MEN'S QUESTIONNAIRE
IDENTIFICATION
NAME OF HOUSEHOLD HEAD: ____
PSU CODE: ____
HOUSEHOLD NUMBER: ____
REGION:
MANZINI 2
SHISELWENI 3
LUBOMBO 4
URBAN/RURAL
RURAL 2
LARGE CITY/SMALL CITY/TOWN/COUNTRYSIDE
SMALL CITY 2
TOWN 3
COUNTRYSIDE 4
NAME AND LINE NUMBER OF MAN_______
INTERVIEWER VISIT 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE_______
INTERVIEWER'S NAME_______
RESULT_____
NEXT VISIT:
DATE_____
TIME______
FINAL VISIT
DAY______
MONTH_______
YEAR2006
INTERVIEWER NUMBER: _______
TOTAL NIMBER OF VISITS________
RESULT CODES
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ________7
LANGUAGE OF INTERVIEW: ____
LANGUAGE:
ENGLISH 2
OTHER 3
RESPONDENT'S LANGUAGE_______
TRANSLATOR USED
SOMETIMES 2
ALL THE TIME 3
SUPERVISOR
NAME______
DATE_______
FIELD EDITOR
NAME______
DATE_______
OFFICE EDITOR______
KEYED BY______
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is __________ and I am working with the Central Statistical Office. We are conducting a national survey about the health of men, women and children. We would very much appreciate your participation in this survey. I would like to ask you some questions related to health. This information will help the government to plan health services. The survey usually takes about 30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be shown to other persons.
Participation in this survey is voluntary and you can choose not to answer any individual question or all of the questions. However, we hope that you will participate in this survey since your views are important.
At this time, do you want to ask me anything about the survey?
May I begin the interview now?
SIGNATURE OF INTERVIEWER_________
DATE_______
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES_______
102) How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)
103) Just before you moved here, did you live in a city, in a town, or in the countryside?
TOWN 2
COUNTRYSIDE 3
104) In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?
NONE 00 (GO TO 106)
105) In the last 12 months, have you been away from your home community for more than 1 month at a time?
NO 2
106) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
107) How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.
108) Have you ever attended school?
NO 2 (GO TO 112)
109) What is the highest level of school you attended: primary, secondary, or higher?
HIGHER PRIMARY 2
SECONDARY 3
HIGH SCHOOL 4
TERTIARY 5
110) What is the highest (grade/form/year) you completed at that level?
SECONDARY OR HIGHER CODE '3' OR '4' CIRCLED____ (GO TO 115)
112) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any other part of the sentence to me?
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) ___________4
BLIND/VISUALLY IMPAIRED 5
113) Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?
NO 2
CODE '1' OR '5' CIRCLED____ (GO TO 116)
115) Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
116) Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
117) Do you watch television almost every day, at least once a week, less than once a week or not at all?
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4
CHARISMATIC 02
PROTESTANT 03
ROMAN CATHOLIC 04
PENTECOSTAL 05
ZIONIST 06
APOSTOLIC SECT 07
ISLAM 08
NONE 09
OTHER (SPECIFY) ________96
201) Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name.
Have you ever fathered any children with any woman?
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)
202) Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (GO TO 204)
203) How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTER'S AT HOME______
204) Do you have any sons or daughters you have fathered who are alive but do not live with you?
NO 2 (GO TO 206)
205) How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE________
206) Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 308)
207) How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.
GIRLS DEAD_______
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL. IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD______ (GO TO 212)
HAS NOT HAD ANY CHILDREN____ (GO TO 213)
210) Did all of the children you have fathered have the same biological mother?
NO 2
211) In all, how many women have you fathered children with?
212) How old were you when your (first) child was born?
213) I will now read you some statements about pregnancy. Please tell me if you agree or disagree with them.
a) Childbearing is a woman's concern and there is no need for the father to get involved.
b) It is crucial for the mother's and child's health that a woman have assistance from a doctor or nurse at delivery.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy
Which ways or methods have you heard about?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
(SPECIFY) ________
(SPECIFY) _______
NO 2
302) Have you ever used (METHOD)?
