The following surveys have been designed and tested by CAPS scientists and are made available free of charge for use by HIV researchers, evaluators, prevention program planners and designers.
Warning: Survey needs vary from population to population and project to project. Please consider carefully the needs of your particular intervention before using one of these instruments.
We encourage researchers and service providers to use these instruments, adapting and modifying as you see fit. Please cite CAPS as the source in any presented or published work, and, if the instruments were modified in any way from their original (as downloaded from the CAPS Web site) please note that in any presentations.
Focus group 9
STD testing 6
Outside CAPS Links
1. Condom Use Among Hispanics
- Condom use for Females in English
- Condom use for males in English
- Uso de condones para mujeres en Español
- Uso de condones para hombres en Español
Scoring: Please read the detailed
description of the instruments.
Reliability and/or validity: "Condom use among Hispanic men with secondary female sexual partners" by Barbara VanOss Marin, Cynthia A. Gomez, and Jeanne M. Tschann, printed in Public Health Reports. Also, Gómez, C., Marín, B.V. (1996). Gender, culture, and power: Barriers to safe sex. Journal of Sex Research, 33(4), 355-362.
2. Latino Gay/Bisexual Men
The following Spanish survey has been used to assess risk behavior. It was developed through the Hermanos de Luna y Sol program, a culturally-appropriate HIV risk-reduction intervention that targets immigrant, Spanish-speaking gay/bisexual men in San Francisco, CA. See the latest report of the program evaluation for HLS that includes a comparative of behavioral change pre and post intervention as well as barriers and limitations for this instrument.
- Behavioral Risk Assessment Survey (The survey is only available in Spanish--PDF document)
3. Measures of Sexual Attitudes and Behavior of Latino Adults
- Questionnaire for Unmarried Latina Women
- Questionnaire for Unmarried Latino Men
- Cuestionario para mujeres latinas solteras
- Cuestionario para hombres latinos solteros
Reliability and/or validity: Please see a description of the instruments. Marín, B.V., Tschann, J., Gomez, C., Gregorich, S.E. (1998). Self efficacy to use condoms in unmarried Latino adults. American Journal of Community Psychology. 26(1), 53-71.
4. National Sexual Health Survey (NSHS)
NSHS is national telephone survey of adults 18 years and older residing in the 48 contiguous states. Measures were developed to assess a wide range of HIV-related and human sexuality topics, including, but not limited to: condom attitudes, condom slips and breaks, HIV-related caregiving, HIV-testing and home testing use, STD histories, perceived risk for HIV and other STDS and optimistic bias assessments, extramarital sex, sexual development, sexual abuse and rape, sexual dysfunctions, various psychological scales (sensation-seeking, machismo), family assessments and history, health and demographics, and a detailed assessment was conducted of sexual activities with each of the respondent’s sexual partners in the past year up to a total of 10 partners, and, in addition, demographic, geographic, and HIV/STD risk characteristics of their sexual partners were determined.
- Screening questionnaire
- Questionnaire guidelines
- Questionnaire map
- National Sexual Health Survey (NSHS) (Warning: This is a large survey - 118 pages - and a large PDF file to download - 4.4 MB)
- Cuestionario de selección
- Información sobre el cuestionario de NSHS
- Cuestionario NSHS (Warning: This is a large survey - 118 pages - and a large PDF file to download - 4.4 MB)
- Table of contents
- Sample design & proceedures
- Disposition codes
- Variables & univariate statistics (Warning: This is a huge PDF file to download - 6.8 MB)
- Derived variables
- Contact information
Reliability and/or validity: Catania JA, Coates TJ, Stall R, Turner HA, Peterson J, Hearst N, Dolcini MM, Hudes E, Gagnon J, Wiley J, Groves R, (1992). Prevalence of AIDS-related risk factors and condom use in the United States. Science, 258, 1101-1106.
5. Teen Peer Educators
The following surveys are used with the Healthy Oakland Teens project, at an urban, ethnically diverse junior high school. The project's goal is to reduce adolescents' risk for HIV infection by using peer role models to advocate for responsible decision making, healthy values and norms, and improved communication skills.
