looking deeper into the hiv epidemic: a questionnaire for

Looking deeper intothe HIV epidemic:

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Con t e n t s

1. Introduction.........................................................................................................................................................................................................................32.The individual questionnaire for evaluation......................................................................................................................33. Risk networks: the needs for research in sexual networks ..................................................................44. Implications for data collection methods............................................................................................................................55. Questionnaire design ...........................................................................................................................................................................................56. Collecting data ................................................................................................................................................................................................................67.Analysing the data ......................................................................................................................................................................................................68. Future research .............................................................................................................................................................................................................7References ...................................................................................................................................................................................................................................7

Append i x : Mult i -s i te study

Par t A : Household form ....................................................................................................................................................................................8

Pa r t B : Individual questionnaire..........................................................................................................................................................10

1. Identification ...................................................................................................................................................................................................................10

2. Background characteristics.....................................................................................................................................................................11

3. Marriage.................................................................................................................................................................................................................................14

4. Sexual relations with other partners than spouses........................................................................................17

5. STDs and health issues .................................................................................................................................................................................21

U N A I D S B E S T P R A C T I C E C O L L E C T I O N

Acknow l edgmen t s

This questionnaire was developed with the assistance ofJ. Cleland, E. Konings and J. Anarfi and was finalized byM. Caraël. It has benefitted from fruitful comments fromthe 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 alsoreviewed by M. Morris.

UNAIDS/98.27 ©Joint United Nations Programme on HIV/AIDS, 1998. All rights reserved. This publication may befreely 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 fromUNAIDS (contact: UNAIDS Information Centre – 20, avenue Appia – 1211 Geneva 27 – Switzerlandor e-mail: [email protected]).

U N A I D S Looking deeper into the HIV epidemic

3

This new questionnaire is part of anattempt to gain those insights�it isrecommended for use in countrieswhere managers of AIDS programmesand researchers are primarily interestedin gaining additional information onsexual mixing patterns for interventionpurposes.

Population surveys have a central andvaluable role to play in the measurementof two of the main determinants of therate of HIV transmission: number of sex-ual partners and use of condoms duringsexual intercourse. Measurement of thesedeterminants over time is crucial for theevaluation of prevention programmes.

In recognition of that fact, WHO/GPAdeveloped in 1994 a package entitledEvaluation of a national AIDS programme:A methods package�1. Prevention of HIVinfection [1].

Among the array of methods to measureHIV/AIDS prevention-related indicators,a central place was given to repeatedpopulation surveys as a tool for betterunderstanding of the sexual risk behav-iours in the general population and ofthe impact of programme activities onthose risk behaviours.

The GPA package gives a comprehensiveoverview of the design of populationsurveys and of the necessary steps to beundertaken in the planning of such sur-veys. There is detailed discussion of objec-tives; measurement of selected preven-tion indicators; questionnaire content anddesign; sampling; training of field staffand collection of data; data manage-ment, analysis and reporting; surveytimetables; and in-country survey costs.

The methods package, including thepopulation survey, has been used exten-sively over the four years since it waspublished. More than 30 countries havecarried out geographically focused popu-lation surveys for evaluation purposes,while some 60 countries have used otherparts of the package for evaluation oftheir own national programmes [2, 3].This effort is expected to continue withthe support of UNAIDS, cosponsors andbilateral and multilateral agencies. In par-ticular, UNAIDS is encouraging repeatedsurveys that would allow monitoring ofbehaviour change over time.

National AIDS programmes around theworld are currently using epidemiologicalfact sheets in which the prevention indi-cators are an essential element.

The sexual networkquestionnaire appended

hereto is similar in manyrespects to the preventionindicators questionnaire

[1]; the primary differenceis that the new module asksfor considerably more detailabout each relationship the

survey respondentparticipates in.

While UNAIDS still enthusiastically

endorses the use of the earlier package,

especially for evaluatingnational programmes, theneed for more insights into

sexual networks for understanding

the dynamics of the epidemic

has become apparent.

