CLUSTER NUMBER ___
PROVINCE ___________________
DISTRICT ______________________
HOUSEHOLD NUMBER ___
NAME OF HOUSEHOLD HEAD ________________
RURAL 2
LUSAKA/OTHER CITY/TOWN/VILLAGE
OTHER CITY 2
TOWN 3
VILLAGE 4
NAME AND LINE NUMBER OF MAN _________________
NAME AND LINE NUMBER OF FIRST WIFE _________________
NAME AND LINE NUMBER OF SECOND WIFE _________________
NAME AND LINE NUMBER OF THIRD WIFE _________________
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______________
INTERVIEWER'S NAME _______________
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) _________ 7
NEXT VISIT:
DATE ______
TIME _____
FINAL VISIT
DAY ____
MONTH ____
YEAR ___
NAME ___
RESULT ____
LANGUAGE OF QUESTIONNAIRE: ENGLISH 01
BEMBA 02
KAONDE 03
LOZI 04
LUNDA 05
LUVALE 06
NYANJA 07
TONGA 08
OTHER 09
BEMBA 02
KAONDE 03
LOZI 04
LUNDA 05
LUVALE 06
NYANJA 07
TONGA 08
OTHER 09
SOMETIME 2
ALL THE TIME 3
SUPERVISOR
NAME _________
DATE ________
FIELD EDITOR
NAME _________
DATE ________
OFFICE EDITOR
KEYED BY
SECTION 1. RESPONDENT'S BACKGROUND
MINUTES _______
102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village?
OTHER CITY 2
TOWN 3
VILLAGE 4
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a city, in a town, or in a village?
OTHER CITY 2
TOWN 3
VILLAGE 4
105. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
106. How old were you at your last birthday?
COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT.
107. Have you ever attended school?
NO 2 (GO TO 111)
108. What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109. How many years did you complete at that level?
SECONDARY OR HIGHER (GO TO 112)
111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)
112. How often do you usually read a newspaper or magazine? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONE ANSWER.
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6
113. How often do you usually listen to a radio? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONE ANSWER.
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6
114. How often do you usually watch television? Would you say every day, every other day, at least once a week, at least once a month, a few times a year, or never?
CIRCLE ONLY ONE ANSWER.
EVERY OTHER DAY 2
AT LEAST ONCE A WEEK 3
AT LEAST ONCE A MONTH 4
FEW TIMES A YEAR 5
NEVER 6
115. Are you currently working?
NO 2
116. Have you done any work in the last 12 months?
NO 2 (GO TO 124)
117. What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE (GO TO 120)
119. Do you work mainly on your own land or on family land, or do you rent land, or work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
120. 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
121. Do you usually work at this job 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
122. During the last 12 months, how many months did you work at this job?
123. How much do you earn for this work?
PROBE: Is this by the hour, by the day, by the week, by the month or by the year?
PER DAY 2 ___
PER WEEK 3 ___
PER MONTH 4 ___
PER YEAR 5 ___
OTHER (SPECIFY) ______________ 99999996
PROTESTANT 2
MUSLIM 3
OTHER (SPECIFY) ______________ 4
125. What tribe do you belong to?
201. Now I would like to ask about your children. I am interested only in your own children. Do not include children you may have adopted or care for as a father but whose real father is someone else. Have you ever had children?
NO 2 (GO TO 206)
202. Do you have any sons or daughters 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'.
204. Do you have any sons or daughters 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'.
206. Have you ever had a son or daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
207. How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.
208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.
209. CHECK 208:
Just to make sure that I have this right: you have had in total ____ children during your life. Is that correct?
NO (PROBE AND CORRECT 201-208 AS NECESSARY.)
HAS NEVER HAD CHILDREN (NONE) (GO TO 301)
210A. In what month and year was your last child born?
BEFORE JANUARY 1991 (GO TO 301)
211. When you were expecting your last born child, did you want to have the child then, did you want to wait until later, or did you not want to have any (more) children at all?
LATER 2
NOT AT ALL 3
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?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 301 OR 302, ASK 303..
