prescribed to you but you took more than directed?
[USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Used tranquilizers

Label_Painkn5_21
TRANQN5_21

Label_TRANQN5_21
OTHERDRUGN21

OTHERDRUGN21

UN.10.0. During the past 12 months, did you use any other drug? Remember, don’t include drugs
you injected or drugs that were used for medical purposes.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Used other drug

Topic: Injection drug use (UI)
Intro_EVRINJN5
EVRINJN5

Label_EVRINJN5
Skip_EVRINJN5

UI.1.0.

“The next questions are about injection drug use. This means injecting drugs yourself or
having someone else inject you.”
Have you ever shot up or injected any drugs that weren’t used for medical purposes? By
shooting up, I mean anytime a needle was used to inject drugs in your veins, under the
skin, or in the muscle.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever used injection drugs
If EVRINJN5 (Ever used injection drugs) is 1 (yes), go to INJECTN5 (Used injection drugs past
12 months).
Else, skip to Calculation_ENDRUGN5 (End of alcohol, smoking, and drug use).

Page |82
INJECTN5

UI.1.1.

Label_INJECTN5
Skip_INJECTN5

Intro_COCINJN5

COCINJN5

UI.2.0.

Label_COCINJN5
HERINJN5

Label_SPDBALN5

“Now I'm going to read you a list of drugs. For each drug I mention, please tell me how
often you injected it during the past 12 months. We’ll use Response Card F for these
questions.”
During the past 12 months, how often did you inject powder cocaine? [USE RESPONSE
CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected powder cocaine

UI.3.0.

During the past 12 months, how often did you inject heroin? [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected heroin

UI.4.0.

During the past 12 months, how often did you inject heroin and cocaine together, also
called speedball? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected speedball

Label_HERINJN5
SPDBALN5

During the past 12 months, have you shot up or injected any drugs that weren’t used for
medical purposes?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Used injection drugs past 12 months
If INJECTN5 (Used injection drugs past 12 months) is 1 (yes) then go to Intro_COCINJN5
(Injected powder cocaine).
Else, skip to next topic Calculation_ENDRUGN5 (End of alcohol, smoking, and drug use).

Page |83
METINJN5

UI.5.0.

During the past 12 months, how often did you inject methamphetamines, such as crystal
meth, tina, crank or ice? [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Daily
2 Weekly
3 Monthly
4 Less than monthly
5 Never
8 Don't Know
7 Refused to Answer
Injected methamphetamines

UI.7.0.

During the past 12 months, how often did you inject painkillers, such as oxycodone, hydrocodone,
Percocet, or Vicodin? [USE RESPONSE CARD. SELECT ONLY ONE.]

Label_METINJN5
PKINJN5_21

1
2
3
4
5
8
7

Daily
Weekly
Monthly
Less than monthly
Never
Don't Know
Refused to Answer
If INJECTN5 (Used injection drugs past 12 months) is 1 (yes) and [COCINJN5 (Injected
powder cocaine), HERINJN5 (Injected heroin), SPDBALN5 (Injected speedball), METINJN5
(Injected methamphetamines), AMPINJN5, or PKINJN5] are all 5 (Never), then read, “The
respondent said that he/she didn’t inject any of the specific drugs that you asked about.
Verify that the respondent injected drugs during the past 12 months.” Allow the program
to move forward.

Soft_edit_PKINJN5_21

Intro_SHRNDLN5
SHRNDLN5

UI.7.0.

Label_SHRNDLN5
SHR_WRKS

UI.8.0.

Label_SHR_WRKS
Intro_GETNDAN5
GETNDAN5

Label_GETNDAN5

UI.9.0.

“Now I am going to ask you some questions about sharing needles and other injection
equipment. When I ask you about needles, I’m talking about needles and syringes.”
When you injected during the past 12 months, did someone use the same needle after you
used it to either inject drugs or divide drugs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Shared needles
When you injected during the past 12 months, did someone use the same cookers, cotton,
or rinse water after you used it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Shared injection works
“During the past 12 months when you injected, did you get your needles at any of the
following places:”
A needle exchange program?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needles at needle exchange

Page |84
GETNDBN5

UI.9.1.

A pharmacy or drug store?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needles at pharmacy

UI.9.2.

A doctor’s office, clinic, or hospital?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needles Dr. office, clinic, hospital

UI.9.3.

A friend, relative, or sex partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
A friend, relative, or sex partner

UI.9.4.

Label_GETNDEN5

A needle or drug dealer, shooting gallery, or off the street?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get needle dealer, shooting gallery, st.

Calculation_ENDRUGN5 U.0.a.
Label_Calculation_ENDRUGN5

ENDRUGN5 = Current time
End of alcohol, smoking, and drug use

Calculation_TLDRUGN5 U.0.b.
Label_8_Calculation_TLDRUGN5

Calculate elapsed time between STDRUGN5 and ENDRUGN5 = TLDRUGN5
Total time - Alcohol, smoking, drug use

Label_GETNDBN5
GETNDCN5

Label_GETNDCN5
GETNDDN5

Label_GETNDDN5
GETNDEN5

Page |85

Module: Stigma and discrimination (R)
Topic: Stigma (RS)
Calculation_STSTIGN5
R.0.
Label_Calculation_STSTIGN5

STSTIGN5 = Current time
Start time stigma and discrimination

Intro_21_STGA12N8

"Next, I'll read statements that some people with HIV feel. We want to know if you
experience these feelings. These statements are not things that I or anyone in this project
thinks. Remember that you don't have to answer any question you don't want to. For each
statement that I read, tell me how strongly you disagree or agree. We'll use Response Card
G."
During the past 12 months, I have been hurt by how people reacted to learning I have HIV.
[USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Stigma – hurt by people p12m

STGA12N8

RS.1.0

Label_STGA12N8
STGB12N8

RS.2.0

During the past 12 months, I have stopped socializing with some people because of their
reactions to my HIV status. [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Stigma – stopped socializing p12m

RS.3.0

During the past 12 months, I have lost friends by telling them I have HIV. [USE RESPONSE
CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Stigma - lost friends p12m

RS.4.0.

I am very careful who I tell that I have HIV. [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Careful who I tell I have HIV

Label_STGB12N8
STGC12N8

Label_STGC12N8
STIGMDN5

Label_STIGMDN5

Page |86
STIGMEN5

RS.5.0.

I worry that people who know I have HIV will tell others. [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Worry people will tell others

RS.6.0.

I feel that I am not as good a person as others because I have HIV. [USE RESPONSE CARD.
SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Not as good a person as others

RS.7.0.

Having HIV makes me feel unclean. [USE RESPONSE CARD. SELECT ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Having HIV makes me feel unclean

RS.8.0.

Having HIV makes me feel that I’m a bad person. [USE RESPONSE CARD. SELECT ONLY
ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Feel I’m a bad person

RS.9.0.

Most people think that a person with HIV is disgusting. [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
HIV is disgusting

Label_STIGMEN5
STIGMFN5

Label_STIGMFN5
STIGMGN5

Label_STIGMGN5
STIGMHN5

Label_STIGMHN5
STIGMIN5

Label_STIGMIN5

Page |87
STIGMJN5

RS.10.0.

Label_STIGMJN5

Most people with HIV are rejected when others find out. [USE RESPONSE CARD. SELECT
ONLY ONE.]
1 Strongly disagree
2 Somewhat disagree
3 Neutral
4 Somewhat agree
5 Strongly agree
8 Don't Know
7 Refused to Answer
Most people with HIV are rejected

Topic: Discrimination (RD)
Skip_DISC1N8

Intro_DISC1N8

DISC1N8

RD.1.0.

