WARD/VILLAGE __________
NAME OF HOUSEHOLD HEAD __________
CLUSTER NUMBER ___
HOUSEHOLD NUMBER ___
PROVINCE ___
RURAL 2
OTHER URBAN 2
RURAL 3
LINE NUMBER ___
FIRST VISIT:
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 _____
SECOND VISIT:
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 _____
THIRD VISIT:
DATE _____
INTERVIEWER'S NAME __________
RESULT * __________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
FINAL VISIT:
DAY ___
MONTH __________
YEAR _____
NAME __________
RESULT* __________
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) __________ 7
LANGUAGE OF QUESTIONNAIRE: ENGLISH
NDEBELE 2
ENGLISH 3
OTHER (SPECIFY) __________ 6
DATE _____
FIELD EDITOR
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 town or in a rural area? IF TOWN: Which town?
OTHER URBAN 2
RURAL 3
105) In what month and year were you born?
DON'T KNOW 98
DON'T KNOW 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 (SKIP TO 114)
108) What is the highest level of school you attended: primary, secondary, or higher?
SECONDARY 2
HIGHER 3
109) What is the highest (grade/form/year) you completed at that level?
AGE 25 OR ABOVE ___ (SKIP TO 113)
111) Are you currently attending school?
NO 2
112) What was the main reason you stopped attending school?
HAD TO CARE FOR YOUNGER CHILDREN 02
FAMILY NEEDED HELP ON FARM OR IN BUSINESS 03
COULD NOT PAY SCHOOL FEES 04
NEEDED TO EARN MONEY 05
GRADUATED/HAD ENOUGH SCHOOLING 06
BAD GRADES 07
DID NOT LIKE SCHOOL 08
SCHOOL NOT ACCESSIBLE/TOO FAR 09
OTHER (SPECIFY) __________ 96
DON'T KNOW 98
SECONDARY OR HIGHER ___ (SKIP TO 115)
114) Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (SKIP TO 116)
115) Do you usually read a newspaper or magazine at least once a week?
NO 2
116) Do you usually listen to a radio every day?
NO 2
117) Do you usually watch television at least once a week?
NO 2
SPIRITUAL 2
CHRISTIAN 3
OTHER (SPECIFY) __________ 6
WHITE 2
COLOURED 3
ASIAN 4
OTHER (SPECIFY) __________ 6
120) Are you currently working?
NO 2
121) Have you done any work in the last 12 months?
NO 2 (SKIP TO 201)
122) What is your occupation, that is, what kind of work do you mainly do?
DOES NOT WORK IN AGRICULTURE ___ (SKIP TO 125)
124) Do you work mainly on your own land or on family land, or do you rent land, or work on communal land or on someone else's land?
RENTED LAND 2
COMMUNAL/RESETTLEMENT LAND 3
SOMEONE ELSE'S LAND 4
125) 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
126) Do you usually work at this job throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY 2
ONCE IN A WHILE 3
127) During the last year, how many months did you work at this job?
128) In a typical day, week, or month how much do you earn for this job?
RECORD IN ZIMBABWE DOLLARS
PER WEEK 2 _____
PER MONTH 3 _____
NO CASH EARNED 999995
SECTION 2. MARRIAGE AND REPRODUCTION
201) Are you currently married?
NO, NOT CURRENTLY MARRIED 2 (SKIP TO 204)
202) How many wives do you have?
203) Does (Do) your wife (wives) live in this household? IF YES, What is (are) her name(s)?
RECORD: LINE NUMBER(S) OF THE WIFE (WIVES) IN HOUSEHOLD QUESTIONNAIRE
(AFTER ALL WIVES' NUMBERS ARE RECORDED SKIP TO 206)
SECOND WIFE ___
THIRD WIFE ___
FOURTH WIFE ___
204) Have you ever been married or lived with a woman?
NO 2 (SKIP TO 209)
205) What is your marital status now: are you widowed or divorced?
DIVORCED 2
206) In what month and year did you start living with your (first) wife?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
207) How old were you when you started living with her?
CURRENTLY MARRIED ___ (SKIP TO 210)
209) Do you currently have a regular partner, or occasional partner(s) or no partner at all?
OCCASIONAL PARTNER(S) 2
NO PARTNER AT ALL 3
210) 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 anyone?
DAYS AGO 1 ___
WEEKS AGO 2 ___
MONTHS AGO 3 ___
YEARS AGO 4 ___
211) How old were you when you first had sexual intercourse?
WHEN FIRST MARRIED 96
212) Now I would like to ask about all the children you have had during your life. Do you have children?