Have you ever had an operation to avoid having any more children?
NO 2
NO 2
NO 2
NO 2
MAN STERILIZED____ (GO TO 305A)
304) Are you currently doing something or using any method with any partner to delay or avoid a pregnancy?
NO 2 (GO TO 306)
305) Which methods are you or your partner using to delay or avoid a pregnancy?
Any other method (with any partner)?
CIRCLE ALL MENTIONED.
305A) CIRCLE 'B' FOR MALE STERILIZATION.
MALE STERILIZATION B
PILL C
IUD D
INJECTABLES E
IMPLANTS F
CONDOM G
FEMALE CONDOM H
DIAPHRAGM I
FOAM/JELLY J
LACTATIONAL AMEN. METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER (SPECIFY) _______X
306) In the last six months have you heard/seen about family planning:
On the radio?
On the television?
In a newspaper or magazine?
NO 2
NO 2
NO 2
307) In the last six months, have you discussed the practice of family planning with a health worker or health professional?
NO 2
308) Now I would like to ask you about a woman's risk of pregnancy From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?
NO 2 (GO TO 310)
DON'T KNOW 8 (GO TO 310)
309) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ______6
DON'T KNOW 8
310) Do you think that a woman who is breastfeeding her baby can become pregnant?
NO 2
DEPENDS 3
DON'T KNOW 8
311) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
a) Contraception is women's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living together with a woman as if married?
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3
402) Have you ever been married or lived together with a woman as if married?
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)
403) What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
(ALL GO TO 410)
404) Is your wife/partner living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405) Do you have more than one wife or do you have more than one woman with whom you are living as if married?
NO 2 (GO TO 407)
DON'T KNOW 8 (GO TO 407)
406) In total, how many wives do you have or other partners do you live with now as if married?
DON'T KNOW 98
407) CHECK 405
ONE WIFE/PARTNER____:
Please tell me the name of your wife (the woman you are living with as if married).
MORE THAN ONE WIFE/PARTNER____:
Please tell me the name of each of your current wives (and/or of each woman you are living with as if married).
RECORD THE NAME(S) AND THE LINE NUMBER(S) FROM THE HOUSEHOLD QUESTIONNAIRE FOR THE WIFE (WIVES) AND LIVE-IN PARTNER(S). IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. ASK 408 FOR EACH PERSON.
LINE NUMBER______
408) How old was (NAME) on her last birthday?
MORE THAN ONE WIFE/PARTNER_______ (GO TO 411A)
410) Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2 (GO TO 411A)
411) In what month and year did you start living with your wife (partner)?
411A) Now I would like to ask a question about your first wife/partner. In what month and year did you start living with your first wife/ partner?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
412) How old were you when you first started living with her?
413) CHECK FOR THE PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
414) Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family life issues.
How old were you when you had sexual intercourse for the very first time?
AGE IN YEARS______ (GO TO 416)
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 416)
415) Do you intend to wait until you get married to have sexual intercourse for the first time?
NO 2
DON'T KNOW/UNSURE 8
(GO TO 445)
AGE 25-49____ (GO TO 421)
417) The first time you had sexual intercourse, was a male/female condom used?
YES, FEMALE CONDOM 2 (GO TO 418)
NO 3
417A) What was the main reason you did not use a condom the first time you had sexual intercourse?
NOT NECESSARY 2
NOT THOUGHT OF 3
PARTNER REFUSED 4
REDUCES PLEASURE 5
OTHER (SPECIFY) ________6
418) How old was the person you first had sexual intercourse with?
DON'T KNOW 98
419) Was this person older than you, younger than you, or about the same age as you?
