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DEMOGRAPHIC AND HEALTH SURVEY-MALAWI 2010-MEN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME _________________________

NAME OF HOUSEHOLD HEAD __________________

DISTRICT _____________________

CLUSTER NUMBER __

HOUSEHOLD NUMBER ___

NAME AND LINE NUMBER OF MAN ______________

INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE __________
INTERVIEWER'S NAME ___________
RESULT* _____________

COMPLETED 1
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
INCAPACITATED 6
OTHER (SPECIFY) ___________ 7

NEXT VISIT:
DATE __________
TIME ___________

FINAL VISIT
DAY ____
MONTH ____
YEAR ___
INTERVIEWER NUMBER ____
RESULT* _____

TOTAL NUMBER OF VISITS __

LANGUAGE OF QUESTIONNAIRE**:

ENGLISH 04

LANGUAGE OF INTERVIEW**: ___

CHICHEWA 01
TUMBUKA 02
YAO 03
ENGLISH 04
OTHER (SPECIFY) __________________ 06

NATIVE LANGUAGE OF RESPONDENT**: ___

CHICHEWA 01
TUMBUKA 02
YAO 03
ENGLISH 04
OTHER (SPECIFY) __________________ 06

TRANSLATOR USED

NOT AT ALL 1
SOMETIME 2
ALL THE TIME 3

SUPERVISOR
NAME ________ ___
DATE ________

FIELD EDITOR
NAME ________ ___
DATE ________

OFFICE EDITOR____

KEYED BY_____

SECTION 1. RESPONDENT'S BACKGROUND

INTRODUCTION AND CONSENT

INFORMED CONSENT

Hello. My name is ____________and I am working with the National Statistical Office.
We are conducting a national survey that asks men and women about various health issues.
We would very much appreciate your participation in this survey.
This information will help the government to plan health services.
The survey usually takes about 20 minutes to complete.
Whatever information you provide will be kept strictly confidential and will not be shared with anyone other than members of our survey team.

Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let me know and I will go on to the next question; or you can stop the interview at any time.
However, we hope that you will participate in this survey since your views are important.

At this time, do you want to ask me anything about the survey?
May I begin the interview now?

Signature of interviewer: ___________________ Date: _________

RESPONDENT AGREES TO BE INTERVIEWED 1 (GO TO 101)
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

101. RECORD THE TIME.

HOUR ___
MINUTES ___

102. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)?
IF LESS THAN ONE YEAR, RECORD '00' YEARS.

YEARS ____
ALWAYS 95 (GO TO 104)
VISITOR 96 (GO TO 104)

103. Just before you moved here, did you live in a city, in a town, or in a rural area?

CITY 1
TOWN 2
RURAL AREA 3

104. In the last 12 months, on how many separate occasions have you traveled away from your home community and slept away?
IF NUMBER OF TRIPS IS GREATER THAN 95, WRITE 95.

NUMBER OF TRIPS ___
NONE 00 (GO TO 106)

105. In the last 12 months, have you been away from your home community for more than one month at a time?

YES 1
NO 2

106. In what month and year were you born?

MONTH __
DON'T KNOW MONTH 98
YEAR __
DON'T KNOW YEAR 9998

107. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT.

AGE IN COMPLETED YEARS ____

108. Have you ever attended school?

YES 1
NO 2 (GO TO 112)

109. What is the highest level of school you attended: primary, secondary, or higher?

PRIMARY 1
SECONDARY 2
HIGHER 3

110. What is the highest (class/form/year) you completed at that level?

CLASS/FORM/YEAR _______

111. CHECK 109:

PRIMARY (GO TO 112)
SECONDARY OR HIGHER (GO TO 113A)

112. Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me?

CANNOT READ AT ALL 1
ABLE TO READ ONLY PARTS OF SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _______ 4
BLIND/VISUALLY IMPAIRED 5

113. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2

113A. CHECK 107:
AGE

AGE 15-24 (GO TO 113B)
AGE 25 OR OLDER (GO TO 114)

113B. Have you ever participated in a vocational training program such as carpentry, tinsmithing, tailoring, photoprocessing, or any other vocational training program?