Label_DISC1N8
DISC2N8

RD.2.0.

During the past 12 months, how often were you treated with less respect than other
people? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – treated less respect

RD.3.0.

During the past 12 months, how often have you received poorer service than others? [USE
RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – poorer service

Label_DISC2N8
DISC3N8

Label_DISC3N8

If EVERCR_8 (Ever rcvd. HIV care) is 1 (yes) and LASCA_8 (Date most recent outpt. HIV care
visit) <= 12 months from IDATE (Interview date), go to Intro_DISC1N8 (Discrimination –
treated less courtesy).
Else, go to Calculation_ENSTIGN5 (End of stigma and discrimination).
“Now, I’m going to ask you about things that may have happened when you got HIV care
at a doctor’s office or a clinic. Please tell me how often the following things happened to
you in the past 12 months. We are going to use Response Card D.”
During the past 12 months, how often were you treated with less courtesy than other
people? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – treated less courtesy

Page |88
DISC4N8

RD.4.0.

During the past 12 months, how often has a doctor or nurse acted as if he or she thought
you were not smart? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – not smart

RD.5.0.

During the past 12 months, how often has a doctor or nurse acted as if he or she was
afraid of you? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – provider afraid

RD.6.0.

During the past 12 months, how often has a doctor or nurse acted as if he or she was
better than you? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – provider better

RD.7.0.

During the past 12 months, how often have you felt like a doctor or nurse was not
listening to what you were saying? [USE RESPONSE CARD. SELECT ONLY ONE.]
0 Never
1 Rarely
2 About half the time
3 Most of the time
4 Always
8 Don't Know
7 Refused to Answer
Discrimination – provider not listening

Label_DISC4N8
DISC5N8

Label_DISC5N8
DISC6N8

Label_DISC6N8
DISC7N8

Label_DISC7N8

Page |89
Skip_21_DISHIV_8

Intro_21_DISHIV_8
DISHIV_8

RD.8.0.

Label_DISHIV_8
DISGEN_8

Label_DISGEN_8
DISSEX_8

Label_DISSEX_8
DISRAC_8

Label_DISRAC_8
DISINCN8

Label_DISINCN8
Skip_DISINCN8

DISDRG_8

Label_DISDRG_8

RD.9.0.

If DISC1N8 (Discrimination – treated less courtesy) or DISC2N8 (Discrimination – treated
less respect) or DISC3N8 (Discrimination – poorer service) or DISC4N8 (Discrimination –
not smart) or DISC5N8 (Discrimination – provider afraid) or DISC6N8 (Discrimination –
provider better) or DISC7N8 (Discrimination – provider not listening) is 1 (rarely), 2 (about
half the time), 3 (most of the time), or 4 (always), then go to Intro_21_DISHIV_8 (Your HIV
infection) .
"Based on your responses, you may have experienced discrimination when getting HIV
care. Did the discrimination occur because…”
…of your HIV infection?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your HIV infection
…of your gender?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your gender

RD.10.0. …of your sexual orientation or sexual practices?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your sexual orientation or practices
RD.11.0. …of your race or ethnicity?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your race or ethnicity
RD.12.0. …of your income or social class?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Your income or social class
If EVRINJN5 (Ever used injection drugs) is 1 (yes), then go to DISDRG_8 (Someone thought
they injected drugs).
Else, skip to Calculation_ENSTIGN5 (End of stigma and discrimination).
RD.13.0. …someone at your doctor's office or clinic thought you injected drugs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Someone thought they injected drugs

Page |90
Calculation_ENSTIGN5 R.0.a.
Label_Calculation_ENSTIGN5

ENSTIGN5 = Current time
End of stigma and discrimination

Calculation_TLSTIGN5
R.0.b.
Label_Calculation_TLSTIGN5

Calculate elapsed time between STSTIGN5 and ENSTIGN5 = TLSTIGN5
Total time for stigma and discrimination

Page |91

Module: Gynecological and reproductive history (G)
Topic: Gynecological care (GH)
Calculation_STOBGYN5 G.0.
Label_Calculation_STOBGYN5

STOBGYN5 = current time
Start time gyn and reproductive history

Skip_21_PLV_EX_9

If BIRTGEN (Sex at birth) and GENDER (Gender) = 2 (female), then go to Intro_PLV_EX_9
(Pelvic exam). Else, skip to Skip_INTENTDADN21 (Try biological father).
“I’m now going to ask some questions about pelvic exams and Pap smears. A pelvic exam is
a vaginal examination. A Pap smear, also called a cervical cancer test or Pap test, is a test
used to check for cancer of the cervix. Often a pelvic exam and Pap smear are performed
at the same time.”
During the past 12 months, have you had a pelvic examination?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Pelvic exam

Intro_PLV_EX_9

PLV_EX_9

GH.1.0.

Label_PLV_EX_9
PAP_EX_8

GH.2.0.

[During the past 3 years or Since testing positive for HIV], have you had a Pap smear?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV)<3 years prior to interview date, then
question should read, "Since testing positive for HIV, have you had a Pap smear?" If
POS1S_9 (Date first tested positive for HIV) > =3 years ago, then question should read as
"During the past 3 years, have you had a Pap smear?"
Pap smear

GH.3.0.

Are you post-menopausal, meaning you don’t have periods anymore?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Post menopausal

GH.4.0.

Have you had a tubal ligation, also known as having your “tubes tied”?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Tubal ligation

GH.5.0

Have you had a hysterectomy? A hysterectomy is when all or some of your uterus is
removed.
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Hysterectomy
If POSTMEN8 (Post menopausal) is 1 (yes) or TUBLIGN8 (Tubal ligation) is 1 (yes) or
HYSTERN8 (Hysterectomy) is 1 (yes), then skip to PREG_9 (Number of times pregnant).
Else, go to Skip_INTENTDADN21 (Try biological father).

Alt_text_PAP_EX_8

Label_PAP_EX_8
POSTMEN8

Label_POSTMEN8
TUBLIGN8

Label_TUBLIGN8
HYSTERN8

Label_HYSTERN8
Skip_21_HYSTERN8

Page |92

Topic: Family Planning (GF)
Skip_INTENTDADN21

Intro_INTENTDADN21
INTENTDADN21

FP.1.0.

Label_INTENTDADN21
Skip2_INTENTDADN21

PREGNOWN21

FP.2.0.

Are you currently pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Currently pregnant

FP.3.0.

At any time during the past 12 months, have you tried to get pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If PREGNOWN21 (Currently pregnant) = 1 (yes), then display question as, “Were you trying
to get pregnant?”
Pregnancy intent
If INTENTN8_21 (Pregnancy intent) = 1 (yes), skip to KIDTALKN21 (Dr talked about
children).
If INTENTN8_21 (Pregnancy intent) = 0 (no), 7 (refused to answer), or 8 (don’t know), skip
to NOPREGN21 (Prevent pregnancy).

FP.4.0.

During the past 12 months, has a doctor, nurse, or other healthcare worker talked with
you about your desire to have children?
0 No
1 Yes
8 Don’t Know
7 Refused to Answer
Dr talked about children
If BIRTGEN (Sex at birth) = 1 (male) and GENDER (Gender) = 1 (male), all responses skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
Else go to NOPREGN21 (Prevent pregnancy).

