Library
Prisons and jails
What is the role of prisons and jails in HIV prevention?
Is prevention in prisons and jails important?
Absolutely. The US has the highest incarceration rate in the world, and the numbers keep growing.1 In 2007, the US had over 2.4 million people in state, federal and local correctional facilities.2 For the first time, more than 1 in every 100 adults in the US is confined in a jail or prison.1 Persons in prison and jail have higher rates of many diseases and health problems than the general population.3 HIV rates among incarcerated persons are 2 ½ times higher than in the general population. In any given year, about 25% of all HIV+ persons in the US pass through a correctional facility.4 Persons in prison and jail also have higher rates of STIs, tuberculosis and viral hepatitis, as well as substance abuse and mental illness.5 These high infection rates in prisons and jails in the US reflect the fact that the majority of persons who are incarcerated come from impoverished and disenfranchised communities with limited access to prevention, screening and treatment services.6 These are the same neighborhoods with high rates of HIV, STIs and other infectious diseases. Criminal justice and public health systems can work together to provide comprehensive prevention and treatment inside and outside facilities. Incarceration presents a window of opportunity for primary prevention, screening, treatment and establishing comprehensive, pro-active transitional linkages for persons approaching release and follow-up.What is the HIV connection between prisons, jails and the community?
At least 95% of persons in prison are released into the community at some point.7 The impact of incarceration and disease is not limited to the men and women being locked up, but extends to their families, partners and communities. There is a mistaken belief that men and women acquire HIV inside, when in fact, the vast majority of HIV+ persons in prison and jail enter the criminal justice system HIV+.8,9 Persons with a history of mental illness, trauma or physical and sexual abuse, who do not have access to mental health services, may self-medicate with substance use. This combination puts them at increased risk for behaviors that may both lead to HIV and land them in jail or prison. Rates of mental health diagnoses for persons in jail and prison are 45-65%, while rates of substance abuse are as high as 75%.10How does incarceration impact HIV risk?
Persons in prison and jail may engage in risk behaviors before, during and after incarceration. However, behavior during incarceration may be riskier for those who do not have access to condoms, clean syringes and other prevention tools. Sexual activity (both consensual and coerced), substance use, injecting and tattooing can all put individuals at risk for HIV/STIs and viral hepatitis.11 In one study of incarcerated young men, 50% had used substances and 17% had consensual sex with men or women while confined.12 Release from correctional settings and re-entry into the community can be a stressful time and often carries higher risks than being incarcerated. Persons released from prison and jail may celebrate their release with HIV risk-related behaviors such as drinking, drug use and sex. Persons released with few resources often return to the same precarious environments where they were arrested. A study of persons formerly incarcerated in Washington found a high risk of drug overdose within the first two weeks of release.13 There is a misperception that incarcerated men are responsible for increasing rates of HIV/STIs. Imprisonment does affect HIV/STI rates in the community, but not from men getting infected on the inside and bringing it out to their female sexual partners once they are released. Instead, incarceration decreases the number of men in the community, which disrupts stable partnerships, changes the male-to-female ratio and promotes higher-risk concurrent, or overlapping, partnerships.14What can be done inside?
Across the US, many HIV prevention agencies and public health departments are working with the criminal justice system to improve the health of persons who are incarcerated and their communities. Agencies can provide: peer-based prevention programs, including prevention with positives; harm reduction programs; quality health care; treatment for HIV/STIs; treatment for substance abuse and mental illness; links to community services pre-release; help with community reintegration post-release.10,15Counseling, testing and treatment for HIV/STI/hepatitis/TB. Incarceration can be an opportunity for screening and treating a group of individuals with high risk behaviors. This should include comprehensive pre-test counseling with a consent process describing the implications of testing positive or negative, as these can have consequences within correctional facilities, such as limiting housing and work assignments, and restricting visiting privileges. It should also include providing treatment for those who test positive and prevention education to those who test positive and negative. Mental health treatment. Persons in prison and jail have high rates of mental illness. Conditions in correctional settings such as overcrowding, violence and isolation have negative effects on mental health. Prisons and jails can help by providing assessment and effective treatment. Persons with mental illness who have committed minor offenses should be diverted to mental health services before or instead of prison or jail.16Comprehensive substance abuse treatment. While many jails and prisons in the US offer detoxification, professional and peer counseling, self-help groups and drug and alcohol education, very few offer methadone maintenance. The capacity of effective substance abuse treatment programs falls far short of the need. The KEEP program, based in New York, NY, provides jail-based methadone treatment and dedicated treatment slots to released individuals in the community.17What are transitional interventions?
Effective transitional interventions ensure that prevention and treatment services provided on the inside are continued on the outside. Many communities will have an increasing role in transitional planning with enactment of the Second Chance Act.18 Project START is the only intervention for incarcerated populations in the CDC’s Compendium of Evidence-Based Interventions. Project START is a client-centered, 6-session HIV, STI and hepatitis risk reduction intervention for persons being released from a correctional setting. Based in harm reduction, it uses a prevention case management model and motivational enhancement to encourage risk reduction. The first two sessions are pre-release and the last four are post-release. All sessions include facilitated referrals for housing, employment, substance abuse and mental health treatment, legal issues, and avoiding reincarceration. Research demonstrated that Project START was effective in reducing unprotected sex among young men after their release from prison.19 Project Bridge in Providence, RI, provides intensive case management for HIV+ persons being released from state prison. Enrollees receive 18 months of case management by a social worker and an outreach worker. Participants meet weekly for 12 weeks, then once a month, at a minimum. Project Bridge is effective in helping HIV+ persons obtain and maintain much needed post-release services. Research showed that despite high levels of addiction (97%) and mental illness (34%), participants received post-release medical care (95%), secured housing (46%), linked to mental health care (71%) and linked to addiction services (51%).20What are next steps?
