Looking Deeper into the HIV Epidemic: A questionnaire for Tracing Sexual Networks (Joint United Nations Programme on HIV/AIDS, 1998, 24 p.): Appendix - Multi-site study : questionnaire I - Men and Women: Part B: Individual questionnaire (for adults aged 15-49 who slept in the household)

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

Appendix - Multi-site study : questionnaire I - Men and Women

		(introduction...)
		Part A: Household form
		Part B: Individual questionnaire (for adults aged 15-49 who slept in the household)

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? ----------------------