Label_PREGNOWN21
INTENTN8_21

Alt_text_INTENTN8_21
Label_INTENTN8_21
Skip_INTENTN8_21

KIDTALKN21

Label_KIDTALKN21
SKIP_KIDTALKN21

If BIRTGEN (Sex at birth) = 2 (female) and GENDER (Gender) = 2 (female) and SX_TMPN4
(Number of male partners) = 0, 777 (refused to answer) or 888 (don’t know), skip to PREG_
9 (Number of times pregnant).
If BIRTGEN (Sex at birth) = 2 (female) and GENDER (Gender) = 2 (female) and SX_TMPN4
(Number of male partners) >=1, skip to PREGNOWN21 (Currently pregnant).
If BIRTGEN (Sex at birth) = 1 (male) and GENDER (Gender) = 1 (male), skip to
Intro_INTENTDADN21 (Try biological father).
Else, skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
Now I’m going to ask you about becoming a biological father.
At any time during the past 12 months, have you tried to become a biological father?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Try biological father
If INTENTDADN21 (Try biological father) = 0 (no), 7 (refused to answer) or 8 (don’t know),
skip to SKIP_PREGTALKN21.
If INTENTDADN21 (Try biological father) = 1 (yes), skip to KIDTALKN21 (Dr talked about
children).

Page |93
NOPREGN21

FP.5.0.

Label_NOPREGN21
SKIP_NOPREGN21

SKIP_PREGTALKN21

PREGTALKN21

FP.6.0.

Alt_Text_PREGTALKN21

Label_PREGTALKN21
Skip_VERTRANN21

VERTRANN21

Label_VERTRANN21

FP.7.0.

Some things women do to prevent pregnancy include using birth control pills or condoms.
At any time during the past 12 months, have you tried to prevent getting pregnant?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Prevent pregnancy
If NOPREGN21 (Prevent pregnancy) = 1 (yes) go to PREGTALKN21 (Dr talk prevent
pregnancy).
Else, skip to Skip_VERTRANN21 (Prevent vertical trans).
If BIRTGEN (Sex at birth) = 1 (male) and GENDER (Gender) = 1 (male) AND SX_TFPN4
(Number of female partners) ≥ 1, go to PREGTALKN21 (Dr talk prevent pregnancy).
Else, skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
During the past 12 months, has a doctor, nurse, or other healthcare worker talked with
you about how to prevent pregnancy?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If INTENTDADN21 (Try biological father) = 0 (no), then question should read, “Some things
men do to prevent getting someone pregnant include using condoms or getting a
vasectomy. During the past 12 months, has a doctor, nurse, or other healthcare worker
talked with you about doing anything to prevent getting someone pregnant?”
Dr talk prevent pregnancy
If PREGNOWN21 (Currently pregnant) = 1 (yes) or INTENTN8_21 (Pregnancy intent) = 1
(yes), go to VERTRANN21 (Prevent vertical trans).
If INTENTN8_21 (Pregnancy intent) = 0 (no) or 7 (refused) or 8 (don’t know), skip to PREG_
9 (Number of times pregnant).
Else, skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
During the past 12 months, has a doctor, nurse, or other healthcare worker talked with
you about how to prevent passing HIV on to your baby?
0 No
1 Yes
8 Don’t Know
7 Refused to Answer
Prevent vertical trans

Page |94

Topic: Reproductive history (GR)
Intro_N21_PREG_9

PREG_9

GR.1.0.

Alt_text_21_PREG_9

Label_PREG_9
Range_PREG_9
Skip_21_PREG_9

Skip_OUTCM1N3_21
OUTCM1N3_21

GR.2.0.

Label_OUTCM1N3_21
Skip2_OUTCM1N3_21

OUTCM1N21

Label_OUTCM1N21
Range_OUTCM1N21
Skip_OUTCM1N21

GR.3.0.

Now I’m going to ask about pregnancies you may have had since testing positive for HIV.
These pregnancies could have resulted in a live birth, miscarriage, abortion, stillbirth, or
ectopic pregnancy.
Since testing positive for HIV in [INSERT POS1S_9 (date of first positive test)], how many
times have you been pregnant?
888 Don't Know
777 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) is 77/7777 (refused to answer) or 88/8888
(don’t know), then PREG_9 (Number of times pregnant) should read as follows: "Since
testing positive for HIV, how many times have you been pregnant?" If PREGNOWN21
(Currently pregnant) = 1 (yes), then question should display as “Since testing positive for
HIV in [INSERT POS1S_9 (Date first tested positive for HIV)], how many times have you
been pregnant? Don’t count your current pregnancy.” If POS1S_9 (Date first tested
positive for HIV) is 77/7777 (refused to answer) or 88/8888 (don’t know) and
PREGNOWN21 (Currently pregnant) = 1 (yes), then PREG_9 (Number of times pregnant)
should read as follows: "Since testing positive for HIV, how many times have you been
pregnant? Don’t count your current pregnancy.”
Number of times pregnant
0-100
If PREGNOWN21 (Currently pregnant) = 1 (yes) AND PREG_9 (Number of times pregnant) =
0, then skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
If PREG_9 (Number of times pregnant) = 0, 777 (refused to answer), or 888 (don’t know),
skip to Calculation_ENOBGYN5 (End of gynecological and reproductive hi).
Else, skip to Skip_OUTCM1N3_21 (Single pregnancy outcome).
If PREG_9 (Number of times pregnant) = 1, go to OUTCM1N3_21 (Single pregnancy
outcome). Else, skip to OUTCM1N21 (Outcome-live birth).
What was the outcome of this pregnancy? [READ RESPONSES. SELECT ONLY ONE.]
1 Live birth
2 Miscarriage
3 Abortion
4 Stillbirth
5 Ectopic pregnancy
8 Don’t know
7 Refused to answer
Single pregnancy outcome
If OUTCM1N3_21 (Single pregnancy outcome) = 1 (Live birth), then skip to KID1HVN3_21
(Single pregnancy vertical transmission). Else, skip to Calculation_ENOBGYN5 (End of
gynecological and reproductive hi).
How many of these pregnancies resulted in a live birth?
888 Don’t know
777 Refused to Answer
Outcome-live birth
0-100
If PREG_9 (Number of times pregnant) = OUTCM1N21 (Outcome-live birth), skip to
KIDHIVN21 (Children born HIV+). Else, go to OUTCM2N21 (Outcome-miscarriage).

Page |95
OUTCM2N21

GR.4.0.

How many of these pregnancies resulted in a miscarriage?
888 Don’t know
777 Refused to Answer
Outcome-miscarriage
0-100
If PREG_9 (Number of times pregnant) = OUTCM2N21 (Outcome-miscarriage), skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive hi). If PREG_9 (Number of
times pregnant) = OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcomemiscarriage), then skip to Skip_KID1HVN3_21 (Single pregnancy vertical transmission).
Else, go to OUTCM3N21 (Outcome-abortion).

GR.5.0.

How many of these pregnancies resulted in an abortion?
888 Don’t know
777 Refused to Answer
Outcome-abortion
0-100
If PREG_9 (Number of times pregnant) = OUTCM3N21 (Outcome-abortion), skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive hi). If PREG_9 (Number of
times pregnant) = OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcomemiscarriage) + OUTCM3N21 (Outcome-abortion), then skip to Skip_KID1HVN3_21 (Single
pregnancy vertical transmission). Else, go to OUTCM4N21 (Outcome-stillbirth).

GR.6.0.

How many of these pregnancies resulted in a stillbirth?
888 Don’t know
777 Refused to Answer
Outcome-stillbirth
0-100
If PREG_9 (Number of times pregnant) = OUTCM4N21 (Outcome-stillbirth), skip to
Calculation_ENOBGYN5 (End of gynecological and reproductive hi). If PREG_9 (Number of
times pregnant) = OUTCM1N21 (Outcome-live birth) + OUTCM2N21 (Outcomemiscarriage) + OUTCM3N21 (Outcome-abortion) + OUTCM4N21 (Outcome-stillbirth), then
skip to Skip_KID1HVN3_21 (Single pregnancy vertical transmission). Else, go to
OUTCM5N21 (Outcome-ectopic pregnancy).