Effectively addressing HIV in prisons, jails and communities requires both effective prevention strategies (such as peer education, access to condoms, HIV counseling and testing) and effective structural and medical strategies. Some of the proven effective strategies and policies that can help reduce HIV/STIs in prisons and jails include: harm reduction programs (providing clean syringes);21 substance abuse treatment;17 mental health treatment;16 STI/HIV treatment;5 transitional discharge planning;19,20 housing;5 alternatives to incarceration;15 and sentencing and parole reform.1 Collaboration between the criminal justice system (prison, jail, parole and probation) and the community public health system (social services, medical/health clinics, treatment programs, etc.) is essential, and there are several effective models. Building partnerships can help tackle public health issues while understanding the challenges of public safety and custody priorities. If we truly want to decrease rates of HIV, STIs and hepatitis in our communities, we have to work together to create a seamless continuum that will improve prevention, care and treatment both inside prisons and jails as well as in disproportionately affected communities.Says who?
1. PEW Center on the States. One in 31: The long reach of American corrections. March 2009. 2. West HC, Sabol WJ. Prisoners in 2007. Bureau of Justice Statistics Bulletin. 2008. 3. Maruschak L. HIV in Prisons, 2006. Bureau of Justice Statistics Bulletin. 2008. 4. Hammett TM, Harmon MP, Rhodes W. The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997. American Journal of Public Health. 2002 ;92:1789-1794. 5. The Foundation for AIDS Research. HIV in correctional settings: implications for prevention and treatment policy. Issue Brief No 5, March 2008. 6. Golembeski C, Fullilove R. Criminal (in)justice in the city and its associated health consequences. American Journal of Public Health. 2005;95:1701–1706. 7. Hughes T, James Wilson D. Reentry trends in the United States. Bureau of Justice Statistics. 8. Vlahov D, Putnam S. From corrections to communities as an HIV priority. Journal of Urban Health. 2006;83:339-348. 9. Zack B, Kramer K. HIV prevention education in correctional settings. Project UNSHACKLE discussion paper. May 2008. 10. James DJ, Glaze LE. Mental health problems of prison and jail inmates. Bureau of Justice Statistics Special Report. September 2006. 11. HIV transmission among male inmates in a state prison system – Georgia, 1992-2005. Morbity and Mortality Weekly Report. 2006;55:421-426. 12. Seal DW, Margolis AD, Morrow KM, et al. Substance use and sexual behavior during incarceration among 18- to 29-year old men: prevalence and correlates.AIDS and Behavior. 2008;12:27-40. 13. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison—a high risk of death for former inmates. New England Journal of Medicine. 2007;356:157-165. 14. Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372:337-340. 15. Freudenberg N. Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health. Journal of Urban Health. 2001;78:214-235. 16. World Health Organization. Mental health and prisons. 2005. 17. Tomasino V, Swanson AJ, Nolan J, et al. The Key Extended Entry Program (KEEP): A methadone treatment program for opiate-dependent inmates. The Mount Sinai Journal of Medicine. 2001;68:14-20. 18. Second Chance Act. 19. Wolitski RJ, The Project START study group. Relative efficacy of a multi-session sexual risk-reduction intervention for young men released from prison in 4 states. American Journal of Public Health. 2006;96:1845-1861. 20. Zaller ND, Holmes L, Dyl AC, et al. Linkage to treatment and supportive services among HIV-positive ex-offenders in Project Bridge. Journal of Health Care for the Poor and Underserved. 2008;19:522-531. 21. Jürgens R, Ball A, Verster A. Interventions to reduce HIV transmission related to injecting drug use in prison. Lancet Infectious Diseases. 2009;9:57-66.Prepared by Barry Zack MPH and Katie Kramer MSW/MPH, The Bridging Group LLC March 2009. Fact Sheet #13R Special thanks to the following reviewers of this Fact Sheet: Tim Flanigan, Nick Freudenberg, Robert Fullilove, Robert Greifinger, Ted Hammett, Bob Hogg, Ralf Jürgens, Beth Justiniano, James Learned, Robin MacGowan, Alex Margolis, Dan O’Connell, Anthony Papa, Robin Pollini, Hugh Potter, Cristine Rodriguez, David Seal, Dan Wohlfeiler, Jeanne Woodford. Reproduction of this text is encouraged; however, copies may not be sold, and the University of California San Francisco should be cited as the source. Fact Sheets are also available in Spanish. To receive Fact Sheets via e-mail, send an e-mail to [email protected] with the message “subscribe CAPSFS first name last name.” ©March 2009, University of CA.
Woman
What are US women’s HIV prevention needs?
are women at risk?
Yes. HIV is taking an increasing toll on women and girls in the US. In 1985, women comprised 8% of all AIDS cases in the US, while by 2005, women made up 27% of all AIDS cases. In 2005, women accounted for 30% of all new HIV infections. Of these, 60% occurred among African Americans, 19% among Whites, 19% among Hispanics, and 1% each among Asian/Pacific Islanders and American Indian/Alaska Natives.
who are women most affected by HIV?
African American and Hispanic women in particular are disproportionately affected by HIV/AIDS. Although African American and Hispanic women comprise only 23% of the total female population in the US, in 2005 they accounted for 79% of all new HIV infections (African American women: 60%, Hispanic women: 19%). Accordingly, in 2004 HIV infection was the leading cause of death for Black women (including African American women) aged 25-34 years. Younger women are also affected by HIV/AIDS. In recent years, the largest number of HIV/AIDS diagnoses among women occured in women 15-39 years old. In 2005, young women represented 28% of AIDS cases among young men and women aged 20-24.
what places women at risk?
