Looking Deeper into the HIV Epidemic: A questionnaire for Tracing Sexual Networks (Joint United Nations Programme on HIV/AIDS, 1998, 24 p.): 6. Collecting data

Looking Deeper into the HIV Epidemic: A questionnaire for Tracing Sexual Networks (Joint United Nations Programme on HIV/AIDS, 1998, 24 p.)

		(introduction...)
		1. Introduction
		2. The individual questionnaire for evaluation
		3. Risk networks: the need for research in sexual networks
		4. Implications for data collection methods
		5. Questionnaire design
		6. Collecting data
		7. Analysing the data
		8. Future research
		References
		Appendix - Multi-site study : questionnaire I - Men and Women

(introduction...)

UNAIDS

Acknowledgments

This questionnaire was developed with the assistance of J. Cleland, E. Konings and J. Anarfi and was finalized by M. Carael. It has benefitted from fruitful comments from the multi-site study team: A. Buve, M. Laga, R. Hayes, L. Williams, B. Auvert, N.J. Robinson, B. Ferry, M. Laourou, L. Kanhonou, P Huygens, E. Akam, S. Abega, T. Sukwa, F. Kaona, N. Ruthenberg and J. Shege. It was also reviewed by M. Morris.

UNAIDS/98.27

© Joint United Nations Programme on HIV/AIDS, 1998.All rights reserved. This publication may be freely reviewed, quoted, reproduced or translated, in part or in full, provided the source is acknowledged. It may not be sold or used in conjunction with commercial purposes without prior written approval from UNAIDS (contact: UNAIDS Information Centre - 20, avenue Appia - 1211 Geneva 27 - Switzerland or e-mail: [email protected]).

1. Introduction

The sexual network questionnaire appended hereto is similar in many respects to the prevention indicators questionnaire [1], the primary difference is that the new module asks for considerably more detail about each relationship the survey respondent participates in. While UNAIDS still enthusiastically endorses the use of the earlier package, especially for evaluating national programmes, the need for more insights into sexual networks for understanding the dynamics of the epidemic has become apparent

This new questionnaire is part of an attempt to gain those insights - it is recommended for use in countries where managers of AIDS programmes and researchers are primarily interested in gaining additional information on sexual mixing patterns for intervention purposes.

Population surveys have a central and valuable role to play in the measurement of two of the main determinants of the rate of HIV transmission: number of sexual partners and use of condoms during sexual intercourse. Measurement of these determinants over time is crucial for the evaluation of prevention programmes.

In recognition of that fact, WHO/GPA developed in 1994 a package entitled Evaluation of a national AIDS programme: A methods package-1. Prevention of HIV infection [1]

Among the array of methods to measure HIV/AIDS prevention-related indicators, a central place was given to repeated population surveys as a tool for better understanding of the sexual risk behaviours in the general population and of the impact of programme activities on those risk behaviours.

The GPA package gives a comprehensive overview of the design of population surveys and of the necessary steps to be undertaken in the planning of such surveys. There is detailed discussion of objectives; measurement of selected prevention indicators; questionnaire content and design; sampling; training of field staff and collection of data; data management, analysis and reporting; survey timetables; and in-country survey costs.

The methods package, including the population survey, has been used extensively over the four years since it was published. More than 30 countries have carried out geographically focused population surveys for evaluation purposes, while some 60 countries have used other parts of the package for evaluation of their own national programmes [2, 3]. This effort is expected to continue with the support of UNAIDS, cosponsors and bilateral and multilateral agencies. In particular, UNAIDS is encouraging repeated surveys that would allow monitoring of behaviour change over time.

National AIDS programmes around the world are currently using epidemiological fact sheets in which the prevention indicators are an essential element.

2. The individual questionnaire for evaluation

The questionnaire for the measurement of four prevention indicators [1] is divided into eight sections: identification; background characteristics; marriage and regular partnerships; non-regular and commercial sex; condoms; STDs and health issues; knowledge of AIDS; and risk perception, behaviour change and attitudes toward persons with HIV/AIDS.