YES 1
NO 2

114. CHECK 112:

CODE '2', '3' OR '4' CIRCLED (GO TO 115)
CODE '1' OR '5' CIRCLED (GO TO 116)
NOT ASKED (GO TO 115)

115. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

116. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

117. Do you watch television almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

118. What is your religion?

CATHOLIC 01
CCAP 02
ANGLICAN 03
SEVENTH DAY ADVENT./BAPTIST 04
OTHER CHRISTIAN 05
MUSLIM 06
NO RELIGION 07
OTHER (SPECIFY) _______________ 96

119. What is your tribe or ethnic group?

CHEWA 01
TUMBUKA 02
LOMWE 03
TONGA 04
YAO 05
SENA 06
NKHONDE 07
NGONI 08
OTHER (SPECIFY) ___________________ 96

SECTION 2A. REPRODUCTION

201. Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name. Have you ever fathered any children with any woman?

YES 1
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)

202. Do you have any sons or daughters that you have fathered who are now living with you?

YES 1
NO 2 (GO TO 204)

203. How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.

SONS AT HOME _______
DAUGHTERS AT HOME _________

204. Do you have any sons or daughters that you have fathered who are alive but do not live with you?

YES 1
NO 2 (GO TO 206)

205. 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'.

SONS ELSEWHERE ______
DAUGHTERS ELSEWHERE ______

206. Have you ever fathered 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 did not survive?

YES 1
NO 2 (GO TO 208)
DON'T KNOW 8 (GO TO 208)

207. How many boys have died? And how many girls have died?
IF NONE, RECORD '00'.

BOYS DEAD ____
GIRLS DEAD ____

208. SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.

TOTAL CHILDREN ___

209. CHECK 208:

HAS HAD MORE THAN ONE CHILD (GO TO 210)
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)

210. Did all of the children you have fathered have the same biological mother?

YES 1 (GO TO 212)
NO 2

211. In all, how many women have you fathered children with?

NUMBER OF WOMEN __

212. How old were you when your (first) child was born?

AGE IN YEARS __

SECTION 2B. PARTICIPATION IN HEALTH CARE

213. CHECK 203 AND 205:

AT LEAST ONE LIVING CHILD (GO TO 214)
NO LIVING CHILDREN (GO TO 301)

214. How many years old is your (youngest) child?

AGE IN YEARS __

215. CHECK 214:

(YOUNGEST) CHILD IS AGE 0-3 YEARS (GO TO 216)
OTHER (GO TO 301)

216. What is the name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD

NAME OF (YOUNGEST) CHILD___________________

217. When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?

YES 1
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)

218. Were you ever present during any of those antenatal check-ups?

PRESENT 1
NOT PRESENT 2

218A. At any time while (NAME)'s mother was pregnant with (NAME), did you yourself talk with a doctor or any other health care provider about the health of the mother or of the pregnancy?

YES 1
NO 2

218B. In your opinion, what are some serious health problems that can occur during labour and childbirth that could endanger the life of a pregnant woman or the baby?
PROBE: Any others?
RECORD ALL MENTIONED

SEVERE BLEEDING A
SEVERE HEADACHE B
HIGH FEVER C
LOSS OF CONSCIOUSNESS D
LABOUR LASTING MORE THAN 12 HOURS E
PLACENTA STILL NOT DELIVERED 30 MINUTES AFTER THE BABY F
OTHER (SPECIFY) _______________ X
NONE Y
DON'T KNOW Z

219. Was (NAME) born in a hospital or health facility?

HOSPITAL/HEALTH FACILITY 1 (GO TO 220A)
OTHER 2

220. What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?

COST TOO MUCH 01 (GO TO 220C)
FACILITY CLOSED 02 (GO TO 220C)
TOO FAR/NO TRANSPORTATION 03 (GO TO 220C)
DON'T TRUST FACILITY 04 (GO TO 220C)
POOR QUALITY SERVICE 05 (GO TO 220C)
NO FEMALE PROVIDER 06 (GO TO 220C)
NOT THE FIRST CHILD 07 (GO TO 220C)
CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 08 (GO TO 220C)
HE DID NOT THINK IT WAS NECESSARY 09 (GO TO 220C)
FAMILY DID NOT THINK IT WAS NECESSARY 10 (GO TO 220C)
OTHER (SPECIFY) ___________ 96 (GO TO 220C)
DON'T KNOW 98 (GO TO 220C)

220A. Were there any costs for the medical care received for the birth of (NAME), including fees for delivery care, supplies, medicines, transport or any other costs?

YES 1
NO 2 (GO TO 220C)
DON'T KNOW 8 (GO TO 220C)

220B. Who paid MOST of the costs for the medical care for the birth of (NAME)?

MEDICAL SCHEME 01
RESPONDENT 02
CHILD'S MOTHER 03
RESPONDENT'S FAMILY 04
CHILD'S MOTHER'S FAMILY 05
OTHER 96
DON'T KNOW 98

220C. Does (NAME) live with you in your household?

