Female questionnaire - Center for AIDS Prevention Studies

Transcription

I-Þ_
PLACE ID LABEL I{ERE
/ ÞAY- t :IE\K
Date:SQtr$l
roday's
month
daY
Year
rnitiak'l['hJf'68 WR
rnterviewer
SUDISSITE: (checkbelow)
¿--+-
ll-t tr
site(specifysite number)
| -Field
Other(sPecifY)
2Universþ of California,SanFrancisco
3
Time interview started:
TrMl
Time interviewstoPPed:
IAM/PM
_ tAMÆMl
Reviewed bY CleanedbY Transcribed by -
.ìUDISWOMEN'S QIIESTIONNAIRJ
Introduction:
askaboutarevery personal.I wantto makesureyou
Thankyou for beinga partof this study someof thethingsI will
they areprivateandwill not be sharedwith
that all of your answerswill be keptconfidential,meaningthat
understand
materialwill bekept
pro-t""tionoîpriväcy. All research
others.your namewill not be written on this surveyto add,no."
in a lockedfile anddestroyedafterthe researchhasended'
in the answersyou give'
your answerswill be usedto help designprogramsfor otherpeoplewith Hrv. Try to be honest
usecondomsor nevershareoutfits' But for this
For example,somepeoplefeel it might be beãerto saythattúeyãlways
in your feelings,thoughtsandexperiences'
study,thereareno righi or wronganswers.I ammosiinteresteã
but pleaseanswerall of
feel freeto askthemat anytime. somequestionssoundthe same,
If you haveanyquestions,
duringthe interview,pleaselet me
theyareall importantfor this research.If you needtå takea break
them,because
\ve cando that.
know,because
call Kelly Knight,M'Ed' at
or thingsthat vor¡'.dlike to talk aboutafterthis interview,you can
If you havequestions,
in this packetmightbe
included
Guide
Referral
(41s) 5gi-46st.elså,itr" ugãn"i",ándindividualsin thecommunity
services'
ù"pn t in answeringyour quistionsor connectingyou with other
FemaleVersion,SectionA, PageI
your health, and what
rn this first sectionI,d like to know more about your health, especiallyhow HfV has affected
health care servicesyou receive.
date'
When did you first test positive for HfV, or learn that you had HW? If you are unsur€ of the specific
give your best estimate.
please
^
(If reslondent can not specifu month, but can only provide the season,0l:winter, 14:spring, 07:summer,
Al.
I|--fau)
nronthliErlMOye*llff
TESTEÞ
Wasnot tested;wastold by a healthcareproviders/hehadHIV à GO TO Â'3
-l
Whenyou first got a positiveHfV-test result,wherewere you tested? ÉSTW LIR F
l)Health departmentor otherpublictestsite
2)Publichospitalor communityclinicor STDclinic
clinic or prenatalvisit or whenpregnant(ADDED)
:jfamity pla-nning
4)Privatedoctor,clinic, hospital,or HMO
5)Jail(city, countY)
6)Prison(state,Federal)
7)AnotherstudY(sPeciff)
8)Field-testedby outreachworker; mobile van
9)Drug treatment center
1O)NeedleexchangeProgram
\.,
-g f\bf ÍÉsíeÞ
,STOTHR
11)Other:
43.
What kind of healthinsurancedo you havenow? 5
1) None
or SSI
MediCaid/Care
2)
-_ 3) Private
ÑSU R I
f ÑisuRclt'H
4) other:
you go (a clinic or a doctor)regularlyfor your HfV care? eAßE
A4. Do you havesomewhere
0)No )GOTOA4b
l) Yes
_
8) Don't knowornot sureà GO TO A5
9) Declines) GO TO A5
a. If YES: Where do you go mostoftento getmedicalcarefor IIfv? (Chooseonly one.)
uoFEV
cA*Ê
1) Publichealthclinicor hospital
inqrwirÊ,,r :,0
3ux/ssfttN e^
2) Privatedoctoror privateclinic
3) Familyplanningclinic(ADDED)
(Iß4O)
organization
4) Healthmaintenance
5) VA hosPitalor clinic
room
6) Emergencydepartment/Emergency
or
7)
Jail
Prison
progam fl
_ 8) Needleexchange
-
e)other:
4122199
SUDISQuestionnaire
uARECtrI\R
FemaleVersion, SectionA,PageZ
If NO: Why aren't you receiving regular medical care for your HfV?
(INTERVIEWER: DO NOT read aloud or suggestany answers Check-all^that.apply-)
1) Don't know where to go for medical care
-
CARENOl
_
-
benefits) CNiNpI
Couldn'taffordcare(i.e.,nomoneyor insurance
HIV
withHIV
with
assomeone
as
someone
beidentified
identified
Couldbe
Could
CARE N05
4)
Could be identified as a drug user
\AREN04
CAQENÖ!
5i Couldhaveeffectson family(e.g.,losecustodyof kids)
concerns:
shelter,drughabit,etc.) CAQ,ENÕb^
6) Toobusy(i.e.,competing
clinichours,etc.) @ARENOI
(i.e.,no transportation,
needfor chìldcare,
7) Inconvenient
C.AÊ.8ÑOð
S) Not interested
gi Don't trusthealthcargqy;fem(i.e.,badpriorexperience) (,AP,ENoq
CAß'e
CAReruolo
WHYL
tól
0) othert: [4Qst,l{yt
cAReñÔ11
11) Other2:
-_
_
A5.
2i
3)
3i
-g REcÉLvÈ¡{rvcAeL
- I Þi</Ns/Ì,it=t^",
Are you currently receiving any gÉhertvpg of llfV-related servicesother than medical care?
-o)No ) GoroAsb
SVCSOTHR
l) Yes
Don't know or not sure ) GO TO A6
-8)
- 9) Declines) GO TO A6
'What
kinds of servicesare you receiving?
If YES:
(INTERVIEWER:READanswers'Checkall that apply') -ìr ,^¿1^
1) Housingor shelterfor peoplewith HIV/AIDS >VLJI'
_
2) FoodsÃvices(OpenFiund,FoodBank,etc') SVCSlr'
3) Casemanagement
SVCS q
S_Vç,S]-_ 4) Early InterventionProgtam
SVCS (e
treatment
drug
or
elcõnol
5i
3V¿S7
- 6i Needleexchangeprogram
-
-;;i
'- ?
{?€IH.Ev
- &Þx/r.¡s/Þ¿Lr.r
'erti Élv
;; ij;;;;;p'í.r'oroËi.alcounpge-,
suctø"rrr, Éy.gåtp
;j üp".e'";pi-tîËiry'
.qwnerr
ts\rc,Ss
9) Legalassistance
SVcalLl
ról Fiãancialassistance
. .rt, taol,
cleaning)Sv(-Þl{
with
11) Practical support(bills, buddy program, help
;;*f
treatmentä"rpp¡",
HrV medical
äancial assistancewith
9VcaJ5
r
rì+l,arTrr\/ nr nnn-lrTV-rcl¡rerìservices 7s.r".ifu:38ßVl0ÉI-SÊRVÏLí?
lSoeci
-'t;;13)
"\ Other HIV or non-HfV-related """1""*
öi;;;;;h
studies
tsp."iry'RSÈiH l,ffil
) SVCSIO
Svcs11
RËCV O-ÍH HIV ÉÊEVICES
If NO: Why aren't you receivingHfV-relatedservicesotherthan medicalcare?-?
-A Þx/ris/ ÞeLÑ óTH \'{1v
that
apply.)
all
(INTERIIIEWER:DO NOT readaloudor suggestaly^rysy:f ;^check
l) Didn'tknowthatservicesexisted ÑOSVCS11,
ÑOSVCS I
Didn't knowwhereto go for services
2)
no
insurancÐ
ÑOqyq5.?
it
afford
3) Couldn't
çinctiding
i-2.
\ilorried
user
as
a
drug
ÀJ_OSVC.S
identified
aboutbeing
4)
SVOS!3
NO
with
HIV
5) Worriedaboutbein! identifiedut to*"ãn"
5
ÑOSVCS
6i Notconvenient
q
7) No transportation
ñOSVCS
(a
Not
interested
8)
ñosvcs -T
No Svcs
9) Servicesdidn't fit mYneeds
in my area
10)No HfV-relatedservices
ÑOSVCS I
asa womenbecauseclientsaremostlymen Ñosvcs 1L{
11)Feeluncomfortable
SVC'/OT\{ß
iií-oit'"'lspecifu:
4122199
SUDISQuestionnaire
) Nosvcs10
FemaleVersion,SectionA, page3
46.
Have you ever had a CD4 or T-cell count? This is a blood test used to check the health of people with HfV,
to seeif they may be at risk for getting sick.
-
CÞL{
o) No ) co ro A7
1) Yes ) GO TO A6a
S) Don't Know or not sure ) GO TO A7
9) Declines) GO TO A7
A6a.
Whenwasthe last time you had a CD4 or T-cellcount? If you are unsureof the specificdate'
pleasegiveYour bestguess.
- cl LIo/Dk/r.6lDcLN
cÞL{ coL¡NT
Month:CÞtll,lô year:QDLIYß
I 0=fall)
(0l:winter, O4=spring,
O7=summer,
A6b.
A1.
What was your last CD4 or T-cell count? If you don't know the exact number, pleasegive your
-9xo/ux,lNs/xLlJ
cÞq coub.rr
best suess.
I Þr¡ Ns oF cDtl côuNT
Don't know, not sure
CD4lT-celI count:ôbL\ CouNif
Have you ever had your y¡ral loâd measured? This is a blood test that measuresthe amount of HfV virus in
your blood. Like T-cells, it is also usedto check the health of peoplewith HfV.
0) No ) co ro A8
VLOAD
1) Yes à GO TO A7a
8) Don't K¡rowor not sure ) GO TO A8
9) Declinesà GO TO A8
Aia. Whenwasthe last time you had your viral load measured?
(01:winter, O4:spring,07:summer,l0=fall)
-9
ÑOiOI4/NS/DCLÑ VTR LÞ
Month:v!QAþ!!$ Year:! LrQ
{þ[ f;,
A7b.
What was your viral load at that time?
(INTERVIEWER: If respondenthtows the value of viral load test record it on line one, if doesn't lcnow
exact value ask them if their provider indicated the result was undetectable, low or high; CHECK ONLY
oNE)
-9 t'r¡rbxlss/æt-xw1Ç,uQ
"ülonU
_ r)VLoAÞNuB-8É.C#¿ffi;
-
2)
3)
4)
8)
9)
Undetectable
Low or good
High or bad
Don't know
Declines
with AIDS?
.A'8. Haveyou everbeendiagnosed
-0)No)GOTOÁ.9
AIbS
1) Yes) Go To A8a
S) Not sure à GO TO A9
Declines à GO TO A9
9)
-
4/22199
SLIDISQuestionnaire
ESf,
-e xo/>xlrrs/ucux
vLRLÞ
FemaleVersion, SectionA, Page4
'/ ' '
A8a.
with AIDS?
When wereyou first diagnosed
- I ñolr.JS/UCuu AñS AIDS
10=fall)
O7:summer,
(0l:winter, O4=spring,
Month:AfÞ5ULYeanALDÞYR
A9.
Now I'm going to ask you about STDs or VD, that is, diseasesone can get through sex.
(0 :No; 1 : Vei 8 :Don'tfno* otNot Sut.;9 :D"tlh
,ii
,t.lu,l:.,t,
0
0
Gonorrheaor clap (If YES,probefor site) GÕ¡l
ln y"rr *g"r" (genital) GOU GEFtrÍ** 0
0
-in youranus(rectal) GqNANIS*|
0
0
chiamydt"
CHúH
haemophilus)$
gardnerella,
l 0
nu"toøt nuginosis(BV,
site)
(If
probefor
YES,
Herpes
UEp,p
l 0
SYPv\
Syphltt--
@
eo_Nuad1
1
r
1
1
1
1
8
8
8
8
8
8
9
9
9
9
9
9
1 8 e
1 8 e
VPtiB}
i9SYPHYK+I
]YPHMCry
^
,-s¡L
^.1Ér+
sONÌ1LI7'I9BONYK
^.1
bñßÉñHd/lsGoNcE-ñY?1
in.mû,ufiy'ronrrrln*rt,Väl
r.^rlMfut|!
4fri:gp,.fd
iIl4t1t10 / tx¿htlllllK
#jffffi
ueapud7re
HÊRPY*I
I
ryllo*/reb¿ff.1
1
1
1
1
1
1
8
8
8
8
8
8
9 HEßPff
g
9 iIEßPA6
***
9 ,VMiÞü
9
**t*
"ääina
9
/ legER'qyÄ 0
1
8
9 :Rvx6
'ttt"rtr$j¡'@fr
o 1 8 e
r{E8PA!!
ì0/ I
..on ornearYouranus
I1QRPjXUC r 0 r 8 e
*rt
101
8 e V\¿AFflSl
Wuttsor condyloma(If YES,probeÍo!::te)N¡\KÉ l o r
)l**,
.invou.uæinuor onyourlabiaI.|ERPGEUI
r
. . .in your vaginaor on your labiawAKce NIJ F
...on or nearyour anus
WÍ\RI-AñUS*' f o
Any sore,ulceror blisterin your genitalor rectal l o
area
SORE- I
Cervicitis (inflammation or irritation of the
tYPe
cervix):unknown
Yeastinfection
CervicalCancer
PID (infection in Your tubes)
other rectalinfection RECT
AnyotherSTD,specif,:U$TÞ
* -e r.rev/uxþcuu(si>)
4/22199
SUDISQuestionnaire
CER\llX
l o
l o
PrÞ ] o
RECTÑAHEi 0
UãrÞÑAHÊl o
Yfnsf
C(ANC
vW
o l 8 eWARTE
l 8 e WAßIANI{ö,
- + 1g\,VA$i.
i 8 e !o_KE!!o/leu¿lEvK
&{Ëu
,Wffi
t('
l0 1 8 e
l
***
0
0
0
0
0
0
0 1 8 9
8 e Bqtrd rsVasrv{'tÍ#,{;ffi!íll¡!W.,ñ,y
leeeañclÄ
I e
l
l
1 I s
1 8 e
1 I e
19PIDYË
rsREeTVd
=rutldrt s ñ
un>(sru) ** * ::iËYi5,#"Íi?r"l
+* -e ruevan
tÉ
*F
à,10. Now I'm going to ask you about health problems that injection drug users mây experience.
=Declines)
=Yes;8:Don'tKnoworNotSure;9
(Ol:winter,O4:spring,O7:summer,
(0:No: I =Yes;8:
l0=fall)
Declines)
(0:No;
Don'tKnoworNotSure;9=
Skinabscess
4est¡c'/ leAÞggESYR
ñev/u<lq¡r:rs.N
,ABSCÉS
0
ABõCÉS
Endocarditis (an infection on your heart valves)
ÉNÞO
0
8
/ IgENÞOYR,
9 EJ.IDOHÔ
HepatitisA
0
8
9
HÉPA
--eNrvÞK/Ef*-s;;s
HEPAI{O/ I9HEPAYR o*råort '
*
9x¿v/ux/ueLñ HEPA eNÉviDK/BÉþå
HepatitisB
I{EPB
0
8
/ 19HËPBYR 0
9 I{EPtsHÔ
HepatitisC
t-tER
0
8
/ l9liEPcvR
9 i-{EPcmo
Hepatitis,unknowntype
9 ruev/ux/pcLN t{Epc-
0
HEP
(TB)
Positiveskintest(PPD)for tuberculosis
0
TB or tuberculosisin your lungs
Tb
(you wereaskedto takeat least3 medicines)
0
Drugoverdose
All.
-q *{vþxl>cux i¡ePs
8
8
9
9
1
8
9
HEçßBFI{
Nev/Þr</DcLN
¡{ÊPB
0
PPÞMO/ l9PPÞYR
qtiËv/ÞK/DcLhr ÞPÞ
tsì40 / teTtsyR
g NÊv/Þi</DcLñTb
8
9
sev/uirfrþf
|ÈPEA_/ leHEÞvP. 0
-C ñEV/DI(/DeW UNK r+
r
- llePc.BFl-{
1
8
9
Pki'u¡.{Kl{€
ocut¡
0 1 8 9
PPÞtsFÉ
qNev/ùk/ËrJ¡
e
Tebr*'{
9ñev¡or<þu-N
ÕDìlo_/ leÐvR
OÞ
-q ¡JEvl>kfñLN oÞ
Are you currentlytaking any medicationsprescribedby a doctorfor HW/AIDS? (This doesnot include
vitaminsor alternativetherapiessuchas medicalmarijuana)
0) Noà Go ro ,{16
_
l) Yes ) GO TO Alla
8) Donltknowà GOTOA16
9) Declinesà GO TO 416
-
MÉÞ8
researchstu_dy
that givesyou medicationsfor the treatmentof HIV/AIDS?
411a. Are you currentlyin a-9
-
No/DK/Dcu¡'¡Àrv >eue:i
0) Ño Fta>eip
l'4ÊÞS'i'UD5
(Name
of study:
MÊD5'UÞ9
1) Yes
4122199
SUDISQuestionnaire
)
Llz.
,
Now I'm going to read you a list of different medicinesthat are used to fight HIV. I'm going to ask if you
are taking this medicine. Becausemanaging to take all of one's medicines every day can be difficult, I will
also ask how many days in the LAST MONTH you \ilere not able to take (or forgot to take) one or more
dosesof each medication.
INTERVIEWER: Showpicture card of dffirent pills. May use 30-doy calendar to anchor significant dates and
to assistrespondentrecall. Ask theparticipant f they missedany dosesyesterday. Then askfor the last week,and
work up to 30 days.
Pleasename any other prescription HW medicationsthat you are currently using or taking :
}48b1,
MEÞâ. ME.D3, MEÞLI MEDS
4122199
SUDISQuestionnaire
FemaleVersion, SectionA, page7
,13. D SHOW SCALE: In general, how easyor difficult is it for you to ALWAYS take all your HfV
medicationsas prescribed? For example,remembering to take all your drugs, taking them at the right
time, taking them with/without food, etc.?- _
_
l) vãrydifricult
_
_
_
2)
3)
4)
5)
8)
9)
_
Difficult
Neitherdifñcultnor easy
Easy
Very easy
Don't know
Declinesto state
MEDTAKE
-9 Nol>x/DcLN t{rv ÞPues
414. D SHO\il SCALE: IIow oftendoesyour medicalprovider askyou aboutwhetheryou are taking, or
havingany problemstaking,your HfV medications?
1) Never
_
MEDASK
2) Rarely
-g Nôi Þk/ÞcLñ l{fv Þ?r^Gs
3) Occasionally
4) Often
5) Very often
6) Not Applicable
_
8) Don't know
9) Declines
-
,r15. D SHOW SCALE: Have the HfV medicationsthat you've been taking had an effect on your sex life?
416.
-
0) No effect
_
-
1)
2)
8)
9)
MED- SEX
Yes,mostlya positive(good)effect -9 r.to/ur</ÞcLNHrv ÞQUGS
Yes,mostlya negative(bad)effect
Don't know
Declines
Are you currently using any alternative or complementary or holistic therapies againstHM
(Theseinclude herbs, non-Western medicine,spiritual approaches,therapeutic/medicalmarijuana, etc.)
-
o) No
MEbALI1) Yes(specif:MrÞAft' vtEunn9i VlEu¡.t:r3
-
8) Don't know
9) Declines
SUDISQuestionnaire
4/22/99
)
FemaleSurvey SectionB, page I
The next several sectionsof this interview are about sex. Different people have different definitions of sex. Here
we would like to you to think of "sex" as something that can include: vaginal sex(penis, fingers, or sex toys in
vagina); anal sex (penis, fingers, or sextoys in anus or butt); oral sex (mouth in contact with a penis or vagina or
mouth in contact with an anus); or any other activity that can result in you or your partner having an orgasm.
This definition of sex DOES NOT include, however, activities where you and your partner did not have physical
contact (like phone sex), or sexual activities,such as kissing.
D SHOW SCALE: Displaychert shoìiling'î/ENUS definition of sex"
81. These are some general questionsabout sexual partners you mây have had in last year.
you
A main or primarysexpartner,that is someone
call your spouseor significantother,boyfriendor
girlfriend?
q ì.lo MAfl{
lâMos
Þ43Í
VRPRHPI'R
Sex partners,who have given you money, drugs,
food clothing, or a place to stayin exchangefor
sex?
h¡o REcv blohtÉY
so( tâ Þros
vRcor FRM
Sex partners,who you have given money, drugs, food
clothing, or a place to stay in exchangefor sex?
-gNo PAVFoRSFi
lâ Mos
Vp..GAvrro
Casual or recreational sex partners?
ña cAsqAL sEJ(
¡â Î"lcs
-q Ño cABr¡AL
lX $'los
Anyotherr"* 0"9"ä¿+,iËä"t havementioned?
Sexpartnerswho weretransgender?
(INTERWEIIIER: Categorize
FTM or MTF
accordingto HIV risk, i.e.,partnerwaswith or
withoutbioloeical
INTERVIEWER: Now remove the sectionsof the suryey you will not be using from the binder.
(i.e. Discard the sectionsfor which you have entered a "0" above.Keep the sectionswhere the
participant has reported at least one partner ofthat type.)
4/22199
SLIDISQuestionnaire,
FemaleSurveySectionB,page2
Throughout this next section,I will talk about protected and unprotected sex. For this purpose,I will call the
tllowing items protection: a male latex condom,a female polyurethanecondom,a latex dental dam, a condom cut
a finger cot.
"o be used as a dental dam or
B;2.
In the last 12 months, have you engagedin any of the following sexual activities with a man who told you he
was HfV positive? (Read list, including the prompt statementsonly when necessary)
: Yes: 8 = Don't Know or Not Sure;9 = Declines
Gavehim a blowjob withouta condom.
PO1ÒRPNF
(Youput your mouthon his peniswhenhewasn'twearinga condom.)
-
9 uo MALE PRTNR
r1.HcË
b. Get oral sex from him \tvithoutsomeform of protection. (He put his mouth
on your vagina without using a latex barrier or a dental dam.)þlORVNf
c. Havevaginalsexwith him withouta condom.
0
POI-VANF
d. Haveanalsexwithhimwithoutacondom.
POl-ANNtr
(Heput his penisin youranusor buttwithoutusinga condom.)
83.
1
8
g NO HALE PRÍNR
tâ. MoS
(He put his penis in your vaginawithout using a male or femalecondom.)
-
I xþ HALE PFINR
iâ HoS
In the last 12 months, have you engagedin any of the following sexualactivities with a man who did not tell
you his fIfV status or told you he was HfV negative? (Read list, includìng the prompt statementsonly when
necessary)
a. Gavehim a blowjob withoutwearinga condom.
NOIöRPñF'
(You put your mouthon his peniswhenhe wasn't wearinga condom.)
b. Get oral sex from him rilithout someform of protection. (He put his mouth
on your vagina without using a latex barrier or a dental dam.)ÑCIORVNlF
0
1
8
9
INO $'{ALEPRTNR.
0
1
8
qNOMALE PRÎNR
9
¡â Hos
c. Have vasinal sex with him without a condom.
(He put his penis in your vaginawithout using a male or femalecondom.)
0
1
8
-9NO HALE PRTNR
d. Have anal sex with him without a condom.