Most women are infected with HIV through heterosexual contact, especially women with injection drug using partners. In 2005, 80% of all new infections in women were from heterosexual contact. Women are more likely than men to acquire HIV via sexual intercourse, due to greater exposed surface area in the female genital tract. Injection and non-injection drug use places women at an increased risk for HIV and is strongly linked to unsafe sexual practices. Approximately 20% of new HIV cases in women is related to injection drug use. Women who use crack cocaine may also be at high risk of sexual transmission of HIV, particularly if they sell or trade sex for drugs. Sexually transmitted infections (STIs) other than HIV can increase the likelihood of getting or transmitting HIV. In the US, chlamydia and gonorrhea (both asymptomatic) are the most commonly reported STIs, with highest rates in women of color and young women and adolescents. Sexual abuse (both childhood and adult) and domestic violence play a substantial role in placing women at risk for HIV infection. In the US, annually 2.1 million women are raped and 4 million become victims of domestic violence; of these women, more than 10,000 rape victims and 79,000 violence victims require hospitalization. Women who report early and chronic sexual abuse are seven times more likely to engage in HIV-related risk behaviors compared to women without trauma history. Women disproportionately suffer from poverty, in particular women of color who are affected by HIV. Because of this, women are less likely than men to have health insurance and access to quality healthcare or prevention services. Approximately two-thirds of women with HIV in the US have an annual income of less than $10,000. Poverty can increase HIV risks such as exchanging sex for money, shelter, or drugs. In a survey of young and low-income women in California, women who reported sex work were more likely to have syphilis, herpes, hepatitis C, and a history of sexual abuse. Abuse, violence and poverty can all lessen a woman’s power to negotiate condom use or choose safer partners. They also can lead to psychological distress, such as depression, anxiety and post-traumatic stress disorder (PTSD). Having relationships that overlap in time (concurrent partners) can increase women’s risk of HIV transmission. Concurrency is more likely to occur among women who are not married, are young adults and are poor.
what can help?
Involving male partners. For women to protect themselves from HIV, they must not only rely on their own skills, attitudes, and behaviors regarding condom use, but also on those of their male partner. Often, men and women in relationships may find intimacy to be more important than protection against HIV. Involving women’s partners in HIV prevention programs can help strengthen intimacy and trust and improve sexual communication and negotiation, including asking about past and current partners. Support from other women. Many prevention programs for women offer groups to reduce women’s isolation and allow women to support each other and normalize safer behaviors. Greater social support can increase self esteem and allow women to make healthier choices. A program in Washington DC helped build support and empowerment for HIV+ African American women by holding educational groups during shared meals and providing small gifts (along with condoms) as incentives or thank-yous. Help with non-HIV factors. Women at risk for HIV face many behavioral and structural challenges beyond HIV: poverty and economic strain, unemployment, violence and unhealthy gender relations, migration, STIs, drug use, and caring for children and family members. HIV prevention programs for women should provide transportation, child care, nutritious food and compensation such as money, phone or store cards or gift packs. Programs should provide up-to-date referrals for employment, housing, medical care and mental health services trauma, abuse and depression.
what is being done?
Currently 17 women-specific interventions exist that have been approved by the CDC as best evidence or promising evidence or are part of the Diffusion of Effective Behavioral Interventions (DEBI) project: CHOICES, Communal Effectance-AIDS Prevention, Female and Culturally Specific Negotiation, Project FIO, Project SAFE, RAPP, SiHLE, SISTA, Sisters Saving Sisters, Sister to Sister, WHP, WiLLOW, Women’s Co-op, Condom Promotion, Insights, Safer Sex, and SEPA. The Women’s Leadership and Community Planning project in San Francisco, offered a 2-day training for women with HIV in California who want to take greater leadership roles in state Planning Councils. At the training, women network with each other, as well as learn skills in public speaking, decision-making, and conflict management. Women stay in touch through monthly conference calls. After the first training, 6 of 13 women moved into leadership positions on their local or state Councils. Respeto/Proteger: Respecting and Protecting our Relationships is an HIV prevention program for Latino teen mothers and fathers in Los Angeles, CA. Developed and tested with a community agency and academic researchers, the program recognizes risks young women face, including poverty, drug and alcohol use, history of STIs and physical or sexual abuse. The six-session intervention focuses on healing the wounded spirit and builds on feelings of maternal and paternal protectiveness using cultural and traditional teachings.
what needs to be done?
Because women are more likely to get HIV from their male partners, programs that target men (especially IDUs) will have a beneficial impact on women. Needle exchange and drug treatment strategies are critical. Public health agencies need to raise awareness about sexual abuse and domestic violence to not only help men and women develop the skills to prevent it, but also to curb its effect on the HIV epidemic. HIV testing campaigns that target women and women-friendly testing sites are also needed. Behavioral and structural HIV prevention interventions for women continue to be necessary, given the lack of evidence from biomedical interventions (microbicides, vaccines). However, research needs to continue on how women can protect themselves with an accessible, affordable, comfortable and discrete tool for safer sex. Although research has highlighted the subpopulations of women most affected by HIV/AIDS, it is even more important to translate and materialize study findings into tangible public health programs and effective policies. Interventions that address sexuality, family, culture, empowerment, self-esteem, and negotiating skills, as well as interventions located in varying community settings are especially valuable.
Says who?
1. Kaiser Family Foundation. Women and HIV/AIDS in the United States. Policy Fact Sheet. July 2007. 2. Centers for Disease Control and Prevention. Cases of HIV infection and AIDS in the United States and Dependent Areas, 2005. HIV/AIDS Surveillance Report. 2007;17. 3. Centers for Disease Control and Prevention. HIV/AIDS fact sheet: HIV/AIDS among women. June 2007. 4. National Institute of Allergy and Infectious Diseases at National Institutes of Health. Research on HIV infection in women. 2006. 5. Theall KP, Sterk CE, Elifson KW, et al. Factors associated with positive HIV serostatus among women who use drugs: continued evidence for expanding factors of influence. Public Health Reports. 2003;118:415-424. 6. Sangani P, Rutherford G, Wilkinson D. Population-based interventions for reducing sexually transmitted infections, including HIV infection. Cochrane Database of Systematic Reviews. 2004; 2:CD001220. 7. Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives in Sexual and Reproductive Health. 2004;36:6-10. 8. Koenig LJ, Moore J. Women, violence, and HIV: A critical evaluation with implications for HIV services. Maternal and Child Health Journal. 2000;4:103-109. 9. Wyatt GE, Myers HF, Loeb TB. Women, trauma, and HIV: an overview. AIDS and Behavior. 2004;8:401-403. 10. Bozzette SA, Berry SH, Duan N, et al. The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. New Engand Journal of Medicine. 1998;339:1897-1904. 11. Cohan DL, Kim A, Ruiz J, et al. Health indicators among low income women who report a history of sex work: the population based Northern California Young Women’s Survey. Sexually Transmitted Infections. 2005;81:428-433. 12. Adimora AA, Schoenbach VJ, Bonas DM, et al. Concurrent sexual partnerships among women in the United States. Epidemiology. 2002;13:320-327. 13. Prosper! The Women’s Collective, Washington DC. 14. Dworkin SL, Ehrhardt AA. Going beyond “ABC” to include “GEM”: critical reflections on progress in the HIV/AIDS epidemic. American Journal of Public Health. 2007;97:13-18. 15. Centers for Disease Control and Prevention. Updated Compendium of Evidence-Based Interventions, 2007. 16. Women’s Leadership and Community Planning project, CompassPoint, San Francisco, CA. 17. Lesser J, Koniak-Griffin D, Gonzalez-Figueroa E, et al. Childhood abuse history and risk behaviors among teen parents in a culturally rooted, couple-focused HIV prevention program. Journal of the Association of Nurses in AIDS Care. 2007;18:18-27. 18. Landovitz RJ. Recent efforts in biomedical prevention of HIV. Topics in HIV Medicine. 2007;15:99-103.
