This question is SPECIFICALLY ABOUT Now thinking about your mental health, which INJECTED DRUGS. During the past 30 days, on includes stress, depression, and problems with how many days have you injected any drugs? emotions, for how many days during the past 30 (Count only injections without a days was your mental health NOT good? doctor’s orders—ones you used to feel good or to get high.) enter Responses: IF “none,” enter 0. Otherwise, number of days in past 30 days. 0 days 12 days 24 days    0 days 12 days 24 days 1 day 13 days 25 days       2 days 14 days 26 days 1 day 13 days 25 days       3 days 15 days 27 days 2 days 14 days 26 days       4 days 16 days 28 days 3 days 15 days 27 days       5 days 17 days 29 days 4 days 16 days 28 days       6 days 18 days 30 days 5 days 17 days 29 days       7 days 19 days know 6 days 18 days 30 days    Don’t    8 days 20 days or say 7 days 19 days know   can’t    Don’t 9 days 21 days 8 days 20 days or say     can’t 10 days 22 days 9 days 21 days     11 days 23 days 10 days 22 days     11 days 23 days   Have you ever felt you should cut down on your Sexual Behavior drinking? Yes  No  Now like to ask you about your experience with we’d Have people annoyed you by criticizing your sex. If you cannot remember what we mean by sex, drinking? please refer to the definitions on page 7. Remember, Yes your answers will be kept private.  No  Have you ever had sex (vaginal, oral, or anal)? Have you ever felt bad or guilty about your drinking? Yes  Yes  No  No  Have you had sex (vaginal, oral, or anal) in the Have you ever had a drink first thing in the past 30 days? morning to steady your nerves or to get rid of a hangover? Yes  Yes  No  No  The last time you had sex (vaginal, oral, During the past 30 days, has your use of or anal), was it protected or unprotected? alcohol or drugs caused you to have emotional problems? I have never had sex  Protected  I have not used alcohol or drugs in the past  Unprotected  30 days Not at all  Have you ever had sex with a man? Somewhat  Considerably  Yes  Extremely  No  Have you ever had sex with a woman? Yes  No 
This question is SPECIFICALLY ABOUT INJECTED DRUGS. During the past 30 days, on how many days have you injected any drugs? (Count only injections without a doctor’s orders—ones you used to feel good or to get high.)  0 days  12 days  24 days  1 day  13 days  25 days  2 days  14 days  26 days  3 days  15 days  27 days  4 days  16 days  28 days  5 days  17 days  29 days  6 days  18 days  30 days  7 days  19 days  Don’t know  8 days  20 days or can’t say  9 days  21 days  10 days  22 days  11 days  23 days Have you ever felt you should cut down on your drinking?  Yes  No Have people annoyed you by criticizing your drinking?  Yes  No Have you ever felt bad or guilty about your drinking?  Yes  No Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?  Yes  No During the past 30 days, has your use of alcohol or drugs caused you to have emotional problems?  I have not used alcohol or drugs in the past 30 days  Not at all  Somewhat  Considerably  Extremely Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health NOT good? Responses: IF “none,” enter 0. Otherwise, enter number of days in past 30 days.  0 days  12 days  24 days  1 day  13 days  25 days  2 days  14 days  26 days  3 days  15 days  27 days  4 days  16 days  28 days  5 days  17 days  29 days  6 days  18 days  30 days  7 days  19 days  Don’t know  8 days  20 days or can’t say  9 days  21 days  10 days  22 days  11 days  23 days Sexual Behavior Now we’d like to ask you about your experience with sex. If you cannot remember what we mean by sex, please refer to the definitions on page 7. Remember, your answers will be kept private. Have you ever had sex (vaginal, oral, or anal)?  Yes  No Have you had sex (vaginal, oral, or anal) in the past 30 days?  Yes  No The last time you had sex (vaginal, oral, or anal), was it protected or unprotected?  I have never had sex  Protected  Unprotected Have you ever had sex with a man?  Yes  No Have you ever had sex with a woman?  Yes  No
HIV%20Adult%20Questionnaire_Revised2016.docx