0
1
8
9
-g NO HALEPRTNR
(Heput his penisin youranusor buttwithoutusinga condom.)
iA HOS
II MOS
Now, I'd like you to think about your experiencesonly in the last 3 months. Before answering thesequestions,it
may be helpful to look at this calendar and think about the major eventsin your life during this time.
INTERVIEIIER:
Use 3-month calendar to anchor significant døtesandto assistrespondent recall.
-9 No MALÊPRTNRiâ MOS
Threemonthsago,thedatewas: l'103MÒ/ DÀV3MA / \ß,3 ì4O
B,4.
In the last THREE MONTHS' have you had sex with a man?
_
SEKÒP3MF
1) Yes
iâMos
0) No ) coroBl0 -gñfô MAÉ Pm'NR
e, 4/22/99
SUDISQuestionnair
Female Survey SectionB, page3
5.
In the last TIIREE MONTHS, how many men have you had sexwith?
o
.
.
.
If
If
If
If
you have had about one new partner a day, that would be about 90 partners.
you havehad two or three new partners a week, that would be about30 partners.
you have had aboutone new partner a week, that would be about 12 partners.
you have had one neyvpartner a m-onth,.!hal ¡1out{ bç 3 pgrtners.
'
:affiggi'trlixrJ%iT,
SEXoPÑMF
(Use this number in the questionsbelow.)
Number of men: _*
86.
D SHOW SCALE: of the
men* you had sexwith in the last 3 months, how many
would identifv as:
-gN,OMALE
PRTNRIâgOä
-E ñosex
'utMALE
3MoÊ,
AlaskanNativeSEx36gp
AmericanlndianSF¡3AI F
Asianor PacificIslanderSÉ:(3APfl
,F
Black or African AmericanSEJâA,
5EX3H3PF
Latin or Hispanic
3 CAUÉ
White or CaucasianSEx
:XF
Multi-ethnicor mixedraceSEÁ3H
Other SEx3o*tç
tt.
88.
2
2
2
2
2
2
2
2
J
4
4
4
+
a
J
+
4
5
J
a
J
4
4
5
4
J
5
5
5
5
5
5
5
5
9
9
9
9
9
9
9
9
of the sameracialor ethnicbackgroundasyou?
Do you preferyour MALE sexpartnersto be-9xo
MALEPRTNRlDMos
1) Y"., prèf"rsum.
SExoßA.Cf -8r¡osex
w/vRle 3Mos
2) No,ireferdifferent
(racial/ethnic
backgrounddoesn'tmatter)
3) No preference
_
know
8)
Don't
_
9) Declines
_
men* you had sexwith in the last 3 months,how manywould you say
D SHOW SCALE: Of the
were alsodrug injectors?
- 1 ) N o n e S E x o r x s F - : l . j o M A L-E
E PuoR sÊx
INR'lpl.,lÔ
S
WMALÉ 3 Mos
2) Very few
3) Abouthalf
_
4) More thanhalf
_
5) All or almostall
_
8) Don't know
_
9) Declines
_
MALE sex partners are drug injectors or not?
89. Do you have a preferencewith regard to whether yo_ur
SÉXOPRFF :q No HALe PRTNR,
tâ Hog
l) Prefersmale sexpartnerJtobe IDUs
_
_
_
_
2)
3)
8)
9)
PrefersmalesexpartnerNOT to be IDUs
No, injectiondrugusedoesn'tmatter
Don't know
Declines
e, 4/22199
SUDISQuestionnafu
-ô ¡.losex w/unlE 3HcÈ
FemaleSurveySectionB, page4
I
Recall the definition of 'rsex" I described earlier. (Repeatdefinitionfrom introduction, or show chart again tf
ecessary.)
In the last 12 months, have you engagedin any of the following sexual activities with a woman who told you
810.
shewasIIIV positive?
ïÍ9r+T
lI¡'ì
-9I\þFEM
PRÏNR,
lf'w l+ffi 'rir"rfitf;i-Ë ¡i ïlffit$#,|$åxiÐ
0
1
8
9
:ì
you
fist or sex toy without a glove or condom.
with
a
finger,
a. Shefucked
(Sheput her finser. f,rstor sex toy in your vagina without using a glove or condom.)
b. You fuckedherwith a finger,fist or sextoy withouta gloveor condom.
íYou put vour finser.fist or sextoy in hervaginawithoutusinga gloveor condom.)
c. Shegaveyou oral sexduringyour periodwithouta barrier.(Sheput hermouthon
vourvasinawhenvou werebleedingwithoutusinga latexbarrieror a dentaldam.)
d. You gaveher oral sex during her period without a barrier.
(You put her mouth on her vagina when shewas bleedingwithout using a latex barrier
or a dental dam.)
e. Shefuckedyou in the asswithouta gloveor condom.
(Sheput her finger,fist or sextoy in your anusor buttwithoutusinga maleor female
condom,or glove.)
f. You fuckedher in the asswithout a gloveor condom.
(You putyour finger,fist or sextoy in her anusor buttwithoutusinga maleor female
condom.or slove.)
i9 McÊ
?sl- ru-r.t
0
1
8
9
0
1
8
9
0
I
Psr- uF- ñ
psl_ÒR-ñ
I
9
Psl-or-nl
0
I
8
9
PS1-AR-N
0
I
I
9
Ps1-N-ñ
In the last 12 months, have you engagedin any of the following sexual activities with a ìvoman who did not
tell you her HfV status or told you she was HfV negative?
-g ÑOFEH PRÍNR
t, Mcß
811.
g. Shefucked you with a finger, fist or sex toy without a glove or condom.
(Sheout her finser. f,rstor sex tov in your vaginawithout usine a slove or condom.)
h. You fucked her with a finger, fist or sex toy without a glove or condom.
lYou out vour finser. fist or sex tov in her vaeina without usins a slove or condom.)
l.
Shegaveyou oral sexduringyour periodwithouta barrier.
(Sheput hermouthon your vaginawhenyou werebleedingwithoutusinga latex
barrieror a dentaldam.)
J . You gaveher oral sex during her period without a barrier.
(You put your mouth on her vagina when shewas bleeding without using a latex
barrier or a dental dam.)
k. Shefuckedyou in the asswithouta gloveor condom.
(Sheput herfinger,fist or sextoy in your anusor butt withoutusinga maleor female
condom,or glove.)
l. You fuckedherin the asswithouta gloveor condom.
(You putyour finger,fist or sextoy in her anusor butt withoutusinga maleor female
condom.or slove.)
4122199
SUDISQuestionnaire,
0
I
8
9
NS1- Fu-ñ
I
0
t
0
1
9
N31 u F N
I
9
NSl'-OR.Ñ
0
1
8
9
ñsl-ôr- N
0
I
I
9
Nsl-- AR-s¡
0
1
8
ì{ ST- AT_N
9
I
FemaleSurveySectionB, page5
ì12.
'
Now I'd like you to think about your experiencesonly in the last 3 months. Before answering these
questions,it may be helpful to look at this calendar and think about the major eventsin your life during this
time.
INTERVIEWER: Møy use 3-month cølendar to anchor signiJícant dates and to assßtrespondent recall
Three months ago, the date was:
813.
In the last TIIREE MONTHS, have you had sgxwith a woman?
- l ) Y e s S E X S A 3 H F - g N o F E H P R Í N R . i 0 M o S
0) No ) GOTO SECTIONC
814.
In the last THREE MONTHS, how many women have you had sex with?
.
¡
.
r
If
If
If
If
you have had about one new partner a day, that would be about 90 partners.
you have had two or three new partners a weeþ that would be about 30 partners.
you have had about one new partner a week, that would be about 12 partners.
you have had one new partner a m¡lnth-that wo_uldbç 3.p¿rtners.
sANMÉ :3ffiESTËEù'Jir*
sEX
Number of women: _**
(Use this number in the questionsbelow.)
815.
Do you prefer your FEMALE sex partners to be of the same racial or ethnic bacþround as you?
'ì
-
-9
1) Yes,prefersame
SEX9RACF -8 Ño rEMPKrNR¡â Mos
tvosÈxW/FEM3 Mos
2) No,pìeferdifferent
_
3) No preference(racial/ethnic backgrounddoesn't matter)
8) Don't know
9) Declines
816. D SHOWSCALE: Of the
ìvomen** you had sex with in the last 3 months, how many would you
sây ÌYeredrug injectors?
_
_
_
_
_
Bl7.
1) None
2) very few
3)
4)
5)
8)
9)
SEXSÍNtr'É
eÞ' \ --r - v '
-g N(} rEM PRTNRle Hos
-8 slo sEx wiFÈH 3 Hos
Abouthalf
More thanhalf
All or AlmostAll
Don't know
Declines
Do you preferyour FEMALE sexpartnersto be drug injectors?
to beIDUs
1) Prefersfemalesexpartners
SEXSPRFF
partner
female
NOT
to
be
IDUs
2)
Prefers
sex
_
_ 3) No, injectiondrugusedoesn'tmatter
8) Don't know
_
_ 9) Declines
SUDISQuestionnaire,
4/221
99
-9 NO
FEM PRTNR.I3 MOÊ
-Er.Jo SEX hr/FEH 3 MOS
Female Survey Section C, page I
fhis nextsetof questionsis aboutyour relationshipwith your main or primary sexpartner. Beingableto
rememberthis partner by usingher/hisinitialsmay be helpfulin answeringthe questions.Couldyou pleasegive
me her/hisinitials? If you feelmore comfortable,you can makeup the initials.
(x)
t.
MAf ÑTNT
C1.
What racial or ethnic bacþround is X?
MATN R¡,Cg
_ 1) White/Caucasian
African American/Black
_2)
_ 3) Hispanic/Latino/a
_ 4) AsianÆacific Islander
_ 5) American Indian/Alaskan Native
_ 6) Other or mixed ethnic background
_ 8) Don't know
_ 9) Declines to answer
C2.
-qNo HA1NÊR1NR
râMos
How old (or abouthow old) is X? -HÆÑAê €
=
88 Don't know (INIErRWEWER:first probefor estimate)
99 : Declinesto answer
C3.
":
How long haveyou and X beentogether?
(INTERVIEWER:
If togetherfor lessthana year,write "00" for thenumberof yearsbelow.)
-g
-g hJo
MAlñ pRrñrRtâ !4os
I.,O MAiÑ PRTNR Iâ MC'S
Years:HAINYß Months:M&'Ng0
C4.
IIow would you describe your relationship?
-9 ño MATNPRTNRtâ
Hos
_ 1) Married,livingtogether MA]ñDESC
Married, living apart
_2)
_ 3) Committed (but not manied) living together
Committed (but not manied) living apart
_4)
_
5) Other SpecifyMAf,NÞÉSa
C5. Do you haveany childrenliving with you that you're raising?
*9 No MAINPRINRlamos
_ l) Yes l'.lA,fhlKrÞs
No
-0)
c6' rf yes'low *"oüo*yKtDs
4/22199
SLIDISQuestionnaire
-! Ì't5MA='N
rt Hos
PRII'NR
-8 NO CIIILDREN
FemaleSurveySectionC,page2
fhe rest of the questions in this sectionare about your sexual relationship with X (Initials of main sex partner).
Pleasebe reassured that all your answersare confidential.
C7.
In the last THREE MONTIIS, have you had sex with X?
MAINOSXF -9xoMAlN DRTNR.
rluos
l) Yes
_
- I ÉexRueMAaÑ psa¡¡ç¿
Section
D
GO
TO
)
0)
No
-
C8.
In the last THREE MONTIIS, how many times did you do each of the following activities with X? For each
activity I will ask you how many times with a condom and how many times without a condom. (Readout
loud andwrite in the numberof times).
.
.
.
.
If
If
If
If
you have had sex aboutonce a day, that would be about 90 times.
you have had sex abouttwo or three times a weeþ that would be about 30 times.
you have had sex aboutonce a weeþ that would be about 12 times'
you have had sex aboutonce a month, that would be 3 times.
^. You gavehim a blow job and he camein your
mouth
You gavehim a blow job, but he did NOT cum rn
your mouth
He went down on you (oral sex on your vagina)
d. You had vaginal sex and he cameinsideyou
9N6¡aft
8 FÉHALÉ F,IAÍI¡ PgiI¡R
? Nc sEx w/l'rNru
3 i¡cg
Mo3=_Q.BNF
- g ñé î',lArN PPTr.¡C lt MoS
- Ê FcHALE HA¡N PErl¡R.
- 7 Nc sex wlH¡üN 3 14cs
Ho3-ORvF
f.
You had anal sex and he cameinsideyou
N0 ¡{Ar.$¡ PPTNe te iúéS
FEHALE HAIN PSTNÍ¿
NoSËt( I^¡/HAIñ S}{cS
Mo3-VACF
-g Nc fimlPRÎrc,-ra Hcs
FÊNALÉ HAIN PEINR,
NósËx u¡/NAIN 3 îæs
-ì1o3:V4l'lflâ Mês
No l'tALr.¡ PFINR
ts FEÛ|AL|' HAltl PSll¡c.
7 Ì.¡c aÉx w/i.14¡N 3 s,rd>
FÊr'rALr-HArñ PmHR.
-i¡.¡osÊr wrt{Alr 3flcã
-(¡ N/Â
11CI3:êlsE_
-g h¡o trArN PErl'¡R tâ r{os
-g FE$4ALE HAI|.¡ PRÌNR
7 Nosex wlnn¡x atqcs
g. You had anal sex,but he did NOT cum insideyou
l-,roSORVNF
g No Hãr-¡l?ßt-HP, isTiõçË FE¡'IALË MAIN PSTNE
'7
¡{o s€l úr.rArN 3 }{cg
-6
-?
e. You had vaginal sex, but he did NOT cum inside
you
-ilpr¿rFã-ltu:¡õ--
-q N,l} HA]jñ¡ PRrñC rf mcß
6 FEMA|I HAtrÑ PRTNR'
7 hJosËx wNÀrN 3¡'.lÔ.s
g FÉHALG MAIT¡ PÊTl.¡È
7ñosÉf
WHA¡i{ 3t.|cÊ
v l.¡o ¡.IALNPRINL if r.ro>
F€MALE HAAN PRTNÍ¿
6
't
3MÕ9
Nc5¿r( w/t{At$
For the next setof questions,I will askyou aboutspecificsexualpracticeswith X over the last 30 davs.
You may havedonethesebehaviorsoftenor only tried them onceor twice,or they may not apply to you at all.
Again,pleaserememberthat all your answersare kept confidential.
INTERVIEIITER: SHOIY30-DAy CALENDAR
(Jsethe 30-døycalendarto anchorsignificantdatesand to assistrespondent
recall. Thesemaybe birthday,holidays,
-.heckdates,and otherpersonalevents.SPENDSOMETIMEON THIS CALENDARBECAUSEIT WILL BE USED
THROUGHOWTHESURVEY
re 4/22199
SUDISQuestionnai
FemaleSurvey SectionC, page3
INTERVIEÚI¡ER:
questions
whereindicated.
(*'./t<*)
whenaskingthe subsequent
frequencies
Inserttheasterisked
(Jsecodes:000= None
skipped
777: Not askedor question
888: Don'tknow
999: Declinesto answer
C9.
How many times did you have vaqinal sexwith X?
= ) GOTO C10 MOt-VA
If 000,888,999
-g ño MATñ PRINR1â Hos
-EFE¡IRuE HAlÑ PRTNR
-7uo sex WMAIñ SMoS
times* you had vaginal sex,
a. Of the
how many times did you and X use a male or femalecondom?
ï 000,) Go To d.
everytimqprobe:
ff usedcondoms
So, therewasn'tevenonetime when you didn't use a condom?
-i uo unrx PRTNR
tCf\'tcs
-_g
FEHALE ¡145¡ ffir{R
-7 ñosÊx w/È,tAIN 3MoS
-àuclui</ocrJ.tvAG
w/l
times** you and X used a condom for vaginal sex,
Of the
on how many occasions(i.e., completed sex acts) did X put his
penis insideyour vagina before X put on a male condomor
Lefore you had a female condom inside? MOl -VÔÞi. ^
-9
tâ Mcs
No MAaNPnÌÑR
-8FÉMALÊ HATNPRTNP
-7ñosÊxW/MA¡N 3¡,rcO
- 6 ìtoiÞk læLN v'SGWHAII'¡ 1 HO
- 5r.{o cot¡DôM VACWts{AIN
c. Did a male condom ever break or slip off during vaginal sex
. T\1OI
_vAtsR
with X?
0=No
1:Yes
8: Don't know
d. Of the
-9 r.lo MASh¡ PRÍNR lâ Mcß
- B FEHALE HATI..IPgfNR'
- 7 No so( w/HArN3 Mcs
- d-r.io/>xþruJ vAfr'\ÀI/MAIN
1 HO
- 5 No corJDoHVAG
vMÂ[h¡
0
I
I
9
times* you had vaginal sex with X'
howmanytimeswereyouhighor drunk
",qåT_r#ru.",
-gNO MAIN PRTNRI9 MOS
.8¡'EMALÊ HAIN PETNR
-;,i"isiyitråËffi**
lMO
4122/99
SUDISQuestionnaire
i
INTERVIEII/ER:
whereindicated.
questions
whenaskingthesubsequent
Inserttheasterisked
i+7**¡frequencies
:
Usecodes:000 None
777: Not askedor questionskiPPed
888: Don'tknow
'',rMSF-i
l' i.,.::,.,,,i
l'.....''.
C10. How many times did you perform oral sexon X (give him a
blow job)?
n\I ' IrIE;PA.STi3äÐA,Y'S;-'"i.-;":
.
MO1- OR.
ï 0 0 0 ,8 8 8 ,9 9)9 :GOTO Cll
-9ño
HAlñ PRrñR lâ Hos
.8çEVRI-E HAANPKrNR
-7NOSÊ'Xv¡{ArÑ 3MoS
a. How many times did you and X usea condomwhen you
performed oral sex on him?
*t<
oralsex,) GO TO Cl1.
INTERI/IEWER:
ffAlways usedcondomsfor
MOl - ORj/
9 NO MAIN PKTNÍ<11 MOS
-8FÉ},IALÊ
HA1N PRTÑR
- 7 No sÊXw/unru 3 Hos
-ât\b/Èi</Þct.ì.l oRAL oN HArÑ
LMo
INTERYIEWER: Subtract *times - **times.for this question.
times you DID NOT use a condom for oral sex
b. Of the
with X, how many times did he ejaculate or cum in your mouth?
MOr -ÒRNC
-9 NOMAIN PFTÑR Iâ HOS
-EFEMA|-E MA1NPRTNP
- 7 t ¡o sex u//MAIN 3 MoS
-6 r.¡o/Dk/DCLÑ OPAL oÑ HAIN
-s n"r¡rsrüRrÞoM.EAL'w/rrnrrr
re 4122199
SLJDIS
Questionnai
r'
INTERVIEIVER:
whenaskingthe subsequent
questions
whereindicated.
(*/**) frequencies
r Inseltthe asterisked
lJsecodes:000= None
777: Not askedor questionskiPPed
888: Don'tknow
999= Declinesto answer
j
n riTffi- .p-¡ST.$.0ÐA^.Y.S;.iji
C11. How many times did you have anal sexwith X?
999: ) cO TOC12I40I- ANr
rf 000,888,
*
-9t.r5 r4ÉN PRÍÑR ie McS
- 8 FEi{ALE HAIÑ PRINI-¿
-? ño sEr wMAlFt3Mcs
times* you had anal sex,
Of the
how many times did you and X usea male or female condom?
+ Go ro d.
rf ooo,
+*
/ used condoms every time, probe:.So, there\ryasn'tevenone
iime when you didn'tusea condom?M01- ANYF^
-9 rr(cl4ArN PcrNR lâ MoS
.ETEUNUEMAÍN PRTÑR
-7Nos-sx wlvars 3 P4oS
-t- r¡o/ur/rjcLN ANAL w/r-narN
1MO
times** you and X useda condom for anal sex,
b. Of the
on how many occasions(i.e.,completedsex acts) did his penis
enter your assbefore X put on a male condom or before you had
MOIAÑDf.F
a female condom inside?
-gNOHAI,N PRTNRIâMOS
-8 FÉI,IALÈ I'{AIN PRÍNR
-7ñOSËX vMArN 3MoS.
-(Þ NO/ÞI</DCLNAÑAL WHA]-N LMO
- 5 ño ccñDoï4ANAL'wiumN
Did a male condom ever break or slip off during anal sex with
X?
0 : No
1=Yes
g : Don't know
-9hrc MOIANBRF
MI{LNPRIñR, ¡3 l'4os
-BFÉMALEMATNPRrNR
0
r*o
--¿SSr3',ðJßi[írTff"*N
'w/wRf
5 No CoúÞoM Auau
s
8
9
times*you had analsexwith X'
how many timeswereyou high Uiüüf"Äúüåsubstance?
"t
d . Of the
.qÑO MAINPRTNR
iT HOS
-8
FEMALEHAI,NPRINR
-? xo sÊx W/MAÍN3 MoS , . ._. ¡
- L F¡o/DK rÈcuU ANAL w/MAaN
x |40
4122199
SUDISQuestionnaire
I
C,page6
Female
SurveySection
Clz. The LAST TIME you had unprotectedsexwith X, was it vaginal sex,analsexor both?
INTERVIEI4/ER:Unprotectedsexmeansvaginalor analpenetrationwithouta maleor femalecondom.
"9r.lo MAlñ Pç¿TNRt9 Mos
Vaginal
1_
" g FÉMALÈ MAf N Pç{ÍNR
2
Anal
-7ñosEx W/MAÎ'N
3Mos
MffiñLAUñ
I and anal
Both
3
to usea condomfor vaginalor anal sex
C13. D SHOW SCALE: Somepeoplefind it difficult or unnecessary
with their main partner. I will readyou a list of reasonspeopleoftengive. TeIl me how stronglyyou agree
or disagreewith thesepossiblereasonswhy a condomwasn't usedthat lasttime you just mentioned?
Strongly
Disagree
Disagree
Neither
Agree Nor
Disasree
a. You wanted to set preÊnant
Ägree
Strongly
Agree
MNOCoÑ1F
I)on't know
I
2
J
b. Condomsmakeit difficult for vour partnerto keepan erectionMNOC.ON&FI
c. You d dn'tthink condomswouldprotectyourpartnerfrom IIIVMNOCôñ3F I
2
a
J
2
J
d. You didn't think it was likely that you would infect your partner through
¿
a
)
2
2
a
J
a
J
z
a
J
2
a
J
2
2
)a
¿
â
)
L
J
2
a
J
2
a
J
2
2
a
J
sex
unorotected
I
MNôCohl5 I
f. You didn'tthink aboutusinga condomor didn'twantto useoneMNOC0Nb 1
s. Condomsinterfere with your pleasure
trlNôCol,¡-1 1
h. You had too much to drink
Ì4ñOcON8 I
i. You werehish
Mñocoñq
I
i. You didn'twantto intemrptthepassionof the moment l4NOeOñ1O
your
partner
1
didn'twantto usea condom MNOe,ñil,F
k. You wereafraid
L Your partnerrefusedto use/puta condomon
MÑOCNIÍIF I
I
m. Your partner already has HfV
MÑOCNßF
I
n. You wereafraidyour partnerwouldyell at you or hurtyou if you
sussested
usinsa condom
MñOCN1¿IF
o. A condomwasused,butthecondomslippedoffor broke MñOCÕtr116 I
I
p. You were offered something(money, a gift, drugs,etc) not to use a
4
5
5
5
5
I
I
8
8
9
9
9
9
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
I
I
I
I
I
I
8
8
8
8
9
9
9
9
9
9
9
9
9
9
J
4
4
5
5
I
8
9
9
J
4
5
I
9
J
a
$4hlocoñ1-7
MNocNlStr
I
I
2
9 Nc HASN PKrñR, ¡eMcÊ
-8F€HALE
HAIN PßI-NR
-7 No
3s1c,S
VtlAfN
"SEx
- è N/ArDK, DcLñ uñPr4cir sÉx
4/22199
SUDISQuestionnaire
4
4
4
l,{NocoNt{F
e. You didn't have a condom with you at that time
condom
o. You wanted to feel close to him
I)eclines to
answer
FemaleSurvey SectionC,pageT
ClA. D SHOW SCALE: Now, try to imagine how you would feel in the following circumstanceswith
your main sex partner. Your responsescan be: very uncomfortable, somewhatuncomfortable,
somewhatcomfortable or very comfortable.
