January 2006

Developing Message Concepts for HIV-Positive Persons

Phase III Final Report

Prepared for

Carolyn Guenther-Grey, M.A.

Prevention Research Branch

Division of HIV/AIDS Prevention

National Center for HIV, STD, and TB Prevention

Centers for Disease Control and Prevention

8 Corporate Square Blvd., NE

Mail Stop E37

Atlanta, GA 30329-2013

Prepared by

Jennifer D. Uhrig, Ph.D.

Kristine Fahrney, M.Sc.

May Kuo, Ph.D.

Carla Bann, Ph.D.

Afua Appiah-Yeboah, M.P.H.

Peyton Williams, B.A.

Meredith Jarblum, M.P.H.

Laxminarayana Ganapathi, Ph.D.

**Jean Richardson, B.S.**

RTI International

Research Triangle Park, NC 27709

and

**Jeff Henne, M.A.**

**Barbara Burbridge, B.L.S.**

The Henne Group

San Francisco, CA 94103

RTI Project Number 08235.008

RTI Project Number

08235.008

Developing Message Concepts for HIV-Positive Persons

Phase III Final Report

January 2006

Prepared for

Carolyn Guenther-Grey, M.A.

Prevention Research Branch

Division of HIV/AIDS Prevention

National Center for HIV, STD, and TB Prevention

Centers for Disease Control and Prevention

8 Corporate Square Blvd., NE

Mail Stop E37

Atlanta, GA 30329-2013

Prepared by

Jennifer D. Uhrig, Ph.D.

Kristine Fahrney, M.Sc.

May Kuo, Ph.D.

Carla Bann, Ph.D.

Afua Appiah-Yeboah, M.P.H.

Peyton Williams, B.A.

Meredith Jarblum, M.P.H.

Laxminarayana Ganapathi, Ph.D.

**Jean Richardson, B.S.**

RTI International\*

Research Triangle Park, NC 27709

and

**Jeff Henne, M.A.**

**Barbara Burbridge, B.L.S.**

The Henne Group

San Francisco, CA 94103

\*RTI International is a trade name of Research Triangle Institute.

Contents

Section Page

1 Introduction 1-[1](#section-1-introduction)

2 Message Concept Development and Screening
2-[1](#section-2-message-concept-development-and-screening)

2.1 Phase I: Message Concept Development
2-[1](#phase-i-message-concept-development)

2.2 Phase II: Message Concept Screening
2-[2](#phase-ii-message-concept-screening)

3 Message Concept Testing 3-[1](#section-3-message-concept-testing)

3.1 Research Design 3-[1](#research-design)

3.2 Data Collection Preparation 3-[1](#data-collection-preparation)

Questionnaire Development 3-[1](#questionnaire-development)

Programming the Instruments 3-[2](#programming-the-instruments)

Randomization Procedure 3-[3](#randomization-procedure)

Hiring/Training of Field Staff 3-[5](#hiringtraining-of-field-staff)

3.3 Recruitment 3-[6](#recruitment)

Recruitment Process 3-[8](#recruitment-process)

Recruitment Results 3-[8](#recruitment-results)

3.4 Data Collection Procedures 3-[15](#data-collection-procedures)

Participant Check-in and Consent Procedures
3-[15](#participant-check-in-and-consent-procedures)

Technical Support to Participants
3-[16](#technical-support-to-participants)

Participant Incentives 3-[17](#participant-incentives)

Quality Control 3-[17](#quality-control)

Recruitment and Data Collection Reporting
3-[18](#recruitment-and-data-collection-reporting)

3.5 Data Cleaning, File Construction, Measures and Analytic Methods
3-[18](#data-cleaning-file-construction-measures-and-analytic-methods)

Data Cleaning and File Construction
3-[18](#data-cleaning-and-file-construction)

Measures 3-[19](#measures)

Analytic Methods 3-[20](#analytic-methods)

3.6 Results 3-[21](#results)

Participant Characteristics 3-[21](#participant-characteristics)

Descriptive Results 3-[28](#descriptive-results)

Multivariate Results 3-[35](#multivariate-results)

4 Conclusions and Recommendations
4-[1](#section-4-conclusions-and-recommendations)

Conclusions 4-[1](#conclusions)

Recommendations 4-[2](#recommendations)

5 Lessons Learned 5-[1](#section-5-lessons-learned)

5.1 Lessons Learned from Recruiting
5-[1](#lessons-learned-from-recruiting)

5.2 Lessons Learned from Data Collection
5-[2](#lessons-learned-from-data-collection)

References R-[1](#references)

Appendix

A: Final Survey Instrument A-1

List of Tables

Number Page

2-1 Final Message Concepts for Phase III Testing
2-[4](#__RefHeading___Toc125871026)

3-1 Message Frequency 3-[4](#__RefHeading___Toc125871027)

3-2 Frequency of Each Message Appearing as the First Message
3-[4](#__RefHeading___Toc125871028)

3-3 HIV Prevention Messages, Phase III: Agenda for Field Staff Telephone
Training 3-[6](#__RefHeading___Toc125871029)

3-4 HIV Prevention Messages, Phase III: Agenda for Field Staff In-Person
Training 3-[7](#__RefHeading___Toc125871030)

3-5 Participant Characteristics (percent)
3-[22](#__RefHeading___Toc125871031)

3-6 Participant Characteristics: Sex Partners, Sex Behaviors, and Trust
in Information Sources (means) 3-[27](#__RefHeading___Toc125871032)

3-7 Percentage of Participants Who Selected Each Word to Describe the
Message 3-[29](#__RefHeading___Toc125871033)

3-8 Commonly Used Positive and Negative Adjectives to Describe Each
Message 3-[32](#__RefHeading___Toc125871034)

3-9 Mean Positive Adjective Scale Scores by Message by Segment
3-[33](#__RefHeading___Toc125871035)

3-10 Mean Negative Adjective Scale Scores by Message by Segment
3-[34](#__RefHeading___Toc125871036)

3-11 Percentage of Participants Who Selected Each Response by Evaluative
Statement by Message 3-[36](#__RefHeading___Toc125871037)

3-12 Mean Message Perceptions Scale Scores by Message by Segment
3-[40](#__RefHeading___Toc125871038)

3-13 Regression Model Predicting Perceptions of Message 6 (Abstinence)
3-[41](#__RefHeading___Toc125871039)

3-14 Regression Model Predicting Perceptions of Message 11 (Monogamy)
3-[42](#__RefHeading___Toc125871040)

3-15 Regression Model Predicting Perceptions of Message 8 (Condoms)
3-[43](#__RefHeading___Toc125871041)

3-16 Regression Model Predicting Perceptions of Message 3 (Disclosure to
Partners) 3-[44](#__RefHeading___Toc125871042)

# Section 1 Introduction

The purpose of this study was to identify and develop human
immunodeficiency virus (HIV) prevention strategies and arguments that
will be effective in encouraging prevention behaviors among HIV-positive
persons. Formative research was conducted in three phases, and the
findings from each phase were used to develop the next phase of the
study. In Phase I, *Concept Generation*, idea-generation techniques were
used in group settings to generate a comprehensive list of prevention
*strategies* and persuasive *arguments* for these strategies that could
be recommended for HIV-positive persons. The idea-generation groups were
conducted with HIV-positive persons (men who have sex with men \[MSM\]
and heterosexual men and women) and HIV prevention experts. In Phase II,
*Concept Screening*, focus groups (FGs) and semistructured interviews
with HIV-positive individuals were conducted to obtain a preliminary
(mostly qualitative) indication of acceptance of the strategies and
arguments identified in Phase I and identify a subset of the most
promising strategies and arguments for more thorough testing in Phase
III. In Phase III, *Concept Testing*, interviews were conducted with 647
HIV-positive persons to quantitatively evaluate the acceptance of the
"message concepts" (particular prevention strategies and associated
arguments) from Phase II and to distinguish the characteristics of
HIV-positive persons who demonstrate a preference for particular message
concepts. Because the findings from each phase contributed to the
selection of messages for the next phase, this report on Phase III
findings serves as the culmination of this study's results.

HIV-positive persons have often been neglected in HIV prevention efforts
(DiClemente, 2002; Janssen et al., 2001); yet in 2003, there was an
estimated 1.1 million HIV-positive persons living in the United States
(Kaiser Family Foundation, 2005c). While this estimate partially
reflects the growing number of HIV/acquired immunodeficiency syndrome
(AIDS) patients who are living longer because of antiretroviral
treatment, it also reflects an increasing incidence in HIV. According to
the Centers for Disease Control and Prevention (CDC), HIV infection
among heterosexuals and MSM is rising unabatedly, and an estimated 25%
of HIV-positive individuals are unaware of their HIV status and
presumably transmitting the virus to sexual partners (CDC, 2003). More
disconcertingly, studies have found that knowledge of HIV-positive
status does not preclude risky sexual behaviors among HIV-positive
persons (Wilson et al., 2004; Kalichman et al., 2001) and that many
HIV-positive persons do not disclose their HIV status to their sexual
partners (Ciccarone et al., 2003; Gorbach et al., 2004).

In response to mounting research evidence that more should be done to
address the needs of HIV-positive persons and their crucial role in
HIV-prevention efforts, CDC launched the initiative *Advancing HIV
Prevention: New Strategies for a Changing Epidemic* (CDC, 2003). Among
the initiative's goals is to work with HIV-positive persons to reduce
behaviors that increase risk of HIV transmission to their sexual
partners. CDC, through the technical assistance of RTI International
(RTI), sought to identify effective prevention message concepts that
appeal to HIV-positive persons. CDC and RTI collaboratively designed the
message concepts and through a systematic, formative research design,
RTI elicited ideas and opinions about the messages through FGs,
semistructured interviews, and an audio computer-assisted self-interview
(ACASI) survey of HIV-positive persons. Ultimately, CDC and its
prevention partners may select the message concepts with the most
audience appeal to design future HIV-prevention messages, program
activities, and mass-communication campaigns.

In addition to identifying appealing message concepts, this study also
aims to bridge the gaps in research knowledge about effective prevention
messages for HIV-positive individuals. Although a couple of studies
indicate that HIV-positive persons can adopt safer sexual behaviors
after they learn they are HIV positive through prevention programs and
interventions (CDC, 2000; Rotheram-Borus et al., 2001), more current
research on the acceptability and the motivational value of the
prevention strategies and arguments is needed. Specifically, there is
little information about the acceptability of various prevention
strategies (e.g., abstinence, mutual monogamy with an HIV-positive
partner, consistent condom use) for HIV-positive persons. There is even
less information about whether some arguments or motivations are more
persuasive than others for HIV-positive persons and whether their
perceived persuasiveness varies by population (MSM, heterosexual males,
and heterosexual females).

There is an established body of knowledge about factors that fuel the
HIV epidemic in certain populations, however. For instance, a recent
study shows that almost one in three MSM who tested positive in 2004
said that they had used crystal methamphetamine, which is nearly triple
the rate of "meth" use among MSM who tested as HIV positive in 2001
(Kaiser Family Foundation, 2005a). Another study revealed that the "down
low" phenomenon, in which men are covertly involved in homosexual
relationships and maintain a heterosexual identity with their female
sexual partners, occurs among Hispanic and white men as well as
African-American men. CDC revealed that 76% of new HIV cases among women
that were reported between 1999 and 2003 occurred among women in the
U.S. South, even though only 29% of U.S. women live in the region (based
on 32 states). Moreover, girls aged 13 to 19 in the South are
increasingly affected by HIV; 8% of new HIV diagnoses in the South occur
in that age group, which is four times the rate found in other U.S.
regions. In another study, North Carolina African-American women were 18
times as likely to be diagnosed with HIV in 2003 as white women, and
Hispanic women were four times as likely to test positive as white women
(Kaiser Family Foundation, 2005b). CDC and RTI explored similar
literature and other resources to inform the development of each message
concept and the rationale for selecting the audience for which each
message would be best suited.

# Section 2 Message Concept Development and Screening

## 2.1 Phase I: Message Concept Development

In Phase I of this research, RTI identified prevention strategies and
arguments through qualitative idea-generation groups (IGGs), a FG
variant that stresses the capture of spontaneous group ideas. RTI
conducted IGGs with HIV-prevention experts and HIV-positive individuals
to produce a comprehensive list of prevention strategies that could be
promoted for HIV-positive persons (e.g., abstinence, mutual monogamy
with an HIV-positive partner, condom use) and persuasive arguments for
these strategies (e.g., to protect yourself from sexually transmitted
diseases \[STDs\], to show your partner you care).

In the IGGs, a facilitator guided participants in two activities: the
generation of ideas to prevent the transmission of HIV and the
development of arguments to support the ideas. The first activity
involved the group free-listing behavioral strategies for prevention.
After a cursory ranking of the ideas generated to prevent the
transmission of HIV, the group then reviewed each behavior listed and
provided arguments to support adopting each behavior. A total of 67
people participated in eight IGGs conducted in three U.S. cities: 24
participants were HIV-prevention experts (three IGGs), 19 participants
were HIV-positive MSM (two IGGs), 8 participants were bisexual men (one
IGG), 8 participants were heterosexual females (one IGG), and 8
participants were heterosexual males (one IGG).

The research team analyzed the data from the IGGs, first by looking at
the range of strategies and arguments produced in each group and then by
identifying key topics across groups. To better organize the various
prevention strategies offered by each group, RTI applied a visual
organization scheme to the list of identified behaviors. As a starting
point for this scheme, RTI sorted the behaviors provided by two of the
groups into domains such as risk context, personal influences, and
social influences. From the domains identified from those two groups,
RTI developed a visual organization scheme to use with all of the
groups. This scheme helped to enumerate the types of behaviors that each
group focused on when presenting prevention strategies. We also created
a chart to show the suggested prevention behaviors and their associated
arguments or benefits for each group.

Based on the overall responses from the groups, RTI summarized common
prevention strategy themes as well as the more unique prevention
strategies identified by participants. Cross-cutting themes or concepts
were derived from comparing the summary information for each group. In
reporting the findings, we emphasized group nuances and differences in
suggested strategies rather than commonalities across groups.

As a product of the IGG process, we created a table with the various
prevention strategies developed by the groups and their supporting
arguments, organized by a set of concept categories (e.g.,
treatment/medications, disclosure, abstain, condoms, sexual practices,
partners drugs/other triggers, STDs, and HIV). CDC reviewed the revised
message concepts, and CDC and RTI collaboratively finalized the message
concepts for screening for Phase II.

## 2.2 Phase II: Message Concept Screening

In Phase II of *Developing Message Concepts for HIV-Positive Persons*,
69 potential HIV-prevention message concepts developed from the
prevention strategies and persuasive arguments identified in Phase I of
the study were screened for acceptability, attractiveness, feasibility,
and other evaluative responses through a combination of FGs and
semistructured interviews. The goal of Phase II was to obtain a
preliminary, qualitative indication of acceptance of the particular
prevention strategies and associated arguments to identify a subset of
the most promising message concepts to evaluate quantitatively in Phase
III of the research.

To evaluate acceptability, we conducted a total of nine FGs and 27
open-ended, semistructured interviews in Chicago, IL; Los Angeles, CA;
and Washington, DC. Participants included 52 HIV-positive MSM, 25
HIV-positive heterosexual males, and 23 HIV-positive heterosexual
females for a total of 100 participants.

In the FGs and semistructured interviews, we began by asking
participants about any recent exposure to HIV-prevention messages. The
moderator/interviewer then directed discussion towards evaluating the
message concepts, following a series of five questions for each message
concept outlined in the FG and semistructured interview guides.

After each message concept was reviewed, the moderator/interviewer asked
the participants to individually sort the message concepts that they had
reviewed into three categories: "red flag" (message concepts that the
participant thought were problematic), "green check" (message concepts
that the participant liked or thought would be effective), and "okay"
(message concepts that the participant had no strong feeling about).
After the sorting task was completed, participants discussed how they
sorted their cards, commenting on some of the cards that they had sorted
as either red flags or green checks. Participants were asked to leave
the cards sorted into the piles on the table when the FG or
semistructured interview was finished so that RTI could tally the number
of red flags, green checks, and okays for each participant.

Phase II analysis focused primarily on the emotive responses to each
message concept. Specifically, we considered the valence (positive
attitudes/negative attitudes) of opinions held by groups or individuals
about particular message concepts, what factors inform and shape the
views of the concepts, and the efficacy that participants ascribed to
each concept.

From both qualitative comments and informal quantitative analysis
(sorting task results), we made an initial recommendation as to the
acceptability of each message concept and whether it should be
considered for further testing in Phase III. Our goal was to reduce the
69 message concepts that were screened in Phase II to the approximately
20 most-promising message concepts for testing in Phase III. Working
collaboratively with CDC, we discussed recommendations for each message
concept and reduced the total number of message concepts to be tested in
Phase III to 19 (see Table 2-1).

Of the 19 message concepts, one message concept will be tested with men
only and another will be tested with women only. Of the 19 final message
concepts, each Phase III participant will review a total of 12 message
concepts---one of the two gender-specific message concepts and 11
message concepts randomly selected from the remaining pool of 17 final
message concepts.

[]{#__RefHeading___Toc125871026 .anchor}Table 2-1. Final Message
Concepts for Phase III Testing

+--------------------+-------------------------------------------------+
| **Message Concept  | **Messages for Phase III Concept Testing**      |
| Category**         |                                                 |
+--------------------+-------------------------------------------------+
| Tre                | Message 1:                                      |
| atment/Medications |                                                 |
|                    | Don't delay your HIV treatment...               |
|                    |                                                 |
|                    | You owe it to yourself! Start treatment as soon |
|                    | as your doctor tells you so that you have a     |
|                    | longer, healthier life.                         |
|                    |                                                 |
|                    | Take your meds and love yourself!               |
+--------------------+-------------------------------------------------+
| Disclosure to      | Message 2:                                      |
| Partners           |                                                 |
|                    | Don't delay!                                    |
|                    |                                                 |
|                    | Tell your partner that you have HIV early on in |
|                    | the relationship. A partner who knows and       |
|                    | accepts you is much more likely to be there for |
|                    | you and give you the support you need.          |
|                    |                                                 |
|                    | And that's the kind of partner you want to be   |
|                    | with for the long haul.                         |
+--------------------+-------------------------------------------------+
|                    | Message 3:                                      |
|                    |                                                 |
|                    | Tell all your partners that you have HIV before |
|                    | you have sex. Don't you wish you had been told? |
+--------------------+-------------------------------------------------+
|                    | Message 4:                                      |
|                    |                                                 |
|                    | Ask and Tell.                                   |
|                    |                                                 |
|                    | Never assume that you know someone else's HIV   |
|                    | status. Never assume that your partner knows    |
|                    | yours. Ask your partners about their HIV status |
|                    | and tell them that you are HIV positive.        |
|                    |                                                 |
|                    | Avoid the negative consequences of infecting    |
|                    | someone with HIV.                               |
+--------------------+-------------------------------------------------+
| Learn              | Message 5:                                      |
|                    |                                                 |
|                    | Knowledge is power.                             |
|                    |                                                 |
|                    | There is always something more to know about    |
|                    | HIV. Keep educating yourself about HIV, its     |
|                    | treatment and new developments in HIV research. |
|                    | Use your knowledge to take care of your health  |
|                    | and to work with your health care providers so  |
|                    | you can lead a longer, healthier life.          |
+--------------------+-------------------------------------------------+
| Abstinence         | Message 6:                                      |
|                    |                                                 |
|                    | Wait!                                           |
|                    |                                                 |
|                    | Do not have sex until you know all you need to  |
|                    | know about HIV and your partner.                |
|                    |                                                 |
|                    | What you don't know CAN hurt you and your       |
|                    | partner.                                        |
+--------------------+-------------------------------------------------+
| Condoms            | Message 7:                                      |
|                    |                                                 |
|                    | Smart lovers use condoms.                       |
|                    |                                                 |
|                    | Use condoms correctly to help protect you and   |
|                    | your positive partners from HIV re-infection    |
|                    | and other STDs. And to protect your             |
|                    | HIV-negative partners from HIV and STDs.        |
|                    |                                                 |
|                    | Using condoms is the smart, healthy and         |
|                    | responsible thing to do!                        |
+--------------------+-------------------------------------------------+

(continued)

Table 2-1. Final Message Concepts for Phase III Testing (continued)

+--------------------+-------------------------------------------------+
| **Message Concept  | **Messages for Phase III Concept Testing**      |
| Category**         |                                                 |
+--------------------+-------------------------------------------------+
| Condoms            | Message 8:                                      |
| (continued)        |                                                 |
|                    | No condoms? No way!                             |
|                    |                                                 |
|                    | You know that living with HIV is not easy.      |
|                    | Using condoms will spare others from having to  |
|                    | live with HIV.                                  |
|                    |                                                 |
|                    | Give them the chance that you didn't have.      |
+--------------------+-------------------------------------------------+
| Sexual             | Message 9:                                      |
| Practices/Safe Sex |                                                 |
|                    | Always be ready for safer sex.                  |
|                    |                                                 |
|                    | You never know when the right moment will come  |
|                    | along. Keep a safe sex kit handy and fill it    |
|                    | with condoms and your favorite lube.            |
|                    |                                                 |
|                    | Always be prepared.                             |
+--------------------+-------------------------------------------------+
|                    | Message 10:                                     |
|                    |                                                 |
|                    | Take control.                                   |
|                    |                                                 |
|                    | Choose protected sex and have no regrets! Your  |
|                    | partner may have lots of reasons for not having |
|                    | safer sex, but you're the one who will have to  |
|                    | live with the guilt if you give your partner    |
|                    | HIV.                                            |
|                    |                                                 |
|                    | Safer sex means no regrets.                     |
+--------------------+-------------------------------------------------+
| Partners/Monogamy  | Message 11:                                     |
|                    |                                                 |
|                    | More isn't always better.                       |
|                    |                                                 |
|                    | Having multiple partners is not as fulfilling   |
|                    | as having one special partner. Be with one      |
|                    | faithful partner and have a more understanding  |
|                    | and supportive relationship.                    |
+--------------------+-------------------------------------------------+
|                    | Message 12:                                     |
|                    |                                                 |
|                    | Be with someone who understands.                |
|                    |                                                 |
|                    | Many times it is easier to relate to a partner  |
|                    | who knows what it's like to have HIV. Be with   |
|                    | an HIV-positive partner and have a more         |
|                    | understanding relationship.                     |
+--------------------+-------------------------------------------------+
| Partners/Partners' | Message 13:                                     |
| Past               |                                                 |
|                    | Your life and your health are your              |
|                    | responsibility.                                 |
|                    |                                                 |
|                    | Your partner could be infected with an STD,     |
|                    | Hepatitis C, or another type of HIV. Learn      |
|                    | about your partner's sexual and drug history    |
|                    | before having sex.                              |
|                    |                                                 |
|                    | Protect your health!                            |
+--------------------+-------------------------------------------------+

(continued)

Table 2-1. Final Message Concepts for Phase III Testing (continued)

+--------------------+-------------------------------------------------+
| **Message Concept  | **Messages for Phase III Concept Testing**      |
| Category**         |                                                 |
+--------------------+-------------------------------------------------+
| Drugs/Other        | Message 14:                                     |
| Triggers           |                                                 |
|                    | Sex and drugs just don't mix.                   |
|                    |                                                 |
|                    | Using drugs or alcohol means you may wake up    |
|                    | and worry about what happened the night before. |
|                    | So value your health and your life.             |
|                    |                                                 |
|                    | Don't mix, don't worry.                         |
+--------------------+-------------------------------------------------+
| Social             | Message 15:                                     |
| Support/Connect    |                                                 |
|                    | Reach out to the people who care about you and  |
|                    | support you. A strong support system will help  |
|                    | you live a healthy HIV-positive life.           |
+--------------------+-------------------------------------------------+
|                    | Message 16:                                     |
|                    |                                                 |
|                    | Be a "positive" role model.                     |
|                    |                                                 |
|                    | Teach prevention and do prevention. Nobody can  |
|                    | do that better than you!                        |
+--------------------+-------------------------------------------------+
| STDs and HIV       | Message 17:                                     |
|                    |                                                 |
|                    | Get STDs out of your life.                      |
|                    |                                                 |
|                    | They will make it harder for your body to fight |
|                    | HIV. If you think you might have an STD, get    |
|                    | tested and treated.                             |
+--------------------+-------------------------------------------------+
| Sexual             | Message 18:                                     |
| Pra                |                                                 |
| ctices/Negotiation | Be upfront.                                     |
|                    |                                                 |
| (Females only)     | For the safety and peace of mind of you and     |
|                    | your sex partners, tell them what you will and  |
|                    | won't do sexually before things get too hot.    |
+--------------------+-------------------------------------------------+
| Sexual             | Message 19:                                     |
| Practices/Group    |                                                 |
| Sex                | Don't get caught up in the crowd.               |
|                    |                                                 |
| (Males only)       | Group sex situations are hard to predict and    |
|                    | you don't know what you could be getting        |
|                    | yourself into.                                  |
|                    |                                                 |
|                    | Stay out of group sex and stay healthy.         |
+--------------------+-------------------------------------------------+

# Section 3 Message Concept Testing

The objective of Phase III was to quantitatively evaluate the acceptance
of the subset of message concepts that were identified as most promising
in Phase II and to identify the characteristics of HIV-positive persons
who demonstrate a preference for particular message concepts.

