Table 5.
Survey items, HIV/AIDS and condom use survey, Toffo county, Benin (June – July 2002).
| SURVEY ITEMS | RESPONSE CATEGORIES |
| General knowledge on HIV/AIDS | |
| 1. Have you ever heard about HIV/AIDS | Yes/No |
| 2. In your knowledge how severe is HIV/AIDS | Deadly, don't know, imaginary, other |
| 3. How could someone get infected by HIV? | At least 2, one or no correct answer(s), |
| 4. Who you think are at risk of getting HIV? | Everyone/specific groups/Don't know |
| 5. In your knowledge, what are the prevention methods of getting HIV? | Abstinence, Fidelity, Condom, Other, Don't know |
| 6. How could you recognize a HIV-infected person? | Could not, Cachexia, Other symptoms, Don't know |
| Beliefs on HIV/AIDS | |
| 7. Do you believe HIV really exists? | Yes/No/Don't know |
| 8. Do you think you are at risk of getting HIV? | Yes/No/Don't know |
| 9. If no to 8) why? | Fidelity/Condom use/Other/Don't know |
| 10. Where you believe HIV originates from? | God/Bewitchment/Other/Don't know |
| 11. Do you think one can completely cure from HIV/AIDS? | Yes/No/Don't know |
| 12. If yes to 11) how? | Medicine/Herbs/Prayers/Other/Don't know |
| 13. How would you rate the protective effect provided by condoms? | Complete/Incomplete/Useless/Don't know |
| 14. Does your religion believe HIV exists? | Yes/No/Don't know |
| 15. What is the position of your religion towards condom use? | Favorable/Unfavorable/Indifferent/Don't know |
| Behaviors and attitudes | |
| 16. Would you mind taking a HIV screening test if you were asked? | Yes / No / Don't know |
| 17. Do you use condoms? | Yes / No / No answer |
| 18. If No or No answer to 17) why? | Don't like / Only God save / Other |
| 19. How often do you use condoms? | Always / Sometimes / Never |
| 20. Did you use condom during the last occasional intercourse? | Yes / No |
| 21. Do you encounter any problem using condoms? | Yes / No |
| 22. If yes to 21) what type of problems | Less lubrificated / Less pleasure / break easily / Other |
| 23. Numbers of sexual partners during the last 12 months | |
| Socio demographic characteristics | |
| 24. Age | Full years |
| 25. Sex | Male / Female |
| 26. Marital status | Married monogamous / Married polygamous/ Single / Divorced / Widowed / Separated |
| 27. Education (Ability to read) | Fluent / With difficulty / Not able to read at all |
| 28. Occupation | Student / Farmer / |
| 29. Religion | Christianity / Islam / Animist / Other |
| 30. Place (please give the name of your village) | Village name |
Adapted from the World Health Organization / Global AIDS Program's questionnaire