Literal question
708) READ THE DECLARATION OF CONSENT FOR ANEMIA AND HIV TEST TO THE PARENT/OTHER ADULT IDENTIFIED IN 707 AS RESPONSIBLE FOR ADOLESCENT
DECLARATION OF CONSENT FOR ANEMIA AND HIV TEST FROM THE PARENT/OTHER ADULT RESPONSIBLE FOR THE ADOLESCENT
As part of this survey, we are asking people all over the country to take an anemia test. Anemia is a serious health problem that usually results from poor nutrition, infection, or chronic disease.
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 Benin.
This survey will assist the government to develop programs to prevent and treat anemia and AIDS.
For the anemia and 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.
The blood will be tested for anemia immediately, and the result will be told to you right away. The result will be kept strictly confidential and will not be shared with anyone other than member of our survey team.
For the HIV 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 the results of (NAME OF THE ADOLESCENT) either.
If you want to know (NAME OF ADOLESCENT)'s HIV status, I can provide a list of [nearby] facilities to (NAME OF ADOLESCENT) that offer counseling and testing for HIV. I will also give you a voucher for free services for (NAME OF ADOLESCENT) to 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.
708A) ASK FOR CONSENT FOR THE ANEMIA TEST TO THE PARENT/OTHER RESPONSIBLE ADULT
REQUEST FOR CONSENT FROM PARENT/OTHER RESPONSIBLE ADULT FOR THE ANEMIA TEST
Will you allow (NAME OF ADOLESCENT) to take the anemia test?
708B) CIRCLE THE APPROPRIATE CODE FOR THE CONSENT FOR THE ANEMIA TEST AND SIGN YOUR NAME.
GRANTED 1 (SIGN________)
REFUSED 2 (SIGN_________)