- Teen knowledge, attitude, behavior, belief (KABB) questionnaire
- Adult evaluation of peer educators
- Student evaluation of peer educators
Scoring: Please read the detailed description
of the instruments.
Reliability and/or validity: Ekstrand, ML, Siegel D, Nido V, Faigeles B, Krasnovsky F, Battle R, Cummings G, Chiment E, and Coates TJ. (July, 1996). Peer-led AIDS prevention delays sexual debut among U.S. junior high school students. Oral presentation to the XI International Conference on AIDS, Vancouver, Canada.
6. HIV Counseling and Testing in Developing Countries
The following surveys are used with the Voluntary HIV Counseling and Testing Efficacy study was a randomized clinical trial of the effectiveness of HIV counseling and testing for the prevention of new HIV infections. The study was conducted at three sites: Nairobi, Kenya; Dar-Es- Salaam, Tanzania and Port-of-Spain, Trinidad.
- Baseline survey
- Six-month follow-up survey
- Twelve-month follow-up survey
Scoring: See variable
Reliability and/or validity: Coates T. J., Grinstead O. A., Gregorich S. E., Heilbron D. C., et al. (2000). "Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial." Lancet V356(N9224): 103-112.
7. Qualitative Survey -- HIV Testing and Counseling Among Injection Drug Users
The following qualitative survey was used with Project Access, a qualitative needs assessment commissioned by the California State Office of AIDS and the Centers for Disease Control and Prevention to examine counseling and testing utilization and prevention programs through the perspective of drug-using clients. The instrument is designed to assess: 1) the behavioral, psychosocial and social risk factors that influence high-risk drug users decisions to test for HIV, 2) the service delivery factors that influence high-risk drug users' decision to test for HIV; 3) how high-risk drug users employ HIV testing in personal prevention strategies; 4) and how knowledge of HIV test results affects risk behavior.
Scoring: not applicable
Reliability and/or validity: not applicable
8. Self-Report Adherence to Medications
This questionnaire was developed by the AIDS Clinical Trials Group (ACTG) Recruitment, Adherence and Retention Subcommittee, Margaret A. Chesney, Ph.D., and Jeannette Ickovics, Ph.D., Co-Chairs. Please read the two abstracts on adherence in clinical trials and practice.
Reliability and/or validity: Chesney M. A., Ickovics J. R., Chambers D. B., Gifford A. L., Neidig J., Zwickl B. and Wu A. W. (2000). "Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG)." AIDS Care 12(3): 255-66.
9. Focus Group Questions for Sexual Negotiations
The following two outlines of focus group questions are taken from the following research study: "Sexual Negotiations Among Young Adults in the Era of AIDS." Prepared by Diane Binson, PI. Funded by the Universitywide AIDS Research Program, R94-SF-050.
- Focus Group Questions for Young Women who Have Sex with Men
- Focus Group Questions for Young Gay/Bisexual Men
10. Sexual Behavior for Students at Public Middle Schools
Barbara Marín and Cynthia Gomez at the Center for AIDS Prevention Studies at UCSF and Karin Coyle and Doug Kirby at ETR Associates developed this questionnaire as part of an evaluation study. These questionnaires are available as PDF files both in English and Spanish. Please read a description of the questionnaires.
Scoring: See scales
Reliability and/or validity: Marín, B.V., Coyle, K., Gomez, C., Carvajal, S. , Kirby, D. (2000). Older Boyfriends and Girlfriends Increase Risk of Sexual Initiation in Young Adolescents. Journal of Adolescent Health, 27, 409-418.
11. Prevention Services for HIV+ Patients
The following exit survey instruments were developed to assess frequency and variation of prevention services as reported by HIV positive patients at Ryan White-funded clinics across the US.
- Ryan White Prevention Project Patient Exit Survey (English) (PDF)
- Ryan White Prevention Project Patient Exit Survey (Spanish) (PDF)
Reliability and/or validity: Learn more about the methods used.