## 3.1 Research Design

To accomplish this, a structured, quantitative survey instrument was
administered to a sample of 647 HIV-positive individuals using ACASI
technology in Atlanta, GA; Baltimore, MD; Boston, MA; Chicago, IL;
Detroit, MI; Ft. Lauderdale, FL; Houston, TX; Los Angeles, CA; Miami,
FL; New York, NY; Philadelphia, PA; San Francisco, CA; and Washington,
DC. Participants were asked to read each message concept and evaluate it
by answering several questions. Data from this phase will provide a
profile of HIV-positive persons (e.g., demographic, psychosocial, and
behavioral characteristics) based on their responses to the HIV
prevention message concepts.

Participants included HIV-positive MSM, HIV-positive heterosexual men,
and HIV-positive heterosexual women. To be eligible, participants had to
be 18 years of age or older, able to provide documentation of his/her
HIV seropositivity (i.e., a prescription bottle, documentation from a
doctor or confidential testing site, or HIV/AIDS service program
registration card), and sexually active in the past 5 years.
HIV-positive men were eligible for the MSM focus groups if they reported
having sex with a man in the past 5 years. HIV-positive men and women
were eligible for the heterosexual focus groups if they reported having
sex only with someone of the opposite gender in the past 5 years.

Individuals were excluded from participating if they were
unwilling/unable to provide written informed consent, were non-English
speakers, or worked or volunteered with any organizations or programs
that were involved in HIV-prevention/education activities in the past
year.

## 3.2 Data Collection Preparation

### Questionnaire Development

CDC and RTI collaboratively developed the Phase III questionnaire using
an iterative process. We used the baseline and posttest questionnaires
from Study B of the main study as a starting point. We revised relevant
questions to make them appropriate for Phase III's target audience (MSM,
heterosexual men, and heterosexual women). Finally, we added a section
of questions to assess participants' reactions to and opinions of the
message concepts. The Phase III questionnaire had a total of 36 core
items. In addition, each participant answered another 15 items about
each of the 12 messages they reviewed.

### Programming the Instruments

The ACASI instrument was programmed using a modified version of a
computer-assisted interviewing application known as the RTI Forms System
(RTIFS). This program was originally developed by RTI as a touch-screen
application but was modified for the purposes of this study to be used
with a mouse.

The ACASI instrument was developed through an iterative process.
Programming staff used the questionnaire developed by CDC and RTI to
create a test version of the instrument. After the programming staff had
conducted initial testing, the instrument was released to data
collection staff for further testing. Data collection staff conducted
extensive testing to look for the following types of problems:

-   typos or inaccuracies in the wording of questions and response
    options,

-   problems with the appearance and layout of the questions and other
    usability issues,

-   errors in the numbering or sequencing of the questions,

-   errors in skip patterns, and

-   other system malfunctions.

Data collection staff recorded all identified problems in a testing log.
As the programmers addressed the problem, they updated the log to
communicate that the changes were ready to be verified. Data collection
staff then conducted additional testing and updated the log to reflect
whether problems had been addressed.

Once the question wording was correct on each screen, a female
professional "voice" recorded audio files for the question and response
options on each screen. Data collection staff tested these audio files
to ensure accurate audibility. After the files were added to the
interviewing program, additional testing was conducted to ensure that
all files were added to the correct screens. A laptop with test versions
of the ACASI instrument was also sent to CDC for review and approval.

### Randomization Procedure

Each participant reviewed 11 message concepts that were randomly
selected from the pool of 17. Once a message was selected for a
participant, it was removed from the basket of available messages for
random selection to ensure that the same message never got repeated
within a participant's survey.

Seventeen messages were listed in the randomization pool in a serial
order. The program used the *Rnd* function call, in Microsoft's Visual
Basic 6 package to generate a number, *n*, between 1and 17. The *n^th^*
message from the list then formed the first message to be displayed for
a specific survey. This specific message was then pulled out of the list
making the list 16 in length. A second call would generate a number *n*
between 1 and 16. Accordingly the *n*^th^ message from the list would
form the second message. This process was repeated 11 times to generate
a sequence of 11 nonrepeating, randomly selected messages from an
initial pool of 17 messages.

The randomizing seed was initialized for every new survey by calling the
*Randomize* function in the beginning of the above loop that was
executed 11 times. This guaranteed that the same message would not
appear as the first message all the time.

Each message was reviewed by an average of 419 participants. Message 5
was reviewed by the fewest number of participants (395), while Message
17 was viewed by the most participants (443) (see Table 3‑1).

On average, each message appeared as the first message 38 times. Message
3 appeared first the fewest number of times (29), while Messages 9 and
10 appeared first the highest number of times (45) (see Table 3‑2).

Two additional messages were "fixed" in that they were not included in
the pool of 17 messages. Message 18 was reviewed by all female
participants, while Message 19 was reviewed by all male participants.
Message 18 or 19 (depending on whether the participant was male or
female) was always shown as the last message. For each message, the
message was shown, and then the participant was asked a series of
questions about the message before moving on to the next message.

[]{#__RefHeading___Toc125871027 .anchor}Table 3-1. Message Frequency

  ----------------------------------- -----------------------------------
  **Message**                         **Message Frequency**

  1                                   433

  2                                   424

  3                                   415

  4                                   407

  5                                   395

  6                                   423

  7                                   413

  8                                   424

  9                                   415

  10                                  428

  11                                  407

  12                                  422

  13                                  409

  14                                  413

  15                                  435

  16                                  411

  17                                  443
  ----------------------------------- -----------------------------------

Mean 418.65, median 415, mode 424, standard deviation 12.03, range 48,
minimum 395, maximum 443.

[]{#__RefHeading___Toc125871028 .anchor}Table 3-2. Frequency of Each
Message Appearing as the First Message

  ----------------------------------- -----------------------------------
  **Message**                         **Frequency as First**

  1                                   41

  2                                   35

  3                                   29

  4                                   43

  5                                   39

  6                                   44

  7                                   34

  8                                   36

  9                                   45

  10                                  45

  11                                  37

  12                                  43

  13                                  30

  14                                  38

  15                                  33

  16                                  35

  17                                  40
  ----------------------------------- -----------------------------------

Mean 38.06, median 38, mode 35, range 16, minimum 29, maximum 45.

### Hiring/Training of Field Staff

For cost-efficiency purposes and to benefit from the availability of
experienced field staff in different parts of the country, two teams
were hired to work the 13 data collection sites. Each team consisted of
one team leader and four team members (field interviewers). Members of
Team 1 completed the San Francisco, Los Angeles, Houston, Detroit,
Boston, and New York City sites. Members of Team 2 completed the Miami;
Ft. Lauderdale; Washington, DC; Baltimore; Philadelphia; Chicago; and
Atlanta sites. All team members were experienced field staff and had
previously worked for RTI; many had worked on the main study portion of
this project in the summer of 2004.

Each member of the field staff received an interviewer manual and a
computer manual, which provided details about the study procedures. They
were asked to read the manuals and complete a home study exercise, which
was submitted to the RTI supervisor prior to the telephone training.

#### Telephone Training

Each team participated in a 1-hour telephone training conference just
prior to the start of the data collection assignment. The training was
conducted by the RTI Data Collection Task Leader and was attended by the
CDC Project Coordinator. The telephone training consisted of a project
overview, a discussion of field staff responsibilities, and a review of
the general site logistics and procedures for data collection. The
telephone training agenda is presented in Table 3‑3.

#### In-Person Training

An in-person training was conducted for each team prior to the first day
of data collection. This was a hands-on training where each team member
walked through various interview scenarios on the laptop computers. The
training was conducted by an RTI data collection staff member. Training
topics included discussion of problem questions, entering dates, dealing
with break-offs, troubleshooting technical problems, and role playing of
the greeter and technical support roles. The in-person training agenda
is presented in Table 3‑4.

[]{#__RefHeading___Toc125871029 .anchor}Table 3-3. HIV Prevention
Messages, Phase III: Agenda for Field Staff Telephone Training

+-----------------------------------------------------------------------+
| 1.0 Introductions                                                     |
+-----------------------------------------------------------------------+
| 2.0 Project Overview                                                  |
+-----------------------------------------------------------------------+
| 3.0 Respondent Recruitment and Payment                                |
+-----------------------------------------------------------------------+
| 4.0 Team Leader and Interviewer Responsibilities                      |
+-----------------------------------------------------------------------+
| > 4.1 Role of Greeter                                                 |
+-----------------------------------------------------------------------+
| > 4.2 Role of Technical Support Person                                |
+-----------------------------------------------------------------------+
| 5.0 Maintaining Respondent Privacy and Sensitivity                    |
+-----------------------------------------------------------------------+
| 6.0 Daily Schedule for Field Staff                                    |
+-----------------------------------------------------------------------+
| 7.0 Laptop Logistics                                                  |
+-----------------------------------------------------------------------+
| 8.0 Site Close Down and Disposition of Materials                      |
+-----------------------------------------------------------------------+
| 9.0 Administrative Topics                                             |
+-----------------------------------------------------------------------+
| > 9.1 Communicating with your Supervisor                              |
+-----------------------------------------------------------------------+
| > 9.2 Submitting PT&Es                                                |
+-----------------------------------------------------------------------+
| > 9.3 Travel Logistics                                                |
+-----------------------------------------------------------------------+
| > 9.4 On-Site Training                                                |
+-----------------------------------------------------------------------+
| > 9.5 Site Visits by Project Management and CDC                       |
+-----------------------------------------------------------------------+
| 10.0 Working as a Team                                                |
+-----------------------------------------------------------------------+
| 11.0 Question and Answer                                              |
+-----------------------------------------------------------------------+

## 3.3 Recruitment

The Henne Group (THG) selected and reserved focus group facilities in
each of the 13 cities for the administration of the ACASI interviews.
THG worked with the focus group facilities and local agencies
(community-based organizations \[CBOs\] and clinics) in each city to
recruit HIV-positive persons (MSM and heterosexual men and women) for
Phase III using the following methods as appropriate for each city:

-   Advertisements were placed in publications aimed primarily at the
    HIV-positive community. The advertisements featured a toll-free
    number that potential participants called to be screened to
    determine if they were eligible for the study.

-   Flyers with the toll-free number were posted or distributed in
    locations frequented by HIV-positive persons (e.g., bars, health
    clinics, community centers, churches, electronic bulletin boards).

-   Networking was conducted to locate potential participants. For
    example, THG contacted organizations that serve HIV-positive
    persons, and individuals within the organizations referred potential
    participants to the project.

[]{#__RefHeading___Toc125871030 .anchor}Table 3-4. HIV Prevention
Messages, Phase III: Agenda for Field Staff In-Person Training

+-----------------------------------------------------------------------+
| **ACASI Practice**                                                    |
+-----------------------------------------------------------------------+
| > 1\. Using the case management system to start a case                |
+-----------------------------------------------------------------------+
| > 2\. Tutorial and use of headphones                                  |
+-----------------------------------------------------------------------+
| > 3\. Resolving error messages                                        |
+-----------------------------------------------------------------------+
| > 4\. Backing up to prior screens                                     |
+-----------------------------------------------------------------------+
| > 5\. Practice breakoff                                               |
+-----------------------------------------------------------------------+
| > 6\. Trainees complete questionnaire at own pace                     |
+-----------------------------------------------------------------------+
| **Mock Interview**                                                    |
+-----------------------------------------------------------------------+
| > 1\. Interviewers role-play respondent scenarios using:              |
+-----------------------------------------------------------------------+
| > • Appointment schedule                                              |
+-----------------------------------------------------------------------+
| > • CDC envelope                                                      |
+-----------------------------------------------------------------------+
| > • Activated case list                                               |
+-----------------------------------------------------------------------+
| > • Consent form                                                      |
+-----------------------------------------------------------------------+
| > • Laptop                                                            |
+-----------------------------------------------------------------------+
| > 2\. Interviewers reverse roles until each one has practiced each    |
| > staff role                                                          |
+-----------------------------------------------------------------------+
| **Transmission Practice**                                             |
+-----------------------------------------------------------------------+
| > 1\. Team leader practice:                                           |
+-----------------------------------------------------------------------+
| > • Collecting data from each laptop on floppy disk                   |
+-----------------------------------------------------------------------+
| > • Transmitting data                                                 |
+-----------------------------------------------------------------------+
| > 2\. All team members should understand data collection and          |
| > transmission and the use of diskettes                               |
+-----------------------------------------------------------------------+
| **Troubleshooting and Problem Resolution**                            |
+-----------------------------------------------------------------------+
| > • Problem form                                                      |
+-----------------------------------------------------------------------+
| > • Job aids                                                          |
+-----------------------------------------------------------------------+
| > • Tool bar and window closure after brochure                        |
+-----------------------------------------------------------------------+
| > • Dial up properties, using a 9 or an 8                             |
+-----------------------------------------------------------------------+
| > • Other potential problems                                          |
+-----------------------------------------------------------------------+

-   Street outreach was conducted in select neighborhoods to help
    recruit potential participants.

-   THG passively recruited respondents in chat rooms. THG entered the
    chat room and waited for interested members to read the study's chat
    room profile. Interested persons inquired about the study through
    the information provided in our chat room profile.

-   THG and focus group facilities within each city relied to some
    extent on their own proprietary databases to help recruit potential
    participants.

-   THG used samples of respondents who had a high probability of being
    MSM and/or HIV positive, such as the general subscriber list for
    *POZ* magazine. THG also contacted respondents who have previously
    agreed to be a part of a panel and have indicated a willingness to
    participate in research studies. THG contacted these people by
    e‑mail or phone, depending on the information that the respondent
    provided.

### Recruitment Process

Once initial contact was made with a potential participant, the
individual was told that we were conducting a research study to learn
what people think about new HIV-prevention messages. Participants were
also told that we needed to ask them some personal questions, including
questions about their experience with HIV testing and their HIV status
(if they know it) to see if they qualify for the study. We obtained
verbal consent from the potential participants to screen them for
eligibility. If the potential participant agreed to be asked the verbal
screener questions and satisfied the eligibility requirements, he/she
was invited to participate in the study and told the location, time, and
date of the interview. Participants were told to bring a legal
identification card and documentation, such as a prescription bottle, a
note from a doctor, or a program registration card, to show that they
are HIV positive; they were told that they would not be permitted to
participate without showing the documentation.

Once individuals were recruited, THG prepared specification sheets. The
specification sheets listed the participants' initials and some
demographic information obtained from the screener. The specification
sheets allowed THG and the FG facilities to keep track of recruitment.
THG sent reminder letters and made confirmation calls to ensure that
each potential participant was confirmed.

### Recruitment Results

Across all 13 cities, only THG (and not local facilities) used
Internet-based recruitment methods, including passively recruiting
potential participants in chat rooms and posting flyers or
advertisements on electronic bulletin boards or HIV-related Web sites.
Flyers or advertisements were posted on www.craigslist.org,
www.HIVnet.com, www.HIVsearch.com, www.HIVforum.com,
HIV.AIDS.forum.poz.ca, www.HIVdate.com, www.HIVanonymous.com,
www.planetpoz.org, and www.pozpersonnals.com. The Web site
www.positiveconnections.com also sent two e-mail advertisements to their
members in the study markets. In addition, THG recruited from the *POZ*
magazine subscriber list across cities. A total of 2,907 potential
participants were screened. Of the 2,907 people screened, 2,021 were
eligible for the study. A total of 778 participants were scheduled into
the study and 647 completed an interview. THG alone recruited
approximately 50% of the participants. Below we describe the specific
recruitment methods used in each city and the number of potential
participants who were screened, were scheduled, and completed an
interview.

#### San Francisco

THG alone recruited all participants in the San Francisco market. The
most productive recruitment methods in San Francisco were outreach to
HIV-related resource centers in the area, Craig's List, and widespread
distribution of flyers. THG contacted the following centers: AIDS
Emergency Fund, SF AIDS Foundation, Metropolitan Community Church,
Larkin Street Youth Center, and the Lyon Martin Clinic. Participants
were also asked if they knew of anyone else who may be interested in the
study, and this snowball sampling through word of mouth produced a
number of recruits. For example, on the day of data collection, THG
received numerous calls from individuals who were interested in
participating in the study. We assume that participants who completed
the study told their friends about it and this generated the incoming
calls. Individuals who called were screened and if they met the
eligibility criteria and were available to participate, they were
scheduled into the study. The biggest challenge in San Francisco was
recruiting young participants (under age 40) and Hispanic participants.
This proved to be a challenge in other cities as well.

A total of 226 people were screened in San Francisco, and 82 were
determined to be ineligible during the screening process. Of the 144
people who screened eligible, 62 were invited to participate and
scheduled. The other 82 individuals were screened and were eligible for
the study but were not scheduled to participate because of age and/or
ethnicity targets. Of the 62 people who were scheduled, 52 showed and
completed the interview.

#### Ft. Lauderdale

The most effective recruitment method in Ft. Lauderdale was the Internet
because passive chat room monitoring and Internet postings yielded
roughly one third of the recruits in this market. Referrals from
physicians resulted in about 10 recruits. CBOs, such as South Florida
AIDS Project, The Children's Diagnostic and Treatment Center, Broward
County Health Department, NOMA West Clinic, and The Northwest Health
Department, also helped with recruitment. One challenge in Ft.
Lauderdale, although to a lesser degree than in Miami, was mistrust of
the government. Several individuals terminated during the screening
process because they did not trust a study that was sponsored by a
government agency.

A total of 139 people were screened in Ft. Lauderdale, and 58 were
determined to be ineligible during the screening process. Of the 81
people who screened eligible, 56 were invited to participate and
scheduled. The other 25 individuals were screened and were eligible for
the study but were not scheduled to participate because of age and/or
ethnicity targets. Of the 56 people who were scheduled, 49 showed and
completed the interview.[^1]

#### Miami

THG placed ads in the *New Times Weekly* and the *Miami Herald*, and
they produced a significant number of calls. However, many of the people
who responded to the ads were over age 40 and were not recruited for the
study. THG also posted flyers in trendy areas of Miami as well as in
clinics, support groups, bars and clubs. THG and the local facility
recruited from their databases and participants who were scheduled for
the study were asked for referrals. Snowball sampling through word of
mouth was most effective for recruitment of Hispanic participants. Some
of the CBOs that assisted with the recruitment included South Florida
AIDS Network, Camilla House, Broward County Health Department, the Free
Clinic in Miami, Community Health of South Dade, University of Miami
Project Outreach, The Village, Economic Opportunity Health Center,
Liberty City Health, PET Center, and Christ Crusaders. As mentioned for
Ft. Lauderdale, we experienced distrust of the government during the
recruitment process as we did in the main study in 2004. Several
potential participants terminated the screening process upon learning
that the study was being sponsored by CDC.

A total of 259 people were screened in Miami and 53 were determined to
be ineligible during the screening process. Of the 206 people who
screened eligible, 66 were invited to participate and scheduled. The
other 140 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 66 people who were scheduled, 49 showed and completed
the interview.

#### Washington, DC

THG placed three ads in two different papers in the DC area. Two ads
were placed in the *Washington Post Express*, a free commuter paper
published by *The Washington Post*, and the *City Paper*. The
*Washington Post Express* ads were most effective generating nearly 70%
of all responses. CBOs such as Whitman Walker Clinic, the Community of
Hope, La Clinica del Pueblo, Us Helping Us, NOVA Juniper Clinic, and
Food & Friends were contacted for assistance with recruitment. THG
distributed flyers throughout neighborhoods with heavy gay and ethnic
minority populations and also faxed and emailed flyers to local interest
groups and clinics. Infectious disease specialists were contacted by the
local facility through their medical database and several physicians
referred patients to be screened for eligibility. Although approved
recruitment methods were used in DC, recruiting Caucasian and Hispanic
participants proved to be very challenging. African Americans were most
responsive to our recruitment methods and as a result the majority of
participants in DC were African American.