-9 rtol.¿RrrJ
pR-Iñpta Mos
..8 rennueHAIN pRrñR
- 7 ruosex w/uacN3 llos
Talkingto your
partnerabout
sex?
COMFKTTF
b.
Talkingto your
partnerabout
condoms?
côHFRtetr
Beingnakedin
front ofyour
partner?
COMFRT3F
Puttinga
condomon your
partner?
C.OMFRTIItr
Havingsexwith
the lietìtson?
Copr-roero
Masturbatingin
front ofyour
partner?
COMFKT6F
Touchingyour
partner's
eenitals?
êouçRrzr
your
Discussing
sexualdesires
andfantasies
with your
partner?
COMFRTgF
Teachingyour
partnerwhat
feelspleasurable
to you during
sex?
CÔMF
SUDISQuestionnaire
4/22/99
BIRTH CONTROL METHODS
The next two questions are about birth control methods you may have usedwith X. These are things you used not
lo get pregnant.
C15. ftz SHOW SCALE: During the past THREE MONTHS, when you had VAGINAL sex with X' which
type(s) of birth control did you use? Of these,about how often did you use them? Pleaseuse the scaleto
ans\ryerthis part of the question.
INTERVIEWER: Ask theparticipant to think about what would be 50% or about half of the tíme and whether she using
any of thefollowing birth control methodslessthan, more than, about half, never,or always.
Codedfrequencies
0 : Never
I : Lessthanhalf of thetime
2 : About half of thetime
3 = More thanhalf thetime
4 : Always(100%of the time)
8 : Don't know
9 = Declinesto answer
-9 ño MAIN PRrl{RllHcf
- g FEMALÊ
MAXNPCÍNR
--? ñosexw/ønru ano:
a.
Withdrawal (he pulls out before he cums)
BClF
BClA
b.
Femalecondoms
BCåF
BCâA
SpermicideONLY (foam, cream,gel, film, suppository
or sponge)
Bc3tr
BC3A
d.
Diaphragm or cervical cap with spermicide
tsci{F
tsCLI
A
e.
Diaphragm or cervical cap without spermicide
Male condoms
BCSF
BgbF
BCSA
f.
g.
Injections(Depo-Provera)
R¿-7tr
BC(oA.
BL'74
h.
Birth controlpills
BCAF
BCBA
i.
Abortion
j.
ruD
k.
Vasectomy
wqF
Rcstr
e/-ItF
B¿114
l. Tuballigation(tubestied)
BCl'F
BC1}A
m. Norplant
tsc13tr
tsclqtr
rc-15tr
tsc-l34
n. Other:speciff þ()j,L{ õrco.
None
p.
Declines to answer
BCqA
tseloA
B¿$A
H-ti.
C16. Have you and X made an agreementabout the birth control mgthodg¡ou will use together?
- o j N o - 8 r , É l r ' p r t'lv'-rv
r ç - 9 'x' o' ' H A I -8
NpRrNR'leHoS
HAINPßT|¡R'
FÉ|-4ALE
t)
Yes
- 7 ÑosEXVslArN 3${oS
7) Not applicable;(e.g. I can't get pregnant¡
_ 8) Don't know
re 4122199
SUDIS Questionnai
Now that we've finished talking about birth control and specific types of sex you may have had with X, I want to
move on to some different questions. Thesenext questionshave to do with your thouehts about having vaginal sex
and using condomswith X.
-9NoHArñRÍNR t9r,,lcs
-EFeunue MÆiNpRrNR
-7NOSËX qMAlN3trcrs
Cl7.
D SHO\il SCALE: How strongly do you agreeor disagreewith the following statements?
z. I plan on using condomsevery time with X when we have
t 2
b. Most peoplewho a¡eimportantto methink that a condom
shouldbe usedwith X whenwe havevaeinal
sex
MSN-VAF
1
2 3
4
5
I
9
t
2
3
4
5
I
9
d. X thinks a condom should be usedwhen we have vaginal
t
2
3
4
5
I
9
e. When it comesto safer sex with X, I want to do what he
1
2 3
4
5
8
9
When it comesto safer sex with X, I want to do what most
people who are important to me think I should do.
3 4 5 8
thinksI shoulddo.
C18. D SHOW SCALE: In your opinion,how manyother positivewomenyou know who shootdrugs have
vaginalsexwithout a condomwith their main malesexpartners?
None
NOCNMAIF
_ l)
-gNo HAI,ñmñR, tr Hos
Few
_2)
.8 FEMALË
AboutHalf
MAIN PÊI-NR
_ 3)
- 7 No SËX \^/MAIñ 3 HoS
Most
_4)
All or AlmostAll
_ 5)
8)
Don'tknow
_
Declinesto answer
_ 9)
4/22/99
SUDISQuestionnaire
Female
SurveySectionC,pagel0
C19. ftz SIIOW SCALE: Many peopleresponddifferentlywhenit comesto usingcondomsin various
situations.For the followingsituations,how sureare you that you can usea condomfor vaginalsexwith X,
,
if YOU WA¡IT TO HAVE SEX?
(Ifyou do not have vaginal sex or do not plan on havingsex,pleasetry to answer thesequestionsin the way
::iåtr'#üil
you think you would respond.)
3MoS
can use a condom
When vou want to have sex with
AbsolutelySure
CA¡{NOT
Pretty Sure
CA¡[
1
2
NOT ST]RE
Pretty Sure
CA¡INOT
a. evenif he does not want to
Ì.45E.-VA1F
b. absolutelyevery time you have sex with him MSE.-VAEç
c. even if you both really want to feel close
d. even if you are making up after a fight
r
2
Absolutely Sure
cAtt
3
4
5
3
4
5
MsE-VA3F
1
2
3
4
5
MSE-VALItr
1
2
3
4
5
e. even if he wants you to get Pregnant
MSE-VA5F
1
2
3
4
5
even if he might lose his erection
MSE-VA6F
1
2
3
4
5
g. evenif vouhave not used them before
M3Ê-vA-rF
1
2
3
4
s
f.
J20. ffz SHO\ry SCALE: The following items askabout specificsituationsin which you might be TEMPTED to
_g NoHAlñ PRrñB,
have vaginal sex with X without a condom or barrier.
-sJ3"iLËHATNPÊtN
-7t¡osËx wlHAlN
3MaË
a. You havebeendrinking(alcohol) MTEMPIF
MTEMP'F
b. You havebeenusing(drugs)
c. You think he will getangryif you insistusinga
MTE¡1P3F
condom
$^TEMFLIF
d. You aresexuallyaroused
MTE}4PSF
e. You areusingbirth control
f. You wanthim to knowyou arecommittedto your
MTEMP6F
relationship
is low MTEMPTF
g. You thinktherisk of disease
h. You areangry
MTÉMfÐf
you to takea chancethis time' Î'4TEHPtr
i. He pressurcs
j. You aredepressed.
4/22199
SUDIS Questionnaire
MTÉMPlOF
I
2
J
4
5
3
4
5
a
t
4
5
J
4
5
a
J
4
5
a
J
A
5
a
J
4
5
a
J
4
5
I
2
2
2
a
4
5
I
2
a
J
4
5
I
,)
I
2
1
2
2
2
I
I
I
I
FemaleSurveySectionC, pageI I
Czl.
',
Have you made an agreementwith X about the safer sex methods you would use together?
SÞSAGRï4F--8)-Don'tknow
--ojNo
to
answer:åi.""ity""îHå"äi*
s) Declines
1)Yes
-7|t|osËxw/FlAlN
3î4aE
C22. Whenyou havevaginalsexwith X, who is usuallyRESPONSIBLEfor decidingwhetheror not to usea
condom?(Readlist,if necessøry)MOSSRSPF
1) Me
2) He
3) Both
Neither
_4)
know
8)
Don't
to answer
9)
Declines
-
_
-gNo MA1.NPRTNRtâ F4os
-8 re¡lelu MArñ PRrNR
-7 NcsÈx v'lw\rtl 3 Hês
These next questionsdeal with very sensitiveissues. I would like to ask you about the possibletimes in the last 12
months when X might have hurt you, threatened to hurt you or verbally abused you when you were having a
disagreement. Pleaseremember that all this information is confidential and won't be shared with your partner.
C23. ftz SHOW SCALE: No matter how well couplesget along, there are times when they disagreewith each
other or have fights about having sex.
-9ÑO T4AlN?RÍNR
IA HôS
-EFEHALE HAIN PRTNÍ
-7ñôsEx wfr.lnrusuo:
Of the times you had sexwith X in the
past 12 months,how often.. .
a.
Did X insiston havingsexwhenyou
CN FLSTIF
weren'tinterested?
b.
Did you insiston havingsexwhenX
c NFLC.I9 F
wasnot interested?
Werevou afraidthat X miehtYell at
CNFLCÏ3F
vou?
d.
e.
Wereyou
- afraidthatX mighthit You?
CNFLCTL{F
Wereyou afraidthatX mightharmyou
in someotherway?CNtrLCTbF
Did he initially resistbutthenchanged
cñrLcT6F
hismind?
g.
Did youtell him a lie to convincehim
to hãvesexwith you? CI{FLCTTF
4122/99
SUDISQuestionnaire
Never
Lessthan
half the
time
Half
the
time
More than
half the
time
Always
D/A
c24.
In the last 12 months, how many times did your partner ever force you to have sex?
-9 No MAf.ñ ?R1ñR l2 i'los
CTINU},T
.
StrEHALE f.tAINPR:TNR,
888: Don'tknow
Usecodes:
- 7 Ño SeX h'ryMAl.N
3 f'los
:
999 Declines to answer
C25. In the last 12 months, how many times has your partner emotionally or verbally abusedyou, such as
insulted you, yelled at you, humiliated or cursed you?
c ï 5 ñ u lUse
4codes:
i
,^,.-'-:åË:ff.J,mJiJ:,,.i-
888 : Don't know
--? No sex wllArru 3 MoS
ggg= Declinesto answer
C26. In the last 12 months, how manY times has your partner used a weapon or threatened you with a weapon'
such as a gun or knife?
-9
Ño MA1N PRTÑR I' I',IoS
ET3NUMF
Usecodes:
-8 çevnuÉ.ô.rA1r.¡
pRrNR
888: Don't know
-TNosex
wluAru3Mcs
:
999 Declinesto answer
C27. In the last 12 months, how many times has your partner threatened to physically mistreat you?
CTIINUMF
(Jsecodes:
ggg : Don't know
-9 No MAlÑ ?RTNR l1 rvlos
=Declines
:9531ti=ql,H H:5
toanswe'
eee
C28. In the last 12 months,how manytimeshasyour partner shoved,hit, slapped,kickedor otherwisephysically
hurt you?
-9ñoMArñ PE.'NRre Mos
- re mRuuHA¡NPRÎÑR
ÛTSNUHF .
I
888= Don'tknow
[ß, codes:
-TNosEx h/MAlN3 Èîos
I
INTERVIEWER:If ZEROtimesis reportedfor#C24to #C28,GO TO #C30
did you receiveany help or counseling?
c29. When this / thesehappened,
0_
No
-9 Ño MALN PPff hlR le MoS
Yes
-E FEMALE HIIIN PRTNR
1_
crcouñs
8_
9
Don'tknow
Declinesto answer
-7 Nó so< w/vlrx
-6 No ABUsE
3 uos
INTERVIEúI/ER: refer pørticipant to crisis numbers, and counseling, ìn the participant packet.
4/26199
SUDISQuestionnaire
'30. DoesX know that you inject (or shootdrugs)? MßÚ'ÑKNWF
-g No MA1F¡ PRÍNR lâ MÖs
- 8) Don't know
_ 0) No
.êFEMNUE }441N PTTTNR.
_ l) Yes _ 9) Declinesto answer
C31. DoesX injectdrugs?
0) No
i) Ves
-
-
MATN5h¡-SF
-gNô fqArÑ PPTNR
13Mos
8) Don't know
-eFÊHAL€ MAth¡
Pc¡Nc
gi Declinesto answer
C32. Did you know you ìryereHrV positive when you first met X?
_
-
-_ S)Don'tknow Mrs Hrl/aF
toanswer: 3 fro^.1[11ru*ffi$Ëå?,ji*
s) Declines
l) Yes
0) No
C33. DoesX know that you areHfV positive?ylKñl{rVåF
"g ñc HAI.N m'NR l, Mos
_0)No IFNO)GOTOC36
.EFEHALÉ
HA1NPRTNR
_ l) Yes
_ 8) Don't know
_ 9) Declinesto answer
C34. Did X know your HfV statusbefore or after you had sextogether for the first time?
14Kñ t{1v3F
1) Before
_
-9 ÑO HATN PT¿TÑR
I' HOS
After
_2)
.gFEMALÊ HAIN PRÌNR
- 7 MAIN Not i<uaw HrV*
_ 8) Don't know
i35.
ÊZ SHOW SCALE: Whendid you tell X that you areIIrv positive?
1) He or sheknewmy HfV statusbeforewe met
Thefirsttimewe met
2)
þ4TEL'HIVF
_
"g
t9'Mos
Ño MAINPRi'NR
week
one
less
than
In
- 3)
-
month :9 liljtiL'|T$,i!]ii
one
than
4) Inless
5) ln lessthan3 months
6) In lessthan6 months
1) More than6 monthsafterwe met
C36. What is X's HfV status? -!Ì4ALNt{fVF
1) HfV negative
|9-TAah¡PsrNRle Hos
I FeMALEMAaNPÊTNR'
2) uIv pJsitive
3) Don't know;hasnot beentested
8) Don't know;hasnottoldme
9) Declinesto answer
_
4/22199
SUDISQuestionnaire
The remaining questionsin this section are about having sexwith Y. Pleasebe reassured that all your anstyersare
confidential.
C37. In the last THREE MONTIIS, haveyou had sexwith Y?
-
1) Yes
-
0) No )
MAfÑSSXtr
GO TO Section D -9ño MAIIJPsrNR lÐMos
-8xRue HA1NPARFÎËR.
C38. In the last THREE MONTHS, how many times did you do each of the following activities with Y? For each
activity I will ask you the total number of times, then how many times with a latex barrier and how many
times without a latex barrier. (Readout loud andwrite in the numberof times).
.
.
.
.
If
If
If
If
you have had sex about once a day, that would be about 90 times.
you havehad sex abouttwo or three times a weeþ that would be about 30 times.
you have had sex about once a week, that would be about 12 times.
you have had sex about once a month, that would be 3 times.
*
a. You gaveher oral sex when she
was on her period
11g3_:OIPJ
MS3-OIPYf
b. You gaveher oral sex when she
was not on her period
l1Þè=_eJl{:
M33-Of NV'r*
c. You fuckedherin thevagina
with your fingers,fist or a sex
toy
d. You fuckedher in theasswith
your fingers,fist or a sextoy
e. Shegaveyou oral sex when you
\ /ereon your period
f.
Shegaveyou oral sex when you
were not on your period
MS3.VFF{ *
l$3-VtM"
MS3-OIPNXjt
HS3- OINN'ã
ljI3:VErls**
t"t:i-å=.¿!-Fu
M33-AFHN"
1133=AF__H-Y'"
!1s3_=l)EPr
1133:QBPV:* MS3-ORH\f
us5_-qBN.
l-433-ORN\n l1Þ3:oB_N_N',
g. Shefuckedyou in your vagina
with her fingers, fist or sex toy
_t1x3,=\¡sEI M33=VSFr*
MS3-\^>ljg:
h. Shefuckedyou in your asswith
herfingers,fist or sextoy
M53-AÐFÈ
_t1¿ó=À3rNI
lY>s= lLÞl- Y'"
C39. Have you made an agreementwith Y about the safer sex methods you would use together?
_
o¡ No _
1)Yes -
8) bon't know
SSOACRMF
\l HcÊ
PRTNR
to answer -9 t'¡cURfu
9) Declines
- 8 URUEMßN PA?TNEÊ
- 7 ño sEx wluûrñ 3ilos
Jt
4/22199
SUDISQuestionnaire
-9NoH6N
PRÍIR l3 ltcß
.8}1ALÉ HAIhJ PAßÍIJER
-7 NôsEX w/haArN 5T{aS
**
-9ñ0HAI,N PRTNß19r"1€ß
. HAtÉ
É
HAIN PAEí¡JÉB
* 7 ño SEX W/MAII¡ 3Has
" r- N/A
FemaleSurveySectionC, Page15
a
C40. When you have vaginal sexwith Y, who is usually RESPONSIBLE for deciding whether or not to use
'i
barrie r2 (Reød list, if necessary) ì4SSSßSPF
-g
¡a419 PRÍNR t9 $,los
¡jc
_1)Me
- 8 HALE MÆN PAÊTNÉR.
She
_2)
- -TNo sex w/xnr¡ 3 uos
_ 3) Both
_4) Neither
don't havevaginalsex
Not applicable;
-])
_ 8) Don't know
_9) Declinesto answer
MAf NSKNF
C41. DoesY knowthat you inject(or shootdrugs)?
-g NolqArNPntNR1l slcs
know
- dl Doft
- 0) No
- E l'lALl:MAIÑp¡sagsg
gi Declinesto answer
1)
Yes
C42. DoesY inject drugs?
- 0)No 1) Yes
-
-
sl Don'tknow
MNSf,NJF
:å ffi.ËäT*ofll$.f"*
C43. Did you know you were IIfV positivewhen you first met Y?
S) Don'tknow
MKNI'{IV¿{F
--ö¡ No
1)Yes -
to answer:;fÎÉ'X[iü-lii*'
e) Declines
C44. DoesY know that you are HIV positive?MKNt{1V5F
-ghlo MArr.¡ Pt¿Tr.lP¡9 Mc:j
IFNOàGOTOC47
-0)No
-bMALÉ HArh¡ PAÊlÈ¡Ê¡_ 1) Yes
_ 8) Don't know
- 9) Declinesto answer
C4S. Did Y know your HfV status before or after you had sex together for the first time?
_ 1)
_2)
_ 8)
_ 9)
Before
MK¡JHIV6F
-gño MAI.NPr¿ÎNP.11Hos
After
- 8 MALÉ HAIN hEruEø
Don't know
-7 ilt\lrJ NCtrkh¡ov/ HIV+
Declinesto answer
c46. Þ sHow SCALE: When did you tell Y that you are IIIV positive?
i) He or sheknewmy HfV statusbeforewe met
2) Thefirst time we met
-
-
_
3irnr.,,ttun;; *""i, lt?IhilJ-I,NR
râMos
4) In lessthanonemonth -S¡ntr_i
-
5) In less than 3 months
-
rrnrrie¡ersee
-7 HAIN h¡<lrKt'¡ovJÉ1vt
6) In lessthan6 months
7) More than6 monthsafterwe met
C47. What is Y's HfV status? MNSHIVF
PRrrlRì9 Èlos
1) HIV negative -gù4ALE
J S YryN
HAIN PAeIN€ß
2)
-
HIV pãsitive
3) Don't know;hasnotbeentested
8) Don't know;hasnottold me
4 126199
SUDISQuestionnaire
FemaleSurvey SectionD, page1
t
1
Introduction: The next set of questionsis about your sexual experiencesonly with partners who paid you or gave
you somethingspecifically in exchangefor you giving them sex. This could be money, food, drugs, or a place io
stay. This doesnot include your main sexpartner, people you have sex with for fun or someoneyou âre
considering for a serious relationship. From this point on, f will refer to thesepartners as "paying partners.f'
INTERVIEWER:
Møy use 3-month culendar to anchor signiJicant døtes ønd to assistrespondent recall.
Dl. Theseare some general questionsabout sexual partners you may have had in the last three months.
Sexpartners,who have given you
Money, drugs, food or clothing,
or a place to stay in exchangefor sex?
-
-9 hþ Þ/pvNtq
GoTFRI'131"1
-9ruom/RvuePRTNR.
PsÏ VR.
Sex partners,whom you have given
Money, drugs, food or clothing,
or a place to stay in exchangefor sex?
GAVETÔ3H
- 9 i.to
@Pvue pelNR
P$Í YR
b¡ve
Pr¿run
I ño PAvrNG
PF{TNR3 S1ôS
-g,.ioÞ/PyNG
Pm'NÈ PsivÊ.
g NO PAYTÑG
PRTNR,31'1OS
-9¡iopVPvr.¡e
pÊrNr¿
Psí yR
8 No PA¡.ÞPÈTNR
3Hog
If NO à GO TO SectionE
SUDISQuestionnaire,
4/22/99
9 No PÞ/PVÑg
PRÍNÍ¿ÞSTYR
¡lo P4tù PffNe
3MoS
FemaleSurveySectionD,page2
* men who have paid or given you something for sex in the past three months-- in
Think about the _
other words, your paying partners. Think about whether or not they told you their HfV status before you had sex.
In the next series of questions,I will ask you about paying partners who told you they were IIIV positive, paying
partners who told you they were HfV negativeand paying partners whoseHfV status you did not know.
D2.
In the last three months, have you had sexwith a paying male partner who told you he was HfV
PeyOpOSf
ÏtilTå
-s h¡oPù/PVN.
p5¡vç
PRrNrè
I N0 hyrUe mNR. 3Hos
-0)No+GOTOQuestionD4--7NoPA)ENGHALÉ?s'rÔs
D2a. IIow many HMOSITIVE
months?
men have paid vou or eiven you somethins for sex in the last three
Numberof HIV positivepayingmalesexpartners:
PAùOpt t!1E_
D2b.
partners
I{ow many of these HMOSITIVE
first time?
-9tvc mTevugPsrNp,psíyß
-gff 3î*Xå liJifr.,ff,S
-6uo.ãy¡r¡e
RrV+ HALËAr{os
knew your status before you had sex together for the
PßÎ'¡eest
9tlod)Þ/Þ'/6tc
- 8å?.4:e/I.ñfs
PÊ.ÎuR.
Numberof HIV positivepayingmalesexpartnerswhomknewmy HIV status:EYÞP!!\tEgüåE¡*s
HAL:
_Hi,-E^f,*o*
D3.
In the last three months, how many times did you do each of the activities below with a male paying partner
whoseIIIV STATUSWAS POSITM?