Prepared by Roshan Rahnama, CAPS April 2008. Fact Sheet #4ER Special thanks to the following reviewers of this fact sheet: Abby Charles, Beth Freedman, Bridget Hughes, Winifred King, Linda Koening, Maureen Miller, Adeline Nyamathi, Nancy Padian, Kate Perkins, Gina Wingood, Gail Wyatt, Toni Young. Reproduction of this text is encouraged; however, copies may not be sold, and the University of California San Francisco should be cited as the source. Fact Sheets are also available in Spanish. To receive Fact Sheets via e-mail, send an e-mail to [email protected] with the message “subscribe CAPSFS first name last name.” ©April 2008, University of CA.
Condom use Among Hispanics - Female
Hispanic Condom Use Study 1991 Questionnaire for Use with Females
TIME AT BEGINNING: ______________
Many of the questions we will be asking relate to sexual matters and it is
possible that you may feel a bit uncomfortable. But please remember that
your responses are completely confidential and that you may indicate if there
are any questions you do not wish to answer.
I would like to ask you some general questions about AIDS. Your answer can be
"yes," "probably yes," "probably no," or "no."
1. Do you think it's possible to get the AIDS virus from a mosquito bite?
Would you say yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (06)
2. Do you think it's possible to get the AIDS virus by sitting on a public
toilet?
1 Yes 2 Probably Yes 3 Probably No 4 No (07)
3. Do you think AIDS is a problem only for homosexuals and drug addicts?
1 Yes 2 Probably Yes 3 Probably No 4 No (08)
4. Do you think it's possible to know by appearance if a person has the AIDS
virus?
1 Yes 2 Probably Yes 3 Probably No 4 No (09)
5. Have you personally known someone who had AIDS or was infected with the
AIDS virus?
1 Yes 2 Probably Yes 3 Probably No 4 No
8 DON'T KNOW (10)
6. How often do you worry that you might get the virus that causes AIDS?
Would you say very often, often, sometimes, or never?
(11)
1 Very often 2 Often 3 Sometimes 4 Never
I'll be asking some questions about condoms or rubbers.
7. Would you like me to use the word "condom" or "rubber?"
4 CONDOM 5 RUBBER (12)
6 NO PREFERENCE (USE "CONDOM")
The following items ask for information about how condoms/rubbers are used.
If you have never used condoms/rubbers, your answers are still important to
us.
8. Do you think vaseline is a good lubricant or cream for condoms/rubbers?
1 YES 0 NO 8 DOESN'T KNOW (13)
9. Do you think a condom/rubber should be unrolled before putting it on a
man's penis?
1 YES 0 NO 8 DOESN'T KNOW (14)
Now we would like to ask you some questions about your experiences with
condoms/rubbers and other sexual activities. I will be using the word
"partner" to refer to the person with whom one has sex. This information is
very important for our study. Each person has different sexual experiences,
so some questions may not apply to you.
10. How often do you carry a condom/rubber with you? Would you say
always, sometimes, hardly ever, or never?
(15)
1 Always 2 Sometimes 3 Hardly ever 4 Never
11. Have you ever had sex with a partner who used condoms/rubbers?
1 YES 0 NO [GO TO Q 15] 9 RA (16)
12. Have you ever used condoms/rubbers to avoid a pregnancy?
1 YES 0 NO 9 RA (17)
13. Have you ever used condoms/rubbers to avoid diseases?
1 YES 0 NO 9 RA (18)
14. How did you get condoms/rubbers?
[IF RESPONDENT GIVES MORE THAN ONE ANSWER, ASK WHERE SHE HAS BOUGHT
THEM OR GOTTEN THEM MORE OFTEN AND CIRCLE ONLY THAT RESPONSE]
[DO NOT READ RESPONSES]
______ BOUGHT THEM ASK: Where?
1 PHARMACY OR DRUG STORE
2 RESTROOM VENDING MACHINES
3 SUPERMARKET
9 RA
(19)
______ GIVEN TO THEM ASK: Where?
4 AT A HEALTH CENTER
5 ON THE STREET
6 BY A FRIEND/RELATIVE
7 FROM A PARTNER
8 ELSEWHERE __________________________
9 RA
15. In these questions we'll talk about a steady sex partner. A steady sex
partner is a person one has sex with in an ongoing relationship and might be a
spouse.
Imagine that you will have sex with a husband or steady partner in the next
30 days. How often do you think your partner would use condoms/rubbers?
Would you say always, more than half the time, half the time, less than half
the time, or never?
IF RESPONDENT SAYS NOT APPLICABLE, SAY: "Even if you don't know, please
try to guess."
1 Always (20)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
9 RA
16. Imagine that you will have sex with a person other than a steady partner
in the next 30 days. How often do you think that partner would use
condoms/rubbers?