A total of 155 people were screened in Washington and 40 were determined
to be ineligible during the screening process. Of the 115 people who
screened eligible, 46 were invited to participate and scheduled. The
other 69 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 46 people who were scheduled, 45 showed and completed
the interview.

#### Baltimore

Contacting members of the facility's database and conducting outreach to
physicians, health clinics and shelters were the primary recruiting
methods used in Baltimore. THG did place one ad in a free local paper,
but it produced few calls. Snowball sampling through word of mouth was
the most successful method in Baltimore. People in support groups as
well as those who saw ads or flyers passed on the information to others
and this generated a large number of inbound calls. Similar to the
experience in DC, people who responded to our recruitment methods were
overwhelmingly African American.

A total of 176 people were screened in Baltimore and 46 were determined
to be ineligible during the screening process. Of the 130 people who
screened eligible, 50 were invited to participate and scheduled. The
other 80 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 50 people who were scheduled, 42 showed and completed
the interview.[^2]

#### Los Angeles

THG ran print ads in the following three papers: *L.A. Weekly*,
*Pasadena Weekly*, and the *Los Angeles Times*. The ad in the *L.A.
Weekly* produced more inbound calls than the other two papers combined.
CBOs such as Being Alive, H.O.P.E., Angel Food, Valley Community Clinic,
Pacific Oaks, African American AIDS Foundation, Green Medicine Group,
Clinica Romero, Women's Care of Los Angeles, The Wall, Oasis Clinic, and
Tarzana Treatment Center were contacted and asked for their assistance
with recruitment by posting flyers on their bulletin boards or passing
on the information about the study to their clientele. Recruitment of
people under age 40, Caucasian, and Hispanic was most challenging.

A total of 194 people were screened in Los Angeles and 30 were
determined to be ineligible during the screening process. Of the 164
people who screened eligible, 105 were invited to participate and
scheduled. The other 59 individuals were screened and were eligible for
the study but were not scheduled to participate because of age and/or
ethnicity targets. Of the 105 people who were scheduled, 83 showed and
completed the interview.[^3]

#### Philadelphia

The most effective recruitment methods in Philadelphia were THG's
database, local facility's database, referrals from database members,
and outreach to CBOs and resource centers. THG also posted flyers in the
Action AIDS Office, University of Pennsylvania Health Center, community
clinics, and community centers. THG did not use print advertisements in
Philadelphia because response to ads in the past had not proven to be
effective in reaching the populations we were recruiting. As in other
locations, recruitment of participants who were under age 40, Caucasian
or Hispanic was most challenging.

A total of 190 people were screened in Philadelphia and 45 were
determined to be ineligible during the screening process. Of the 145
people who screened eligible, 60 were invited to participate and
scheduled. The other 85 individuals were screened and were eligible for
the study but were not scheduled to participate because of age and/or
ethnicity targets. Of the 60 people who were scheduled, 51 showed and
completed the interview.[^4]

#### Houston

The most effective recruitment methods in Houston included outreach to
CBOs, THG's and the local facility's database, and flyers. CBOs in
Houston included Houston AIDS Commission, Project Life Road, Bering
Community Services, Swehla Housing, and Covenant House. Flyers were
distributed in areas where young people, gay men, and people of specific
ethnicities might be reached. Young participants, Hispanics, and
Caucasians continued to be challenging to recruit. The language barrier
when recruiting Hispanics was significant and resulted in 34
terminations during the screening process. THG placed print ads in the
*Houston Press* and *The Greensheet* and although both produced inbound
calls, they only resulted in six participants scheduled into the study.

A total of 371 people were screened in Houston and 162 were determined
to be ineligible during the screening process. Of the 209 people who
screened eligible, 49 were invited to participate and scheduled. The
other 160 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 49 people who were scheduled, 42 showed and completed
the interview.[^5]

#### Chicago

THG involved an outside recruiter specializing in Hispanic recruiting in
Chicago which resulted in 12 participants being scheduled into the
study. Recruitment in Chicago relied heavily on outreach and referrals.
Flyers were posted at Howard Brown Clinic, Project Vida (a Hispanic HIV
social services agency), The Community Center, Test Positive Aware
Network, Beehive, Vital Bridges, and at infectious disease/HIV
specialist physicians' offices. Howard Brown Clinic and Project Vida
were especially helpful and generated the majority of inbound calls from
the outreach. Recruiting participants under age 40 continued to be a
challenge in Chicago.

A total of 440 people were screened in Chicago and 144 were determined
to be ineligible during the screening process. Of the 296 people who
screened eligible, 70 were invited to participate and scheduled. The
other 226 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 70 people who were scheduled, 61 showed and completed
the interview.[^6]

#### Detroit

THG placed an advertisement in the *Metro Times,* which generated some
response from older, African Americans. THG posted flyers in infectious
disease specialists' offices. The following CBOs were helpful in the
recruitment effort: The Livonia Health Center, Affirmation Lesbian/Gay
Community Centers, Community Health Awareness Group, Wellness House of
Michigan, and the Midwest AIDS Prevention Project. Word of mouth was an
effective recruitment method in Detroit. For example, participants who
were recruited help spread the word by announcing the study at their
support groups. Very few members of THG's or the local facility's
database were appropriate to contact in Detroit.

A total of 74 people were screened in Detroit, and 11 were determined to
be ineligible during the screening process. Of the 63 people who
screened eligible, 21 were invited to participate and scheduled. The
other 42 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 21 people who were scheduled, 20 showed and completed
the interview.

#### Boston

THG's and the local facility's databases were effective recruitment
sources in Boston. The facility also had several contacts with
physicians who made referrals from their patient base, and several
participants were recruited from that source. Flyers were very
effective. They were distributed in places such as the Massachusetts
Department of Public Health---AIDS Bureau, Quincy Health Department, The
Boston Living Center, AIDS Action Committee, The Community Research
Initiative of New England, Search for a Cure, Project Care, and Fenway
Community Health.

A total of 157 people were screened in Boston, and 81 were determined to
be ineligible during the screening process. Of the 76 people who
screened eligible, 19 were invited to participate and scheduled. The
other 57 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 19 people who were scheduled, 17 showed and completed
the interview.

#### Atlanta

Of the 13 cities, Atlanta proved to be the most difficult in terms of
recruiting participants across all three groups: MSM, heterosexual men,
and heterosexual females. The facility's database, referrals, the
Internet, and flyers posted in physicians' offices were the most
effective recruitment methods in Atlanta. As was the case in San
Francisco, word of mouth from respondents who completed interviews
prompted several people to call; be screened; and if eligible, scheduled
into the study. Our past experience in Atlanta with print advertisements
proved they are an ineffective recruitment technique, so print ads were
not run for this study. Flyers were posted in locations other than
physicians' offices but were only minimally effective.

A total of 141 people were screened in Atlanta, and 41 were determined
to be ineligible during the screening process. Of the 100 people who
screened eligible, 38 were invited to participate and scheduled. The
other 62 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 38 people who were scheduled, 32 showed and completed
the interview.

#### New York

Word of mouth, flyers, and THG's and the local facility's databases were
the most effective recruiting methods used in New York. CBO outreach was
also effective and included contacting the following organizations:
Betances Health Center, Citiwide Harm Reduction, Mount Sinai Medical
Center, The Jack Martin Clinic, GMHC, the Momentum Project, Minority
Task Force, Bronx AIDS Services, The Gay Men's Health Center, Project
Samaritan, CHAPS, and The Women's Center. Physicians and one nursing
agency were helpful in referring patients to the study. In addition, THG
worked with an independent recruiter who specialized in recruiting
Hispanic respondents. The independent recruiter generated 19 young
Hispanics who were scheduled into the study.

A total of 385 people were screened in New York, and 93 were determined
to be ineligible during the screening process. Of the 292 people who
screened eligible, 136 were invited to participate and scheduled. The
other 156 individuals were screened and were eligible for the study but
were not scheduled to participate because of age and/or ethnicity
targets. Of the 136 people who were scheduled, 111 showed and completed
the interview.

## 3.4 Data Collection Procedures

Data collection procedures included checking in the participant,
verifying identity and eligibility, and administering informed consent;
providing technical support to participants; providing participant
incentives; and ensuring quality control.

### Participant Check-in and Consent Procedures

Upon arrival at the site, participants first checked in with the site
(local focus group facility) staff. The site staff checked the
appointment list and confirmed the participant's appointment. Site staff
were asked to reconcile any discrepancies in participant appointment
times, participant initials, or date of birth. The site staff then
escorted or directed the participant to one of the project team members.

One team member was designated as the "greeter." The greeter checked the
appointment list because participants were identified only by
appointment, initials, and month and year of birth. The greeter then
escorted the participant into a private room and verified the
participant's identity by checking a photo ID. Next, the greeter checked
the participant's proof of HIV status. Acceptable proof consisted of
medicine containers, a prescription, a doctor's note, or lab results
that clearly indicated that the individual was HIV positive. The list of
HIV medications was updated as new medications were presented by
participants and approved by project management.

If a participant was unable to provide proof of HIV status, he or she
was unable to participate. The participant could reschedule for another
time when he or she could provide the necessary proof of eligibility.

After verifying the participant's identity and eligibility to
participate, the greeter provided the participant with an informed
consent form. After the participant read the consent form, the greeter
and the participant both signed and dated a copy of the consent form.
The greeter kept a signed copy and placed it in a consent form envelope
for that particular city. The participant received an unsigned copy of
the consent form.

After the participant signed the consent form, he or she was asked if he
or she would like to receive results of the study. All participants who
indicated that they would like to receive results self-addressed a CDC
envelope. The self-addressed envelope was placed in the results request
envelope for that particular city. The envelopes were sent via FedEx to
RTI and are being stored in a locked file cabinet until analysis is
complete and we are ready to send the results.

Finally, the greeter provided each participant with a sheet of contact
information for local service agencies. Each city had a separate local
referral number sheet. Once this step was completed, the greeter
escorted the participant into the production room and handed him or her
off to the technical support person.

### Technical Support to Participants

One team member was designated as the primary technical support person.
This person was responsible for verifying that consent was administered,
assigning each participant a case ID, and logging them into the ACASI
program.

Case IDs were assigned in the order in which they were printed on the
labels sheet. As each case ID was assigned, the interviewer transferred
the case ID to the "Activated Case ID Sheet." The technical support
person noted the time, the laptop station, and the participant's
initials on each activated case ID label to ensure that the interviewer
could retrieve the appropriate case ID for the participant if necessary.
Activated case ID labels were destroyed after completing data
collection.

The technical support person provided instructions to the participant
regarding the use of the laptop, the headphones, and the reference
calendar. They remained with the participant during the completion of
the tutorial to verify that the participant could use the software and
to address any questions that arose.

The technical support person was always available if the participant
needed assistance yet allowed the participant to complete the interview
in private. The team member did not provide explanation to any
questions; he/she only provided assistance with questions related to the
equipment or the program. The most common technical problems were the
following:

-   Some participants encountered problems using the number pad on the
    screen.

-   A couple of participants inadvertently closed out of the program
    during the middle of the interview. The interviewers pulled up the
    case again, and the participants resumed the interviews.

-   In a few instances, laptops lost power during the interview.
    Interviewers diagnosed the problem, rebooted the laptop, and pulled
    up the case. Participants were then able to complete their
    interviews.

### Participant Incentives

When the participant notified the team member that he/she was finished
with the interview, the team member escorted him/her to the site staff
member who was responsible for paying the \$75 incentive. Each
participant was asked to initial a receipt and was paid \$75 in cash.
Site staff also gave each participant a CDC HIV-prevention/education
brochure.

### Quality Control

To ensure quality of data and adherence to protocol, several quality
control measures were implemented.

-   **Verification of consent:** The technical support person verified
    that each participant had been administered informed consent before
    assigning a case ID.

-   **Project management site visits:** A member of the project
    management team was present during set up and data collection for
    the first few sites worked by each team. The observers included the
    Data Collection Task Leader and the California Field Supervisor.
    Project management staff observed data collection at 50% of the
    sites.

-   **Daily conference call:** Each day the Team Leader had a conference
    call with the Data Collection Task Leader to discuss daily
    production and other pertinent items for the day such as problem
    forms and schedules.

-   **Reconciliation of daily production reports:** Each day, the Data
    Collection Task Leader reviewed and reconciled reports generated
    electronically based on the daily transmission of data. These
    reports were reconciled with the production reported by the Team
    Leader.

-   **Conference call with all team members:** Individual conference
    calls were also scheduled with other team members to maintain
    communication with the entire group.

### Recruitment and Data Collection Reporting

THG prepared weekly reports summarizing the recruitment progress for
upcoming cities and e-mailed the reports to RTI and CDC. RTI generated
data collection reports that listed numbers of participants by city and
cumulative totals by gender and sexual orientation, race/ethnicity, and
age. These reports were sent to CDC and THG on a weekly basis. RTI and
THG worked together to track the number of eligible participants to
ensure that quotas for each site were met. Throughout the recruitment
and data collection period, CDC, RTI, and THG held weekly conference
calls to discuss recruitment and data collection progress using the
summary reports.

## 3.5 Data Cleaning, File Construction, Measures and Analytic Methods

### Data Cleaning and File Construction

Once data collection was completed, RTI began the data cleaning and file
construction process. The initial codebook was an Excel file containing
information about each data item. The information included initial
variable name, status (keep or delete), new variable name, type
(character or numeric), length, beginning position, ending position, and
description. The codebook was used to generate SAS input, length, label,
and rename statements that were used to process the data. Information
similar to what is in the codebook was programmatically generated for
the series of data items indicating the effectiveness of the messages
(e.g., accurate, dishonest, offensive).

The data were stored in a series of files containing one record each.
The files were read using the generated SAS statements and consolidated
into one file. Dates and times were converted to SAS dates and times.
Character variables with a length of 1 or 2 were converted to numeric
variables. Attributes such as variable name, variable label, and length
were associated with the numeric versions of the variables.

A file containing the value labels was created, and associations between
the variable names and the value labels were made. Value labels indicate
the meaning of a coded value, (e.g., 1 = Yes and 2 = No). New variables
were constructed to indicate the order, in which the messages were
presented, sexual preference, and age categories.

To create the final deliverable file for CDC in SPSS, a SAS transport
format file was created from the SAS dataset. SPSS variable labels and
value labels were generated using the SAS dataset. Finally, the SAS
transport format file was opened in SPSS, and the SPSS variable labels
and value labels were applied. The resulting file was saved and
delivered to CDC.

### Measures

We created a message perceptions scale using participants' responses to
the nine evaluative statements shown below:

-   This message is very appealing to me.

-   This message is confusing.

-   This message speaks to me.

-   This message said something important to me.

-   This message promotes a behavior which is difficult for me to do.

-   I did not like this message.

-   This message is very convincing.

-   This message would motivate HIV-positive persons to act in ways that
    would prevent further transmission of HIV.

-   This message contradicts what I know about HIV prevention.

Responses for negative statements were reverse-coded so that higher
values for each item indicated more positive perceptions of the message.
The mean of the item responses for each message was then used as the
score for overall perceptions of that message. Cronbach's alphas for
each message perceptions scale were 0.80 and higher, suggesting that the
scales have good internal consistency.

In addition, we created two scales using the adjectives. One scale was
created for the 12 positive adjectives:

+-----------------------------------+-----------------------------------+
| -   Accurate                      | -   Creative                      |
+-----------------------------------+-----------------------------------+
| -   Believable                    | -   Informative                   |
+-----------------------------------+-----------------------------------+
| -   Effective                     | -   Interesting                   |
+-----------------------------------+-----------------------------------+
| -   Clever                        | -   Original                      |
+-----------------------------------+-----------------------------------+
| -   Clear                         | -   Realistic                     |
+-----------------------------------+-----------------------------------+
| -   Familiar                      | -   Worth Remembering             |
+-----------------------------------+-----------------------------------+

Higher scores on the positive adjectives scale indicated more positive
perceptions of the message.

A separate scale was created for the 12 negative adjectives:

+-----------------------------------+-----------------------------------+
| -   Annoying                      | -   Inappropriate                 |
+-----------------------------------+-----------------------------------+
| -   Complex                       | -   Irritating                    |
+-----------------------------------+-----------------------------------+
| -   Embarrassing                  | -   Offensive                     |
+-----------------------------------+-----------------------------------+
| -   Condescending                 | -   Pointless                     |
+-----------------------------------+-----------------------------------+
| -   Dishonest                     | -   Silly                         |
+-----------------------------------+-----------------------------------+
| -   Farfetched                    | -   Stigmatizing                  |
+-----------------------------------+-----------------------------------+

Higher scores on the negative adjectives scale indicated more negative
perceptions of the message.

### Analytic Methods

RTI conducted preliminary analysis to evaluate the acceptance of the
identified message concepts and to determine whether HIV-positive
participants with different characteristics demonstrated preferences for
particular message concepts. We began by describing the sample. We
computed means for continuous, normally distributed variables of
interest and frequencies for categorical variables of interest for the
entire sample.

We then calculated the percentage of participants who selected each of
24 adjectives to describe each message. Similarly, for each message, we
calculated the percentage of participants who strongly agreed, agreed,
neither agreed nor disagreed, disagreed, or strongly disagreed with 10
evaluative statements about each message. We present specific results by
sexual orientation, age, race/ethnicity, and education level, including
the statistical significance of chi-square and Fisher's Exact Tests, for
each message concept in the Descriptive Data Tables addendum to this
report.

We report mean scores on the message perceptions scale as well as on the
positive and negative adjectives scales for each message by nine
audience segments: white MSM, African-American MSM, Hispanic MSM, white
heterosexual men, African-American heterosexual men, Hispanic
heterosexual men, white heterosexual women, African-American
heterosexual women, and Hispanic heterosexual women.

Finally, we selected four of the 19 messages to further analyze using
linear ordinary least squares regression modeling to identify
demographic, sexual behaviors, and attitudes and beliefs that
significantly predict perceptions of each message. We selected an
abstinence message (Message 6), a monogamy message (Message 11), a
condoms message (Message 8), and a disclosure message (Message 3) for
the multivariate analysis.

We took several steps to select the most appropriate independent
variables for the regression models. First, all of the models included
demographic variables (gender, age, race/ethnicity, and sexual
orientation) as control variables. We also included the following two
attitudes and beliefs items in each model: (1) It is my responsibility
to protect others from getting HIV, and (2) Because of new treatments
for HIV, I'm less concerned about infecting someone else. We
hypothesized that these beliefs may be central to the motivation of
HIV-positive individuals to protect (or fail to protect) others from HIV
exposure. In addition, an item concerning trust of the CDC as a source
of information was included in each model because the participants knew
that they were participating in a CDC-funded study.

Next, we selected other relevant independent variables for each message
based on content and our hypotheses. For example, we hypothesized that
participants who had used condoms in the past 30 days would have more
positive perceptions of Message 8 (Condoms) than those who had not used
condoms. As another example, we hypothesized that those who had more
partners in the past year would view Message 11 (Monogamy) less
favorably than those with fewer partners. Finally, to help avoid omitted
variable bias, we conducted backwards stepwise regressions, controlling
for the aforementioned variables, to identify any additional variables
from the study that should be included in the models. All variables that
were statistically significant in bivariate analyses were entered into
the stepwise regressions. Variables identified through the stepwise
regressions were reviewed on a substantive basis for relevance before
adding them to a model. These analyses resulted in the addition of an
item on understanding of safer sex strategies to the models for Messages
6 (Abstinence) and 8 (Condoms) and an item on attending parties and bars
where people are using drugs or alcohol and having sex to Message 6
(Abstinence).

## 3.6 Results

### Participant Characteristics

The entire study sample included a total of 647 participants (see Table
3-5). Two hundred nine (32%) were MSM, 208 (32%) were heterosexual men,
and 200 (31%) were heterosexual women. Thirty participants (5%) were not
included in the MSM, heterosexual male, or heterosexual female
categories because 10 were unsure of their sexual orientation (8 men and
2 women), and 20 females self-identified as bisexual.