301. Which ways or methods have you heard about?
302. Have you ever heard of (METHOD)?
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
PROBED YES 2
NO 3
NO 3
303. Have you ever used (METHOD)?
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
NO, DOES NOT KNOW 2
AT LEAST ONE 'YES' (EVER USED) (GO TO 307)
305. Have you or any of your partners ever used anything or tried in any way to delay or avoid pregnancy?
NO 2 (GO TO 309)
306. What have you used or done?
CORRECT 303 AND 304 (AND 302 IF NECESSARY).
307. Are you or your partner doing something or using a method to delay or avoid a pregnancy?
NO 2 (GO TO 309)
308. Which method are you using?
IUD 02 (GO TO 401)
INJECTIONS 03 (GO TO 401)
IMPLANTS 04 (GO TO 401)
FOAMING TABLETS/JELLY 05 (GO TO 401)
CONDOM 06 (GO TO 401)
FEMALE STERILIZATION 07 (GO TO 401)
MALE STERILIZATION 08 (GO TO 401)
NATURAL FAMILY PLANNING 09 (GO TO 401)
WITHDRAWAL 10 (GO TO 401)
OTHER (SPECIFY) ____________ 96 (GO TO 401)
309. What is the main reason you are not using a method of contraception to avoid pregnancy?
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
WIFE PREGNANT 27
HUSBAND OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _______________ 96
DOES NOT KNOW 98
401. Are you currently married or living with a woman?
YES, LIVING WITH A WOMAN 2 (GO TO 402A)
NO, NOT IN UNION 3 (GO TO 404)
402. How many wives do you have?
402A. How many women are you living with as if you are married?
403. WRITE THE LINE NUMBERS FROM THE HOUSEHOLD QUESTIONNAIRE FOR HIS WIFE/WIVES. IF A WIFE DOES NOT LIVE IN THE HOUSEHOLD, WRITE '00'.
THE NUMBER OF BOXES FILLED MUST EQUAL THE NUMBER OF WIVES.
404. Do you currently have a regular sexual partner, an occasional sexual partner or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
405. Have you ever been married or lived with a woman?
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410F)
406. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2
SEPARATED 3
407. Have you been married or lived with a woman only once, or more than one?
MORE THAN ONCE 2
MARRIED/LIVED WITH A WOMAN ONLY ONCE: In what month and year did you start living with your wife/woman?
MARRIED/LIVED WITH A WOMAN MORE THAN ONCE: Now we will talk about your first wife/woman you lived with. In what month and year did you start living with her?
DOES NOT KNOW MONTH 98
DOES NOT KNOW YEAR 9998
409. How old were you when you started living with her?
NOT IN UNION (GO TO 410F)
410. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse with (your wife/the woman you are living with)?
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
KNOWS CONDOM: The last time you had sex with (your wife/the woman you are living with), did you use a condom?
DOES NOT KNOW CONDOM: Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex with (your wife/the woman you are living with) did you use a condom?
NO 2
DOES NOT KNOW/NOT SURE 8
410B. Have you had sex with anyone other than (your wife/the woman you are living with) in the last 12 months?
NO 2 (GO TO 410J)
410C. When was the last time you had sexual intercourse with someone other than (your wife/the woman you are living with)?
WEEKS AGO 2 __
MONTHS AGO 3 __
410D. Did you use a condom that time?
NO 2
DOES NOT KNOW/NOT SURE 8
410E. In the last 12 months, how many different persons other than (your wife/the woman you are living with) have you had sex with?
DOES NOT KNOW 98 (GO TO 410J)
410F. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues. When was the last time you had sexual intercourse (if ever)?
DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
KNOWS CONDOM: The last time you had sex, did you use a condom?
DOES NOT KNOW CONDOM: Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, did you use a condom?
NO 2
DOES NOT KNOW 8
12 MONTHS OR LONGER SINCE LAST SEX (GO TO 410J)
410I. In the last 12 months, how many different persons have you had sex with?
DOES NOT KNOW 98
CURRENTLY MARRIED OR LIVING WITH A WOMAN: The last time you had sex, was it with your (wife/the woman you live with), a regular partner, an acquaintance, someone you paid for sex, or someone else?
NOT CURRENTLY MARRIED AND NOT LIVING WITH A WOMAN: The last time you had sex, was it with a regular partner, an acquaintance, someone you paid for sex, or someone else?