^.
You gave him a blow job and
he came in vour mouth
þÐ3tÐRCl-
" I l.¡oPõ7FFG?-6tr8ffiYê.arbfìAyf!ê Pl¿rrJR
3þßs
,tÀbÞìì,¡Nc ¡{aLg3}þ3
-(ölJo È{V¡r¡€ i{SI+ F4ALE 3ïßs
lioóÌ,{cKNlb. You gavehim a blow job, but -9xopu7F9!ñ-ifr
Fõ-rçr=_
.Ér.ro PÊ)tuê PÊflì¡C.3i.rcs
hedid NOT cum in vour
- 7 l.¡oÈvtr¡G ¡.taLl93Èr6s
.ø ¡o Plv¡r,¡Ê x¡vt ì'{ALg 3 iqcs
mouth
c. He went down on you (oral
sexon your vagina)
d. You had vaginal sex and he
cameinsidevou
e. You had vaginal sex, but he
did NOT cum inside vou
tlDSt/oKvt.gxopo/-py¡epF-rppærF
.F.No HtfNS pRrr¡R 3 ilóa
'ir¡o P¡Y¡l¡g HALE 3 |4ca
'6 Nc, PAyr|.¡c, tl¡v+lrALË
3ilcs
lðsPVACl-
-qNoPs/-pyarcprzræ-Þst]¡_W_
.t5r¡ô flt¡|lc
?ÊfHc a Hô'? tJo ñy¡LtG l.lÀtg 3 i',rÉs
'ë hb PAtaHG i{lvf Hßl.e 3}1cs
T4CSPVANF
.9à,cPDFidE--ßPf rTETsl-.ßr,þ ÈÍÍING ?¿rÈe 3 î{oE
.TNC NV¡Íg HALG-3þTcs
-G rrô mtralG l{lv+ }lAt-É3¡{cs
f.
You had anal sex and he
cameinside vou
g. You hadanalsex,but he did
NOT cuminsideyou
t{)SPANCF
-9 xô PÞÆÍë-þEi¡Îãtr-r-E-
:Tffi
Ílfls,x'Ë"
tåHo'
-ølrc ?^walGi¡!V+ FiAI€3 ¡4õs
IìCSPANNF
ËXBH{ffi-#m-ffil'-? l¡é ñv¡uc HAL€ 3 vtóS
.6rþ mv¡Ne ilw+r',rJ\LÉ3t{ô,3
SUDISQuestionnaire,
4122199
POPORCYF
- ç rjo pD/pÆG-ffi l.|?-T5rye-ävô PÀ)âNc ?erNR aMcE
-7lJoÞ1yJNG¡.At€3Hcs
- -.,t^
"é No'múrt¡Gi{sv+HAL€
3i.rè5 Þry'l
Ið}ðKNYF
- ., ¡¡c eo/p-vúe?ßiñ-e ps;ì-tÉ--
t{o}ÐR(-Nt_
-9r.¡oeufñ¡ewr@FE-
-a|¡o PAY!ß€PÈlNa'3rcS
-7 r.¡ôãY¡I¡g LrAL€3 r4cs
5t ¡/A
-(¿ r¡oÞtvarJc f¡ñt+ ttÀLF1t{ês
- , tlQtP_|RNNh
-qr¡6PD/ÞfiE
-S{a
æñ¡AEE-5N/A ..gr{olAyrr¡c.?çrliß
strcs
:å,f9âåX"',niËå',#'
'?r¡OmYrLreHrL€ 3lraa
'c
hbRAyÍN¡q¡$vf HALe3 H6s
- _ tatÐKvJL_
-giþ?Þ/PyNE:EtFa-Fttr-8Xo?Á'ì'¡ñ¡G'?¡¿n¡PA¡{OS
-5NlA
-7 No PAy¡r.¡C ¡.tAU; 3 ¡'rcs
-(ø NoPAvr\¡GfIV+ ÈrALË3ilas
POPVACYþ
-cil¡ôpyF/¡E-psç|¡-R,psryì---t|Nc SìÆl¡c ?Clr¡F .3 ¡,tcs
- B H/A
.7 ñd?Aìa¡¡G ¡.rALE3Fros
'(c ño ilYft¡o
tllv+ btALE3irós
l.tc! /AN YF
-9r¡op>/evr¡¡-ppräê-FvT--
-¿r,¡c HVtNe itlvl
- cli¡o
HALEsì,rês
T()KOKVNF
PDrñ;¡õ-tr¿lTrEÉ-TE'-
-6N/h
:Ii,3ËIüS'nT,e3.Y"":
'(9Àla
FåVING $aV+ HALE3¡tS
IJOPYAS:NF
'9 '.J6PD/P/ñG PCrF¡Cesr YÊ
-ft t¡o PAy¡NG PefÑe 3 Fró9
-7No FìqYtNe llAlE, 3¡{É
-5 }¡/A
- ø .tft myf f\IÊ i{IV+ MAtli 3btcs
rcPVANNF
-cxoPÞ/Py-rJe'FPrgê-É'r-F-
-sr.¡tn '9S#FiïÊ'mËåã,ff'-ss/n
.f,ü¡åJfSÉ,äIg3ûF
'gr€
PAVJhßt{S/t
HAIE 3rtcs
'"*"/o#*#S,"Jt-
'64þ ñ)Ar¡G PEri.¡c3i..ê5
- 5h¡fA
,T }¿O?ÍIYIÀ¡GF,IALE.3HOS
-6 r.Þ ?AyJNGÉrv+ ÈrALÉ3 Mos
TOPANNYF
-91¡oPr/Py-uFffir¡-ßP5¡Yß.a r,¡oP¡t¿r{GPßrt¡P3 ¡ro3
- ñ¿'tt'
|la
'7Ñfny¡t¡ê
ilALÈ3s{É'"
,i¿N¡o ?ñYJllg ilrl,f ilálÆ 3$¡\o1
-6 i.¡o mYING l{lv* HÂLE.3¡rcs
FCPANSNT'q r¡cPryffiTËñiFãYE-
'8¡¡0 ?Av¡l¡€?Êil¡Ê3Êtct
-5 N/A
.7Nc P¡trrNg |tAL€ 3.{ÊS
{Þ ß myri¡C it$,+ taAt-E3 î.{,ûi
.IICPANN
NF
.9r,¡oPò/PFé--flûrTE-?S-,TE-
-ãh/A
:ln#*Ëgr"g',,Ë'
.6
r¡onYJ¡¡êi*1$l-HÀUtí3ças*
D4.
In the tast three months, have you had sexwith a paying male partner who told you he was HfV
.lNoPD/Py$¡e,pgí|.lRPsîYR
NEGATIVE?
PAYONËGF
-
_
-
1) Yes
0) No ) GO TO QuestionD6
D4a. How many HMEGATM
months?
"ANC ÞAYINGPRÍNR3¡tCS
.7 NO PA/ÍÑG HALE 3 MCS
men have paid you or siven vou something for sex in the last three
:1iï'J#lJ"-rHHfil"
paying
mate
sexparrners:
ofHrVnegative
Number
IAyAIJIIW
Ï i: ltriJ,f ffi)i,ïffiå r *.,
-. before you had sex tqgetþf f-o¡JÞe.^-..^
D4b. How many of theseHfV NEGATIVE- partners
r --- status
r--- knew your
-ËI3By'fi^T--i#,ìi¡'i
-
firsrtime?
? r.lo PAV¡HG ¡46¡9 3 tloB
payingmalesexpartners
whoknewmyHIV status:
Numberof HIV negative
?n'fO¡xUf
D5.
whoseHMTATUS
WAS NEGATIVE?
:P,.,
,ñ
a. You gave him a blow job and he camein
your mouth
You gavehim a blow job, but he did NOT
cum in your mouth
c. He went down on you (oral sex on your
vagina)
d. You had vaginal sex and he cameinside
you
e. You had vaginal sex, but he did NOT cum
insideyou
f.
-"m¡åtttintfu-
You had anal sex and he cameinsideyou
g. You had anal sex,but he did NOT cum
insideyou
e, 4/22/99
SUDISQuestionnair
Ì¿OSNORCF
-g A¡oP-Þ/PY¡¡E-PRIÉRF-YR.
-girc fl{YrÉG ?ÊrNe3î4c3
..? ¡.lc PAY¡!Je HqLE 3.'1oS
- 6 l¡c ?Ay¡Nè f¡f'r- HALÊ 316
- 9 uoPO3NORNF
Þ>7F¡rGF¡¡FF*-vr¿
"8l¡ó PAy¡r¡G?Í¿TNR3î{ès
-7ñc P/CYINê
HALE3l{ê5
.øNc ?ìy¡xG i{I\r- ÈIALE3 s1c6
POSNORVF
PcNQESE_
- gÈ0 PÞ/ÞyÉc PerHR P5ïYR
' I Nc ?Ay¡h¡G ?f¿tNÊ å Hô5
17 rþ Ptvr..¡G tlALË 3 i40s
'ÉfV- itlALE 3t'rès
-br.¡c PAYTNG
- ã 'ñ/A
'reNAKNTE-
tpNWrt_
.9NCíÞ'PYNG ?ATNR PfiYR
'8 ì,¡oPAV¡|JS PEÍNP, 3 MoS
'NO PAYTIJG MALE 3 i.TCS
.bñè PÀf¡Nc, illv- ¡4AL€3r{cs
-S hl/A
rc3NVACF
IðNVACYF
'q NoPulpvr¡E
psn{ß PsTYË
9ú
lðóñvANt-
PilPvre-ffi[r[-Ps-' Ye
.8hþ PAÈrlG ?gtl¡R, S}rcE
,?NoPAyrle HALË3t'rca
.(Þr.ieìÂYJ{g ittv- HALE3 ¡'1ê5
ìæ5NANCtr
-5 N/A
.gI.¡C PDIñ/ÚG ?RTIJR P5ì YR
-gNc PA)1¡hJG
?ErHÊ 3 ttcß
-?Ho ?AYINGltÂLE 3¡{c5
-t9 ìlc ?AV¡ñGHtv- ''IALE 3Ë,os
-q ñ/Â
'gNoPÐFme-?EfñtrF-YR
'8 [b PAf¡]'rc ?ÊtÉR å ilas
-7¡¡o çhvrNc I{ALE 3 $,los
-øNo Q4ì¡rl.JG
HIV- HAI-G,3HoS
.qxc"ÞTi,¡G-?-RTUR-E1R
-Ê tJôPAìttNSfærl,lR3 T,lós
-7No P/rvrtJeÌtnu:3Hos
.5 ¡¡e
illV- MALË3 tb's
"AYrt'lG
PQNARC-NT-
- g Nô PÞ/PY).¡G ;RTNR Psl Ye
-t5I¡O PAV¡Ne PÊfhr8 3l+s
-?NO PAY1Ñ¿HALE 3 i-1A5
- ¿' NO PAY¡TG I{i\,- ilALE3Hq
.SNOPA9I$G?gÌHß 3 H6S
_ThJcRAVINçHÁtE 3$4c6
.(âNO P^VrrlG ilW- HALE 3 tlcs
-5 ¡¡/R
rcNVANYF
'9xoÐ-Pyr¡G-Per6¡e-Ps-Je
.a r¡ÈtPAV¡¡¡G
PÊrr.lÊ 3 l,lcs
,7ñó PêYrrg HALE ãltL
'è h¡oÈAY¡NG iirv- ltl{LE åt'tcÈ
-6ñ/A
rcNANCYF
i-lcNoR\iN r-
'glElÞ/Pys-e?F-r.¡E-F-Ye.
'8 r€ îdyr¡¡c ?Êfl.¡R, 3slcr¡
-TLb PAI¡slGHALE3il.Ê
<o}õ äYING ¡ûv- HALe 3 Ê{ês
-S i.¡/¡
l-4fNvAcN I-
'gNo-Pù/PYi¡G-ñ-1t¡EEî-Ye
'6NÔPÄYTN€?EÍNC 3I{S
,7I{OPAìtrT¡GHAL€ 3¡'E'
,G|þPAIENG FIV -HALE 3 i{cs
-5x/¡
rcNVANNF
-9x,iÞl/-pyriõ--tJ-crurve
'8$o PA\6i¡e ?Þf}JÊ 314c3
-'r re PÀY¡NG i,rALË à'FrÈÊ
-t¡¡ mv¡r¡e iltv- HALE3Hd3
-5 ñ/A
R)NANCNF
-gxotñii]ê.ffiA¡-Ê
PSTF- g r.io /åv¡|{' PÊlh¡Ê ål{c5
itNo ?Áì4INê Þ,lALÉ3 ¡{cs
-6Ñ0 tv¡NG l¡IV- i{At€ 3¡4ôs
'9xapü7-pvxe-ffi -xC-FTe
.A NôPAV¡NG
?grl{c 3 lJlcs
{úamv¡¡J6 þiALESi.rcÉ
i4ALE5'r{c->
itrvPAY¡NG
¿ño
TìC3NAN
NF
'9tlop-pleyve-Fstui¿ET5E
iðNANNYF
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FCNANNN
'glûEmeTçiÑ-È-ÈrìÉ
'5u/n
.|l¡om\ßr{G WI¡JC a¿+r'S
'7l.ËP^y¡f¡GHALE3trc5
'¡aNóPêitsrrGhrv- ilAUí 3H(
.5NÍ\
'8.{cDÀ\¡$¡G PF$¡ß 3 ¡.rcE
'.INOPAY¡TJGHALE 3HCS
'sr¡Õ FrWgG ¡¡IV- HALE 3$ls5
-5 ñ/A
-6 ¡j0 trvrtJc Ppr¡¡e3ilæ'
^? NCPAVTNG
HALÉ 3I.iôÞ
- {âNê PñYrNG$IV-}lAlE 3 ã46
-iþ-ffixTfi¡ã-FYe
i,iJåi,f"1'
:rtr"JläiÊ
*; ñã pÀv¡r¡e ür\r- I.IALE5 ìta3
-5
f,|'A
F
D6.
-srArus? PAYourqKF
:e$¡ÌltÎdgJEËy,Hvê
-r
In the last three months, have you had sex with a male paying partner and you did not discussHIS HfV
_
_
l) Yes
0) No )
so?A\ÆñG
untÈ5t*s
GO TO Question D8
D6a, In the last three months, how many men paid vou or save you something for sex and whose IIIV
-gF¡ÞÞÞFVNGÞerñR
PSTvR
STA.TUS YOU DIDN'T KNOW?
I Nc PA''¿INêFz$JR 3Ftos
malesexpartners
withunknown
of paying
Hrv status:SþUNMF-¿i#ÏIË
Number
D6b.
lîb! åff*o'.=
How many of these partners knew your HfV status before you had sex with them for the first time?
paying
status
ofHrvunknown
male
sexpartners
whoknew
myHrvJåY9ry;:ffi.ffi;i
Number
*iíånä,qHrv-uNk
D7.
whoseHIV STATUSYOU DIDN'T KNO\il?
^. You gave him a blow job and he came in
your mouth
-
You gave him a blow job, but he did NOT
cum in your mouth
æ3UA,f-<q_
POUORCNF
-9¡rcEeyrlE
Peruc psiYe
- g{.rÕPvPtÀtC
FEr}Jc ?5î Yß
-8tJO PA\IING Pø1r¡R 3fïos
.7,JÖ FMYT'JGHôLE 3I.OS
-61{0 PA'rtr,lG
HaV-i¡rü( HAL€t HcE
tðSuoRNF
'qþPÞ/¡-ñ/t¡G,?ÊrHÞÞñ9ã
'8 ñc Ð{f¡NG æTNeã i*lcs
€ lt3 ñy1Ne ?øÍÀ¡e 3 f'rc,s
'7 i.¡ópAvrA¡eMAÉ3 iros
:?ä#f'-
tÕuoRNvF
-9rcÞ7F¡c=ÞEiFcEîle
d. You had vaginal sex and he came inside
you
e. You had vaginal sex, but he did NOT cum
inside you
f.
You had anal sex and he cameinside vou
g. You had anal sex, but he did NOT cum
insideyou
SUDISQuestioruraire,
4/22/99
IÐUOKNNF
'9Naffide-PÊraREYE,
-8iNo Prl'yfNG PÈTI¡R.å ÈtcÊ
- g No PÊ¡\r¡^16PÈrÉÊ 3 i.las
- 7 h¡oPAìö{G Hil-E 3 S{o9
.7ÀJOPAìtr¡¡GHAI€3HCS .'7NO PÂYINS HALE 3 i{CS
'6
-615
l{Aj
llttþUr¡¡(
uw- trlrk¡'lAl-b
?lrruc
3r{0s
't¿ ¡lê ?AY¡NÊt{rV-UNk },lALË3l{d
ryry*e
-5,¡ln
c. He went down on you (oral sex on your
vagina)
nil-ur{kHnLE
POóUOKVF
'9Noaõ7rygP7gs-l€çTa
-8 ñê PAyTNGPfëfN¿ -?i'ros
-? No PAvr^'GllALÉ 3 i\tas
-(Þh¡ô?AVrNc lilv- uNk HALE
3?þa
'9r.¡o tðsuvAcF
d-Pv¡eT¡1-¡c=oe
,6 h¡o P^YING PSfr.lR 3 r.6
'? ñÕ FAYINg HALÉ 3 i-tcç
.b No FltYJl.lG¡+sr'- UNK Þ,|ÂL€
3 ¡{c6
}.¡O3UVANF
.gtlopu/-]ñê-pprxeFî-vR
-€ìNo PAY!å¡GPÊrf ß 3 tloS
-7 ño PÁvrNeilA¿E åF,lcs
,tê h¡oPAIIEI.¡C
illv- ur.¡k HALE
3 ${ô3
PO3UANCF
-9No?Ìt-FFp-ÉlFE-e.-¡rt-lê' S N O P A Y ¡ N G? Ê r N ß 3 i l o s
..T NOAAY'.NqHALÉ 3T4CS
-(p IJOPAYIT¡G
ilrV- ur¡x Uat€
3t{6
-YNo
t4cáuANNr
rtmtõ-'P-ñNFElYe
.8Ñc PAYING
PffiNR 3MoS
"7ñ6 PA\/f,NG trAL€ 3t{cs
-(aÑc ?A\Æ-NG
ilI.v- UÑk F{ALE
3 MôS
tðuoR/YF
-5r.¡/C
-gxcEiFy¡'¡ê-PñNïEyß
ÞI)UORVNF
-:¡¡ô6imëÞme-es¡ve
-5u/e
::lfêt-n
'Þr.¡ó PAV¡IJG,PÉTHß.
.€ f{c PAfTXG Per$R. 3 Hcs
3 i{cs
.7¡Jo PAytNGl.loLE 3b,\cs
?NO PßYTNEHALE 3I{O5
-øNo mv¡NG ¡{IV-U¡{xù{At-E 3¡{cE
É
¡<HAL
¡{v- ur'¡
t-{)uvAcvF
-9tod@n=tFZ-asrT
POUVAC-NF
.8 i{o PAy¡r¡G PÊÎ|tÊ 3 Nó3
.8No Prlv¡l¡G Pcr||f¿ 3 í{cg
'T 16 ?*y¡r¡G HALE å TtcS
"7ro ÈAY¡I¡GMALÉ3Mos
{" r.¡óPÁrtrNG¡{IV- tirik HALE 3 i'tos ' b¡.JoPillrNG HrV- U|¡k HáLe
SHcg
'5
U/A
t{.)uvANYF
-.rl¡cÞt-pyñeFgfi
ft-Fye
,8 i¡a PAy¡r.¡G PFrNR 5 ${oS
..I N6 PÁY ô¡G}IALE 3 MO3
-r¿ña P4Ytr.tg HiV-t¡ñk IiALE
- 53i,fc6
É/A
tðuANcyt-
-s ñlå,
IðUVANNtr
-9uo-tuFpe
ePnÈ-ls-vP
-èþP^f¡f¡g ?erxø
3t{êS
. -T}.IÔRAYTNEHÂLE 3iTCS
' 6_Ëo.So *e HrV- ü rlk l{ALb
-å b¡/A
ä[fF^mmrH.J.
'? ¡,¡c PAyTNGHALE 3 i,tc5
.(?r{c PAYTHeiln/- a¡NKSrAl€
3StcS
'5r{A
[,tcuANNYr'src FD-FIe-ffie-FYe
'BNC
PAV1Nê PÊÍNR3H6S
'1 NC PAYI|¡G fiAL€ 3¡65
' càHåAv!ñG i{1V- u ñt<${ALE
'5t¡/R
I.OUANCNF
'9¡þÞÚ-PYNc-?Èr¡R.-FY¿
.€rsPAVrNc øô¡e3ilcs,
'7tb pAViNeHALEStlc'g
-6ì¡0lA\tr|¡G iltV- ìlNic MAùE
-5l,yA
IðUANNNF
-qN6El-PYl¡TffiFa.--FfYê
-8 ¡Jo PÀirNG ?t1!¡Ê ã r"bs
- 7lS ?ÂYrxGl¡AL€ 3 H6s
-6 r{c PAyr}¡ci{1v- f¡ Ét< }tALÉ
3l-{og
"s ¡¡/A
J8.
\ilhen you have vaginal sexwith a male paying partner, who is usually RESPONSIBLE for deciding
whether or not to use a condom? (Read list if necessary)
_l)Me
FCVSRSPF
.q Ñ,13PD/PYÑE PRTNPP'I VR
_ 2) Him
- g No pAyJNg.ppÎNp Bi.rcs
_ 3) Both
"
7 Ñ o P A y ¡ N GH A L E S H ó s
_ 4) Neither
_7) Neverhadvaginalsex
_ 8) Don't know
D9.
Whenyou haveanal sexwith a male paying partner, who is usuallyRESPONSIBLEfor decidingwhether
or not to usea condom?(Reødlist if necessary)
_1)Me
POASRSPF
-gNo
_ 2) Him
PÞ/pvñe PÊTNR?5i YR
.S No PAyTÚGFÌEfÑR,3 TTS
_3) Both
- 7 Nó PAYJNEHALE
3MC6
_ 4) Neither
Never had anal sex
_7)
Don't know
8)
_
D10. Do you tell your IIIV status to men who pay you or give you something for sex?
_ l) Yes, all the time
-9r.lo wlryue ppTNRpsi yR
Yes, someof the time
_2)
FCrruurvr
-3) Never
4/26/99
SUDISQuestionnaire,
:9"f J*i^1Ënrmyr:r*
FemaleSurveySectionD, page6
* women who have paid or given you something for sex in the past three months-Think about the _
in other words, your paying partners. Think about whether or not they told you their IIIV status before you had
sex. In the next seriesof questions,I will ask you about paying paÉners who told you they were HfV positive'
paying partners who told you they were HfV negative and paying partners whose HfV status you did not know.
Dl1.
In the last three months, have you had sexwith a female paying partner who told you she was HfV
POSITIVE?
l) Yes
0) No à GO TO QuestionD13
-
PRlepesr
Dlla. How many IIMOSITIVE
months?
womenhavepaidyou or savevou somethingfor sexin the last three
PAWP tl vf
Numberof Hrv positivepayingfemalesexpartners'
Dllb. How many of theseHrV POSITIVEsexpaÉnersknewyour statusbeforeyou had sextogetherfor
the first time?