[]{#__RefHeading___Toc125871031 .anchor}Table 3-5. Participant
Characteristics (percent)

+-----------------------------+--------+--------+----------+----------+
| **Characteristics**         | **     | **MSM\ | **Hete   | **Hete   |
|                             | Total\ | (n =   | rosexual | rosexual |
|                             | (n =   | 209)** | Males\   | Females\ |
|                             | 647    |        | (n =     | (n =     |
|                             | ^a^)** |        | 208)**   | 200)**   |
+-----------------------------+--------+--------+----------+----------+
| **Age group**               |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > 18--29                    | 9.74   | 13.88  | 4.33     | 9.00     |
+-----------------------------+--------+--------+----------+----------+
| > 30--39                    | 41.73  | 46.89  | 36.06    | 41.50    |
+-----------------------------+--------+--------+----------+----------+
| > 40--49                    | 38.33  | 34.45  | 41.83    | 41.50    |
+-----------------------------+--------+--------+----------+----------+
| > 50--64                    | 10.20  | 4.78   | 17.79    | 8.50     |
+-----------------------------+--------+--------+----------+----------+
| **Race/ethnicity**          |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Black or African American | 44.51  | 32.06  | 51.44    | 50.00    |
+-----------------------------+--------+--------+----------+----------+
| > Hispanic, Latino, or      | 25.04  | 30.14  | 23.08    | 22.50    |
| > Chicano                   |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > White                     | 25.50  | 32.06  | 20.19    | 24.50    |
+-----------------------------+--------+--------+----------+----------+
| > Other                     | 4.95   | 5.74   | 5.29     | 3.00     |
+-----------------------------+--------+--------+----------+----------+
| **Education**               |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Did not complete high     | 20.40  | 8.13   | 22.60    | 29.00    |
| > school                    |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > High school diploma/GED   | 31.53  | 24.40  | 37.02    | 33.00    |
+-----------------------------+--------+--------+----------+----------+
| > Some college or           | 34.00  | 41.63  | 32.69    | 29.00    |
| > Associate's degree        |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Bachelor's degree         | 10.05  | 17.22  | 5.77     | 7.50     |
+-----------------------------+--------+--------+----------+----------+
| > Master's, doctoral, or    | 4.02   | 8.61   | 1.92     | 1.50     |
| > other professional degree |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| **City**                    |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Atlanta, GA               | 4.95   | 7.66   | 3.85     | 4.00     |
+-----------------------------+--------+--------+----------+----------+
| > Baltimore, MD             | 6.34   | 5.26   | 6.73     | 6.50     |
+-----------------------------+--------+--------+----------+----------+
| > Boston, MA                | 2.63   | 2.39   | 2.88     | 2.00     |
+-----------------------------+--------+--------+----------+----------+
| > Chicago, IL               | 9.27   | 8.13   | 13.46    | 6.50     |
+-----------------------------+--------+--------+----------+----------+
| > Detroit, MI               | 3.09   | 3.35   | 2.88     | 3.50     |
+-----------------------------+--------+--------+----------+----------+
| > Ft. Lauderdale, FL        | 7.42   | 8.61   | 5.77     | 8.00     |
+-----------------------------+--------+--------+----------+----------+
| > Houston, TX               | 6.34   | 6.70   | 4.81     | 7.50     |
+-----------------------------+--------+--------+----------+----------+
| > Los Angeles, CA           | 12.67  | 16.27  | 8.17     | 12.00    |
+-----------------------------+--------+--------+----------+----------+
| > Miami, FL                 | 7.57   | 7.66   | 7.69     | 7.50     |
+-----------------------------+--------+--------+----------+----------+
| > New York, NY              | 17.16  | 10.53  | 23.08    | 18.50    |
+-----------------------------+--------+--------+----------+----------+
| > Philadelphia, PA          | 7.57   | 6.70   | 7.21     | 8.50     |
+-----------------------------+--------+--------+----------+----------+
| > San Francisco, CA         | 8.04   | 9.57   | 7.21     | 8.00     |
+-----------------------------+--------+--------+----------+----------+
| > Washington, DC            | 6.96   | 7.18   | 6.25     | 7.50     |
+-----------------------------+--------+--------+----------+----------+
| **AIDS diagnosis**          |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 51.31  | 54.55  | 54.33    | 46.00    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 48.69  | 45.45  | 45.67    | 54.00    |
+-----------------------------+--------+--------+----------+----------+

(continued)

Table 3-5. Participant Characteristics (percent) (continued)

+-----------------------------+--------+--------+----------+----------+
| **Characteristics**         | **     | **MSM\ | **Hete   | **Hete   |
|                             | Total\ | (n =   | rosexual | rosexual |
|                             | (n =   | 209)** | Males\   | Females\ |
|                             | 647    |        | (n =     | (n =     |
|                             | ^a^)** |        | 208)**   | 200)**   |
+-----------------------------+--------+--------+----------+----------+
| **Ever had viral load       |        |        |          |          |
| test**                      |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 97.83  | 97.60  | 98.56    | 97.50    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 2.17   | 2.40   | 1.44     | 2.50     |
+-----------------------------+--------+--------+----------+----------+
| **Taking HIV medications**  |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 77.90  | 76.56  | 84.13    | 74.50    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 22.10  | 23.44  | 15.87    | 25.50    |
+-----------------------------+--------+--------+----------+----------+
| **Use alcohol or drugs      |        |        |          |          |
| before or during sex**      |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Never                     | 42.57  | 26.79  | 46.86    | 52.50    |
+-----------------------------+--------+--------+----------+----------+
| > Rarely                    | 15.79  | 23.44  | 11.11    | 14.00    |
+-----------------------------+--------+--------+----------+----------+
| > Sometimes                 | 24.77  | 27.75  | 28.50    | 19.50    |
+-----------------------------+--------+--------+----------+----------+
| > Most of the time          | 13.78  | 17.70  | 12.08    | 11.00    |
+-----------------------------+--------+--------+----------+----------+
| > Every time                | 3.10   | 4.31   | 1.45     | 3.0      |
+-----------------------------+--------+--------+----------+----------+
| **Go to parties, bars, or   |        |        |          |          |
| other places where alcohol  |        |        |          |          |
| or drugs and sex are        |        |        |          |          |
| mixed**                     |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Never                     | 56.19  | 34.93  | 59.90    | 74.50    |
+-----------------------------+--------+--------+----------+----------+
| > About once a year         | 14.09  | 19.62  | 13.53    | 11.00    |
+-----------------------------+--------+--------+----------+----------+
| > Once every few months     | 15.94  | 27.75  | 12.56    | 6.50     |
+-----------------------------+--------+--------+----------+----------+
| > About once a month        | 7.28   | 8.61   | 7.73     | 5.00     |
+-----------------------------+--------+--------+----------+----------+
| > Once a week or more often | 6.50   | 9.09   | 6.28     | 3.00     |
+-----------------------------+--------+--------+----------+----------+
| **Main partner in past 30   |        |        |          |          |
| days**                      |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 62.17  | 43.78  | 58.64    | 83.89    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 37.83  | 56.22  | 41.36    | 16.11    |
+-----------------------------+--------+--------+----------+----------+
| **Main partner's HIV        |        |        |          |          |
| status**                    |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > HIV negative              | 42.16  | 36.78  | 39.29    | 46.31    |
+-----------------------------+--------+--------+----------+----------+
| > HIV positive              | 52.70  | 59.77  | 58.93    | 46.31    |
+-----------------------------+--------+--------+----------+----------+
| > Has not been tested       | 5.14   | 3.45   | 1.79     | 7.38     |
+-----------------------------+--------+--------+----------+----------+
| **Sex in past 30 days**     |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 77.33  | 75.61  | 77.03    | 80.38    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 22.67  | 24.39  | 22.97    | 19.62    |
+-----------------------------+--------+--------+----------+----------+
| **Sex with a nonmain        |        |        |          |          |
| partner in past 30 days**   |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 35.50  | 56.22  | 32.98    | 15.00    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 64.50  | 43.78  | 67.02    | 85.00    |
+-----------------------------+--------+--------+----------+----------+

(continued)

Table 3-5. Participant Characteristics (percent) (continued)

+-----------------------------+--------+--------+----------+----------+
| **Characteristics**         | **     | **MSM\ | **Hete   | **Hete   |
|                             | Total\ | (n =   | rosexual | rosexual |
|                             | (n =   | 209)** | Males\   | Females\ |
|                             | 647    |        | (n =     | (n =     |
|                             | ^a^)** |        | 208)**   | 200)**   |
+-----------------------------+--------+--------+----------+----------+
| **My responsibility to      |        |        |          |          |
| protect others from getting |        |        |          |          |
| HIV**                       |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Strongly disagree         | 12.21  | 10.05  | 9.62     | 16.00    |
+-----------------------------+--------+--------+----------+----------+
| > Disagree                  | 2.47   | 1.91   | 1.92     | 3.50     |
+-----------------------------+--------+--------+----------+----------+
| > Neither disagree nor      | 6.34   | 11.00  | 4.33     | 3.50     |
| > agree                     |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Agree                     | 17.77  | 19.14  | 20.67    | 13.00    |
+-----------------------------+--------+--------+----------+----------+
| > Strongly agree            | 61.21  | 57.89  | 63.46    | 64.00    |
+-----------------------------+--------+--------+----------+----------+
| **Less concerned about      |        |        |          |          |
| infecting someone else      |        |        |          |          |
| because of new HIV          |        |        |          |          |
| treatments**                |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Strongly disagree         | 59.13  | 57.89  | 61.84    | 57.50    |
+-----------------------------+--------+--------+----------+----------+
| > Disagree                  | 23.37  | 27.27  | 21.74    | 23.50    |
+-----------------------------+--------+--------+----------+----------+
| > Neither disagree nor      | 4.80   | 3.35   | 6.28     | 4.00     |
| > agree                     |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Agree                     | 4.95   | 5.26   | 3.38     | 6.50     |
+-----------------------------+--------+--------+----------+----------+
| > Strongly agree            | 7.74   | 6.22   | 6.76     | 8.50     |
+-----------------------------+--------+--------+----------+----------+
| **Participated in HIV/AIDS  |        |        |          |          |
| prevention activities or    |        |        |          |          |
| events**                    |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 56.88  | 56.94  | 61.06    | 52.00    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 43.12  | 43.06  | 38.94    | 48.00    |
+-----------------------------+--------+--------+----------+----------+
| **Participated in           |        |        |          |          |
| activities/events for       |        |        |          |          |
| HIV-positive people**       |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 66.15  | 66.03  | 68.27    | 64.00    |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 33.85  | 33.97  | 31.73    | 36.00    |
+-----------------------------+--------+--------+----------+----------+
| **Participated in gay       |        |        |          |          |
| community activities or     |        |        |          |          |
| events, read a gay          |        |        |          |          |
| publication or logged onto  |        |        |          |          |
| a gay Web site**^b^         |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Yes                       | 76.15  | 81.82  |          |          |
+-----------------------------+--------+--------+----------+----------+
| > No                        | 23.85  | 18.18  |          |          |
+-----------------------------+--------+--------+----------+----------+
| **Understanding of safer    |        |        |          |          |
| sex strategies**            |        |        |          |          |
+-----------------------------+--------+--------+----------+----------+
| > Poor                      | 0.93   | 0.48   | 1.44     | 1.00     |
+-----------------------------+--------+--------+----------+----------+
| > Fair                      | 4.02   | 2.39   | 4.33     | 4.50     |
+-----------------------------+--------+--------+----------+----------+
| > Good                      | 15.30  | 15.31  | 14.90    | 14.00    |
+-----------------------------+--------+--------+----------+----------+
| > Very good                 | 37.40  | 44.50  | 33.65    | 35.50    |
+-----------------------------+--------+--------+----------+----------+
| > Excellent                 | 42.35  | 37.32  | 45.67    | 45.00    |
+-----------------------------+--------+--------+----------+----------+

^a^This number includes 8 males who were unsure of their sexual
orientation, 20 females who identified their sexual orientation as
bisexual, and 2 women who were unsure of their sexual orientation.

^b^Only asked of participants who identified as gay or bisexual.

#### Sociodemographics

The mean age for all participants was 40. On average, MSM were younger,
with a mean age of 38. The mean age for heterosexual male participants
was 42, and the mean age for heterosexual female participants was 40.
Approximately 60% of MSM participants were under age 40, 40% of
heterosexual male participants were under age 40, and 51% of
heterosexual female participants were under age 40.

Across all participants, about 45% were African American, one quarter
were Hispanic or Latino, just over one quarter were white, and about 5%
were of other race/ethnicity. The race/ethnicity distribution differed
across the three target populations. Thirty-two percent of MSM
participants were African American, 30% were Hispanic, 26% were white,
and 6% were of other race/ethnicity. Fifty-one percent of heterosexual
male participants were African American, 23% were Hispanic, 20% were
white, and 5% were of other race/ethnicity. One half of heterosexual
female participants were African American, 23% were Hispanic, one
quarter were white, and 3% were of other race/ethnicity.

About one fifth of the study sample did not complete high school, 32%
had a high school diploma, 34% had some college, 10% had a bachelor's
degree, and 4% had a graduate degree. The MSM participants were more
educated than the heterosexual male and female participants in the
sample. About 8% of MSM participants did not complete high school, 24%
had a high school diploma, 42% had some college, and 26% had a
bachelor's degree or higher. About 23% of heterosexual male participants
did not complete high school, 37% had a high school diploma, 33% had
some college, and 8% had a bachelor's degree or higher. Twenty-nine
percent of heterosexual female participants did not complete high
school, one third had a high school diploma, 29% had some college, and
9% had a bachelor's degree or higher.

Overall, the largest percentage of participants was from New York (17%),
followed by Los Angeles (13%) and Chicago (9%). The smallest percentage
of participants came from Boston (3%). The largest percentage of MSM
participants came from Los Angeles (16%), followed by New York (11%) and
San Francisco (10%). The smallest percentage of MSM participants came
from Boston (2%). The largest percentage of heterosexual male
participants came from New York (23%), followed by Chicago (14%) and Los
Angeles (8%). The smallest percentage of participants came from Detroit
and Boston at 3% each. The largest percentage of heterosexual female
participants came from New York (19%), followed by Los Angeles (12%) and
Philadelphia (9%). The smallest percentage of female participants came
from Boston (2%).

#### Viral Load Test, HIV Medications, and AIDS Diagnosis

Almost all participants (98%) reported having had a viral load test.
More than three quarters of all participants (77% of MSM, 84% of
heterosexual men, and 75% of heterosexual women) reported taking HIV
medications. About one half of participants reported being diagnosed
with AIDS. Fifty-five percent of MSM, 54% of heterosexual men, and 46%
of heterosexual women reported being diagnosed with AIDS.

#### Drugs, Alcohol, and Sex

About 43% of participants said that they never use alcohol or drugs
before or during sex, 16% said that they rarely do, 25% said that they
sometimes do, 14% said that they do most of the time, and 3% said that
they do every time. However, responses to this question differed by
target population. For example, 27% of MSM participants said that they
never use alcohol or drugs before or during sex compared with 47% of
heterosexual male participants and 53% of heterosexual female
participants.

Just over one half of the participants said that they never go to
parties, bars, or other places where alcohol or drugs and sex are mixed,
14% go about once a year, 16% go once every few months, 7% go about once
a month, and 7% go at least once a week. Again, responses differed by
target population. For example, 35% of MSM said that they never go,
compared with 60% of heterosexual men and 75% of heterosexual women.

#### Main Partners

About 62% of all participants reported having a main partner in the past
30 days. Forty-four percent of MSM, 59% of heterosexual men, and 84% of
heterosexual women reported having a main partner in the past 30 days.
About 42% reported that their main partner's HIV status was negative,
53% reported that their partner was positive, and 5% reported that their
partner had not been tested. Sixty percent of MSM, 59% of heterosexual
men, and 46% of heterosexual women reported that their main sex partner
was HIV positive.

#### Sexual Behavior

Participants reported having an average of nine sex partners in the past
year (see Table 3‑6). MSM had significantly more sex partners (14) than
heterosexual men (6) or women (4). Three quarters of participants
reported having sex in the past 30 days (see Table 3-5). Of those who
reported having sex in the past 30 days, 36% reported having sex with a
nonmain partner, and this varied by target population. Fifty-six percent
of MSM, 33% of heterosexual

[]{#__RefHeading___Toc125871032 .anchor}Table 3-6. Participant
Characteristics: Sex Partners, Sex Behaviors, and Trust in Information
Sources (means)

  ------------------------------ ----------- ---------- ---------------- ----------------
  **Variables**                  **Total\    **MSM\     **Heterosexual   **Heterosexual
                                 (n =        (n =       Males\           Females\
                                 647^a^)**   209)**     (n = 208)**      (n = 200)**

  Number of sex partners (past   9.40        14.45^^   6.41             3.48
  year)                                                                  

  Number of HIV-positive nonmain 1.54        1.78       1.60             0.22
  partners (past 30 days)                                                

  Number of HIV-negative nonmain 1.17        1.18       1.02             0.59
  partners (past 30 days)                                                

  Number of unknown status       3.12        3.96       1.84             1.04
  nonmain partners (past 30                                              
  days)                                                                  

  Number of times sex without a  3.78        3.89       3.19             3.63
  condom                                                                 

  Number of times sex with a     6.30        4.42^^    7.96             5.60
  condom                                                                 

  Trust doctor, nurse, or health 8.65        8.75       8.50             8.69
  care professional as                                                   
  information source^b^                                                  

  Trust local AIDS organizations 6.24        6.72^^    6.23             5.70
  as information source^b^                                               

  Trust CDC as information       6.48        6.84       6.29             6.30
  source^b^                                                              
  ------------------------------ ----------- ---------- ---------------- ----------------

^a^This number includes 8 males who were unsure of their sexual
orientation, 20 females who identified their sexual orientation as
bisexual, and 2 women who were unsure of their sexual orientation.

^b^1--10 scale, where 1 = do not trust at all and 10 = trust completely.

Note: We calculated pairwise comparisons using a Bonferroni adjustment
(p\<0.0167 critical value for reporting significance).

^^ MSM statistically significantly different from HetM and HetF.

^^ MSM statistically significantly different from HetM.

^^ MSM statistically significantly different from HetF.

men, and 15% of heterosexual women reported having sex with a nonmain
partner in the past 30 days. Participants had an average of two
HIV-positive nonmain partners, one HIV-negative nonmain partner, and
three partners of unknown HIV status (see Table 3-6). Participants
reported having sex without a condom an average of four times and with a
condom an average of six times in the past 30 days. The difference
between the number of times MSM had sex with a condom (4) and
heterosexual men had sex with a condom (8) was statistically
significant.

#### Responsibility and Concern

Seventy-nine percent of participants agreed or strongly agreed with the
statement "It is my responsibility to protect others from getting HIV"
(see Table 3-5). Eighty-three percent of participants disagreed or
strongly disagreed with the statement "Because of new treatments for
HIV, I'm less concerned about infecting someone else."

#### Participation in Activities or Events

About 57% of participants reported participating in HIV/AIDS prevention
activities or events in the past year. Heterosexual females were less
likely to report participating (52%) compared with MSM (57%) and
heterosexual men (61%). About two thirds of participants reported
participating in any activities or events for HIV-positive people in the
past year. Again, fewer heterosexual females reported participating
(64%) compared with MSM (66%) and heterosexual men (68%). Over three
quarters of gay or bisexual participants reported participating in a gay
community activity or event, reading a gay publication, or logging on to
a gay Web site in the past year.

#### Understanding of Safer Sex Strategies

Almost 80% of participants rated their understanding of safer sex
strategies as excellent or very good.

#### Trust in Information Sources

On a scale from 1 to 10, where 1 equals do not trust at all and 10
equals trust completely, participants rated their doctor, nurse, or
health care professional as a 9, local AIDS organization as a 6, and CDC
as a 7 (see Table 3-6). The difference between the mean rating MSM gave
their local AIDS organization (7) and heterosexual women gave theirs (6)
was statistically significant.

### Descriptive Results 

We begin by presenting descriptive results across all of the messages.
More specific results by sexual orientation, age, race/ethnicity, and
education level, including the statistical significance of chi-square
and Fisher's Exact Tests, for each message concept may be found in the
Descriptive Data Tables addendum to this report.

#### Adjectives

For each message, we began by calculating the percentage of participants
who selected each adjective to describe the message (see Table 3-7).
Considering only the results from Table 3-7, Message 5 seemed to be the
message that was received best by participants because it was almost
always the message that had the highest percentage of participants using
the positive

[]{#__RefHeading___Toc125871033 .anchor}Table 3-7. Percentage of
Participants Who Selected Each Word to Describe the Message

  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  **Descriptor**   **Message**                                                                                                                                           
  ---------------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- -------
                   **1\          **2\    **3\    **4\    **5\    **6\    **7\    **8\    **9\    **10\   **11\   **12\   **13\   **14\   **15\   **16\   **17\   **18\   **19\
                   **(n= 433)    **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=
                                 424)    415)    407)    395)    423)    413)    424)    415)    428)    407)    422)    409)    413)    435)    411)    443)    222)    425)

  Accurate         70            62      67      66      77      60      73      70      65      63      62      46      67      66      69      66      72      58      57

  Annoying         7             9       11      10      2       16      8       11      7       12      14      20      9       11      5       8       7       9       21

  Believable       58            58      54      58      69      57      63      60      57      60      57      46      62      61      64      55      67      54      49

  Complex          9             17      15      18      12      14      12      9       8       14      14      19      10      13      11      8       10      11      13

  Effective        62            54      60      55      67      51      59      63      60      57      50      39      56      49      60      58      55      54      43

  Embarrassing     3             13      15      11      1       7       3       7       7       7       4       6       7       7       5       5       5       12      11

  Clever           33            31      31      31      41      31      31      38      39      32      32      24      31      31      32      39      28      32      28

  Clear            81            71      74      71      80      68      77      74      74      68      67      55      74      69      78      73      79      72      63

  Condescending    8             10      11      8       4       9       9       9       9       13      16      20      7       13      6       8       7       8       17

  Dishonest        4             4       3       3       1       3       3       4       2       7       5       12      2       5       1       2       1       2       7

  Familiar         47            46      43      42      51      42      47      50      45      43      46      32      41      44      54      40      46      37      34

  Farfetched       3             11      10      9       3       10      3       4       6       7       8       16      7       7       3       6       2       13      12

  Creative         38            35      33      30      42      35      33      41      42      38      36      26      32      36      37      44      31      32      27

  Inappropriate    4             6       7       4       2       5       3       6       6       9       5       18      3       6       2       3       4       8       12

  Informative      70            62      65      67      79      63      72      68      66      64      58      47      72      67      69      59      72      59      56

  Interesting      52            53      49      49      59      45      48      54      49      53      56      45      51      49      56      56      49      56      41

  Irritating       7             10      11      10      2       14      8       7       8       13      11      17      7       10      5       6       5       8       17

  Offensive        4             7       9       6       1       8       4       7       6       11      8       17      6       6       2       4       3       7       13

  Original         38            39      36      32      40      33      35      40      37      37      37      27      34      35      37      42      33      38      31
  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

(continued)

Table 3-7. Percentage of Participants Who Selected Each Word to Describe
the Message (continued)

  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  **Descriptor**   **Message**                                                                                                                                           
  ---------------- ------------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- ------- -------
                   **1\          **2\    **3\    **4\    **5\    **6\    **7\    **8\    **9\    **10\   **11\   **12\   **13\   **14\   **15\   **16\   **17\   **18\   **19\
                   **(n= 433)    **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=   **(n=
                                 424)    415)    407)    395)    423)    413)    424)    415)    428)    407)    422)    409)    413)    435)    411)    443)    222)    425)

  Pointless        3             8       7       6       2       8       6       5       5       7       9       12      6       8       3       5       5       10      14

  Realistic        70            65      70      68      75      64      70      72      68      71      63      52      72      68      71      69      73      60      58

  Silly            3             3       4       3       1       6       3       4       6       5       6       12      4       6       2       4       3       4       13

  Stigmatizing     8             8       9       11      3       8       6       9       5       14      13      23      8       9       5       7       7       7       16

  Worth            54            54      55      56      63      53      59      57      53      54      53      39      55      52      60      55      56      54      42
  Remembering                                                                                                                                                            
  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

adjectives to describe it and the lowest percentage of participants
using the negative adjectives to describe it. Conversely, Message 12
seemed to be the worst received because it was almost always the message
that had the lowest percentage of participants using the positive
adjectives to describe it and the highest percentage of participants
using the negative adjectives to describe it.

For each message, we looked at the adjectives and identified positive
adjectives used by at least 60% of participants to describe the messages
(see Table 3-8). At least 60% of participants used the adjectives
"clear" and "realistic" to describe 17 of the 19 messages. "Accurate"
was used to describe 16 of the 19 messages and "informative" was used to
describe 14 of the 19 messages by at least 60% of participants. Message
12 was the only message for which none of the positive adjectives were
used by at least 60% of participants to describe it.