REGULAR PARTNER 2
ACQUAINTANCE 3
SOMEONE HE PAID FOR SEX 4
SOMEONE ELSE 5
413. Do you know of a place where you can get condoms?
NO 2 (GO TO 416)
414. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GOVERNMENT HEALTH CENTER 12
FIELDWORKER 13
OTHER PUBLIC (SPECIFY) ___________ 16
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 27
FRIENDS/RELATIVES 32
OTHER (SPECIFY) _________________ 36
416. How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
SECTION 5. FERTILITY PREFERENCES
CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO 503)
OCCASIONAL SEXUAL PARTNER (GO TO 503)
NO SEXUAL PARTNER (GO TO 505A)
503. Is your wife (or one of your wives)/partner pregnant now?
NO 2 (GO TO 505A)
UNSURE 8 (GO TO 505A)
504. When she became pregnant, did you want her to become pregnant then, did you want her to wait until later, or did you not want this pregnancy at all?
LATER 2 (GO TO 505B)
NOT AT ALL 3 (GO TO 505B)
505A) WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER: 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?
505B) WIFE/PARTNER PREGNANT: Now I have some questions about the future. After the child your wife/partner is expecting, would you like to have another child or would you prefer not to have any more children?
NO MORE/NONE 2 (GO TO 507)
SAYS WIFE CAN'T GET PREGNANT 3 (GO TO 507)
SAYS HE CAN'T HAVE ONE ANY MORE 4 (GO TO 507)
UNDECIDED/DOES NOT KNOW 8 (GO TO 507)
WIFE/PARTNER NOT PREGNANT OR UNSURE OR NO WIFE/PARTNER: How long would you like to wait from now before the birth of (a/another) child?
WIFE/PARTNER PREGNANT: After the child your wife/partner is expecting, how long would you like to wait before the birth of another child?
YEARS 2 __
SOON/NOW 993
SAYS WIFE CAN'T GET PREGNANT 994
AFTER MARRIAGE 995
OTHER (SPECIFY) ___________ 996
DOES NOT KNOW 998
507. CHECK 308:
USING A METHOD?
NOT CURRENTLY USING (GO TO 508)
CURRENTLY USING (GO TO 512)
508. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DOES NOT KNOW 8
509. Do you think you will use a method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 511)
DOES NOT KNOW 8 (GO TO 511)
510. Which method would you prefer to use?
IUD 02 (GO TO 512)
INJECTIONS 03 (GO TO 512)
IMPLANTS 04 (GO TO 512)
FOAMING TABLETS/JELLY 05 (GO TO 512)
CONDOM 06 (GO TO 512)
FEMALE STERILIZATION 07 (GO TO 512)
MALE STERILIZATION 08 (GO TO 512)
NATURAL FAMILY PLANNING 09 (GO TO 512)
WITHDRAWAL 10 (GO TO 512)
OTHER (SPECIFY) _____________ 96 (GO TO 512)
UNSURE 98 (GO TO 512)
511. What is the main reason that you think you will never use a method?
WIFE MENOPAUSAL/HYSTERECTOMY 23
WIFE SUBFECUND/INFECUND 24
WANTS (MORE) CHILDREN 26
WIFE OPPOSED 32
OTHERS OPPOSED 33
RELIGIOUS PROHIBITION 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NORMAL PROCESSES 56
OTHER (SPECIFY) _______________ 96
DOES NOT KNOW 98
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: 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.
OTHER (SPECIFY) ____________ 96 (GO TO 514)
513. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?
OTHER (SPECIFY) _____________ 96
OTHER (SPECIFY) _____________ 96
OTHER (SPECIFY) _____________ 96
514. Would you say that you approve or disapprove of couples using a method to avoid pregnancy?
DISAPPROVES 2
NO OPINION 3
515. Is it acceptable or not acceptable to you for information on family planning to be provided:
On the radio?
On the television?
NOT ACCEPTABLE 2
DON'T KNOW 8
NOT ACCEPTABLE 2
DON'T KNOW 8
516. In the last few months have you heard about family planning:
On the radio?
On the television?
In a newspaper or magazine?
From a billboard?
At a live drama?
From a doctor or nurse?