GR.7.0.

How many of these pregnancies resulted in an ectopic pregnancy?
888 Don’t know
777 Refused to Answer
Outcome-ectopic pregnancy
0-100
If PREG_9 (Number of times pregnant) does not equal OUTCM1N21 (Outcome-live birth) +
OUTCM2N21 (Outcome-miscarriage) + OUTCM3N21 (Outcome-abortion) + OUTCM4N21
(Outcome-stillbirth) + OUTCM5N21 (Outcome-ectopic pregnancy), then display “The
number of pregnancy outcomes does not add up to the number of pregnancies.” Allow the
program to move forward.
If PREG_9 (Number of times pregnant) = OUTCM5N21 (Outcome-ectopic pregnancy), skip
to Calculation_ENOBGYN5 (End of gynecological and reproductive hi). Else, go to
Skip_KID1HVN3_21 (Single pregnancy vertical transmission).

Label_OUTCM2N21
Range_OUTCM2N21
Skip_OUTCM2N21

OUTCM3N21

Label_OUTCM3N21
Range_OUTCM3N21
Skip_OUTCM3N21

OUTCM4N21

Label_OUTCM4N21
Range_OUTCM4N21
Skip_OUTCM4N21

OUTCM5N21

Label_OUTCM5N21
Range_OUTCM5N21
Soft_edit_OUTCM5N21

Skip_OUTCM5N21

Page |96
Skip_KID1HVN3_21

KID1HVN3_21

GR.8.0.

Label_KID1HVN3_21
Skip2_KID1HVN3_21
KIDHIVN21

GR.9.0.

If OUTCM1N21 (Outcome-live birth) = 1, then go to KID1HVN3_21 (Single pregnancy
vertical transmission). If OUTCM1N21 (Outcome-live birth) > 1, then go to KIDHIVN21
(Children born HIV+). Else, go to Calculation_ENOBGYN5 (End of gynecological and
reproductive hi).
Was the child diagnosed with HIV?
0 No
1 Yes
2 Indeterminate
8 Don’t know
7 Refused to answer
Single pregnancy vertical transmission
All responses skip to Calculation_OBGYN5.

Label_KIDHIVN21
Range_KIDHIVN21
Hard_edit_KIDHIVN21

How many of your biological children were born with HIV?
888 Don’t know
777 Refused to Answer
Children born HIV+
0-100
KIDHIVN21 (Children born HIV+) must be ≤ OUTCM1N21 (Outcome-live birth). If
KIDHIVN21 (Children born HIV+) > OUTCM1N21 (Outcome-live birth) then read, “Earlier
you said that you had [OUTCM1N21 (Outcome-live birth)] live births, but the number you
just gave me is greater than that.” Do not allow the program to advance.

Calculation_ENOBGYN5 G.0.a.
Label_Calculation_ENOBGYN5

ENOBGYN5 = Current time
End of gynecological and reproductive hi

Calculation_TLOBGYN5 G.0.b.
Label_Calculation_TLOBGYN5

Calculate elapsed time between STOBGYN5 and ENOBGYN5 = TLOBGYN5
Total time for gyn and reproductive hist

Page |97

Module: Met and unmet needs (N)
Topic: Services and assistance programs (ND)
Calculation_STNEEDN5 N.0.
Label_Calculation_STNEEDN5

STNEEDN5 = Current time
Start time met and unmet needs

Intro_8_CSMNA_5

“For these next questions, I’m going to ask about services you used or needed during the
past 12 months. First, I'll ask whether you got the service, and if you didn’t, I'll ask whether
you needed it. These questions might sound similar, but I need to ask you all of them.”
The first question is about HIV case management services. A case manager is a professional
who helps you to get care and other services that you or your family may need. During the
past 12 months, did you get HIV case management services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get HIV case management services
If CSMNA_5 (Get HIV case management services) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to CSMNB_5 (Needed HIV case management services).
Else, skip to Skip1_6_TKMDA_5 (Get help taking meds on time/correctly).

CSMNA_5

ND.1.0.

Label_CSMNA_5
Skip_6_CSMNA_5

CSMNB_5

ND.1.1.

Label_CSMNB_5
Skip_6_CSMNB_5

Intro_CSMNC_5
CSMNC_5

ND.1.2.

Label_CSMNC_5
CSMNE_5

Label_CSMNF_5

“Were you not able to get this service for any of the following reasons:”
...because you didn't have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-HIV case management

ND.1.3.

…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-HIV case management

ND.1.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-HIV case management

Label_CSMNE_5
CSMNF_5

During the past 12 months, have you needed HIV case management services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed HIV case management services
If CSMNB_5 (Needed HIV case management services) is 1 (yes), go to Intro_CSMNC_5
(Barrier-financial-HIV case management).
Else, skip to Skip1_6_TKMDA_5 (Get help taking meds on time/correctly).

Page |98
CSMND_5

ND.1.5.

Label_CSMND_5
Skip1_6_TKMDA_5

TKMDA_5

ND.2.0.

Label_TKMDA_5
Skip2_6_TKMDA_5

TKMDB_5

ND.2.1.

Label_TKMDB_5
Skip_TKMDB_5

Intro_TKMDC_N5
TKMDC_N5

ND.2.2.

Label_TKMDC_N5
TKMDE_N5

Label_TKMDE_N5

ND.2.3.

...because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-HIV case management
If CART_N5 (Currently taking ART) = 1 (yes) or ATMD12_9 (Took ART in past 12 months) = 1
(yes), then go to TKMDA_5 (Get help taking meds on time/correctly).
Else, skip to Skip_NEDADA_5 (Needed ADAP).
During the past 12 months, did you get professional help on how to take your HIV
medicines on time or correctly?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get help taking meds on time/correctly
If TKMDA_5 (Get help taking meds on time/correctly) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to TKMDB_5 (Need help taking meds on time/correctly).
Else, skip to Skip_NEDADA_5 (Needed ADAP).
During the past 12 months, have you needed professional help on how to take your HIV
medicines on time or correctly?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need help taking meds on time/correctly
If TKMDB_5 (Need help taking meds on time/correctly) is 1 (yes), go to Intro_TKMDC_N5
(Barrier-financial-help taking HIV meds).
Else, skip to Skip_NEDADA_5 (Needed ADAP).
“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-help taking HIV meds
…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-struct. 1-help taking HIV meds

Page |99
TKMDF_N5

ND.2.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-struct. 2-help taking HIV meds

ND.2.5.

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-help taking HIV meds

Label_TKMDF_N5
TKMDD_N5

Label_TKMDD_N5
Skip_NEDADA_5
NEDADA_5

ND.3.1.

Label_NEDADA_5
Skip2_NEDADA_5
Intro_ADAPC_N5
ADAPC_N5

ND.3.2.

Label_ADAPC_N5
ADAPD_N5

Label_ADAPB_N5

“Were you not able to get this service for any of the following reasons:”
…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-ADAP

ND.3.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-ADAP

ND.3.4.

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-ADAP

Label_ADAPD_N5
ADAPB_N5

If KINDD_5 (Insurance-Ryan White or ADAP) is 0 (no), go to NEDADA_5 (Needed ADAP).
Else, skip to Intro_PATNAVN5 (Get patient navigation services).
Earlier you told me that during the past 12 months you did not have Ryan White or ADAP
coverage. During the past 12 months, have you needed to get medicine through ADAP?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed ADAP
If NEDADA_5 (Needed ADAP) is 1 (yes), go to Intro_ADAPC_N5 (Barrier-structural 1-ADAP).
Else, skip to Intro_PATNAVN5 (Get patient navigation services).