Next, we looked at the adjectives and identified the negative adjectives
that at least 10% of participants used to describe each message (see
Table 3-8). For 9 of the 19 messages, none of the negative adjectives
were used by at least 10% of participants. At least 10% of participants
used the adjective "complex" to describe nine of the messages.
"Annoying," "condescending," and "irritating" were used by at least 10%
of participants to describe five of the messages.

Table 3-9 displays the mean scores on the positive adjectives scale for
each message by nine audience segments. Message 5 had the highest mean
score for four of the nine segments (white MSM, Hispanic MSM,
African-American heterosexual men, and African-American heterosexual
women). Message 8 had the highest mean score for two segments: white
heterosexual men and women. Message 7 had the highest mean score for
African-American MSM, Message 9 had the highest mean score for Hispanic
heterosexual men, and Message 13 had the highest mean score for Hispanic
heterosexual women.

Table 3-10 shows the mean scores on the negative adjectives scale for
each message by nine audience segments. Message 12 had the highest mean
score (indicating more negative perceptions of the message) for seven of
the nine segments: white MSM, African-American MSM, Hispanic MSM,
African-American heterosexual men, Hispanic heterosexual men, white
heterosexual women, and African-American heterosexual women. Message 19
had the highest mean score for white heterosexual men. Message 4 had the
highest mean score for Hispanic heterosexual women.

[]{#__RefHeading___Toc125871034 .anchor}Table 3-8. Commonly Used
Positive and Negative Adjectives to Describe Each Message

  -----------------------------------------------------------------------------
  **Message**   **Positive Adjectives\         **Negative Adjectives\
                (At Least 60% of Participants  (At Least 10% of Particpants
                Used Adjective to Describe the Used Adjective to Describe the
                Message)**                     Message)**
  ------------- ------------------------------ --------------------------------
  1             Accurate, believable,          N/A
                effective, informative         
                realistic                      

  2             Accurate, clear, effective,    N/A
                informative, realistic         

  3             Accurate, clear, effective,    N/A
                informative, realistic         

  4             Accurate, clear, effective,    N/A
                informative, realistic         

  5             Accurate, clear, effective,    N/A
                informative, realistic         

  6             Accurate, clear, effective,    N/A
                informative, realistic         

  7             Accurate, clear, effective,    N/A
                informative, realistic         

  8             Accurate, believable, clear,   Annoying
                effective, informative,        
                realistic                      

  9             Accurate, clear, effective,    N/A
                informative, realistic         

  10            Accurate, believable, clear,   Annoying, complex,
                informative, realistic         condescending, irritating,
                                               offensive, stigmatizing

  11            Accurate, clear, realistic     Annoying, complex,
                                               condescending, irritating,
                                               stigmatizing

  12            N/A                            Annoying, complex,
                                               condescending, dishonest,
                                               farfetched, inappropriate,
                                               irritating, offensive,
                                               pointless, silly stigmatizing

  13            Accurate, believable, clear,   Complex
                informative, realistic         

  14            Accurate, believable, clear,   Annoying, complex,
                informative, realistic         condescending, irritating

  15            Accurate, believable, clear,   Complex
                effective, informative,        
                realistic, worth remembering   

  16            Accurate, clear, realistic     N/A

  17            Accurate, believable, clear,   Complex
                informative, realistic         

  18            Clear, realistic               Complex, embarrassing,
                                               farfetched, pointless

  19            Clear                          Annoying, complex, embarrassing,
                                               condescending, farfetched,
                                               inappropriate, irritating,
                                               offensive, pointless, silly,
                                               stigmatizing
  -----------------------------------------------------------------------------

[]{#__RefHeading___Toc125871035 .anchor}Table 3-9. Mean Positive
Adjective Scale Scores by Message by Segment

  ------------- ----------- ----------- -------------- ---------------- ----------- -------------- ---------------- ----------- --------------
                **MSM**                                **Heterosexual                              **Heterosexual               
                                                       Men**                                       Women**                      

  **Message**   **White**   **Black**   **Hispanic**   **White**        **Black**   **Hispanic**   **White**        **Black**   **Hispanic**

  1             4.87        7.33        7.29           6.73             6.25        7.51           5.59             7.28        6.97

  2             5.92        6.76        7.24           7.11             5.89        5.81           5.41             6.30        5.93

  3             6.44        6.64        7.62           6.40             6.34        5.81           6.11             6.61        5.46

  4             5.62        6.19        7.35           6.57             6.48        6.03           6.56             6.24        4.89

  5             7.23        7.03        8.50           7.00             7.14        7.45           7.29             8.02        7.07

  6             4.96        6.47        5.58           5.59             5.63        6.64           6.45             7.19        5.71

  7             5.51        7.60        6.43           7.00             6.39        7.14           7.32             7.32        6.84

  8             5.43        6.8         8.02           7.31             6.03        7.00           7.37             7.35        7.07

  9             5.80        5.75        7.38           6.16             6.14        7.68           6.66             7.30        6.83

  10            4.40        6.75        6.87           5.74             6.68        6.54           6.57             6.98        6.44

  11            4.25        6.21        6.15           5.07             6.24        7.28           5.89             6.61        6.86

  12            3.09        4.69        4.95           5.83             5.17        5.13           4.44             5.37        4.75

  13            5.03        6.63        7.15           6.83             5.84        6.68           6.91             6.86        7.48

  14            4.97        6.90        5.85           6.63             5.89        6.83           6.20             6.88        6.87

  15            7.20        6.68        7.76           7.18             6.60        6.87           6.42             7.13        5.59

  16            5.87        6.67        7.19           5.74             6.12        7.10           5.17             7.94        6.55

  17            6.58        7.10        6.98           6.42             5.99        7.15           6.58             7.25        6.65

  18            N/A         N/A         N/A            N/A              N/A         N/A            5.67             6.22        6.24

  19            3.68        5.73        5.73           4.89             5.83        6.09           N/A              N/A         N/A
  ------------- ----------- ----------- -------------- ---------------- ----------- -------------- ---------------- ----------- --------------

[]{#__RefHeading___Toc125871036 .anchor}Table 3-10. Mean Negative
Adjective Scale Scores by Message by Segment

  ------------- ----------- ----------- -------------- ---------------- ----------- -------------- ---------------- ----------- --------------
                **MSM**                                **Heterosexual                              **Heterosexual               
                                                       Men**                                       Women**                      

  **Message**   **White**   **Black**   **Hispanic**   **White**        **Black**   **Hispanic**   **White**        **Black**   **Hispanic**

  1             1.31        0.43        0.95           0.77             0.42        0.37           0.55             0.51        0.47

  2             1.30        1.16        1.05           0.61             0.96        0.94           1.53             1.30        1.00

  3             1.88        1.22        0.82           0.63             1.02        1.11           0.86             1.35        0.54

  4             1.44        1.28        1.24           0.47             0.69        1.10           0.75             0.95        1.43

  5             0.34        0.26        0.33           0.38             0.23        0.16           0.45             0.44        0.30

  6             1.78        1.21        1.68           0.69             1.02        0.33           0.90             0.88        0.46

  7             1.53        0.42        0.80           0.55             0.43        0.38           0.46             0.52        0.36

  8             2.00        1.10        1.32           0.56             0.59        0.38           0.33             0.61        0.46

  9             1.11        1.40        0.95           0.50             0.70        0.18           0.59             0.67        0.57

  10            2.58        1.21        1.18           1.00             0.80        1.31           1.34             1.05        0.44

  11            2.25        1.45        1.94           1.22             0.87        0.45           1.08             1.01        0.34

  12            3.81        1.79        2.93           0.93             1.38        1.28           1.91             1.77        1.41

  13            1.28        1.00        1.05           0.62             0.61        0.59           0.52             0.80        0.41

  14            2.16        0.84        1.46           0.50             0.98        0.47           0.63             0.88        0.53

  15            0.48        0.68        0.59           0.24             0.42        0.32           0.39             0.43        0.26

  16            0.82        0.63        0.84           0.65             0.62        0.40           1.40             0.38        0.45

  17            0.42        0.53        0.70           0.64             0.49        0.23           0.30             0.88        0.52

  18            N/A         N/A         N/A            N/A              N/A         N/A            1.20             0.91        0.76

  19            3.00        1.57        2.32           1.43             0.95        0.93           N/A              N/A         N/A
  ------------- ----------- ----------- -------------- ---------------- ----------- -------------- ---------------- ----------- --------------

#### Evaluative Statements

Similarly, for each message, we calculated the percentage of
participants who strongly agreed, agreed, neither agreed nor disagreed,
disagreed, or strongly disagreed with 10 evaluative statements (see
Table 3-11). For descriptive purposes, we focused on the messages that
had the highest percentage of participants agreeing with positive
evaluative statements and disagreeing with negative evaluative
statements. Again, Message 5 tended to have the most favorable reaction
by the participants, while Messages 12 and 19 had more negative
reactions.

Table 3-12 displays the mean scores for the message perceptions scale
for each message by nine audience segments. Message 5 had the highest
mean score (indicating positive perceptions of the message) for six of
the nine audience segments: white MSM, African-American MSM, Hispanic
MSM, African-American heterosexual men, Hispanic heterosexual men, and
African-American heterosexual women. Message 7 had the highest mean
score for white heterosexual women. Message 13 had the highest mean
score for Hispanic heterosexual women. Message 15 had the highest mean
score for white heterosexual men.

### Multivariate Results

Below we report the results for the four multivariate models that we
estimated to further explore the demographic, sexual behaviors, and
attitudes and beliefs that significantly predict perceptions of each of
four messages.

#### Abstinence (Message 6)

***Positive Perceptions.*** Having greater trust in CDC as a source of
information, having a greater understanding of safer sex strategies, and
using a condom in the past 30 days were associated with having a
positive perception of the message (see Table 3-13).

***Negative Perceptions.*** Being male; being less concerned about
infecting someone else because of new treatments for HIV; having more
partners in the past year; having a main partner who is HIV negative;
and going to parties, bars, and other places where people use drugs or
alcohol and have sex were associated with having a negative perception
of the message.

#### Monogamy (Message 11)

***Positive Perceptions.*** Being African-American, Hispanic, or of
other race/ethnicity (compared with white); feeling more personal
responsibility to protect others from getting HIV; and having greater
trust in CDC as an information source were associated with having a
positive perception of the message (see Table 3-14).

[]{#__RefHeading___Toc125871037 .anchor}Table 3-11. Percentage of
Participants Who Selected Each Response by Evaluative Statement by
Message

<table>
<colgroup>
<col style="width: 6%" />
<col style="width: 11%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
</colgroup>
<thead>
<tr class="header">
<th colspan="2" rowspan="2"><strong>Evaluative Statements</strong></th>
<th colspan="19"><strong>Messages</strong></th>
</tr>
<tr class="odd">
<th><strong>1<br />
</strong>(n= 433)</th>
<th><strong>2<br />
</strong>(n= 424)</th>
<th><strong>3<br />
</strong>(n= 415)</th>
<th><strong>4<br />
</strong>(n= 407)</th>
<th><strong>5<br />
</strong>(n= 395)</th>
<th><strong>6<br />
</strong>(n= 423)</th>
<th><strong>7<br />
</strong>(n= 413)</th>
<th><strong>8<br />
</strong>(n= 424)</th>
<th><strong>9<br />
</strong>(n= 415)</th>
<th><strong>10<br />
</strong>(n= 428)</th>
<th><strong>11<br />
</strong>(n= 407)</th>
<th><strong>12<br />
</strong>(n= 422)</th>
<th><strong>13<br />
</strong>(n= 409)</th>
<th><strong>14<br />
</strong>(n= 413)</th>
<th><strong>15<br />
</strong>(n= 435)</th>
<th><strong>16<br />
</strong>(n= 411)</th>
<th><strong>17<br />
</strong>(n= 443)</th>
<th><strong>18<br />
</strong>(n= 222)</th>
<th><strong>19<br />
</strong>(n= 425)</th>
</tr>
</thead>
<tbody>
<tr class="odd">
<td rowspan="5"><blockquote>
<p>This message told me something I didn’t already know.</p>
</blockquote></td>
<td>Strongly disagree</td>
<td>24</td>
<td>21</td>
<td>22</td>
<td>28</td>
<td>22</td>
<td>25</td>
<td>25</td>
<td>30</td>
<td>25</td>
<td>23</td>
<td>25</td>
<td>22</td>
<td>26</td>
<td>29</td>
<td>25</td>
<td>19</td>
<td>26</td>
<td>20</td>
<td>22</td>
</tr>
<tr class="even">
<td>Disagree</td>
<td>19</td>
<td>14</td>
<td>13</td>
<td>15</td>
<td>16</td>
<td>15</td>
<td>15</td>
<td>15</td>
<td>16</td>
<td>18</td>
<td>16</td>
<td>21</td>
<td>17</td>
<td>17</td>
<td>14</td>
<td>18</td>
<td>15</td>
<td>18</td>
<td>23</td>
</tr>
<tr class="odd">
<td>Neither disagree or agree</td>
<td>5</td>
<td>7</td>
<td>8</td>
<td>7</td>
<td>5</td>
<td>10</td>
<td>4</td>
<td>5</td>
<td>9</td>
<td>8</td>
<td>8</td>
<td>16</td>
<td>7</td>
<td>7</td>
<td>6</td>
<td>9</td>
<td>5</td>
<td>5</td>
<td>10</td>
</tr>
<tr class="even">
<td>Agree</td>
<td>15</td>
<td>20</td>
<td>21</td>
<td>20</td>
<td>17</td>
<td>21</td>
<td>15</td>
<td>14</td>
<td>19</td>
<td>14</td>
<td>19</td>
<td>18</td>
<td>17</td>
<td>16</td>
<td>18</td>
<td>21</td>
<td>18</td>
<td>23</td>
<td>19</td>
</tr>
<tr class="odd">
<td>Strongly agree</td>
<td>37</td>
<td>38</td>
<td>36</td>
<td>29</td>
<td>40</td>
<td>29</td>
<td>40</td>
<td>35</td>
<td>31</td>
<td>37</td>
<td>32</td>
<td>22</td>
<td>33</td>
<td>30</td>
<td>37</td>
<td>33</td>
<td>36</td>
<td>34</td>
<td>27</td>
</tr>
<tr class="even">
<td rowspan="5"><blockquote>
<p>This message is very appealing to me.</p>
</blockquote></td>
<td>Strongly disagree</td>
<td>5</td>
<td>6</td>
<td>5</td>
<td>6</td>
<td>3</td>
<td>8</td>
<td>4</td>
<td>5</td>
<td>5</td>
<td>8</td>
<td>6</td>
<td>12</td>
<td>5</td>
<td>5</td>
<td>3</td>
<td>4</td>
<td>5</td>
<td>4</td>
<td>8</td>
</tr>
<tr class="odd">
<td>Disagree</td>
<td>7</td>
<td>6</td>
<td>8</td>
<td>7</td>
<td>3</td>
<td>11</td>
<td>8</td>
<td>7</td>
<td>7</td>
<td>7</td>
<td>8</td>
<td>15</td>
<td>6</td>
<td>13</td>
<td>3</td>
<td>5</td>
<td>6</td>
<td>9</td>
<td>17</td>
</tr>
<tr class="even">
<td>Neither disagree or agree</td>
<td>11</td>
<td>12</td>
<td>11</td>
<td>14</td>
<td>6</td>
<td>15</td>
<td>10</td>
<td>11</td>
<td>16</td>
<td>12</td>
<td>13</td>
<td>16</td>
<td>13</td>
<td>15</td>
<td>9</td>
<td>11</td>
<td>15</td>
<td>9</td>
<td>18</td>
</tr>
<tr class="odd">
<td>Agree</td>
<td>31</td>
<td>30</td>
<td>34</td>
<td>40</td>
<td>34</td>
<td>36</td>
<td>32</td>
<td>31</td>
<td>39</td>
<td>34</td>
<td>31</td>
<td>27</td>
<td>35</td>
<td>32</td>
<td>35</td>
<td>42</td>
<td>37</td>
<td>40</td>
<td>26</td>
</tr>
<tr class="even">
<td>Strongly agree</td>
<td>46</td>
<td>46</td>
<td>43</td>
<td>33</td>
<td>54</td>
<td>30</td>
<td>45</td>
<td>46</td>
<td>33</td>
<td>39</td>
<td>42</td>
<td>30</td>
<td>41</td>
<td>36</td>
<td>49</td>
<td>39</td>
<td>37</td>
<td>39</td>
<td>30</td>
</tr>
<tr class="odd">
<td rowspan="5"><blockquote>
<p>This message is confusing.</p>
</blockquote></td>
<td>Strongly disagree</td>
<td>44</td>
<td>40</td>
<td>44</td>
<td>36</td>
<td>51</td>
<td>37</td>
<td>41</td>
<td>44</td>
<td>40</td>
<td>40</td>
<td>40</td>
<td>33</td>
<td>47</td>
<td>40</td>
<td>47</td>
<td>42</td>
<td>43</td>
<td>36</td>
<td>35</td>
</tr>
<tr class="even">
<td>Disagree</td>
<td>34</td>
<td>41</td>
<td>38</td>
<td>39</td>
<td>35</td>
<td>39</td>
<td>37</td>
<td>34</td>
<td>40</td>
<td>31</td>
<td>40</td>
<td>36</td>
<td>36</td>
<td>35</td>
<td>37</td>
<td>36</td>
<td>38</td>
<td>46</td>
<td>42</td>
</tr>
<tr class="odd">
<td>Neither disagree or agree</td>
<td>10</td>
<td>10</td>
<td>9</td>
<td>14</td>
<td>6</td>
<td>13</td>
<td>11</td>
<td>10</td>
<td>11</td>
<td>13</td>
<td>10</td>
<td>17</td>
<td>9</td>
<td>14</td>
<td>7</td>
<td>11</td>
<td>8</td>
<td>10</td>
<td>12</td>
</tr>
<tr class="even">
<td>Agree</td>
<td>5</td>
<td>4</td>
<td>4</td>
<td>5</td>
<td>3</td>
<td>7</td>
<td>5</td>
<td>5</td>
<td>5</td>
<td>9</td>
<td>6</td>
<td>9</td>
<td>4</td>
<td>7</td>
<td>4</td>
<td>7</td>
<td>6</td>
<td>5</td>
<td>8</td>
</tr>
<tr class="odd">
<td>Strongly agree</td>
<td>7</td>
<td>5</td>
<td>5</td>
<td>5</td>
<td>6</td>
<td>4</td>
<td>6</td>
<td>7</td>
<td>5</td>
<td>7</td>
<td>3</td>
<td>6</td>
<td>4</td>
<td>4</td>
<td>4</td>
<td>5</td>
<td>4</td>
<td>3</td>
<td>3</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td colspan="4">(continued)</td>
</tr>
</tbody>
</table>

Table 3-11. Percentage of Participants Who Selected Each Response by
Evaluative Statement by Message (continued)