At a community event?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
518. In the last few months have you discussed the practice of family planning with your (wife, partner), friends, neighbors, or relatives?
NO 2 (GO TO 520)
519. With whom?
Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
COMMUNITY HEALTH WORKER I
LOCAL COMMUNITY LEADER J
RELIGIOUS LEADER K
OTHER (SPECIFY) ___________ X
LIVING WITH A WOMAN (GO TO 521)
NOT IN UNION (GO TO 601A)
521. Spouses do not always agree on everything. Now I want to ask you about your wife's/the woman you live with's views on family planning. Do you think that your wife/the woman you live with approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DOES NOT KNOW 8
522. How often have you talked to your wife/the woman you live with about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES
601A. Have you heard about diseases that can be transmitted through sexual intercourse?
NO 2 (GO TO 601F)
601B. Which diseases do you know?
RECORD ALL RESPONSES.
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DON'T KNOW Z
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 601F)
601D. During the last twelve months, did you have any of these diseases?
NO 2 (GO TO 601F)
DOES NOT KNOW 8 (GO TO 601F)
601E. Which of the diseases did you have?
RECORD ALL RESPONSES.
GONORRHEA B
AIDS C
GENITAL WARTS/CONDYLOMATA D
OTHER (SPECIFY) _______________ W
OTHER (SPECIFY) _______________ X
DON'T KNOW Z
601F. During the last twelve months, did you have a discharge from your penis?
NO 2
DOES NOT KNOW 8
601G. During the last twelve months, did you have a sore or ulcer on your penis?
NO 2
DOES NOT KNOW 8
601H. CHECK 601E, 601F AND 601G
NONE OF THE DISEASES (GO TO 601N)
601I. The last time you had (DISEASE FROM 601E/DISCHARGE/SORE) did you seek advice or treatment?
NO 2 (GO TO 601JA)
601J. Where did you seek advice or treatment?
Any other place or person?
RECORD ALL MENTIONED.
GOVERNMENT HEALTH CENTER 12
FIELDWORKER 13
OTHER PUBLIC (SPECIFY) ___________ 16
MISSION HOSPITAL/CLINIC 22
PHARMACY 23
PRIVATE DOCTOR 24
MOBILE CLINIC 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 27
FRIENDS/RELATIVES 33
OTHER (SPECIFY) _________________ 36
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 601N)
601K. When you had (DISEASE FROM 601E/DISCHARGE/SORE) did you inform your partner(s)?
NO 2
601L. When you had (DISEASE FROM 601E/DISCHARGE/SORE) did you do something not to infect your partner(s)?
NO 2 (GO TO 601N)
PARNTER ALREADY INFECTED 3 (GO TO 601N)
601M. What did you do?
RECORD ALL MENTIONED.
USED CONDOMS B
TOOK MEDICINES C
OTHER (SPECIFY) ___________ X
MENTIONED 'AIDS' (GO TO 602)
601O. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 611C)
602. From which sources of information have you learned most about AIDS?
Any other sources?
RECORD ALL MENTIONED.
TV B
NEWSPAPERS/MAGAZINES C
PAMPLETS/POSTERS D
HEALTH WORKERS E
MOSQUES/CHURCHES F
SCHOOLS/TEACHERS G
COMMUNITY MEETINGS H
FRIENDS/RELATIVES I
WORK PLACE J
OTHER (SPECIFY) ___________X
602B. How can a person get AIDS?
Any other ways?
RECORD ALL MENTIONED.
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS B
SEX WITH PROSTITUTES C
NOT USING CONDOM D
HOMOSEXUAL CONTACT E
BLOOD TRANSFUSION F
INJECTIONS G
KISSING H
MOSQUITO BITES I
CONTAMINATED RAZOR BLADES J
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z
603. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 607)
DOES NOT KNOW 8 (GO TO 607)
604. What can a person do?
Any other ways?
RECORD ALL MENTIONED.
ABSTAIN FROM SEX B
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID KISSING I
AVOID MOSQUITO BITES J
SEEK PROTECTION FROM TRADITIONAL HEALER K
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z
DID NOT MENTION 'SAFE SEX' (GO TO 607)
606. What does 'safe sex' mean to you?
RECORD ALL MENTIONED.