1 . In t roduc t i on

2. The ind iv idua l quest ionna i re for eva luat ion

3

The questionnaire for the measurementof four prevention indicators [1] is di-vided into eight sections: identification;background characteristics; marriageand regular partnerships; non-regularand commercial sex; condoms; STDs andhealth issues; knowledge of AIDS; andrisk perception, behaviour change andattitudes toward persons with HIV/AIDS.

The main purpose of the sections onmarriage and sexual partners was tomeasure sexual risk behaviour for eachindividual respondent. The sequence ofquestions was carefully designed toprogress from consideration of marriageto other regular partnerships and finallyto more transient and potentially highrisk sexual relationships. Clearly, these

distinctions are multi-dimensional andcomplex. Any comprehensive classifica-tion would have to take into account notonly the persistence of the relationshipover time but also the associated expec-tations and obligations.

A blunt and somewhat oversimplifiedsolution was reached: a regular partnerwas defined as a person with whom therespondent has a relationship involvingsexual intercourse for a period of 12months or more; anyone else is a non-regular partner. Among non-regularpartnerships, a commercial sex encounterwas defined as a relationship where sexwas exchanged for money and wherepartners did not know each other [4].

The underlying principle was that theconcept of non-regular partnerships canbe conveyed clearly by interviewers onlyafter careful definition and measurement

of regular partnerships. Sexual inter-course within such regular relationshipscarries a low risk of HIV infection, pro-vided that the partnership is mutuallyexclusive (and of course that neitherparty is already infected).

This questionnaire design has proved tobe successful in identifying who was atincreased risk of HIV, with what type ofbehaviour and where. These surveyshave been very informative for the eval-uation and development of preventionstrategies. However, programme design-ers and researchers may want to gobeyond those objectives and be interest-ed in better explaining why, within thesame �risk behaviour� groups, certainpeople are more likely to be HIV infect-ed than others. Insights into that ques-tion will require information on how dif-ferent individuals are connected via risknetworks.

4

Mathematical models show that differ-ent patterns of sexual mixing have wide-ly different implications for the spread ofthe HIV epidemic [5, 6, 7]. If people mixwithin relatively closed groups�homo-sexuals only with homosexuals, marriedpeople only with their partners or othermarried people, prostitutes only with awell defined group of individual clients�HIV may spread quickly within some ofthe groups but will have a limited impacton the population as a whole. But if thereis much more mixing between groups,with injecting drug users having sex withprostitutes, whose clients have sex withtheir own wives, for instance, the diseasemay take off slowly but will insinuateitself into many more corners of society.Bridge populations, which form a link

between otherwise unconnected groups,may be of particular importance for thedynamic of the epidemic by linking lowand high risk behaviour populations.

Population surveys such as those recom-mended by WHO/GPA and UNAIDShave brought better knowledge of highrisk groups and high risk behaviours.However, people are put at risk not justby their own behaviour but by that ofothers to whom they are linked in sexu-al networks. Policy makers should, fromthe shape of these networks, be able toidentify useful points for intervention. Itis up to social scientists to identify howsexual networks are spread across thesociety, by whom and why.

3. R isk networks : the need for research in sexual networks

Ideally, for a better understanding of thenature of these networks, informationshould be collected on every sexuallyactive person and every relationship inthe population at risk. This would requirerespondents to identify their partners sothat each partnership could be uniquelyidentified. That approach would raiseserious issues with regard not only to

practicability but also to privacy and con-fidentiality.By contrast, local network data requireonly information collected from a repre-sentative sample of respondents onselected attributes for each sexual part-ner in a given period. This is theapproach that is proposed in the newUNAIDS sexual networks questionnaire.

Thus, with the move from evaluation asthe primary objective to that of more in-depth understanding of sexual networks,there is also a shift to an analyticalframework that makes partnershipsrather than individuals the primary unitof analysis [7]. Individual-based approach-es explain behaviours by noting the char-

acteristics of the individual: attitudes,knowledge, beliefs and education; whilepartnership-based approaches will try toexplain behaviours by noting the charac-teristics of the relationship: its duration,mutual expectations or gender roles, forexample.

Each eligible respondent is asked to report on a list

of characteristics aboutthemselves and their partners.No contact tracing is needed,nor are the partners named.