<table>
<colgroup>
<col style="width: 6%" />
<col style="width: 11%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 4%" />
</colgroup>
<thead>
<tr class="header">
<th colspan="2" rowspan="2"><strong>Evaluative Statements</strong></th>
<th colspan="33"><strong>Messages</strong></th>
</tr>
<tr class="odd">
<th><strong>1<br />
</strong>(n= 433)</th>
<th colspan="2"><strong>2<br />
</strong>(n= 424)</th>
<th colspan="2"><strong>3<br />
</strong>(n= 415)</th>
<th colspan="2"><strong>4<br />
</strong>(n= 407)</th>
<th colspan="2"><strong>5<br />
</strong>(n= 395)</th>
<th colspan="2"><strong>6<br />
</strong>(n= 423)</th>
<th><strong>7<br />
</strong>(n= 413)</th>
<th colspan="2"><strong>8<br />
</strong>(n= 424)</th>
<th colspan="2"><strong>9<br />
</strong>(n= 415)</th>
<th colspan="2"><strong>10<br />
</strong>(n= 428)</th>
<th colspan="2"><strong>11<br />
</strong>(n= 407)</th>
<th colspan="2"><strong>12<br />
</strong>(n= 422)</th>
<th><strong>13<br />
</strong>(n= 409)</th>
<th colspan="2"><strong>14<br />
</strong>(n= 413)</th>
<th colspan="2"><strong>15<br />
</strong>(n= 435)</th>
<th colspan="2"><strong>16<br />
</strong>(n= 411)</th>
<th colspan="2"><strong>17<br />
</strong>(n= 443)</th>
<th><strong>18<br />
</strong>(n= 222)</th>
<th><strong>19<br />
</strong>(n= 425)</th>
</tr>
</thead>
<tbody>
<tr class="odd">
<td rowspan="5"><blockquote>
<p>This message speaks to me.</p>
</blockquote></td>
<td>Strongly disagree</td>
<td>3</td>
<td colspan="2">4</td>
<td colspan="2">4</td>
<td colspan="2">4</td>
<td colspan="2">2</td>
<td colspan="2">6</td>
<td>4</td>
<td colspan="2">4</td>
<td colspan="2">6</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td colspan="2">10</td>
<td>5</td>
<td colspan="2">7</td>
<td colspan="2">3</td>
<td colspan="2">5</td>
<td colspan="2">5</td>
<td>2</td>
<td>10</td>
</tr>
<tr class="even">
<td>Disagree</td>
<td>7</td>
<td colspan="2">6</td>
<td colspan="2">7</td>
<td colspan="2">5</td>
<td colspan="2">3</td>
<td colspan="2">8</td>
<td>7</td>
<td colspan="2">6</td>
<td colspan="2">7</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td colspan="2">13</td>
<td>6</td>
<td colspan="2">12</td>
<td colspan="2">4</td>
<td colspan="2">4</td>
<td colspan="2">8</td>
<td>7</td>
<td>18</td>
</tr>
<tr class="odd">
<td>Neither disagree or agree</td>
<td>11</td>
<td colspan="2">11</td>
<td colspan="2">10</td>
<td colspan="2">14</td>
<td colspan="2">8</td>
<td colspan="2">19</td>
<td>11</td>
<td colspan="2">12</td>
<td colspan="2">17</td>
<td colspan="2">13</td>
<td colspan="2">12</td>
<td colspan="2">16</td>
<td>10</td>
<td colspan="2">13</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td colspan="2">15</td>
<td>13</td>
<td>18</td>
</tr>
<tr class="even">
<td>Agree</td>
<td>35</td>
<td colspan="2">41</td>
<td colspan="2">41</td>
<td colspan="2">45</td>
<td colspan="2">40</td>
<td colspan="2">40</td>
<td>40</td>
<td colspan="2">36</td>
<td colspan="2">43</td>
<td colspan="2">41</td>
<td colspan="2">36</td>
<td colspan="2">33</td>
<td>41</td>
<td colspan="2">37</td>
<td colspan="2">43</td>
<td colspan="2">47</td>
<td colspan="2">41</td>
<td>45</td>
<td>30</td>
</tr>
<tr class="odd">
<td>Strongly agree</td>
<td>43</td>
<td colspan="2">37</td>
<td colspan="2">39</td>
<td colspan="2">32</td>
<td colspan="2">47</td>
<td colspan="2">27</td>
<td>37</td>
<td colspan="2">42</td>
<td colspan="2">29</td>
<td colspan="2">30</td>
<td colspan="2">36</td>
<td colspan="2">28</td>
<td>38</td>
<td colspan="2">32</td>
<td colspan="2">42</td>
<td colspan="2">36</td>
<td colspan="2">31</td>
<td>34</td>
<td>23</td>
</tr>
<tr class="even">
<td rowspan="5"><blockquote>
<p>This message said something important to me.</p>
</blockquote></td>
<td>Strongly disagree</td>
<td>4</td>
<td colspan="2">3</td>
<td colspan="2">5</td>
<td colspan="2">3</td>
<td colspan="2">2</td>
<td colspan="2">5</td>
<td>3</td>
<td colspan="2">4</td>
<td colspan="2">4</td>
<td colspan="2">5</td>
<td colspan="2">5</td>
<td colspan="2">10</td>
<td>4</td>
<td colspan="2">6</td>
<td colspan="2">3</td>
<td colspan="2">3</td>
<td colspan="2">3</td>
<td>3</td>
<td>5</td>
</tr>
<tr class="odd">
<td>Disagree</td>
<td>4</td>
<td colspan="2">4</td>
<td colspan="2">5</td>
<td colspan="2">4</td>
<td colspan="2">2</td>
<td colspan="2">6</td>
<td>4</td>
<td colspan="2">5</td>
<td colspan="2">4</td>
<td colspan="2">7</td>
<td colspan="2">9</td>
<td colspan="2">13</td>
<td>4</td>
<td colspan="2">7</td>
<td colspan="2">3</td>
<td colspan="2">5</td>
<td colspan="2">3</td>
<td>5</td>
<td>13</td>
</tr>
<tr class="even">
<td>Neither disagree or agree</td>
<td>8</td>
<td colspan="2">9</td>
<td colspan="2">7</td>
<td colspan="2">9</td>
<td colspan="2">4</td>
<td colspan="2">11</td>
<td>7</td>
<td colspan="2">9</td>
<td colspan="2">11</td>
<td colspan="2">9</td>
<td colspan="2">10</td>
<td colspan="2">14</td>
<td>7</td>
<td colspan="2">11</td>
<td colspan="2">7</td>
<td colspan="2">7</td>
<td colspan="2">9</td>
<td>9</td>
<td>18</td>
</tr>
<tr class="odd">
<td>Agree</td>
<td>38</td>
<td colspan="2">41</td>
<td colspan="2">43</td>
<td colspan="2">45</td>
<td colspan="2">40</td>
<td colspan="2">45</td>
<td>40</td>
<td colspan="2">36</td>
<td colspan="2">44</td>
<td colspan="2">42</td>
<td colspan="2">35</td>
<td colspan="2">34</td>
<td>42</td>
<td colspan="2">37</td>
<td colspan="2">43</td>
<td colspan="2">46</td>
<td colspan="2">45</td>
<td>45</td>
<td>36</td>
</tr>
<tr class="even">
<td>Strongly agree</td>
<td>47</td>
<td colspan="2">43</td>
<td colspan="2">40</td>
<td colspan="2">39</td>
<td colspan="2">52</td>
<td colspan="2">33</td>
<td>46</td>
<td colspan="2">46</td>
<td colspan="2">36</td>
<td colspan="2">37</td>
<td colspan="2">40</td>
<td colspan="2">29</td>
<td>43</td>
<td colspan="2">40</td>
<td colspan="2">44</td>
<td colspan="2">39</td>
<td colspan="2">40</td>
<td>38</td>
<td>28</td>
</tr>
<tr class="odd">
<td rowspan="5"><blockquote>
<p>This message promotes<br />
a behavior that is<br />
difficult for me to do.</p>
</blockquote></td>
<td>Strongly disagree</td>
<td>41</td>
<td colspan="2">35</td>
<td colspan="2">36</td>
<td colspan="2">34</td>
<td colspan="2">44</td>
<td colspan="2">30</td>
<td>35</td>
<td colspan="2">39</td>
<td colspan="2">34</td>
<td colspan="2">36</td>
<td colspan="2">35</td>
<td colspan="2">30</td>
<td>35</td>
<td colspan="2">35</td>
<td colspan="2">40</td>
<td colspan="2">38</td>
<td colspan="2">38</td>
<td>33</td>
<td>33</td>
</tr>
<tr class="even">
<td>Disagree</td>
<td>34</td>
<td colspan="2">28</td>
<td colspan="2">31</td>
<td colspan="2">31</td>
<td colspan="2">34</td>
<td colspan="2">32</td>
<td>33</td>
<td colspan="2">31</td>
<td colspan="2">34</td>
<td colspan="2">34</td>
<td colspan="2">34</td>
<td colspan="2">31</td>
<td>30</td>
<td colspan="2">29</td>
<td colspan="2">33</td>
<td colspan="2">35</td>
<td colspan="2">38</td>
<td>36</td>
<td>30</td>
</tr>
<tr class="odd">
<td>Neither disagree or agree</td>
<td>12</td>
<td colspan="2">13</td>
<td colspan="2">9</td>
<td colspan="2">14</td>
<td colspan="2">10</td>
<td colspan="2">17</td>
<td>11</td>
<td colspan="2">13</td>
<td colspan="2">12</td>
<td colspan="2">14</td>
<td colspan="2">14</td>
<td colspan="2">20</td>
<td>13</td>
<td colspan="2">14</td>
<td colspan="2">11</td>
<td colspan="2">10</td>
<td colspan="2">10</td>
<td>13</td>
<td>15</td>
</tr>
<tr class="even">
<td>Agree</td>
<td>8</td>
<td colspan="2">15</td>
<td colspan="2">16</td>
<td colspan="2">13</td>
<td colspan="2">6</td>
<td colspan="2">15</td>
<td>13</td>
<td colspan="2">10</td>
<td colspan="2">13</td>
<td colspan="2">10</td>
<td colspan="2">10</td>
<td colspan="2">12</td>
<td>13</td>
<td colspan="2">14</td>
<td colspan="2">11</td>
<td colspan="2">10</td>
<td colspan="2">7</td>
<td>9</td>
<td>14</td>
</tr>
<tr class="odd">
<td>Strongly agree</td>
<td>6</td>
<td colspan="2">9</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td colspan="2">7</td>
<td colspan="2">6</td>
<td>8</td>
<td colspan="2">7</td>
<td colspan="2">6</td>
<td colspan="2">7</td>
<td colspan="2">7</td>
<td colspan="2">7</td>
<td>9</td>
<td colspan="2">8</td>
<td colspan="2">6</td>
<td colspan="2">6</td>
<td colspan="2">6</td>
<td>10</td>
<td>7</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3">(continued)</td>
</tr>
</tbody>
</table>

Table 3-11. Percentage of Participants Who Selected Each Response by
Evaluative Statement by Message (continued)

<table>
<colgroup>
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 9%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 4%" />
</colgroup>
<thead>
<tr class="header">
<th colspan="4" rowspan="2"><strong>Evaluative Statements</strong></th>
<th colspan="33"><strong>Messages</strong></th>
</tr>
<tr class="odd">
<th colspan="2"><strong>1<br />
</strong>(n= 433)</th>
<th><strong>2<br />
</strong>(n= 424)</th>
<th colspan="2"><strong>3<br />
</strong>(n= 415)</th>
<th colspan="2"><strong>4<br />
</strong>(n= 407)</th>
<th colspan="2"><strong>5<br />
</strong>(n= 395)</th>
<th colspan="2"><strong>6<br />
</strong>(n= 423)</th>
<th colspan="2"><strong>7<br />
</strong>(n= 413)</th>
<th><strong>8<br />
</strong>(n= 424)</th>
<th colspan="2"><strong>9<br />
</strong>(n= 415)</th>
<th colspan="2"><strong>10<br />
</strong>(n= 428)</th>
<th colspan="2"><strong>11<br />
</strong>(n= 407)</th>
<th colspan="2"><strong>12<br />
</strong>(n= 422)</th>
<th colspan="2"><strong>13<br />
</strong>(n= 409)</th>
<th><strong>14<br />
</strong>(n= 413)</th>
<th colspan="2"><strong>15<br />
</strong>(n= 435)</th>
<th colspan="2"><strong>16<br />
</strong>(n= 411)</th>
<th colspan="2"><strong>17<br />
</strong>(n= 443)</th>
<th><strong>18<br />
</strong>(n= 222)</th>
<th><strong>19<br />
</strong>(n= 425)</th>
</tr>
</thead>
<tbody>
<tr class="odd">
<td colspan="2" rowspan="5"><blockquote>
<p>I do not like this message.</p>
</blockquote></td>
<td colspan="2">Strongly disagree</td>
<td colspan="2">47</td>
<td>39</td>
<td colspan="2">40</td>
<td colspan="2">36</td>
<td colspan="2">54</td>
<td colspan="2">35</td>
<td colspan="2">42</td>
<td>42</td>
<td colspan="2">37</td>
<td colspan="2">39</td>
<td colspan="2">38</td>
<td colspan="2">32</td>
<td colspan="2">39</td>
<td>36</td>
<td colspan="2">47</td>
<td colspan="2">41</td>
<td colspan="2">37</td>
<td>35</td>
<td>29</td>
</tr>
<tr class="even">
<td colspan="2">Disagree</td>
<td colspan="2">30</td>
<td>36</td>
<td colspan="2">35</td>
<td colspan="2">36</td>
<td colspan="2">31</td>
<td colspan="2">35</td>
<td colspan="2">34</td>
<td>32</td>
<td colspan="2">35</td>
<td colspan="2">29</td>
<td colspan="2">33</td>
<td colspan="2">26</td>
<td colspan="2">34</td>
<td>30</td>
<td colspan="2">34</td>
<td colspan="2">37</td>
<td colspan="2">40</td>
<td>36</td>
<td>29</td>
</tr>
<tr class="odd">
<td colspan="2">Neither disagree or agree</td>
<td colspan="2">10</td>
<td>10</td>
<td colspan="2">12</td>
<td colspan="2">13</td>
<td colspan="2">10</td>
<td colspan="2">12</td>
<td colspan="2">11</td>
<td>14</td>
<td colspan="2">16</td>
<td colspan="2">14</td>
<td colspan="2">14</td>
<td colspan="2">18</td>
<td colspan="2">15</td>
<td>17</td>
<td colspan="2">11</td>
<td colspan="2">10</td>
<td colspan="2">14</td>
<td>15</td>
<td>18</td>
</tr>
<tr class="even">
<td colspan="2">Agree</td>
<td colspan="2">7</td>
<td>9</td>
<td colspan="2">7</td>
<td colspan="2">9</td>
<td colspan="2">2</td>
<td colspan="2">12</td>
<td colspan="2">8</td>
<td>7</td>
<td colspan="2">7</td>
<td colspan="2">9</td>
<td colspan="2">8</td>
<td colspan="2">12</td>
<td colspan="2">8</td>
<td>12</td>
<td colspan="2">6</td>
<td colspan="2">8</td>
<td colspan="2">5</td>
<td>10</td>
<td>16</td>
</tr>
<tr class="odd">
<td colspan="2">Strongly agree</td>
<td colspan="2">6</td>
<td>6</td>
<td colspan="2">5</td>
<td colspan="2">5</td>
<td colspan="2">3</td>
<td colspan="2">7</td>
<td colspan="2">4</td>
<td>7</td>
<td colspan="2">5</td>
<td colspan="2">9</td>
<td colspan="2">7</td>
<td colspan="2">12</td>
<td colspan="2">4</td>
<td>6</td>
<td colspan="2">2</td>
<td colspan="2">4</td>
<td colspan="2">3</td>
<td>4</td>
<td>8</td>
</tr>
<tr class="even">
<td colspan="2" rowspan="5"><blockquote>
<p>This message is very convincing.</p>
</blockquote></td>
<td colspan="2">Strongly disagree</td>
<td colspan="2">3</td>
<td>4</td>
<td colspan="2">5</td>
<td colspan="2">4</td>
<td colspan="2">2</td>
<td colspan="2">5</td>
<td colspan="2">4</td>
<td>2</td>
<td colspan="2">4</td>
<td colspan="2">6</td>
<td colspan="2">6</td>
<td colspan="2">9</td>
<td colspan="2">4</td>
<td>3</td>
<td colspan="2">3</td>
<td colspan="2">3</td>
<td colspan="2">4</td>
<td>4</td>
<td>7</td>
</tr>
<tr class="odd">
<td colspan="2">Disagree</td>
<td colspan="2">6</td>
<td>6</td>
<td colspan="2">7</td>
<td colspan="2">8</td>
<td colspan="2">4</td>
<td colspan="2">10</td>
<td colspan="2">7</td>
<td>5</td>
<td colspan="2">7</td>
<td colspan="2">9</td>
<td colspan="2">8</td>
<td colspan="2">13</td>
<td colspan="2">6</td>
<td>9</td>
<td colspan="2">5</td>
<td colspan="2">6</td>
<td colspan="2">6</td>
<td>8</td>
<td>13</td>
</tr>
<tr class="even">
<td colspan="2">Neither disagree or agree</td>
<td colspan="2">11</td>
<td>17</td>
<td colspan="2">15</td>
<td colspan="2">14</td>
<td colspan="2">8</td>
<td colspan="2">17</td>
<td colspan="2">12</td>
<td>13</td>
<td colspan="2">17</td>
<td colspan="2">14</td>
<td colspan="2">17</td>
<td colspan="2">23</td>
<td colspan="2">12</td>
<td>16</td>
<td colspan="2">14</td>
<td colspan="2">14</td>
<td colspan="2">12</td>
<td>13</td>
<td>20</td>
</tr>
<tr class="odd">
<td colspan="2">Agree</td>
<td colspan="2">43</td>
<td>38</td>
<td colspan="2">39</td>
<td colspan="2">44</td>
<td colspan="2">41</td>
<td colspan="2">41</td>
<td colspan="2">40</td>
<td>39</td>
<td colspan="2">42</td>
<td colspan="2">39</td>
<td colspan="2">37</td>
<td colspan="2">30</td>
<td colspan="2">41</td>
<td>39</td>
<td colspan="2">42</td>
<td colspan="2">45</td>
<td colspan="2">46</td>
<td>46</td>
<td>34</td>
</tr>
<tr class="even">
<td colspan="2">Strongly agree</td>
<td colspan="2">37</td>
<td>36</td>
<td colspan="2">35</td>
<td colspan="2">29</td>
<td colspan="2">45</td>
<td colspan="2">27</td>
<td colspan="2">37</td>
<td>40</td>
<td colspan="2">30</td>
<td colspan="2">32</td>
<td colspan="2">31</td>
<td colspan="2">24</td>
<td colspan="2">36</td>
<td>33</td>
<td colspan="2">36</td>
<td colspan="2">32</td>
<td colspan="2">32</td>
<td>29</td>
<td>26</td>
</tr>
<tr class="odd">
<td colspan="2" rowspan="5"><blockquote>
<p>This message would motivate HIV-positive persons to act in ways that
would prevent further transmission of HIV.</p>
</blockquote></td>
<td colspan="2">Strongly disagree</td>
<td colspan="2">4</td>
<td>5</td>
<td colspan="2">5</td>
<td colspan="2">5</td>
<td colspan="2">3</td>
<td colspan="2">7</td>
<td colspan="2">3</td>
<td>4</td>
<td colspan="2">5</td>
<td colspan="2">6</td>
<td colspan="2">8</td>
<td colspan="2">13</td>
<td colspan="2">4</td>
<td>5</td>
<td colspan="2">4</td>
<td colspan="2">3</td>
<td colspan="2">4</td>
<td>4</td>
<td>7</td>
</tr>
<tr class="even">
<td colspan="2">Disagree</td>
<td colspan="2">12</td>
<td>8</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td colspan="2">5</td>
<td colspan="2">9</td>
<td colspan="2">7</td>
<td>6</td>
<td colspan="2">6</td>
<td colspan="2">8</td>
<td colspan="2">10</td>
<td colspan="2">14</td>
<td colspan="2">8</td>
<td>11</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td>8</td>
<td>14</td>
</tr>
<tr class="odd">
<td colspan="2">Neither disagree or agree</td>
<td colspan="2">17</td>
<td>15</td>
<td colspan="2">12</td>
<td colspan="2">16</td>
<td colspan="2">10</td>
<td colspan="2">19</td>
<td colspan="2">14</td>
<td>12</td>
<td colspan="2">14</td>
<td colspan="2">9</td>
<td colspan="2">16</td>
<td colspan="2">20</td>
<td colspan="2">14</td>
<td>18</td>
<td colspan="2">19</td>
<td colspan="2">13</td>
<td colspan="2">12</td>
<td>15</td>
<td>18</td>
</tr>
<tr class="even">
<td colspan="2">Agree</td>
<td colspan="2">31</td>
<td>36</td>
<td colspan="2">37</td>
<td colspan="2">38</td>
<td colspan="2">40</td>
<td colspan="2">38</td>
<td colspan="2">35</td>
<td>35</td>
<td colspan="2">40</td>
<td colspan="2">39</td>
<td colspan="2">30</td>
<td colspan="2">29</td>
<td colspan="2">38</td>
<td>33</td>
<td colspan="2">34</td>
<td colspan="2">41</td>
<td colspan="2">40</td>
<td>39</td>
<td>33</td>
</tr>
<tr class="odd">
<td colspan="2">Strongly agree</td>
<td colspan="2">36</td>
<td>36</td>
<td colspan="2">38</td>
<td colspan="2">34</td>
<td colspan="2">42</td>
<td colspan="2">27</td>
<td colspan="2">41</td>
<td>43</td>
<td colspan="2">35</td>
<td colspan="2">37</td>
<td colspan="2">36</td>
<td colspan="2">25</td>
<td colspan="2">37</td>
<td>33</td>
<td colspan="2">34</td>
<td colspan="2">35</td>
<td colspan="2">36</td>
<td>34</td>
<td>27</td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3">(continued)</td>
</tr>
</tbody>
</table>

Table 3-11. Percentage of Participants Who Selected Each Response by
Evaluative Statement by Message (continued)

<table>
<colgroup>
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 4%" />
</colgroup>
<thead>
<tr class="header">
<th colspan="4" rowspan="2"><strong>Evaluative Statements</strong></th>
<th colspan="34"><strong>Messages</strong></th>
</tr>
<tr class="odd">
<th><strong>1<br />
</strong>(n= 433)</th>
<th colspan="2"><strong>2<br />
</strong>(n= 424)</th>
<th colspan="2"><strong>3<br />
</strong>(n= 415)</th>
<th colspan="2"><strong>4<br />
</strong>(n= 407)</th>
<th colspan="2"><strong>5<br />
</strong>(n= 395)</th>
<th colspan="2"><strong>6<br />
</strong>(n= 423)</th>
<th><strong>7<br />
</strong>(n= 413)</th>
<th colspan="2"><strong>8<br />
</strong>(n= 424)</th>
<th colspan="2"><strong>9<br />
</strong>(n= 415)</th>
<th colspan="2"><strong>10<br />
</strong>(n= 428)</th>
<th colspan="2"><strong>11<br />
</strong>(n= 407)</th>
<th colspan="2"><strong>12<br />
</strong>(n= 422)</th>
<th><strong>13<br />
</strong>(n= 409)</th>
<th colspan="2"><strong>14<br />
</strong>(n= 413)</th>
<th colspan="2"><strong>15<br />
</strong>(n= 435)</th>
<th colspan="2"><strong>16<br />
</strong>(n= 411)</th>
<th colspan="2"><strong>17<br />
</strong>(n= 443)</th>
<th colspan="2"><strong>18<br />
</strong>(n= 222)</th>
<th><strong>19<br />
</strong>(n= 425)</th>
</tr>
</thead>
<tbody>
<tr class="odd">
<td colspan="2" rowspan="5"><blockquote>
<p>This message contradicts what I know about HIV prevention.</p>
</blockquote></td>
<td colspan="2">Strongly disagree</td>
<td>41</td>
<td colspan="2">42</td>
<td colspan="2">41</td>
<td colspan="2">41</td>
<td colspan="2">45</td>
<td colspan="2">36</td>
<td>44</td>
<td colspan="2">45</td>
<td colspan="2">42</td>
<td colspan="2">40</td>
<td colspan="2">39</td>
<td colspan="2">28</td>
<td>42</td>
<td colspan="2">38</td>
<td colspan="2">41</td>
<td colspan="2">39</td>
<td colspan="2">39</td>
<td colspan="2">36</td>
<td>34</td>
</tr>
<tr class="even">
<td colspan="2">Disagree</td>
<td>35</td>
<td colspan="2">33</td>
<td colspan="2">39</td>
<td colspan="2">34</td>
<td colspan="2">32</td>
<td colspan="2">37</td>
<td>34</td>
<td colspan="2">32</td>
<td colspan="2">34</td>
<td colspan="2">33</td>
<td colspan="2">35</td>
<td colspan="2">32</td>
<td>33</td>
<td colspan="2">34</td>
<td colspan="2">34</td>
<td colspan="2">39</td>
<td colspan="2">37</td>
<td colspan="2">36</td>
<td>38</td>
</tr>
<tr class="odd">
<td colspan="2">Neither disagree or agree</td>
<td>11</td>
<td colspan="2">13</td>
<td colspan="2">11</td>
<td colspan="2">14</td>
<td colspan="2">10</td>
<td colspan="2">12</td>
<td>11</td>
<td colspan="2">10</td>
<td colspan="2">10</td>
<td colspan="2">13</td>
<td colspan="2">12</td>
<td colspan="2">20</td>
<td>11</td>
<td colspan="2">13</td>
<td colspan="2">12</td>
<td colspan="2">9</td>
<td colspan="2">12</td>
<td colspan="2">13</td>
<td>15</td>
</tr>
<tr class="even">
<td colspan="2">Agree</td>
<td>8</td>
<td colspan="2">7</td>
<td colspan="2">5</td>
<td colspan="2">8</td>
<td colspan="2">6</td>
<td colspan="2">9</td>
<td>4</td>
<td colspan="2">5</td>
<td colspan="2">7</td>
<td colspan="2">6</td>
<td colspan="2">7</td>
<td colspan="2">11</td>
<td>8</td>
<td colspan="2">8</td>
<td colspan="2">8</td>
<td colspan="2">7</td>
<td colspan="2">6</td>
<td colspan="2">9</td>
<td>8</td>
</tr>
<tr class="odd">
<td colspan="2">Strongly agree</td>
<td>6</td>
<td colspan="2">5</td>
<td colspan="2">4</td>
<td colspan="2">3</td>
<td colspan="2">6</td>
<td colspan="2">7</td>
<td>8</td>
<td colspan="2">7</td>
<td colspan="2">7</td>
<td colspan="2">8</td>
<td colspan="2">6</td>
<td colspan="2">9</td>
<td>6</td>
<td colspan="2">7</td>
<td colspan="2">4</td>
<td colspan="2">5</td>
<td colspan="2">6</td>
<td colspan="2">6</td>
<td>6</td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