Page |100
Intro_PATNAVN5

PATNAVN5

ND.4.0.

Label_PATNAVN5
Skip_PATNAVN5

PATNABN5

ND.4.1.

Label_PATNABN5
Skip_PATNABN5

Intro_PATNACN5
PATNACN5

ND.4.2.

Label_PATNACN5
PATNAEN5

Label_PATNADN5

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-patient navigation
…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-patient navigation

ND.4.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-patient navigation

ND.4.5.

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-patient navigation

Label_PATNAFN5
PATNADN5

During the past 12 months, have you needed patient navigation services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed patient navigation services
If PATNABN5 (Needed patient navigation services) is 1 (yes), go to Intro_PATNACN5
(Barrier-financial-patient navigation).
Else, skip to GET_GRP (Get HIV peer group support).

ND.4.3.

Label_PATNAEN5
PATNAFN5

“The next question is about patient navigation services. This is someone whose job it is to
help you get the best medical care for you. For example, a patient navigator might help
you talk to your doctor about your care or go with you to your medical appointments.”
During the past 12 months, did you get patient navigation services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get patient navigation services
If PATNAVN5 (Get patient navigation services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to PATNABN5 (Needed patient navigation services).
Else, skip to GET_GRP (Get HIV peer group support).

Page |101
GET_GRP

ND.5.0.

During the past 12 months, did you get HIV peer group support?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get HIV peer group support
If GET_GRP (Get HIV peer group support) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to NED_GRP (Needed HIV peer group support).
Else, skip to DENS12_9 (Get dental care).

ND.5.1.

During the past 12 months, have you needed HIV peer group support?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed HIV peer group support
If NED_GRP (Needed HIV peer group support) is 1 (yes), go to Intro_RSGRPCN5 (Barrierstructural 1-HIV peer support).
Else, skip to DENS12_9 (Get dental care).

Label_GET_GRP
Skip_GET_GRP

NED_GRP

Label_NED_GRP
Skip_NED_GRP

Intro_RSGRPCN5
RSGRPCN5

ND.5.2.

Label_RSGRPCN5
RSGRPDN5

ND.5.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-HIV peer support

ND.5.4.

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-HIV peer group support

ND.6.0.

During the past 12 months, did you get dental care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get dental care
If DENS12_9 (Get dental care) is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
DENSER_9 (Needed dental care).
Else, skip to GET_SUBU (Get drug/alcohol counseling or treatment).

Label_RSGRPDN5
RSGRPBN5

Label_RSGRPBN5
DENS12_9

Label_DENS12_9
Skip_DENS12_9

“Were you not able to get this service for any of the following reasons:”
…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-HIV peer support

Page |102
DENSER_9

ND.6.1.

Label_DENSER_9
Skip_DENSER_9

Intro_DENSA_N5
DENSA_N5

ND.6.2.

Label_DENSA_N5
DENSC_N5

…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-dental care

ND.6.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-dental care

ND.6.5.

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-dental care

ND.7.0.

During the past 12 months, did you get drug or alcohol counseling or treatment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get drug/alcohol counseling or treatment
If GET_SUBU (Get drug/alcohol counseling or treatment) is 0 (no), 7 (refused to answer), or
8 (don’t know), go to NED_SUBU (Need drug/alcohol counsel or treatment).
Else, skip to MENTA_5 (Get mental health counsel or treatment).

Label_DENSD_N5
DENSB_N5

Label_DENSB_N5
GET_SUBU

Label_GET_SUBU
Skip_GET_SUBU

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-dental care

ND.6.3.

Label_DENSC_N5
DENSD_N5

During the past 12 months, have you needed dental care?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed dental care
If DENSER_9 (Needed dental care) is 1 (yes), go to Intro_DENSA_N5 (Barrier-financialdental care).
Else, skip to GET_SUBU (Get drug/alcohol counseling or treatment).

Page |103
NED_SUBU

ND.7.1.

Label_NED_SUBU
Skip_NED_SUBU

Intro_SUBUA_N5
SUBUA_N5

ND.7.2.

Label_SUBUA_N5
SUBUB_N5

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-drug/alcohol TX

ND.7.4.

…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-drug/alcohol TX

ND.7.5.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-drug/alcohol TX

ND.8.0.

During the past 12 months, have you seen or talked to a mental health professional such
as a psychologist, psychiatrist, psychiatric nurse, or clinical social worker about your
health?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get mental health counsel or treatment
If MENTA_5 (Get mental health counsel or treatment) is 0 (no), 7 (refused to answer), or 8
(don’t know), go to MENTB_5 (Need mental health counsel or treatment).
Else, skip to TRAS12_9 (Get transportation assistance).

Label_SUBUC_N5
SUBUD_N5

Label_SUBUD_N5
MENTA_5

Label_MENTA_5
Skip_MENTA_5

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-drug/alcohol TX

ND.7.3.

Label_SUBUB_N5
SUBUC_N5

During the past 12 months, have you needed drug or alcohol counseling or treatment?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need drug/alcohol counsel or treatment
If NED_SUBU (Need drug/alcohol counsel or treatment) is 1 (yes), go to Intro_SUBUA_N5
(Barrier-financial-drug/alcohol TX).
Else, skip to MENTA_5 (Get mental health counsel or treatment).

Page |104
MENTB_5

ND.8.1.

Label_MENTB_5
Skip_MENTB_5

Intro_MENTC_5
MENTC_5

ND.8.2.

Label_MENTC_5
MENTE_5

…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-mental health TX

ND.8.4.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-mental health TX

ND.8.5.

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-mental health TX

ND.9.0.

During the past 12 months, did you get transportation assistance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get transportation assistance
If TRAS12_9 (Get transportation assistance) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to TRASAS_9 (Needed transportation assistance).
Else, skip to SHLTA_5 (Get shelter or housing services).

Label_MENTF_5
MENTD_5

Label_MENTD_5
TRAS12_9

Label_TRAS12_9
Skip_TRAS12_9

“Were you not able to get this service for any of the following reasons:”
...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-mental health TX

ND.8.3.

Label_MENTE_5
MENTF_5

During the past 12 months, have you needed to see or talk to a mental health professional
about your health?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need mental health counsel or treatment
If MENTB_5 (Need mental health counsel or treatment) is 1 (yes), go to Intro_MENTC_5
(Barrier-financial-mental health TX).
Else, skip to TRAS12_9 (Get transportation assistance).

Page |105
TRASAS_9

ND.9.1.

Label_TRASAS_9
Skip_TRASAS_9

Intro_TRANC_N5
TRANC_N5

ND.9.2.

Label_TRANC_N5
TRAND_N5

Label_TRANB_N5
SHLTA_5

Label_SHLTA_5
Skip_8_SHLTA_5

SHLTB_5

Label_SHLTB_5
Skip_8_SHTLB_5

“Were you not able to get this service for any of the following reasons:”
…because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-transportation

ND.9.3.

…because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-transportation

ND.9.4.

…because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-transportation

Label_TRAND_N5
TRANB_N5

During the past 12 months, have you needed transportation assistance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed transportation assistance
If TRASAS_9 (Needed transportation assistance) is 1 (yes), go to Intro_TRANC_N5 (Barrierstructural 1-transportation).
Else, skip to SHLTA_5 (Get shelter or housing services).

ND.10.0. During the past 12 months, did you get shelter or housing services where you got help
with temporary or long-term housing including section 8 vouchers?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get shelter or housing services
If SHLTA_5 (Get shelter or housing services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to SHLTB_5 (Needed shelter or housing services).
Else, skip to FOODA_N5 (Get food assistance).
ND.10.1. During the past 12 months, have you needed shelter or housing services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed shelter or housing services
If SHLTB_5 (Needed shelter or housing services) is 1 (yes), go to Intro_SHLTC_N5 (Barrierstructural 1-shelter/hous servic).
Else, skip to FOODA_N5 (Get food assistance).