The main purpose of the sections on marriage and sexual partners was to measure sexual risk behaviour for each individual respondent. The sequence of questions was carefully designed to progress from consideration of marriage to other regular partnerships and finally to more transient and potentially high risk sexual relationships. Clearly, these distinctions are multi-dimensional and complex. Any comprehensive classification would have to take into account not only the persistence of the relationship over time but also the associated expectations and obligations.

A blunt and somewhat oversimplified solution was reached: a regular partner was defined as a person with whom the respondent has a relationship involving sexual intercourse for a period of 12 months or more; anyone else is a non-regular partner. Among non-regular partnerships, a commercial sex encounter was defined as a relationship where sex was exchanged for money and where partners did not know each other [4].

The underlying principle was that the concept of non-regular partnerships can be conveyed clearly by interviewers only after careful definition and measurement of regular partnerships. Sexual intercourse within such regular relationships carries a low risk of HIV infection, provided that the partnership is mutually exclusive (and of course that neither party is already infected).

This questionnaire design has proved to be successful in identifying who was at increased risk of HIV, with what type of behaviour and where. These surveys have been very informative for the evaluation and development of prevention strategies. However, programme designers and researchers may want to go beyond those objectives and be interested in better explaining why, within the same “risk behaviour” groups, certain people are more likely to be HIV infected than others. Insights into that question will require information on how different individuals are connected via risk networks.

3. Risk networks: the need for research in sexual networks

Mathematical models show that different patterns of sexual mixing have widely different implications for the spread of the HIV epidemic [5, 6, 7]. If people mix within relatively closed groups - homosexuals only with homosexuals, married people only with their partners or other married people, prostitutes only with a well defined group of individual clients - HIV may spread quickly within some of the groups but will have a limited impact on the population as a whole. But if there is much more mixing between groups, with injecting drug users having sex with prostitutes, whose clients have sex with their own wives, for instance, the disease may take off slowly but will insinuate itself into many more corners of society. Bridge populations, which form a link between otherwise unconnected groups, may be of particular importance for the dynamic of the epidemic by linking low and high risk behaviour populations.

Population surveys such as those recommended by WHO/GPA and UNAIDS have brought better knowledge of high risk groups and high risk behaviours. However, people are put at risk not just by their own behaviour but by that of others to whom they are linked in sexual networks. Policy makers should, from the shape of these networks, be able to identify useful points for intervention. It is up to social scientists to identify how sexual networks are spread across the society, by whom and why.

Thus, with the move from evaluation as the primary objective to that of more in-depth understanding of sexual networks, there is also a shift to an analytical framework that makes partnerships rather than individuals the primary unit of analysis [7]. Individual-based approaches explain behaviours by noting the characteristics of the individual: attitudes, knowledge, beliefs and education; while partnership-based approaches will try to explain behaviours by noting the characteristics of the relationship: its duration, mutual expectations or gender roles, for example.

4. Implications for data collection methods

Ideally, for a better understanding of the nature of these networks, information should be collected on every sexually active person and every relationship in the population at risk. This would require respondents to identify their partners so that each partnership could be uniquely identified. That approach would raise serious issues with regard not only to practicability but also to privacy and confidentiality.

By contrast, local network data require only information collected from a representative sample of respondents on selected attributes for each sexual partner in a given period. This is the approach that is proposed in the new UNAIDS sexual networks questionnaire.

5. Questionnaire design

Each eligible respondent is asked to report on a list of characteristics about themselves and their partners. No contact tracing is needed, nor are the partners named. Table 1 shows the characteristics asked about in the questionnaire.

Table I - Attributes asked about in the sexual network module

Respondent’s characteristics	Relationship attributes	Partners’ characteristics
Gender	Type of relationship	Gender
Age	Duration of relation	Age
Education	Living arrangement	Education
Literacy	Frequency of sex	Ethnic group
Ethnic group	Use of condoms	Marital status
Religion	Place of first sex	Number of other sexual partners
Place of origin	Duration of relationship before first sex
Place of residence	Ongoing or ended relation
Marital status	Number of sexual acts
Mobility	Exchange of money
Occupation
Age at first marriage
Age at first sex
Number of sexual partners

A key issue is the question of how many partnerships to collect information on. The decision has been to ask respondents about their partnerships in the last 12 months to a maximum of eight relationships, starting with the most recent and going back in time. This is probably a maximum and may be not justified everywhere.