IF RESPONDENT SAYS NOT APPLICABLE, SAY: "Even if you don't know, please
try to guess."
1 Always (21)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
9 RA
17. Have you had sex at least once in the past 12 months, that is, since
[THIS MONTH] of 1990?
1 YES [GO TO Q19] 0 NO [GO TO Q18] 9 RA [GO TO Q18] (22)
18. Have you had sex at least once in the last 5 years?
1 YES [GO TO Q19] 0 NO [GO TO Q26] 9 RA [GO TO Q26] (23)
19. As I said, some questions may not apply to you. If a question does not
apply to you, please let me know.
When you had sex with your husband or steady partner in the last 12 months,
how often did he use condoms/rubbers? Would you say always, more than
half the time, half the time, less than half the time, or never?
1 Always (24)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
6 NO MALE PARTNER [GO TO Q26]
7 NO STEADY PARTNER
8 NO SEX PAST 12 MONTHS [GO TO Q26]
9 RA
20. When you had sex with a man other than your husband or steady partner in
the last 12 months, how often did that partner use condoms/rubbers?
1 Always (25)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
7 NO CASUAL PARTNER
8 NO MALE PARTNER [GO TO Q26]
9 RA
BLANK (26-28)
23. How many men have you had sex with in the last 12 months in total?
___ ___ NUMBER OF MEN (29-30)
[90 OR MORE = 90]
99 RA
IF Q23 IS 00, GO TO Q26
24. In the last 12 months, how often did you drink alcoholic beverages before
having sex? Would you say always, more than half the time, half the time,
less than half the time, or never?
1 Always (31)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
9 RA
25. In the last 12 months, how often did you use drugs before having sex?
1 Always (32)
2 More than half the time
3 Half the time
4 Less than half the time
5 Never
9 RA
26. Do you think you're going to have sex in the next 30 days? Would you say
yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (33)
27. Is it possible to know beforehand if you're going to have sex?
1 Yes 2 Probably Yes 3 Probably No 4 No (34)
In the following questions I am going to ask your opinions about the use of
condoms or rubbers. If you have never had sex or if you have never used a
condom/rubber, please answer the questions trying to imagine how you would
feel in each case.
28. Do you think condoms/rubbers are only for men having sex with female
prostitutes? Would you say yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (35)
29. Do you think it's difficult to find places to buy condoms/rubbers?
1 Yes 2 Probably Yes 3 Probably No 4 No (36)
BLANK (37)
31. Would you ask a partner to use a condom/rubber even if you had been
drinking alcoholic beverages or using drugs?
1 Yes 2 Probably Yes 3 Probably No 4 No (38)
32. Would you be able to ask a partner to use a condom/rubber if you thought
he was having sex with someone else?
1 Yes 2 Probably Yes 3 Probably No 4 No (39)
33. Would you be able to refuse to have sex if your partner didn't want to use
a condom/rubber?
1 Yes 2 Probably Yes 3 Probably No 4 No (40)
34. Imagine that your partner used a condom/rubber the next time you had sex.
Would you feel less sexual pleasure than if he didn't use one?
1 Yes 2 Probably Yes 3 Probably No 4 No (41)
35. If your partner used a condom/rubber, would sex last longer than if he
didn't use one?
1 Yes 2 Probably Yes 3 Probably No 4 No (42)
36. If your partner used a condom, would you feel guilty?
1 Yes 2 Probably Yes 3 Probably No 4 No (43)
37. If a condom/rubber were used, would you feel an emotional barrier with
your sex partner?
1 Yes 2 Probably Yes 3 Probably No 4 No (44)
38. Do you think the condom/rubber would cause a burning sensation?
1 Yes 2 Probably Yes 3 Probably No 4 No (45)
39. Do you think putting on a condom/rubber would interrupt sex?
1 Yes 2 Probably Yes 3 Probably No 4 No (46)
40. Do you think sex would be cleaner than if your partner didn't use a
condom/rubber?
1 Yes 2 Probably Yes 3 Probably No 4 No (47)
Continue to imagine that your partner used a condom/rubber the next time you
had sex
41. Do you think the condom/rubber would feel uncomfortable or too tight to
your partner?
1 Yes 2 Probably Yes 3 Probably No 4 No (48)
42. Do you think the condom/rubber might come off inside you?
1 Yes 2 Probably Yes 3 Probably No 4 No (49)
43. Do you think the condom/rubber might break?
1 Yes 2 Probably Yes 3 Probably No 4 No (50)
44. If your partner used a condom/rubber, do you think you might get cancer?
1 Yes 2 Probably Yes 3 Probably No 4 No (51)
45. If your partner used a condom/rubber, do you think you would get
pregnant?
1 Yes 2 Probably Yes 3 Probably No 4 No 9 RA (52)
46. If your partner used a condom/rubber, would it be more difficult for him
to ejaculate or come than if he didn't use one?
1 Yes 2 Probably Yes 3 Probably No 4 No (53)
47. If your partner used a condom/rubber, would it be more difficult for him
to keep an erection than if he didn't use one?
1 Yes 2 Probably Yes 3 Probably No 4 No (54)
In the following questions we'll talk about two types of partners: steady sex
partners and casual sex partners. As you recall, a steady sex partner is a
person one has sex with in an ongoing relationship. A casual sex partner
refers to a person one doesn't know very well and has sex with only once or a
few times.
48. Would you be able to ask a steady partner to use a condom/rubber?
1 Yes 2 Probably Yes 3 Probably No 4 No (55)
49. Would you be able to ask a casual partner to use a condom/rubber?
1 Yes 2 Probably Yes 3 Probably No 4 No (56)
Imagine that you were going to have sex with a casual partner and he used a
condom/rubber.
50. Do you think you could get a venereal disease such as gonorrhea or
syphilis?
Would you say yes, probably yes, probably no, or no?
1 Yes 2 Probably Yes 3 Probably No 4 No (57)
51. If this casual partner used a condom/rubber, do you think you could get the
virus that causes AIDS?