Page |106
Intro_SHLTC_N5
SHLTC_N5

Label_SHLTC_N5
SHLTD_N5

Label_SHLTD_N5
SHLTE_N5

Label_SHLTE_N5
FOODA_N5

Label_FOODA_N5
Skip_FOODA_N5

FOODB_N5

Label_FOODB_N5
Skip_FOODB_N5

Intro_FOODE_N5
FOODE_N5

Label_FOODE_N5

“Were you not able to get this service for any of the following reasons:”
ND.10.2. …because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-shelter/hous servic
ND.10.3. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-shelter/hous servic
ND.10.4. …because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-shelter or housing
ND.11.0. During the past 12 months, did you get food assistance or food stamps from SNAPSupplemental Nutrition Assistance Program or WIC-The Special Supplemental Nutrition
Program for Women, Infants, and Children?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get food assistance
If FOODA_N5 (Get food assistance) is 0 (no), 7 (refused to answer), or 8 (don’t know), go to
FOODB_N5 (Needed food assistance).
Else, skip to Intro_n5_MLSF12_9 (Get meal or food services).
ND.11.1. During the past 12 months, have you needed food assistance or food stamps?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed food assistance
If FOODB_N5 (Needed food assistance) is 1 (yes), go to Intro_FOODE_N5 (Barrier-structural
1-food assistance).
Else, skip to Intro_n5_MLSF12_9 (Get meal or food services).

“Were you not able to get this service for any of the following reasons:”
ND.11.2. …because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-food assistance

Page |107
FOODF_N5

Label_FOODF_N5
FOODD_N5

Label_FOODD_N5
Intro_n5_MLSF12_9

MLSF12_9

Label_MLSF12_9
Skip_MLSF12_9

MLSFOD_9

Label_MLSFOD_9
Skip_MLSFOD_9

Intro_MEALA_N5
MEALA_N5

Label_MEALA_N5
MEALC_N5

Label_MEALC_N5

ND.11.3. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-food assistance
ND.11.4. …because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-food assistance

“Next I’m going to ask about meal or food services. This is different from food assistance,
which I just asked you about. Meal or food services include services such as soup kitchens,
food pantries, food banks, church dinners, or food delivery services.”
ND.12.0. During the past 12 months, did you get meal or food services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get meal or food services
If MLSF12_9 (Get meal or food services) is 0 (no), 7 (refused to answer), or 8 (don’t know),
go to MLSFOD_9 (Needed meal or food services).
Else, skip to GET_DOMS (Get domestic violence services).
ND.12.1. During the past 12 months, have you needed meal or food services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed meal or food services
If MLSFOD_9 (Needed meal or food services) is 1 (yes), go to Intro_MEALA_N5 (Barrierfinancial-meal or food services).
Else, skip to GET_DOMS (Get domestic violence services).

“Were you not able to get this service for any of the following reasons:”
ND.12.2. ...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-meal or food services
ND.12.3. …because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-meal/food services

Page |108
MEALD_N5

Label_MEALD_N5
MEALB_N5

Label_MEALB_N5
GET_DOMS

Label_GET_DOMS
Skip_8_GET_DOMS

NED_DOMS

Label_NED_DOMS
Skip_8_NED_DOMS

Intro_DOMSA_N5
DOMSA_N5

Label_DOMSA_N5
DOMSC_N5

Label_DOMSC_N5

ND.12.4. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-meal/food services
ND.12.5. …because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-meal or food services
ND.13.0. During the past 12 months, did you get domestic violence services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get domestic violence services
If GET_DOMS (Get domestic violence services) is 0 (no), 7 (refused to answer), or 8 (don’t
know), go to NED_DOMS (Needed domestic violence services).
Else, skip to Intro_SSIA_N8 (Get SSI).
ND.13.1. During the past 12 months, have you needed domestic violence services?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Needed domestic violence services
If NED_DOMS (Needed domestic violence services) is 1 (yes), go to Intro_DOMSA_N5
(Barrier-financial-domestic violence).
Else, skip to Intro_SSIA_N8 (Get SSI).

“Were you not able to get this service for any of the following reasons:”
ND.13.2. ...because you didn’t have enough money or insurance?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-financial-domestic violence
ND.13.3. …because you couldn’t find the information you needed to get the service or didn’t know it
existed?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 1-domestic violence

Page |109
DOMSD_N5

Label_DOMSD_N5
DOMSB_N5

Label_DOMSB_N5
COND12_9

Label_COND12_9
SKIP_21_COND12_9
NEDCOND_N21

Label_NEDCOND_N21

ND.13.4. …because the service didn’t meet your needs or you weren’t eligible for it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-structural 2-domestic violence
ND.13.5. …because of personal reasons, such as you were afraid or embarrassed to get the service
or you had other things going on in your life that made it difficult to get it?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Barrier-personal-domestic violence
ND.14.0. During the past 12 months, have you gotten any free condoms, not counting those given
to you by a friend, relative, or sex partner?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Gotten any free condoms
If COND12_9 (Gotten any free condoms) is 0 (no), 7 (refused to answer), or 8 (don't know),
go to NEDCOND_N21 (Need free condoms). Else, skip to INTRO_SSIA_N8.
ND.14.1. During the past 12 months, have you needed free condoms?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Need free condoms

Topic: Other disability (NS)
Intro_SSIA_N8

SSIA_N8

Label_SSIA_N8
Skip_SSIA_N8

NS.1.0.

"The next question is about Supplemental Security Income or SSI. SSI is a federal program
that provides money for food, clothing, and shelter for older persons or persons with
disabilities."
During the past 12 months, did you get SSI?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get SSI
If SSIA_N8 (Get SSI) is 1 (yes), go to DSSSIN8 (Date received SSI).
Else, skip to Intro_SSDIA_N8 (Get SSDI).

Page |110
Intro_SSDIA_N8
SSDIA_N8

NS.2.0.

Label_SSDIA_N8
Skip_SSDIA_N8

"Now I’m going to ask about Social Security Disability Insurance or SSDI. SSDI is a federal
insurance program that provides income to people unable to work because of a disability."
During the past 12 months, did you get SSDI?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Get SSDI
If SSDIA_N8 (Get SSDI) is 1 (yes), go to DSSDIN8 (Date received SSDI).
Else, skip to Calculation_ENNEEDN5 (End of met and unmet needs).

Calculation_ENNEEDN5 N.0.a.
Label_Calculation_ENNEEDN5

ENNEEDN5 = Current time
End of met and unmet needs

Calculation_TLNEEDN5 N.0.b.
Label_Calculation_TLNEEDN5

Calculate elapsed time between STNEEDN5 and ENNEEDN5 = TLNEEDN5
Total time for met and unmet needs

Page |111

Module: Prevention activities (P)
Topic: Prevention messages (PM)
Calculation_STPREVN5 P.0.
Label_Calculation_STPREVN5

STPREVN5 = Current time
Start prevention activities

Intro_21_INFTX1N8
INFTX1N8

"Next, I'll ask you some questions about HIV information."
Have you ever looked for information about HIV care and treatment from any source?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Ever looked for care and tx info
If INFTX1N8 (Ever looked for care and tx info) = 1 (Yes), go to INFTX2N8 (Recent search HIV
care and tx info). Else, skip to TALK_A_21 (Conversation with a doctor, nurse…).

PM.1.0.

