Read the Research Participation Agreement:

QUESTION

REPLY ENCRYPTION

TRANSFER

C101

What month and year were you born?

Month | | | Year | | | | | Don't remember 99

C102

What is your highest level of education?

(Circle one answer )

Illiterate 1

Elementary School (Grades 1-5) 2 Middle School (Grades 6-9) 3

High school (Grade 10-12) 4 College, university (>Grade 12)

5

C103

How long have you lived in this province/city?

| | | month

| | | year

If less than 1 month, write 01

Don't remember 99

C104

What ethnicity are you?

Sutra 1

Flower 2

Se post 3

Flag Tu 4

M'Nong 5

Other 6 (Specify)…………………………

C105

In the past 12 months , have you traveled anywhere outside thisprovince/citycontinuously for more than one month?

There is 1

No 2

Don't remember 9

C106

Who are you living with now ?

Alone 1 Living with wife/girlfriend 2 Living with relatives 3 Living with friends 4

Unstable (wandering) 5 Other (specify) 6

C107

In the past month , how often have you drunk alcohol or beer?

(Circle one answer )

Daily 1

At least once a week 2

Less than once a week 3

Do not drink 4

C108

Do you smoke?

There is 1

No 2

 C110

QUESTION

REPLY ENCRYPTION

TRANSFER

C109

If so, how many cigarettes do you smoke a day on average?

| | | Cigarette Don't Remember 99

C110

In the past 12 months , what was your average monthly income?

(Enter total income from all sources)

| | | |, | | | |, | | | | VND

Don't remember, don't answer 99

C111

CurrentlyWhat do you do?

Suggested answer: Are there any other jobs?

Do not read the possibilities, just suggest and circle the appropriate answers.

C

K

2

2

2

Farming

1

State employee

1

Service staff

1

Sales agent

1

2

2

2

Business owner/trader

1

Student

1

Freelance (motorbike taxi, water seller...)

1

2

2

Illegal activities (gambling, trafficking)

drugs…)

1

Currently unemployed

1

2

Other (specify)……..………

1 2

QUESTION

REPLY ENCRYPTION

TRANSFER

C201

In what month or year did you start using drugs (all routes: snorting, drinking, injecting…)?

Month | | |

Don't Remember 99 Years | | |__||

Don't remember 9999

C202

What month or year did you start injecting drugs?

Month | | |

Don't Remember 99 Years | | |__||

Don't remember 9999

C203

What drugs do you use?

Circle all the appropriate answers.

From before tonow

CK

In 1 monthvia

CK

Opium

1 2

1 2

Heroin 1 2

1 2

Marijuana, weed, grass 1 2

1 2

Ecstasy, bite, fly, 1 2

love

1 2

QUESTION

REPLY ENCRYPTION

TRANSFER

Stone, pink slab 1 2

1

2

Glue hit, glue 1 2

1

2

Ketamine, Ketamine 1 2

1

2

Magic Mushrooms 1 2

1

2

Cocaine 1 2

1

2

Sedative, lotus, 1 2

valium, seduxen

1

2

Other 1 2

1

2

(Specify)

C204

Which of the following drugs have you injected?

Circle all that apply.

From before

so far

In 1

last month

CK

C

K

a. “Black” Opium

1 2

1

2

b. “White” Heroin

1 2

1

2

c. Sedatives, Sen, Valium, Seduxen, Benzo

1 2

1

2

d. Ecstasy, bite, fly, love, love, lion

1 2

1

2

e. Stone, lump, pink slab

1 2

1

2

f. Ketamine, ketamine

1 2

1

2

g. Cocaine

1 2

1

2

h. Other (specify)……………………………...

1 2

1

2

In the past month,you have

≥ 4 times a day

1

regular drug user

2 to 3 times a day

2

C205

Are not?

About once a day

Less than once a day

3

4

(Circle only one answer)

Don't know/no answer

9

best)

C206

In the past week,You go to drug injection sites or places where many people inject drugs.

how many times

| | | times Don't remember 99

In the past month , how often have you

Pharmacies Medical facilities Drug dealers Injecting partners

Health worker Peer

Other clubs, educational facilities (specify……..….)

1

2

3

4

5

6

7

8

buy/get syringes

(syringe, syringe) most

C207

from where

(Circle only one answer)

best)

QUESTION

REPLY ENCRYPTION

TRANSFER

Up to now, when injecting

inject drugs, have you ever used

shared syringe

now?

C301

(PVV explains: Sharing needles means using

Yes No

1

2

 C308

re-use the used syringe

someone else's finished OR give

for others to reuse

the syringe you just used

used​

In the past 6 months,when you

C302

injecting drugs, do you regularly use needles that someone else has used or has just used OR give to someone else to use

the syringe you just used

All times Most times

Sometimes Never No answer

1

2

3

4

9

 C308

use?

In the past 6 months, what was the main reason you shared needles?