NO 2 (SKIP TO 217)
213) Do you have any sons or daughters who are now living with you?
NO 2 (SKIP TO 215)
214) How many sons live with you? And how many daughters live with you?
IF NONE RECORD '00'.
DAUGHTERS AT HOME ___
215) Do you have any sons or daughters who are alive but do not live with you?
NO 2 (SKIP TO 217)
216) 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 ___
217) Have you ever had 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 survived only a few hours or days?
NO 2 (SKIP TO 219)
218) How many boys have died? And how many girls have died?
IF NONE RECORD '00'.
GIRLS DEAD ___
219) SUM ANSWERS TO 214, 216, AND 218, AND ENTER TOTAL.
IF NONE RECORD '00'.
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 212-219 AS NECESSARY)
HAS HAD NO CHILDREN ___ (SKIP TO 301)
222) In what month and year was your last child born?
DON'T KNOW MONTH 98
YEAR _____
223) Is your last child still alive?
NO 2
224) When your wife became pregnant with this last child, did you want her to become pregnant then, did you want her to wait until later, or did you not want her to become pregnant at all?
LATER 2
NOT AT ALL 3
301) Now I would like to talk to you 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 302 FOR EACH METHOD MENTIONED SPONTANEOUSLY THEN PROCEED DOWN THE COLUMN, 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 CHECK IN 303 IF HE HAS EVER HAD SEX. IF NO, SKIP TO 401. IF YES, GO ON WITH 304. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 304 BEFORE PROCEEDING TO THE NEXT METHOD.
302) Have you ever heard of (METHOD)? READ DESCRIPTION OF EACH METHOD.
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
YES/PROBED 2
NO 3
NO 3 (SKIP TO 305)
2. (SPECIFY) __________
HAS NEVER HAD SEX ___ (SKIP TO 401)
304) Have you ever used (METHOD) with anyone?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
2. (SPECIFY) __________
AT LEAST ONE "YES" (EVER USED) ___ (SKIP TO 308)
306) Have you ever used anything or tried anything in any way to delay or avoid having a child?
NO 2 (SKIP TO 316)
307) What have you used or done?
CORRECT 304-305 (AND 302 IF NECESSARY)
MAN STERILIZED ___ (SKIP TO 310A)
309) Are you currently doing something or using any method to delay or avoid having a child?
NO 2 (SKIP TO 316)
310) Which method are you using?
(NOTE: DO NOT ASK QUESTION 310A IF THE MAN IS NOT STERILIZED)
310A) You have said that you had an operation that keeps you from getting a woman pregnant. Is that correct? IF RESPONDENT SAYS "NO", CORRECT 303-304 (AND 302 IF NECESSARY). IF RESPONDENT CONFIRMS WITH A "YES", CIRCLE '08' FOR MALE STERILIZATION.
IUD 02 (SKIP TO 315)
INJECTIONS 03 (SKIP TO 315)
IMPLANTS 04 (SKIP TO 315)
DIAPHRAGM/FOAMING TABLET/SPONGE 05 (SKIP TO 315)
CONDOM 06 (SKIP TO 315)
FEMALE STERILIZATION 07
MALE STERILIZATION 08
SAFE PERIOD/RHYTHM 09 (SKIP TO 316)
WITHDRAWAL 10 (SKIP TO 316)
OTHER (SPECIFY) __________ 96 (SKIP TO 316)
311) Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
PROVINCIAL HOSPITAL 12
DISTRICT/RURAL HOSPITAL 13
OTHER PUBLIC (SPECIFY) __________ 16
MISSION FACILITY 19
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
DON'T KNOW 98
312) Do you regret that (you/your wife) had the operation not to have any (more) children?
NO 2 (SKIP TO 314)
313) Why do you regret the operation?
WIFE WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY) __________ 96
314) In what month and year was the sterilization performed?
YEAR __________ (SKIP TO 316)
315) Where did you obtain (METHOD) the last time?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC MOBILE CLINIC 14
MINISTRY OF HEALTH MOBILE CLINIC 15
ZNFPC CBD 16
MINISTRY OF HEALTH CBD 17
OTHER PUBLIC (SPECIFY) __________ 18
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
CHURCH 32
FRIENDS/RELATIVES 33
NOT CURRENTLY MARRIED AND NOT HAVING A REGULAR PARTNER ___ (SKIP TO 319)
317) Is your wife (or one of your wives)/ regular partner pregnant now?