YES 1
NO 2 (GO TO 221)

220D. In your household who usually decides what to do if (NAME) is ill?
RECORD ALL PERSONS MENTIONED.

RESPONDENT A
CHILD'S MOTHER B
WIFE/PARTNER WHO IS NOT CHILD'S MOTHER C
FEMALE RELATIVE D
MALE RELATIVE E
OTHER X
CHILD HAS NEVER BEEN ILL Y (GO TO 221)

220E. Have you yourself ever taken (NAME) to a health facility for care?

YES 1
NO 2

221. When a child has diarrhea, how much should he or she be given to drink: more than usual, the same amount as usual, less than usual, or should he or she not be given anything to drink at all?

MORE THAN USUAL 1
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8

221A. Have you ever heard of a special product called THANZI or ORS that can be used to treat diarrhea?

YES 1
NO 2

SECTION 3. CONTRACEPTION

301. Now I would like to talk 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?
FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)?

CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF
EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD
IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR METHODS 02, 07, 08, 09 AND 10, ASK 302 IF 301 HAS CODE 1 CIRCLED.

01) FEMALE STERILIZATION: Women can have an operation to avoid having any more children.
YES 1
NO 2
02) MALE STERILIZATION: Men can have an operation to avoid having any more children.
YES 1
NO 2
03) PILL: Women can take a pill every day to avoid becoming pregnant.
YES 1
NO 2
04) IUD: Women can have a loop or coil placed inside them by a doctor or a nurse.
YES 1
NO 2
05) INJECTABLES: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.
YES 1
NO 2
06) IMPLANTS: Women can have two or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.
YES 1
NO 2
07) MALE CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM: Women can place a sheath in their vagina before sexual intercourse.
YES 1
NO 2
09) RHYTHM OR PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2
11) EMERGENCY CONTRACEPTION: As an emergency measure after unprotected sexual intercourse, women can take special pills at any time within five days to prevent pregnancy.
YES 1
NO 2 (GO TO NEXT METHOD)
12) Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO DIFFERENT METHODS.
SPECIFY____
YES 1
NO 2

302. Have you ever used (METHOD)?

02) MALE STERILIZATION: Men can have an operation to avoid having any more children: Have you ever had an operation to avoid having any more children?
YES 1
NO 2
07) MALE CONDOM: Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08) FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse: Have you and your wife/partner ever used a female condom.
YES 1
NO 2
09) RHYTHM OR PERIODIC ABSTINENCE: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
10) WITHDRAWAL: Men can be careful and pull out before climax.
YES 1
NO 2

303A. In the last few months have you heard about family planning:

On the radio?
YES 1
NO 2
On the television?
YES 1
NO 2
In a newspaper or magazine?
YES 1
NO 2
On a poster?
YES 1
NO 2
On clothing (i.e., cap, chitenji, t-shirt)?
YES 1
NO 2
In a drama?
YES 1
NO 2
Somewhere else?
YES 1
NO 2

303B. In the last few months, have you listened to any of the following program series about family planning or health on the radio?

Safe motherhood?
YES 1
NO 2
Phukusi la Moyo?
YES 1
NO 2
Radio Doctor/Doctor wapawairesi?
YES 1
NO 2
Umoyo M'Malawi?
YES 1
NO 2
Tikuferanji?
YES 1
NO 2
Chitukuku M'Malawi?
YES 1
NO 2
Uku ndiko kudya?
YES 1
NO 2
Other?
YES 1
NO 2

304. In the last few months, have you discussed the practice of family planning with a health worker or health professional?

YES 1
NO 2

305. Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant if she has sexual relations?

YES 1
NO 2 (GO TO 308)
DON'T KNOW 8 (GO TO 308)

306. Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?

JUST BEFORE HER PERIOD BEGINS 1
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ___________ 6
DON'T KNOW 8

308. I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.

a) Contraception is women's business and a man should not have to worry about it.
AGREE 1
DISAGREE 2
DON'T KNOW 8
b) Women who use contraception may become promiscuous.
AGREE 1
DISAGREE 2
DON'T KNOW 8

309. Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 312)

310. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HSA E
CBDA/DOOR TO DOOR F
OTHER PUBLIC G
CHAM/MISSION
HOSPITAL H
HEALTH CENTER I
MOBILE CLINIC J
DOOR TO DOOR K
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR L
PHARMACY M
MOBILE CLINIC N
CBDA/DOOR TO DOOR O
OTHER PRIVATE MEDICAL P
BLM Q
MACRO R
YOUTH DROP IN CENTRE S
OTHER SOURCE
SHOP T
CHURCH U
FRIEND/RELATIVE V
OTHER X