12. Risk behavior for gay men
These questionnaires were used with the Explore project and cover social activiy, attitude, PEP, drug use and sexual behavior.
- Baseline risk assessment (PDF)
- 6 & 12 month risk assessement (PDF)
- 18-48 month risk assessment (PDF)
- Feedback survey (PDF)
Scoring: See Data collection section of the Explore
Reliability and/or validity: BA Koblin, MA Chesney, MJ Husnik, et al. High-Risk Behaviors Among Men Who Have Sex With Men in 6 US Cities: Baseline Data From the EXPLORE Study American Journal of Public Health. 2003 93: 926-932.
13. Risk behavior and health care for HIV+ injection drug users
These instruments were used to measure the effectiveness of the multi-site INSPIRE Study (VOICE in San Francisco) and cover medication use and adherence, health care utilization, substance abuse, injection behavior, sexual behavior, partner relationships and more.
- Screening questionnaire (PDF)
- Baseline survey (Warning: This is a huge PDF file to download - 7.4 MB)
Reliability and/or validity: Purcell DW, Metsch LR, Latka M, Santibanez S, Gómez CA, Eldred L, Latkin CA; INSPIRE Study Group. Interventions for seropositive injectors-research and evaluation: an integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction. J Acquir Immune Defic Syndr. 2004 Oct 1;37 Suppl 2:S110-8.
14. Risk behavior and health care for HIV+ injection drug users
These instruments were used with the SUDIS Study and cover medication use and adherence, health care utilization, disclosure, alcohol and drug use, sexual behavior, partner relationships, social support and more.
- Screening questionnaire (PDF)
- Female questionnaire (Warning: This is a huge PDF file to download - 7.9 MB)
- Male questionnaire (Warning: This is a huge PDF file to download - 5.9 MB)
Scoring: Included in instruments.
Reliability and/or validity: Knight KR, Purcell D, Dawson-Rose C, Halkitis PN, Gomez CA; Seropositive Urban Injectors Study Team. Sexual risk taking among HIV-positive injection drug users: contexts, characteristics, and implications for prevention. AIDS Educ Prev. 2005 Feb;17(1 Suppl A):76-88.
15. Women with incarcerated male partners
These instruments were used with the HOME Study.
- Longitudinal survey - baseline (We administered these to women visiting their incarcerated partners at the prison under study. Women completed the baseline while their partner was incarcerated and they completed the follow-up 30 days after their partner was released from custody.)
- Longitudinal survey - follow-up
- Cross-sectional survey (We administered this survey to women visiting incarcerated men at the prison under study before our intervention began and after our intervention ended to measure community impact.)
Reliability and/or validity: See instruments.
16. Attitudes and risk behavior for healthcare providers and their HIV+ patients
These instruments were used with the EPPEC Project.
- Patient Assessment
- Provider Assessment
- Patient program evaluation - qualitative
- PI and Project Director implementation - qualitative
Reliability and/or validity: RISK ASSESSMENT QUESTIONS: Morin, S. et al. Predicting HIV Transmission Risk Among HIV-infected MSM: Findings from the Healthy Living Project. J Acquir Immune Defic Syndr. 2005 Oct 1;40(2):226-3. STIGMA QUESTIONS: Westbrook, L. E., and Bauman, L. J. (1996). Perceived Stigma of HIV/AIDS Scale. Bronx, New York: Albert Einstein College of Medicine. Purcell DW, Metsch L, Latka M, et al. Behavioral prevention trial with HIV-seropositive injection drug users: rationale and methods of the INSPIRE Study. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S110–S118. ATTITUDINAL QUESTIONS: Myers et al. Written clinic procedures enhance delivery of HIV "prevention with positives" counseling in primary health care settings. J Acquir Immune Defic Syndr. 2004 Oct 1;37 Suppl 2:S95-S100. Morin et al. Missed Opportunities: Prevention with HIV+ Patients in Clinical Care Settings. J Acquir Immune Defic Syndr. 2004 Aug 1;36(4):960-6. Steward et al. Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings. AIDS Behav. 2006 Jan;10(1):3-12. TREATMENT OPTIMISM QUESTIONS: Vanable, PA, Ostrow DG, McKirnan DJ. 2003. Viral load and HIV treatment attitudes as correlates of sexual risk behavior among HIV-positive gay men. J of Psychosomatic Research 54:263-269.