Table 1 shows thecharacteristics asked about in

the questionnaire.


5

4. Impl i cat ions for data co l lec t ion methods

5 . Quest ionna i re des ign

Table 1 � 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 manypartnerships to collect information on.The decision has been to ask respondentsabout their partnerships in the last 12months to a maximum of eight relation-ships, starting with the most recent andgoing back in time. This is probably amaximum and may be not justified eve-rywhere.

The questionnaire consists of a short formgathering information about the house-

hold of the respondent, then questions forthe individual her/himself: identification,background characteristics, marriage(s),sexual relations with other partners andquestions relating to STDs and other heal-th issues such as contraception. Questionsabout income level may be added in somesettings, although they are usually verysensitive. Other questions useful for pre-vention programmes might seek to deter-mine where the respondents meet theirsexual partners.

This new sexual network module in thequestionnaire is relevant for researchersand managers who want to have a bet-ter understanding of the dynamics of theHIV epidemic in a context where hetero-sexual transmission is predominant. Forevaluation purposes, though, the stan-dard questionnaire [1] is still recom-men-ded. Note that the general design of thepopulation survey is still the same andthat all the sections in the methods pac-kage on sampling, sample size and otherissues remain quite useful.

Five teams of investigators have alreadyapplied this new module in Dakar,Senegal; Cotonou, Benin; Lusaka, Zambia;Kisumu, Kenya and Yaoundé, Cameroon,with technical support from UNAIDS.Biological information on HIV infection

and on STDs has also been collected atthese sites.

It should be noted that although the make-up of the teams collecting behaviouraldata is essentially the same as for theearlier questionnaire, more training willbe needed for the application of this newnetwork module, and data analysis is alsomore complex. The average budget of US$30,000 for the survey should be increasedby 15% to take into account increasedefforts in training, a longer average timefor interviews and more time spent ondata analysis and report writing. UNAIDSand its partners stand ready to providetechnical assistance in, for example, iden-tifying consultants to help with training inboth the administration of the survey andsubsequent analysis of data.

Analysing the data collected with thesexual network questionnaire is some-what more complicated than for the pre-vention indicators questionnaire. Skills inboth computation and data analysis will

be essential for any research groupimplementing the survey. The questionof how to simplify the data analysis isbeing studied and will, it is hoped, beclearer after completion of the five-city

6

6. Co l lec t ing data

7. Analys ing the data

survey now being undertaken.Comparisons of the data from those sur-veys may give insights into which facts

are most useful, and how to moststraightforwardly extract them from thedata collected.

Ultimately, it is expected that the infor-mation gained from this question-nairewill give pointers to where in the popu-lation interventions can most usefully bemade. If we can see more clearly theweb of infections making up the epide-

mic, it should be possible identify theintersections in the web, where there isparticular danger or likelihood of HIVtransmission, and focus our attentionthere.

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

2 Mertens T, Caraël M, Sato P, et al.Prevention indicators for evaluatingthe progress of National AIDSIntervention Programmes. AIDS 1994;8:1359�69.

3 Mehret M, Mertens TE, Caraël M, etal. Baseline for the evaluation of anAIDS programme using preventionindicators: a case study in Ethiopia.Bulletin of the World HealthOrganization 1996; 74:509�16.

4 Caraël M. Sexual behaviour. In:Cleland J, Ferry B, editors. Sexualbehavior and AIDS in the developingworld. London: Taylor and Francis;1995. p. 75�123.

5 Anderson RM, May RM, Boily MC,Garnett GP, Rowley JT. The spread ofHIV-1 in Africa: sexual contact pat-terns and the predicted demo-graphicimpact of AIDS. Nature 1991;352:581�9.

6 Hudson CP. Concurrent partners andthe results of the Ugandan RakaiProject. AIDS 1993; 7:286�8.

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


7

8. Fu ture research

Re f e r ence s

H O U S E H O L D I D E N T I F I C A T I O N

City name ........................................................................................................................................................................................

Cluster number

Household/dwelling number

INTERV I EW V I S I T S

Vis i t 1 Vis i t 2 Vis i t 3

Da t e ............................................ ............................................ ............................................