311. If you wanted to, could you yourself get a male condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

312. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 401)

313. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HSA E
CBDA/DOOR TO DOOR F
OTHER PUBLIC G
CHAM/MISSION
HOSPITAL H
HEALTH CENTER I
MOBILE CLINIC J
DOOR TO DOOR K
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR L
PHARMACY M
MOBILE CLINIC N
CBDA/DOOR TO DOOR O
OTHER PRIVATE MEDICAL P
BLM Q
MACRO R
YOUTH DROP IN CENTRE S
OTHER SOURCE
SHOP T
CHURCH U
FRIEND/RELATIVE V
OTHER X

314. If you wanted to, could you yourself get a female condom?

YES 1
NO 2
DON'T KNOW/UNSURE 8

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. Are you currently married or living together with a woman as if married?

YES, CURRENTLY MARRIED 1 (GO TO 404)
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3

402. Have you ever been married or lived together with a woman as if married?

YES, FORMERLY MARRIED 1
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)

403. What is your marital status now: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 410)
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)

404. Is your wife/partner living with you now or is she staying elsewhere?

LIVING WITH HIM 1
STAYING ELSEWHERE 2

405. Do you have more than one wife or woman you live with as if married?

YES 1
NO 2 (GO TO 407)

406. Altogether, how many wives do you have or other partners do you live with as if married?

TOTAL NUMBER OF WIVES AND LIVE-IN PARTNERS ___

407. CHECK 405:

ONE WIFE/PARTNER: Please tell me the name of your wife (the woman you are living with as if married).

MORE THAN ONE WIFE/PARTNER: Please tell me the name of each of your current wives (and/or of each woman you are living with as if married).

RECORD THE NAME AND THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'. ASK 408 FOR EACH PERSON.

NAME ________
LINE NUMBER _______

408. How old was (NAME) on her last birthday?

AGE ________

409. CHECK 407:

ONE WIFE/PARTNER (GO TO 410)
MORE THAN ONE WIFE/PARTNER (GO TO 411A)

410. Have you been married or lived with a woman only once or more than once?

ONLY ONCE 1
MORE THAN ONCE 2 (GO TO 411A)

411. In what month and year did you start living with your (wife/partner)?
411A. Now I would like to ask a question about your first wife/partner. In what month and year did you start living with your first wife/partner?

MONTH _____
DON'T KNOW MONTH 98
YEAR _____ (GO TO 413)
DON'T KNOW YEAR 9998

412. How old were you when you first started living with her?

AGE ___________

413. CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

414. Now I would like to ask you some questions about sexual activity in order to gain a better understanding of some important life issues. How old were you when you had sexual intercourse for the very first time?

NEVER HAD SEXUAL INTERCOURSE 00 (GO TO 501)
AGE IN YEARS ___
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95 (GO TO 417)

414A. The first time you had sexual intercourse, was it to participate in a cultural practice or ritual such as chinamwali or kuchosa fumbi?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

417. CHECK 107:

AGE 15-24 (GO TO 418)
AGE 25-54 (GO TO 419)

418. The first time you had sexual intercourse, was a condom used?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

419. Now I would like to ask you some questions about your recent sexual activity in the last 12 months. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.

420. When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.

DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __ (GO TO 434A)

421. When was the last time you had sexual intercourse with this person?
[FOR LAST THREE SEXUAL PARTNERS EXCEPT FOR THE LAST PARTNER]

DAYS 1 __
WEEKS 2 __
MONTHS 3 __

422. The last time you had sexual intercourse (with this second/third person), was a condom used?

YES 1
NO 2 (GO TO 424)

423. Was a condom used every time you had sexual intercourse with this person in the last 12 months?

YES 1
NO 2

424. What was your relationship to this (second/third) person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'. IF NO, CIRCLE '3'.

WIFE 1
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 425A)
CASUAL ACQUAINTANCE 4 (GO TO 425A)
PROSTITUTE 5 (GO TO 425A)
OTHER 6 (GO TO 425A)

424A. CHECK 410:

410 = '1' (GO TO 424B)
410 = '2' OR NOT ASKED (GO TO 425A)

424B. CHECK 414:

FIRST TIME WHEN STARTED LIVING WITH FIRST WIFE (GO TO 428)
OTHER (GO TO 425A)

425A. How long ago did you first have sexual intercourse with this (second/third) person?

