We are doing a survey to improve health services. Some questions may be personal and embarrassing, but they are necessary to get important information. We will NOT ask you your name, so your answer will be secret. You do not have to answer these questions if you do not want to.

Are you willing to answer? [IF NOT STOP HERE] Please answer accurately.

NO#

Questionnaire Identification

Q101

Interviewer's name

Q102

Date (day/month/year)

Q103

Site

Q104

Subject Number

Subject Information

Q201

How old are you?

[0 = DON'T KNOW]

Q202

How many years of school have you completed?

Q203

How many years have you stayed in this place [NAME THE PLACE]?

[99 = SINCE BIRTH]

Q204

In the last 12 months, have you lived outside this place [NAME THE PLACE] for one month or more?

YES

1

NO

2

NR

9

AIDS Issues

Q301

Have you ever heard of AIDS?

YES

1

NO

2

® 401

NR

9

® 401

Q302

Is AIDS a fatal disease?

YES

1

NO

2

DK

3

Q303

Is there a cure for AIDS?

YES

1

NO

2

DK

3

Q304

Can a person get AIDS from having sexual intercourse?

YES

1

NO

2

DK

3

Q305

Can a person get AIDS by working next to a person with AIDS?

YES

1

NO

2

DK

3

Q306

Can an AIDS infected pregnant woman give AIDS to her unborn baby?

YES

1

NO

2

DK

3

Q307

Can a healthy looking person have AIDS?

YES

1

NO

2

DK

3

Q308

Do you think you can get AIDS?

YES

1

NO

2

DK

3

Q309

Is there anything you can do to avoid getting AIDS?

YES

1

NO

2

DK

3

Q310

Have you personally made any changes in your sexual behavior to avoid getting AIDS?

YES

1

NO

2

® 312

NR

9

® 312

Q311

When did you start making these sexual behavior changes?

[RECORD IN MONTHS]

Q312

Have you ever attended an AIDS education meeting held by peer educators in this place [NAME THE SITE]?

YES

1

NO

2

® 315

NR

9

® 315

Q313

How many AIDS education meetings held by peer educators have you attended in this place [NAME THE SITE] in the last three months?

Q314*

Have you ever received any condoms in an AIDS education meeting in this place [NAME THE SITE]?

YES

1

NO

2

NR

9

Q315

Have you ever talked about AIDS with a peer educator in this place [NAME THE SITE]?

YES

1

NO

2

® 317

NR

9

® 317

Q316

How many times have you talked about AIDS with a peer educator in this place [NAME THE SITE] in the last three months?

Q317*

Have you ever received any condoms from a peer educator in this place [NAME THE SITE]?

YES

1

NO

2

NR

9

Sexual relations and condom use

Now I am going to ask you some personal questions about your sex life. Remember we do not know your name, so your answers are completely secret. Please answer accurately.

Q401*

Do you know what a condom is?

[USE LOCAL TERM FOR A CONDOM]

YES

1

NO

2

NR

9

SKIP CONDOM QUESTIONS

Q402*

Do you know any places or people where you can obtain condoms?

YES

1

NO

2

NR

9

Q403*

Have you ever used a condom?

YES

1

NO

2

NR

9

SKIP CONDOM QUESTIONS

Q404*

What is the main reason why you use condoms?

[DO NOT READ OUT THE ANSWERS]

1. To avoid pregnancy
2. To avoid giving a disease
3. To avoid getting a disease
4. Pressure from partner
5. Other:________________

9. No response

Q405*

Are there any other reasons why you use condoms?

[PROBE FOR MORE ANSWERS]

1. To avoid pregnancy
2. To avoid giving a disease
3. To avoid getting a disease
4. Pressure from partner
5. Other:________________

9. No response

Q406

Are you married?

YES

1

NO

2

® 409

NR

9

® 409

Q407*

In the past three months, how often did you use a condom with your husband?

1. Never (® 409)
2. Sometimes
3. Always

9. No response

Q408*

The last time you had sexual intercourse with your husband, did you use a condom?