NO 2 (SKIP TO 319)
UNSURE 8 (SKIP TO 319)
318) 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
NOT AT ALL 3
NEVER HAD SEX ___ (SKIP TO 401)
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
321) Do you know where you can get condoms?
NO 2 (SKIP TO 323)
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RURAL/MUNICIPAL CLINIC 11
ZNFPC CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC MOBILE CLINIC 14
MINISTRY OF HEALTH MOBILE CLINIC 15
ZNFPC CBD 16
MINISTRY OF HEALTH CBD 17
OTHER PUBLIC (SPECIFY) __________ 18
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
CHURCH 32
FRIENDS/RELATIVES 33
NOT CURRENTLY MARRIED ___ (SKIP TO 332)
324) Who did you have sex with the last time you had sexual intercourse? Was it with your wife or was it with someone else?
SOMEONE ELSE 2
325) Have you had sex with your wife in the last four weeks
NO 2 (SKIP TO 328)
DON'T KNOW 98
327) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?
YES, SOMETIMES 2
NEVER 3
328) Have you had sex with anyone other than your wife in the last four weeks?
NO 2 (SKIP TO 401)
329) With how many persons other than your wife have you had sex with in the last 4 weeks?
DON'T KNOW 98
330) How many times have you had sex with someone apart from your wife in the last 4 weeks?
DON'T KNOW 98
331) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?
YES, SOMETIMES 2 (SKIP TO 401)
NEVER 3 (SKIP TO 401)
332) Have you had sex with anyone in the last four weeks?
NO 2 (SKIP TO 401)
333) With how many persons have you had sex in the last 4 weeks?
DON'T KNOW 98
334) How many times have you had sex with someone in the last 4 weeks?
DON'T KNOW 98
335) Was a condom used on any of these occasions? IF YES: Was it each time or sometimes?
YES, SOMETIMES 2
NEVER 3
SECTION 4. FERTILITY PREFERENCES
NEVER HAD SEX ___ (SKIP TO 413)
NO MORE/NONE 2 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 3 (SKIP TO 406)
UNDECIDED/DON'T KNOW 8 (SKIP TO 404)
NO MORE/NONE 2 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 3 (SKIP TO 406)
UNDECIDED/DON'T KNOW 8 (SKIP TO 404)
YEARS 2 ___
SOON/NOW 993 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 994 (SKIP TO 406)
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998
YEARS 2 ___
SOON/NOW 993 (SKIP TO 406)
SAYS WIFE CAN'T GET PREGNANT 994 (SKIP TO 406)
AFTER MARRIAGE 995
OTHER (SPECIFY) __________ 996
DON'T KNOW 998
WIFE PREGNANT OR MAN NOT CURRENTLY MARRIED ___ (SKIP TO 406)
405) If your wife became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?
UNHAPPY 2
WOULD NOT MATTER 3
406) CHECK 309: USING A METHOD?
NOT CURRENTLY USING ___
CURRENTLY USING ___ (SKIP TO 413)
407) Do you intend to use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DON'T KNOW 8
408) Do you intend to use a method at any time in the future?
NO 2 (SKIP TO 410)
DON'T KNOW 8 (SKIP TO 410)
409) Which method would you prefer to use?
IUD 02 (SKIP TO 413)
INJECTIONS 03 (SKIP TO 413)
IMPLANTS 04 (SKIP TO 413)
DIAPHRAGM/FOAM/JELLY 05 (SKIP TO 413)
CONDOM 06 (SKIP TO 413)
FEMALE STERILIZATION 07 (SKIP TO 413)
MALE STERILIZATION 08 (SKIP TO 413)
SAFE PERIOD 09 (SKIP TO 413)
WITHDRAWL 10 (SKIP TO 413)
OTHER (SPECIFY) __________ 96 (SKIP TO 413)
UNSURE 98 (SKIP TO 413)
410) What is the main reason you never intend to use a method?
WIFE MENOPAUSAL/HYSTERECTOMY 23
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
DON'T KNOW 98
CODE 11 NOT CIRCLED ___ (SKIP TO 413)
412) Would you ever use a method if you were married?
NO 2
DON'T KNOW 8
OTHER (SPECIFY) __________ 96 (SKIP TO 415)
OTHER (SPECIFY) __________ 96 (SKIP TO 415)
414) How many of these children would you like to be boys and how many would you like to be girls?
NUMBER GIRLS ___
NUMBER EITHER ___
OTHER (SPECIFY) __________ 999996
415) Do you approve or disapprove of couples using a method of family planning to avoid getting pregnant?
DISAPPROVE 2 (SKIP TO 417)
NO OPINION (SKIP TO 417)
416) Have you ever recommended family planning to a friend, relative, or anyone else?
