Namulaba Community AIDS Project questionnaire 12 Dec 07

Introduction:
My name is .I am a social worker working for the Namulaba
Community AIDS Project. We are here to ask you a few questions to help us understand
the peoples knowledge and understanding about HIV/AIDS. This information will help
us to plan for the project which is based at the Namulaba health centre which was built
near Namulaba Church. These questions will take just a few minutes. All the information
will be confidential and will not bear your name. I will start by asking you about yourself
and then I will ask you about what you know about AIDS.

100 Time started interview ..

101 Questionnaire Number
102 Date of Interview ../../
103 Name of Township
104 Name of Parish (Muluka) 1. Nakibano 2. Namataba 3. Nagojje
4. Waggala 5. Kyajja 6. Namagunga
7. Other (specify)..
105 Sex of respondent 1. Male 2. Female
106 Age in completed years ____
107 Date when born .//
108 Highest level of education 1. None 2. Primary 3. O Level 4. A Level 5. University 6.
Other (specify)
109 Employment status 1. Student 2. Employed with a salary
3. Self-employed 4. Unemployed
5. Other (specify)
110 Marital Status 1. Single 2. Married 3.Divorced/separated
4. Widowed 5. Other (specify)
201 In the past six months did you 1. Yes 2. No
Receive any HIV/AIDS
information/counseling/service
from anyone?
202 If yes what type of 1. HIV Leaflet 2. HIV Seminar 3. HIV Music Dance and
information/counseling/service Drama 4. HIV testing 5. HIV counseling 6.HIV
did you Receive? (multiple discussion 7.Other (specify)
responses possible)

203 From whom did you Receive this
information/counseling/service?
(multiple responses possible)
204 In the past six months did you
Give any HIV/AIDS
information/counseling/service to
anyone?
205 If yes what type of
information/counseling/service
1. Health Worker 2. Clinic based Counselor 3.
Community based Counselor 4. Peer 5. Relative 6. School
Teacher 7.Religious worker 8. Social worker 9.Music
Dance and Drama Performers 10.Other (specify)
1. Yes 2. No
1. HIV Leaflet 2. HIV Seminar 3. HIV Music Dance and
Drama 4. Home-based care 5. HIV counseling 6. Escorted

Namulaba Community AIDS Project questionnaire 12 Dec 07 1

 did you Give? (multiple responses someone to clinic. 7. HIV discussion 8.Other (specify)
possible)

206 Whom did you Give this 1. Peers 2. Relative 3. Community Members 4.Other
information/counseling/service? (specify)
(multiple responses possible)

301 Can the virus that causes AIDS be 1. Yes 2. No 3 Dont Know
transmitted from the mother to the
child?
302 Is there any thing a person can do 1. Yes 2. No 3 Dont Know
to avoid getting AIDS or a virus
that causes AIDS?
303 What can a person do to avoid 1. Abstain from sex 2. Use condoms 3.Be faithful 4.Limit
getting AIDS or a virus that causes number of partners 5. Avoid sex for money 6. Avoid blood
AIDS? (multiple responses transfusion 7. Avoid unsafe injections 8.Avoid sex with
possible) infected person 9.Go for HIV testing 10. Other (Specify)
.
401 If a family member got sick with 1. Yes 2. No 3 Not Sure
the virus which causes AIDS,
would you be willing to care for
her/him in your own household?
501 People may have mixed reasons
for not having sex. I will read out
some reasons, please tell me for
each reason whether it applies to
you or not.
501a I don't feel ready to have sex 1. Applies 2. Doesnt Apply 3. Not Sure
501b I have not had the opportunity 1. Applies 2. Doesnt Apply 3. Not Sure
501c I think that sex before marriage is 1. Applies 2. Doesnt Apply 3. Not Sure
wrong
501d I think that sex outside of 1. Applies 2. Doesnt Apply 3. Not Sure
marriage is wrong
501e I am afraid of getting pregnant or 1. Applies 2. Doesnt Apply 3. Not Sure
making someone pregnant
501f I am afraid of getting HIV/AIDS 1. Applies 2. Doesnt Apply 3. Not Sure
or another sexually transmitted
infection
502 When did you last have sex? 1. Never had sex 2. Today 3. Yesterday 4.Last week 5.
Last month 6. More than three months ago 7. More than
six months ago 8. More than one year ago
503 Who did you have sex with? 1. Spouse 2. Boyfriend/Girlfriend 3.One night stand 4.
Other (specify)..
504 Where you ever concerned that 1. Very concerned 2. Somewhat concerned 3. Not
you might catch AIDS or another concerned
sexually transmitted disease? If

Namulaba Community AIDS Project questionnaire 12 Dec 07 2

 Yes very or somewhat?
505 Were you able to do anything to
reduce the risk of infection?
506. What did you do to reduce the
risk?
507. What did you do afterwards as a
result of your concern?
508. How many sexual partners have
you had in the past six months?
509. During the last twelve months,
have you had a sexually
transmitted disease?
510. If yes which signs and symptoms
of STD did you have?
511. The last time you had an STD, did
you seek help from any of the
following places?
601 Do you know a place where you
could go and get an AIDS test?
602 How much does it cost for
transport one way to go there?
603 Do you know a place where a
person from this village could go
and get ARVs?
604 How much does it cost for
transport one way to go there?
605 Do you know a place where a
person from this village could go
and get PMTCT services?
606. How much does it cost for
transport one way to go there?
605 Do you know a place where a
person from this village could go
and get condoms?
606. How much does it cost for
transport one way to go there?
1000 Do you have any comments:?
1001 Time ended interview
Namulaba Community AIDS Project questionnaire 12 Dec 07
1. Yes 2. No
1. Used condoms 2. Nothing 3. Talked to him/her about
AIDS issues 4. Other (specify)
1. Used condoms 2. Avoided sex 3.Avoided thinking
about it 4.Went for an HIV test 5. Decided to be faithful
6.Talked to him/her about AIDS issues 7. Other (specify)
1. None 2. One 3. Two 4. Three to five 5. More than five.
1. Yes 2. No
1. Discharge from the genitals 2.Swelling on the genitals
3.Itching in the genitals 4. Pain during urination
5.Ulcer/wound on the genitals 6.Lower abdominal pain 7.
Other (specify).
1. Nowhere 2. Clinic or Hospital 3.Traditional healer 4.
Seek advice or buy medicine from a drug shop 5.Friends
or relatives 6. Do self medication
1. Yes 2.No
1. Shs 1000 2. Shs 2000 3. Shs 3000 to 5000 4. More than
Shs 5000 5.Walking distance
1. Yes 2.No
1. Shs 1000 2. Shs 2000 3. Shs 3000 to 5000 4. More than
Shs 5000 5.Walking distance
1. Yes 2.No
1. Shs 1000 2. Shs 2000 3. Shs 3000 to 5000 4. More than
Shs 5000 5.Walking distance
1. Yes 2.No
1. Shs 1000 2. Shs 2000 3. Shs 3000 to 5000 4. More than
Shs 5000 5.Walking distance
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