[]{#__RefHeading___Toc125871038 .anchor}Table 3-12. Mean Message
Perceptions Scale Scores by Message by Segment

  ------------- ----------- ----------- -------------- ---------------- ----------- -------------- ---------------- ----------- --------------
                **MSM**                                **Heterosexual                              **Heterosexual               
                                                       Men**                                       Women**                      

  **Message**   **White**   **Black**   **Hispanic**   **White**        **Black**   **Hispanic**   **White**        **Black**   **Hispanic**

  1             3.72        4.09        4.06           3.86             3.99        4.19           3.89             4.17        4.06

  2             3.90        3.89        4.01           3.95             4.03        4.05           3.61             4.02        4.03

  3             3.79        3.93        4.21           4.09             3.94        4.02           4.21             4.06        3.87

  4             3.80        3.86        4.03           4.03             3.89        4.01           3.98             3.97        3.71

  5             4.24        4.21        4.28           3.96             4.20        4.26           4.25             4.29        4.23

  6             3.48        3.69        3.57           3.65             3.72        4.07           4.09             3.99        3.82

  7             3.68        4.09        3.78           4.00             4.14        3.96           4.29             4.14        4.13

  8             3.67        3.88        4.05           3.94             4.00        4.22           4.24             4.18        4.14

  9             3.65        3.87        3.93           3.83             3.91        4.20           4.01             3.96        3.94

  10            3.36        3.98        3.93           3.83             3.97        3.90           3.90             3.94        3.91

  11            3.56        3.83        3.70           3.61             3.87        4.07           3.94             4.03        4.22

  12            3.21        3.58        3.47           3.94             3.70        3.57           3.49             3.57        3.63

  13            3.58        3.93        3.92           3.84             4.05        3.98           4.15             4.01        4.43

  14            3.57        3.96        3.59           3.63             3.84        3.92           3.88             4.06        4.04

  15            4.05        4.11        4.12           4.11             4.11        4.24           4.01             4.06        3.95

  16            3.87        4.03        4.10           3.74             3.98        4.07           3.83             4.20        4.04

  17            3.90        4.12        3.97           3.76             3.99        4.14           4.03             4.04        3.97

  18            N/A         N/A         N/A            N/A              N/A         N/A            3.86             4.01        3.94

  19            3.16        3.75        3.56           3.47             3.85        3.95           N/A              N/A         N/A
  ------------- ----------- ----------- -------------- ---------------- ----------- -------------- ---------------- ----------- --------------

[]{#__RefHeading___Toc125871039 .anchor}Table 3-13. Regression Model
Predicting Perceptions of Message 6 (Abstinence)

+------------------------------------+-------+-------+-------+-------+
| **Variable**                       | **B** | *     | **β** | **p** |
|                                    |       | *SE** |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Demographics**                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Age                              | 0.00  | 0.01  | 0.02  | .6487 |
+------------------------------------+-------+-------+-------+-------+
| > Gender                           |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Male                             | -     | 0.10  | -     | **.0  |
|                                    | -0.22 |       | -0.13 | 310** |
+------------------------------------+-------+-------+-------+-------+
| > Female                           | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Race/ethnicity                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > White                            | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > African American                 | 0.15  | 0.10  | 0.10  | .1154 |
+------------------------------------+-------+-------+-------+-------+
| > Hispanic                         | 0.16  | 0.11  | 0.09  | .1441 |
+------------------------------------+-------+-------+-------+-------+
| > Other race/ethnicity             | 0.23  | 0.17  | 0.07  | .1785 |
+------------------------------------+-------+-------+-------+-------+
| > Sexual orientation               |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Gay/bisexual                     | -     | 0.09  | -     | .1722 |
|                                    | -0.13 |       | -0.08 |       |
+------------------------------------+-------+-------+-------+-------+
| > Heterosexual                     | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Sexual Behaviors**               |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Number of partners               | -     | 0.00  | -     | **.0  |
|                                    | -0.00 |       | -0.13 | 171** |
+------------------------------------+-------+-------+-------+-------+
| > How often go to parties, bars,   | -     | 0.03  | -     | **.0  |
| > etc. where people are using      | -0.08 |       | -0.14 | 078** |
| > drugs or alcohol and having sex  |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Main partner's HIV status        |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Positive                         | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Negative                         | -     | 0.11  | -     | .0540 |
|                                    | -0.21 |       | -0.11 |       |
+------------------------------------+-------+-------+-------+-------+
| > Unknown/no main partner          | 0.04  | 0.09  | 0.03  | .6512 |
+------------------------------------+-------+-------+-------+-------+
| > Condom use in past 30 days       |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Used condom                      | 0.27  | 0.14  | 0.18  | .0560 |
+------------------------------------+-------+-------+-------+-------+
| > Did not use condom               | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > No sex in past 30 days           | 0.15  | 0.14  | 0.09  | .3139 |
+------------------------------------+-------+-------+-------+-------+
| **Attitudes and Beliefs**          |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > It is my responsibility to       | 0.03  | 0.03  | 0.06  | .2378 |
| > protect others from getting HIV. |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Because of new treatments for    | -     | 0.03  | -     | **.0  |
| > HIV, I'm less concerned about    | -0.06 |       | -0.10 | 464** |
| > infecting someone else.          |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Trust in CDC as source of        | 0.05  | 0.01  | 0.17  | **.0  |
| > information.                     |       |       |       | 010** |
+------------------------------------+-------+-------+-------+-------+
| > Understanding of safer sex       | 0.11  | 0.05  | 0.12  | **.0  |
| > strategies.                      |       |       |       | 230** |
+------------------------------------+-------+-------+-------+-------+

Note: N = 361; R^2^ = 0.20; Adjusted R^2^ = 0.17.

[]{#__RefHeading___Toc125871040 .anchor}Table 3-14. Regression Model
Predicting Perceptions of Message 11 (Monogamy)

+------------------------------------+-------+-------+-------+-------+
| **Variable**                       | **B** | *     | **β** | **p** |
|                                    |       | *SE** |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Demographics**                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Age                              | 0.01  | 0.01  | 0.05  | .3733 |
+------------------------------------+-------+-------+-------+-------+
| > Gender                           |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Male                             | -     | 0.10  | -     | **.0  |
|                                    | -0.27 |       | -0.16 | 095** |
+------------------------------------+-------+-------+-------+-------+
| > Female                           | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Race/ethnicity                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > White                            | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > African American                 | 0.20  | 0.11  | 0.12  | .0574 |
+------------------------------------+-------+-------+-------+-------+
| > Hispanic                         | 0.26  | 0.12  | 0.13  | **.0  |
|                                    |       |       |       | 376** |
+------------------------------------+-------+-------+-------+-------+
| > Other race/ethnicity             | 0.41  | 0.20  | 0.12  | **.0  |
|                                    |       |       |       | 364** |
+------------------------------------+-------+-------+-------+-------+
| Sexual orientation                 |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Gay/bisexual                     | -     | 0.11  | -     | .6970 |
|                                    | -0.04 |       | -0.02 |       |
+------------------------------------+-------+-------+-------+-------+
| > Heterosexual                     | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Sexual Behaviors**               |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Number of partners               | -     | 0.00  | -     | **.0  |
|                                    | -0.00 |       | -0.12 | 272** |
+------------------------------------+-------+-------+-------+-------+
| **Attitudes and Beliefs**          |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > It is my responsibility to       | 0.07  | 0.03  | 0.12  | **.0  |
| > protect others from getting HIV. |       |       |       | 238** |
+------------------------------------+-------+-------+-------+-------+
| > Because of new treatments for    | -     | 0.03  | -     | .3894 |
| > HIV, I'm less concerned about    | -0.03 |       | -0.04 |       |
| > infecting someone else.          |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Trust in CDC as source of        | 0.06  | 0.02  | 0.19  | **.0  |
| > information.                     |       |       |       | 005** |
+------------------------------------+-------+-------+-------+-------+

Note: N = 345; R^2^ = 0.14; Adjusted R^2^ = 0.11.

***Negative Perceptions.*** Being male and having more partners in the
past year were associated with having a negative perception of the
message.

#### Condoms (Message 8)

***Positive Perceptions.*** Being older, Hispanic (compared with white),
feeling more responsibility to protect others from getting HIV, having
greater trust in CDC as a source of information, having a greater
understanding of safer sex strategies, using a condom in the past 30
days, or having no sex in the past 30 days (compared with having sex
without a condom) were associated with having a positive perception of
the message (see Table 3-15).

***Negative Perceptions.*** Being male and being less concerned about
infecting someone else because of new treatments for HIV were associated
with having a negative perception of the message.

[]{#__RefHeading___Toc125871041 .anchor}Table 3-15. Regression Model
Predicting Perceptions of Message 8 (Condoms)

+------------------------------------+-------+-------+-------+-------+
| **Variable**                       | **B** | *     | **β** | **p** |
|                                    |       | *SE** |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Demographics**                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Age                              | 0.01  | 0.00  | 0.13  | **.0  |
|                                    |       |       |       | 097** |
+------------------------------------+-------+-------+-------+-------+
| > Gender                           |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Male                             | -     | 0.09  | -     | *     |
|                                    | -0.39 |       | -0.24 | *\<.0 |
|                                    |       |       |       | 001** |
+------------------------------------+-------+-------+-------+-------+
| > Female                           | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Race/ethnicity                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > White                            | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > African American                 | 0.08  | 0.09  | 0.05  | .4127 |
+------------------------------------+-------+-------+-------+-------+
| > Hispanic                         | 0.20  | 0.10  | 0.12  | **.0  |
|                                    |       |       |       | 438** |
+------------------------------------+-------+-------+-------+-------+
| > Other race/ethnicity             | 0.18  | 0.18  | 0.05  | .3238 |
+------------------------------------+-------+-------+-------+-------+
| Sexual orientation                 |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Gay/bisexual                     | -     | 0.09  | -     | .4060 |
|                                    | -0.07 |       | -0.05 |       |
+------------------------------------+-------+-------+-------+-------+
| > Heterosexual                     | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Sexual Behaviors**               |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Condom use in past 30 days       |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Used condom                      | 0.24  | 0.13  | 0.16  | .0691 |
+------------------------------------+-------+-------+-------+-------+
| > Did not use condom               | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > No sex in past 30 days           | 0.26  | 0.13  | 0.17  | .0536 |
+------------------------------------+-------+-------+-------+-------+
| **Attitudes and Beliefs**          |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > It is my responsibility to       | 0.09  | 0.03  | 0.16  | **.0  |
| > protect others from getting HIV. |       |       |       | 013** |
+------------------------------------+-------+-------+-------+-------+
| > Because of new treatments for    | -     | 0.03  | -     | *     |
| > HIV, I'm less concerned about    | -0.18 |       | -0.28 | *\<.0 |
| > infecting someone else.          |       |       |       | 001** |
+------------------------------------+-------+-------+-------+-------+
| > Trust in CDC as source of        | 0.05  | 0.01  | 0.16  | **.0  |
| > information.                     |       |       |       | 011** |
+------------------------------------+-------+-------+-------+-------+
| > Understanding of safer sex       | 0.09  | 0.04  | 0.10  | **.0  |
| > strategies.                      |       |       |       | 500** |
+------------------------------------+-------+-------+-------+-------+

Note: N = 353; R^2^ = 0.25; Adjusted R^2^ = 0.22.

#### Disclosure to Partners (Message 3)

***Positive Perceptions.*** Feeling more responsibility to protect
others from getting HIV, feeling more personal responsibility for one's
own HIV infection, and having greater trust in CDC as a source of
information were associated with having a positive perception of the
message (see Table 3-16).

***Negative Perceptions.*** Being male, being less concerned about
infecting someone else because of new treatments for HIV, and having
more partners in the past year were associated with having a negative
perception of the message.

[]{#__RefHeading___Toc125871042 .anchor}Table 3-16. Regression Model
Predicting Perceptions of Message 3 (Disclosure to Partners)

+------------------------------------+-------+-------+-------+-------+
| **Variable**                       | **B** | *     | **β** | **p** |
|                                    |       | *SE** |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Demographics**                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Age                              | 0.01  | 0.01  | 0.05  | .3252 |
+------------------------------------+-------+-------+-------+-------+
| > Gender                           |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Male                             | -     | 0.10  | -     | **.0  |
|                                    | -0.21 |       | -0.12 | 441** |
+------------------------------------+-------+-------+-------+-------+
| > Female                           | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Race/ethnicity                   |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > White                            | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > African American                 | -     | 0.10  | -     | .8059 |
|                                    | -0.02 |       | -0.02 |       |
+------------------------------------+-------+-------+-------+-------+
| > Hispanic                         | 0.00  | 0.11  | 0.00  | .9956 |
+------------------------------------+-------+-------+-------+-------+
| > Other race/ethnicity             | -     | 0.19  | -     | .1912 |
|                                    | -0.25 |       | -0.07 |       |
+------------------------------------+-------+-------+-------+-------+
| Sexual orientation                 |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Gay/bisexual                     | 0.07  | 0.10  | 0.04  | .4702 |
+------------------------------------+-------+-------+-------+-------+
| > Heterosexual                     | REF   |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| **Sexual Behaviors**               |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Number of partners               | --    | 0.002 | -     | **.0  |
|                                    | 0.004 |       | -0.11 | 353** |
+------------------------------------+-------+-------+-------+-------+
| **Attitudes and Beliefs**          |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > It is my responsibility to       | 0.06  | 0.03  | 0.11  | **.0  |
| > protect others from getting HIV. |       |       |       | 373** |
+------------------------------------+-------+-------+-------+-------+
| > Because of new treatments for    | -     | 0.04  | -     | **.0  |
| > HIV, I'm less concerned about    | -0.12 |       | -0.17 | 009** |
| > infecting someone else.          |       |       |       |       |
+------------------------------------+-------+-------+-------+-------+
| > Feel personally responsible for  | 0.05  | 0.02  | 0.14  | **.0  |
| > your HIV infection.              |       |       |       | 085** |
+------------------------------------+-------+-------+-------+-------+
| > Trust in CDC as source of        | 0.05  | 0.02  | 0.15  | **.0  |
| > information.                     |       |       |       | 037** |
+------------------------------------+-------+-------+-------+-------+

Note: N = 352; R^2^ = 0.14; Adjusted R^2^ = 0.11.

# 

# Section 4 Conclusions and Recommendations

## Conclusions

We began this project by conducting a set of IGGs with HIV-prevention
experts and HIV-positive individuals to produce a comprehensive list of
prevention strategies that could be promoted for HIV-positive persons
and persuasive arguments for these strategies. Based on the information
gained through Phase I, CDC and RTI collaboratively finalized 69
potential message concepts for screening in Phase II. Phase II involved
screening the 69 potiental message concepts in FGs and semistructured
interviews with HIV-positive individuals. From both the qualitative data
and informal quantitative analysis (sorting task results), CDC and RTI
collaboratively worked to reduce the 69 message concepts screened in
Phase II to 19 message concepts that were quantitatively evaluated by
HIV-positive individuals in Phase III.

Overall, participants had more positive than negative perceptions of the
19 messages evaluated in Phase III, suggesting that the process of
message development, screening, and evaluation followed in this project
was successful. We did find that some of the messages were perceived
more positively than others. For example, Message 5, with its empowering
message, "Knowledge is power. There is always something more to know
about HIV. Keep educating yourself about HIV, its treatment, and new
developments in HIV research. Use your knowledge to take care of your
health and to work with your health care providers so you can lead a
longer, healthier life" was the message most positively received by
Phase III participants. Message 15, promoting social support, "Reach out
to the people who care about you and support you. A strong support
system will help you live a healthy HIV-positive life," was also well
received by participants.

On the other hand, Message 12, which promoted seroconcordant
relationships, "Be with someone who understands. Many times it is easier
to relate to a partner who knows what it's like to have HIV. Be with an
HIV-positive partner and have a more understanding relationship,"
received more negative reactions compared with the other messages
evaluated in Phase III. Message 19, which was only evaluated by male
participants, cautioned participants to avoid group sex situations,
"Don't get caught up in the crowd. Group sex situations are hard to
predict and you don't know what you could be getting yourself into. Stay
out of group sex and stay healthy." This message was also one that
received more negative reactions compared with other messages evaluated
during Phase III.

Interestingly, we found that when we analyzed perceptions of the
messages in a multivariate framework, sociodemographics and sexual
orientation played less of a role than sexual behaviors and/or attitudes
and beliefs for some messages. For example, for Message 6, "Wait! Do not
have sex until you know all you need to know about HIV and your partner.
What you don't know CAN hurt you and your partner," number of partners,
frequenting parties or bars where people mix drugs, alcohol and sex,
treatment optimism, trust in CDC as a source of information, and
understanding of safer sex strategies were all significant predictors of
message perception whereas gender was the only sociodemographic
predictor. Similarly, for Message 3, "Tell all your partners that you
have HIV before you have sex. Don't you wish you had been told?," number
of partners, personal responsibility for protecting others, treatment
optimism, feeling personally responsible for one's own HIV infection,
and trust in CDC as an information source were all signficiant
predictors of message perception while gender was the only
sociodemographic predictor.

## Recommendations

The findings presented in this report provide the groundwork for the
next logicial step---to take the core message ideas developed and tested
in this project and refine them for eventual use in social marketing or
health communication campaigns targeting HIV-positive individuals.

Results from this study provide insights into message concepts that seem
to resonate with HIV-positive individuals. Furthermore, the results
suggest that certain message concepts may be more appealing to different
subgroups of HIV-positive individuals who differ by sexual orientation
and/or race/ethnicity while others seem to appeal to HIV-positive
individuals regardless of sociodemographics or sexual orientation, but
that sexual behaviors and/or attitudes and beliefs play a more important
role in message acceptance. These findings should be taken into
consideration when defining the target audience for a social marketing
or health communication campaign that incorporates message concepts.

The message concepts tested in the current study were presented to
participants as plain text. We recommend that the next step involve
working with a creative team to further develop the "raw" message
concepts into professionally designed advertisements (print, outdoor,
radio, television). The advertisements would then need to be further
tested with the target audience before being launched as elements of a
campaign.

# Section 5 Lessons Learned

In this section we report lessons learned during both the recruitment
and the data collection processes.

## 5.1 Lessons Learned from Recruiting

The following list includes some of the tips that proved to be most
helpful for Phase III:

-   **Working with subcontractors who have specific expertise in
    recruiting the target populations for our study was an effective
    strategy.** Working with local coordinators who specialize in
    recruiting Hispanics proved to be as effective as working with local
    coordinators who had HIV expertise. By working with such
    organizations, we were able to increase the percentage of
    respondents who were Hispanic.

-   **Recruiting centrally from one location (THG in San Francisco) and
    coordinating with local organizations (the specific research
    agencies in each market) proved to be very effective.** Although we
    recruited for previous phases in this same manner, it proved
    incredibly effective in Phase III, where THG's core staff could
    focus on whatever city might be having difficulty at the moment,
    thereby allowing all cities to be successfully recruited.

-   **Recruiting within a compressed timeline is possible.** The
    timeline in which we recruited for Phase III was much shorter than
    in previous phases. This was only possible because the THG core
    staff were trained and began recruiting before we finalized
    arrangements with other local facilities in each market.

-   **The use of online recruiting resources---especially those geared
    toward HIV-positive populations---proved very effective.** However,
    it was important to have an online presence with a number of
    entities and not just one. For instance, using *POZ* magazine's site
    was effective in generating inbound calls, but many of those calls
    were from older (over age 40) respondents. It was possible to locate
    some online "umbrella" organizations (such as
    [www.HIV-AIDS-POZ.com](http://www.HIV-AIDS-POZ.com/)), which allowed
    us to have a presence on many different sites at the same time.

-   **The inability to proactively approach people online affected our
    ability to recruit.** We were only granted IRB approval to passively
    monitor chat rooms, and we were not able to e-mail potential
    respondents based on information in their profiles (which often
    listed ethnicity, HIV status, and age**---**many of the attributes
    we were recruiting for). The ability to have actively recruited
    through chat rooms may have been a better way to reach some of these
    populations. However, having *POZ* magazine send a targeted e-mail
    to young men and women in their personal database (a relatively new
    service while we were recruiting) proved to be very ineffective.

-   **Other online sites centering around dating were very effective.**
    We were able to identify a number of online sites whose sole purpose
    was to serve as a matchmaking tool for people who are HIV positive.
    Using these sites proved to be very effective in recruiting
    HIV-positive heterosexuals. Some of these were just locally focused,
    such as Positive Connections in south Florida.

-   **Recruiting non-African American HIV-positive heterosexuals is much
    more difficult than recruiting African-American HIV-positive
    heterosexuals.** Developing clearly defined recruiting materials
    (which would have allowed us to say upfront what ethnicities we were
    looking for) would be an effective way of targeting these
    populations.

-   **Recruiting very young (under 30 years of age) HIV-positive
    heterosexuals (as well as MSM) also proved to be very difficult.**
    Again, having targeted materials would have better allowed us to
    look for these populations.

-   **Being very clear about what specific materials respondents needed
    to bring as proof of HIV status was necessary.** It also proved
    necessary to tell respondents what materials *would not* be
    acceptable as proof of HIV status. Several respondents arrived at
    the interview site with laboratory reports that were difficult for
    onsite staff to interpret.

