Translator's note: Brackets [ ] are used to emphasise or resolve ambiguities stemming from the translation or conversion of layout.

1997

Dear blood donor

SEXUAL HABITS AND BLOOD DONATION

At the Blood Bank of Ullevål Hospital we are now conducting a survey of the sexual habits of blood donors. We hope that you are willing to participate in this study which of course is completely anonymous and voluntary. None of your responses will be traceable to your blood or to you as a person. The questionnaire is relatively detailed because it will be compared with a previous study performed by the National Institute of Public Health.

Our reason for performing this study is that the Blood bank needs good routines to minimise the risk that the blood contains infectious agents. The study is part of the Blood Bank's quality assurance strategy. If you are willing to participate, please fill in the questionnaire and send it to the National Institute of Public Health. Postage is pre-paid.

This survey is a joint project between the Blood Bank of Ullevål Hospital and the National Institute of Public Health.

Thank you for your assistance!

Yours sincerely

Harald Ørjasæter
Senior consultant
The Blood Bank, Ullevål Hospital

Per Magnus
Senior consultant
The National Institute of Public Health

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Everybody should answer questions 1 through 17.
After question 17 further instructions are given.

1 Are you: (1) Male. (2) Female.

2 Year of birth: 19__

3 Which citizenship do you hold? (1) Norwegian. (2) Other.

4 In which country were you born? (1) Norway. (2) Elsewhere.

5 Are you cohabiting with a partner? (1) No. (2) Yes.

6 Please state your marital status: (1) Married. (2) Unmarried. (3) Separated/divorced. (4) Widow(er).

7 Have you been married previously? (1) No. (2) Yes. Please state the number of marriages: ____

8 Have you been cohabiting with a partner previously (not counting partners which you subsequently married)? (1) No. (2) Yes. Please state the number of previous cohabiting relationships: ____

9 Please state the highest level of general education which you have completed: (1)--(6) [various alternatives, exact translation impossible].

10 Please state your professional training: (1)--(5) [various alternatives, exact translation impossible].

11 Are you a student now? (1) No. (2) Yes.

12 What are your main reasons for taking the time to be a blood donor? (you may fill in more than one alternative) (1) Donating blood is important for society. (2) My blood type is in high demand. (3) I feel that I am doing something useful. (4) I may need blood some day myself. (5) Other reasons: ___ PLEASE USE BLOCK LETTERS

13 How many times have you donated blood? ___ How old were you the first time? ___

14 Have you taken an AIDS/HIV test? (not counting testing in conjunction with blood donation, pregnancy or military service) (1) No. (2) Yes. Please state the number of times: ___

 If yes, please state the year in which you were tested: The first time: 19__ The last time: 19__

15 Have you ever donated blood in order to be HIV tested? (1) No. (2) Yes. Please state the year: 19__

16 Have you ever had sexual intercourse? (1) No. (2) Yes.

17 Have you ever taken part in any form of sexual activity with a person of the same sex as yourself? (1) No. (2) Yes. Please state the number of partners: ___ How old were you the first time? ___ How old were you the last time? ___

If you answered "NO" to both questions 16 and 17, you have completed the questionnaire. THANK YOU FOR YOUR ASSISTANCE.
If you answered "YES" to either question 16 or 17, or to both, please continue filling in the form until further instructions are given.

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18 How old were you the first time you had sexual intercourse? ___

19 How many sexual partners have you had up until now (counting spouses and partners you were cohabiting with)? Please state the number: ___

20 Have you ever had sexual intercourse with an HIV/AIDS infected person? (1) No. (2) Yes. Please state the number of persons: ___ (3) Don't know.

 If yes, was a condom used the last time you had sexual intercourse with an HIV/AIDS infected person? (1) No. (2) Yes. (3) Don't remember.

21 Have you ever had sexual intercourse with a hepatitis infected person? (1) No. (2) Yes. Please state the number of persons ___ (3) Don't know.

 If yes, was a condom used the last time you had sexual intercourse with a hepatitis infected person? (1) No. (2) Yes. (3) Don't remember.

22 Have you ever paid for (purchased) sexual services? (4) No. (5) Yes. Please state the number of times: ___

 How old were you the first time? ___

 How old were you the last time? ____

 If yes, was a condom used the last time you paid for sexual services? (1) No. (2) Yes. (6) Don't remember. (7) Did not have sexual intercourse.