YOUNGER 2 (GO TO 421)
ABOUT THE SAME AGE 3 (GO TO 421)
DON'T KNOW/DON'T REMEMBER 8 (GO TO 421)
420) Would you say this person was ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
421) Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
421A) When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO_______2
MONTHS AGO________3
YEARS AGO__________3 (GO TO 435)
422) When was the last time you had sexual intercourse with this person?
WEEKS_______2
MONTHS_________3
423) The last time you had sexual intercourse with this (second/ third) person, was a male condom or a female condom used?
YES, FEMALE CONDOM 2 (GO TO 424)
NO 3
423A) What was the main reason you did not use a condom the last time you sexual intercourse?
NOT NECESSARY 2
NOT THOUGHT OF 3
PARTNER REFUSED 4
REDUCES PLEASURE 5
OTHER (SPECIFY) ________6
424) Did you use a condom every time you had sexual intercourse with this person in the last 12 months?
NO 2
425) What was your relationship to this person with whom you had sexual intercourse?
IF PARTNER Were you living together as if married?
IF YES, CIRCLE '2' IF NO, CIRCLE '3'
LIVE-IN PARTNER 2 (GO TO 431)
PARTNER NOT LIVING WITH RESPONDENT 3
CASUAL ACQUAINTANCE 4
COMMERCIAL SEX WORKER 5
OTHER (SPECIFY) ______6
426) For how long (have you had/did you have) a sexual relationship with this person?
IF ONLY HAD SEXUAL RELATIONS WITH THIS PERSON ONCE, RECORD '01' DAYS.
MONTHS________2
YEARS_________3
AGE 25-49____ (GO TO 431)
DON'T KNOW 98
429) Is this person older than you, younger than you, or about the same age?
YOUNGER 2 (GO TO 431)
SAME AGE 3 (GO TO 431)
DON'T KNOW 8 (GO TO 431)
430) Would you say this person is ten or more years older than you or less than ten years older than you?
LESS THAN TEN YEARS OLDER 2
OLDER, UNSURE HOW MUCH 3
431) The last time you had sexual intercourse with this person, did you or this person drink alcohol or used any other intoxicating substance?
NO 2
NO 2 (GO TO 433)
432) Were you or your partner drunk at that time?
IF YES: Who was drunk?
PARTNER ONLY 2
RESPONDENT AND PARTNER BOTH 3
NEITHER 4
433) Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?
NO 2 (GO TO 434)
434) In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'
DON'T KNOW 98
435) In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95.'
DON'T KNOW 98
437) CHECK FOR PRESENCE OF OTHERS: DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.
Now I would like to ask you some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
PRIVACY NOT POSSIBLE____ (GO TO 445)
440) CHECK 423, MOST RECENT PARTNER (FIRST COLUMN):
NO CONDOM USE____ (GO TO 445)
441) You told me that you used a condom the last time you had sex. Do you have the package of condoms you used that time?
IF YES: May I see it?
RECORD NAME OF BRAND IF PACKAGE SEEN.
BRAND NAME (SPECIFY) _______ (GO TO 443)
DOES NOT HAVE/NOT SEEN 2
442) Do you know the brand name of the condom you used that time?
RECORD NAME OF BRAND.
DON'T KNOW 98 (GO TO 443)
442A) What is the main reason you chose this brand?
AVAILABILITY 2
FREE 3
OTHER (SPECIFY) _______6
443) How many condoms did you get the last time?
DON'T KNOW 998
444) From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
WRITE THE NAME OF PLACE
GOVT. HEALTH CENTER 12
PHU/CLINIC 13
MOBILE CLINIC 14
RHM/CBD 15
OTHER PUBLIC (SPECIFY) _______16
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
CBD 25
OTHER PRIVATE (SPECIFY) _______26
CLINIC 32
OTHER MISSION (SPECIFY) _______36
OTHER NGO (SPECIFY) ________46
CHURCH 52
FRIENDS/RELATIVES 53
(ALL GO TO 448)
444A) How do you usually dispose the used condoms?