Label_INFTX1N8
Skip_21_INFTX1N8
INFTX2N8

PM.1.1.

Label_INFTX2N8
Intro_INFT3N8A
INFT3N8A

PM.2.1.

Label_INFT3N8A
INFT3N8B

Label_INFT3N8C

"In general, how much would you trust information about HIV care or treatment from each
of the following sources?"
A doctor, nurse, or other health care worker [READ RESPONSES. SELECT ONLY ONE.]
0 Not at all
1 Somewhat
2 A great deal
8 Don't Know
7 Refused to Answer
Trust provider for HIV info

PM.2.2.

Family or friend [READ RESPONSES. SELECT ONLY ONE.]
0 Not at all
1 Somewhat
2 A great deal
8 Don't Know
7 Refused to Answer
Trust family or friend for HIV info

PM.2.3.

Centers for Disease Control and Prevention or CDC [READ RESPONSES. SELECT ONLY ONE.]
0 Not at all
1 Somewhat
2 A great deal
8 Don't Know
7 Refused to Answer
Trust CDC for HIV info

Label_INFT3N8B
INFT3N8C

The most recent time that you looked for information about HIV care and treatment, what
source did you use first? [READ RESPONSES. SELECT ONLY ONE.]
1 Internet
2 Brochure or pamphlet
3 Magazine
4 Doctor, nurse, or other healthcare worker
5 Family or friend
6 Other source
8 Don't Know
7 Refused to Answer
Recent search HIV care and tx info

Page |112
INFT3N8D

PM.2.4.

State or local health department [READ RESPONSES. SELECT ONLY ONE.]
0 Not at all
1 Somewhat
2 A great deal
8 Don't Know
7 Refused to Answer
Trust health department for HIV info

PM.2.5.

Community-based organization [READ RESPONSES. SELECT ONLY ONE.]
0 Not at all
1 Somewhat
2 A great deal
8 Don't Know
7 Refused to Answer
Trust CBO for HIV info

PM.2.6.

Religious organization [READ RESPONSES. SELECT ONLY ONE.]
0 Not at all
1 Somewhat
2 A great deal
8 Don't Know
7 Refused to Answer
Trust religious orgs for HIV info

Label_INFT3N8D
INFT3N8E

Label_INFT3N8E
INFT3N8F

Label_INFT3N8F

Topic: Risk reduction (PR)
TALK_A_21

PR.1.0

During the past 12 months, have you talked to a doctor, nurse, or other healthcare worker
about how to prevent HIV or other STDs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) is less than 12 months from IDATE (Interview
date) then display the text as follows, "During the past 12 months, not including when you
may have been tested for HIV, have you talked to a doctor, nurse, or other healthcare
worker about how to prevent HIV or other STDs?"
Conversation with a doctor, nurse…

PR.2.0

During the past 12 months, have you talked to an outreach worker, counselor, or
prevention program worker about how to prevent HIV or other STDs?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
If POS1S_9 (Date first tested positive for HIV) is less than 12 months from IDATE (Interview
date) then display the text as follows, "During the past 12 months, not including when you
may have been tested for HIV, have you talked to an outreach worker, counselor, or
prevention program worker about how to prevent HIV or other STDs?"
Conversation with an outreach worker…

Alt_Text_TALK_A_21

Label_TALK_A_21
TALK_B_21

Alt_Text_TALK_B_21

Label_TALK_B_21

Page |113

Topic: HIV treatment as prevention (PB)
TASP1N8

TB.1.0.

Label_TASP1N8

Have you heard that if you have an undetectable viral load, you will not pass on HIV to
sexual partners?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Aware of treatment as prevention

Calculation_ENPREVN5 P.0.a.
Label_Calculation_ENPREVN5

ENPREVN5 = Current time
End of prevention activities

Calculation_TLPREVN5 P.0.b.
Label_Calculation_TLPREVN5

Calculate elapsed time between STPREVN5 and ENPREVN5 = TLPREVN5
Total time for prevention activities

Page |114

Module: Interview completion (E)
Topic: End of interview (EE)
Calculation_EN_INTN5 E.0.
Label_Calculation_EN_INTN5

EN_INTN5 = Current time
End of interview

Calculation_TL_TIMN5 E.0.a.
Label_Calculation_TL_TIMN5

Calculate elapsed time between ST_INTN5 and EN_INTN5 = TL_TIMN5.
Total interview time

Intro_RECCOMP_8

"Thank you again for taking part in this interview. Please remember that all the
information you have given me will be kept confidential. Now we are going to talk about
services you may need or want."
Interview end date:
Interview end date
Automatically calculate RECCOMP (Interview end date) in QDS using the date on the device

RECCOMP
EE.1.0.
Label_RECCOMP
QDS_programming_RECCOMP

Topic: Referrals and follow-up (EO)
Skip_RFLKPN8

RFLKPN8

EO.1.0

Label_RFLKPN8
RFLKA1N8

EO.1.1

[DON'T READ ALOUD] Did you offer to refer the respondent to a provider or HIV agency for
appropriate HIV medical services or treatment?
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Active referral: provider or HIV agency

EO.1.2

[DON'T READ ALOUD] Did you offer to make a medical appointment for the respondent for
HIV medical services or treatment?
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Active referral make appt

EO.2.0

[DON'T READ ALOUD] Did you offer the respondent HIV prevention materials such as palm
cards, pamphlets, or videos?
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Offered prevention materials

Label_RFLKA1N8
RFLKA2N8

Label_RFLKA2N8
PREV_N8

Label_PREV_N8

If EVERCR_8 (Ever rcvd. HIV care) is 0 (no), go to RFLKPN8 (Passive referral: LTC or reengagement).
If LASCA_8 (Date most recent outpt. HIV care visit) is > 12 months prior to IDATE
(Interview date), go to RFLKPN8 (Passive referral: LTC or re-engagement).
Else, skip to PREV_N8 (Offered prevention materials).
[DON'T READ ALOUD] Did you offer the respondent information about a provider or HIV
agency they can go to for HIV medical services or treatment? This includes offering them
written or verbal information such as a contact name, location, phone number, or hours of
operation of a provider or agency.
0 No
1 Yes, and respondent refused
2 Yes, and respondent accepted
Passive referral: LTC or re-engagement

Page |115
Skip_SMOKCEN8

SMOKCEN8

Alt_text_SMOKCESN8

Label_SMOKCEN8

EO.3.0

If CIG_OFT (Current use cigarettes) is 1 (daily), 2 (weekly), 3 (monthly) or 4 (less than
monthly), go to SMOKCEN8 (Need smoking cessation).
If CIGARFN5 (Current use cigars, etc.) is 1 (every day), 2 (some days) or 3 (rarely), go to
SMOKCEN8 (Need smoking cessation).
Else, skip to RFANS_8 (Refs ancillary services).
Earlier, you said that a healthcare professional has not advised you to quit smoking in the
past 12 months. Would you like any assistance, information, or additional advice to help
you quit smoking?
0 No
1 Yes
8 Don't Know
7 Refused to Answer
Tokens are used to alter how this question appears based on the respondent’s answer to
CIG_DQ_8 (Doctor advised to quit smoking). If CIG_DQ_8 (Doctor advised to quit smoking)
is 0 (no), then question should read, “Earlier, you said that a healthcare professional has
not advised you to quit smoking in the past 12 months. Would you like any assistance,
information, or advice to help you quit smoking?” If CIG_DQ_8 (Doctor advised to quit
smoking) is 1 (yes), then question should read, “Earlier, you said that a healthcare
professional advised you to quit smoking in the past 12 months. Would you like any
assistance, information, or additional advice to help you quit smoking?” If CIG_DQ_8
(Doctor advised to quit smoking) is 7 (don’t know) or 8 (Refused), the question should read
“Earlier, we asked you if a healthcare professional has advised you to quit smoking in the
past 12 months. Would you like any assistance, information, or additional advice to help
you quit smoking?”
Need smoking cessation

Page |116
RFANS_8

EO.4.0

Label_RFANS_8
QDS_programming_note_21_RFA
NSN8

RFANS_8A

HIV case management services
0 No
1 Yes
Refs ancillary services: HIV case mgmt

EO.4.0.