Numberof HIV positivepayingfemalesexpartnerswho knewmy HIV status:ÞASPKNF
DlZ. In the last threemonths,how manytimesdid you do eachof the activitiesbelowwith a female paying
'r
partner whose HIV STATUS \ilAS POSITM?
ù. You gaveher oral sex when shewas on her period
b. You gave her oral sex when shewas not on her
period
c. You fucked her in the vagina with your fingers, fist
or a sextoy
d. You fuckedher in the asswith your fingers,fist or a
sextov
e. Shegaveyou oral sex when you were on your
period
f. Shegave you oral sex when you \ilere not on your
oeriod
g. Shefucked you in your vagina with her fingers, fist
or sex tov
h. Shefuckedyou in your asswith her fingers,fist or
sextoy
*
4126/99
SUDISQuestionnaire,
-g
-E
-7
.è
WWPJ-
re'WY**
Ps3PorNt
P53pof{)/*j
NMPß::
P53@ru¡V'
--P]ø.HL
ËåryEHri
PSEPVfHN-
trÉ'PÆ]J:_
'tô3PAF.tUï
Í-ãþyaFHN:'*
wswp*
lö3t-ÐßPY',*
t¿53PoRP_^,r*
pD3&Bñlf*
tô-ßNyF':
fögÔzuNtr*'
resyvÞt_a
ÆPVÞEN:
¿/s_311/sEr.r
ø.3!24ôF"
-ÆIEASFY'^ P33PASF^/"r
No"D/P/NG ?arNR ?sÍ YR
No mlai.¡c ærNß 3¡{ês
ñc ?AY1N6 FÉH .3HcS
NO ?AYIIJê |JIV+ FÉH 3HCS
* * -C No"D/P,/ñe ?PÍNR P5TYE
- 8 hþ PAYINg PÊTNß 3 HCS
- 7 NO ?AvfNG F'ÉM 3 ì'ìcS
-(r l.¡o PAvfr{c ijlvf F€M 3Mcs
- 5 ^¡/R
Female
SurveySection
D, page7
Df3.
i
In the last three months,havey_ouhad sexwith.a femalepaying partner who told you shewas II[V
NÕ?D/Þy*¡êPRIÑRPsi-YR
NEcATTvE?
PA\6NÉGF
:?
ö NO pAytNG ?ÈrNR 3 ¡.ios
-7ÑO PAYJNGFËM 3MOS
-
I\
I)
\./^^
I Eù
_
0) No ) GO TO QuestionD15
D13a. IIow many HIV FI-EGATM
months?
women have naid you or siven vou somethins for sex in the last three
ïîårÌ.f,TËIEfJäå,H'-
paying
female
Number
of Hrv negative
sexpartners'B\ßNt'tMF- Ji:
m{i|S,iiilt#it
no,
D13b. How many of theseHIV YEGATfVE partners knew your IIIV statusbeforeyou had sexwith them
forthefirsttime?
PAvSNt<NF_3m¡ÌJIîä,iH{jÉmß
-7hfo PAWNG
F€M 3 3-tos
Number of HIV negative paying female sex partners who knew my HIV status: __:r"gopfgrñG
Dl4.
In the last three months, how many times did you do each of the activities below with a female payrng
partner whoseHMTATUS
a. You gave her oral sex when she was
on her period
,You gave her oral sex when she was
. noton herperiod
c. You fuckedher in thevaginawith
d. You fuckedher in theasswith your
fingers,fist or a sextoy
e.
WAS NEGATM?
PS3No:IP
-pruoe¡7-øvxE-eerr.r-E-þyq
-ËNo PA\â.I¡G?ÊrNR3t405 -7Nc PA)r¡ñGFEM 3lr¡S
-6rJoPAYr$rg¡{iV- FÊM gilos
PS3NOIN
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FÐÓNAh H
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YR
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}ã5NORP
NoPõ7mf€ÞFmiEFYÊ,
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on your period
..TNô PAY¡NGFGH3HOS
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f.
ÉIv- FeH
Shegaveyou oral sexwhenyou were
not on your period
g. Shefuckedyou in yourvaginawith
her fingers,fist or sextoy
h. Shefuckedyou in your asswith her
fingers,fist or sextoy
SIJDISQuestionnaire,
4/22199
IÕÓNOKNþ
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with a female paying partner and did not discussIIER HIV
.]Df 5. In the last three months, have you had sex
*]^J"TIry-:I:'NR'P5îVR
STATUS?
PAVSUUXP
'
_ 1) Yes
-
0) No ) GO TO QuestionDl6
-"î$nåi".ËJtiå*
D15a. In the last three months,how manywomenDaidyou or gaveyou somethinqfor sexand whoseHfV
-9 ñc ÞlPvr¡g ÞÈTt'¡Ê.
P'sÏ Ye
STATUS YOU DIDN'T KNOW?
-6
i{ì5
UT PAÊNG PÍ¿TNR3
withunknown
HrV status:
?Á\6uñMF :;$
Numberof payingfemalesexpartners
näfttf#-=,I^ñ trttH3øcs
D15b. How many of thesepartners knew your IIfV status before you had sexwith them for the first time?
o' un
PA\Þu K NF-] SJ"ofl*-
NumberofHIVunknownstatuspayingfemalesexpartnerswhoknewmyHIVstatus:
-(¿ñc mV¡ì¡G il¡V-
D16. In the last three months,how manytimesdid you do eachof the activitiesbelowwith a female puJiffg-t"t"tt
partner whose HIV STATUS YOU DIDN'T KNOW?
PS3UOIP
a. You gaveher oral sex when she
\ryason her period
"q¡s P>/wiê-perue-psve
-
h- You gaveher oral sex when she
' was not on her period
.gr.rpüi@p-erse e$ve
ê ts PAviHe PsrF¡ß 3 ltÕ!
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-(â ¡.rE?AyrNe i¡fv - uhlk FËß{3 ¡J{É
IJS3UOI.N
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'? Na P/qvruGFÉM 3$kr>
-6ñô P4vrNCifiV- UÑk treH3hrcó
PS3UVFH
c. You fuckedher in the vaginawith -qNcP-ulw,vsTFNa-ET-Ve
your fingers,fist or a sextoY
- b¡{0 PAv¡Ñe
?ßßR3 i6s
-7rJc Pn!4Né FEM 3 l4cs
-rÔtJo tìAyJñSiiIV-uÑK FÉfq 3î'la5
d. You fuckedher in the asswith
tåóuorPy
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'I ilc mVINGPelNr¿3 i'la5
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t
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:
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-(2 Nô PÂYINGÈrv- uili( FÉ.H3 Ttog
f.
She gaveyou oral sex when you
were not on your period
g. Shefuckedyou in yourvagina
with herfingers,fist or sextoY
h. Shefuckedyou in your asswith
her fingers,fist or sextoy
4122199
SUDISQuestionnaire,
tÕ5u()RP
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e. Shegaveyou oral sexwhenYou
wereon your period
FrsóuolPN
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)17. \ilhen you have sex with a female paying partner, who is usually RESPONSIBLE for deciding whether or
not to use a latex barrier?
_1)Me
_2) Her
- 3) Both
_4) Neither
_ 8) Don't know
_
PSLARÉSP
-9r.ro PÞ/PVNG PRTF¡RPrl YR
- E No PAY1ÑGPtzTNR3l'4cË
-? ñc pA\trñG FÉM 3hlôS
D18. Do you tell your IIIV statusto womenwho pay you or giveyou somethingfor sex?
_ 1) Yes,all thetime
PSTUHTVF
_2) Yes,someof thetime -q ño ÞÞ/PvNê PE-fNR?SiVÊ.
-8rJô envîwe PRlÑR SMos
_ 3) No, never
t4os
- i ñô invrue FÉ.H3
4122199
SUDISQuestionnaire,
FemaleSurveySectionE, pageI
Introduction:
The next set of questions is about your experienceswith casual sex partners. This might include someonewho was
a one-time partner, an occasionalpartner, or someoneyou are consideringfor a serious relationship.
They do not include your main sex partner or your paying partners (i.e. peoplewho pay you or trade something
specifically for sex.) From this point onr l will refer to these partners as "casual sex partners"
INTERVIEIIER:
May use 3-month calendar to anchor signiJicanl datesand to assistrespondent recall.
El. These are some general questionsabout casual sexual partners you may have had in the last three months.
MA3MCAS
Casual,one-time,or recreationalsexpartners?
cA3rrR.3l.4
'9
r.tocas/orHPP-rñRPsrYR
Any other sex partnersI may not have mentioned?
OT HER3M
-eËt$å/orHFRÍNR'
Speciff:OTH3MSPI,' ÕIH3MSPâ
N0cAS/cìli
pefNe f¡sí yR
-E ñÒcAS Pf¿r
3MOS
-q l.JécASþïH
?T¿TNR
ÞsTYR
-8 No CAs?RlNf¿
3 l4a3
3MC'THR, MA3Ì1CrfH
NccAs/Gît{
?81$R?sî yR,
-8NócnS PffNe
3 MOS
uo eRsJor$
PRIhJU Psi vR
-8 Ne CASPÊrñr¿
3MOS
If NO ) GO TO SectionF
4126/00
SUDISQuestionnaire,
FemaleSurveySectionE,page2
Þl
** casualwomen sex partners you have had in the past three months, and about
Think about the _
whether or not they totd you their HfV status before you had sex. In the next seriesof questions,I will ask you
about casualpartners who told you they were HfV positive,casualpartners who told you they were HfV negative
and casual partners whose HfV status you did not know.
82.
In the last three months, have you had sexwith a casualfemale partner who told you she was HfV
CÁ.SSPCSF
POSITIVE?
l)
Yes
_
0) No à GO TO QuestionE4
_
casual female sexpartners did you have in the last three months?
CASSpÑMFNumber of HIV positive casualfemale sex partners'
EZa. How many HMOSITfVE
casual sex partners knew your status before you had sex
Ezb. How many of these HMOSITIVE
together for the first time?
CASSPTST
who knewmy HIV status:
Numberof HIV positivecasualfemalesexparûrers
83.
In the last THREE MONTHS, how many times did you do each of the activities below with a female casual
sex partnerwho was HMOSITM?
L. You gave her oral sex when shewas on her period
b. You gave her oral sex when shewas not on her
period
c. You fuckedher in thevaginawith your fingers,f,tst
or a sextov
d. You fuckedher in the asswith your fingers,fist or a
6þporpL
c&?orcyy
CS3POTNÉ
gSgPqrNY** cs3PoIl{ñ"
QíþWEHÍ_
cô3PÆllff
Cg3PVFHN*
css?ÁJIH:_
caþl\[HI!À
CS3PAFHN'"
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q3c8g
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CS3'JOKPN*'
%tr
@Rr{N_EÍ'
gsSPySF r
_cs3illsrrt
çs_lPysFV**
SåðlNE:
c5ólJAsF:Yr6¡
CSSPASENJ*
sextov
e. Shegaveyou oral sexwhenyou wereon your
period
f.
Shegaveyou oral sex when you were not on your
period
g. Shefuckedyou in your vaginawith herfingers,fist
or sextov
h. Shefuckedyou in your asswith her fingers,fist or
sextov
t 'q uc ces/ota PRit'lR P5î YÈ
- I ¡¡o cas¡ciH PRÍNR:ål"las
-7 nJo cA.e/oTH FéH Sb,tos
- è Nc c¡s iriVi
FeH 3 ì.lcs
4126199
SUDISQuestionnaire,
* * -c
-8
- 7
''è
-. 5
uS3PorPN**
ñ¡Þ c^sloft{ pßfNR P5-í vR
Nù CA3y'oÌHPRTñR.3Hs"
ñc cAÊiorH FÉì4 3 ç{cs
¡.Jo cAs ¡i-rv+ FÉtl 3i'1cs
N/A
FemaleSurveySectionE, page3
84.
In the last three months, have you h4ve sexwith a casualfemale partner who told you she was HfV
NEGATTVE?
-
1) Yes
_
0) No )
CASSNEGF
:;ffiåî_./å,iJff.",Ì-:I"
--? No cas/o-rnFEM sMcs
GO TO Question E6
E4a. How many HMEGATIVE
casualfemale sex partners did you have in the last three months?
CASSNñIYF :-Ei3Hl.:fi1Ë!qf-{.""t"
casual
femalesexpartners:
Numberof Hrv negative
3 i-lae
? NC c¡s7o¡t+ FÉM
-("No cAS i{lv- FÉM 3uas
E4b. How many of these HfV NEGATM
together fôr the first time?
casual female sex partners knew your status before you had sex
pß1.¡¿ÈÎV¿
I r.¡ocnls/brr
c AesNk r.¡F:-("ç.T3'åïiËå'gü'"?*':
¡'¡G
cASi+Iv- FÉM3 ¡{as
Number of HIV negativecasualfemale sex partnerswho knew my HIV slatus:
85.
In the last TIIREE MONTHS, how many times did you do each of the activities below with a female casual
sex partner who was HfV I\¡-EGATM?
You gave her oral sex when
shewas on her period
You gave her oral sex when
shewas not on her period
c. You fuckedher in the
vaginawith your fingers,
fist or a sextoy
d. You fuckedher in the ass
with your fingers,fist or a
sextoy
Shegaveyou oral sex when
you were on your period
f. Shegaveyou oral sexwhen
you werenot on your
period
g. Shefuckedyouin your
vaginawith herfingers,fist
or sextoy
Shefuckedyou in your ass
with her fingers,fist or sex
toy
SUDISQuestionnaire,
4/22/99
hlc cAÊ/cÍ{ p¡¿1¡g Prï YR
lCCASlcill PÊrH&3ìlcg
FËH3ivtcg
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È Nr)cistclr{ PqÞ!e,LHli
¿Ë:å3iiv:"#il*åIo'
FemaleSuwey SectionE,page 4
86.
In the last three months, have you had sex with a casual female partner whose HfV STATUS YOU DID
NOT KNOW?
-
E6a.
1) Yes
0i No )
CASSUNI<F
Go ro Question E8
-9 t¡ocasforr-t
Psrva
?Èrhrp.
- ^'e c"as/oin?Rrt-lÊ'3ì"lcÊ
- 79 NogA5JcîliFÉM3 HcÊ
In the last three months, how many casual female sex partners did you have whose HfV status you
-gñocASioTHçRÍNÈPsrvR,
didnrt know?
:;T$såå.iffi?JtiElä
casual
female
sexparrners,Q\i$uttJMF
of HIVunknown
Number
.- rÞ Nc cAS iliv- uh¡!< FÉM
3 ï4e3
E6b. How many of thesepartnersknewyour statusbeforeyou had sextogetherfor the first time?
k,NF:se'ls.ßìf,#"mä
Ë,H'o
CASSU
Numberof HIV unknowncasualfemalesexpartnerswho knewmy HIV status:
F,7.
3Hcs
In the last THREE MONTHS, how many times did you do each of the activities below with a female casual
YOU DID NOT KNOW?
sex partner WHOSE HMTATUS
^. You gaveher oral sexwhen
shewason herperiod
b. You gave her oral sex when
. shewas not on her period
c. You fuckedher in the
vaginawith your fingers,
fist or a sextoy
d. You fucked her in the ass
with your fingers, fist or a
sex toy
e. Shegave you oral sex when
you were on your period
f.
:¿,Tf."Ëff$jt#,¿?:,
She gave you oral sex when
you were not on your
period
g. Shefuckedyou in your
vaginawith her fingers,fist
or sextov
h. Shefuckedyou in your ass
with her fingers,fist or sex
toy
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INTERVIEIIIER: IF NO CASUALMALE PARTNERS GO TO SECTION F
4/22/99
SUDISQuestionnaire,
c53U\,ÞFN
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- K. ñ/Â
¡¡¡¡K
* casual men sex partners you have had in the past three months, and about
Think about the _
whether or not they totd you their HfV status before you had sex. In the next series of questions, I will ask you
about casual partners who told you they were HfV positive, casual partners who told you they were HfV negative
and casual partners whose IIIV status you did not know.
f,$.
In the last three months, have you had sex with a casual male partner who told you he was HrV POSITM2
_ r) yes
E$a.
t
CASOPoSF'
:3illtf=',,.Fl-omË%fJ,*
" z t¡o ca4¡oruMALE3 Ttos
0) No à GO TO 810
IIow many HMOSITM
casual male sex partners did you have in the last threg months?
male
casual
sexpu.tno*CNolrukf:8ffi äi,ffi"#ü.äd$
ofHrvpositive
Number
-(êNôCAS i+rv+
HauÉ 3ilcs
E8b. How many of theseHMOSITTVE
first time?
partners knew your statusbefore you had sextoggtle_qfqfLEq
cr4slorH
HALE.tsj{rì
CASPKN tr - I hb
ùóená-JivÏ.n¡uei ¡'ros
partners
who knew-y Filìiìã;;
Numberof Hrv positivecasualmalesex
:-t
E9.
In the last TIIREE MONTHS, how many times did you do each of the activities below with a male casual
sex partner who was HMOSITIVE?
^. You gavehim a blowjob
andhe camein vour mouth
b. You gavehim a blow job,
but he did NOT cum in
your mouth
(þórcRCF
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coSlðRVF
c. He went down on you (oral -qmcÁs7õFtrErr.fÊ-EÎTE
-8
your
vagina)
sex on
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- 5 rr/A
cAs HfV t t4áLÊ3McS
g. You had analsex,but he
didNOT cuminsideyou
LO},IORNNF
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- hlA
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ê ¡iocÁS¡+:tvf HALE
3'r,105 5
"-t,r,'
e. You hadvaginalsex,but he -1rn (-:CIót/vANh
9FI6Rl¡m-qÈssrTø
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did NOT cum insidevou
--7 cas/ó'fH PgfNR 3 i,tos
came inside you
'5 ñ/A
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came inside you
f.
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-(ÊF¿)c/qsiilv+ H,lLÊ 3HcS
. Eü/A
810.
In the last three months, have you had sexwith a casual male partner who told you he was HfV
CASONEGF
NEGATIVE?
Yes
1)
_
0) No)GOTOE12
_
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psryR
-b
No cAsioTr.l RefÁJfL3 $4ae
-7 No eAS/õrHHALÉ3 F.tcs
E10a. How many IIfV NEGATIVE casual male sex partners did you have in the last three months?
-g ño cAS/o-rH PtzítJß Psr YR.
-8Ncc"As,oTH PPTHRsilas
Number of HIV negativecasualmale sexpartners:CASONNHF
-lr.J,ocnsloruHALE3Mcs
-6 so cAs iliv-
MAL€ 3h4as
partners knew your status before you had sextogetherfor the _
810b. How many of theseI{TV NEGATM
:å,i"%*/.ï,19$SË
m:l:
rirsrtime?
cAsoNk NF: im æ':l+-lÎ;i;iå?.
Number of HIV negativecasualmale sex partnerswho knew my HIV status:
Elf.
In the last THREE MONTHS, how many times did you do eachof the activities below with a casual male
sex partner who was HMOSITM?
a. You gave him a blow job and
he camein your mouth
(jOj'NOl<cL
- qrNc cA+E
ffi-e-FÏiz
-8 t¡o CAs¿cr*Pørì.|ÊåHês
-7 ñÞ cAslo-rHHALË 3 itcs
*(rñê CAs ¡{IV- $,IALEBîss
L(,)'NOKNF
h. You gavehim a blowjob, but
-gñacAEõrñæ.FYR.
-8Nc ces/bru Pi¿rNß3 ù{as
he didNOT cumin vour
- i n¡ocns/b;u MALË 3 Mcs
mouth
- 6 ÑO CAS ;{I'V.
c. He went down on you (oral
sex on your vagina)
cameinsideyou
e. You had vaginal sex, but he
did NOT cum insideyou
f.
cameinside you
g. You had anal sex, but he did
NOT cum insideyou
MALL=3HOS
CIlSNoKvl-
j6iTffi Ñi¡<-Þr.n
"g¡.rocÁE
- 8 hþ cAs/orH PRrh¡R.3tbs
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-.? NOCASþTHHALE 3HÕS
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CO3NANCF
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cAsro-,lrpñNe 3i.þS
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-.oh¡c cASlìIv- HALE 3il,þS
NF
COSNAN
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'ì Nc cAs/étrrt HALE 3 s4è3
(ê h¡o cAg ifJv - HALGSMoS
.5 N/A
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SUDISQuestionnair
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FemaleSurveySectionE,page7
Elz.
\'
In the last three months, have you had sex with a casualmale partner whose HMTATUS
KNow?
_
1) Yes
-
0) No )
YOU DID NOT
cAScuuxr :3$ffiis;,i8å_iffiH"I.
-T No cA5/orr{ F{ALe3s.1cß
GO TO Question E14
El?a. In the last three months, how many casualmale sex partners did you have whose HfV status you
didn'tknow?
F' så H.lu
il8"'å=/#å
- ï
Numberof HIV unknowncasualmalesexpartners:OASOUNMF-iNêUÀlÞï*.r'rnue Cnci
-¿rño
cAS i{lv- UNKMALÊ3t1C5
El2b. How many of these partners knew your statusbefore you had sex together for the first tirn"?
ðÄåoü;ÑË=Sif""ffi
åftt""HËgm
Numberof HIV unknownstatuscasualmalesexpartners
whoknewmyHIV status:
:;f.c#iIiYITJ*.t
813. In thelastTHREEMONTHS,howmanytimesdidyoudoeachof the activitiesbelowwith a Jittrtf *itsexpartnerWHOSEHfV STATUSYOU DID NOTKNOW?
You gavehim a blow job and
he came in your mouth
7Nc c¡ls/orH MAL€3ircs
ø úo cÁs i{Iv- uNk MALÉ3 ¡G
You gavehim a blow job, but
he did NOT cum in vour mouth
couoRcNtr
-pdr:6F8ffi
gNacgsr7õîf
yß
8r.¡c cÆ'i611{ Pf¿frJR'3 94ê5
i.¡a cÁ5i6f kl I''IALE 3 È4os
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g¡¡ocFJ-o:Rçer-uRF Ê
CnsreîHÞEfl.rR3 f16
8Nc
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B hlccÂs/crrH PßïNR 3 t{cs
I tloc-/lßíÕ-rHHALe 3Mo'¡
-lo iJO4As iilv-
You had vaginal sex, but he did
NOT cum insideyou
Ul.¡t<l{AL€ 3¡"rcs
NO C/[3/OîH PUf Nr¿ PS-i vR
No cAs/orH PRÍHP 3 ¡.loã
r No C4sioîH MALE .3ilos
þ ño Cr+BHIV- Ut¡k MALE
3 Mats
f.