YES

1

NO

2

NR

9

Q409

In the past three months, how many men have you had sexual intercourse with?

[PROBE FOR A NUMBER]

Q410

In the past three months, have you had a steady boyfriend? By steady boyfriend I mean someone:

• who is not your husband
• who you have been seeing regularly for at least a month
• who is not paying for sexual intercourse

YES

1

NO

2

® 414

NR

9

® 414

Q411

How many steady boyfriends have you had sexual intercourse with in the past three months?

[PROBE FOR A NUMBER]

Q412*

In the past three months, how often did you use a condom with steady boyfriend?

[IF VAGUE ASK: Was there a time when you haven't used a condom?]?

1. Never (® 414)
2. Sometimes
3. Always

9. No response

Q413*

The last time you had sexual intercourse with a steady boyfriend, did you use a condom?

YES

1

NO

2

NR

9

Q414

In the past three months, have you had a casual sex partner? By casual partner I mean someone you have had sexual intercourse with a few times without being paid.

YES

1

NO

2

® 418

NR

9

® 418

Q415

How many casual partners have you had sexual intercourse with in the past three months?

[PROBE FOR A NUMBER]

Q416*

In the past three months, how often did you use a condom when you had sexual intercourse with casual sex partners?

[IF VAGUE ASK: Was there a time when you haven't used a condom?]?

1. Never (® 418)
2. Sometimes
3. Always

9. No response

Q417*

The last time you had sexual intercourse with a casual sex partner, did you use a condom?

YES

1

NO

2

NR

9

Q418

During the last week, how many regular paying clients did you have sexual intercourse with?

[PROBE FOR A NUMBER]

Q419*

During the last week, how often did you use a condom when you had sexual intercourse with a regular paying client?

[IF VAGUE ASK: Was there a time when you haven't used a condom?]?

1. Never (® 421)
2. Sometimes
3. Always

9. No response

Q420*

The last time you had sexual intercourse with a regular paying client, did you use a condom?

YES

1

NO

2

NR

9

Q421

During the last week how many one time paying clients have you had sexual intercourse with?

[PROBE FOR A NUMBER]

Q422*

During the last week, how often did you use a condom when you had sexual intercourse with a one time paying client?

1. Never (® 424)
2. Sometimes
3. Always

9. No response

Q423*

The last time you had sexual intercourse with one time paying client, did you use a condom?

YES

1

NO

2

NR

9

Q424

In the past 3 months, have you traveled outside this place? [NAME THE PLACE]

YES

1

NO

2

® 501

NR

9

® 501

Q425

During your travel have you had sexual intercourse with anyone other than your husband or boyfriend?

YES

1

NO

2

NR

9

STI and health issues

Q501

Some women have a smelly discharge from the vagina or experience abdominal pain. During the past 6 months, have you experienced any such discharge or pain?

YES

1

NO

2

NR

9

Q502

Some women have sores in the genital area. During the last 6 months, have you had any such sores?

YES

1

NO

2

NR

9

FILTER: IF THE ANSWER TO EITHER 501 OR 502 IS YES ® 506

Q503

Would you consider the symptoms I have just described (discharge, sores) to be a sign of an illness?

YES

1

NO

2

DK

8

Q504

If you had any of the symptoms I described what would you do?

[DO NOT READ OUT THE ANSWERS]

1. Go to a clinic or hospital
2. Buy drugs from a shop/market
3. Go to a traditional healer
4. Seek help from a friend or relative
5. Wait/Do Nothing
6. Other:______________________

9. No response

Q505

Do you think that the symptoms I described can be passed on to your spouse or sexual partner(s)?

YES

1

NO

2

DK

8

THIS IS THE END OF THE QUESTIONNAIRE. THANK YOU FOR YOUR COOPERATION!

Q506

Did you consider the symptoms you had to be a sign of an illness?

YES

1

NO

2

DK

8

Q507

What, if anything, did you do about the symptoms you had?