I n t e r v i ewe r ............................................ ............................................ ............................................

Resu l t* ............................................ ............................................ ............................................

Result codes*Completed 1

No one at home 2Refused 3

Household away for duration of survey 4Dwelling vacant or address not a household 5

Dwelling not found 6Postponed 7

Other (specify) 8 ....................................................................................................

ID No.Facilities available in the cluster

All-weather road Y NHealth centre/hospital Y N

Trading centre (market) Y NElectricity Y N

Running water Y NHotel/bar/boarding house Y N

001

002

003

004

005

P a r t A : Househo l d f o rm

AppendixMult i - s i te s tudy : ques t ionna i re 1�Men and women

8

Initialsof firstname

01 Head

02 _____

03 _____

04 _____

05 _____

06 _____

07 _____

08 _____

09 _____

10 _____

11 _____

12 _____

Relationship

_______

_______

_______

_______

_______

_______

_______

_______

_______

_______

_______

_______

From line ___

& line ___

__ & __

__ & __

__ & __

__ & __

__ & __

__ & __

__ & __

__ & __

__ & __

__ & __

__ & __

__ & __

Sex

M F

M F

M F

M F

M F

M F

M F

M F

M F

M F

M F

M F

Age

______

______

______

______

______

______

______

______

______

______

______

______

Slept herelast day ornight (Y/N)

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Y N

Eligibility(aged 15-49who slept

there)

______

______

______

______

______

______

______

______

______

______

______

______

21 _____

22 _____

23 _____

_______

_______

_______

__ & __

__ & __

__ & __

M F

M F

M F

______

______

______

Y N

Y N

Y N

______

______

______

Enquire about anyoneelse aged 15 years orover (including non-family members) whoslept in the householdlast day or night (e.g.servants, lodgers).

HOUSEHOLD MEMBERS FORM

U N A I D S Appendix: Multi-site studyQuestionnaire 1, men and women

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

9

Usua l househo ld members

A l l o the r s

10

H O U S E H O L D I D E N T I F I C A T I O N

City name ........................................................................................................................................................................................

Cluster number

Household/dwelling number

Respondents initials and line number .....................................................

Interviewer code

INTERV IEW V I S I TS ( IND IV IDUALS )

Vis i t 1 Vis i t 2 Vis i t 3

Da t e ............................................ ............................................ ............................................

I n t e r v i ewe r ............................................ ............................................ ............................................

Resu l t* ............................................ ............................................ ............................................

Result codes*Completed 1

Not at home 2Refused 3

Partially completed 4Other (specify) 8 ....................................................................................................

Checked by supervisor ID No.

Signature ............................................................................................................

Date ............................................................................................................

SECT ION 1

101

102

103

104

105

106

107

Pa r t B : Ind iv idua l ques t ionna i re (for adults aged 1549 who slept in the household)

Questions and filters

Record sex of respondent

How old are you?

[PROBE FOR BEST ESTIMATE]

Have you ever attended school?

If YES: What was the highest level

that you completed?

Can you read a newspaper or letter?

What is your religion?

What ethnic group do you belong to?

..........................................................................

Where were you born?

(write down the District/County)

..........................................................................

..........................................................................

Coding categories

Male 1

Female 2

Age ___

Primary 1

Secondary 2

Higher 3

Primary not completed 4

Never 5

YES 1

NO 2

Protestant 1

Catholic 2

Muslim 3

Traditional 4

No religion 5

Other 6

____

Same city 1

Other urban area 2

Rural area 3

Other countries 4

Skip to

ÕÕQ205

ÕÕQ205

ÕÕQ205

N °

Q201

Q202

Q203

Q204

Q205

Q206

Q207

B A C K G R O U N D C H A R A C T E R I S T I C SSECT ION 2


11

12


How long have you stayed in this city?

� Since birth, ENTER 98

and SKIP to Q210

� If less than 1 month, ENTER 00

Where were you before? (location)

..........................................................................

Why did you move? (main reason)

..........................................................................

..........................................................................

How many years or months

do you intend to live in this city?