You had anal sex and he came
insideyou
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5 N/A
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Pr¿fNÈ
i{cs
uc c¡ts/brtr HÀLE 3-iles
Ñó ens füv- uÑk l'l'lLf
COUVANNF
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:9,Ë'.*ìås,,i'ff
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re
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¿"Ño cns i+rv- ilNk ilALE 3 Ho'J
NO CAS,C'ÎR PRTNR
PsT YR
r|c cnsiqtn PÈrtJl¿3 i4c9
r¡ó cnsioiit HALE 3 F'lcs
uo cas i+ÎV- u r¡ K HALb-3rt6
CÐUANNÑ tr
PÈTNR3Iæ.S
å NO CNSiOTH
7ñe cAs/oÎH $rAuË 3w,
- uNk }'lrl|.E 3 }403
(2
t-{o
i{lv
cAs
N0cÆ iltv - uñKSlALÉ3 ì{oS '5
I h¡oc¿ASiof H PaÍNR.3 i'lct¡
MALE 3T4ê5
ì r.¡o cli/cÏH
$riA
SUDISQuestionnaire,
4122/99
5ñlA
COUANCYF
ño c"ASi"äV - Uñi<HALE
You had anal sex,but he did
NOT cum insideyou
Y XoCAsrøTt{PßfH&.Psr\f¿
I hrce¿s'løru Pgf tjt¡.3r4ús
7 rJocAsro-rti }ÂLE 3 StCt
6 No cÀ9 ÉIV- Liñi¿, $-lALt 3 i'lcE
.? hJEC.AS,OIHMALE3SIOS
c,1sioÌH HALE 3i"loE
ø No cÂs ilrv- uNl< F.tALÊe$4êç br.¡o cAS HIV- Uô¡K l.{AL€
5 ñ/A
cameinsideyou
3 HoS
NcCåSlorHçÊ11.¡E
tic cAsiorH HALE 3-rrê3
Xo Cns ilf V U l.¡k s4ÂLÉ3'.lcs
5 ñiA
g r¡o cÆFrnEllejsï-ra
crqs-tc,ruPCæîFEFìte
-Ê No cÁsia.rtr PPfiln 3 Hcs
Br.¡c cÂsr6?H Pr¿ÌNP,3ì-1a!
-? NÞc4sia'iÌ¡HALÊ3f{cs
I No eAs iêrH MALE 3 i"És
-6 ilO cis i{IV- Uñk T{ALE3HcS ib Ncc s ì{lV - UhikHALË 3 $4aS
5illA
c. He went down on vou (oral sex
on your vagina)
hJa(ÆislHEÎ¡E EiV-Ê
8r'¡C cAsrorH PßrilR 3 |los
7 Nc CÂsié¡H HALe 3 ¡'1ÕS
(" ¡i6 ÈAs'rllv - UiJk $lÀL€ 3ílCS
NôiÂs/-êrl-PsrNFffi-vß
I Nc cAst'61h'PRl'-l-q ?i'{:cs
ii¡o cÀs¡cruHALË3l"lcç
(9h¡ecAsr13V-uAk llÁ|.E3l'{c6
FemaleSurveySectionE, Page8
The next set of questions is about your most recent sexualexperiencewith a man who has been your casual sex
partner. Being able to remember him by the initials of his name may be helpful in answering the questions.
-Could
you give me his initials? If you feel more comfortable, you can make up theseinitials.
Ef 4. How would you describeyour relationshipwith Z? (Reu! li:t¿ño cAslorrrpE.*R ps.,yE
buos
CASþESCF - e'ù"cõFÊjõt¡ips(hrB
_ 1) A onetime partner
- 7 N0 cAs/of l{ HALE 3'È{oS
sex
- 2) A partnerfor recreational
- 3) A candidatefor a seriousrelationship
815. What racial or ethnicbacþround is Z?
1) White/Caucasian
CASUETI{N
-q
African American/Black
No cRs/aiHqqL!
-_2)
3) Hispanic/Latino.
_ 4) AsianÆacificIslander
_ 5) American Indian/Alaskan Native
_ 6) Other or mixed ethnic background
_ 9) Don't know
_ l0) Declinesto answer
Ps.-l-vta
P5íYR
C ASUASE F -: || :i:{:li lÈrNR
E16. Howold(or abouthowold)is Z? - t*S*==*nH'
VIEÍYER:firstprobefor estimaie):9X3 åR',S:å
88: Don'tknow(,rN?'EA
to answer
99: Declines
ßr7. Ù
SHOW SCALE: In the pastsix months,how often did you seeZ?
orrwice
1) onlyonce
F :gË:ËHr ERiËffis
cAsusÊË
3gos
2) Once a month or less(but more than once or twice)
3) 2-3 times a month
4) Once a week or more (1 - 4 times per week)
5) Every day or almost every day (5 - 7 times per week)
8) Don't know/ not sure
9) Declines to answer
i ¡rê cnércrg HALÉ
818. The LAST TIME you had unprotectedsexwith Zrwas it vaginalsex,analsexor both?
withouta maleor femalecondom.
lyfn-nWnWnn Unprotectedsexmeansvaginalor analpenetration
r_
vaginar
2
Anal
4/22199
SUDISQuestionnaire,
CASr-ÁuNtr
:4ffiff"=/"?,if$,:T.?_È.
- T ño cAgisrlt HALË 3 ì4ca
,'-. nlg. D SHOW SCALE: Somepeoplefind it difficult or unnecessary
to usea condomfor vaginalor anal sexwith
their casualpartner. I will read you a list of reasonspeopleoften give. Do any of thesehaveto do with why a
condomwâsn'tusedthat last time you just mentioned?
-9 r',o
cAs/oÍr-{ PgrNR PsTyR
-g ¡¡c cesTbru?cruP3
tlos
- 7 ño cAs/Õrt{HALÊ HoS
3
.- ø .ñ/A,iÞk/ bcutJ i¡¡.¡*P¡¿o-¡
Strongly
Disagree
Disagree
Neither
AgreeNor
Agree
Strongly
Agree
I)on't know
I)eclines to
answer
I)isapree
a. You wanted to get pregnant
I
2
5
4
5
I
9
I
2
a
J
4
5
I
9
c. You didnt think condomswouldprotectyourparher from HIV"uôcôht3F I
J
J
4
5
I
9
d. You didn'tthink it was likely thatyou wouldinfectyour partnerthrough I
unprotectedsex
cNoc,oNqF
2
a
J
4
5
I
I
e. You didnt have a condom with you at that time
2
2
a
J
4
5
I
I
a
J
4
5
I
9
3
4
5
I
9
)
4
)
8
9
a
J
4
5
I
9
a
J
4
5
I
9
4
5
8
9
CñlocoNlf
b. Condomsmake it difficult for your parbrerto keep an erectior¿rb.o*gF
f.
I
cNor_ôrt'F
You didnt think about using a condom or didnt want to use onÊ.r¡o"on,¿r I
g. Condomsinterferewith your pleasure
ciþcoN'IF
I
h. You had too much to drink
("uarauqF
t
i.
You werehigh
j
You didn't want to intemrpt the passionof the moment
k. You wereafraidyour partnerdidn'twantto usea condom
L
Your partner refusedto use/put a condom on
m. Your partneralreadyhasHIV
I
2
2
I
1
a
J
I
2
J
4
5
I
9
I
2
2
J
4
5
8
9
J
4
5
I
9
2
a
J
4
)
I
9
I
2
a
J
4
5
8
9
cNÖcor.lllr I
2
a
J
4
5
I
9
aNô¡r)|.lqtr
cñ^.ô.1^F
cñôcôr.¡1.F
cNôeôñ19F
c,ñôeôil1qÉ
I
n. You wereafraidyour partnerwouldyell at you or hurt you if you
I
suggested
usinga condom
Ch¡ocoñlqF
o. A condom was used,but the condom slþed offor broke
I
ertôcôrrl'tr
p. You wereofferedsomething(money,a gift, drugs,etc)not to usea
condom
euoeaillLf
q. You wanted to feel close to him
4122/99
2
2
820.
When you have vaginal sexwith Z,who is usually RESPONSIBLE for deciding whether or not to use a
condom or barrier?
C6SRSpF
- q
No cAsforFi PRINR ixr VR
- b ¡¡c cÁs/oiH pÊih¡R.3 Hcs
-?
- No cAsi ôrH I.4ALE3
Hcs
_l)Me
_2) He
_ 3) Both
_4) Neither
Never had vaginal sex
_7)
8)
Don't know
_
Ezl. DoesZ know that you inject(or shootup) drugs?CASUKNWI
- 9 No cÂs/oTr{ PRTñRPsî vR
_ 8) Don't know
_ 0) No
-ENô CAAioï{ Pf¿rÀrF,
3tros
_ 1) Yes _ 9) Declinesto answer
-7Na cAÊ/orH HALË 3s4os
F;22. Does Z inject drugs? cASu3-NJ
F
know
- 0)N; - slDon't
_
1) Yes
_
-g hlocAS/orHPRTNRPsl VR,
:9,iåä=liolltfi,il?
3ili;
n23. Did you know you were HfV positivewhen you first met Z? ^
-ir¡ No
_
l) Yes
_
8)Don'tknow CX¡ll-.llV1F luoffiffi'l$iffi,ËilJf
-7 Frl cås/orþtHALÊ3MoS
F;24. DoesZ know that you are HfV positive? CKrugfVf
f
-qh¡o cnslotll PPrNRPsrve
à
GO
TOE?I
0)
No
_
-BNc cRsiorl{ PPTÑR 3l-1cs
-
_
t\ v^.
) GO TOE27
ôj oãn', *o*
answer
I GO TOE27
9) Declinesto
- ? Nc cnslotH HALÉ3 Mcs
f,25. Did Z know your HfV status before or after you had sex together for the first time?
l) Before
_
-_
_9)
826.
D
_
-_
_
ckNt{1v3r
2) After
know
8i Don't
-g No cAsloÍH PBINR Psl YR
:}$.".n',f;;i -K5ËåJ*
Declinestoans\¡/er*ø No¡ôx/utLN cAs r¡rw'r¡rv*
SHOW SCALE: When did you tell Z that you are HfV positive?
1) He or sheknew myHfV statusbeforewe met CTÊLI-|IVF
-9No cAs/orH PRTNI¿
Ffi vp
2) The first time we met
- I ¡¡o c4sioTl{ PRrh¡ 3 i'los
R
week
than
one
3i In less
- 7 No cnsiorg HALE3 Mcs
4) In lessthan one month
-¿" l'¡olDK/ÞcLN cAs kNw ¡+rv+
5) In lessthan 3 months
6) In lessthan 6 months
7) More than 6 months after we met
f,27. What is Z's HfV status?
1) HIV negative
2)
HIV positive
-
CASUH1VF
-ghb
3) Don't know; hasnot beentested
8) Don't know; hasnot told me
4122/99
SUDISQuestionnaire,
Psrve
c¡slors PÊTñR
-EtJo c.As/orH
FPrrup3Þ,ros
- 7 h J o cAS/orH l4ALË Syros
'82S.
Doesyour main partner know you had sexwith Z?
l"lKNwcasr
_0)No
.-Q Ño cesloru PRlt.lRPsr
VÈ
-8 No C.ASiOrri
_ l) Yes
PsrNR3 hog
No main partner - 7 Nô cASloilJ Maue 3 uos
_2)
8)
Don't know
_
Now that we've finished talking about specific types of sex you may have had with 2.,I want to move on to some
different questions. Thesenext questionshave to do with your ûr.gughtsabout having vaginal sex and using
condomswith a casual or recreational sex partner'
-täg:il-ti
PP'NP
Ezg.
- õNo cAslctfHPsfN e
D SHOW SCALE: How strongly do you agreeor disagreewith the following statements?- rio c¡{orr HALÊ3${l
Neither
Agree Nor
a. I planon usingcondomseverytime with my casualpartnerswhenwe
havevaginalsex
CA.I.IT-VAtr
b. Most people who are important to me think that a condom should be
whenwe havevaginalsexCSN-VA
usedwith mY casual
c. When it comesto safer sex with my casualpartners,I want to do what
most people who are important to me think I should do.
My casual sex partnersthink a condom should be used when we have
CPII-VAF
vaeinalsex.
e. Whenitcomestosafersexwithmycasualpartners,Iwanttodowhat |
he thinksI shoulddo.
2
3
4
5
8
9
c
830. D SHOW SCALE: In your opinion,how many other positivewomenyou know who shootdrugshave
vaginalsexwithout a condomwith their casualmalesexpartners?
1
None
2
3
VeryFew
AboutHalf
4
5
I
9
NOCÑCASF
-g No c/rslorlf Pørh¡r¿PSt-YR
-8 ño cAs/orH PPïÑB å ï'tos
- 7 ñô cRsiorHHALE3 s.los
More ThanHalf
All or AlmostAll
Don't know
Declinesto answer
4122199
SUDISQuestionnaire,
FemaleSwvey SectionE, page 12
t -831.
D SHOW SCALE: Peopleresponddifferentlywhenit comesto usingcondomsin varioussituations.
For the followingsituations,how sureare you that you canusea condomfor vaginalsexif YOU WANT
TO HAVE SEX with a casualsexpartner who is eitherHMEGATIVE
or YOU DON'T KNOW IIIS HIV
STATUS?
who is HfV negativeor whosestatusyou do not
Qf you don't plan on havingvaginalsexwith someone
know, pleasetry to answerthesequestionsin the way you think you would respond.)
When you want to have sexwith a casual male partner who is HfV negative or whose status you do not know,
how sure are vou that vou can . . .
AbsolutelySure
CANNOT
Pretty Sure
CANNOT
NOT STIRE
Pretty Sure
CAI\
a. usea condomor barrie¡evenif he doesnot want meto useone.O'Sí-VAIF'i'
I
2
a
J
b. usea condomevenif I havenot told him I am HfV positive.
2
4
5
a
ì
4
5
2
3
4
5
I
2
5
4
5
CSE-VA5F X- 1
2
a
J
4
5
1
2
a
J
4
1
2
3
4
5
2
3
4
5
OSE-VA3F*
I
refuseto havesexwithouta condomor barrierevenif I'm verv turnedoÞ_VOar/
d . even if he might lose his erection
cÊÉ-vAqF*
e . usea condomor barrierabsolutelyeverytime we havesex.
AbsolutelySure
CAN
startusingcondomsor barrierswith a partnerevenwhen\rye've
åêde.jünaf X
beforewithoutone.
g. usea condomor barrierevenif I've beendrinkingalcohol.
CSE-VAltr t
f.
h. usea condomor barrierevenif I'm high (on anydrugor substancel.CsÉ-Va¿f,
F,32. D SHOW SCALE: The followingitemsask aboutsituationsin which you might be temptedto have
vasinal sexWITHOUT A CONDOM with casualmalesexpartnerswho are HMEGATIVE
or WHO
YOU BELIEVE TO BE IIIV hIEGATIVE.
a. you havebeendrinkingalcohol. CTÊMPIF*
io
b. you havebeenusingdrugs.
CTgmPlf
I
c. you think hewill getangryif you insiston safe
.,
CTEMPSF r
sex.
d. you aresexuallyaroused.
CtgMPqf f,
I
I
I
e. youthinktherisk of disease
is low. CTEMPSFT
I
f. you areangry.
1
CirE] PbF*
g. he pressures
you to takea chancethistime. CTÉMflFl
CTÊMf€F*t
h. you aredepressed.
-9r¡c
.:F -8No
-
SUDISQuestionnair
e,4l2l | 99
2
2
2
3
4
5
a
J
4
5
3
4
5
2
2
2
2
2
a
J
+
5
J
4
5
)
5
J
4
4
a
J
4
5
¿Asloîr{ PRTNRP5Í vR,
c.AÊiofll PßfNß 3ì.{cs¡
7 Ñ o c A ã ^ ¡ o r t 1M A L € 3 H c s
5
FemaleSectionF, page I
In this sectionwe'd like to learn more about how you think about sex,your own sexuality, and HfV. Other
questionsalso deal with some of your past sexual experiences,such as unwanted sex or coercion.
Fl.
When it comesto a main sex partner do you have a preferenceabout their HfV status? (Read tist)
doesn'tT{t"t '
HfV status
No-Mypartner's
_0)
'
prefer
who
is
HfV positive MPREF
someone
1)
Yes--I
_
whois HIV negative
_2) Yes-I prefersomeone
F2.
When it comesto sex partners who pay or give you something for sex, do you have a preferenceabout their
IIIV status?(Readlist)
a'pRf
'
_ 0) No--My partner'sHfV statusdoesn'tmatter
who is HIV positive
_ 1) Yes--I prefersomeone
prefer
who
is HIV negative
someone
_2) Yes--I
f
F3.
Whenit comesto casualsexpartnersdo you have a preferenceabouttheir HfV status?(Readlist)
_ 0) No--My partner'sHIV statusdoesn'tmatter OpREF
who is HIV positive
_ 1) Yes-I prefersomeone
prefer
who
is HfV negative
Yes--I
someone
_2)
F4.
D SHOW SCALE: Peopleoffer differentreasonswhy sexwithout a condomor barrier might be risþ
betweenpartners who are BOTH HfV POSITTYE.How strongly do you agreeor disagreewith these
reasons:
It can increaseyour viral load.
_Yl
b . You canbecomeinfectedwith strainsof HIV
that areresistantto currentHfV,treafnents.
a.
Youcangetothersexually
'
"Åffih"¡Ll
?RISK-Y3
diseases.
d. You can get other viruses that leadto
opportunisticlnfections.
PRfSX-Y¿{
SUDISQuestionnaire,
4122199
F,page2
FemaleSection
would like to learn about what you feel about the spread of HfV infection through various practices.
-Now,I
''
am not interested in knowing what doctors or health care workers have told you, but what you reallv believe
about transmission.
F5.
D SHOW SCALE: How likely doyou thinka WOMAN INT'ECTED WITHIIIVwiII
her male sex Dartner if they have...
INTERVIEWER: If participant soysshe doesn't know, ask her to pick a bestguess
VAGINAL SEX
a. Vaginal sex to ejaculation withoqt a co4dom
FM RÏSKI
wheretheman
b. Vaginalsexwithouta condom,
withdraws (pulls out) before ejaculatingor
coming
FMRISK9'
-Ëînçgåry
vaginalsexto ejaculation
ANAL SEX
d. Anal sex to ejaculation withoutil c-qn{pm
trMÊISKLI
e. Anal sex without a condom,where a man
FFIRTSk5
coming
with
a condom
ejaculation
f. Anal sex to
ORAL SEX
FMRISKb
OraVvaginalsex withoutusinga latexbarrieror
dentaldam(themangoesdownon thewoman;
he putshis mouthon hervagina)FMRSKT
h. OraVvaginalsexusinga latexbarrieror dental
dam(themangoesdownon thewoman;he puts
his mouthon hervasinausinsa dam)FMRlSK8
4/22199
SUDISQuestionnaire,
give thevirus to
FemaleSectionF, page3
ftz SHOW SCALE: How likely do you think a MAN INFECTED WITH IIfV will givethe virus to his
femalesexDartnerif theYhave...
6.
INTERVIEIIER:
If participant saJ)sshe doesn't know, ask her to pick a bestguess
VAGINAL SEX
a.
cpndom
Vaginalsexto ejaculation
WitbqUle
MFRJSK1.
b . Vaginal sex without a condom,where the man
ng
h4FRISKl
c. Vaginal sex to ejaculationwith a-condom
ANAL SEX
MFRTS[<3
d. Anal sexto ejaculationwilhp1rþ-condom
e. Analsexwithoutu
"on¿o,S[ffiSî*
or
beforeejaculating
withdraws(pullsout)
coming
MFRISkS
f.
Anal sex to ejaculationwith a condom
ORAL SEX
Mfnrsviø
(' OraVpenilesexwithoutusinga condom(the
Þ'
womangoesdownon the manandhe ejaculates
or comesin her mouthwithqulu¡ing a condom)
h.
where
sexwithout
oraVpenile
"Sf*ffi"mm
goes
down
on
the man withdraws (the woman
themanandhedoesn't*TiÈþ¡gËå*?
OraVpenilesexto ejaculationusinga condom
e, 4122199
SUDISQuestionnair
,'1
D SHOW SCALE: How likely do you think it is for HTV to be spreadTO AN IININFECTED PERSON
in the followingsituations...
INTERVIEIIIER:
she doesn't
ask her to
An infectedpersonis takingthe drugcocktail
(i.e. proteaseinhibitors,"thetriple combination
vaginalsex
therapy")andis havingunprotected
with anuninfectedpersonRISKMEÞS
b. An HfV-positivepersonhasa very low viral
load,that is whenthe HIV virus cannotbe
foundin the blood,andis havingunprotected
vasinalsexwith an HlV-negativeperson
p"rFn?u["\H
*- *-n" ru,i.,o"
orother
HIV medicationsafter having had unprotected
vaginal sex with an HlV-positive person
KTSKPOST
4127
/99
SUDISQuestionnaire,
her best
D
[.Q
which describesomepossiblereasons
SHOW SCALE: Now I am goingto readyou a few statements
that you think may haveplayeda part in howyou wereinfectedwith HfV. Pleaseusethis scaleto indicate
how much you agreeor disagreewith eachof the possiblereasonslisted.
Disagree
Strongly Disagree
Neither Agree Nor
Strongly Agree
Agree
a.
Nobodyreally knewaboutHIV/AIDS whenyou \4/ereinfected.LTKELyI
2
a
J
4
b.
You didn't know muchabouthow to protectyourselffrom inf""rlllkElyr.
2
a
J
+
You didn't have your own rig or works.
LIKELYll
2
J
4
Lrt<Err/3
2
a
J
4
e. You didn't takeHIV seriouslybeforeyou wereinfected.Lf KÉLYq
2
J
4
else'sfaultthatyou got infected.LIKELY5
1. It wassomeone
2
J
4
ç It wasjust a matterof time beforeyou got infected.LIKELyþ
Þ'
2
a
I
4
andgotinfected.LIKELYS
h. You tookyour chances
2
a
4
4
A condom broke.
i.
You werehigh.
LIKELYl3
2
a
a
j.
You weredopesick.
LÍKÉLYlLl
2
3
+
2
a
J
4
2
a
J
4
who lied to you abouttheirHIV
sexwith someone
m. You hadunprotected
2
J
4
LIKELYq
'LfkELYll
you to havesexwithouta condom.
forcedor pressured
n. Someone
2
a
J
4
k. You didn'tprotectyourselfandgot infectedwith HIV. LIKÉLYtÒ
l.
who didn't know theirHIV status.lJKÊLY-?
You hadsexwith someone
StAtUS.
4/22199
SUDISQuestionnaire,
INTRO: Thesenext questionsare about how comfortable you feel talking to different people in your life about
rhingslike sex,using drugs, and your IIIV status.
F9. n
SHOW SCALE: How comfortable are you talking to the following people about your HfV status?
very
Uncomfofiable
Uncomfortable
Neither Comfortable
Nor Uncomfortable
a. Mother
very
Comfortable
TLK1qOM_ 1{
2
3
b' Father
c.
d.
e.
f.
g.
TL*ÞA\>- l{
Sister(s)
TLKSÍS_*
Brother(s)
TLKBRO_ H
Your mainsexualpartner(spouse,boy/girlfriend)TLKI4SP-t{
-f
Casualor one-timesexpartners
LKôS?-*{
Peopleyou usuallyuse(drugs)with
TlxuR\Ä-H
staffTLkouTh. Outreachworkers(CHOWs)or needleexchange
¿
l-{
l.
Health care providers: doctors and nurses
TLKMÉb-I{
j.
Socialserviceoroviders: socialworkers
TLKSoe-U
Ff 0. D
Not
Applicable
Comfortable
J
4
5
9
+
5
9
4
5
9
4
5
9
5
5
5
5
5
5
e
e
e
e
e
e
",
7,
4
Z
J
4
2
3
4
2
3
4
4
¿
J
+
SHOW SCALE: How comfortableare you talkingto the followingpeopleaboutyour DRUG USE?