DAYS 1 __
WEEKS 2 __
MONTHS 3 __
YEARS 4 __

425B. CHECK 424:

WIFE OR LIVE-IN PARTNER (GO TO 428)
OTHER (GO TO 425C)

425C. How many times during the last 12 months did you have sexual intercourse with this person: once, twice, or more?

ONCE 1
TWICE 2
MORE 3

428. Apart from [this person/these two people], have you had sexual intercourse with any other person in the last 12 months?
[FOR LAST AND SECOND-TO-LAST SEXUAL PARTNER]

YES 1 (GO BACK TO 421 IN NEXT COLUMN)
NO 2 (GO TO 430)

429. In total, with how many different people have you had sexual intercourse in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

NUMBER OF PARTNERS LAST 12 MONTHS ______
DON'T KNOW 98

430. CHECK 424 (ALL COLUMNS):

AT LEAST ONE PARTNER IS PROSTITUTE (GO TO 431)
NO PARTNERS ARE PROSTITUTES (GO TO 432)

431. CHECK 424 AND 422 (ALL COLUMNS):

CONDOM USED WITH EVERY PROSTITUTE (GO TO 434)
OTHER (GO TO 435)

432. In the last 12 months, did you pay anyone in exchange for having sexual intercourse?

YES 1
NO 2 (GO TO 434A)

433. The last time you paid someone in exchange for having sexual intercourse, was a condom used?

YES 1
NO 2 (GO TO 435)
DON'T KNOW 8

434. Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?

YES 1 (GO TO 435)
NO 2 (GO TO 435)
DON'T KNOW 8 (GO TO 435)

434A. Have you ever paid for sex?

YES 1
NO 2

435. In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS GREATER THAN 95, WRITE '95'

NUMBER OF PARTNERS IN LIFETIME ________
DON'T KNOW 98

435A. CHECK 414A:

IF ANSWER IS 'NO' OR 'DON'T KNOW' OR QUESTION NOT ASKED (GO TO 435B)
IF ANSWER IS 'YES' (GO TO 436)

435B. Have you ever had sexual intercourse as part of a cultural practice or ritual?

YES 1
NO 2
DON'T KNOW/DON'T REMEMBER 8

436. CHECK 422, MOST RECENT PARTNER (FIRST COLUMN):

CONDOM USED (GO TO 438)
NO CONDOM USED (GO TO 442)
NOT ASKED (GO TO 442)

438. Do you know the brand name of the condom used at that time?
IF BRAND IS LISTED, CIRCLE THE MATCHING CODE. IF BRAND IS NOT LISTED, RECORD NAME OF BRAND. IF RESPONDENT DOES NOT KNOW WHAT BRAND OF CONDOMS SHE IS USING, CIRCLE 'DON'T KNOW'.

CHISHANGO 01
MANYUCHI 02
CARE (FEMALE CONDOM) 03
OTHER BRAND (SPECIFY) _____________ ___
DON'T KNOW 98

441. From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST/OUTREACH 13
MOBILE CLINIC 14
HSA 15
CBDA/DOOR TO DOOR 16
OTHER PUBLIC 17
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
DOOR TO DOOR 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
PHARMACY 32
MOBILE CLINIC 33
CBDA/DOOR TO DOOR 34
OTHER PRIVATE MEDICAL 36
BLM 41
MACRO 51
YOUTH DROP IN CENTRE 61
OTHER SOURCE
SHOP 71
CHURCH 72
FRIEND/RELATIVE 73
OTHER 96

442. CHECK 302 (02): RESPONDENT EVER STERILIZED

NO (GO TO 443)
YES (GO TO 501)

443. The last time you had sex did you and your partner use any method (other than a male condom) to avoid or prevent a pregnancy?

YES 1
NO 2 (GO TO 501)
DON'T KNOW 8 (GO TO 501)

444. What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED.

FEMALE STERILIZATION A
PILL B
IUD C
INJECTABLES D
IMPLANTS E
FEMALE CONDOM F
PERIODIC ABSTINENCE J
WITHDRAWAL K
OTHER (SPECIFY) ________________ X

SECTION 5. FERTILITY PREFERENCES

501. CHECK 407:

ONE OR MORE WIVES/PARTNERS (GO TO 502)
QUESTION NOT ASKED (GO TO 508)

502. CHECK 302:

MAN NOT STERILIZED (GO TO 503)
MAN STERILIZED (GO TO 508)

503. (Is your wife (partner)/Are any of your wives (partners)) currently pregnant?

YES 1
NO 2
DON'T KNOW 8

504. CHECK 503:

NO WIFE/PARTNER PREGNANT OR DON'T KNOW: Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?