1 Yes 2 Probably Yes 3 Probably No 4 No (58)
52. If this casual partner used a condom/rubber, would you worry less about
giving a steady partner a disease such as syphilis, gonorrhea or AIDS?
1 Yes 2 Probably Yes 3 Probably No 4 No (59)
Imagine that you asked a steady partner to use a condom/rubber the next time
you had sex,
53. Would it lead the steady partner to think you had had sex with someone
else?
1 Yes 2 Probably Yes 3 Probably No 4 No (60)
54. If you asked a steady partner to use condoms/rubbers, do you think he
would get angry?
1 Yes 2 Probably Yes 3 Probably No 4 No (61)
55. Would a casual partner get angry?
1 Yes 2 Probably Yes 3 Probably No 4 No (62)
56. If you asked a steady partner to use condoms/rubbers, do you think he
would get violent?
1 Yes 2 Probably Yes 3 Probably No 4 No (63)
57. Would a casual partner get violent?
1 Yes 2 Probably Yes 3 Probably No 4 No (64)
58. If you asked a steady partner to use a condom/rubber, do you think he
would refuse to have sex with you?
1 Yes 2 Probably Yes 3 Probably No 4 No (65)
59. Would a casual partner refuse to have sex with you?
1 Yes 2 Probably Yes 3 Probably No 4 No (66)
60. Imagine that you carried condoms/rubbers in your pocket or purse. Do you
think that your women friends would think badly of you?
1 Yes 2 Probably Yes 3 Probably No 4 No (67)
9 RA
61. If you had condoms/rubbers with you, would a casual partner respect you
more than if you didn't have them?
1 Yes 2 Probably Yes 3 Probably No 4 No (68)
62. If you had condoms/rubbers with you, would men think you're willing to
have sex with someone you just met?
1 Yes 2 Probably Yes 3 Probably No 4 No (69)
Respondent ID __ __ __ __.
(01-04)
Card = 3 (05)
In the following questions we want to know how much you would be bothered
by some things that could happen to a person who used condoms/rubbers.
These questions may seem repetitive but they are very important and we
would appreciate your patience.
The responses can be "A lot" "Somewhat" or "Very little"
63. How much would it bother you to feel less pleasure during sex? Would it
bother you a lot, somewhat or very little?
1 A lot 2 Somewhat 3 Very little (06)
64. How much would it bother you to feel a burning sensation in your sex
organs?
1 A lot 2 Somewhat 3 Very little (07)
65. How much would it bother you to interrupt sex?
1 A lot 2 Somewhat 3 Very little (08)
66. How much would it bother you to feel guilty?
1 A lot 2 Somewhat 3 Very little (09)
67. How much would it bother you to have a condom/rubber that feels
uncomfortable or too tight to your partner?
1 A lot 2 Somewhat 3 Very little (10)
68. How much would it bother you if a condom/rubber came off inside you?
1 A lot 2 Somewhat 3 Very little (11)
69. How much would it bother you if a condom/rubber broke?
1 A lot 2 Somewhat 3 Very little (12)
70. How much would it bother you if you felt an emotional barrier with your
partner?
1 A lot 2 Somewhat 3 Very little (13)
BLANK (14)
72. How much would it bother you if your partner had trouble ejaculating?
1 A lot 2 Somewhat 3 Very little (15)
73. How much would it bother you if your partner had trouble keeping an
erection?
1 A lot 2 Somewhat 3 Very little (16)
74. How much would it bother you to get a venereal disease like gonorrhea or
syphilis?
1 A lot 2 Somewhat 3 Very little (17)
75. How much would it bother you to have a steady partner think you had had
sex with someone else?
1 A lot 2 Somewhat 3 Very little (18)
76. How much would it bother you to have a steady partner get angry?
1 A lot 2 Somewhat 3 Very little (19)
77. How much would it bother you to have a casual partner get angry?
1 A lot 2 Somewhat 3 Very little (20)
78. How much would it bother you to have a steady partner refuse to have
sex with you?
1 A lot 2 Somewhat 3 Very little (21)
79. How much would it bother you to have a casual partner refuse to have
sex with you?
1 A lot 2 Somewhat 3 Very little (22)
80. How much would it bother you to have your women friends think badly
of you?
1 A lot 2 Somewhat 3 Very little (23)
81. Now, please tell me, how much would you like to have a casual partner
respect you more? Would you say a lot, somewhat or very little?
6 A lot 5 Somewhat 4 Very little (24)
82. How much would you like not having to worry about giving a steady
partner a disease like syphilis, gonorrhea or AIDS?
6 A lot 5 Somewhat 4 Very little (25)
83. How much would you like to have sex feel cleaner?
6 A lot 5 Somewhat 4 Very little (26)
For the following items, first tell me if you would like it or dislike it,
then tell me how much you would like or dislike it.
84. Would you like or dislike getting pregnant now? How much, a lot,
somewhat or very little?
like it: 6 A lot 5 Somewhat 4 Very little (27)
dislike it: 1 A lot 2 Somewhat 3 Very little
85. Would you like or dislike having sex last longer? How much?
like it: 6 A lot 5 Somewhat 4 Very little (28)
dislike it: 1 A lot 2 Somewhat 3 Very little
86. Would you like or dislike having men think you're willing to have sex
with someone you just met? How much?
like it: 6 A lot 5 Somewhat 4 Very little (29)
dislike it: 1 A lot 2 Somewhat 3 Very little
87. Would you like or dislike using a condom/rubber with a steady partner?
How much?
like it: 6 A lot 5 Somewhat 4 Very little (30)
dislike it: 1 A lot 2 Somewhat 3 Very little
88. Would you like or dislike using a condom/rubber with a casual partner?
How much?
like it: 6 A lot 5 Somewhat 4 Very little (31)
dislike it: 1 A lot 2 Somewhat 3 Very little
89. Would you like or dislike carrying a condom/rubber with you?
How much?
like it: 6 A lot 5 Somewhat 4 Very little (32)
dislike it: 1 A lot 2 Somewhat 3 Very little
90. How many of your closest women friends do you think carry condoms
with them?
