Module 20: HIV/AIDS Risk Behaviors Form

A Module Used in The Measurement Group's Cross-Cutting Evaluation of the HRSA HIV/AIDS Bureau's Special Projects of National Significance on Innovative Models of HIV/AIDS Care

Purpose

• Code major issues of HIV risk and retransmission risk due to sexual contact.
• Code major issues of HIV risk and retransmission risk due to injection drug use.
• Code major issues of HIV risk and retransmission risk due to other means.

Content Domain - Number of sexual partners, sex acts with and without latex protection, injection drug use, hemophilia and other blood transfers, tendency to have sex while intoxicated or high, sex trade, sexual history of sex partners.

Operational Data Items - ID Letters/ID Numbers, Site, Sub-Provider, Date, Gender, Risk Behaviors Assessed for Last 24 Hours, Last 30 Days, Prior to Last 30 Days, Never, Refused, Don't Know: Sex with Males, Unprotected Sex with Males, Sex with Females, Unprotected Sex with Females, Sex with IDU, Sex Work/Survival Sex, Sex with HIV+ Person, STD, Injection Drug Use, Needle Sharing, Received Blood Transfusion, Cigarette Smoker, Inferred Alcohol Problem, Heroin Use, Crack Use, Other Illicit Drug Use, CJS-Involved, Has Hemophilia/ Coagulation Disorder.

Citation - Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 20: HIV/AIDS Risk Behavior Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Usage - Permission is granted for non-commercial use so long as form is not altered, the copyright is not removed, and a proper citation is made to the instrument. Non-commercial use is use by a not-for-profit organization in which the instrument is not sold. If you have questions about appropriate and proper uses, contact The Measurement Group.