NO 2
417) Is it acceptable or not acceptable to you for information on family planning to be provided:
NOT ACCEPTABLE 2
DON'T KNOW 8
NOT ACCEPTABLE 2
DON'T KNOW 8
NOT ACCEPTABLE 2
DON'T KNOW 8
418) In the last six months have you heard or learned about family planning:
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
419) In the last six months have you discussed the practice of family planning with your friends or relatives?
NO 2 (SKIP TO 421)
420) With whom? Anyone else? RECORD ALL MENTIONED.
MOTHER B
REGULAR PARTNER (NOT WIFE) C
FATHER D
SISTER(S) E
BROTHER(S) F
DAUGHTER G
MOTHER-IN-LAW H
FRIENDS I
OTHER (SPECIFY) __________ X
421) Do you think most, some, or none of the men you know use some kind of family planning?
SOME 2
NONE 3
DON'T KNOW 8
NO, NOT CURRENTLY MARRIED ___ (SKIP TO 501)
423) Now I want to ask you about your wife's view on family planning. Do you think that your wife approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
424) Have you and your wife ever discussed the number of children you would like to have?
NO 2
425) Do you think your wife wants the same number of children that you want, or does she want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 5. AIDS AND SEXUALLY TRANSMITTED DISEASES
501) Have you heard about diseases that can be transmitted through sex?
NO 2 (SKIP TO 514)
502) Which diseases have you heard about? RECORD ALL RESPONSES
GONORRHEA B
AIDS/HIV INFECTION C
GENITAL WARTS / CONDYLOMATA D
CHANCROID E
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
HAS NEVER HAD SEX ___ (SKIP TO 513)
504) During the last 12 months, did you have any of these diseases?
NO 2 (SKIP TO 513)
DON'T KNOW 8 (SKIP TO 513)
505) Which? RECORD ALL RESPONSES
GONORRHEA B
AIDS/HIV INFECTION C
GENITAL WARTS / CONDYLOMATA D
CHANCROID E
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
506) During the last 12 months, did you have a discharge from your penis?
NO 2
DON'T KNOW 8
507) During the last 12 months, did you have a sore or ulcer on your penis?
NO 2
DON'T KNOW 8
508) When you had the most recent episode of (DISEASE FROM 505, 506, 507) did you seek advice or treatment?
SELF TREATMENT 2 (SKIP TO 510)
DID NOT DO ANYTHING 3 (SKIP TO 510)
509) Where did you seek advice or treatment? Any other place or person? RECORD ALL MENTIONED
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTRE D
RURAL/MUNICIPAL CLINIC E
VILLAGE COMMUNITY WORKER F
OTHER PUBLIC SECTOR (SPECIFY) __________ G
PHARMACY J
PRIVATE DOCTOR K
VILLAGE COMMUNITY WORKER L
OTHER MEDICAL PRIVATE SECTOR (SPECIFY) __________ M
RELATIVES/FRIENDS O
TRADITIONAL HEALER P
510) When you had (DISEASE of 505, 506, 507) did you advise your partner to seek treatment?
NO 2
511) When you had (DISEASE of 505, 506, 507) did you do something not to infect your partner?
NO 2 (SKIP TO 513)
PARTNER ALREADY INFECTED 3 (SKIP TO 513)
512) What did you do? RECORD ALL MENTIONED
USED CONDOMS B
RECEIVED MEDICAL TREATMENT C
OTHER (SPECIFY) __________ X
MENTIONED 'AIDS' ___ (SKIP TO 515)
514) Have you ever heard of an illness called AIDS?
NO 2 ___ (SKIP TO 531)
515) 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
516) How can a person get the AIDS virus? Any other ways? RECORD ALL MENTIONED
SEX WITH PROSTITUTES B
HOMOSEXUAL CONTACT C
SEXUAL INTERCOURSE WITH MULTIPLE PARTNERS D
BLOOD TRANSFUSION E
INJECTIONS F
KISSING G
MOSQUITO BITES H
OTHER (SPECIFY) __________ W
OTHER (SPECIFY) __________ X
DON'T KNOW Z
517) Is there anything a person can do to avoid getting the AIDS virus?