The questionnaire consists of a short form gathering information about the household of the respondent, then questions for the individual her/himself: identification, background characteristics, marriage(s), sexual relations with other partners and questions relating to STDs and other health issues such as contraception. Questions about income level may be added in some settings, although they are usually very sensitive. Other questions useful for prevention programmes might seek to determine where the respondents meet their sexual partners.

6. Collecting data

This new sexual network module in the questionnaire is relevant for researchers and managers who want to have a better understanding of the dynamics of the HIV epidemic in a context where heterosexual transmission is predominant. For evaluation purposes, though, the standard questionnaire [1] is still recommended. Note that the general design of the population survey is still the same and that all the sections in the methods package on sampling, sample size and other issues remain quite useful.

Five teams of investigators have already applied this new module in Dakar, Senegal; Cotonou, Benin; Lusaka, Zambia; Kisumu, Kenya and Yaounde, Cameroon, with technical support from UNAIDS. Biological information on HIV infection and on STDs has also been collected at these sites.

It should be noted that although the makeup of the teams collecting behavioural data is essentially the same as for the earlier questionnaire, more training will be needed for the application of this new network module, and data analysis is also more complex. The average budget of US$ 30,000 for the survey should be increased by 15% to take into account increased efforts in training, a longer average time for interviews and more time spent on data analysis and report writing. UNAIDS and its partners stand ready to provide technical assistance in, for example, identifying consultants to help with training in both the administration of the survey and subsequent analysis of data.

7. Analysing the data

Analysing the data collected with the sexual network questionnaire is somewhat more complicated than for the prevention indicators questionnaire. Skills in both computation and data analysis will be essential for any research group implementing the survey. The question of how to simplify the data analysis is being studied and will, it is hoped, be clearer after completion of the five-city survey now being undertaken. Comparisons of the data from those surveys may give insights into which facts are most useful, and how to most straightforwardly extract them from the data collected.

8. Future research

Ultimately, it is expected that the information gained from this questionnaire will give pointers to where in the population interventions can most usefully be made. If we can see more clearly the web of infections making up the epidemic, it should be possible identify the intersections in the web, where there is particular danger or likelihood of HIV transmission, and focus our attention there.

References

1 Global Programme on AIDS (WHO/GPA). Evaluation of a National AIDS Programme: A methods package. Geneva: World Health Organization; 1994.

2 Mertens T, Carael M, Sato R et al. Prevention indicators for evaluating the progress of National AIDS Intervention Programmes. AIDS 1994; 8:1359-69.

3 Mehret M, Mertens TE, Carael M, et al. Baseline for the evaluation of an AIDS programme using prevention indicators: a case study in Ethiopia. Bulletin of the World Health Organization 1996; 74:509-16.

4 Carael M. Sexual behaviour. In:Cleland J, Ferry B, editors. Sexual behavior and AIDS in the developing world. London: Taylor and Francis; 1995. p.75-123.

5 Anderson RM, May RM, Boily MC, Garnett GP, Rowley JT. The spread of HIV-1 in Africa: sexual contact patterns and the predicted demo-graphic impact of AIDS. Nature 1991; 352:581-9.

6 Hudson CP Concurrent partners and the results of the Ugandan Rakai Project. AIDS 1993; 7:286-8.

7 Morris M. Sexual networks and HIV. AIDS 1997; 11(suppl. A):S209-16.

(introduction...)