� Forever, ENTER 97

� Do not know, ENTER 96

In the last 12 months, that is since

last ____, how many trips of more

than 1 night did you have outside this

city? [PROBE]

If less than 1 year in the city, ENTER 98

Altogether, how many days, weeks

or months were you away from home

in the last 12 months

Coding categories

Years ___

Months ___

Same city 1

Other urban 2

Rural 3

Other country 4

Marriage 1

Family move 2

Work 3

Visit 5

School 5

Other 6

Years ___

Months ___

Number ___

Days ___

Weeks ___

Months ___

Skip toN °

Q208

Q209

Q209B

Q210

Q211

Q212


13


What is your usual occupation?

[PROBE: What kind of work do you do

most of your time? record verbatim

and then code]

..........................................................................

..........................................................................

..........................................................................

..........................................................................

Are you now?

[READ OUT]

Did you have drinks containing

alcohol in the last four weeks?

How often did you have drinks

containing alcohol in the last 4 weeks?

Would you say? [READ OUT]

Coding categories

Fishing 0

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

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

YES 1

NO 2

At least once a day 1

At least once a week 2

Less than once a week 3

Skip to

ÕÕQ301

N °

Q213

Q214

Q215

Q216

14


Have you ever been married

or ever lived as married

Have you ever had penetrative

sexual intercourse? [PROBE]

Are you now married or living as

married, single, separated/divorced

or widowed?

[MEN]

Do you have more than one spouse?

[WOMEN]

Does your spouse have other spouses?

IF YES: How many spouses in total now?

Coding categories

YES 1

NO 2

YES 1

NO 2

Married 1

Single 2

Separated/Divorced 3

Widowed 4

YES 1

NO 2

Number ___

Questions

First name initials

Is it a customary, civil, religious or consensual

union? Customary

Civil

Religious

Consensual

How long have you been married or living as

married with this spouse?

IF LESS THAN 1 YEAR, ENTER OO Years

Spouse(s)

1 2 3 4

____ ____ ____ ____

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

___ ___ ___ ___

Skip to

ÕÕQ303

ÕÕQ321

ÕÕQ515

ÕÕQ317

ÕÕQ317

ÕÕQ317

ÕÕQ306

N °

Q301

Q302

Q303

Q304

Q305

�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)

M A R R I A G ESECT ION 3

Q306

Q307

Marriage mayinvolve a legalarrangement,a religiousceremony orcustomarycelebration.It may also be an informal unionin which a manand woman livetogether andregard themselvesas married.Thusby spouse, wemean married orliving as married.

For each currentspouse, ask Q306to Q316


15

Questions

First name initials

How old is he/she? [PROBE] YEARS

Do you usually live together in the same

house/compound? YES 1

IF YES, SKIP TO Q311 NO 2

IF NO, where does he/she usually live?

Same city 1

Other city 2

Rural 3

Abroad 4

Do you have children with this spouse?

IF NO, SKIP TO Q314 YES 1

NO 2

How old is your youngest one? Years

IF YEARS, SKIP TO Q314 Months

IF CHILD IS LESS THAN 12 MONTHS, have you resumed

sex with this spouse since the birth of this child?

YES 1

NO 2

How many days has it been since you had your

last sexual act with this spouse?

�Within the last 30 days, ENTER 0�30

�More than 30 days but within the last year,

ENTER 95 and SKIP to Q316

�More than one year, ENTER 96 and SKIP to

Q306 for next spouse

Spouse(s)

1 2 3 4

____ ____ ____ ____

___ ___ ___ ___

1 1 1 1

2 2 2 2

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

1 1 1 1

2 2 2 2

___ ___ ___ ___

___ ___ ___ ___

1 1 1 1

2 2 2 2

___ ___ ___ ___

Q308

Q309

Q310

Q311

Q312

Q313

Q314

16

Questions

First name initials

IF WITHIN THE LAST 30 DAYS, how many times did

you have sex with your spouse in the last week?

Did you use a condom with him/her in the past

12 months? IF YES, how often?

Always 1

Often 2

Half of the time 3

Rarely 4

Never 5

IF MORE THAN ONE SPOUSE, GO BACK TO Q306

(NOW THINK BACK TO THE PAST). Apart from

this/these spouse(s), how many persons have

you been married to in your whole lifetime?