NO 2 (SKIP TO 521)
DON'T KNOW 8 (SKIP TO 521)
518) What can a person do to avoid getting the AIDS virus? Any other ways? RECORD ALL MENTIONED
ABSTAIN FROM SEX B
USE CONDOMS DURING SEX 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
DON'T KNOW Z
DID NOT MENTION SAFE SEX ___ (SKIP TO 521)
520) What does "safe sex" mean to you? RECORD ALL MENTIONED
USE CONDOMS DURING SEX B
AVOID MULTIPLE SEX PARTNERS C
AVOID SEX WITH PROSTITUTES D
AVOID SEX WITH HOMOSEXUALS E
OTHER (SPECIFY) __________ X
DON'T KNOW Z
521) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
522) Can AIDS be cured, or do all persons with AIDS die from the disease?
NO, EVERYONE WITH AIDS DIES 2
DON'T KNOW 8
523) Can the AIDS virus be transmitted from mother to child during pregnancy or childbirth?
NO 2
DON'T KNOW 8
524) Do you personally know someone who has AIDS or has died of AIDS?
NO 2
DON'T KNOW 8
525) Do you think a person who has AIDS should be cared for at home, cared for in a medical facility, or left alone to take care of himself/herself?
MEDICAL FACILITY 2
LEFT ALONE 3
DON'T KNOW 8
526) Do you think your chances of getting the AIDS virus are small, moderate, great, or no risk at all?
SMALL 2
MODERATE 3 (SKIP TO 528)
GREAT 4 (SKIP TO 528)
527) Why do you think that you have (NO RISK/A SMALL CHANCE) of getting the AIDS virus? Any other reasons? RECORD ALL MENTIONED
USE CONDOMS DURING SEX B (SKIP TO 529)
HAVE ONLY ONE SEX PARTNER C (SKIP TO 529)
LIMITED NUMBER OF SEX PARTNERS D (SKIP TO 529)
NO HOMOSEXUAL CONTACT E (SKIP TO 529)
NO BLOOD TRANSFUSIONS F (SKIP TO 529)
NO INJECTIONS G (SKIP TO 529)
OTHER (SPECIFY) __________ X (SKIP TO 529)
DON'T KNOW Z (SKIP TO 529)
528) Why do you think that you have a (MODERATE/GREAT) chance of getting the AIDS virus? Any other reasons? RECORD ALL MENTIONED
MULTIPLE SEX PARTNERS B
SPOUSE HAS MULTIPLE PARTNERS C
HOMOSEXUAL CONTACT D
HAD BLOOD TRANSFUSION E
HAD INJECTIONS F
OTHER (SPECIFY) __________ X
DON'T KNOW Z
529) Since you heard of AIDS, have you changed your behavior to prevent getting the AIDS virus?
NO 2 (SKIP TO 531)
530) What did you do? Anything else? Anything else? RECORD ALL MENTIONED
STARTED USING CONDOMS B
RESTRICTED SEX TO ONE PARTNER C
REDUCED NUMBER OF PARTNERS D
NO MORE HOMOSEXUAL CONTACTS E
STOPPED INJECTIONS F
OTHER (SPECIFY) __________ X
DON'T KNOW Z
531) Some people use a condom during sexual intercourse to avoid getting the AIDS virus or other sexually transmitted diseases. Have you ever heard of this?
NO 2
HAS NEVER HAD SEX ___ (SKIP TO 601)
533) Have you ever used a condom during sex to avoid getting or transmitting diseases, such as the AIDS virus?
NO 2
534) Have you given or received money, gifts or favours in return for sex at any time in the last 4 weeks?
NO 2
601) Now I would like to ask you some questions about your brothers and sisters, that is, all of the children born to your natural mother, including those who are living with you, those living elsewhere, and those who have died.
How many children did your mother give birth to, including you?
ONLY ONE BIRTH ___ (RESPONDENT ONLY) (SKIP TO 615)
603) How many of these births did your mother have before you were born?
604) What was the name given to your oldest (next oldest) brother or sister?
605) Is (NAME) male or female?
FEMALE 2
NO 2 (SKIP TO 608)
DON'T KNOW (SKIP TO NEXT COLUMN)
608) How many years ago did (NAME) die?
609) How old was (NAME) when she/he died?
610) Did (NAME) die during childbirth?
NO 2
611) Was (NAME) pregnant when she died?
NO 2
612) Did (NAME) die within six weeks after the end of a pregnancy or childbirth?
NO 2
613) Did (NAME) die because of complications of pregnancy or childbirth?
NO 2 (SKIP TO NEXT COLUMN)
DON'T KNOW 8
614) How many children had (NAME) given birth to before that pregnancy?
MINUTES ___
To be filled in after completing interview
Comments about Respondent:
Comments on Specific Questions:
Any Other Comments:
Name of Supervisor __________
Date _________
Name of Editor __________
Date _____