Multi-site study : questionnaire I - Men and Women

Part A: Household form

HOUSEHOLD IDENTIFICATION
001	City name	________________________________
002	Cluster Number	________________________________
003	Household/Dwelling number	________________________________
004	INTERVIEW VISITS
		Visit 1	Visit 2	Visit 3
	Date	________	_________	________
	Interviewer	________	_________	________
	Result*	________	_________	________
	Result codes*
	Completed	1
	No one at home	2
	Refused	3
	Household away for duration of survey	4
	Dwelling vacant or address not a household	5
	Dwelling not found	6
	Postponed	7
	Other (Specify)	8	--------------------------------
005	ID NO.	________________________________
	Facilities Available in the Cluster
	All -Weather Road		Yes	No
	Health centre/hospital		Yes	No
	Trading centre (market)		Yes	No
	Electricity		Yes	No
	Running Water		Yes	No
	Hotel/Bar/Boarding house		Yes	No

HOUSEHOLD MEMBERS FORM

Enquire about anyone else aged 15 years or over (including non-family members) who slept in the household last day or night (e.g. servants, lodgers).

"Now I would like some information about the persons aged 15 years or over who usually live in this household. First what is the given name of the head of household?" [Record in line 01]

Initials of first name	Relationship	From line __ & line __	Sex		Age	Slept here last day or night		Eligibility Aged (15-49 who slept there)
			M	F		Y	N
Usual household members
01 Head	___________	____&____			____			_________
02 ______	___________	____&____			____			_________
03 ______	___________	____&____			____			_________
04 ______	___________	____&____			____			_________
05 ______	___________	____&____			____			_________
06 ______	___________	____&____			____			_________
07 ______	___________	____&____			____			_________
08 ______	___________	____&____			____			_________
09 ______	___________	____&____			____			_________
10 ______	___________	____&____			____			_________
11 ______	___________	____&____			____			_________
12 ______	___________	____&____			____			_________










All others
21 ______	___________	____&____			____			_________
22 ______	___________	____&____			____			_________
23 ______	___________	____&____			____			_________

Part B: Individual questionnaire (for adults aged 15-49 who slept in the household)

SECTION 1: HOUSEHOLD IDENTIFICATION

101	City name	___________________________________
102	Cluster number	___________________________________
103	Household/Dwelling number	___________________________________
104	Respondent’s initial and line number	___________________________________
105	Interviewer code	________________________________
106	INTERVIEW VISITS (INDIVIDUALS)
		Visit 1	Visit 2	Visit 3
	Date
	Interviewer
	Result*
	Result codes*
	Completed	1
	Not at home	2
	Refused	3
	Partially completed	4
	Other (specify)	8 ________
107	Checked by supervisor	ID No.	__________
		Signature	__________
		Date	__________

SECTION 2: BACKGROUND CHARACTERISTICS

N°	Questions and filters	Coding categories		Skip to
Q201	Record sex of respondent	Male	1
		Female	2
Q202	How old are you? [PROBE FOR BEST ESTIMATE]	Age ___
Q203	Have you ever attended school? If Yes: What was the highest level that you have completed?	Primary	1	® Q205
		Secondary	2	® Q205
		Higher	3	® Q205
		Primary not completed	4
		Never	5
Q204	Can you read a newspaper or letter?	YES	1
		NO	2
Q205	What is your Religion?	Protestant	1
		Catholic	2
		Muslim	3
		Traditional	4
		No religion	5
		Other	6
Q206	Which ethnic group you belong to? ____________________________	________
Q207	Where were you born? (write down the district/country)	Same city	1
		Other urban area	2
		Rural area	3
		Other countries	4
Q208	How long have you stayed in this city?	Years ___
	Since birth, enter 98 and skip to Q210	Months ___
	If less than 1 month ENTER 00
Q209	Where were you before? (location) ____________________________	Same city	1
		Other urban	2
		Rural	3
		Other country	4
Q209B	Why did you move? (main reason) ___________________________	Marriage	1
		Family move	2
		Work	3
		Visit	4
		School	5
		Other	6
Q210	How many years or months you intend to live in this city?	Years ___
		Months ___
	Forever, ENTER 97
	Do not know, ENTER 96
Q211	In the last 12 months, that is since last ____, how many trips more than one night did you have outside this city? [PROBE]	Number ___
	If less than 1 year in the city, ENTER 98
Q212	Altogether how many days, or weeks, or months, were you away from home in last 12 months?	Days___
		Weeks___
		Months___
Q213	What is your usual occupation?	Fishing	0
	[PROBE: What kind of work do you do most of your time? record verbatim and then the code]	Farmer, works in agriculture, forestry, fishing	1
		Soldier, Policeman	2
		Driver	3
		Manual worker	4
		Sales, service workers	5
		Clerical	6
		Professional managerial	7
		No employment (housework, student, unemployed)	8
		Other	9
Q214	Are you now? [READ OUT]	Regularly employed full time	1
		Employed seasonally or on a day to day basis	2
		Self employed	3
		Unemployed/looking for Work	4
		A homemaker with some part-time work outside	5
		A homemaker with no other work outside	6
		A student	7
		Retired or disabled	8
		Other	9
Q215	Did you have drinks containing alcohol in last four weeks?	YES	1	® Q301
		NO	2
Q216	How often did you have drinks containing alcohol in last four weeks? Would you say? [READ OUT]	At least once a day	1
		At least once a Week	2
		Less than once a Week	3