Would you say almost all, more than half, half, less than half or almost
none?
[IF THE PERSON DOESN'T KNOW, SAY: "Even if you don't know, please try
to guess"]
(33)
1 Almost 2 More 3 Half 4 Less 5 Almost
all than half than half None
7 NO FRIENDS [GO TO Q93]
91. How many of your closest women friends do you think use
condoms/rubbers when they have sex with a steady partner?
(34)
1 Almost 2 More 3 Half 4 Less 5 Almost
all than half than half None
92. How many of your closest women friends do you think use
condoms/rubbers when they have sex with a casual partner?
(35)
1 Almost 2 More 3 Half 4 Less 5 Almost
all than half than half None
7 NO FRIENDS HAVE CASUAL PARTNERS
93. Try to imagine how comfortable you would feel in the following
situations.
How comfortable would you feel buying a condom/rubber? Would you feel
very comfortable, somewhat comfortable, somewhat uncomfortable or very
uncomfortable?
1 Very 2 Somewhat 3 Somewhat 4 Very (36)
comfortable comfortable uncomfortable uncomfortable
94. How comfortable would you feel asking a steady partner to use a
condom/rubber?
1 Very 2 Somewhat 3 Somewhat 4 Very (37)
comfortable comfortable uncomfortable uncomfortable
95. How comfortable would you feel asking a casual partner to use a
condom/rubber?
1 Very 2 Somewhat 3 Somewhat 4 Very (38)
comfortable comfortable uncomfortable uncomfortable
96. How comfortable would you feel watching your partner put on a
condom/rubber?
1 Very 2 Somewhat 3 Somewhat 4 Very (39)
comfortable comfortable uncomfortable uncomfortable
97. How comfortable would you feel putting a condom/rubber on your
partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (40)
comfortable comfortable uncomfortable uncomfortable
98. How comfortable would you feel having a steady partner use a
condom/rubber?
1 Very 2 Somewhat 3 Somewhat 4 Very (41)
comfortable comfortable uncomfortable uncomfortable
99. How comfortable would you feel having a casual partner use a
condom/rubber?
1 Very 2 Somewhat 3 Somewhat 4 Very (42)
comfortable comfortable uncomfortable uncomfortable
100. How comfortable would you feel being naked in front of a sex partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (43)
comfortable comfortable uncomfortable uncomfortable
101. How comfortable would you feel having sex with the lights on?
1 Very 2 Somewhat 3 Somewhat 4 Very (44)
comfortable comfortable uncomfortable uncomfortable
102. How comfortable would you feel having sex with a new partner?
1 Very 2 Somewhat 3 Somewhat 4 Very (45)
comfortable comfortable uncomfortable uncomfortable
Now I'd like to ask you...
103. Do you have any children?
00 NO YES How many? ___ ___ (46-47)
104. BLANK (48)
IF NECESSARY, ASK: Do you have a husband or steady partner?
YES [GO TO Q105] ***No [GO TO Q111]
105. Are you pregnant?
1 YES [GO TO Q. 111] (49)
0 NO
7 HE/SHE CANNOT HAVE CHILDREN [GO TO Q111]
8 DON'T KNOW
9 RA
106. Are you trying to get pregnant?
1 YES [GO TO Q. 111] (50)
0 NO
7 HE/SHE CANNOT HAVE CHILDREN [GO TO Q111]
9 RA
IF Q103 ABOVE IS 00, GO TO Q108
107. Have you given birth in the last 3 months?
1 YES [GO TO Q. 111] (51)
0 NO
7 HE/SHE CANNOT HAVE CHILDREN [GO TO Q111]
9 RA
108. Have you or your steady partner used some form of birth control
other than condoms/rubbers in the last 12 months?
YES >>>>>>>>>>>>>>[IF THE ANSWER IS YES] Which kind? (52)
[CIRCLE ALL THAT APPLY]
1 PILL
0 NO 2 IUD
3 DIAPHRAGM
4 SPONGE/FOAM/JELLY
5 DOUCHE
9 RA 6 WITHDRAWAL
7 ABORTION
8 OTHER ____________________
IF ANSWER IS YES, GO TO Q111
109. Is there a reason why your partner is unable to have children either
due to an operation or some other cause?
1 YES [GO TO Q. 111] (53)
0 NO
8 DON'T KNOW
9 RA
110. Is there a reason why you are unable to have children either due
to an operation or some other cause?
1 YES (54)
0 NO
8 DON'T KNOW
9 RA
111. Now I'm going to ask you some questions about how you have been
feeling during the last seven days. Since [ TODAY'S DAY OF THE WEEK]
of last week
Were you bothered by things that usually don't bother you?
O NO [IF THE ANSWER IS YES, SAY]: (55)
How many days during the past week?
[DO NOT READ RESPONSES]
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
112. Did you feel like not eating or was your appetite poor?
O NO [IF THE ANSWER IS YES, SAY]: (56)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
113. Did you feel like you couldn't shake off the blues even with the help
of family and friends?
O NO [IF THE ANSWER IS YES, SAY]: (57)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
114. Did you feel depressed?
O NO [IF THE ANSWER IS YES, SAY]: (58)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
115. Did you feel as if your life had been a failure?
O NO [IF THE ANSWER IS YES, SAY]: (59)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
116. Did you feel afraid?
O NO [IF THE ANSWER IS YES, SAY]: (60)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
117. Was your sleep restless?
O NO [IF THE ANSWER IS YES, SAY]: (61)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
118. Did you feel lonely?
O NO [IF THE ANSWER IS YES, SAY]: (62)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
119. Did you feel sad?
O NO [IF THE ANSWER IS YES, SAY]: (63)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
120. Did you have crying spells?
O NO [IF THE ANSWER IS YES, SAY]: (64)
How many days during the past week?
