What about
you? Are you at risk for HIV, hepatitis, or other sexually transmitted
diseases? How would you answer the following questions?
1. During
the past year, have you engaged in any of these sexual acts?
A.
Unprotected vaginal intercourse
B.
Unprotected anal intercourse
C.
Unprotected
oral intercourse
2. How many
sexual partners have you had in the past year? Past 5 years?
A.
None
B.
1
C.
2 - 5
D.
Over 5
3. Have you
ever had sex with someone who has HIV, hepatitis B or C, or another
sexually transmitted disease?ring the past year, have you engaged
in any of these sexual acts?
A.
No
B.
Yes, and I had protected sex.
C.
Yes, and I had unprotected sex.
D.
I'm not certain
4. During
the past year, have you used any drugs such as cocaine, speed,
crack, meth, etc.?
A.
I haven't used any of these drugs during the past year.
B.
I sometimes use one or more of these drugs, but I never get high.
C.
I sometimes use one or more of these drugs and sometimes get high.
D.
I often use one or more of these drugs, but only get high at times.
E.
I often use one or more of these drugs and I often get high.
5. During
the past year, have you injected any drugs?
A.
I haven't injected any drugs during the past year.
B.
I have injected drugs, but I never shared needles or other equipment.
C.
shared needles and other equipment, but I cleaned everything with
bleach every time.
D.
I shared needles and other equipment, but I did not clean everything
with bleach every time.
6. Have you
ever had any of the following infections?
A.
I have been diagnosed with herpes.
B.
I have been diagnosed with hepatitis B.
C.
I have been diagnosed with hepatitis C.
D.
I have been diagnosed with chlamydia.
E.
I have been diagnosed with gonorrhea.
F.
I have been diagnosed with syphilis.
G.
I have been diagnosed with another sexually transmitted disease.
7. Have you
ever had sex with someone who injects drugs?
A.
No
B.
Yes, and I had protected sex.
C.
Yes, and I had unprotected sex.
D.
I'm not certain.
8. Have you
been tested for HIV?
A.
No, I have
never been tested.
B.
Yes, and my last test was negative.
C.
Yes, and my last test was positive.
D.
Yes, I have been tested, but I did not go back to get my results.