SECTION 3: MARRIAGE

Marriage may involve a legal arrangement, a religious ceremony or customary celebration. It may also be an informal union in which a man and woman live together and regard themselves as married. Thus by spouse, we mean married or living as married.

N°	Questions and filters	Coding categories		Skip to
Q301	Have you ever been Married or lived as Married?	YES	1	® Q303
		NO	2
Q302	Have you ever had penetrative sexual intercourse? [PROBE]	YES	1	® Q321
		NO	2	® Q515
Q303	Are you now married, or living as married, single, separated, divorced, or widowed?	Married	1	® Q317
		Single	2	® Q317
		Separated/Divorced	3	® Q317
		Widowed	4
Q304	[MEN] Do you have more than one spouse? [WOMEN] Does your have other spouses?	YES	1	® Q306
		NO	2
Q305	If YES: How many spouses in total now?	Number ____

For each current spouse, ask Q306 to Q316

Now I am going to ask you more details about your current spouse(s): Firstly, what are the initials of your current spouse? (see below)

		Spouse(s)
		1	2	3	4
	Questions
N°	First name initials	----	----	----	----
Q306	Is it a customary, civil, religious, or consensual union?	1	1	1	1
	Customary
	Civil	2	2	2	2
	Religious	3	3	3	3
	Consensual	4	4	4	4
Q307	How long have you been married or living as married with this spouse? Years	___	___	___	___
	IF LESS THAN 1 YEAR, ENTER 00
Q308	How old is he/she? [PROBE] YEARS	___	___	___	___
Q309	Do you usually live together in the same house/compound?
	If YES:, SKIP to 311
	YES	1	1	1	1
	NO	2	2	2	2
Q310	If NO, where does he/she usually live?
	Same city	1	1	1	1
	Other city	2	2	2	2
	Rural	3	3	3	3
	Abroad	4	4	4	4
Q311	Do you have children with this spouse?
	If NO, SKIP to 314
	YES	1	1	1	1
	NO	2	2	2	2
Q312	How old is your youngest one?
	YEARS	___	___	___	___
	MONTHS	___	___	___	___
	If YEARS, SKIP to Q314
Q313	If child is less than 12 MONTHS, have you resumed sex with the spouse since the birth of the child?
	YES 1	___	___	___	___
	NO 2
Q314	How many days since you had last sexual act with this spouse?	___	___	___	___
	Within last 30 days, ENTER 0-30
	More than 30 days, but within last year, ENTER 95 and SKIP to Q316
	More than one year, ENTER 96 and SKIP to Q306 for next spouse
Q315	IF WITHIN THE LAST 30 DAYS, how many times did you have sex with this spouse in the last week?	___	___	___	___
Q316	Did you use a condom with him/her in the past 12 months? If YES, how often?	1	1	1	1
	Always	2	2	2	2
	Often	3	3	3	3
	Half of the time	4	4	4	4
	Rarely	5	5	5	5
	Never
	IF MORE THAN ONE SPOUSE, GO BACK TO Q306
Q317	(Now think back to the past). Apart from this/these spouse(s), how many persons have you been married to you in your whole life time?	__________________
Q318	How old were you when you got first married?	__________________
Q319	How old was your first spouse at that time?	__________________
Q320	How many different sexual partners did you have penetrative sex with (before you first got married)?	__________________
Q321	How old were you when you had penetrative intercourse for the first time?	__________________
Q322	How many different sexual partners did you have penetrative sex up to now? [PROBE]	__________________

SECTION 4 SEXUAL RELATIONS WITH OTHER PARTNERS THAN SPOUSES

“Now I would like to ask you a few questions about other partners that you may have had in the last 12 months that is since....”