WIFE (WIVES)/PARTNER(S) PREGNANT: Now I have some questions about the future.
After the child(ren) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not to have any more children?

HAVE (A/ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 508)
COUPLE INFECUND 3 (GO TO 508)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 508)
UNDECIDED/DON'T KNOW 8 (GO TO 508)

505. CHECK 407:

ONE WIFE/PARTNER (GO TO 506)
MORE THAN ONE WIFE/PARTNER (GO TO 507)

506. CHECK 503:

WIFE/PARTNER NOT PREGNANT OR DON'T KNOW: How long would you like to wait from now before the birth of (a/another) child?

WIFE/PARTNER PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS 1 __ (GO TO 508)
YEARS 2 __ (GO TO 508)
SOON/NOW 993 (GO TO 508)
COUPLE INFECUND 994 (GO TO 508)
OTHER (SPECIFY) _________ 996 (GO TO 508)
DON'T KNOW 998 (GO TO 508)

507. How long would you like to wait from now before the birth of (a/another) child?

MONTHS 1 __
YEARS 2 __
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) __________________ 996
DON'T KNOW 998

508. CHECK 203 AND 205:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE FOR A NUMERIC RESPONSE.

NONE 00 (GO TO 601)
NUMBER __
OTHER (SPECIFY) ___________ 96 (GO TO 601)

509. How many of these children would you like to be boys, how many would you like to be girls and for how many would the sex not matter?

NUMBER OF BOYS____
OTHER (SPECIFY)____ 96
NUMBER OF GIRLS____
OTHER (SPECIFY)____ 96
NUMBER OF EITHER SEX____
OTHER (SPECIFY)____ 96

SECTION 6. EMPLOYMENT AND GENDER ROLES

601. Have you done any work in the last seven days?

YES 1 (GO TO 604)
NO 2

602. Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?

YES 1 (GO TO 604)
NO 2

603. Have you done any work in the last 12 months?

YES 1
NO 2 (GO TO 613)

604. What is your occupation, that is, what kind of work do you mainly do?

OCCUPATION________________ __

605. CHECK 604:

WORKS IN AGRICULTURE (GO TO 606)
DOES NOT WORK IN AGRICULTURE (GO TO 607)

606. Do you work mainly on your own land or on family land, or do you work on land that you rent from someone else, or do you work on someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4

607. Do you do this work for a member of your family, for someone else, or are you self-employed?

FOR FAMILY MEMBER 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

608. Do you usually work throughout the year, or do you work seasonally, or only once in a while?

THROUGHOUT THE YEAR 1
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3

609. Are you paid in cash or kind for this work or are you not paid at all?

CASH ONLY 1
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4

610. CHECK 407:

ONE OR MORE WIVES/PARTNERS (GO TO 611)
QUESTION NOT ASKED (GO TO 613)

611. CHECK 609:

CODE 1 OR 2 CIRCLED (GO TO 612)
OTHER (GO TO 613)

612. Who usually decides how the money you earn will be used: mainly you, mainly your (wife (wives)/partner(s)), or you and your (wife (wives)/partner(s)) jointly?

RESPONDENT 1
WIFE (WIVES)/PARTNER(S) 2
RESPONDENT AND WIFE (WIVES)/PARTNER(S) JOINTLY 3
OTHER (SPECIFY) ___________ 6

613. In a couple, who do you think should have the greater say in each of the following decisions: the husband, the wife or both equally:

a) making major household purchases?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
b) making purchases for daily household needs?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
c) deciding about visits to the wife's family or relatives?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
d) deciding what to do with the money she earns for her work?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8
e) deciding how many children to have?
HUSBAND 1
WIFE 2
BOTH EQUALLY 3
DON'T KNOW/DEPENDS 8

614. I will now read you some statements about pregnancy. Please tell me if you agree or disagree with them.

a) Childbearing is a woman's concern and there is no need for the father to get involved.
AGREE 1
DISAGREE 2
DON'T KNOW/DEPENDS 8
b) It is crucial for the mother's and child's health that a woman have assistance from a doctor or nurse at delivery.
AGREE 1
DISAGREE 2
DON'T KNOW/DEPENDS 8
c) Taking care of people who are sick is the women's role, and men do not need to be involved.
AGREE 1
DISAGREE 2
DON'T KNOW/DEPENDS 8

615. Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations:

If she goes out without telling him?
YES 1
NO 2
DON'T KNOW 8
If she neglects the children?
YES 1
NO 2
DON'T KNOW 8
If she argues with him?
YES 1
NO 2
DON'T KNOW 8
If she refuses to have sex with him?
YES 1
NO 2
DON'T KNOW 8
If the food is not properly cooked?
YES 1
NO 2
DON'T KNOW 8

616. Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to…

a) Get angry and reprimand her?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
b) Refuse to give her money or other means of support?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
c) Use force and have sex with her even if she doesn't want to?
YES 1
NO 2
DON'T KNOW/DEPENDS 8
d) Go ahead and have sex with another woman?
YES 1
NO 2
DON'T KNOW/DEPENDS 8

617. As far as you know, did your father ever beat your mother?

YES 1
NO 2
DON'T KNOW 8

SECTION 7. HIV/AIDS

701. Now I would like to talk about something else. Have you ever heard of an illness called AIDS?

YES 1
NO 2 (GO TO 733)

702. Can people reduce their chances of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?

YES 1
NO 2
DON'T KNOW 8

703. Can people get the AIDS virus from mosquito bites?

YES 1
NO 2
DON'T KNOW 8

704. Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?

YES 1
NO 2
DON'T KNOW 8

705. Can people get the AIDS virus by sharing food with a person who has AIDS?

YES 1
NO 2
DON'T KNOW 8

706. Can people reduce their chance of getting the AIDS virus by not having sexual intercourse at all?

YES 1
NO 2
DON'T KNOW 8

707. Can people get the AIDS virus because of witchcraft or other supernatural means?

YES 1
NO 2
DON'T KNOW 8

708. Is it possible for a healthy-looking person to have the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

709. Can the virus that causes AIDS be transmitted from a mother to her baby:

During pregnancy?
YES 1
NO 2
DON'T KNOW 8
During delivery?
YES 1
NO 2
DON'T KNOW 8
By breastfeeding?
YES 1
NO 2
DON'T KNOW 8

710. CHECK 709:

AT LEAST ONE 'YES' (GO TO 711)
OTHER (GO TO 712)

711. Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?

YES 1
NO 2
DON'T KNOW 8

712. Have you heard about special antiretroviral drugs (USE LOCAL NAME) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?

YES 1
NO 2
DON'T KNOW 8

720. Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?

YES 1
NO 2
DON'T KNOW 8

721. If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

722. If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

723. In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8

731. Should children age 12-14 be taught about using a condom to avoid getting AIDS?

YES 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

733. CHECK 701:

HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?

NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?

YES 1
NO 2

734. CHECK 414:

HAS HAD SEXUAL INTERCOURSE (GO TO 735)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 742)

735. CHECK 733:
HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?

YES (GO TO 736)
NO (GO TO 737)

736. Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DON'T KNOW 8

737. Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?

YES 1
NO 2
DON'T KNOW 8

738. Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DON'T KNOW 8

739. CHECK 736, 737, AND 738:

HAS HAD AN INFECTION (ANY 'YES') (GO TO 740)
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 742)

740. The last time you had (PROBLEM FROM 736/737/738), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 742)

741. Where did you go? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE
CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ____________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
HSA D
DOOR TO DOOR E
OTHER PUBLIC F
CHAM/MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
DOOR TO DOOR J

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
PRIVATE COMPANY HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL M
BLM N
MACRO O
OTHER X

742. Husband and wives do not always agree in everything. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in refusing to have sex with him?

YES 1
NO 2
DON'T KNOW 8

743. If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?

YES 1
NO 2
DON'T KNOW 8

744. Is a wife justified in refusing to have sex with her husband when she is tired or not in the mood?

YES 1
NO 2
DON'T KNOW 8

745. Is a wife justified in refusing to have sex with her husband when she knows her husband has sex with women other than his wife or wives?

YES 1
NO 2
DON'T KNOW 8

SECTION 8. OTHER HEALTH ISSUES

801. Have you ever heard of an illness called tuberculosis or TB?

YES 1
NO 2 (GO TO 805)

802. How does tuberculosis spread from one person to another?
PROBE: Any other ways?
CIRCLE ALL MENTIONED.

THROUGH THE AIR WHEN COUGHING OR SNEEZING A
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

802A. Has a doctor or other health care professional ever told you that you had tuberculosis?

YES 1
NO 2 (GO TO 803)
DON'T KNOW 8 (GO TO 803)

802B. How long ago did a doctor or other healthcare professional tell you that you had tuberculosis: in the past year, more than one year ago, but less than five years ago, or more than five years ago?