[DO NOT READ OUT THE ANSWERS]

1. Go to a clinic or hospital
2. Buy drugs from a shop/market
3. Go to a traditional healer
4. Seek help from a friend or relative
5. Wait/Do Nothing
6. Other:______________________

9. No response

Q508

Do you think that the symptoms you had could be passed on to your spouse or sexual partner(s)?

YES

1

NO

2

DK

8

THIS IS THE END OF THE QUESTIONNAIRE. THANK YOU FOR YOUR COOPERATION!

DK = Don't Know

NR = No Response

* = Condom question

We are doing a survey to improve health services. Some questions may be personal and embarrassing, but they are necessary to get important information. We will NOT ask you your name, so your answer will be secret. You do not have to answer these questions if you do not want to.

Are you willing to answer? [IF NOT STOP HERE] Please answer accurately.

NO#

Questionnaire Identification

Q101

Interviewer's name

Q102

Date (day/month/year)

Q103

Site

Q104

Subject Number

Subject Information

Q201

How old are you?

[0 = DON'T KNOW]

Q202

How many years of school have you completed?

Q203

How many years have you stayed in this place [NAME THE PLACE]?

[99 = SINCE BIRTH]

Q204

In the last 12 months, have you lived outside this place [NAME THE PLACE] for one month or more?

YES

1

NO

2

NR

9

AIDS Issues

Q301

Have you ever heard of AIDS?

YES

1

NO

2

® 401

NR

9

® 401

Q302

Is AIDS a fatal disease?

YES

1

NO

2

DK

8

Q303

Is there a cure for AIDS?

YES

1

NO

2

DK

8

Q304

Can a person get AIDS from having sexual intercourse?

YES

1

NO

2

DK

8

Q305

Can a person get AIDS by working next to a person with AIDS?

YES

1

NO

2

DK

8

Q306

Can an AIDS infected pregnant woman give AIDS to her unborn baby?

YES

1

NO

2

DK

8

Q307

Can a healthy looking person have AIDS?

YES

1

NO

2

DK

8

Q308

Do you think you can get AIDS?

YES

1

NO

2

DK

8

Q309

Is there anything you can do to avoid getting AIDS?

YES

1

NO

2

DK

8

Q310

Have you personally made any changes in your sexual behavior to avoid getting AIDS?

YES

1

NO

2

® 312

NR

9

® 312

Q311

When did you start making these sexual behavior changes?

[RECORD IN MONTHS]

Q312

Have you ever attended an AIDS education meeting held by peer educators in this place [NAME THE SITE]?

YES

1

NO

2

® 315

NR

9

® 315

Q313

How many AIDS education meetings held by peer educators have you attended in this place [NAME THE SITE], in the last three months?

Q314*

Have you ever received any condoms in an AIDS education meeting in this place [NAME THE SITE]?

YES

1

NO

2

NR

9

Q315

Have you ever talked about AIDS with a peer educator in this place?

[NAME THE SITE]

YES

1

NO

2

® 317

NR

9

® 317

Q316

How many times have you talked about AIDS with a peer educator in this place [NAME THE SITE] in the last three months?

Q317*

Have you ever received any condoms from a peer educator in this place? [NAME THE SITE]?

YES

1

NO

2

NR

9

Sexual relations and condom use

Now I am going to ask you some personal questions about your sex life. Remember we do not know your name, so your answers are completely secret. Please answer accurately.

Q401*

Do you know what a condom is?

[USE LOCAL TERM FOR A CONDOM]

YES

1

NO

2

NR

9

SKIP CONDOM QUESTIONS

Q402*

Do you know any places or people where you can obtain condoms?

YES

1

NO

2

NR

9

Q403*

Have you ever used a condom?

YES

1

NO

2

NR

9

SKIP CONDOM QUESTIONS

Q404*

What is the main reason why you use condoms?

[DO NOT READ OUT THE ANSWERS]

1. To avoid pregnancy
2. To avoid giving a disease
3. To avoid getting a disease
4. Pressure from partner
5. Other:_______________________

9. No response

Q405*

Are there any other reasons why you use condoms?