N°	Questions	Coding categories		SKIP to
Q401	Have you had sexual intercourse with anyone else in the last 12 months? (other than a spouse)? [PROBE: Please include the following people that you might have sex with: mistresses, girlfriends, casual partners, prostitutes, somebody else that you may have met in bars, during special events such as wedding etc.]	YES	1	® Q502 [MEN]
		NO	2	® Q517 [WOMEN]
Q402	With how many different people have you had sexual intercourse with in last 12 months (apart from spouse(s)	Number	___

“I would like to know more about these sexual partners, beginning with the most recent one you had sex with. What was his/her initials?” (For each sex partner, ask Q403 to Q421)

Questions		Sexual Partner(s)
N^o	Initial’s or Don’t know (DK)	1	2	3	4	5	6	7	8
Q403	How would you describe your relationship in local terms?	___	___	___	___	___	___	___	___
Q404	What educational level has he/she completed?
	Primary	1	1	1	1
	Secondary	2	2	2	2
	Higher	3	3	3	3
	Primary not completed	4	4	4	4
	None	5	5	5	5
	DK	6	6	6	6
Q405	How old is he/she? [PROBE]	___	___	___	___	___	___	___	___
Q406	Is he/she married, divorced, widowed, separated, single?
	Married	1	1	1	1	1	1	1	1
	D/S/W	2	2	2	2	2	2	2	2
	Single	3	3	3	3	3	3	3	3
	DK	4	4	4	4	4	4	4	4
Q407	Which ethnic group does he/she belong to?	___	___	___	___	___	___	___	___
Q408	Where did you have sex first time with her? [SKIP TO Q411]	1	1	1	1	1	1	1	1
	Same city	2	2	2	2	2	2	2	2
	Other urban area	3	3	3	3	3	3	3	3
	Rural Area
Q409	[IF OUTSIDE THIS CITY] Why were you there? Was It for [READ OUT]
	Professional Reasons	1	1	1	1	1	1	1	1
	Family Reasons	2	2	2	2	2	2	2	2
	Economic Reasons	3	3	3	3	3	3	3	3
	Others (Specify)	4	4	4	4	4	4	4	4
Q410	[IF OUTSIDE THE CITY] How long did you have stayed in that place?
	Days	___	___	___	___	___	___	___	___
Q411	How long did you know him/her before having sexual relation?
	Months	___	___	___	___	___	___	___	___
	Days	___	___	___	___	___	___	___	___
	· If more than 5 years ENTER 99
	· If less than one year ENTER 00
Q412	Are these sexual relations currently going on or has sexual relations ended?
	Relationship going on	1	1	1	1	1	1	1	1
	Relationship Ended	2	2	2	2	2	2	2	2
	Do not Know	3	3	3	3	3	3	3	3
Q413	[IF CURRENT RELATION] How many times in the last month did you have sex with this person?	___	___	___	___	___	___	___	___
Q414	[IF ENDED OR DK] How many times did you have sex with him/her in the last year ?	___	___	___	___	___	___	___	___
Q415	[IF ENDED] How many months ago did it finish?
	Months	___	___	___	___	___	___	___	___
Q416	How long did the relationship Last? (I mean how long was it between the first time you had sex and the last time?) [IF Less Than I Day, ENTER 00]
	Days	___	___	___	___	___	___	___	___
	Months	___	___	___	___	___	___	___	___
Q417	In your last intercourse with him/her did you use a condom?	1	1	1	1	1	1	1	1
	YES	2	2	2	2	2	2	2	2
	NO
Q418	Usually did you use a condom with him/her? [READ OUT]
	Always	1	1	1	1	1	1	1	1
	Most of the time	2	2	2	2	2	2	2	2
	Rarely	3	3	3	3	3	3	3	3
	Never	4	4	4	4	4	4	4	4
Q419	Did you receive/give money in exchange for sex with him/her?
	YES always	1	1	1	1	1	1	1	1
	YES often	2	2	2	2	2	2	2	2
	Never	3	3	3	3	3	3	3	3
Q420	Do you think that over the last year, apart from you, he/she has sex with [READ OUT]
	Steady partner: Yes: 1 No: 2 Dk:3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3
	Casual partner Yes: 1 No: 2 Dk: 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3
	Others with exchange of money Yes: 1 No: 2 Dk: 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3	1 2 3
Q421	If you took a guess how many Partners do you think he/she had in the past 12 months? (apart from you)?	___	___	___	___	___	___	___	___

