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Appendix 1: Survey Materials
Survey
•We are conducting an Undergraduate Research Project with the title “Comparison of
sexual behavior of students at FGCU and the University of Antsiranana/Madagascar” and
would like to anonymously collect information from you.
•Please take your time to read the following information carefully before starting the
survey.
•Your participation in the study is completely voluntary. If you decide to participate now
you may change your mind and stop at any time, for any reason, without penalty or loss of
any future services you may be eligible to receive from the University.
•If you have any questions about this study, you may contact the faculty sponsor Dr. Peter
Reuter at 590-7512 or via email at preuter@fgcu.edu.
•If you have any questions about your rights as a subject/participant in this research, or if
you feel you have been placed at risk, you can contact the Chair of the Human Subjects’
Institutional Review Board through Sandra Terranova, Office of Research and Sponsored
Programs, at 239-590-7522.
•Completing the survey should take no more than 10 minutes.
•You do not have to answer all of the questions in this survey. If you do not feel
comfortable answering a specific question, please leave it blank. If you do not feel
comfortable taking the survey entirely just deposit the blank survey into the survey box.
•DO NOT PUT YOUR NAME ON THE SURVEY.
•DO NOT SIGN THE SURVEY WITH YOUR NAME.
By returning my survey, I agree to participate in this research survey. I understand that if
my answers are used there is no one who will be able to identify me.
I agree I do not agree
_____________________________________________________________________________
______________
1) How old are you? ____________________ years □ Prefer not to answer
2) What is your gender? □ Male □ Female □ Prefer not to answer
3) Do you have any children? □ Yes □ No □ Prefer not to
answer
If you have children please provide the following information:
Child One: Age: Male Female
Child Two: Age: Male Female
Child Three: Age: Male Female
Child Four: Age: Male Female
Child Five: Age: Male Female
4) What is your marital status? □ Single □ Married □ Divorced □
Widowed □ Prefer not to answer
5) What is your sexual orientation? □ Heterosexual □ Homosexual □ Bisexual
□Transgender □ Asexual □ Prefer not to answer
6) Please fill out the following table to the best of your knowledge:
Have you
participated in
this type of sex
act?
What age
did you first
do this sex
act?
How often do
you do this
sex act per
month?
Do you use
protection
when you do
this sex act?
If you use
protection,
what kind of
protection do
you use?
Oral Sex □ Yes
□ No
□ Prefer not to
answer
Intercourse □ Yes
□ No
□ Prefer not to
answer
Anal Sex □ Yes
□ No
□ Prefer not to
answer
7) Please fill out the following table to the best of your knowledge. List all sexually transmitted diseases that you know about (including
HIV/AIDS).
Sexually Transmitted
Disease
Do you know
anyone who has
this disease?
Have you ever
had this disease?
Do you believe
that this disease
exists?
Why or why not do you
think this disease
exists?
How do you
protect against
this disease?
Do you know any
cures to this
disease?
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
□ Yes
□ No
□ Prefer not to
answer
Appendix 2:
Table S1: The tests used to examine the effects of place of study as summarized from the narrative of the manuscript. Additional tests,
including Odds Ratio calculations are described in the results section and are omitted here.
Objective Test Independent
variable
Dependent variable Random effect Sampl
e size
Chi-
square
p-value
One Generalized Linear
Mixed Effects Model
(Poisson Distribution)
Place of study
(Madagascar
vs. USA)
Number of STIs listed that were not
HIV/AIDS (scale: 0 – 5)
Gender (Male
or Female)
436 69.265 < 0.0001
One Wald Chi-Square Test Place of study
(Madagascar
vs. USA)
Whether or not a student listed at least
one STI that was not HIV/AIDS
(presence/absence)
Gender (Male
or Female)
436 0.843 0.3587
Two Wald Chi-Square Test Place of study
(Madagascar
vs. USA)
Whether or not a student believed in
the existence of syphilis
(presence/absence)
Gender (Male
or Female)
182 1.125 0.2888
Two Wald Chi-Square Test Place of study
(Madagascar
vs. USA)
Whether or not a student believed in
the existence of gonorrhea
(presence/absence)
Gender (Male
or Female)
163 0.3296 0.2949
Two Wald Chi-Square Test Place of study
(Madagascar
vs. USA)
Whether or not a student believed in
the existence of HIV/AIDS
(presence/absence)
Gender (Male
or Female)
353 11.784 0.0006
Three Wald Chi-Square Test Place of study
(Madagascar
vs. USA)
Whether or not a student reporting
having had one of the STIs they
named in their survey responses
(presence/absence)
Gender (Male
or Female)
436 9.618 0.0019
Three Likelihood Ratio Test Place of study
(Madagascar
vs. USA)
Whether or not a student reporting
having had syphilis (presence/absence)
Gender (Male
or Female)
194 19.2988 < 0.0001
Three Wald Chi-Square Test Place of study
(Madagascar
vs. USA)
Whether or not a student reporting
having had gonorrhea
(presence/absence)
Gender (Male
or Female)
163 4.840 0.0278
Three Wald Chi-Square Test Place of study
(Madagascar
vs. USA)
Whether or not a student reporting
having had HIV/AIDS
(presence/absence)
Gender (Male
or Female)
362 1.143 0.285
Appendix 3: Respondent characteristics
Respondent demographics differed by nationality (Table 3). The proportion of females
and males surveyed differed between the USA and Madagascar (Wilcoxon Test, X2 =
43.088, DF = 2, P < 0.0001; Table 3). American respondents were younger than Malagasy
respondents (Mixed Effects Model, F(1, 51.08) = 10.6967, P = 0.0019; gender as a random
effect) and were less likely to have children (Wilcoxon Test, X2 = 11.618, DF = 2, P =
0.0030). However, the proportion of individuals who reported different types of marital
status (single, married, divorced, widowed) did not differ between the two countries
(Wilcoxon Test, DF = 3, X2 = 4.687, P = 0.1962); most respondents were single (Table
S2).