-   **Greeters needed to be vigilant for those respondents trying to
    "scam" the system.** Although rare, we did have instances in which
    the same person attempted to show up for two separate appointments.

-   **Word of mouth from those who had already participated was an
    effective way to generate some additional same-day recruits.**
    Having recruiting staff available on those days to conduct screening
    was necessary.

## 5.2 Lessons Learned from Data Collection

The lessons learned from the earlier phase of this project proved to be
helpful in guiding our efforts for Phase III. The following list
includes some of the tips that proved to be most helpful for Phase III
and a few additional new lessons.

-   **Using traveling interviewers provides efficiencies.** Using a
    field staff of traveling interviewers proved to be an efficient
    alternative to having a staff of 30+ "local" interviewers. Increases
    in travel costs were offset by decreases in training and supervision
    costs. For Phase III, we hired a team of nine field staff (instead
    of six), which ensured that extra staff were always available in the
    case of last minute emergencies.

-   **Field staff from separate teams can be combined.** Because
    training was standardized between the two teams, individual team
    members from Team 1 were able to work with individual members from
    Team 2, as needed.

-   **Providing a diagram to the sites and the interviewers provided
    clear expectations for the layout of the production room.** Sites
    were better prepared in terms of room logistics when site
    coordinators had the diagram in advance.

-   **Some participants shortcut the interview.** Team members must be
    alert to participants who are not taking the study seriously. A
    couple participants rushed through the interview in 15 minutes or
    less. Interviewers documented these cases using problem forms.

-   **Problem forms again proved to be useful for capturing information
    about technical problems, procedural problems, and unexpected
    situations.** The forms were a good resource for the daily telephone
    conference and provided useful information for project management
    and CDC.

-   **Only one staff member should be allowed to assign case IDs at a
    time**. Even if this caused some delay and participants needed to
    wait in the lobby, it was a very important step to follow to avoid
    errors in assigning case IDs.

-   **A ratio of two field staff to six computer stations or three field
    staff to eight computer stations is manageable.** Two field staff
    can provide adequate coverage for six computer stations; this ratio
    was employed in most of the cities. In New York, we used a ratio of
    three field staff to eight computer stations, and that ratio also
    worked well.

-   **Entering numbers was the most difficult part of the ACASI
    interview for participants.** For Phase III, we added a verification
    screen after numerical questions that verified that the participant
    had entered the intended number. This eliminated the problem of
    respondents getting kicked out of the study because they entered an
    age that was too young.

-   **Field visits by data collection staff provided an important
    quality control step.** It was helpful to have data collection staff
    present at the first few data collection sites for each team so that
    data collection staff could verify that the team knew how to set up
    the site correctly, model the role of technical support with "live"
    participants, demonstrate how to problem solve with facility staff,
    be on hand to answer questions regarding the adequacy of the
    respondent's proof of HIV status, and verify that all data
    collection procedures were followed correctly.

-   **Respondents need explicit guidelines regarding adequate proof of
    HIV status.** Respondents sometimes brought in inadequate proof of
    HIV status, such as lab results for hepatitis tests or individual
    unlabeled pills. In addition, some respondents completely forgot
    that they needed to bring proof of their status. When this occurred,
    the field staff asked the respondent to have their doctor fax
    additional proof to the facility. Doctors were often reluctant to
    provide a specific letter regarding their status but were typically
    willing to fax a list of prescription medications. All such notes
    were given to the respondent or shredded after they were reviewed by
    the field staff.

-   **A visual add identifying the appearance of all HIV pills could
    have been helpful.** Some respondents brought in individual
    unlabeled pills as proof of their HIV status. Field staff were
    unable to accept this as proof of their HIV status because they did
    not have any documentation on the appearance of the various HIV
    drugs.

# References

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Centers for Disease Control and Prevention (CDC). (2003, April 18).
Advancing HIV prevention: New strategies for a changing
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Ciccarone, D. H., Kanouse, D. E., Collins, R. L., Miu, A., Chen, J. L.,
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DiClemente, R. J., Wingood, G. M., Del Rio, C., & Crosby, R. A. (2002).
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Transmitted Infections*, *78*, 393-395.

Gorbach, P. M., Aman, B., Shin, A., Fernandez-Ortega, C., Celum, C.,
Handsfield, H., & Golden, M. (2004). Don't ask, don't tell: Patterns of
HIV disclosure among HIV positive men who have sex with men (MSM)
practicing high risk behavior in Los Angeles and Seattle. *Sexually
Transmitted Infections*, *80*(6), 512-517.

Janssen, R. S., Holtgrave, D. R., Valdiserri, R. O., Shepherd, M.,
Gayle, H. D., & De Cock, K. M. (2001). The serostatus approach to
fighting the HIV epidemic: Prevention strategies for infected
individuals. *American Journal of Public Health*, *91*(7), 1019-1024.

Kaiser Family Foundation. (2005a, June 16). *Across the
nation \| crystal meth use fuels rise in HIV cases among white MSM;
'down low' term should apply to all races, studies say*. Retrieved June
22, 2005, from [http://www.kaisernetwork.org/daily_reports/\
rep_index.cfm?DR_ID=30788](http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=30788).

Kaiser Family Foundation. (2005b, June 15). *Across the
nation \| HIV-positive U.S. women more concentrated in south, among
minorities, CDC says*. Retrieved June 22, 2005, from
<http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=30762>.

Kaiser Family Foundation. (2005c, June 16). *Opinion \| Kaiser daily
HIV/AIDS report summarizes opinion pieces on CDC announcement that 1M
HIV-positive people live in U.S*. Retrieved June 22, 2005, from
[http://www.kaisernetwork.org/daily_reports/\
rep_index.cfm?DR_ID=30794](http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=30794).

Kalichman, S. C., Rompa, D., Cage, M., DiFonzo, K., Simpson, D., Austin,
J., Luke, W., Buckles, J., Kyomugisha, F., Benotsch, E., Pinkerton, S.,
& Graham, J. (2001). Effectiveness of an intervention to reduce HIV
transmission risks in HIV-positive people. *American Journal Preventive
Medicine*, *21*(2), 84-92

Rotheram-Borus, M. J., Lee, M. B., Murphy, D. A., Futterman, D., Duan,
N., Birnbaum, J. M., & Lightfoot, M. (2001). Efficacy of a preventive
intervention for youths living with HIV. *American Journal of Public
Health*, *91*, 400-405.

Wilson, T. E., Gore, M. E., Greenblatt, R., Cohen, M., Minkoff, H.,
Silver, S., Robison, E., Levine, A., & Gange, S. J. (2004). Changes in
sexual behavior among HIV-infected women after initiation of HAART.
*American Journal of Public Health*, *94*, 1141-1146.

[]{.mark}

[]{.mark}

[]{.mark}

# Appendix A: Final Survey Instrument

**PHASE III INSTRUMENT**

Final Version: 2/10/05

Staff completed items:

\_\_\_\_ Participant ID# (enter twice)

\_\_\_\_ Participant ID \#

\_\_\_\_ Staff ID#

\_\_\_\_ City code

Automatic variables that will be added in ACASI program:

Date of Interview

Start Time

End Time

String variables for behavior

Study "arm" (order of presentation of message concepts) assigned to
(found in ID)

Within programming, let participants answer before everything is read by
ACASI AND ORIENT THEM on HOW TO REFUSE TO ANSWER.

[First screen]{.underline}

Thank you for agreeing to be in our research study today. We will now
ask you a series of questions, and this will take about one hour. Again,
let us remind you that your answers will be kept private. You have the
right to refuse to answer any question. If you do not recall an exact
answer or you are not quite sure how to respond, we would like your best
guess. Please feel free to ask your host any questions before you get
started or during the interview.

We will be using the computer to ask you a number of questions. Before
starting, you need to understand a few things about the computer. We
will be asking you different types of questions, and they all require
that you use your mouse to click on buttons on the screen. Click on the
continue button to go to the next screen.

[Next screen]{.underline}

Across the top of every screen, you will see four buttons.

Click on the BACK UP button to go to the previous question to change an
answer.

Click on the DON'T KNOW button if you don't know the answer to a
question

Click on the REFUSE button if you choose not to answer a particular
question

Click on the REPLAY button to listen to the audio for a question again

Click to continue.

[Next screen]{.underline}

Some of the questions will ask you to answer either YES or NO. For
example,

Are you wearing blue today? Please use your mouse to click on YES or NO.

Yes G

No G

Refuse to answer G

[Next screen]{.underline}

Some questions will ask you to pick an answer from the list. For
example,

> **How much do you agree or disagree with the following statement: Blue
> is my favorite color?**

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

[Next screen]{.underline}

Some questions will allow you to select more than one answer.

> **What kind of music do you listen to?** Click on the buttons to
> select as many answers as you like. When you are done with your
> selection, click on the button in the lower right corner to continue.

Country G

Soul/R&B G

Jazz G

Classical G

Pop/Rock G

Hip Hop G

Techno G

Folk/Ethnic G

[Next screen]{.underline}

If the list is long, and we come to your answer before the end, you can
interrupt the voice and put your answer in as soon as you decide what it
is.

Try doing this on the next question. Click on an answer button while the
list is being read.

**When do you want to interrupt this list?**

First answer,

Second answer,

Third answer,

Fourth answer,

Fifth answer,

Sixth answer,

Seventh answer,

Eighth answer

[Next screen]{.underline}

Some questions will require that you enter numbers as your answer. For
those questions, you will click on the number buttons for your
responses. After entering your response, you will have to press the
large black button that says "ENTER" to move to the next question. Here
is a practice question:

> **In the past 30 days, on how many days did you eat breakfast?** Use
> the mouse to click on the numbers on the keypad, then click on the
> black button that says "ENTER" to continue.

[Next screen]{.underline}

Some questions will ask you to enter a specific date. To enter a date,
click on the number pad on the screen. We will ask you to include only
the month and year. For example, March 2004 would be entered as 032004.

> **Practice entering a date now.** Use the number pad on the screen to
> enter the month and year for today's date. Then click on the "ENTER"
> button to go to the next screen.

  ---------- ---------- ----------- ---------- ---------- ---------- --------
                                                                     

  Month                             Year                             
  ---------- ---------- ----------- ---------- ---------- ---------- --------

[Next screen]{.underline}

That concludes the practice questions. The interviewer will allow you to
complete the study in private. The interviewer will not know either the
question or your answer. When you are ready to hear the next question,
click on the continue button.

The first few questions ask for some basic information about you.

1\. How old are you?

  ----------------------------------- -----------------------------------
                                      

  ----------------------------------- -----------------------------------

Refuse to answer G

**Note:** If under 18 or if "Refuse to answer"/"dk" stop interview and
skip to screen out pattern. Flag as ineligible for both.

For *refuse to answer/dk* participants:  Based on your answer, this
study may not be right for you. Please check with the host.

 

For those participants who enter *age \< 18*:  Based on your answer,
this study is not right for you. Please check with the host.

the host can be responsible for explaining to the participant why this
screen appears.

CONFIRMATION BOX AFTER RESPONSES THAT USE KEYPAD

2\. What is your gender?

Male G

Female G

Refuse to answer G

3\. Are you Hispanic/Latino/Chicano?

Yes G

No G

Don't know G

Refuse to answer G

4\. What are [ALL]{.underline} the categories that describe your racial
background? Click on all that apply.

American Indian or Alaskan Native G

Asian G

Black or African American G

Native Hawaiian or Other Pacific Islander G

White G

Other G

None G

Refuse to answer G

5\. Which category [BEST]{.underline} describes how you identify
yourself? Click on only one.

American Indian or Alaskan Native G

Asian G

Black or African American G

Hispanic or Latino or Chicano G

Native Hawaiian or Other Pacific Islander G

White G

Other G

Refuse to answer G

6\. Which category best describes your educational background?

Did not complete high school G

High school diploma or GED G

Some college or associates degree G

Bachelors degree G

Masters, doctoral, or other professional degree (e.g., M.A., Ph.D.,
M.D., J.D.) G

Refuse to answer G

7\. Which do you consider yourself to be?

Straight, heterosexual G

Gay, homosexual G

Bisexual G

None of the above / unsure G

Refuse to answer G

The next few questions are about being tested for HIV and your viral
load.

8\. What month and year did you get your first positive test for HIV?

  ----------- ----------- ---- ---------- ---------- ---------- ----------
                                                                

  Month                        Year                             
  ----------- ----------- ---- ---------- ---------- ---------- ----------

Refuse to answer G

IF THE RESPONDENT ENTERS A YEAR PRIOR TO 1985: "THIS TEST WAS NOT
AVAILABLE BEFORE 1985. PLEASE ENTER A YEAR THAT IS BETWEEN 1985 -- 2005.
CLICK ON THE CONTINUE BUTTON TO RETURN TO THIS QUESTION." DISALLOW DATES
IN THE FUTURE.

9\. Have you ever been diagnosed with AIDS?

Yes G

No G

Don't know G

Refuse to answer G

10\. Have you ever had a VIRAL LOAD test?

Yes G

No G

Refuse to answer G

11\. Are you taking any medications that a doctor has prescribed to
treat HIV?

Yes G

No G

Refuse to answer G

The next two questions ask your feelings about being infected with HIV.
Please rate each item on a scale from 1 (not at all) to 7 (very much).

12\. Do you feel personally responsible for your HIV infection?

1 Not at all G

2 G

3 G

4 G

5 G

6 G

7 very much G

Refuse to answer G

13\. Do you feel that another person is responsible for your HIV
infection?

1 Not at all G

2 G

3 G

4 G

5 G

6 G

7 very much G

Refuse to answer G

Sexual Behavior -- Past Year

**14a. These next** **questions are** about your sexual behavior in the
past year, that is since \[DATE\]. Remember all of your answers are kept
private.

Over the past year, how often did you use alcohol or drugs before or
during sex?

Never

Rarely

Sometimes

Most of the time

Every time

**14b. ##** Over the past year, how often did you go to parties, bars or
other places where people were having sex and using alcohol or drugs?

Never

About once a year

Once every few months

About once a month

Once a week or more often

14\. Over the past year, how many people did you have sex with?

Number of sex partners

**IF Q 14 = 0, SKIP TO Q 24**

In this next section, you will be asked about your behavior in just the
past 30 days, that is since \[DATE -- 30 days\].

15\. In the past 30 days, did you have a main sex partner---that is, a
partner you would call your spouse, lover, significant other, or life
partner?

Yes G

No**** Skip to q17 G

Refuse to answer**** Skip to Q17 G

16\. What is your main partner's HIV status?

My main partner is HIV-negative G

My main partner is HIV-positive G

My main partner has not been tested for HIV G

Don't know G

Refuse to answer G

17\. In the past 30 days, did you have sex with a nonmain partner- that
is, somebody who you did not consider to be a spouse, significant other,
or life partner?

Yes G

No**** Skip to q21 G

Refuse to answer**** Skip to q21 G

NOTE: If "NO" or "REFUSED" to [both]{.underline} Q15 and Q17, skip to
Q24.

18\. In the past 30 days, how many of these non-main sex partners told
you they were HIV-positive?

  ----------------------- ----------------------- -----------------------
                                                  

  ----------------------- ----------------------- -----------------------

Refuse to answer G

19\. In the past 30 days, how many of your non-main sex partners told
you they were HIV-negative?

Refuse to answer G

20\. In the past 30 days, how many of your non-main sex partners were
partners whose HIV status you did not know?

Refuse to answer G

Now we would like you to think about the sex you have had with
[all]{.underline} of your partners (main [and]{.underline} non-main
partners) in the past 30 days.

21\. In the past 30 days, did you have [vaginal or anal sex]{.underline}
with *any* of your sex partner(s)?

Yes G

No **** Skip to q24 G

Refuse to answer **** Skip to q24 G

22\. In the past 30 days, how many times did you have [vaginal or anal
sex]{.underline} *with a condom* with any of your sex partner(s)?

  ----------------------- ----------------------- -----------------------
                                                  

  ----------------------- ----------------------- -----------------------

Refuse to answer G

23\. In the past 30 days, how many times did you have [vaginal or anal
sex]{.underline} *without a condom* with any of your sex partner(s)?

  ----------------------- ----------------------- -----------------------
                                                  

  ----------------------- ----------------------- -----------------------

Refuse to answer G

The next couple of questions ask you to compare the pleasure of
unprotected and protected sex.

NOTE: IF RESPONSE TO Q2 IS "female" SKIP TO Q25.

24\.

{Programmer note: if q2 = male and if q7 is "straight, heterosexual, use
this version of the question wording.}

Compared to vaginal or anal sex with a condom, how would you rate having
vaginal or anal sex without a condom?

Much less pleasurable G

Somewhat less pleasurable G

About the same G

Somewhat more pleasurable G

Much more pleasurable G

Refuse to answer G

{Programmer note: if q2 = male and if q7 is NOT "straight, heterosexual,
use this version of the question wording.}

Compared to insertive vaginal or anal sex with a condom, how would you
rate having insertive vaginal or anal sex without a condom? By insertive
vaginal or anal sex, we mean you put your penis in your partner's vagina
or anus.

Much less pleasurable G

Somewhat less pleasurable G

About the same G

Somewhat more pleasurable G

Much more pleasurable G

Refuse to answer G

NOTE: IF RESPONSE TO Q2 IS "male" AND Q7 IS "STRAIGHT, HETEROSEXUAL"
SKIP TO Q26.

25\. Compared to receptive vaginal or anal sex with a condom, how would
you rate having receptive vaginal or anal sex without a condom? By
receptive vaginal or anal sex, we mean that your partner puts his penis
into your vagina or anus.

Much less pleasurable G

Somewhat less pleasurable G

About the same G

Somewhat more pleasurable G

Much more pleasurable G

Refuse to answer G

Now please tell us how much you disagree or agree with the following
statements.

26\. It is my responsibility to protect others from getting HIV.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

27\. Because of new treatments for HIV, I'm less concerned about
infecting someone else.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

In this next section you'll be asked if you have participated in
different activities or events.

28\. In the PAST YEAR, have you participated in any HIV/AIDS prevention
activities or events? 

Yes G

No G

Refuse to answer G

29\. In the PAST YEAR, have you participated in any activities or events
for HIV-positive people?

Yes G

No G

Refuse to answer G

NOTE: IF RESPONSE TO Q7 IS "straight, heterosexual" SKIP TO Q31.

30\. In the PAST YEAR, have you participated in any gay community
activities or events, read a gay publication, or logged onto a gay
website?

Yes G

No G

Refuse to answer G

The following questions ask about your trust in various sources of
HIV/AIDS information. Please rate each information source from 1 (Do not
trust at all) to 10 (Trust completely).

31\. My doctor, nurse or health care professional.

1 2 3 4 5 6 7 8 9 10

Do not Trust

trust at all Completely

Not applicable G

Refuse to answer G

32\. AIDS organizations in my local community.

1 2 3 4 5 6 7 8 9 10

Do not Trust

trust at all Completely

Not familiar with organization G

Refuse to answer G

33\. Centers for Disease Control and Prevention (CDC).

1 2 3 4 5 6 7 8 9 10

Do not Trust

trust at all Completely

Not familiar with organization G

Refuse to answer G

The following question asks about your understanding of HIV/AIDS
issues**.**

34\. How would you rate your understanding of safer sex strategies?

Poor G

Fair G

Good G

Very good G

Excellent G

Refuse to answer G

Evaluation of Message Concepts

Now we will show you twelve brief messages about HIV prevention. After
you look at the first message, we will ask you to answer some questions
about it. Then you will look at a second message, and answer questions
about it. You will do the same thing for each of the rest of the
messages. We are interested in your initial impressions, therefore,
please move quickly and do not spend too much time answering the
following questions.

When you are ready, click on the continue button to go to the first
message.

**\[There will be approximately 15-18 total message concepts. Each
participant will view 10 of the 15-18 messages. The 10 messages will be
randomly selected from the 15-18 messages and will appear in a random
order.\]**

**\[MESSAGE #1\]**

Please tell us how much you disagree or agree with the following
statements about this message.

35\. This message told me something I didn't already know.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

36\. This message is very appealing to me.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

37\. This message is confusing.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

38\. This message speaks to me.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

39\. This message said something important to me.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

40\. This message promotes a behavior which is difficult for me to do.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

41\. I did not like this message.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

42\. This message is very convincing.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

43\. This message would motivate HIV positive persons to act in ways
that would prevent further transmission of HIV.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

44\. This message contradicts what I know about HIV prevention.

Strongly disagree G

Disagree G

Neither disagree nor agree G

Agree G

Strongly agree G

Refuse to answer G

45a. How would you describe this message? Choose all that apply.

Accurate G

Annoying G

Believable G

Complex G

Effective G

Embarrassing G

None of the above G

Refuse to answer G

45b. How would you describe this message? Choose all that apply.

Clever G

Clear G

Condescending G

Dishonest G

Familiar G

Farfetched G

None of the above G

Refuse to answer G

45c. How would you describe this message? Choose all that apply.

Creative G

Inappropriate G

Informative G

Interesting G

Irritating G

Offensive G

None of the above G

Refuse to answer G

45d. How would you describe this message? Choose all that apply.

Original G

Pointless G

Realistic G

Silly G

Stigmatizing G

Worth remembering G

None of the above G

Refuse to answer G

That is the last question about this message. When you are ready, click
on the continue button to go to the next message.

**\[MESSAGE #2\]**

NOTE: Repeat Q35-Q45d for MESSAGE #2, **AND** for each of the other
messages.

After Q45d for MESSAGE #10 (the last message to be evaluated):

That was the last question.

THANK YOU for your time and participation in this research study. Please
use your mouse to click on the "continue" button and tell the host that
you are finished. We will now compensate you for your time, effort and
travel expenses.

Thank you again for participating and have a nice day.

[^1]: One of the 49 participants only partially completed the interview.
    Therefore, we had a total of 48 fully completed interviews in Ft.
    Lauderdale.

[^2]: One of the 42 participants only partially completed the interview.
    Therefore, we had a total of 41 fully completed interviews in
    Baltimore.

[^3]: One of the 83 participants only partially completed the interview.
    Therefore, we had a total of 82 fully completed interviews in Los
    Angeles.

[^4]: Two of the 51 participants only partially completed the interview.
    Therefore, we had a total of 49 fully completed interviews in
    Philadelphia.

[^5]: One of the 42 participants only partially completed the interview.
    Therefore, we had a total of 41 fully completed interviews in
    Houston.

[^6]: One of the 61 participants only partially completed the interview.
    Therefore, we had a total of 60 fully completed interviews in
    Chicago.