Please go back to Q403 for other partners

SECTION 5: STDs AND HEALTH ISSUES

N°	Questions and filters	Coding categories		Skip to
Q501	MEN ONLY	WOMEN SKIP TO		® Q517
Q502	Now I would like to ask you Some question about your health in the last 12 months. Some men experience pain during urination or have a discharge from the penis. During the last 12 months have you noticed any pain or discharge?	Number____
	If YES: How many episodes started in the last 12 months?
	If NONE, ENTER 00
Q503	At present do you have any pain when passing urine?	YES	1	® Q505
		NO	2
Q504	For how long do you have this pain?	DAYS___
Q505	In the last 24 hours did you have any discharge from the penis?	YES	1	® Q507
		NO	2
Q506	For how long did you have this discharge?	DAYS___
Q507	Some men experience sores in the genital area. During the last 12 months have you noticed any such sores?	Number___
	If YES, how many episodes started in the last 12 months?
	If none Enter 00
Q508	At present do you have any sores on the genital area? Are they painful?	YES without pain	1	® Q510
		YES painful	2
		NO	3
Q509	For how long do you have these sores?	Days___
Q510	Filter: SEE Q502 TO Q508 ONE OR MORE EPISODES	NO EPISODE SKIP To		® Q515
Q511	Which of the following did you do for the last episode? [READ OUT]
	Sought advice from friend or relative	YES	1
		NO	2
	Used medicine that you had at home	YES	1
		NO	2
	Sought advice from a traditional healer	YES	1
		NO	2
	Sought advice from a clinic, hospital, or a health worker	YES	1
		NO	2
	Obtained free drugs from a clinic, hospital, or a health worker	YES	1
		NO	2
	Bought medicines from a clinic, a hospital, or a health worker	YES	1
		NO	2
	Bought medicine from traditional healer	YES	1
		NO	2
	Bought medicine from a pharmacy or shop	YES	1
		NO	2
	Nothing	YES	1
		NO	2
	Other (specify)
Q512	Did you tell (any of) your spouse(s) or partner(s) about this last episode?	YES	1
		NO	2
Q513	While you had the symptoms, did you do anything to prevent passing the infection to(any of) your spouse(s) or partner(s)? (Seeking treatment excluded)	YES	1	® Q515
		NO	2
Q514	If yes, what did you do?	Abstain from sex	1
		Use a condom	2
		Other	3
Q515	Are you circumcised? (use local terms for operation)	YES	1	® Q600
		NO	2
Q516	How old were you when you circumcised?	Years	___
Q600	Eventually, would you accept to be asked 5 or 10 questions for further clarification? Comments	YES	1
		NO	2

Women Only

Q517	In the last 12 months did you have sex during menstruation (with any of your partners)?	YES	1
		NO	2
Q518	Are you currently doing something or using any method to delay or avoid pregnancy?	YES	1	® Q520
		NO	2	® Q520
		Pregnant	3
Q519	If yes, which method you are using?	Pill	1
		IUD	2
		Injections	3
		Diaphragm/Foam/Jelly	4
		Condom	5
		Calendar/safe period	6
		Withdrawal	7
		Sterilization	8
		Other	9
Q520	Do you actually use something to tighten or dry your vagina before sexual intercourse?	Always		® Q600
		Often
		Rarely
		Never
Q521	If YES, what do you use? ----------------------