1 1-2 DAYS 2 3-4 DAYS 3 5-7 DAYS
IF NON-HISPANIC, GO TO Q128
IF HISPANIC, CONTINUE BELOW
121. Now, please tell me, where were you born?
1 USA [GO TO THE FOLLOWING QUESTION] (65)
2 PUERTO RICO [GO TO Q. 123]
3 MEXICO [GO TO Q. 123]
4 REPUBLICA DOMINICANA [GO TO Q. 123]
5 COLOMBIA [GO TO Q. 123]
6 CENTRAL AMERICA [GO TO Q. 123]
7 SOUTH AMERICA, (NO COLOMBIA) [GO TO Q. 123]
8 SPAIN OR CUBA [GO TO Q. 123]
9 OTHER _______________________ [GO TO THE FOLLOWING QUESTION]
FOR HISPANICS BORN IN THE U.S. OR COUNTRIES LISTED AS 9 ABOVE
122. The families of the majority of people living in the United States
come from other countries. Where is your family from?
[DO NOT READ ALTERNATIVES IF RESPONSE IS MORE THAN ONE COUNTRY,
ASK:]"Which country is the majority of your family from or which country
do you feel closest to?" [CIRCLE ONLY ONE]
2 PUERTO RICO (66)
3 MEXICO
4 REPUBLICA DOMINICANA
5 COLOMBIA
6 CENTRAL AMERICA
7 SOUTH AMERICA, (NO COLOMBIA)
8 CUBA
123. How long have you lived in the United States?
___ ___ YEARS [LESS THAN A YEAR = ONE YEAR{01}] (67-68)
Respondent ID __ __ __ __.
(01-04)
Card = 4 (05)
124. In general what language do you read and speak? Would you say
Spanish only, Spanish more than English, both equally, English more than
Spanish, or English only?
(06)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
125. What language do you usually speak at home?
(07)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
126. In which language do you usually think?
(08)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
127. What language do you usually speak with your friends?
(09)
1 Spanish 2 Spanish more 3 Both 4 English more 5 English
only than English equally than Spanish only
ASK EVERYONE
128. How many years of formal education have you completed?
___ ___ YEARS (10-11)
129. Are you:
1 Married or living with your partner (12)
2 Single
3 Separated or divorced
4 Widowed
130. What is your religion? __________________________
(13)
1 CATHOLIC
2 CHRISTIAN OTHER THAN CATHOLIC
3 OTHER: (SPECIFY: ________________)
4 NONE
131. How important is religion in your life? Would you say...
(14)
1 Extremely important
2 Very important
3 Important
4 Somewhat important
5 Not important at all
132. How many years have you been employed in a full time or part time
job, excluding housework in your own home?
___ ___ YEARS [LESS THAN A YEAR = ONE YEAR{01}] (15-16)
133. Would you say that you live in a town, city, suburb of a city, or a
rural area?
1 TOWN 2 CITY 3 SUBURB 4 RURAL AREA (17)
134. Could you please give me your Zip Code?
__ __ __ __ __ ZIP CODE (18-22)
[99998 >> DK 99999 >> RA]
135. Tell me when I get to the category that best describes your family
income for 1990. [IF LIVING ALONE, ASK FOR PERSONAL INCOME]
[READ THE RESPONSES]
1 Less than $10,000 (23)
2 $10,001 to 20,000
3 $20,001 to 40,000
4 More than $40,000
8 DON'T KNOW
9 RA
As I already explained, your phone number was chosen at random. To avoid
calling your house again, could you please tell me if there is another
telephone number in your house?
[IF THE ANSWER IS YES] What is it?__________________
Is there more than one number?
OTHER NUMBER(S) ________________________
136. NUMBER OF TELEPHONE LINES _________ (24)
[INCLUDING THE ONE BEING CALLED]
IF NON HISPANIC, GO TO PARAGRAPH BEGINNING:
'This is all for now."
IF HISPANIC, CONTINUE BELOW
137. In the future, it is possible that we will do a study of sexual attitudes
and behavior among Hispanic adolescents. The questions will be very
different from the ones you just answered and will be appropriate for
adolescents. To include an adolescent in that study not only would we need
the adolescent's consent but also the permission of a parent or guardian.
Is there an adolescent in this house who is 15, 16 or 17 years old?
YES How many? _____ NO 0 [GO TO END] (25)
Could you give me the name of the parent or guardian who could give
permission to interview the adolescent, if we do call?
____________________________________________________
138. Could you give me the names of the adolescent(s)?
___________________________________________
ASK IF UNCLEAR: NUMBER OF FEMALES ______ (26)
This is all for now. My supervisor may call you back to validate that this
interview was completed. Thank you for your help with this interview.
If you would like any further information about AIDS or AIDS prevention,
you can call this number 1-800-342-2437 [AIDS]. Would you like me to
repeat that number? The call is free and you don't have to give your name.
Again, thank you very much!
__________________________________________________________________
TIME AT THE END OF INTERVIEW:___________
139. LENGTH OF INTERVIEW [ IN MINUTES] ___ ___ (27-28)
140. LANGUAGE OF INTERVIEW: 0 ENGLISH (29)
141. LANGUAGE CHOICE:
1 RESPONDENT 0 RANDOMLY BY INTERVIEWER (30)
142. INTERVIEWER'S NAME:_________________________ [ ___ ___ ___ ] (31-33)
DATE OF INTERVIEW:_____________________________
INTERVIEW TERMINATED BEFORE COMPLETION
1 YES 0 NO (34)
[IF THE ANSWER IS YES] __ __ __ ITEM NUMBER (35-37)
IS RESPONDENT A MEMBER OF HOUSEHOLD?
1 YES 0 NO (38)National Black HIV/AIDS Awareness Day — February 7, 2017 [booklet]
Research & Resources
This brochure lists research projects with African Americans and helpful resources produced by CAPS/PRC. You might use it to:- Stay up-to-date on research and learn what we found out from research
- Provide materials in trainings/presentations
- Advocate for services/funding
- Write grants
- Develop new or modify existing HIV prevention programs
- Evaluate current programs
- Connect with CAPS/PRC to develop new projects. Lead researchers (PIs) are listed for each study. Contact us below to connect.