[PROBE FOR MORE ANSWERS]

1. To avoid pregnancy
2. To avoid giving a disease
3. To avoid getting a disease
4. Pressure from partner
5. Other:_______________________

9. No response

Q406

Are you married?

YES

1

NO

2

® 409

NR

9

® 409

Q407*

In the past three months, how often did you use a condom with your wife or wives?

[IF VAGUE ASK: Was there a time when you haven't used a condom?]

1. Never (® 409)
2. Sometimes
3. Always

9. No response

Q408*

The last time you had sexual intercourse with your wife, did you use a condom?

YES

1

NO

2

NR

9

Q409

In the past three months, how many women have you had sexual intercourse with?

[PROBE FOR A NUMBER]

Q410

In the past three months, have you had a steady girlfriend? By steady girlfriend I mean someone:

• who is not your wife
• who is not asking you to pay each time for sexual intercourse
• who you have been seeing regularly for at least a month

YES

1

NO

2

® 414

NR

9

® 414

Q411

How many steady girlfriends have you had sexual intercourse with in the past three months?

[PROBE FOR A NUMBER]

Q412*

In the past three months, how often did you use a condom with steady girlfriend?

[IF VAGUE ASK: Was there a time when you haven't used a condom?]

1. Never (® 414)
2. Sometimes
3. Always

9. No response

Q413*

The last time you had sexual intercourse with a steady girlfriend, did you use a condom?

YES

1

NO

2

NR

9

Q414

In the past three months, have you had a casual sex partner? By casual partner I mean someone you have had sexual intercourse with a few times without paying.

YES

1

NO

2

® 418

NR

9

® 418

Q415

How many casual partners have you had sexual intercourse with in the past three months? [PROBE FOR A NUMBER]

Q416*

In the past three months, how often did you use a condom when you had sexual intercourse with casual sex partners?

[IF VAGUE ASK: Was there a time when you haven't used a condom?]

1. Never (® 418)
2. Sometimes
3. Always

9. No response

Q417*

The last time you had sexual intercourse with a casual sex partner, did you use a condom?

YES

1

NO

2

NR

9

Q418

Have you ever had sexual intercourse with a sex worker? By sex worker I mean someone who regularly receives money in exchange for sex.

YES

1

NO

2

® 422

NR

9

® 422

Q419

How many times have you had sexual intercourse with a sex worker in the past three months? [PROBE FOR A NUMBER]

Q420*

In the past three months, how often did you use a condom when you had sexual intercourse with a sex worker

[IF VAGUE ASK: Was there a time when you haven't used a condom?]?

1. Never (® 422)
2. Sometimes
3. Always
4. No response

Q421*

The last time you had sexual intercourse with a sex worker, did you use a condom?

YES

1

NO

2

NR

9

Q422

In the past 3 months, have you traveled outside this place [NAME THE PLACE]?

YES

1

NO

2

® 501

NR

9

® 501

Q423

During your travel have you had sexual intercourse with anyone other than your wife or girlfriend?

YES

1

NO

2

NR

9

YES

1

NO

2

NR

9

YES

1

NO

2

NR

9

YES

1

NO

2

DK

8

If you had any of the symptoms I described what would you do?

[DO NOT READ OUT THE ANSWERS]

1. Go to a clinic or hospital
2. Buy drugs from a shop/market
3. Go to a traditional healer
4. Seek help from a friend or relative
5. Wait/Do Nothing
6. Other:______________________

9. No response

YES

1

NO

2

DK

8

YES

1

NO

2

DK

8

What, if anything, did you do about the symptoms you had?

[DO NOT READ OUT THE ANSWERS]

1. Go to a clinic or hospital
2. Buy drugs from a shop/market
3. Go to a traditional healer
4. Seek help from a friend or relative
5. Wait/Do Nothing
6. Other:______________________

9. No response

YES

1

NO

2

DK

8

DK = Don't Know

NR = No Response

* = Condom question