How old were you when you first got married?

How old was your (first) spouse at the time?

How many different sexual partners did you

have penetrative sex with (before you first got

married)?

How old were you when you had penetrative

sexual intercourse for the first time?

How many different sexual partners did you

have penetrative sex with up to now? [PROBE]

Spouse(s)

1 2 3 4

____ ____ ____ ____

___ ___ ___ ___

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

___

___

___

___

___

___

Q315

Q316

Q317

Q318

Q319

Q320

Q321

Q322


1

____

____

1

2

3

4

4

6

2

____

____

1

2

3

4

5

6

3

____

____

1

2

3

4

5

6

4

____

____

1

2

3

4

5

6

5

____

____

1

2

3

4

5

6

6

____

____

1

2

3

4

5

6

7

____

____

1

2

3

4

5

8

____

____

1

2

3

4

5

17

Questions

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 part-

ners, prostitutes, somebody that you

may have met in bars, during special

events such as wedding, etc.]

With how many different people have

you had sexual intercourse within the

last 12 months (apart from spouse(s))?

Coding categories

YES 1

NO 2

Number ___

Skip to

ÕÕQ502

[MEN]

ÕÕQ517

[WOMEN]

N °

Q401

Q402

S E X U A L R E L A T I O N S W I T H O T H E R P A R T N E R S T H A N S P O U S E SSECT ION 4�Now I would like to ask you a few questions about other partners that you mayhave had in the last 12 months that is since....�

Questions

Initials or Don�t Know (DK)

How would you describe your

relationship in local terms?.......................

.............................................................................

What educational level has he/she

completed? Primary 1

Secondary 2

Higher 3

Primary not completed 4

None 5

DK 6

N °

Q403

Q404

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

Sexual partner(s)

Questions


How old is he/she? [PROBE]

Is he/she married, divorced, separated,

widowed, or single? Married 1

D/S/W 2

Single 3

DK 4

What ethnic group does he/she

belong to ? ......................................................

Where did you have sex the first time

with him/her?

[SKIP to Q411] Same city 1

Other urban area 2

Rural area 3

[IF OUTSIDE THIS CITY] Why were you

there? Was it for [READ OUT]

Professional reasons 1

Family reasons 2

Economic reasons 3

Others 4

Specify..............................................................

[IF OUTSIDE THIS CITY] How long did you

stay in that place? Days

1

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

2

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

3

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

4

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

5

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

6

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

7

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

8

____

____

1

2

3

4

____

1

2

3

1

2

3

4

____

N °

Q405

Q406

Q407

Q408

Q409

Q410

18

Sexual partner(s)

ÕÕ


19

Questions


How long did you know him/her before

having sexual relation? Months

Days

� IF MORE THAN 5 YEARS, ENTER 99

� IF LESS THAN 1 DAY, ENTER 00

Are these sexual relations currently

going on or has the sexual relationship

ended? Relationship going on 1

Relationship ended 2

Do not know 3

[IF CURRENT RELATION] How many times

in the last month did you have sex with

this person?

[IF ENDED OR DK] How many times did

you have sex with him/her in the last

year?

[IF ENDED] How many months ago did

it finish? Months

How long did the relationship last?

(I mean how long was it between the

first time you had sex together and the

last time?) [IF LESS THAN 1 DAY, ENTER 00]

Days

Months

1

____

____

____

1

2

3

____

____

____

____

____

2

____

____

____

1

2

3

____

____

____

____

____

3

____

____

____

1

2

3

____

____

____

____

____

4

____

____

____

1

2

3

____

____

____

____

____

5

____

____

____

1

2

3

____

____

____

____

____

6

____

____

____

1

2

3

____

____

____

____

____

7

____

____

____

1

2

3

____

____

____

____

____

8

____

____

____

1

2

3

____

____

____

____

____

N °

Q411

Q412

Q413

Q414

Q415

Q416

Sexual partner(s)

20

Questions


In your last sexual intercourse with him/

her, did you use a condom? YES 1

NO 2

Usually did you use a condom with

him/her? [READ OUT] Always 1

Most of the time 2

Rarely 3

Never 4

Did you give/receive money in exchange

for sex with him/her? YES always 1

YES often 2

Never 3

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

� Casual partner: YES:1 NO:2 DK:3

� Others with exchange of money

YES:1 NO:2 DK:3

If you took a guess, how many partners

do you think he/she has had in the last

12 months (apart from you)?