FLUSH IN TOILET 2
BURY 3
BURNT 4
THROWN AWAY 5
OTHER (SPECIFY) _______6
445) CHECK 301(7), KNOWS MALE CONDOM
HAS NEVER HEARD OF MALE CONDOM___ (GO TO 501)
445A) Do you know of a place where a person can get male condoms?
NO 2 (GO TO 447A)
446) Where is that? Any other place?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
PHU/CLINIC C
MOBILE CLINIC D
RHM/CBD E
OTHER PUBLIC (SPECIFY) ______F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
CBD K
OTHER PRIVATE (SPECIFY) _______L
CLINIC N
MISSION (SPECIFY) _______O
OTHER NGO (SPECIFY) _______Q
CHURCH S
FRIENDS/RELATIVES T
OTHER (SPECIFY) ______X
447) If you wanted to, could you yourself get a condom?
NO 2
447A) CHECK 301(8), KNOW FEMALE CONDOM
HAS NEVER HEARD OF FEMALE CONDOM____ (GO TO 501)
448) Do you know of a place where a person can get female condoms?
NO 2 (GO TO 501)
449) Where is that? Any other place?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).WRITE THE NAME OF THE PLACE
GOVT. HEALTH CENTER B
PHU/CLINIC C
MOBILE CLINIC D
RHM/CBD E
OTHER PUBLIC (SPECIFY) ______F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
CBD K
OTHER PRIVATE (SPECIFY) _______L
CLINIC N
MISSION (SPECIFY) _______O
OTHER NGO (SPECIFY) _______Q
CHURCH S
FRIENDS/RELATIVES T
OTHER (SPECIFY) ______X
450) If you wanted to, could you yourself get a female condom?
NO 2
SECTION 5. FERTILITY PREFERENCES
501) CHECK 407:
MORE THAN ONE WIFE/PARTNER____
NO ANSWER____ (GO TO 506)
MAN STERILIZED____ (GO TO 506)
503) (Is your wife (partner)/Are any of your wives (partners)) currently pregnant?
NO 2
DON'T KNOW 8
NO WIFE/PARTNER PREGNANT OR UNSURE____:
Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
WIFE(WIVES)/PARTNER(S) PREGNANT____:
Now I have some questions about the future. After the child(ren) you and your (wife (wives)/partner(s)) is/are expecting now, would you like to have another child, or would you prefer not to have anymore children?
NO MORE/NONE 2 (GO TO 506)
MAN INFECUND 2 (GO TO 506)
WIFE (WIVES)/PARTNER(S) INFECUND/STERILIZED 4 (GO TO 506)
UNDECIDED/DON'T KNOW 5 (GO TO 506)
505) How long would you like to wait from now before the birth of (a/another) child?
YEARS_______2
SOON/NOW 993
AFTER MARRIAGE 995
OTHER (SPECIFY) ______996
DON'T KNOW 998
HAS LIVING CHILDREN____:
If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN NEVER HAD CHILDREN____:
If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NUMBER_____
OTHER (SPECIFY) _____96 (GO TO 601)
507) How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?
NUMBER______
NUMBER_______
NUMBER_______
601) Are you currently working?
NO 2
601A) Have you done any work in the last seven days?
NO 2
602) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?
NO 2
603) Have you done any work in the last 12 months?
NO 2 (GO TO 603B)
603A) During the last 12 months, how many months did you work?
603B) What have you been doing for most of the time over the last 12 months?
LOOKING FOR WORK 2
RETIRED 3
UNABLE TO WORK, ILL/HANDICAPPED 4
HOUSEWORK/CHILDCARE 5
OTHER (SPECIFY) _______6
(ALL GO TO 610)
604) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE_____
606) Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
607) Do you do this work for a member of your family, for someone else, or are you self-employed?
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3
608) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
609) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT IN UNION___ (GO TO 613)
OTHER_____ (GO TO 613)
612) Who decides how the money you earn will be used: mainly you, mainly your (wife (wives)/partner(s)), or you and your (wife (wives)/partner(s)) jointly?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE JOINTLY 5
612A) On average, how much of your household's expenditures do your earnings pay for: almost none less than half, about half, more than half, or all?