 If yes [to question 22], in which country did you purchase sexual services on the last occation? ________ PLEASE USE BLOCK LETTERS.

23 Have you had sexual intercourse with a foreigner within the last three years (excluding your regular partner if you are married or cohabiting)? (1) No. (2) Yes. Please state the number of persons: __ (3) Don't know.

 If yes, was a condom used the last time you had sexual intercourse with a foreigner? (1) No. (2) Yes. (3) Don't remember.

 If yes [to question 23], where did you meet the person? (1) In Norway. (2) Abroad.

 If yes [to question 23], where did your last foreign sexual partner come from (excluding your partner if you are [or were] married or cohabiting)? Please state nationality/continent: _______ PLEASE USE BLOCK LETTERS

24 Have you had sexual intercourse with an injecting drug-user within the last three years? (1) No. (2) Yes. Please state the number of persons: ___ (3) Don't know.

 If yes, was a condom used the last time you had sexual intercourse with an injecting drug-user? (1) No. (2) Yes. (3) Don't remember.

25 Have you within the last three years had sexual intercourse with a man who has had sex with other men? (1) No. (2) Yes. Please state the number of persons: ___ (3) Don't know.

 If yes, was a condom used the last time you had sexual intercourse with a man who has had sex with other men? (1) No. (2) Yes. (3) Don't remember.

26 Have you ever injected narcotic drugs? (1) No. (2) Yes. Please state the number of times: ____ How old were you the first time? ____ How old were you the last time? ____

If you are married or cohabiting with a partner, please continue. If you are not married or cohabiting with a partner, please skip to question 33.

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Only those who are married or cohabiting with a partner should fill in the questions in the green column (to the left).

27 In which year did you marry or start cohabiting with your present spouse/partner? 19__

28 Is your spouse/cohabiting partner male or female? (1) Male. (2) Female.

29 How long time has passed since you last had sexual intercourse with your spouse/cohabiting partner? (1) Less than one month. (2) 2--6 months. (3) 7--12 months. (4) More than a year.

30 How often have you and your spouse/cohabiting partner had sexual intercourse within the last month? (1) More than once daily. (2) Every day. (3) 5--6 times a week. (4) 3--4 times a week. (5) 1--2 times a week. (6) Once every two weeks. (7) Less often. (8) Not at all.

31 Was contraception/protection used the last time you [and your spouse/cohabiting partner] had sexual intercourse? (1) No. (2) Yes. If yes, which type: (1) Contraceptive pill. (2) Intrauterine device. (3) Diaphragm. (4) Condom. (5) Other.

32 Have you had other sexual partners after the start of your present marriage/cohabiting partnership? (1) No. (2) Yes. Please state the number: ___

If you answered "NO" to question 32, you have finished the questionnaire. THANK YOU FOR YOUR ASSISTANCE.
If you answered "YES" to question 32, please proceed with the remainder of the questionnaire.

3 How long time has passed since you last had sexual intercourse (with somebody else than your regular partner if you are married or cohabiting)? (1) Less than 1 month. (2) 2--6 months. (3) 7--12 months. (4) More than 1 year.

34 How many times have you had sexual intercourse (with somebody else than your regular partner if you are married or cohabiting) during the last month? (1) No times. (2) Once. (3) Twice. (4) 3--4 times. (5) 5--10 times. (6) 11--20 times. (7) 21--30 times. (8) More than 30 times.

35 Was contraception/protection used the last time you had sexual intercourse (with somebody else than your regular partner if you are married or cohabiting)? (1) No. (2) Yes. (3) Don't remember/Don't know.

 If yes, which type: (1) Contraceptive pill. (2) Intrauterine device. (3) Diaphragm. (4) Condom. (5) Other.

36 How many sexual partners (excluding your present regular partner if you are married or cohabiting) have you had during the last 3 years? (0) None. Please state the number: ___

37 How many sexual partners (excluding your regular partner if you are married or cohabiting) have you had during the last 12 months? (0) None. Please state the number: ___

38 Have you had any sexual partners of the same sex as yourself (excluding your regular partner if you are married to or cohabiting with a person of the same sex as yourself) during the last 3 years? (1) No. (2) Yes. Please state the number: ___

You have now completed the questionnaire. THANK YOU FOR YOUR ASSISTANCE.