USE CONDOMS C
AVOID MULTIPLE SEX PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z
607. Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DOES NOT KNOW 8
608. Do you think that persons with AIDS almost never die from the disease, sometimes die, or almost always die from the disease?
SOMETIMES 2
ALMOST ALWAYS 3
DOES NOT KNOW 8
NO 2
DOES NOT KNOW 8
608B. Can AIDS be transmitted from mother to child?
NO 2
DOES NOT KNOW 8
608C. Do you personally know someone who has AIDS or has died of AIDS?
NO 2 (GO TO 609)
DOES NOT KNOW 8 (GO TO 609)
608D. How many people that you personally know now have AIDS?
608E. How many people that you personally know have died of AIDS?
609. CHECK 601E:
IF RESPONDENT HAS AIDS, CIRCLE 5.
Do you think your chances of getting AIDS are small, moderate, great, or no risk at all?
MODERATE 2 (GO TO 609B)
GREAT 3 (GO TO 609B)
NO RISK AT ALL 4
HAS AIDS 5 (GO TO 611A)
609A. Why do you think that you have (NO RISK/A SMALL CHANCE) of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.
USE CONDOMS C (GO TO 611A)
HAVE ONLY ONE SEX PARTNER D (GO TO 611A)
LIMITED NUMBER OF SEX PARTNERS E (GO TO 611A)
AVOID SEX WITH PROSTITUTES F (GO TO 611A)
SPOUSE HAS NO OTHER PARTNER G (GO TO 611A)
NO HOMOSEXUAL CONTACT H (GO TO 611A)
NO BLOOD TRANSFUSIONS I (GO TO 611A)
NO INJECTIONS J (GO TO 611A)
OTHER (SPECIFY) ___________________X (GO TO 611A)
609B. Why do you think that you have a (MODERATE/GREAT) chance of getting AIDS?
Any other reasons?
RECORD ALL MENTIONED.
MORE THAN ONE SEX PARTNER D
MANY SEX PARTNERS E
SEX WITH PROSTITUTES F
SPOUSE HAS OTHER PARTNER(S) G
HOMOSEXUAL CONTACT H
HAD BLOOD TRANSFUSION I
HAD INJECTIONS J
OTHER (SPECIFY) ___________________X
611A. Since you heard of AIDS, have you changed your behavior to prevent getting AIDS?
IF YES, what did you do?
Anything else?
RECORD ALL MENTIONED
STOPPED ALL SEX B (GO TO 611C)
STARTED USING CONDOMS C (GO TO 611F)
RESTRICTED SEX TO ONE PARTNER D (GO TO 611C)
REDUCED NUMBER OF PARTNERS E (GO TO 611C)
AVOID SEX WITH PROSTITUTES F (GO TO 611C)
ASK SPOUSE TO BE FAITHFUL G (GO TO 611C)
NO MORE HOMOSEXUAL CONTACTS H (GO TO 611C)
STOPPED INJECTIONS J
OTHER (SPECIFY) ___________ W
OTHER (SPECIFY) ___________ X
NO BEHAVIOR CHANGE Y
611B. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior?
IF YES, In what way?
RECORD ALL MENTIONED
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
AVOID SEX WITH PROSTITUTES F
NO MORE HOMOSEXUAL CONTACTS G
OTHER (SPECIFY) __________ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DOES NOT KNOW Z
611C. Some people use a condom during sexual intercourse to avoid getting AIDS or other sexually transmitted diseases? Have you ever heard of this?
NO 2 (GO TO 611F)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 613)
611E. We may already have talked about this. Have you ever used a condom during sex to avoid getting or transmitting diseases, such as AIDS?
NO 2 (GO TO 611G)
HAS NEVER HAD SEXUAL INTERCOURSE (GO TO 613)
611G. Have you given or received money, gifts or favors in return for sex at any time in the last 12 months?
NO 2
MINUTES ____
To be filled in after completing interview
Comments about Respondent: ______________________________
Comments on Specific Questions:_______________________________
Any Other Comments:______________________________
SUPERVISOR'S OBSERVATIONS
_______________________________________________________________
Name of Supervisor: _________________________ Date: _____________
EDITOR'S OBSERVATIONS
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Name of Editor: _____________________________ Date: _____________