1

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

2

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

3

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

4

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

5

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

6

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

7

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

8

____

1

2

1

2

3

4

1

2

3

1 2 3

1 2 3

1 2 3

____

N °

Q417

Q418

Q419

Q420

Q421

Sexual partner(s)

Please go back to Q403 for other partners


21


MEN ONLY

Now I would like to ask you some

questions 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 such

pain or discharge?

� IF YES: How many episodes started

in the last 12 months?

� IF NONE, ENTER OO

At present, do you have any pain

when passing urine?

For how long do you have this pain?

In the last 24 hours, did you have any

discharge from the penis?

For how long did you have this

discharge?

Some men experience sores in the

genital area. During the last 12 months,

have you noticed any such sores?

� If YES: How many episodes started

in the last 12 months?

� If none ENTER 00

Coding categories

WOMEN SKIP TO

Number ___

YES 1

NO 2

Days ___

YES 1

NO 2

Days ___

Number ___

Skip to

ÕÕQ517

ÕÕQ505

ÕÕQ507

N °

Q501

Q502

Q503

Q504

Q505

Q506

Q507

S T Ds A N D H E A L T H I S S U E SSECT ION 5

ÕÕ

22


At present, do you have any sores on

the genital area? Are they painful?

For how long do you have these sores?

Filter: SEE Q502 TO Q508

ONE OR MORE EPISODES

Which of the following did you do for

the last episode? [READ OUT]

Sought advice from friend or relative

Used medicine that you had at home

Sought advice from a traditional healer

Sought advice from a clinic, a hospital,

or a health worker

Obtained free drugs from a clinic,

a hospital or a health worker

Bought medicine from a clinic

a hospital or health worker

Bought medicine from traditional healer

Bought medicine from a pharmacy

or shop

Nothing

Other (specify) .....................................................................

Did you tell (any of) your spouse(s) or

partner(s) about this last episode?

Coding categories

YES without pain 1

YES painful 2

NO 3

Days ___

NO EPISODE SKIP TO

YES 1 NO 2

YES 1 NO 2

YES 1 NO 2

YES 1 NO 2

YES 1 NO 2

YES 1 NO 2

YES 1 NO 2

YES 1 NO 2

YES 1 NO 2

YES 1

NO 2

Skip to

ÕÕQ510

ÕÕQ515

N °

Q508

Q509

Q510

Q511

Q512


23


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)

If YES, what did you do?

Are you circumcised?

(use local terms for operation)

How old were you when you were

circumcised?

Eventually, would you accept to be

asked 5 or 10 questions again for

clarification?

Comments ........................................................................

WOMEN ONLY

In the last 12 months, did you have sex

during menstruation (with any of your

partners)?

Are you currently doing something

or using any method to delay or avoid

pregnancy?

Coding categories

YES 1

NO 2

Abstain from sex 1

Use a condom 2

Other 3

YES 1

NO 2

Years ___

YES 1

NO 2

YES 1

NO 2

YES 1

NO 2

Pregnant 3

Skip to

ÕÕQ515

ÕÕQ600

ÕÕQ520

ÕÕQ520

N °

Q513

Q514

Q515

Q516

Q600

Q517

Q518

24


If YES, which method are you using?

Do you usually use something to tighten

or dry your vagina before sexual inter-

course?

If YES, what do you use?

.................................................................................................................

Coding categories

Pill 1

IUD 2

Injections 3

Diaphragm/foam/jelly 4

Condom 5

Calendar/Safe period 6

Withdrawal 7

Sterilization 8

Other 9

Always 1

Often 2

Rarely 3

Never 4

Skip to

ÕÕQ600

N °

Q519

Q520

Q521

looking deeper into the hiv epidemic: a questionnaire for

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