X3. What are the initials of each person with whom you have had a sexual experience in the last 30 days? INTERVIEWER: IF NONE, CODE 00 IN X3a, GO TO X10 | 1. |___|___|___| INITIALS | 2. |___|___|___| INITIALS | 3. |___|___|___| INITIALS | 4. |___|___|___| INITIALS | 5. |___|___|___| INITIALS |
X3a. INTERVIEWER: COUNT NUMBER OF SEXUAL PARTNERS IN PAST 30 DAYS | |___|___| # OF PARTNERS | | | | |
X4. About how many times have you and (FILL FROM X3) had sexual intercourse in the past 30 days, that is since [fill DATE 1 MONTH AGO]? | |____|____|____| # OF TIMES | |____|____|____| # OF TIMES | |____|____|____| # OF TIMES | |____|____|____| # OF TIMES | |____|____|____| # OF TIMES |
DRAFT H:\PROJECT\8593\...\August’s files\7 FINAL sexual behavior.wpd 4 7/13/00 2:38 PM X5. Thinking back over the past 30 days, did you have vaginal sex with (FILL FROM X3)? PROBE: Vaginal sex is when a boy or man inserts his penis into a girl or woman’s vagina YES: ASK a NO: CODE N/A IN a-e | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 |
X5a. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X5b. Of those (FILL FROM X5a) times you had vaginal sex, did you or he ever use a condom | YES (GO TO X5c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X5c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X5c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X5c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X5c) 01 NO (000 IN c) 02 N/A 09 |
X5c. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X5d. Of those (FILL FROM X5a) times that you had vaginal sex with (FILL FROM X3), were you or (FILL FROM X3) ever high on drugs or alcohol? | YES (GO TO X5e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X5e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X5e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X5e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X5e) 01 NO (000 IN e) 02 N/A 09 |
X5e. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
DRAFT H:\PROJECT\8593\...\August’s files\7 FINAL sexual behavior.wpd 5 7/13/00 2:38 PM X6. Thinking back over the past 30 days, did you have receptive anal sex with (FILL FROM X3)? PROBE: (Receptive anal sex is when a boy or man puts his penis into your anus or butt) | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 |
X6a. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X6b. Of those (FILL FROM X6a) times you had receptive anal sex, did you or he ever use a condom? | YES (GO TO X6c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X6c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X6c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X6c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X6c) 01 NO (000 IN c) 02 N/A 09 |
X6c. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X6d. Of those (FILL FROM X6a) times that you had receptive anal sex with (FILL FROM X3), were you or (FILL FROM X3) ever high on drugs or alcohol? | YES (GO TO X6e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X6e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X6e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X6e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X6e) 01 NO (000 IN e) 02 N/A 09 |
X6e. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
DRAFT H:\PROJECT\8593\...\August’s files\7 FINAL sexual behavior.wpd 6 7/13/00 2:38 PM ASK ONLY IF R IS MALE: FEMALES: NA IN a-e X7. Thinking back over the past 30 days, did you have insertive anal sex with (FILL FROM X3)? PROBE: (Insertive anal sex is when you put your penis into the anus or butt of another person) Yes: ASK a N CODE N/A IN a-e | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 |
X7a. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X7b. Of those (FILL FROM X7a) times you had insertive anal sex, did you or he ever use a condom? | YES (GO TO X7c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X7c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X7c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X7c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X7c) 01 NO (000 IN c) 02 N/A 09 |
X7c. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X7d. Of those (FILL FROM X7a) times that you had insertive anal sex with (FILL FROM X3), were you or (FILL FROM X3) ever high on | YES (GO TO X7e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X7e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X7e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X7e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X7e) 01 NO (000 IN e) 02 N/A 09 |
X7e. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
DRAFT H:\PROJECT\8593\...\August’s files\7 FINAL sexual behavior.wpd 6 7/13/00 2:38 PM X8. Thinking back over the past 30 days, did you have oral sex with (FILL FROM X3)? PROBE: (Oral sex is when you put your mouth on someone’s penis, vagina, anus or butt) | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 |
X8a. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X8b. Of those (FILL FROM X8a) times you had oral sex, did you or he ever use a condom? | YES (GO TO X8c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X8c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X8c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X8c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X8c) 01 NO (000 IN c) 02 N/A 09 |
X8c. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X8d. Of those (FILL FROM X8a) times that you had oral sex with (FILL FROM X3), were you or (FILL FROM X3) ever high on drugs or alcohol? | YES (GO TO X8e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X8e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X8e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X8e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X8e) 01 NO (000 IN e) 02 N/A 09 |
X8e. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
DRAFT H:\PROJECT\8593\...\August’s files\7 FINAL sexual behavior.wpd 6 7/13/00 2:38 PM X9. Thinking back over the past 30 days, did you have receptive oral sex with (FILL FROM X3)? PROBE: (Receptive oral sex is when someone puts their mouth on your penis, vagina, anus or butt) | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 | YES 01 NO 02 |
X9a. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X9b. Of those (FILL FROM X9a) times you had receptive oral sex, did (you or he) ever use a condom? | YES (GO TO X9c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X9c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X9c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X9c) 01 NO (000 IN c) 02 N/A 09 | YES (GO TO X9c) 01 NO (000 IN c) 02 N/A 09 |
X9c. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |
X9d. Of those (FILL FROM X9a) times that you had receptive oral sex with (FILL FROM X3), were you or (FILL FROM X3) ever high on drugs or alcohol? | YES (GO TO X9e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X9e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X9e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X9e) 01 NO (000 IN e) 02 N/A 09 | YES (GO TO X9e) 01 NO (000 IN e) 02 N/A 09 |
X9e. How many times? NA:000 | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES | |___|___|___| # OF TIMES |