17. Risk behavior for jail inmates and jail staff
These instruments were used with the Innovative Condom Distribution study and attitudes towrds and awareness of condoms and sexual activity in jail.
- Pre-intervention prisoner survey (PDF)
- Follow-up prisoner survey (PDF)
- Prison staff interview guide (PDF)
Reliability and/or validity:
101. Ways of Coping
Ways of Coping Questionnaire by Susan Folkman and Richard S Lazarus is used to identify the thoughts and actions an individual has used to cope with a specific stressful encounter.
- Ways of Coping (PDF)
Scoring: Included in English instrument
Reliability and/or validity: Folkman S., Lazarus R. S., Gruen R. J. and DeLongis A. (1986). "Appraisal, coping, health status, and psychological symptoms." Journal of Personality & Social Psychology 50(3): 571-579.
102. Female Condom Attitudes Scale (FCAS)
Scoring: Included in article
Reliability and/or validity: Neilands TB, Choi KH. A validation and reduced form of the Female Condom Attitudes Scale. AIDS Education and Prevention. 2002 Apr;14(2):158-71. (PDF of article)
103. Coping Self-Efficacy Scale
Scoring: See scoring information.
Reliability or validity: Chesney MA, Neilands TB, Chambers DB, Taylor JM, Folkman S. A validity and reliability study of the coping self-efficacy scale. Br J Health Psychol 2006 Sep; 11(3): 421-37.
104. SECope - Coping with HIV treatment side effects
- SECope (PDF)
Scoring: Included in article.
Reliability or validity: Mallory O. Johnson, Torsten B. Neilands. Coping with HIV Treatment Side Effects: Conceptualization, Measurement, and Linkages. AIDS and Behavior. 2007 Jul;11(4):575-85.
105. HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES)
- HIV-ASES (PDF)
Scoring: Included in article.
Reliability or validity: Mallory O. Johnson, Torsten B. Neilands, Samantha E. Dilworth, Stephen F. Morin, Robert H. Remien, Margaret A. Chesney. The Role of Self-Efficacy in HIV Treatment Adherence: Validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med. 2007 Jun 23.
106. Modified Schedule of Sexist Events (SSE-LM)
- SSE-LM (PDF)
Scoring: Included in article.
Reliability or validity: Lisa Bowleg, PhD, Torsten B. Neilands, PhD, Kyung-Hee Choi, PhD, MPH. Evaluating the Validity and Reliability of a Modified Schedule of Sexist Events: Implications for Public Health Research on Women’s HIV Risk Behaviors. Women & Health, Vol. 47(2) 2008.
107. China MSM Stigma Scale
- China MSM Stigma Scale (PDF)
Scoring: Included in article.
Reliability or validity: Torsten B. Neilands, Wayne T. Steward, Kyung-Hee Choi. Assessment of Stigma Towards Homosexuality in China: A Study of Men Who Have Sex with Men. Arch Sex Behav. 2008 Oct;37(5):838-44.
108. India HIV-related Stigma Scales
Scoring: Included in article.
Reliability or validity: Wayne T. Steward, Gregory M. Herek, Jayashree Ramakrishna, Shalini Bharat, Sara Chandy, Judith Wrubel, Maria L. Ekstrand. HIV-related stigma: Adapting a theoretical framework for use in India. Social Science & Medicine 67 (2008) 1225–1235.
- An excellent resource for scales can be found at the Center for Identification, Prevention and Treatment Services (CHIPTS), UCLA, Drew University. Assessment Instruments
- Population Council
- The Measurement Group