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 3
ALL 5
NONE, HIS INCOME IS ALL SAVED 6
613) Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:
If she goes out without telling him?
If she neglects the children?
If she argues with him?
If she refuses to have sex with him?
If she burns the food?
If she has sex with other men?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
SECTION 7. HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS
701) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 735)
702) Can people reduce their chances of getting the AIDS virus by having just one sex partner who is not infected and who has no other partners?
NO 2
DON'T KNOW 8
703) Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
704) Can people reduce their chances of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
706) Can people reduce their chance of getting the AIDS virus by abstaining from sexual intercourse?
NO 2
DON'T KNOW 8
707) Can people get the AIDS virus because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707A) Can people get the AIDS virus from having anal sex?
NO 2
DON'T KNOW 8
707B) Can people get the AIDS virus from oral sex?
NO 2
DON'T KNOW 8
707C) Can people get the AIDS virus from open wounds or sores of an infected person?
NO 2
DON'T KNOW 8
708) Is there anything else a person can do to avoid or reduce the chances of getting the AIDS virus?
NO 2 (GO TO 710)
DON'T KNOW (GO TO 710)
709) What can a person do?
Anything else?
RECORD ALL WAYS MENTIONED.
USE CONDOMS B
LIMIT SEX TO ONE PARTNER/STAY FAITHFUL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WHO HAVE MANY PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS WHO INJECT DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING RAZORS/BLADES K
AVOID KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM TRADITIONAL HEALER N
AVOID SHARING UTENSILS O
AVOID SHARING TOILETS P
AVOID DRINKING SAME CUP Q
AVOID SHARING CIGARETTES R
OTHER (SPECIFY) _________W
OTHER (SPECIFY) ________X
DON'T KNOW Z
710) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
711) Can the virus that causes AIDS be transmitted from a mother to her baby:
During pregnancy?
During delivery?
By breastfeeding?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER____ (GO TO 714)
713) Are there any special medications that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
714) Have you heard about special antiretroviral drugs (ARV) that people infected with the AIDS virus can get from a doctor or a nurse?
NO 2
DON'T KNOW 8
714A) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY
715) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 720)
716) When was the last time you were tested?
12-23 MONTHS AGO 2
2 OR MORE YEARS AGO 3
717) The last time you had the test, did you yourself ask for the test or were you advised to take the test, or was it required?
ADVISED 2
REQUIRED 3
718) I don't want to know the results, but did you get the results of the test?
NO 2
718A) How long did it take to get the results?
WITHIN ONE WEEK 2
WITHIN ONE MONTH 3
MORE THAN ONE MONTH 4
719) Where did you go to take the test?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12
PHU/CLINIC 13
MOBILE CLINIC 14
RHM/CBD 15
OTHER PUBLIC (SPECIFY) _______16
STAND-ALONE VCT CENTER 22
MOBILE CLINIC 24
OTHER PRIVATE (SPECIFY) ______26
CLINIC 32
OTHER MISSION (SPECIFY) ______36
TASC 42
OTHER NGO (SPECIFY) ______46
(ALL GO TO 722)
720) Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 722)
721) Where is that? Any other place?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).
WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
MOBILE CLINIC D
OTHER PUBLIC (SPECIFY) ________E
STAND-ALONE VCT CENTER G
MOBILE CLINIC H
OTHER PRIVATE (SPECIFY) _______I
CLINIC K
OTHER (SPECIFY) ____ L
TASC N
OTHER NGO (SPECIFY) ____ O
722) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
723) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW 8
724) If a member of your family got infected with the AIDS virus that causes AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
725) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
726) Do you personally know someone who has been denied health services in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?
NO 2
DON'T KNOW ANYONE WITH AIDS 8 (GO TO 731)
727) Do you personally know someone who has been denied involvement in social events, religious services, or community events in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?