LESS THAN 1 YEAR AGO 1
1-5 YEARS AGO 2
MORE THAN 5 YEARS AGO 3
DON'T KNOW 8

803. Can tuberculosis be cured?

YES 1
NO 2
DON'T KNOW 8

804. If a member of your family got tuberculosis, would you want it to remain a secret or not?

YES, REMAIN A SECRET 1
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8

805. Some men are circumcised. Are you circumcised?

YES 1
NO 2 (GO TO 806)
DON'T KNOW 8 (GO TO 806)

805A. How old were you when circumcision occurred?

AGE IN YEARS ___
DURING CHILDHOOD (LESS THAN 5 YEARS OF AGE) 95
DON'T KNOW 98

805B. Who circumcised you?

TRADITIONAL PRACTITIONER/NGALIBA/ANANKUNGWI 1
FAMILY/FRIEND 2
HEALTH WORKER/HEALTH PROFESSIONAL 3
RELIGIOUS LEADER 4
OTHER 6
DON'T KNOW 8

805C. Where did you go to be circumcised?

HEALTH FACILITY 1
HOME OF A HEALTH WORKER/HEALTH PROFESSIONAL 2
OWN HOME 3
ANOTHER HOME 4
SIMBA 5
DON'T KNOW 8

806. Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 810)

807. Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS GREATER THAN 90, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.

NUMBER OF INJECTIONS ___
NONE 00 (GO TO 810)

810. Do you currently smoke cigarettes?

YES 1
NO 2 (GO TO 812)

811. In the last 24 hours, how many cigarettes did you smoke?

CIGARETTES _____

812. Do you currently smoke or use any other type of tobacco?

YES 1
NO 2 (GO TO 901)

813. What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.

PIPE A
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) ___________ X

SECTION 9. HIV TESTING AND AIDS TREATMENT

901. CHECK FOR PRESENCE OF OTHERS BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.

902. Have you ever been tested to see if you have the AIDS virus?

YES 1
NO 2 (GO TO 910)

903. When was the last time you were tested?

LESS THAN 12 MONTHS AGO 1
12 - 23 MONTHS AGO 2
2 OR MORE YEARS AGO 3

904. The last time you had the test, did you yourself ask for the test, was it offered to you and you accepted, or was it required?

ASKED FOR THE TEST 1
OFFERED AND ACCEPTED 2
REQUIRED 3

905. Where was the test done?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE_________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST/OUTREACH 13
HSA 14
DOOR TO DOOR 15
OTHER PUBLIC 16
CHAM/MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
DOOR TO DOOR 24
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
PRIVATE COMPANY HOSPITAL/CLINIC 32
OTHER PRIVATE MEDICAL 36
BLM 41
MACRO 51
OTHER 96

906. Did you get the results of the test?

YES 1
NO 2 (GO TO 913)

906A. CHECK FOR PRESENCE OF OTHERS:
DO NOT CONTINUE UNTIL EFFECTIVE PRIVACY IS ENSURED.

PRIVACY OBTAINED 1 (GO TO 907)
PRIVACY NOT POSSIBLE 2 (GO TO 912)

907. Let me remind you that all of your answers are confidential, and that the information you provide is very important for the survey. Could you please tell me what was the result of your last test for the AIDS virus?

POSITIVE 1
NEGATIVE 2 (GO TO 913)
UNDETERMINED 3 (GO TO 913)
REFUSED TO ANSWER 4 (GO TO 913)

908. Are you taking ARVs, that is, antiretroviral medicines, daily?

YES, TAKING ARVs DAILY 1 (GO TO 913)
YES, TAKING MEDICINE DAILY, NOT SURE WHAT KIND 2
NO 3

909. Have you ever taken ARV medicines daily?

YES 1
NO 2
DON'T KNOW 8

910. Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 913)

911. Where is that? Anywhere else?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE
CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)____________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
HSA D
DOOR TO DOOR E
OTHER PUBLIC F
CHAM/MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
DOOR TO DOOR J

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
PRIVATE COMPANY HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL M
BLM N
MACRO O
OTHER X

912. INTERVIEWER'S COMMENTS/EXPLANATION FOR NOT FINISHING THE HIV TESTING AND AIDS TREATMENT MODULE:__________________________________

913. RECORD THE TIME.

HOURS __
MINUTES __

INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:____________________________________________

COMMENTS ON SPECIFIC QUESTIONS:____________________________________

ANY OTHER COMMENTS:____________________________________________

SUPERVISOR'S OBSERVATIONS:____________________________________________

NAME OF SUPERVISOR: ____________________
DATE: _____________________

EDITOR'S OBSERVATIONS:_____________________________________________

NAME OF EDITOR: ______________________
DATE: _______________________