1.	Would you be willing to be tested for HIV right now? (Please check one)
□	Yes
□	No
2.	What kind of information would you want to know before being tested for HIV (check all that apply)?
□	The benefits of early diagnosis
□	The testing process
□	How long it takes for results to come back
□	HIV treatment options
□	Support services available in the area
□	The partner notification process
□	Who will have access to the results
□	Other (please specify) ______________________________
3.	What kind of information would you want to know after testing if positive for HIV? (check all that apply)
□	HIV treatment options
□	Support services available in the area
□	Access to appropriate health care services
□	Written information about HIV/AIDS
□	The partner notification process
□	Other (please specify) ______________________________
4.	What would make the HIV testing easier for you? (check all that apply)
□	A non-judgmental attitude from testing providers
□	Offering more information about the testing process
□	Offering more information about treatment options
□	Offering more information about services available in the area
□	Discussing the fears associated with HIV testing
□	Discussing the partner notification process
□	Discussing the prevention of mother-to-child transmission
□	An individualized counselling approach
□	A private room for counselling
□	Other (please specify) ______________________________
5.	Which type of testing would you be willing to undergo? (you may check more than one)
□	Saliva
□	Urine
□	Blood
□	All of the above
6.	If you were found to have a positive result – would you accept intravenous treatment for HIV during labour if there is a chance it would decrease HIV transmission to your baby? (Please check one)
□	Yes
□	No
7.	If you were to have a positive result – would you be willing to formula feed only if there is a chance it would decrease HIV transmission to your baby? (Please check one)
□	Yes
□	No
8.	If you were found to have a positive result – who would you want to discuss it with? (check all that apply)
□	Doctor
□	Nurse
□	Social worker
□	Counselor
□	Family/friends
□	Other (please specify) ______________________________
9.	If you would not be willing to be tested, which of the following describe your reasons for refusal? (check all that apply)
□	Too much labour pain
□	Fear of pain from testing
□	No time
□	Don’t want to know
□	Fear of breach of confidentiality
□	Fear of partner’s/family’s/community’s reaction
□	Fear of losing children
□	Fear of death
□	Fear of losing job
□	Fear of losing home
□	Other ________________________
10.	Which of the following concerns might you have surrounding a positive result: (check all that apply)
□	Negative reaction from partner, family, or community
□	Violence from partner, family or community
□	Loss of employment or housing
□	Loss of custody of children
□	Problems with immigration process
□	Social stigma
□	Other (please specify) ______________________________
□	No concerns
Thank you for your time.