Syringes are too expensive 1 Like to share with friends 2

You NCMT want to share 3 Don't have enough money to inject alone 4

C303

(Do not read the options – choose the closest meaning given by the respondent – ​​circle only one answer)

Cannot self-inject 5

Not enough syringes 6

Other 7 (specify)………………… No answer 9

C304

In the past month, how often have you given someone a needle (syringe, tube) that you have just used?

to inject?

All times Most times

Sometimes Never

1

2

3

4

C305

During the past month, when you injected drugs, how often did you use needles (syringes, tubes) that someone else had or had recently used?

are you done ?

All times Most times

Sometimes Never

1

2

3

4

 C308

In the past month , before

All times

1

you use syringe

Most of the times

2

C306

someone else has used or just used

Sometimes

3

Okay, how often do you clean this syringe?

Never No Answer

4

9

 C308

QUESTION

REPLY ENCRYPTION

TRANSFER

C

K

If any,you often clean

Cold water rinse 1

2

how?

Hot water rinse 1

2

C307

Gargle with antiseptic water 1

2

(Circle the answers you like)

Alcohol rinse 1

2

fit)

Other 1

2

(specify)......................................

In the past 6 months , when you

injections, do you often

All times

1

sharing drugs or tools

Most of the times

2

C308

Do you mix drugs with other people?

Sometimes Never

No reply

3

4

9

 C310

(Sharing drugs means

take medicine from the same container)

C

K

C309

In the past 6 months , have you shared medications or drug-mixing equipment with anyone?

Wife/Girlfriend 1

Prostitutes 1

Sex buyer friend 1 Other sex partner 1

You inject differently 1

2

2

2

2

2

(Circle all appropriate answers)

Drug dealer 1 2

Other 1 2

(specify)......................................

C310

In the past 12 months, have you injected drugs in another city?

Yes No

Don't remember No answer

1

2

8

9

 C312

If so , in which provinces and cities?

Which city (including provinces,

................................................................

C311

city ​​abroad)?

................................................................

................................................................

(Specify the name of the province, city and

................................................................

country name)

C312

Do you know where I can get/buy new syringes?

Are not?

Yes No

1

2

 C401

C

K

If yes , where?

Pharmacy 1

Medical facilities 1

2

2

C313

(Circle all appropriate answers)

Drug dealer 1 Injecting buddy 1

Peer 1

2

2

2

Medical staff 1

2

QUESTION

REPLY ENCRYPTION

TRANSFER

Club 1 2

Other 1 2

(specify)………………………

C314

Can you get/purchase clean syringes whenever needed?

There is 1

No 2 No answer 9

 C401

 C401

C315

Why didn't you get clean needles?

(Do not read but just ask if there are any other reasons - Circle all the answers)

CK

No money 1 2

Don't want to buy 1 2

Syringes are too expensive 1 2

Store closed 1 2

No type is satisfactory 1 2

Sold out 1 2

The place of sale is too far away 1 2

Don't know where to buy 1 2

Other 1 2

(specify)……………………

QUESTION

REPLY ENCRYPTION

TRANSFER

C401

How many days ago was your last injection?

| | | day (Today fill in 00)

Don't remember 99

Black Opium 1

C402

During the last injectionbest,What drugs have you used?

(Do not read the options – Circle only one answer)

“White” Heroin 2 Painkillers, Sedatives, Sen, Valium,

Seduxen, Benzo 3 Ecstasy, fly, love, love 4 Rock, block, pink phien 5

Ketamine, Ke 6

Cocaine 7

Other 8

(specify)……………………………...

C403

During the last injectionbest,you bought all the drugs

how much?

| | | |, | | | |, | | | VND (No charge, fill in 00)

QUESTION

REPLY ENCRYPTION

TRANSFER

At home 1

During the last injectionbestWhere did you get your injection?

At your lover's house 2

At home you inject 3

In public 4

C404

At the injection site 5

At the drug dealer 6

(Do not read the options – Circle one answer)

At the prostitute 7

Elsewhere 8 (specify)………………………

During the last injection

First , do you use a needle pump?

There is 1

C405

new injection (is syringe)

No 2

still in the bag

Don't know 9

ever been peeled off?)

During the last injection

First , do you use a needle pump?

There is 1

C406

injection that someone else has used or has just used OR given

No 2 No answer 9

 C411

let someone else use the pump

the needle you just used

Are not?

C407

During that time , how many other people injected with the drug?

share a needle with a friend?

| | | people

Don't remember, don't answer 99

During that time,What is the main reason you share needles?

Syringes are too expensive 1 Like to share with friends 2 IDUs want to share 3

Not enough money to inject alone 4

C408

(Do not read the options – choose the closest meaning given by the respondent – ​​circle only one answer)

Unable to inject yourself 5 Not enough needles 6

Other 7 (specify)……………………………

No answer 9

C409

In that timeAre the syringes cleaned?

There is 1

No 2

Don't know 9

 C411

If any,So what do you clean the syringe with?

Cold water 1

Hot water 2 Disinfectant 3

C410

(Do not read the options - Circle only one answer)

Alcohol 4 Water Soap 5

Other 6 (specify)……………………………..