SELF-ADMINISTERED QUESTIONNAIRE 2 CASE #:

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Griffin Perry
5 years ago
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1 0/ INSTITUTE FOR SURVEY RESEARCH TEMPLE UNIVERSITY -Of The Commonwealth System Of Higher Education- 60 NORTH BROAD STREET PHILADELPHIA, PENNSYLVANIA 9 FALL/WINTER STUDY # SELF-ADMINISTERED QUESTIONNAIRE CASE #: THE INTERVIEWER WILL READ THE QUESTIONS ABOUT THE FIRST TO YOU. THEN YOU MAY READ AND COMPLETE THIS YOURSELF. PLEASE RECORD AN ANSWER FOR E QUESTION. IF YOU PREFER, THE INTERVIEWER WILL ASK YOU ALL THE QUESTIONS AND RECORD YOUR ANSWERS. IF YOU ARE MALE, ANSWER QUESTIONS -6. IF YOU ARE FEMALE, ANSWER QUESTIONS - AND 7 AND 8. COMPLETED BY: RESPONDENT INTERVIEWER 4 4 BOTH 3 INTERVIEWER: ID#: - (FOR OFFICE USE ONLY) ISR ID#:

2 AGE WHEN YOU DID LAST TIME YOU DURING -MONTH PERIOD THIS FIRST TIME DID THIS BEFORE DATE IN COL. AGE NEVER MO. YR. OFTEN OFTEN TIMES ONCE. had heterosexual intercourse? solitary masturbation to an orgasm? mutual or group masturbation to 95 - an orgasm? COLUMN 4 COLUMN 5 COLUMN 7 PARTNERS WHO WERE IMP. TO SEXUAL PLEASURE CHANGE IN FREQUENCY WHEN CHANGE IN STRANGERS/PICKUPS DURING -MONTH PERIOD BECAUSE OF AIDS THREAT BEFORE DATE IN COLUMN YOU ARE DOING THIS: WAS MADE NONE,ALL SOME- SOME- ALREADY WHAT WHAT NOT AT MORE LESS RELATED MOST SOME KNOWN IMP. IMP. UN IMP. ALL OFTEN OFTEN CHANGE MO. YR / * 03/ 4. kissed, licked or sucked/suckled (placed your mouth 95 - on) a female's. genital organ? sexually caressed, held or touched (placed your hand 95 - on) a male's penis? kissed, licked or sucked/suckled (put your mouth on) 95 - a male's penis? had receptive anal intercourse (had a male put his penis 95 - in your anus)? "rimmed" someone (placed your mouth 95 - on another's anus)? 9. were "rimmed" by someone? CASE #: * 7-8 o: BLANK * * 7 7 so: BLANK 04/ -

3 COLUMN 4 AGE WHEN YOU DID LAST TIME YOU DURING -MONTH PERIOD PARTNERS WHO WERE THIS FIRST TIME DID THIS BEFORE DATE IN COL. STRANGERS/PICKUPS AGE NEVER MO. YR. OFTEN OFTEN TIMES ONCE MOST SOME 0. "fisted" someone (inserted your fist in another's 95 - anus)?. were "fisted" by someone else? were the recipient of "golden showers" (were urinated on by 95 - someone during sexual activity)? COLUMN 5 IMP. TO SEXUAL PLEASURE CHANGE IN FREQUENCY DURING -MONTH PERIOD BECAUSE OF AIDS THREAT BEFORE DATE IN COLUMN YOU ARE DOING THIS: NONE,ALL SOME- SOME- ALREADY WHAT WHAT NOT AT MORE LESS RELATED KNOWN IMP. IMP. UN IMP. ALL OFTEN OFTEN CHANGE COLUMN 7 WHEN CHANGE IN WAS MADE MO. YR. 04/ Lt e gave "golden showers" to 95 - someone else? were the recipient of heavy S&Mphysical pain, piercing, 95 - light blood letting, etc.? gave heavy S&M to someone else? 95 : s were paid to have sex? paid someone else to have 95 - sex? wore drag, cross dressed? / CASE #: - * 7 8 o : BLANK

4 AGE WHEN YOU DID LAST TIME YOU DURING -MONTH PERIOD THIS FIRST TIME DID THIS BEFORE DATE IN COL. 9. engaged in group sex? 95 - c 0. used pornography immediately prior to or during 95 - sexual activity?. engaged in.. activity for pornographic 95 - publication or distribution? COLUMN 4 PARTNERS WHO WERE STRANGERS/PICKUPS AGE NEVER MO. YR. OFTEN OFTEN TIMES ONCE MOST SOME COLUMN 5 IMP. TO SEXUAL PLEASURE CHANGE IN FREQUENCY DURING -MONTH PERIOD BECAUSE OF AIDS THREAT BEFORE DATE IN COLUMN YOU ARE DOING THIS: NONE,ALL SOME- SOME- ALREADY WHAT WHAT NOT AT MORE LESS RELATED KNOWN IMP. IMP. UN IMP. ALL OFTEN OFTEN CHANGE COLUMN 7 WHEN CHANGE IN WAS MADE MO. YR. 06/ paid someone else to have 95 - "telephone" sex? 3 3 (IF YOU ARE A FEMALE, SKIP TO QUESTION 7) 3. had insertive anal intercourse : ' (put your penis 95 in another male's anus)? : ?/ 7,.. 4. had insertive heterosexual anal intercourse (put your penis 95 - in a female's anus)? had a female kiss, lick, or suck/suckle (place her 95 - mouth on) your penis? s- 4 8 CASE#: 7 8 o: BLANK

5 COLUMN 4 AGE WHEN YOU DID LAST TIME YOU DURING -MONTH PERIOD PARTNERS WHO WERE THIS FIRST TIME DID THIS BEFORE DATE IN COL. STRANGERS/PICKUPS NONE,ALL ALREADY AGE NEVER MO. YR. OFTEN OFTEN TIMES ONCE MOST SOME KNOWN 6. had a male kiss, lick, or suck/ suckle your penis 95-3 (take your penis in his mouth)? COLUMN 5 COLUMN 7 IMP. TO SEXUAL PLEASURE CHANGE IN FREQUENCY WHEN CHANGE IN DURING -MONTH PERIOD BECAUSE OF AIDS THREAT BEFORE DATE IN COLUMN YOU ARE DOING THIS: WAS MADE 3 0?/ SOME- SOME- WHAT WHAT NOT AT MORE LESS RELATED IMP. IMP. UN IMP. ALL OFTEN OFTEN CHANGE MO. YR (IF YOU ARE MALE, PLEASE GIVE THE QUESTIONNAIRE TO THE INTERVIEWER) 7. had a female kiss, lick, or suck/suckle (place her mouth 95-3 on) your genital organ? 8. had a male kiss, lick, or suck/ suckle (place his mouth on) 95-3 your genital organ? * 08/ (PLEASE GIVE THE QUESTIONNAIRE TO THE INTERVIEWER) CASE If: * 7ao: BLANK

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