Very
Uncomfortable
Uncomfortable
Neither Comfortable
Nor Uncomfortable
Comfortable
Not
Applicable
Very
Comfortable
TLKMOM. Þ
TLKÞAÞ-Þ
2
3
4
5
9
2
3
4
5
9
c. Sister(s)
TLKSJS. b
2
3
4
5
9
d. Brother(s)
TLKtsRO-D
2
3
4
5
9
2
3
4
5
9
TLKOSÞ. Þ
2
3
4
5
e
TLKÞR.U-Þ
2
3
4
5
9
Outreachworkers(CHOWs)or needleexchangestaff TLkouT-D
-T.LKMÉÞ-Þ
Healthcareproviders:doctorsandnurses
2
3
4
5
9
2
3
4
5
9
TLKSÕC,_Þ
2
3
4
5
9
a. Mother
b. Father
e. Your mainsexualpartner(spouse,boy/girlfriend)TLI<S^SP-D
f.
Casualor one-timesexpartners
Peopleyou usuallyuse(drugs)with
Socialserviceproviders:socialworkers
4l22l99
SUDISQuestionnaire,
FemaleSectionF,pageT
\11.
D SHOW SCALE: Usingthis scale,pleaseshowhow muchyou agreeor disagreewith eachof the
followingstatements.
i,, i' '..''r1
Strongly
Disagree
Disagree
Neither
Disagree nor
Strongly
Agree
Declines to
Answer
a
for meto tell peopleI am.HIVpositiveif I onlyhave
It is notnecessary
ÞSCLBEI
safersex.
2
a
J
4
5
9
b
I have a responsibility to let the people who I am going to have sex with
DSCLBÉ9
know that I;m HfV positive.
2
a
J
4
5
9
c. Most HIV negative people would not want to have sex with someonethey
DS('LB'E¿{
knew was fUÚ po.iiiue.
2
a
J
4
5
9
d . It would not bother me if someonedidn't want to have sex with me
2
J
4
5
9
2
a
J
4
5
9
2
a
4
5
9
4
5
9
ÞSgLBEß
of my HIV status.
because
e. If potentialsexpartnersdo not askaboutmy HIV status,it's not my
DSCLtsET
responsibilityto tell them.
assume
f. I think that sexpartnerswho do not know my
- HIV status-probably
DSCLBÉ9I'm positive.
for me to tell peopleI amHIV positiveif I nevershare
g. It is not necessary
my syringes/needles
DSCLBEI}
h. I havea responsibilityto tell peopleI sharedrugswith thatI'm HfV
positive.
DS0LBÉ13
i. MostHfV negativeuserswould not \ /antto sharetheir workswith
theyknewwasHfV positive.
someone
DSCLtsEILI
j
It wouldnot botherme if someonedidn't wantto usewith mebecauseof
DS0LBÉ15
myHIV status.
it's not my
k. If potentialshootingpartnersdo not askaboutmy HfV_status,
ÈAgLtsElt,
resnonsihilirv
to tell them.
4122/99
SUDISQuestionnaire,
2
J
2
J
4
5
9
2
a
J
4
5
9
2
a
J
4
5
9
2
a
J
4
5
9
õ
'n.
SHOW SCALE: How stronglydo you agreeor disagreewith the followingstatements:
n
Strongly
Disagree
Disagree
Neither
I)isagreenor
Strongly
Agree
a. Thelastthing I wantto think aboutduringsexis HfV.
OE1
¿
3
4
5
b. Usingcondomsdoesn'tbotherme.
o €3
Z
J
4
)
is oneof themostimportantthingsto me.
c. Beingsexuallydesirable
OEï
¿
J
4
5
4
5
4
5
therearegoodreasonsfor not usingcondomsduringanalor OEB
d. Sometimes
2
3
vaginal sex.
Using condoms can be a constantreminder of HIV/AIDS.
oEq
oe7Ò
ç It's very important to me to protect my sex partnersfrom HIV.
Þ'
oE12
e. SometimesI resenthaving to use condomsfor other people.
f.
to keepothersfrom becomineno¿fge.
h. Peoplewith HIV havea responsibility
i.
WhenI havesexwithouta condom,I regretit or feel guilty the nextday.OËltl
j.
HIV is difficult to transmit.
¿
J
4
5
¿
J
I
A
5
2
3
4
5
2
3
4
5
4
5
4
5
4
5
t
OElB
k. Usingcondomsmakessexlessenjoyable.
OETq
2
Condomscanmakea manlosehis hard-on
oEzÕ
Z
l.
3
J
to tell me if theywantto usea condom.OE91
m . It's my partners'responsibility
Z
J
+
5
oE23
z
5
4
5
4
5
/1
5
n. Condomsaren't worth using becausethey break too often.
of someone
who is HfV negative-notsomeone
o. It shouldbe the responsibility
OE25
who is positive-to-makesurethat sexis safe.
p . Peoplewith HIV havea specialobligationto havesafesexwith thosewho are
OEJ6
n"gàtin"or do not knowtheir status.
q. If peoplewho areHIV negativewantto haverisþ sex,it is their choiceto do
oE30
so.
meto havesexwithouta condom,Ö832
r. If anHfV-negativepartnerpressures
I give in.
sometimes
themorelikely we'll havesex**ou&r'
s. ThelongerI'm in a relationship,
condom.
4/27/99
SUDISQuestionnaire,
I
F13. I want to end this sectionwith some questionsthat deal with topics that are often difficult to talk or think
about. They are questionsabout physical and sexual abusethat you may have experiencedin your life.
Unlike the previous ones,thesequestionspertain to anyone,not just your sex partner. Also, when I say
"childr" I mean someoneage 16 or younger, and an "adult" is someoneage l7 or older.
.Atbúspsvr
a. As a child, were you ever beaten,physically attacked,or physically abused?
0
I
9
b. As a child, were you ever sexualþ attacked,raped,or sexually abused?
0
8
9
c. As an adult,haveyou everbeenbeaten,physicallyattacked,or physically
0
8
9
ABuosExr
abused?
A6USPI{Y1
raped,or sexSfl6$usef
d. As an adult,haveyou everbeensexuallyattacked,
0
INTERWEWER: If participant answers "No" , Don't lçtow or "Declinesto answer" t GO TO Section G
\
F13a. When this / these happened,did you receiveany help or counseling?
0_
No
A6usÉcou
Yes
1Don't know
8_
g
Declinesto answer
INTERVIEWER: IF participant answersNO, pleaserefer her to list of phone numbers for counseling resourcesin
the referral packet.
4127
/99
SUDISQuestionnaire,
FemaleSectionG, page1
In this section,I will ask you questionsabout alcohol you may drinþ drugs thaf you inject, and drugs that you may
usewithout injecting.
ALCOHOL
Have you had any alcoholic beverages(beer, wine, hard liquor, or other drinks) in the past 30 days?
Gl.
_
ÞRÎNK3Ò
1) Yes
0) No (If no, go to Gla.)
Gla. Have you had any alcoholic beveragesin the last three months?
_
_
l) Yes
ÞRTNK
0) No à GO TO G6 -q ALcoHoL Ps.r3ounvs
D SHOW SCALE: During the past3 months,how oftendid you usuallydrink alcohol?(suchas beer,
wine,hard liquor, or otherdrinks/
ÞRiNKNuâ
oNeverà Goro G3
- 9 ÑJoALcot{èLLsr 3 Èôg
1Lessthanoncea month
2_lto3timesamonth
Oncea week
3_
4_
2 to 6 timesa week: lessthanoncea day
5_
Everyday
8_
Dontknow ) GO TO G3
Declinesto answer) GO TO G3
9_
G2.
G2a.ù SHOW SCALE: On a typicalday whenyou drink alcohol,abouthow many total drinks do you
of wine,how many mixeddrinks,etc)
have?For example,how manycansof beer,how many glasses
I
I drink
-9 uo ALcc¡lcL Lsf 3'Fros
2-3drinks
2
- I NEv/Dk/RÊF
â
At-CPsï 3¡4or)
J
4 or moredrinks
ÞRlrR>ny
Don't know
Declinesto answer
8_
9_
G3.
How many drinks doesit usually take for you to get drunk?
ÞRUÑKHOVJ
-9 tJo ALcoi{cL Lsi 3llos
G4.
D
SHOW SCALE: During the past3 months,how oftenhaveyou had any beer,wine, or liquor to drink
before or during sex?
Never à GO TO G6
l)
_
2) Almost never
_
3) Sometimes
4) Most of the time
5) Always
_
G5.
ÞRTNKSEX
-gNO
ALCaHÔL LSf 3t{os
During the past three months, how many drinks did you usually have before or during sex?
ÞRNK+SEX
-9
ÑO ALCoHéL Lr)T 3Mêf
-8No ALc wisEx Psr3ì-10
05/ 04/99
SUDISQuestionnaire,
FemaleSectionG,page2
INJECTED DRUGS
with injecteddrugs.
Now I'm goingto askaboutyour experience
G6. Haveyou injectedany drug in the last30 days?This couldbeskin-popping,intramuscular(or muscling),in a vein
(mainlining)?
l) Yes) Go To TABLE BELow fÑ53O
_ 0) No (Go to G6a.)
G6a.Haveyou injectedor skinpoppeda drug in the lastthreemonths?
I) YCS) GO TO TABLE BELOW 1Ñ53MOS
*g3ñJÉCTEÞ
L5ï 3() ÞAYs
O)No ) GO TO G15
_
Pleasego through columnsA through Efor each drug listed. Follow theseguidelines to help you:
INTERVIEWER:
1. For a given drug, if the answer to B is "No," skip C and go directly to D for that drug. If lhe answer to B is "Yes," then
continue with C and Dfor that drug
2. For a given drug, if the answer to D is "No," go on to part Efor that drug. If the answer to D is "Yes," then go directly to
the next drug and skip E.
3. For columns C and E, wrile number of injections on blank line, then circle appropriate interval. For øeømple,for an
',
week". wrtte I¿2 on the blank, then circle "W".
2 times
answer
I
Í NfAiÉ
Cocaine
I
Crack
a NiBtÉ
I
Heroin
rNSbx
Methadone(streetor
prescribed)
1
fNJE,b
(like speed,
Amphetamines
or
crank,crystal, ice)
ft/5F*
I
I
Steroids
f /,./JG*
Crushedor meltedprescription
drugs(like codeine,Percodan,
Dilaudid,morphine,Demerol)
1
Other#3
fñf
ai.lf KorHR
zRÅY/rl[*n'tÍEþwfir
1
aNJ-aùtÉ
8
0
I
D/Wll\4
8 ,
zrV¡L3_Uo*
iNJUTYPX
0
1
D/W/l\4
5:\'¿QSP¡6+.
8
tñ5ETyP*
=ÈLYJN*0
fl.útrHewl,Ê
1
D/W^4
rNÃtr-3t'tù
8
r,?r"l,Jff* fÑsFryP*
0
1
8
D /W lt\4
f^/JcStloiÈ
TÄJJGTYP* D / W / I 4
rRJü{lXxr.
0
1
8
J/vÍilåi-lo*
I
fñ51*x
ffi
fi.fÍDllot¡,f*
0
fñJcryP*
¡R/JtlM*-TNSHTV#
0
1
8
I
Other#2
I
rNflt!-(pwLk.
f f{fr**
T ÀJ]TOÍ¡{R
8 , 1-rMJÆr{or
I
f ñ5ll *
Other#l
ÍNÍJlbtÐt'Jr
PuJ,ElMu.or
0
tP/¡ll¿Mx**
-q F¡cÍr¡T LST 3Mas
*'I Nc o-rHÉR.ÞÈl4G
RricoÊÈEÞ
D/W/ì4
f ñsrrYP,tÍtürÆo*,*
Di rw/lvf
l^/eTlþc,;l*x
Í{lg.i{owi*É
ilxr
-qNC
05/ 04199
SUDISQuestionnaire,
rH&,|il*x
rvf3!¡oi¡i*
I
l
D/w/rvf, I
=PJX'+ll}xr 0
1
8 . Írv¿ç;¡46*
Í.NSBIiôNL{(
f ,vJBTVPI D / W / À 4
ANJCH.Àlj.¡\f
(cocaine& heroin)or
Speedball
goofball(heroin& meth)
0
f NSlrrvP4
iñ.æflO'\^å*
D/W/M,
fñfgr
*ir
fN#Ulôh/1r
1
8
fMJTTPX)
0
1
8
.ur{JJsV¿lit*
D/W/\4
ÍNEKõ!O*
9F D/v//\4
fÀJJKTYP,
'.P-LKLMx¡tx
-g h/c1ñs LSÍ 3 Hos
H, t -qNc iNf, tST 3i,|os ; -q ñôlNS Ls
- g Nc (ÞPr{6) LÊi 3 t1c3
-Ê Nc (ùRtig) ?si
*.*-9 N0 lNS LSì 3¡æ5 . _
-g
3c
u^''
'v bAvs
- ?? ilc
F¡o aNS LSi 3flæ
No .f;r¡ÉR
Þl'¿l,lG *Ê
cîHËR ix¿r,¿
-gr.JOo.rHÉø Ls'i ãH6
RecceÞEÞ
,t* -9 ñ(>1ñ3 Lgf 3 r4cs
-6 No ciHE? P5ì
þo ÞAys
--?NÔ ÓÎHÈRÞ?MG
ÈEccÊ.DEÞ
- 7 ÑO OTHÊR,DÈt^G
RECCTD€D
G7.
D SHOU| SCALE: Think aboutthe total numberof timesyou haveinjecteddrugsin the last3 months.
Now I want to ask aboutyour typicalinjectionpracticesduring thoselast threemonths.
NOlÑ3 LSÍ 3McS
3
a) take a used syringeto load a new one (piggybacking,backloading,
b)
c)
d)
e)
INJPRACT
splitting,frontloading)
usea cookerat the sametime or beforesomeoneelseJNJ PßþLfu
else frrJfPRACb
usecottonat the sametime or beforesomeone
userinse water before someoneelse
JNJPRAS{
cleana needleor syringebeforere-usingit
Ð cleanyour skin with alcoholbeforeinjecting
ANJPRA¡;5
f NJPRAC(c
s)
II'IJPRACT
f:t'tTPRA(ñ
inject someoneelsefor them
h) havesomeoneelsehit (inject)you
*FrequencyScale
O:none of the time, never
l= lessthan half the time
2=half the time
0
0
0
0
0
0
0
1
1
1
1
l
1
1
4
4
4
2
2
3
3
4
¿
3
2
2
3
3
4
4
4
4
3=morethan half the time
4: all the time
G8.
During the past3 months,how manytimesdid yo_ugiveor loansomeoneyour syringeafter or behindyou
-9 Ñc aNi LsT 3h4os
(without bleachingit betweenuses) GAVESyR
rJsecodes:777:don't lçtow; &89:declinesto answer;)}]:none/not applicable
G9.
During the past 3 months, where did you usually get your needlesor syringes from? What were
your three most common sources?
INTERWEWER: DO NOT read lßt of answers; check up to three; PROBE íf necessaryto classify response.
.9 NoANS LST 3HoS
i
1) A pharmacy
ñEEbLGEI
2) A sheet ouheachworker
ÑEEÞLGE2
I
3) A needleexchangeprogram
NEE>LGE3
4) A friend
5) A relative
6) Main sexualparfner
7) Other sexualpartner
8) The black market or a streetdealer
9) Rent at shooting gallery
I
10) other (speciff) ÍJEEÞLGO]77)Don'tknow
to answer
88)Declines
05I 04/99
SUDISQuestionnaire,
G10. During the past 3 months, what did you usually do with your used syringes?What were your three most
corlmon methods of dealing with used syringes?
r
INTERWEIYER: DoNOTreadlistofanswers; checkuptothree; PROBEifnecessarytoclassifuresponse.
1) Exchangedat an NEP
-9rrlo aNJ
2) A friend exchangedthem for me
3) A outreachworker exchangedthem for me
NEEDLÉSl
4) Threw them away
N EEÞLËS O
5) Gave them to a friend
NEEDLES3
6) Cleanedand gave to friend
7) Gave them to a relative
8) Cleanedand gaveto relative
9) Gave them to my main sexualpartner
l0) Cleanedand gaveto main sexualparhrer
11) Gavethem to anothersexualpartner
12) Cleanedand gaveto anothersexualpartner
13) Re-usedfor myself
l4) Cleanedand re-used
15) Sold
16) Cleanedand sold
LsT 3Mos
17)other (speci$)ÑEÉÞLEOT
77) Don't know
'111. With whom do you most often inject? (Checkup to three social situations)
_ 1) alone(If this is the only option checked, t GO TO G12
_2) with a mainsexpartner
_ 3) with casualsexpartner
_4) with tradesexpartners
_ 5) with relatives
_ 6) with a groupof friends
_7) with strangers
_ 8) other1 f.NJwi{oT}l
9) other2
Glla.
f.Nf,wt{ol
-<ìñe LNf, LST 3Hos
r.NswHo
e - åf,.Ë'H'til't=*5"Åro*,
f.N3 WHo3
,
Do you prefer to inject/shootup with peopleof your own ethnicitylrace?
-rNJ
ETH N
_ 8) Don't care;no preference
_ 0) No
-9IVO
lNJ
LST 3 HOS
1)
Yes
_
-gMo6T OFTENa¡5 frLoNË
Do you preferto inject/shootup with peoplewho are alsoHfV positive?
_ 0) No
_ 8) Don'tcare;no preferenceTñJ t{1VP
-9¡Jo 1ñJ
l)
Yes
Lsr b Mos
_
-8uosI
oFTENIN¡ ALÔNÉ
Glz. How old wereyou whenyou first beganinjectingdrugs?
I.NJAG í -q ñô r.NJ LSTg çte
Usecodes:77=Don'tKnow: 99:Declinesto Answer
Gllb.
05i0l/00
SUDISQuestionnaire,
G13. Did you ever inject at leastonce a week?
-
0)No à Go To G14
_
_
_
1)Yes
8) Don't Know
f ñ5WEEK
-9 ño rNJ LsT
3t tas
G13a. How old were you when you first began injecting drugs at least once a week?
(JseCodes:77:Don't Know; &9:Dgcli!e! to4nswer; 99:Not applicable/Never
Ix awk
f'h'¡3
ÑJÔ
LST
3t46
a.ÑsAeÉw
:q
tousebteach
to
Gr4. rz sHow SCALE:whenr"",;P"lttu,-'î"å!lif iå"/XYlfht.r, ir canbedirricutt
clean the needle. What kind of situationswould be more difficult for you. Pleaselisten carefully to each
question. The answersto thesequestionscan be: definitely not, probably not, maybe, probably yes' or
definitely yes.
-9 Ño 1Ñ3LsT 3
HCIS
V/ouldyou be ableto cleanyour
needleafteryou usedit, evenif
your sharingpartneralsois HIVpositive? IN5SEI
If you arefxing with peopleyou
dont know,wouldyou be willing
to lendouttheneedleyoujust
used? -f,VJSE a
Wouldyou lendyour needleout
afteryou usedit, eventherewas
nobleachavailable?
ÍNJSE3
lf you arefixing with peopleyou
don'tknow,wouldyou optto
drawup out ofthe cooker/cotton
last? fNiSEq
by someone
Ifyou arepressured
whois dopesick,wouldyou
lendoutvour usedneedle?fNJS 5
If you arerushedto lendyour
else,
usedneedleto someone
wouldyou be ableto takethe
timeto bleachit firstENSEb
Wouldyou be ableto insistthat
a personbonowingyour used
needlebleachit beforetheyused
it?
fi\tTst7
If you hadbleachwith you,
wouldyou be ableto offer it to a
personborrowingyow used
needle?
.7t /J$EB
e, 05/ 04/99
SUDISQuestionnair
6
9
5
6
9
4
5
6
9
a
J
4
5
6
9
2
a
J
4
5
6
9
I
2
J
4
5
6
9
I
2
J
+
5
6
9
I
2
a
J
4
5
6
9
1
2
I
2
J
4
I
2
J
I
2
1
a
4
NON-INJECTED DRUGS
,Now I want to ask you about drugs that you use, but DO NOT INJECT.
G15. Haveyou usedany drugsin the last30 daysthat you did not shootor inject?Do not includedrugsthat you
took for detoxto relievewithdrawal. ÞRUC3Ò
0) No ) GO TO G15a
_
l)Yes à GO TO TABLE BELOW.
_
G15a. Have you usedany drugs in the last three months that you did not shoot or inject? Do not include
drugs that you took for detox to relieve withdrawal.
_
ÞRuG
O)Noà GO TO G17
)
TO
TABLE
BELOW.
I)YES GO
INTERVIEWER:
Pleasego through columnsA through Efor each drug listed. Follow theseguidelines to help you:
4. For a given drug, if the arurwerto B is "No," skip C and go directly to Dfor that drug. If the answer to B is "Yes," tlten
continuewith C ond Dfor that drug
5. For a given drug, if the etswer to D is "No," go on to part Efor that drug. If the answer to D is "Yes," then go directly to
the next drug and skip E.
6. For columns C and E, write number of injections on blank line, then circle appropriate interval. For acample,for an
answer of " 12 timesper week", write I 2 on the blanh then circle "W\
Marijuana (weed,blunts, etc.)
Crack
Cocaine(sniffed or smoked)
Heroin (sniffed or smoked)
Amphetamines(like speed,
crank, crystal, or ice)
oo*,rLr*
meluorx:k
ËduerttolP/W/M
ÞPßeHôlx)f
ãqte¡*.rD/IV/M
o
oe.lut*
o un
ius*
o
>orluu*
0
Methadone(streetor
prescribed)
0
Amyl nitrate or poppers
0
Hallucinogens(LSD/acid,
mushrooms,peyote/mescaline)
Angel dust or PCP
8
0
l
8, -
D/rw/I4
ÞRuG)rrca
D/W/I4
-Þe¡¡G3¡<o3
ùRuc3ÎY
0
DRG¿IHOIX'
DilWlI4
1
ÞRr,rG¿1Ty
D/W/I4
-Þeußqr-{o3:
ooo*Jr'"å*
-
D/W/I4
0
D/W/M
D/W/M
1
ÞRr.¡cro*
D/W/M
1
Þeuel*
D/W/M 0
1
8 -Þeue'7tYa3
D/W/t\4
ÞRe-l¡.torx* ÞÊ!{ê7ryp*
oo*1,,g* 8
D/W/M
oo*n1"-Jr
-
D/W/M
0
1
0
1
1
ÞRG5ilo1x#
o
other#2pAGÞúfH
o t h e r # 3y(.Gß Þ T H
0
8
8
uo,inurtf
1
1
8 -
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other#lÞ4-cllÚf+l
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.
8
g
0 *^ .L_--
D/W/M
ÞRG11Hl'x
-?
SUDISQuestionnaire,
05| 04199
r
bø^érrvË*-ÞR,uGlMo3
1
ÞRqe5)r
uc'^tq*
Downers or tranquilizers(like
barbituates,chloral hydrate,
Valium, Klonopin, Ativan, etc.)
