Literal question
Declaration of consent for HIV test
READ THE CONSENT TO EACH RESPONDENT. CIRCLE CODE 1 IN 709 IF THE RESPONDENT ACCEPTS THE HIV TEST AND CODE 3 IF SHE REFUSES.
FOR WOMEN AGES 15-17 WHO HAVE NEVER BEEN IN A UNION, ASK FOR THE CONSENT OF HER PARENT/OTHER ADULT IDENTIFIED IN 707 BEFORE ASKING FOR THE CONSENT OF THE ADOLESCENT HERSELF. CIRCLE CODE 2 IN 709 IF THE PARENT/ADULT REFUSES. ONLY CONDUCT THE TEST IF YOU OBTAINED BOTH CONSENTS, THAT OF THE PARENT/ADULT AND OF THE ADOLESCENT RESPONDENT.
As part of the survey we also are asking people all over the country to take an HIV test. HIV is the virus that causes AIDS. AIDS is a very serious illness. The HIV test is being done to see how big the AIDS problem is in the Ivory Coast. HIV treatment is free. This survey will assist the government to develop programs to prevent and treat AIDS.
For the HIV test, we need a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test.
No names will be attached so we will not be able to tell you the test results. No one else will be able to know your test results (RESULTS OF THE ADOLESCENT) either.
If you want to know if you have HIV or not, I can provide a list of [nearby] facilities offering counseling and testing for HIV. I will also give you a voucher for free services for you (and for your partner if you want) that you can use at any of these facilities.
Do you have any questions?
You can say yes to the test, or you can say no. It is up to you to decide.
Will you allow (NAME OF ADOLESCENT) to take the HIV test?
GRANTED 1-(SIGN) _____________
PARENT/OTHER RESPONSIBLE ADULT REFUSED 2-(SIGN)_________________
RESPONDENT REFUSED 3-(SIGN)______________