The majority of respondents (> 73% for each gender, in each country; Figure S1)
identified as heterosexual. The proportion of respondents identifying with different sexual
identities (heterosexual, homosexual, bisexual, and asexual) differed between the US and
Madagascar (Wilcoxon Test, X2 = 37.914, DF = 3, P < 0.0001). The proportion of
respondents who identified with different sexual identities did not differ when comparing
males and females within the same country (within the US: Wilcoxon Test, X2 = 8.099,
DF = 4, P = 0.088; within Madagascar: X2 = 3.377, DF = 3, P = 0.3371).
Figure S1: The percent of respondents, by gender and by country, that self-identified
with different sexual identities.
Appendix 4: Anecdotal information on the ‘quality of awareness’ of STIs
In the US survey, 22 students called STIs by a slang term (usually “the clap”) and 4
students mentioned medical diagnoses that are not STIs [e.g., bacterial infections (n = 2);
Ebola (n = 1); and yeast infections (n = 1)]. This is equivalent to 13.5% and 2.4% of US
respondents who provided information about STIs.
In the Madagascar survey, 20 students used slang terms for STIs (e.g., “chaude-
pisse”) and 6 students mentioned medical diagnoses that are not STIs [e.g. leprosy (n =
1); loss of sex drive (n = 1); yellow fever (n = 1); tuberculosis (n = 2); and yeast
infections (n = 1)]. This is equivalent to 9.1% and 2.7% of Malagasy respondents who
provided information about STIs.
Among American respondents, men and women did not differ in the frequency
with which they used slang words for STIs (4.48% and 2.86%, respectively; Pearson
Chisquare Test, Chisquare = 1.373, DF = 2, P = 0.5032); sample sizes were too small to
test whether gender impacted the likelihood of an individual to incorrectly list a non-STI.
Likewise, in Madagascar, men and women did not differ in the frequency with
which they used slang words to list STIs (3.31% and 3.21%, respectively; Pearson
Chisquare Test, Chisquare = 0.003, DF = 1, P = 0.9529) or in the likelihood of incorrectly
identifying a disease as being sexually transmitted (1.65% and 0.00%, respectively;
Pearson Chisquare Test, Chisquare = 2.609, DF = 1, P = 0.1063).
Table S2: Types of protection suggested by American respondents for common STIs
(numbers indicate the number of respondents who named each type of protection). Data
for Madagascar can be found in Reuter et al. (2015).
USA
Females Males
Gonorrhea
Abstinence
Birth control (unspecified)
Condom
Contraceptive (unspecified)
Doesn’t know
Limit fluid exposure
Limit needle use
Limit Sex
Protection
STD check/Testing
5
1
23
1
0
0
0
1
4
1
8
2
14
0
2
0
0
1
1
0
HIV/AIDS
Abstinence
Birth control (unspecified)
Condom
Contraceptive (unspecified)
Doesn’t know
Limit fluid exposure
Limit needle use
Limit Sex
Protection
STD check/Testing
10
1
42
1
1
3
4
6
5
3
9
2
30
0
2
2
0
3
4
0
Syphilis
Abstinence
Birth control (unspecified)
Condom
Contraceptive (unspecified)
Doesn’t know
Limit fluid exposure
Limit needle use
Limit Sex
Protection
STD check/Testing
4
0
13
0
1
0
0
3
4
2
4
0
13
0
1
0
0
1
1
1
Protection (not explicitly mentioning condoms): protection/safe sex
Limit sexual contact: monogamy/don’t have sex with infected people/choose your
partners/don’t have physical contact/don’t have sex for money/no sex before marriage
Communication: tell people about your infection/ask people about their infection/know
sexual history of partner
Limit fluid contact: limit fluid contact/do not have sex doing outbreaks/do not touch
contaminated blood.
Testing: testing/get tested
Limit needle use: don’t use needles/don’t share needles
Medication: shots/penicillin/medication/vaccination