0
ñè oTHR ¡JcN -ah¡3
RÊCARDEÞ
ÞÊr¡G5Ha3
ÞR.ueø¡r
D/W/l\4
ÞeÀÁeÈÈ{o3
oooråo*åt _ÞpugD / Wq/ l v f
r,{O3
0
1
8
ÞRucáoil)ts
D/W/l\4
_ÞÊeior4og
D/W/I4
'bq,G11Ho3
ÞR.LtGl1
8
D/W/l\4
-,,.G16.
With whom do you most often use non-injected drugs, i.e. in what social situations? (Check up to three)
_
_
_
_
_
-
l)alone
2)with a main sex Parfner
3)with casualsex Partner
4)with trade sex Partners
S)with relatives
6)with a group of friends
-9 r'tc NoN-1.NJLsí 3 Mos
^/f ñ5wf,J1
l./f ñf\^rrH2
t\Æñf WTÍ{J}
I
I
I
7)with stransers
siotherI /'/JNJWoT'{
9)other2
GlZ. ftz SHOW SCALE: During the past3 months,how oftendid you useany alcoholor otherdrugs
BEFORE OR DURING sex?
l) Neverà GO TO SECTIONH
2) Almostnever
_
ÁLCDRSEX
3) Sometimes
_ 4) Most of thetime
5) Everytime
_
05/ 04/99
SUDISQuestionnaire,
FemaleSectionH, pageI
Everybody dealswith HfV in different \ilays. In this sectionI would like to learn more about how you deal
emotionally with your HIV and where you're getting social support.
Hl.
D SHOW SCALE: Below is a list of problems and complaints that people sometimeshave. For each
one, pleaseindicate how much that problem has bothered you during the PÄST WEEK,INCLIJDING
TODAY.
Nervousnessor shakiness
inside
tsõIA1
b. Feeling easily annoyedor
initated
Eõf H1
c. Thoughts of endingyo_r{life
I
2
4
#?ãP.lrn"
scared
d. Suddenty
BSfAL
I
2
4
I
2
4
e. Temperoutburststhatyou
coulãnot control BS-IHâf. Feelinglonely BSI'Þ2
2
3
4
g. FeelingblueBSTUE
2
a
J
I
h. Feeling
" no interesfinlhjnes
2
a
J
4
i.
Feelingfearful BSÍ'A.S
2
a
J
4
i.
Yourfeelingsbeingeasily
2
a
J
4
k. Feelinehopelessaboutthe
2
a
4
B3fÞq
hurr BSr> U
/l
tuture Ésf>tl.
Feelingtenseor keyedup tsStAt{
m. Havineursesto beat.iniure,
o.
p.
q.
r.
o.harä roï"on" BdIt{3
Havingurgesto breakor
things ts51H¿{
smash
Spellsof terroror panicßSÍÄ,5
Gettinginto frequent
argumãnts
ff1t{5
Feelinssorestless
vou could
not sit-still BS1,A,(2
Feelingworthless
BSlbT
05I04/99
SUDISQuestionnaire,
2
J
4
5
2
3
4
5
2
a
2
J
4
5
2
3
4
5
J
4
4
FemaleSectionH,page2
-\H2.
D SHOW SCATE: The following statementsdescribehow people sometimesfeel. For each
statement, pleaseindicate how often you feel the ways described by answering Never, Rarely,
Sometimes,or Always.
a.
How often do you feel that you lack companionship? LONELYS
b.
How often do you feel that you have a lot in contmon with the
you?
people
around
LONELVb
c. How often do you feel close to people?
LONELV'I
d. How often do you feel isolated from others?
LONE LV8
e. How oftendo you feel thattherearepeoplewho really LgNELYS
you?
understand
How oftendo you feelthat peoplearearoundyou but not with
LoNELVIÔ
you?
ø
How oftendo you feelthattherearepeopleyou cantalk to? LONELYI1
h . How oftendo you feel thattherearepeopleyou canturn to? LONELY|L
H3.
D SHOWSCALE:Howoften do you talk with other HIV positive drug users about personal
issues
relatedto DRUGS?
_ 1) Never
_2) Almostnever
_ 3) Sometimes
_ 4) Often
_ 5) Very Often
H4.
TALI<ÞR,UG
D SHOW SCALE: How oftendo you talk with otherHW positivedrug usersaboutpersonalissues
related to SEX?
TALySEXå
_ l) Never
_2) Almostnever
_ 3) Sometimes
- 4) Often
_ 5) Very Often
05/04/99
SUDISQuestionnaire,
FemaleSectionH, page3
15.
D SHOW SCALE: How oftendo you talkwith other userswith IIIV aboutpersonalissuesrelatedto
HW?
-lALt<HfV
_ 1) Never
_2) Almostnever
_ 3) Sometimes
_ 4) Often
_ 5) Very Often
H6.
D SHOlil SCALE: How manypeoplecouldyou go to for supportif you neededit?
_ 1) None
-t
Al-kS\¿PP
_2) One
_ 3) Two or three
- 4) Four or five
_ 5) Six or more
II7.
D SHOW SCALE: For the followingquestions,pleaseanswerusingthe categoriesdefinitelyno,
probablyno, maybe,probablyyes,and definitelyyes.
,#F¡
äËË-Hj6,e1'{l¡å.çi"_-@$fffi.i,#T
j!
',il,l:.',
ii'.;.{!':'-j':,1'.,i!4!.:!-;irr,-;1i#::1
a. Is thereanybodyyou
could dependon to loan
you $10 ifyou needed
I
2
a
J
4
5
8
9
b. Is thereanybodyyou
coulddependon to take
careof you if you were
sick andhadto stayin
bed?bEPSTl t(
I
2
J
4
5
8
9
a. Are there people in you
life you could talk to if
you \üere sad,nervous,
or depressed?ÞÉPõAb
I
2
J
4
5
8
9
d. A¡e therepeoplein your
life you couldtalk to if
vou neededadviceabout
I
2
a
J
4
5
I
9
it? Dr--PMnñr-V
,'l
a Dersonaproblem
ÞEPA
05/ 04199
SUDISQuestionnaire,
SHOW
SCALE: For each of the following statements,pleasetell me how much you agree or disagree.
Strongly
Disagree
Disagree
Neither
Disagreenor
a. I do not think thattherewill everbe a curefor AIDS.
for HfV.
b. Peoplearetoo excitedaboutthe new medicaltreatments
c. I think I will have a long life.
OPTl
OPT}
OPí3
d. Better medicineswill be found in the nearfuturethat will help peoplewith HIV to live
OPíL{
longer.
e.I think I will beatHIV.
05I04/99
SUDISQuestionnaire,
()FfT
1
2
3
4
5
t
2
3
4
5
1
2
3
4
5
1
2
3
4
5
r 2 3 4 s
t -'[9.
Now I am going to read you a list of statements.Pleaseans\ileryes if the statement is true for you, or
answer no if the statement it is not.
INTERWEII/ER: Circle Yesor No
each statement.
SocÞr-ra.I like kinþ sex.
SocÞFg b.I,ve neversolddrugs.
1
t
0
SocÞF3 c. I havemasturbated.
Soc>çq d. SinceI first hadsex,I haveforgottenbirttrcontrolseveraltimes.
lccpç5 e. I havean orgasmeverytime I havesex.
I
0
1
0
I
0
1
0
1
1
0
I
0
I
0
I
0
I
1
0
0
SccÞçlti n.My currentpartneralwayspleases
mein sex.
jocÞtr!5 o. I talk to my partneraboutwhatI like.
SocÞgçr p. I've useddrugsin my lifetime.
SccÞç-l-7 q.I enjoyhavingmy partnerseemenaked.
Soc'>s13 r. I've beenvery sexuallycompatiblewith everyparbrerI've beenwith.
I
'|
0
SocÞçø f. I've only hadsexwith peopleI loved.
Socaç7 g.I've tradedsexfor drugs.
my sexdrive.
€oco6¡r.I've usedillegaldrugsto enhance
SccÞtrq i. Sometimes
I've sharedneedles.
SccSç16 j. I've neverhadsexwhile high.
€ÔcÞtr1l k.My partneralwaysdoeswhatI askhim to whenwe havesex.
SÔcÞtrl1 l. I've neverhadsexanywherebut on a bedin a bedroom'
SocùtrL3 m. I've only beenwith onesexualpartnerin my life.
0
0
I
0
I
0
I
0
1
0
SocÞF1q s. I've takenpills to givemeenergy.
gOcDFgO t. All of my sexualpartnershavebeenwonderfullovers.
1
I
0
0
SccÞtr9l u.I havefakedan orgasm.
Socusgg v. I like my sexualpartnersto be experienced
by thetime I meetthem.
SOCÞç93 w.I considermyselfto be a wonderfullover.
Soc-ÞFA4 x. Sexis betterfor mewhenI'm high
I
0
1
0
I
0
1
0
SOCÞF95y. I've onlytakenmedicinewhenI'm sickor whenmy doctorrecommends.
0
SccÞF9(' z.I've lied aboutmy healthor my periodto getoutof sex.
0
SocÞF97 aa. I haveneverhadsexin a publicplace.
0
SOcÞFt3 bb. I've neverinfluencedanyoneto usedrugsnot evenalcohol,weed,or tobacco.
0
e, 05I04I99
SUDISQuestionnair
Hlg.
Next, I will give you a stack of cards with words written on them. I can read them out loud to you if you
like. pleasearrange thesein order of what you feel is most important to you right now, with the most
important card on the top and the least important card on the bottom.
HI1s. 7NTERVIEúI¡ER: Once the pørticipønt has arranged the cards, give her the card that says "HIV")
Now show me where IIfV fits into that arrangement.
Now record the order of cards, using 7:most important and 8=least important)
(INTERWEIIER:
SAFETYFROMVIoLENCE SoKl'iÆou
-
SoRtHous
HOUSING
_TRANSPORTATION SORTTRAN
_ BErNGABLE TO WORK SORIWORK
_HAVING MONEY SoRIMONE
SoRTFooÞ
-FOOD
CHILDCARE SoRtcHcR,
-
soRTl-üv
_Hrv
Thesenext questionsare the questionsabout treatment for alcohol, drugs, and mental health that we ask of
everyone.
:
H11. Have you ever had treatment for problems with alcohol use?
0
No à co ro rr14
189
Yes
Don't know ) GO TO Hf 4
Declinesto ans\üer) GO TO II14
Augrx
Hllz. Are you currentlyin treatmentfor problemswith alcoholuse?
ALCtxt tow
No ) cO TO H13
0
-g NÊVER/ÞK/REFALc Tx
Yes à GO TO H12a
1
Don'tknow ) GO TO H13
I
Declinesto answer) GO TO H13
9
q ñÊvÊR,lÞKieErnufx
Ê
- Ñ0cuRRÉÑfrrr^
IrrLà. ñz SHOW SCALE: What kind of treatmentis it? (Interviewer:checkall that apply)
ALC.TX
ALCTxt aUCTXIAl-CTx3 ÀfCfiq
ALCTXS
-nr¡rXìã
AucfÉ7 IIl3.
1) AA
for example)
detox(Phenobarbital,
2) Chemical
monitored
3) Physician
.
speciSALCTX'I.A
Ð Relidential,
5) Ouþatient,speciff.
ALCIXSA
6) other,sPeciff ALCIXbA
7) NotAPPlicable
How many times altogether have you receivedtreatment for problems with alcohol use?
[Jsecodes: 77:Don't Know;8$: Declines to answer; 99 = Not Applicable
Al4TxNul,t
-g NEVER/ÞK/RÊF
ALCrx
05I04/99
SUDISQuestionnaire,
_ Hl4.
Have you ever been in treatment for problems with drug use?
No àGOTOH17
ÞRGTX
Yes
0
l_
89
H15. Are you currently in treatment for problems with drug use?
0
No )GOTOH16
1I
Yes ) GO TO H15a
1
ÞRGTXNOW
- I ñÉvEVÞK/Rrf uauO'-X
ì NEVËR/D</9
RÉFD¿USTX
) ÑoeuR'P'EJ'lr.Ë"iñow
scALE3 what kind of rrearmenris it? (rnterviewer:checkall rhat apply)
1) NA' 12steP
DRêTx't
-tRßiiãpill detox
- 2) Chemical,
(14,21,28day)
ÞRGrx3- 3) Methadone,
short-term
ÞReTxt{_ 4)
5)
Þf,er¡s-
program
Methadonemaintenance
specif, ÞRGTXSA
Residential,
ÞRc'D(bÞReTx7_
Non-methadoneOutpatient,speciS ÞRGTxbA
Other, speciff
ÞR6IX7A
6)
7)
H16. How many times altogether have you receivedtreatment for problems with drug use?
- q ruÉvre/ur</cer
uuro-x
Þ RG-rxr.{u1.4
IJsecodes: 77:Don't Know; &8'=Declinesto Answer; 00=Never
p1l7. Haveyou ever beentreatedfor any psychological
or emotionalproblems,not includingalcoholor drug
treatment?
MHT(
No à GO TO H19
0Yes
I
Dont know ) GO TO H19
8_
Declinesto answerà GO TO Hl9
9
H18. Are you currently receiving treatment for any psychologicalor emotional problems, not including alcohol or
drug treatment?
No
0_
Yes
1_
Don't know
8
9
Mt-lTxNOW
-gNeven/Þk/REFPsvcTx
Declines to answer
Hf9. Do you receivea pension(money)for a psychiatricdisability?
No
0
MHÞISAS
Yes
1_
Don't know
8
Declinesto answer
05I 04I99
SUDISQuestionnaire,
seriousdepression? MHÞÉPR
a. Experienced
0
I
9
b . Experiencedhallucinations? Y\HHAUI-UC
0
8
9
c. Had seriousthoughtsaboutsuicide?M t{SufTt-t
0
8
9
d. Attemptedsuicide?
0
8
9
0
8
9
MHSufåT
medications?
psychiatric
MHMEÞS
Beenprescribed
Different people participate in, and enjoy, different things. These questionsask about your involvement
and experiencesin various community and llfV-related activities, eventsand programs.
|fzl.
In the LAST
have
a. Attended a safer sex workshop.
PARTL{
Where?
PART4A; PARTqts
b. Wentto an HIV/AIDS supportgroup. PART5
Where? PARTEA; PART56
c. Participatedin individual,couples,or groupcounselingor therapyPARî-7
0
organization.PAR-II
d. Volunteeredat a community-based
0
Where? PARTBA,'PARTBB
program. PARTIq
e. Volunteeredat a needleexchange
Where? PABì'tgA/' PARTlqb
f. Workedwith a druguser'sorganization'PART2O
lilhere? PARfåon;
PARTJoÉ
g. Attendeda workshopor communityforumaboutHfV-relatedissues.PARTq
Where? PART9A; PAKTqB
h. Workedat a communityhealthfair. PARTg1
or injectingequipment.?AKfll
i. Taughtsomeonehow to cleantheir syringes/needles
l
1
0
j
Told someonewhereto getnewneedles.PAFfe3
k. Taughtsomeonehow to cleanan injectionsite.PART9q
needlesor syringesfor others.PARTÐ5
l. Exchanged
1
0
1
0
1
0
m. Gotteninvolvedin drugtreatmentor recovery.Plgfgø
n. Taushtsomeoneaboutsafersex. PARfg-t
1
0
1
0
0
H22. Haveyou everbeenin anotherresearchstudythat dealtwith HfV-relatedissueslike sex,drug use,or being
HfV positive?(Do not includeclinical triøls or otherstudiesthat lookedat the effectsof newHIV drugsor
treatments.)
HIVRSC\-\
N
o
_0)
l)
l-{IVRscHt; l{lVnscrrg.
Yes,speciff:
-
05/ 04/99
SUDISQuestionnaire,
FemaleSurveySectionI, pageI
This final section is a short set of general questionsabout you and your lifestyle. It also gives you an
opportunity to give me feedbackabout this interview or important issuesthat I may have overlooked.
I1.
What month and yearlvereyou born?
t2.
Which raciaVethnicgroupdo you belongto?
l) Africanameiican,glaðk of African Descent RACÉ9
-_ 2) AlaskanNative
Specifi: RACÉSPC2
3) AmericanIndian
Specifu:
Islander
4) AsianÆacific
Specifu:
s) Hispanic,Latino
6) White,Caucasian
Speciff:
7) Mixed heritage/race
Specifu:
8) Other
e) Unknown
13.
D SHOW SCALE: How much schoolhaveyou completed?
EÞttCA I
gradeschoolor less
_ 1) Completed
school
high
Some
_2)
_ 3) High schooldiplomaor GED
SomeCollege
_4)
Month:tsORN¡,tC Year:þQ(N!R
5) CollegeAssociatesdegree
6) Bachelorsdegree(BA or BS)
_7)
_ 8)
_ 9)
_10)
t4.
Technicalor tradeschool(alsoLPN)
Somegraduateor professionaleducationaftercollege(alsoRN)
Masters,degree
degree(e.g.,Ph.D.,M.D.,J.D.)
Doctoral,or otherprofessional
Are you currently employed? WORKS
_ 1)Yes
_O)No )GOTOI4b
l4a.
How manyhoursper weekdo you work?
1) 1-10hoursperweek
WoRKì1uCt{
-9 ¡¡o cup,r¿ËñT
EMP¡6yHÈNT
_2) 11-20hoursperweek
per
week
2l-30
hours
3)
_
_4) 31-40hoursperweek
_ 5) Over40 hoursperweek
I4b.
If UI{EMPLOYED: Are you on disability?
l) Yes
ÞrsAgrl
_
- g guR.RE¡lruYÊmPLùYED
No
_0)
|99
05104
SUDISQuestionnaire,
FemaleSurveySection1, page2
I4c.
D SHOW SCALE: How long have you currently been on disability or unemployed?
1) Lessthan6 months
UNEM¡orrtG
-q Cuep.ËNÍLYÊHPLOYEÞ
year
to
under
one
6
months
_2)
_ 3) I year to under 3 years
3 yearsto under 5 years
_4)
5)
5 years or more
_
Now I'm goingto read a list of thingsthat peopledo to get by, and askwhich onesyou have
donefor MOFIEY in the last 3 months.So,in the last3 months,haveyou evergottenany
MONEY from: (readlist and checkall that apply)
1) An officialtull-timejob
MoSEyl_
job
MoNÉyJ_ 2) An officialpart-time
Mo NEy3_ 3) A job whereyou didn'thaveto reportyour income(underthetable/underground)
MoNeYq _ Ð Welfare(GA, ADFC, TANF)
MoNEVS_ 5) SSIbenefit
MoruEya- 6) Otherdisabilitybenefits
\,{oXeyZ _ 7) Unemploymentbenefits
8) Sellingfood stamps
MoNE)B _
Panhandling
9)
l.,toUeVQ_
l0)
Hooking/tricking/prostitution
MoñËylg _
11) Othersexwork (stripping,exoticdancing,pornography)
HoñÈVil _
12) Drug sales(includingrunning)
Ho*¡Eylt _
illegal(includes
l3) Anythingelsethafsconsidered
boosting/shoplifting/etc.)
HONEyJS_
14) Anythingelse(specifuMoNEYSPI'
)
Houeyt { _
I4d.
I4e.
15.
your total yearly personalincomeBEFOREyou
D SHOW SCALE: \ilhich bestdescribes
were unemployedor on disability?
1) LessthanS5,000
_
INCO¡1666
2)
$5,000to $10,000-g CuReEñTLV
_
ÈHft-oyEÞ
to 79,999
_ 3) $10,000
_ 4) $20,000to29,999
_ 5) $30,000to 39,999
_ 6) $40,000to 49,999
_ 7) $50,000to 74,999
_ 8) $75,000or more
your total personalincomeduring the lastyear?
ù SHOW SCALE: Which bestdescribes
l) Lessthan$5,000^
IUCOì4Et
2) $5,000to $10,000
to 19,999
3) $10,000
4) $20,000to29,999
to39,999
5) $30,000
6) $40,000to 49,999
to 74,999
7) $50,000
8) $75,000or more
05/ 04/99
SUDISQuestionnaire,
FemaleSurveySectionI, page3
16. How would you describewhereyou live or your living circumstances?
or house)LiVtN g
_ 1) Household(apartment
Shelter
System
_2)
_ 3) Street
Squal Homeless
Encampment
_4)
_ 5) SingleRoomOccupancy
_ 6) other: LIVfNeoT
17. What do you consideryour religionto be?
_ 1) Baptist
of Christ
_2) Churches
_ 3) Disciplesof Christ
_4) Episcopal
_ 5) Lutheran
_ 6) Methodist
_7) Presbyterian
_ 8) United Churchof Christ
_ 9) Unitarian
_10) RomanCatholic
- ,/.
_11) EasternOrthodox
iff )----L
_lz)Other Catholi c (spec
_13)Jewish
R.gUÍ&9
LatterDay Saints
_14)
_ 15) Muslim/lvloslem
_ 16) Buddhist
Seventh
Day Adventist
_17)
18)
Pentecostal
_
Witness
_ 19) Jehovah's
Charismatic
_20)
ChristianScientist
_21)
Hindu
_22)
_25)
No religion/atheisVagnostic
I8.
How important is spiritualityor religionin your life?
1) Not at all important
_
RÉLIGIM'
2) Somewhatunimportant
_
3) Neitherimportantnor unimportant
_
4)
Somewhatimportant
_
5)
Very
important
_
19.
Do you consideryourself: @eadlist) 3ËLFID91) Straight,heterosexual
_
2)
Gay,queer,homosexual
_
Bisexual
3)
_
_ 4) None of the above,unsure
I10.
Do you know other peopleor have friends who are or have been a part of this study?
_0)No
_ 1) Yes
I11.
uY
FRÞSTt¡
Do you have any commentsthat could help us improve this questionnaire? Are there any questions
that didn't make senseor were hard to answer? Continue on the back of this page if necessary.
05/04199
SUDISQuestionnaire,
FemaleSurveySection7, page4
Il2.
Are there other importantissuesor thingsrelatedto beingHIV positivethat you think we've
missed? Continueon backof thispage if necessøry.
I13.
Is there anything elsethat you'd like for us to know or that you want to share with us? Continueon
back.
05I 041
99
SUDISQuestionnaire,
FemaleSurveySectionI, page5
I14.
How confidentdo you feelaboutthevalidity of this participant'sanswers?
confidenr
CôñFf ÞNT
_ l) Completely
Some
doubts
_2)
_ 3) No confidence,GfVE COMMENTSBELOW
I15.
Were you ableto completethe questionnaire?CoMPUETÉ
_ 0) No, GIVE COMMENTSBELOW
_ l) Yes
116.
What was the participant's ethnic affiliation based on visual examination?
1) African American, Black of African Descent
_
_
_
_
_
_
_
_
_
ll7.
2)
2\
3)
4)
5)
6)
7)
8)
9)
AlaskanNative
^*^-:^^- r-r:Âmericanlndian
AsianÆacifrc
Islander
Hispanic,Latino
White,Caucasian
Mixed heritage/race
Other
Unknown
VJEWR.ACE
Y'tLwtlt{uE
what was the participant's born gender basedon visual examination?
_
_
_
_
1) Male
2) Female
3) TransgenderFTM
4) Transgender
MTF
\,4EWGEND
INTERVIEWER'S COMMENTS
(e.g.any specialcircumstances
that would assistus interpretingthis questionnaire)
SUDISQuestionnair
e, 05/04I99
I

Female questionnaire - Center for AIDS Prevention Studies

Transcription

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