NO 2
728) Do you personally know someone who has been verbally abused or teased in the last 12 months because he or she is suspected to have the AIDS virus or has the AIDS virus?
NO 2
OTHER (CONTINUE)
730) Do you personally know someone who is suspected to have the AIDS virus or who has the AIDS virus?
NO 2
731) Do you agree or disagree with the following statement: People with the AIDS virus should be ashamed of themselves?
DISAGREE 2
DON'T KNOW/NO OPINION 8
732) Do you agree or disagree with the following statement: People with the AIDS virus should be blamed for bringing the disease into the community.
DISAGREE 2
DON'T KNOW/NO OPINION 8
733) Should children age 12-14 be taught about using a condom to avoid AIDS?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
734) Should children age 12-14 be taught to wait until they get married to have sexual intercourse in order to avoid AIDS
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?
NO 2
HAS NOT HAD SEXUAL INTERCOURSE IN LAST 12 MONTHS (CODE 4) (GO TO 744)
737) CHECK 735: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (GO TO 739)
738) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
739) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?
NO 2
740) Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?
NO 2
DON'T KNOW 8
HAS NOT HAD INFECTION OR DOES NOT KNOW (GO TO 744)
742) The last time you had (PROBLEM FROM 738/739/740), did you seek any kind of advice or treatment?
NO 2
742A) What is the main reason for not seeking advice or treatment?
EXPENSIVE 2 (GO TO 743A)
RELIGIOUS PROHIBITION 3 (GO TO 743A)
OTHER (SPECIFY) ____ 6 (GO TO 743A)
743) Where did you go? Any other place?
PROBE TO IDENTIFY TYPE(S) OF SOURCE(S) AND CIRCLE THE APPROPRIATE CODE(S).
WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER B
PHU/CLINIC D
RHM/CBD E
OTHER PUBLIC (SPECIFY) ___ F
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
CBD K
OTHER PRIVATE MEDICAL (SPECIFY) ____ L
CLINIC N
OTHER MISSION (SPECIFY) ____ O
OTHER NGO Q
CHURCH S
OTHER (SPECIFY) ____ X
743A) When you had (PROBLEM FROM 738/739/740), did you inform the person with whom you were having sex?
NO 2
SOME/NOT ALL 3
DID NOT HAVE PARTNER 4 (GO TO 744)
743B) When you had (PROBLEM FROM 738/739/740), did you do something to avoid infecting your sexual partner(s)?
NO 2 (GO TO 744)
PARTNER ALREADY INFECTED 3 (GO TO 744)
743C) What did you do to avoid infecting your partner(s)?
Did you...
Use medicine?
Stop having sex?
Use a condom when having sex?
NO 2
NO 2
NO 2
744) Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when she knows he has a disease that can be transmitted through sexual contact?
NO 2
DON'T KNOW 8
745) When a wife knows her husband has a disease that can be transmitted through sexual contact, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
746) Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?
NO 2
DON'T KNOW 8
747) Is a wife justified in refusing sex with her husband when she knows her husband has sex with other women?
NO 2
DON'T KNOW 8
748) Do you believe that young men should wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
749) Do you think that most young men you know wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
750) Do you believe that men who are not married and are having sex should only have sex with one partner?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
751) Do you think that most men you know who are not married and are having sex, have sex with only one partner?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
752) Do you believe that married men should only have sex with their wives?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
753) Do you think that most married men you know have sex only with their wives?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
754) Do you believe that young women should wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
755) Do you think that most young women you know wait until they are married to have sexual intercourse?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
756) Do you believe that women who are not married and are having sex should only have sex with one partner?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
757) Do you think that most women you know who are not married and are having sex, have sex with only one partner?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
758) Do you believe that married women should only have sex with their husbands?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
759) Do you think that most married women you know have sex only with their husbands?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
SECTION 8. OTHER HEALTH AND WELFARE ISSUES
801) Some men are circumcised. Are you circumcised?