Adherence counseling
0 No
1 Yes
Refs ancillary services: Adhere counsel

EO.4.0.

ADAP
0 No
1 Yes
Refs ancillary services: ADAP

EO.4.0.

Patient navigation
0 No
1 Yes
Refs ancillary services: Pt navigation

Label_RFANS_8B
RFANS_8C

Label_RFANS_8C
RFANS_8D

Label_RFANS_8D

[Resources previously indicated as needed by the respondent are flagged with an asterisk
(*)]
Refs ancillary services
If CSMNB_5 (Needed HIV case management services) =1 then show asterisk next to
RFANS_8A (Refs ancillary services: HIV case mgmt). If TKMDB_5 (Need help taking meds
on time/correctly) =1 then show asterisk next to RFANS_8B (Refs ancillary services: Adhere
counsel). If NEDADA_5 (Needed ADAP) =1 then show asterisk next to RFANS_8C (Refs
ancillary services: ADAP). If PATNABN5 (Needed patient navigation services) =1 then show
asterisk next to RFANS_8D (Refs ancillary services: Pt navigation). If NED_GRP (Needed
HIV peer group support) =1 then show asterisk next to RFANS_8E (Refs ancillary services:
HIV grp support). If DENSER_9 (Needed dental care) =1 then show asterisk next to RFANS_
8F (Refs ancillary services: Dental). If NED_SUBU (Need drug/alcohol counsel or
treatment) =1 then show asterisk next to RFANS_8G (Refs ancillary services: Drug alcohol
tx). If MENTB_5 (Need mental health counsel or treatment) =1 then show asterisk next to
RFANS_8H (Refs ancillary services: Mental hlth tx). If TRASAS_9 (Needed transportation
assistance)=1 then show asterisk next to RFANS_8I (Refs ancillary services: Transportation).
If SHLTB_5 (Needed shelter or housing services) =1 then show asterisk next to RFANS_8J
(Refs ancillary services: Shltr or house). If FOODB_N5 (Needed food assistance)=1 then
show asterisk next to RFANS_8K (Refs ancillary services: Food assist). If MLSFOD_9
(Needed meal or food services)=1 then show asterisk next to RFANS_8L (Refs ancillary
services: Meal services). If NED_DOMS (Needed domestic violence services)=1 then show
asterisk next to RFANS_8M (Refs ancillary services: Dom violence). If SMOKCEN8 (Need
smoking cessation)=1 then show asterisk next to RFANS_8N (Refs ancillary services: Smoke
cessation). If NEDCOND_N21 (Need free condoms)=1 then show asterisk next to
RFANS_N21 (Refs ancillary services: Condoms). Due to this programming note, the labels
in the QDS codebook will appear differently from the labels in the gold-standard
questionnaire, which is OK.

EO.4.0.

Label_RFANS_8A
RFANS_8B

[DON'T READ ALOUD] Which of the following additional resources were or will be offered
to the respondent? [SELECT ALL THAT APPLY.]

Page |117
RFANS_8E

EO.4.0.

HIV peer group support
0 No
1 Yes
Refs ancillary services: HIV grp support

EO.4.0.

Dental care
0 No
1 Yes
Refs ancillary services: Dental

EO.4.0.

Drug or alcohol counseling or treatment
0 No
1 Yes
Refs ancillary services: Drug alcohol tx

EO.4.0.

Mental health services
0 No
1 Yes
Refs ancillary services: Mental hlth tx

EO.4.0.

Transportation
0 No
1 Yes
Refs ancillary services: Transportation

EO.4.0.

Shelter or housing services
0 No
1 Yes
Refs ancillary services: Shltr or house

EO.4.0.

Food assistance
0 No
1 Yes
Refs ancillary services: Food assist

EO.4.0.

Meal or food services
0 No
1 Yes
Refs ancillary services: Meal services

EO.4.0.

Domestic violence services
0 No
1 Yes
Refs ancillary services: Dom violence

EO.4.0.

Tobacco cessation services
0 No
1 Yes
Refs ancillary services: Smoke cessation

EO.4.0.

Condoms
0 No
1 Yes
Refs ancillary services: Condoms

Label_RFANS_8E
RFANS_8F

Label_RFANS_8F
RFANS_8G

Label_RFANS_8G
RFANS_8H

Label_RFANS_8H
RFANS_8I

Label_RFANS_8I
RFANS_8J

Label_RFANS_8J
RFANS_8K

Label_RFANS_8K
RFANS_8L

Label_RFANS_8L
RFANS_8M

Label_RFANS_8M
RFANS_8N

Label_RFANS_8N
RFANS_N21

Label_RFANS_N21

Page |118
RFANS_8O_21

EO.4.0.

Label_RFANS_8O_21
Hard_edit_21_RFANS_8O_21

No ancillary resources offered
0 No
1 Yes
Refs ancillary services: none offered
If RFANS_8A (Refs ancillary services: HIV case mgmt), RFANS_8B (Refs ancillary services:
Adhere counsel), RFANS_8C (Refs ancillary services: ADAP), RFANS_8D (Refs ancillary
services: Pt navigation) , RFANS_8E (Refs ancillary services: HIV grp support), RFANS_8F
(Refs ancillary services: Dental) , RFANS_8G (Refs ancillary services: Drug alcohol tx),
RFANS_8H (Refs ancillary services: Mental hlth tx), RFANS_8I (Refs ancillary services:
Transportation), RFANS_8J (Refs ancillary services: Shltr or house), RFANS_8K (Refs
ancillary services: Food assist), RFANS_8L (Refs ancillary services: Meal services), RFANS_
8M (Refs ancillary services: Dom violence), RFANS_8N (Refs ancillary services: Smoke
cessation), or RFANS_N21 (Refs ancillary services: Condoms) is selected and RFANS_8O_21
(Refs ancillary services: none offered) (Refs ancillary services: none offered) is selected,
then READ: "You cannot select an ancillary service and also select that none was offered.
Correct the error." Program should not move forward until error is corrected.

Topic: Data validity (EV)
Intro_N8_CONF

CONF

EV.1.0.

Label_CONF
ADDCOM1

EV.2.0.

Label_ADDCOM1
QDS_programming_ADDCOM1

Interviewer instructions [DON'T READ ALOUD]: Don’t pay the respondent if the respondent
already participated in an MMP interview during the [INSERT CYCLE YEAR] data collection
cycle OR the respondent is < 18 years old. Pay the respondent if the interview was partially
or fully completed.
[DON'T READ ALOUD] How confident are you of the validity of the respondent’s answers?
1 Confident
2 Some doubts
3 Not confident at all
Validity confidence
[DON'T READ ALOUD] Record any additional comments, including disruptions that might
have taken place during the interview, reason the interview might have been stopped, or
why the respondent’s answers may not have been reliable.
666 Not Applicable
Additional comments
Include a 6 (not applicable) response option. Character limit is 250 words.

Topic: Local questions (EL)
LOCSURN6

Label_LOCSURN6

EL.1.0.

Interviewer instructions: Does your project area ask local questions? If yes, press "Yes" to
continue to local questions. If not, press "No" to end.
0 No
1 Yes
Local survey verification question