Domain I- Sociodemographic
|
CVI
|
DRI
|
1. Age (years) |
1.00 |
0.96
|
2. Sex (biological) |
1.00 |
() Male () Female () Intersex |
3. Gender identity |
0.80 |
() Man () Woman () Trans man () Trans woman () Non-binary () Other |
4. Sexual orientation |
0.90 |
() Heterosexual () Homosexual () Bisexual () Asexual () Pansexual () Other |
5. Self-declared race/color |
1.00 |
() White () Brown () Black () Yellow () Indigenous |
6. Education: (Years of study) |
1.00 |
7. Municipality of residence/neighborhood: |
1.00 |
Domain II- Sociostructural
|
|
|
8. Current occupation |
1.00 |
0.95
|
() Student () Formal work () Informal work () Self-employed () Unemployed () Others |
9. Current relationship status |
1.00 |
() Fixed relationship () Casual relationship () Relationship with more than one partner () No relationship () Others |
10. Parental status |
0.80 |
() Living parents () Orphan of mother () Orphan of father () Orphan of both parents () Do not know |
11. Who do you currently share your home with (multiple choice) |
1.00 |
() Mother () Father () Partner () Siblings () Children () Grandparents () Relatives () Friends () Alone |
12. How many people live in the house:_____ |
0.90 |
13. Monthly family income |
1.00 |
() ≤ 1 minimum wage () > 1 and ≤ 3 minimum wage () > 3 minimum wage |
14. Financial or material support: |
1.00 |
() Yes () No If yes, which?___________ |
15. House where you live: |
1.00 |
() Own paid off () Own paid off in progress () Rented () Assigned () Other |
16. Cellphone |
1.00 |
() Yes () No |
17. Access to the internet at home |
1.00 |
() Yes () No |
18. In the last month, was the amount of food in your home sufficient? |
0.90 |
() Yes () No |
19. Have you ever been arrested or institutionalized? |
0.90 |
() Yes () No () Would rather not answer |
20. History of psychiatric treatment |
0.90 |
() Yes () No () Would rather not answer |
21. Sexual relationships in exchange for benefits |
0.80 |
() Yes () No () Would rather not answer |
22. Suffered discrimination based on gender identity |
0.90 |
() Yes () No () Would rather not answer If yes, where (multiple choice): |
() In the family () In health services () At work () At university/school () Others: _______________ |
23. Suffered discrimination based on sexual orientation |
1.00 |
() Yes () No () Would rather not answer If yes, where (multiple choice): |
() In the family () In health services () At work () At university/school () Others: _________________ |
24. Suffered some type of sexual violence/abuse |
0.90 |
() Yes () No () Would rather not answer If yes, from whom (multiple choice): |
() Partner () Relative () Unknown () Other () Would rather not answer |
25. First service you turn to when your health situation requires care |
1.00 |
() FHS () ECU () Public hospitals () Private services () Others |
26. Received guidance on HIV prevention |
1.00 |
() Yes () No If yes, where (multiple choice): |
() Health services () School/university () Work () Television/media () Family () Others |
27. Difficulty acquiring condoms |
1.00 |
() Yes () No If yes, what difficulty(ies): |
28. Difficulty performing rapid HIV test: |
1.00 |
() Yes () No If yes, what difficulty(ies): |
29. Difficulty accessing the Testing and Counseling Center |
0.90 |
() Yes () No If yes, what difficulty(ies): |
30. How satisfied were you with the service you received at CTA |
0.90 |
() Satisfied () Not very satisfied () Not at all satisfied |
Domain III- Behavioral
|
|
|
31. First time seeking rapid HIV test |
1.00 |
0.95
|
() Yes () No If no: How many times did you perform the RT: _____________ |
For how long held the last RT (in months):____________________ |
32. Reason for taking the current test |
1.00 |
() Sexual exposure () Sharing of sharp objects () Curiosity () Periodic examination () Infection/comorbidity () Pregnancy () Other: |
33. Age at first sexual intercourse (years):_________ |
0.80 |
34. First consensual sexual intercourse |
1.00 |
() Yes () No () Do not know |
35. Diagnosis of Sexually Transmitted Infection (STI)? |
1.00 |
() Yes () No () Do not know If yes, which STI?________________ |
36. Use of medication to reduce the risk of HIV infection (Post-Exposure Prophylaxis (PEP) |
1.00 |
() Yes () No If yes, for how long:_______________ |
37. Preventive use of medications before exposure to the risk of acquiring HIV (PrEP) |
0.90 |
() Yes () No If yes, for how long:_______________ |
38. Self-perceived risk of having acquired HIV |
0.90 |
() Low () Moderate () High () Do not know |
39. During sexual intercourse, how often do you use a condom? |
1.00 |
() Always () Sometimes () Never |
If sometimes and/or never, justify: _____________________ |
40. Difficulty negotiating condom use with your partner |
1.00 |
() Always () Sometimes () Never |
41. Difficulty negotiating condom use with your partner (multiple choice): |
0.90 |
() Vaginal () Insertive anal () Receptive anal () Oral |
42. History of a relationship with someone positive for HIV |
0.90 |
() Yes () No () Do not know |
43. Serological status of current partner: |
0.90 |
() HIV-negative () HIV-positive () Do not know () No relationship at the moment |
44. Drink alcohol |
1.00 |
() Yes () No If yes, did you stop using condoms while under the influence of alcohol? |
() Yes () No () Do not know |
45. Use of illicit drugs |
1.00 |
() Yes () No If yes, did you stop using condoms while under the influence of alcohol? () Yes () No () Do not know |