NO 2 (GO TO 805)
802) At what age were you circumcised?
12 - 19 YEARS OLD 2
20 OR MORE YEARS 3
803) Who performed the circumcision?
HEALTH PROFESSIONAL 2
DON'T KNOW 8
804) What is the main reason you were circumcised?
HEALTH/HYGIENE 2 (GO TO 808)
SEXUAL SATISFACTION 3 (GO TO 808)
EASE OF PUTTING ON CONDOM 4 (GO TO 808)
OTHER (SPECIFY) ____ 6 (GO TO 808)
DON'T KNOW 8 (GO TO 808)
805) Would you want to get circumcised?
NO 2 (GO TO 807)
DON'T KNOW 8 (GO TO 808)
806) What is the main reason you would want to get circumcised?
HEALTH/HYGIENE 2 (GO TO 808)
SEXUAL SATISFACTION 3 (GO TO 808)
EASE OF PUTTING ON CONDOM 4 (GO TO 808)
OTHER (SPECIFY) ____ 6 (GO TO 808)
DON'T KNOW 8 (GO TO 808)
807) What is the main reason you would not want to get circumcised?
HEALTH/HYGIENE 02
SEXUAL SATISFACTION 03
DIFFERENT 04
COST 05
PAIN 06
OTHER (SPECIFY) ____ 96
DON'T KNOW 98
808) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 812)
809) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'.
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 812)
810) The last time you had an injection given to you by a health worker, where did you go to get the injection?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE
WRITE THE NAME OF THE PLACE.
GOVERNMENT HEALTH CENTER 12
PHU/CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) ____ 16
DENTAL CLINIC/OFFICE 22
OFFICE OR HOME OF NURSE/HEALTH WORKER 23
MOBILE CLINIC 24
OTHER PRIVATE (SPECIFY) ____ 26
CLINIC 32
OTHER MISSION (SPECIFY) ____ 36
OTHER (SPECIFY) ____ 96
811) Did the person who gave you that injection take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
812) Do you currently smoke cigarettes?
NO 2 (GO TO 814)
813) In the last 24 hours, how many cigarettes did you smoke?
814) Do you currently smoke or use any other type of tobacco?
NO 2 (GO TO 816)
815) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) ____ X
816) Have you ever heard of an illness called tuberculosis or TB?
NO 2 (GO TO 820)
817) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ____ X
DON'T KNOW Z
818) Can tuberculosis be cured?
NO 2
DON'T KNOW 8
819) If member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
820) Are you covered by any medical aid?
NO 2 (GO TO 822)
821) What type of medical aid?
RECORD ALL MENTIONED.
SELF B
EMPLOYER AND SELF C
OTHER (SPECIFY) ____ X
822) Are you the primary care giver for any children?
NO 2 (GO TO 826)
823) Are any of these children for whom you are the primary caregiver under the age of 18?
NO 2 (GO TO 826)
824) Now I would like to ask you about the child(ren) who (is/are) under the age of 18 and for whom you are the primary caregiver.
Have you made arrangements for someone to care for(this child/these children) in the event that you fall sick or are unable to care for (him/her/them)?
NO 2
UNSURE 8
825) Are you comfortable talking to the children in your care about sex and HIV/AIDS?
NO 2
CHILDREN NOT OLD ENOUGH 3
DON'T KNOW/UNSURE/DEPENDS 4
MINUTES ____
INTERVIEWER'S OBSERVATIONS
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ABOUT RESPONDENT: ____
COMMENTS ON SPECIFIC QUESTIONS: ____
ANY OTHER COMMENTS: ____
SUPERVISOR'S OBSERVATIONS
OBSERVATIONS: ____
NAME OF SUPERVISOR: ____
DATE: ____
EDITOR'S OBSERVATIONS
OBSERVATIONS ____
NAME OF EDITOR: ____
DATE: ____